Background：Rapid eye movement （REM） sleep behavior disorder （RBD） and obstructive sleep apnea （OSA） are the most common sleep disorders in Parkinson’s disease （PD）. The aim of this study was to identify whet...Background：Rapid eye movement （REM） sleep behavior disorder （RBD） and obstructive sleep apnea （OSA） are the most common sleep disorders in Parkinson’s disease （PD）. The aim of this study was to identify whether RBD could alleviate OSA severity in PD patients and its effect on cognitive impairment.Methods：From February 2014 to May 2017, we recruited 174 PD patients from the Second Affiliated Hospital of Soochow University, all of whom underwent polysomnography （PSG）. We collected clinical data, PSG results, and compared information between patients with and without RBD or OSA by analysis of covariance. We also investigated the effect of these sleep disorders on cognitive impairment using linear regression.Results：We grouped participants as follows： PD only （n = 53）, PD ＋ OSA （n = 29）, PD ＋ RBD （n = 61）, and PD ＋ RBD ＋ OSA （n = 31）. Minimum oxygen saturation （SaO2） during whole sleep and in REM sleep was higher in PD ＋ RBD ＋ OSA patients than that in PD ＋ OSA patients. PD ＋ RBD patients had worse Mini-Mental Status Examination and Montreal Cognitive Assessment （MoCA） scores than those in the PD group （P 〈 0.001）, especially in visuospatial/executive, attention, and memory functions. The PD ＋ OSA group performed worse than the PD group in the delayed recall domain. After adjusting for age, sex, body mass index, education, disease severity, and other sleep disorders, MoCA was negatively associated with OSA （β = ？0.736, P = 0.043） and RBD （β = ？2.575, P 〈 0.001）. The severity of RBD （tonic/phasic electromyography activity） and OSA （apnea-hypopnea index/oxygen desaturation index/minimum SaO2） were also associated with MoCA. The adjusted β values of RBD-related parameters were higher than that for OSA.Conclusions：We found that RBD alleviated OSA severity; however, RBD and OSA together exacerbated PD cognitive impairment. Further studies are needed to evaluate whether OSA treatment can improve cognition in PD.展开更多
Background： Rapid eye movement （REM） sleep behavior disorder （RBD） may be a risk factor for cognitive impairment in patients with Parkinson＆#39;s disease （PD）.However, little is known regarding the relation be...Background： Rapid eye movement （REM） sleep behavior disorder （RBD） may be a risk factor for cognitive impairment in patients with Parkinson＆#39;s disease （PD）.However, little is known regarding the relation between the severity of RBD and the different domains of cognitive impairment.The aim of this study was： （1） to investigate the domains of cognitive impairment in patients with PD and RBD, and （2） to explore risk factors for PD-mild cognitive impairment （PD-MCI） and the relationship between RBD severity and impairment in different cognitive domains in PD.Methods： The participants were grouped as follows： PD without RBD （PD-RBD;n =42）, PD with RBD （PD ＋ RBD;n =32）, idiopathic RBD （iRBD;n =15）, and healthy controls （HCs;n =36）.All participants completed a battery of neuropsychological assessment of attention and working memory, executive function, language, memory, and visuospatial function.The information of basic demographics, diseases and medication history, and motor and nonmotor manifestations was obtained and compared between PD-RBD and PD ＋ RBD groups.Particular attention was paid to the severity of RBD assessed by the RBD Questionnaire-Hong Kong （RBDQ-HK） and