BACKGROUND Rapid eye movement (REM) sleep behavior disorder (RBD) is a male-predominant parasomnia. Earlier clinical RBD patient studies showed gender differences of clinical symptoms and polysomnographic (PSG) findings. However, no previous investigated this issue by means of validated severity scales or by neuropsychological examination related to alpha-synucleinopathy. This study elucidates gender differences in clinical, physiological, and neuropsychological findings in Japanese idiopathic RBD (iRBD) patients. METHODS From 220 patients with complaint of sleep-related vocalization or behaviors who visited Yoyogi Sleep Disorder Center from June 2003 through December 2016, 43 female (68.7 ± 7.3 yr) and 141 male patients (66.7 ± 6.7 yr) diagnosed as having iRBD by video-polysomnography (v-PSG) were selected. All subjects answered the RBD questionnaire (RBDQ-JP) and underwent olfactory function test (Sniffin' Sticks test) and cognitive function test (MoCA-J). RESULTS Female iRBD patients had later first symptom-witnessed age (sleep-talking 63.2 ± 10.5 yr, behaviors 60.9 ± 8.6 yr) than male patients (sleep-talking 59.1 ± 8.8 yr, behaviors 64.7 ± 8.9 yr). No gender difference was found in age at diagnosis, clinical severity (RBDQ-JP), or olfactory or cognitive function. Regarding electromyogram (EMG) findings during REM sleep, phasic EMG activity was higher in female patients (22.3 ± 17.8% vs. 16.5 ± 16.1%), although no difference was found in tonic EMG activity. CONCLUSIONS Although female iRBD patient symptoms were first recognized later than those of male patients, they showed elevated EMG activity during REM sleep and showed deteriorated olfactory and cognitive function similarly to male patients at the first medical consultation. Results suggest that disease progression in female RBD patients is equivalent to that in male patients.

中文翻译：

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特发性REM睡眠行为障碍患者的临床发现和α-突触核病相关标志物的性别差异。

背景技术快速眼动（REM）睡眠行为障碍（RBD）是男性主导的失眠症。较早的临床RBD患者研究显示临床症状和多导睡眠图（PSG）的性别差异。但是，以前没有人通过验证的严重性量表或与α-突触核蛋白病相关的神经心理学检查来调查此问题。这项研究阐明了日本特发性RBD（iRBD）患者在临床，生理和神经心理学发现中的性别差异。方法自2003年6月至2016年12月访问Yoyogi睡眠障碍中心的220名抱怨与睡眠有关的发声或行为的患者中，有43名女性（68.7±7.3岁）和141名男性（66.7±6.7岁）患者通过视频被诊断出患有iRBD选择了多导睡眠图（v-PSG）。所有受试者都回答了RBD问卷（RBDQ-JP），并进行了嗅觉功能测试（Sniffin's Sticks测试）和认知功能测试（MoCA-J）。结果女性iRBD患者的第一个症状见证人年龄较晚（会说话的睡眠为63.2±10.5岁，行为为60.9±8.6岁），而男性患者（会说话的睡眠为59.1±8.8岁，行为为64.7±8.9岁）。在诊断时，临床严重程度（RBDQ-JP）或嗅觉或认知功能上未发现性别差异。关于REM睡眠期间肌电图（EMG）的发现，女性患者的阶段性EMG活性较高（22.3±17.8％vs. 16.5±16.1％），尽管在补药EMG活性方面没有发现差异。结论尽管女性iRBD患者的症状首先被识别为晚于男性患者，他们在REM睡眠期间表现出EMG活动升高，并且嗅觉和认知功能下降，与男性患者在第一次医疗咨询中相似。结果表明，女性RBD患者的疾病进展与男性患者相同。