Normative EMG Values during REM Sleep for the Diagnosis of REM Sleep Behavior Disorder
Normative EMG Values during REM Sleep for the Diagnosis of REM Sleep Behavior Disorder
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DOI：
10.5665/sleep.1886
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发表时间：
2012-06-01
期刊：
影响因子：
5.6
通讯作者：
Hoegl, Birgit
中科院分区：
文献类型：
--
作者：
Frauscher, Birgit;Iranzo, Alex;Hoegl, Birgit
背景：快速眼动睡眠行为障碍（RBD）的正确诊断非常重要，因为它可能是神经退行性疾病的第一表现，它可能导致严重的损伤，并且它是一种很容易治疗的疾病。我们评估了睡眠Innsbruck Barcelona （SINBAR）蒙太奇（颏肌、指浅屈肌、指短伸肌）和其他肌肉的肌电图（EMG）活动，以获得临床实践中正确诊断RBD的规范值。地点：两所大学医院睡眠障碍中心。参与者：30名RBD患者（15名特发性[iRBD]， 15名帕金森病[PD]）和30名匹配的对照，这些患者来自有效治疗的睡眠相关呼吸障碍患者。干预措施：不适用。方法和结果：参与者接受了视频多导睡眠描记术，包括11块身体肌肉的记录。强直肌、相位肌和“任意”肌电活动（任何类型的肌电活动，不管它是由强直肌、相位肌电活动还是两者的结合组成）对每块肌肉的肌电活动进行盲目量化。当选择100%的特异性时，对于精神肌的“任何”肌电图活动（曲线下面积[AUC] 0.990），诊断RBD的3秒小波切限为18%。上肢肌肉的鉴别能力（100%特异性，AUC 0.987 ~ 9.997）高于下肢肌肉（100%特异性，AUC 0.813 ~ 0.852）。在iRBD和PD-RBD患者中，心肌与两相指浅屈肌的“任意”肌电活动的结合得出了32% （AUC 0.998）的截止值。结论：对于与PD相关的iRBD和RBD的诊断，我们建议使用多导睡眠图蒙太奇来量化“任何”（任何类型的肌电活动，无论它是由强直性、相性还是两者的组合组成）精神肌肌电活动和上肢左右指浅曲肌的相性肌电活动，截断率为32%，使用3秒的小波。
Background: Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is important because it can be the first manifestation of a neurodegenerative disease, it may lead to serious injury, and it is a well-treatable disorder. We evaluated the electromyographic (EMG) activity in the Sleep Innsbruck Barcelona (SINBAR) montage (mentalis, flexor digitorum superficialis, extensor digitorum brevis) and other muscles to obtain normative values for the correct diagnosis of RBD for clinical practice.Setting: Two university hospital sleep disorder centers.Participants: Thirty RBD patients (15 idiopathic [iRBD], 15 with Parkinson disease [PD]) and 30 matched controls recruited from patients with effectively treated sleep related breathing disorders.Interventions: Not applicable.Methods and Results: Participants underwent video-polysomnography, including registration of 11 body muscles. Tonic, phasic, and "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity was blindly quantified for each muscle. When choosing a specificity of 100%, the 3-sec miniepoch cutoff for a diagnosis of RBD was 18% for "any" EMG activity in the mentalis muscle (area under the curve [AUC] 0.990). Discriminative power was higher in upper limb (100% specificity, AUC 0.987-9.997) than in lower limb muscles (100% specificity, AUC 0.813-0.852). The combination of "any" EMG activity in the mentalis muscle with both phasic flexor digitorum superficialis muscles yielded a cutoff of 32% (AUC 0.998) for patients with iRBD and with PD-RBD.Conclusion: For the diagnosis of iRBD and RBD associated with PD, we recommend a polysomnographic montage quantifying "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity in the mentalis muscle and phasic EMG activity in the right and left flexor digitorum superficialis muscles in the upper limbs with a cutoff of 32%, when using 3-sec miniepochs.