Previous studies have shown the therapeutic effects of clonazepam for rapid eye movement sleep behavior disorder (RBD), but they had several limitations such as the lack of clear definition of treatment outcomes and little information about adjuvant therapy. The aims of this study were to evaluate the treatment outcomes with clonazepam and to explore possible determinants of treatment response. We performed a retrospective medical chart review of 171 patients with RBD. All the participants underwent overnight polysomnography and completed questionnaires. The positive treatment response was defined as the absence of disruptive behaviors causing sleep-related injuries during the last year of follow-up. Among the 171 patients presented with disruptive behaviors, 155 (90.6%) experienced positive treatment responses. Of the responders, 18 (11.6%) received adjunctive medication due to insufficient therapeutic effect of clonazepam monotherapy. After adjusted analysis, an earlier age of diagnosis (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.64–0.86, P < .001) and comorbid periodic limb movement during sleep (OR = 4.96, 95% CI = 1.05–23.33, P = .043) were related to poor treatment response. Clinicians should recognize the predictors of poor treatment response and consider combination therapy for better prevention of sleep-related injuries in those who show unsatisfactory responses to clonazepam monotherapy.

先前的研究已经表明氯硝西泮对快速眼动睡眠行为障碍 (RBD) 的治疗效果，但它们有几个局限性，例如缺乏对治疗结果的明确定义以及关于辅助治疗的信息很少。本研究的目的是评估氯硝西泮的治疗结果并探索治疗反应的可能决定因素。我们对 171 名 RBD 患者进行了回顾性病历审查。所有参与者都接受了夜间多导睡眠监测并完成了问卷调查。积极的治疗反应被定义为在随访的最后一年中没有导致睡眠相关损伤的破坏性行为。在出现破坏性行为的 171 名患者中，155 名（90.6%）经历了积极的治疗反应。在响应者中，18 (11. 6%) 由于氯硝西泮单药治疗效果不足而接受辅助药物治疗。校正分析后，诊断年龄更早（比值比 [OR] = 0.74，95% 置信区间 [CI] = 0.64–0.86，P < .001）和睡眠期间共病的周期性肢体运动（OR = 4.96，95% CI = 1.05–23.33，P = .043）与治疗反应差有关。临床医生应认识到治疗反应不佳的预测因素，并考虑联合治疗，以更好地预防对氯硝西泮单药治疗反应不满意的患者的睡眠相关损伤。