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快速動眼期睡眠行為障礙

Rapid Eye Movement Sleep Behavior Disorder

摘要


快速動眼期睡眠行為障礙症可以是一種獨立存在的疾病,也可以是繼發於其他神經系統的退化性疾病,在大多數情況之下,獨立的快速動眼期睡眠行為障礙症暗示著,由於潛在的突觸核蛋白病灶導致的神經退化性疾病(Howell MJ, et al),因此,快速動眼期睡眠行為障礙症的臨床辨別,對於疾病的預後意義重大;多導極的睡眠腦電波圖上沒有張力的快速動眼期行為障礙,是此病的診斷黃金標準,而不同情況之下,有些疾病可能會模仿快速動眼期睡眠行為障礙症,最常見的是睡眠期間的阻塞性睡眠呼吸中止症、非快速動眼期睡眠行為障礙的異態性睡眠(異睡症),與睡眠相關性癲癇等,這些疾病也可能與快速動眼期睡眠行為障礙症合併出現,對於診斷快速動眼期睡眠行為障礙症嚴重程度是一項挑戰,與快速動眼期睡眠行為障礙症治療的選擇和對治療的反應等,Video-PSG(Video-Polysomnography,多項生理睡眠檢查錄影)是確立診斷的黃金標準,藉此可以區分出不同的或合併的睡眠障礙症,而仔細的詢問病史和使用腕動計(actigraphy)可用來作為鑑別診斷快速動眼期睡眠行為障礙症,以及提供睡眠障礙的重要的線索。

並列摘要


Rapid Eye Movement (REM) sleep behavior disorder (RBD) can occur in isolation or as a secondary condition to other neurological or medical disorders. Isolated RBD is often an early indicator of a neurodegenerative condition, typically associated with underlying synucleinopathies, making its recognition critical for prognostic purposes. The presence of REM sleep without atonia on polysomnography is a mandatory diagnostic criterion for RBD. Several conditions can mimic RBD, with the most common being obstructive sleep apnea, non-REM parasomnias, and sleep-related hypermotor epilepsy. These disorders may also coexist with RBD, complicating the assessment of disease severity, treatment decisions, and evaluation of treatment response. Video-polysomnography (Video-PSG) is the gold standard for accurate diagnosis, as it can differentiate between distinct or comorbid sleep disorders. Additionally, a thorough patient history, combined with actigraphy, can provide valuable insights for differential diagnosis.

參考文獻


Antelmi, E., Lippolis, M., Biscarini, F., Tinazzi, M., Plazzi, G. (2021). REM sleep behavior disorder: Mimics and variants. Sleep Medicine Reviews, 60, 101515. https://doi.org/10.1016/j.smrv.2021.101515
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Högl, B., Stefani, A., Videnovic, A. (2018). Idiopathic REM sleep behaviour disorder and neurodegeneration—an update. Nature Reviews Neurology, 14(1), 40-55. https://doi.org/10.1038/nrneurol.2017.157
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