Синдром нарушения поведения в фазе сна с быстрыми движениями глаз при болезни Паркинсона

Abstract

Background: One of the most common sleep disorders in patients with Parkinson’s disease (PD) is rapid eye movement sleep behavioral disorder in Parkinson’s disease (RBD) are considered as the early symptom of PD, as a prognostic factor of cognitive disorders progression and visual hallucinations appearance. Among the unstudied aspects are the correlation of RBD with other disturbances of sleep and wakefulness and the PD course depending on appearance of this parasomnia. Objectives: to precise the pattern of sleep and vigilance disorders in patients with PD and RBD; to estimate the course of these disorders depending on disease progression and time of RBD appearance. Materials and methods: one hundred and forty (140) patients (72 males and 68 females) suffering from PD without dementia (mean age is 61,98±0,78 years, stage of Parkinson’s disease is 2,35±0,05, PD duration consisted 5,82±0,65 years) were examined twice with interval of 2,5 years between screening and follow-up visits. For assessment of motor functions we used UPDRS, for assessment of neuropsychiatric functions we used sleep scales, the Epworth sleepiness scale and Beck’s depression Inventory. RBD were revealed by survey of patients and their relatives who described movements and vocalization during dreaming. The quality of life assessed with use of questionnaire in PD (QoLPD-39). Statistical analysis was performed using software package Statistica 8.0 with estimation of Student’s t-test and ANOVA test for repeated measurements. Results: Possible RBD were detected in 46,4% of patients. In 30,7% of them RBD have appeared before movement disturbances, in 16,9% – simultaneously with movement disturbances and in 52,3% – in two years after movement disorders. Initially, age, duration and stage of PD of patients with RBD did not distinguish from patient without parasomnia. In two years of observation patients with RBD had more score in UPDRS scale (everyday activity part), had more severe depressions, more frequency of sleep attacks and lower quality of life than in patients without parasomnia (p=0,05). Excessive daytime somnolence with sleep attacks was revealed in patients who had parasomnia before appearance of movement disorders. Conclusions: RBD in patients with PD are associated with fast progression of hypersomnia, depression, decrease of everyday activity and quality of life. Early manifestation of RBD is considered as prognostically unfavorable factor. The aspect that RBD are the marker of brainstem spreading of the disease and the sign of unpleasant cause is discussed.