the RBD Screening Questionnaire （RBDSQ）, then we further examined associations between the severity of RBD symptoms and cognitive levels via correlation analysis.Results： Compared to PD-RBD subjects, PD ＋ RBD patients were more likely to have olfactory dysfunction and their Epworth Sleepiness Scale scores were higher （P 〈 0.05）.During neuropsychological testing, PD ＋ RBD patients performed worse than PD-RBD patients, including delayed memory function, especially.The MCI rates were 33%, 63%, 33%, and 8% for PD-RBD, PD ＋ RBD, iRBD, and HC groups, respectively.RBD was an important factor for the PD-MCI variance （odds ratio =5.204, P =0.018）.During correlation analysis, higher RBDSQ and RBDQ-HK scores were significantly associated with poorer performance on the Trail Making 展开更多
目的:探讨肝豆汤治疗湿热内蕴型Wilson病(WD)伴快动眼期睡眠行为障碍(RBD)的疗效。方法:从2019年4月至2023年8月在安徽中医药大学第一附属医院脑病科入院患者中,选取符合纳入标准的湿热内蕴型WD伴RBD患者62例,由计算机分发器随机分为对...目的:探讨肝豆汤治疗湿热内蕴型Wilson病(WD)伴快动眼期睡眠行为障碍(RBD)的疗效。方法:从2019年4月至2023年8月在安徽中医药大学第一附属医院脑病科入院患者中,选取符合纳入标准的湿热内蕴型WD伴RBD患者62例,由计算机分发器随机分为对照组、观察组各31例。对照组予以常规驱铜治疗,观察组在对照组基础上加用肝豆汤治疗。8 d为1个疗程,共3个疗程。比较两组治疗前、后的中医证候积分、RBD筛查问卷(RBDSQ)评分、RBD筛查问卷香港版(RBDQ-HK)评分、多导睡眠图(PSG)参数、24 h尿铜(24 h U-Cu)水平和游离铜(NCC)水平,观察不良反应。结果:最终完成试验病例60例,对照组和观察组各30例。治疗前,两组各项指标比较差异无统计学意义,资料具有可比性。与本组治疗前比较,两组患者中医证侯积分、RBDSQ和RBDQ-HK评分明显降低,24 h U-Cu水平明显增高,NCC水平明显降低(P<0.05,P<0.01);与对照组比较,中医证侯积分、RBDSQ、RBDQ-HK评分和NCC水平观察组改善更优(P<0.05,P<0.01)。与本组治疗前比较,两组总睡眠(TST)时间、睡眠效率(SE)、入睡/快速眼动(REM)潜伏期、N1/N2/REM期占比、微觉醒指数(ARI)和时相性肌电图活动(P-EMG-A)占比明显改善(P<0.05)。与对照组治疗后比较,观察组TST、SE、REM期占比、ARI和P-EMG-A占比改善更明显(P<0.05)。结论:肝豆汤不仅可以改善湿热内蕴型WD伴RBD患者的中医证候,还可以减轻患者的RBD症状。展开更多
文摘Background：Rapid eye movement （REM） sleep behavior disorder （RBD） and obstructive sleep apnea （OSA） are the most common sleep disorders in Parkinson’s disease （PD）. The aim of this study was to identify whether RBD could alleviate OSA severity in PD patients and its effect on cognitive impairment.Methods：From February 2014 to May 2017, we recruited 174 PD patients from the Second Affiliated Hospital of Soochow University, all of whom underwent polysomnography （PSG）. We collected clinical data, PSG results, and compared information between patients with and without RBD or OSA by analysis of covariance. We also investigated the effect of these sleep disorders on cognitive impairment using linear regression.Results：We grouped participants as follows： PD only （n = 53）, PD ＋ OSA （n = 29）, PD ＋ RBD （n = 61）, and PD ＋ RBD ＋ OSA （n = 31）. Minimum oxygen saturation （SaO2） during whole sleep and in REM sleep was higher in PD ＋ RBD ＋ OSA patients than that in PD ＋ OSA patients. PD ＋ RBD patients had worse Mini-Mental Status Examination and Montreal Cognitive Assessment （MoCA） scores than those in the PD group （P 〈 0.001）, especially in visuospatial/executive, attention, and memory functions. The PD ＋ OSA group performed worse than the PD group in the delayed recall domain. After adjusting for age, sex, body mass index, education, disease severity, and other sleep disorders, MoCA was negatively associated with OSA （β = ？0.736, P = 0.043） and RBD （β = ？2.575, P 〈 0.001）. The severity of RBD （tonic/phasic electromyography activity） and OSA （apnea-hypopnea index/oxygen desaturation index/minimum SaO2） were also associated with MoCA. The adjusted β values of RBD-related parameters were higher than that for OSA.Conclusions：We found that RBD alleviated OSA severity; however, RBD and OSA together exacerbated PD cognitive impairment. Further studies are needed to evaluate whether OSA treatment can improve cognition in PD.
