Rapid Eye Movement Sleep Behavior Disorder: What Is Known and What Should Be Studied

Q4 Medicine Sleep Medicine Research Pub Date : 2023-12-31 DOI:10.17241/smr.2023.02026
In-Young Yoon
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Abstract

Rapid eye movement sleep behavior disorder (RBD), characterized by vivid striking dreams and dream-enacting behaviors, can be classified as both young and old. RBD is young in that it was conceptualized as a distinct clinical disorder by Schenck et al. [1] in 1986, and it is old because it mainly affects older people. In Korea, an RBD case, confirmed by polysom-nography, was reported in 1994. REM sleep without atonia (RWA) on the polysomnography is requisite for RBD diagnosis. Currently, qualitative analysis of RWA is used as RWA quantification is burdensome and time-consuming. Notably, patients complaining of vigorous dreams and violent behaviors are occasionally diagnosed with obstructive sleep apnea or show no definite RWA, which may negate diagnosis based on clinical history or RBD questionnaires. Regarding pathophysiology, dopaminergic degeneration was investigated because of its close relationship with alpha-synucleinopathies. Studies using dopamine transporter (DAT) positron emission tomography (PET) or single photon emission computed tomography (SPECT) showed that dopamine (DA) dysfunction might be implicated in RBD. However, several findings suggest that other pathogenic processes can be involved; 1) in managing RBD symptoms, effectiveness of clonazepam with no influence on DA and little effect of dopaminergic drugs, 2) appearance of RBD in narcoleptic patients, 3) young RBD patients without progression to alpha-synucleinopathies, and 4) RBD symptoms induced by anti-depressants.
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快速眼动睡眠行为障碍:已知和应研究的内容
快速眼动睡眠行为障碍(Rapid eye movement sleep behavior disorder,RBD)以生动逼真的梦境和梦中行为为特征,可分为年轻型和老年型两种。说 RBD 年轻,是因为 Schenck 等人[1] 在 1986 年将其概念化为一种独特的临床疾病;说 RBD 老年,是因为它主要影响老年人。韩国于 1994 年报道了一例经多导睡眠图证实的 RBD 病例。多导睡眠图上的快速动眼睡眠无张力(RWA)是 RBD 诊断的必要条件。由于对 RWA 进行定量分析既繁琐又耗时,因此目前采用的是对 RWA 进行定性分析。值得注意的是,主诉剧烈做梦和暴力行为的患者偶尔会被诊断为阻塞性睡眠呼吸暂停或没有明确的 RWA,这可能会否定根据临床病史或 RBD 问卷做出的诊断。在病理生理学方面,由于多巴胺能变性与α-突触核蛋白病关系密切,因此对多巴胺能变性进行了研究。使用多巴胺转运体(DAT)正电子发射断层扫描(PET)或单光子发射计算机断层扫描(SPECT)进行的研究表明,多巴胺(DA)功能障碍可能与 RBD 有关。然而,一些研究结果表明,RBD 还可能涉及其他致病过程:1)在控制 RBD 症状时,氯硝西泮的疗效对 DA 没有影响,而多巴胺能药物的疗效甚微;2)嗜睡症患者出现 RBD;3)年轻的 RBD 患者不会发展为α-突触核蛋白病;4)抗抑郁药会诱发 RBD 症状。
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来源期刊
Sleep Medicine Research
Sleep Medicine Research Medicine-Neurology (clinical)
CiteScore
0.90
自引率
0.00%
发文量
20
审稿时长
8 weeks
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