OBJECTIVES/BACKGROUND Rapid eye movement (REM) Sleep Behavior Disorder (RBD) in Parkinson's disease (PD) may be associated with a malignant phenotype. Despite its prognostic value, little is known about the time course of RBD in PD. In this study, we aimed to ascertain whether or not RBD is a stable feature in PD. In this study, we prospectively evaluated clinical and neurophysiological features of RBD, including REM Sleep Without Atonia (RSWA), in PD patients with RBD at baseline and after three years then assessed whether the changes in measures of RSWA parallel the progression of PD. PATIENTS/METHODS In sum, 22 (17M, mean age 64.0 ± 6.9 years) moderate-to-advanced PD patients (mean PD duration at baseline:7.6±4.8 years) with RBD, underwent a video-polysomnography (vPSG) recording and clinical and neuropsychological assessment at baseline and after three years. RESULTS At follow-up, the self-assessed frequency of RBD symptoms increased in six patients, decreased in six and remained stable in 10, while RSWA measures significantly increased in all subjects. At follow-up, patients showed worse H&Y stage (p = 0.02), higher dopaminergic doses (p = 0.05) and they performed significantly worse in phonetic and semantic fluency tests (p = 0.02; p = 0.04). Changes in RSWA correlated significantly with the severity in levodopa-induced dyskinesia (r = 0.61,p = 0.05) and motor fluctuation (r = 0.54,p = 0.03) scores, and with the worsening of executive functions (r = 0.78,p = 0.001) and visuo-spatial perception (r = -0.57,p = 0.04). CONCLUSION Despite the subjective improvement of RBD symptoms in one-fourth of PD patients, all RSWA measures increased significantly at follow-up, and their changes correlated with the clinical evolution of motor and non-motor symptoms. RBD is a long-lasting feature in PD and RSWA is a marker of the disease's progression.

中文翻译：

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REM睡眠行为障碍会在帕金森氏病的进展中发生变化吗？

目的/背景帕金森病（PD）中的快速眼动（REM）睡眠行为障碍（RBD）可能与恶性表型有关。尽管其具有预后价值，但对PD中RBD的时程了解甚少。在这项研究中，我们旨在确定RBD是否是PD中的稳定特征。在这项研究中，我们前瞻性地评估了基线时和三年后患有PD的PD患者的RBD的临床和神经生理学特征，包括REM无心律睡眠（RSWA），然后评估了RSWA的变化是否与PD的进展平行。患者/方法总的来说，有22名（17M，平均年龄64.0±6.9岁）患有RBD的中度至晚期PD患者（基线时平均PD持续时间：7.6±4.8岁），在基线和三年后进行了视频多导睡眠图（vPSG）记录以及临床和神经心理评估。结果在随访中，RBD症状的自我评估频率在6例患者中增加，在6例中减少，在10例中保持稳定，而所有受试者的RSWA措施均显着增加。在随访中，患者表现出较差的H＆Y分期（p = 0.02），较高的多巴胺能剂量（p = 0.05），并且他们在语音和语义流利度测试中的表现明显较差（p = 0.02; p = 0.04）。RSWA的变化与左旋多巴诱发的运动障碍的严重程度（r = 0.61，p = 0.05）和运动波动（r = 0.54，p = 0.03）得分以及执行功能的恶化（r = 0.78，p = 0.001）和视觉空间感知（r = -0.57，p = 0.04）。结论尽管四分之一的PD患者主观RBD症状有所改善，但所有RSWA措施在随访时均显着增加，其变化与运动和非运动症状的临床进展相关。RBD是PD的持久特征，而RSWA是该疾病进展的标志。