文摘Background： Rapid eye movement （REM） sleep behavior disorder （RBD） may be a risk factor for cognitive impairment in patients with Parkinson＆#39;s disease （PD）.However, little is known regarding the relation between the severity of RBD and the different domains of cognitive impairment.The aim of this study was： （1） to investigate the domains of cognitive impairment in patients with PD and RBD, and （2） to explore risk factors for PD-mild cognitive impairment （PD-MCI） and the relationship between RBD severity and impairment in different cognitive domains in PD.Methods： The participants were grouped as follows： PD without RBD （PD-RBD;n =42）, PD with RBD （PD ＋ RBD;n =32）, idiopathic RBD （iRBD;n =15）, and healthy controls （HCs;n =36）.All participants completed a battery of neuropsychological assessment of attention and working memory, executive function, language, memory, and visuospatial function.The information of basic demographics, diseases and medication history, and motor and nonmotor manifestations was obtained and compared between PD-RBD and PD ＋ RBD groups.Particular attention was paid to the severity of RBD assessed by the RBD Questionnaire-Hong Kong （RBDQ-HK） and the RBD Screening Questionnaire （RBDSQ）, then we further examined associations between the severity of RBD symptoms and cognitive levels via correlation analysis.Results： Compared to PD-RBD subjects, PD ＋ RBD patients were more likely to have olfactory dysfunction and their Epworth Sleepiness Scale scores were higher （P 〈 0.05）.During neuropsychological testing, PD ＋ RBD patients performed worse than PD-RBD patients, including delayed memory function, especially.The MCI rates were 33%, 63%, 33%, and 8% for PD-RBD, PD ＋ RBD, iRBD, and HC groups, respectively.RBD was an important factor for the PD-MCI variance （odds ratio =5.204, P =0.018）.During correlation analysis, higher RBDSQ and RBDQ-HK scores were significantly associated with poorer performance on the Trail Making
文摘目的:探讨肝豆汤治疗湿热内蕴型Wilson病(WD)伴快动眼期睡眠行为障碍(RBD)的疗效。方法:从2019年4月至2023年8月在安徽中医药大学第一附属医院脑病科入院患者中,选取符合纳入标准的湿热内蕴型WD伴RBD患者62例,由计算机分发器随机分为对照组、观察组各31例。对照组予以常规驱铜治疗,观察组在对照组基础上加用肝豆汤治疗。8 d为1个疗程,共3个疗程。比较两组治疗前、后的中医证候积分、RBD筛查问卷(RBDSQ)评分、RBD筛查问卷香港版(RBDQ-HK)评分、多导睡眠图(PSG)参数、24 h尿铜(24 h U-Cu)水平和游离铜(NCC)水平,观察不良反应。结果:最终完成试验病例60例,对照组和观察组各30例。治疗前,两组各项指标比较差异无统计学意义,资料具有可比性。与本组治疗前比较,两组患者中医证侯积分、RBDSQ和RBDQ-HK评分明显降低,24 h U-Cu水平明显增高,NCC水平明显降低(P<0.05,P<0.01);与对照组比较,中医证侯积分、RBDSQ、RBDQ-HK评分和NCC水平观察组改善更优(P<0.05,P<0.01)。与本组治疗前比较,两组总睡眠(TST)时间、睡眠效率(SE)、入睡/快速眼动(REM)潜伏期、N1/N2/REM期占比、微觉醒指数(ARI)和时相性肌电图活动(P-EMG-A)占比明显改善(P<0.05)。与对照组治疗后比较,观察组TST、SE、REM期占比、ARI和P-EMG-A占比改善更明显(P<0.05)。结论:肝豆汤不仅可以改善湿热内蕴型WD伴RBD患者的中医证候,还可以减轻患者的RBD症状。
文摘目的快速眼动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)是帕金森病(Parkinson's disease,PD)常见的非运动症状且是重要预后因素。本研究通过静息态功能磁共振成像,利用度中心度(degreecentrality,DC)和低频振幅(amplitudes of low-frequency fluctuation,ALFF)分析PD伴RBD和不伴有RBD患者组以及健康对照组三组间DC值和ALFF值,探索PD伴RBD患者脑功能活动特征及RBD特异性脑区,探究RBD发生的病理机制。材料与方法招募20例伴有RBD的PD患者(PD-RBD组)、40例无RBD的PD患者(PD-nonRBD组)和44例年龄性别匹配的健康对照(健康对照组),三组被试均接受磁共振扫描。利用静息态数据计算DC值和ALFF值,探测脑功能特征。结果方差分析结果显示三组间DC值主效应脑区为右侧中央前回、颞上回、小脑、额中回(P<0.05,FDR校正);ALFF值主效应脑区为左侧海马旁回、楔叶、舌回(P<0.05,FDR校正)。进一步分析发现相比于PD-nonRBD组,PD-RBD患者表现为右侧额中回DC值升高(t=4.02;P=0.007,FDR校正);左侧楔前叶DC值降低(t=5.30;P=0.009,FDR校正)。相比于健康对照组,PD-RBD患者表现为左侧额上回、小脑、右侧颞上回、左侧颞中回、额中回的DC值升高(P<0.05,FDR校正);左侧中央前回、颞上回和颞中回的DC值降低(P<0.05,FDR校正);右侧楔叶ALFF值降低(P<0.05,FDR校正)。结论PD-RBD在DC和ALFF上有独特的影像学特征,特别是右侧额中回、左侧楔前叶的功能异常可能与PD患者RBD的发生密切相关。
