렘수면행동장애 환자의 수면다원검사에 대한 정량적 분석을 통한 진단적 접근
Diagnostic Approach with Quantitative Analysis of Polysomnography in REM Sleep Behavior Disorder
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초록
Rapid eye movement sleep behavior disorder (RBD) is characterized by the intermittent absence of electromyogram (EMG) atonia during rapid eye movement (REM) sleep and the increase of motor activity associated with dream mentation. However, ICSD-2 criteria did not suggest validated diagnostic criteria and previous studies had no consistency with value ranged 10-20% of REM sleep without atonia (RSWA) in polysomnography (PSG). We investigated standard value about RSWA of Korean RBD patients. Methods: Thirty one patients diagnosed with RBD and 31 normal age- and sex-matched controls were selected. All RBD patients and normal controls were studied using PSG from 2007 to 2012. ICSD-2 criteria was used to select RBD patients and RSWA. We defined RSWA as increasing amplitude by 4 times that of baseline EMG and occupying at least 50% of each epoch or five 3 second mini-epochs. Results: PSG findings showed increased N1 sleep, periodic leg movement index and decreased N2 sleep in RBD patients compared to normal controls. Mean RSWA was 19.21% [±9.93, standard deviation (SD)], with a range of 5.21-38.22% in RBD patients, whereas the mean RSWA in normal control was 0.43% (±0.74, SD) with a range of 0-2.3%. Conclusions: We quantitatively figured out the characteristics of PSG and RSWA in Korean RBD patients. The outcome shows definite differences between RBD patients and normal controls. This study suggest that we may diagnose RBD who have RSWA over 5% of the REM sleep periods.
Abstract
Rapid eye movement sleep behavior disorder (RBD) is characterized by the intermittent absence of electromyogram (EMG) atonia during rapid eye movement (REM) sleep and the increase of motor activity associated with dream mentation. However, ICSD-2 criteria did not suggest validated diagnostic criteria and previous studies had no consistency with value ranged 10-20% of REM sleep without atonia (RSWA) in polysomnography (PSG). We investigated standard value about RSWA of Korean RBD patients. Methods: Thirty one patients diagnosed with RBD and 31 normal age- and sex-matched controls were selected. All RBD patients and normal controls were studied using PSG from 2007 to 2012. ICSD-2 criteria was used to select RBD patients and RSWA. We defined RSWA as increasing amplitude by 4 times that of baseline EMG and occupying at least 50% of each epoch or five 3 second mini-epochs. Results: PSG findings showed increased N1 sleep, periodic leg movement index and decreased N2 sleep in RBD patients compared to normal controls. Mean RSWA was 19.21% [±9.93, standard deviation (SD)], with a range of 5.21-38.22% in RBD patients, whereas the mean RSWA in normal control was 0.43% (±0.74, SD) with a range of 0-2.3%. Conclusions: We quantitatively figured out the characteristics of PSG and RSWA in Korean RBD patients. The outcome shows definite differences between RBD patients and normal controls. This study suggest that we may diagnose RBD who have RSWA over 5% of the REM sleep periods.
참고문헌 (24)
- Schenck CH, "Chronic behavioral disorders of human REM sleep: a new category of parasomnia", Sleep, 9, pp.293~308 (1986)
- Iranzo A, "Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder:a descriptive study", Lancet Neurol, 5, pp.572~577 (2006)
- Schenck CH, "Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults", JAMA, 257, pp.1786~1789 (1987)
- Schenck CH, "REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP", Sleep, 25, pp.120~138 (2002)
- Mahowald MW, "Principles and practice of Sleep Medicine", pp.389~401 (1989), WB Saunders
- Lapierre O, "Polysomnographic features of REM sleep behavior disorder: development of a scoring method", Neurology, 42, pp.1371~1374 (1992)
- Jouvet M, "Locus coeruleus et sommeil paradoxal", C R Soc Biol, 159, pp.895~899 (1965)
- Kimura K, "A discrete pontine ischemic lesion could cause REM sleep behavior disorder", Neurology, 55, pp.894~895 (2000)
- Provini F, "Status dissociatus after surgery for tegmental ponto-mesencephalic cavernoma: a state-dependent disorder of motor control during sleep", Mov Disord, 19, pp.719~723 (2004)
- Tippmann-Peikert M, "REM sleep behavior disorder initiated by acute brainstem multiple sclerosis", Neurology, 66, pp.1277~1279 (2006)
- Schenck CH, "Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder", Neurology, 46, pp.388~393 (1996)
- Zanigni S, "REM behaviour disorder and neurodegenerative diseases", Sleep Med, 12(Suppl 2), pp.S54~S58 (2011)
- American Academy of Sleep Medicine, "The International classification of sleep disorders: Diagnostic and coding manual", American Sleep Disorders Association, ~ (1990)
- American Academy of Sleep Medicine, "The International Classification of Sleep Disorders: Diagnostic and Coding Manual", American Academy of Sleep Medicine, ~ (2005)
- Iber C, "The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications", American Academy of Sleep Medicine, ~ (2007)
- Dauvilliers Y, "REM sleep characteristics in narcolepsy and REM sleep behavior disorder", Sleep, 30, pp.844~849 (2007)
- Consens FB, "Validation of a polysomnographic score for REM sleep behavior disorder", Sleep, 28, pp.993~9937 (2005)
- Montplaisir J, "Polysomnographic diagnosis of idiopathic REM sleep behavior disorder", Mov Disord, 25, pp.2044~2051 (2010)
- Frauscher B, "Quantification of electromyographic activity during REM sleep in multiple muscles in REM sleep behavior disorder", Sleep, 31, pp.724~731 (2008)
- Fantini ML, "Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation", Neurology, 59, pp.1889~1894 (2002)
- Gagnon JF, "REM sleep behavior disorder and REM sleep without atonia in Parkinson’s disease", Neurology, 59, pp.585~589 (2002)
- Bliwise DL, "Elevated PEM (phasic electromyographic metric)rates identify rapid eye movement behavior disorder patients on nights without behavioral abnormalities", Sleep, 31, pp.853~857 (2008)
- Li SX, "Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK)", Sleep Med, 11, pp.43~48 (2010)
- Kim YK, "The implication of nigrostriatal dopaminergic degeneration in the pathogenesis of REM sleep behavior disorder", Eur J Neurol, 17, pp.487~492 (2010)