Polysomnographic Characteristic Association Of Rapid Eye Movementsleep Behavior Disorder With Obstructive Sleep Apnea Hypopnea Syndrome In Parkinson’s Disease

Objective:To analyze the sleep apnea parameters changes of Parkinson’s disease(PD)with REM sleep behavior disorder(RBD)or obstructive sleep apnea hypopnea syndrome(OSAHS).further to investigate and understand the possible relationship between the two kinds of sleep disorders.Methods:61 PD patients were enrolled and all underwent video-polysomnography(PSG)and collect basic clinicle date.According to the criteria of the International Classification of Sleep Disorders second edition(ICSD-3)and the obstructive sleep apnea hypopnea syndrome diagnosis and treatment guidelines(revised in 2011)respectivily,patients were divided into PD with RBD(PD-RBD)and without RBD(PD-nonRBD),PD with OSA(PD-OSAHS)and without OSAHS(PD-nonOSAHS),OSAHS with RBD(OSAHS-RBD)and without OSAHS(OSAHS-nonRBD),to analysis the sleep parameters of each.Results:1.A total of 61 PD patients were enrolled in this study,including a total of 38 men(62.29%)and a total of 23 women(37.70%).The mean age was 66.16±9.33,mean body mass index(BMI)was 21.62 + 3.26,the duration of PD was 5.78±4.53(0.58-22)years.Among of PD patients,35 were PD conbined with RBD(57.37%),22 were PD combined with OSAHS(36.06%),12 were PD combined with OSAHS and RBD(19.67%).2.There was no significant difference in gender,age and BMI between PD-RBD group and PD-nonRBD group.The duration of PD in patients combined with RBD was longer(P<0.05).Patients with RBD had longer TST(P<0.05)and N1%(P<0.05)and REM%(P<0.05).There were no significant differences in SE,SL,MAI,REML,N3%,PLMSI,and N1% between the two groups(P>0.05).Although the ODI of PD patients combined with RBD was lower,but was no significant different[0.9(0.3-2.8)vs1.3(0.6-3.2),P>0.05] between the two groups.Compared with PD-RBD group,PD-nonRBD group have significantly higer REM sleep tonic EMG activity density [15.98 ± 9.39 vs 8.48 ± 6.09 P<0.05],and phasic EMG activity density[26.51 ± 9.17 vs 14.84 ± 4.10,P<0.05].3.compared with the PD-nonOSAHS group,PD-OSAHS group was older,and there was significant difference between the two groups(P=0.01).There was no significant difference between the two groups in gender,BMI,duration of disease,REM sleep tonic EMG activity density [(13.13±7.87)vs(12.6±9.54),P>0.05]and REM sleep phasic EMG activity density [(22.49±11.30)vs(21±8.27),P>0.05].4.the mandibular REM sleep EMG activity without atonia didn’t improve the REM sleep apnea hypoventilation index in RBD-OSAHS group,both of them exhibited no significant linear correlation.Conclusion:1.PD has a high rate of RBD and age,which has an effect on sleep structure.The density of mandibular myoelectric activity in REM may be a objective index for RBD diagnosis.2.PD combined with RBD and OSAHS is common at the same time,and EMG increased activity of RBD has no effect on the nocturnal oxygen saturation and REM sleep apnea hypoventilation index,thus RBD may have a more complex pathological mechanism in obstructive sleep apnea hypoventilation of PD.