Study On Polysomnographic Characteristics Of IRBD And PD-related RBD

Objective: Rapid eye movement sleep behavior disorder(RBD)is a complex dream-related behavior or vocal abnormal sleep that recurs during the rapid eye movement(REM)sleep period,is one of the most valuable non-motor symptoms of Parkinson's disease(PD)diagnosis.The etiology of idiopathic rapid eye movement sleep behavior disorder(iRBD)is unknown,but there is a high risk of conversion to PD.Polysomnography(PSG)is the gold standard for the diagnosis of RBD.In this study,we compared the PSG-related data of patients with idiopathic RBD and PD-related RBD to find differences in PSG parameters and provide clinical diagnosis.Methods: 20 patients diagnosed with iRBD(iRBD group),20 patients with PD combined with RBD(PD-RBD group),and 20 patients without PD with RBD(PD-non RBD group)at the The second hospital of Dalian medical university from June2018 to January 2020,and recruited 20 healthy people(healthy control group)with matching age,gender,height and weight.All groups were monitored by PSG,and the four groups of PSG-related parameters were compared,including total sleep time(TST),sleep efficiency(SE),sleep latency(SL),and R sleep latency.(Rapid eye movement latency,REML),non-rapid eye movement sleep 1 of total sleep time(N1%),non-rapid eye movement sleep 2 of total sleep time(N2%),non-rapid eye movement sleep 3 of total sleep time(N3%),Percent of total sleep time during rapid eye movement sleep(REM%),Apnea hypopnea index(AHI-TST),REM apnea hypopnea index(AHI-REM),Arousal index(MAI),REM arousal index(MAI-REM),index of periodic leg movements during sleep(PLMI),REM Periodic Periodic Leg Movement Index(PLMI-REM),tonic and phasic chin EMG density score,Rapid Eye Movement Index during REM Period.The data was processed using SPSS 23.0 software.Results:1.There was no significant difference in gender,age,BMI,and past history(hypertension,diabetes,smoking)between the four groups(iRBD group,PD-RBD group,PD-non RBD group,healthy control group)(P> 0.05);There was no significant difference in the course of RBD between PD-RBD group and iRBD group(P> 0.05).There was no significant difference in the effective dose of levodopa(LEDD)and Hoehn & Yahr classification between PD-RBD group and PD-non RBD group(P>0.05).2.Compared with the iRBD group,PD-RBD group had shorter TST(288.79 ±54.18 min and 328.63 ± 71.36min),decreased SE(52.21 ± 10.93% and 62.43 ± 13.15%),and increased N1%(24.00 ± 7.99% and 15.86 ± 6.54%),REM rapid eye movement index decreased [(75.10 ± 58.90)times / h and 106.14 ± 40.00)times / h],the tension density of the tension diaphragm increased(20.79 ± 7.21% and 14.98 ± 4.51%),Time-dependent diaphragmatic electromyography increased in density(20.38 ± 5.99%and 15.18 ± 3.60%),and the differences were statistically significant(P<0.05).There was no significant difference in SL,N2%,N3%,REM%,PLMI,PLMI-REM,MAI,MAI-REM,AHI-TST,AHI-REM,AHI-NREM between the two groups(P>0.05).3.Compared with PD-RBD group,PD-RBD group has increased density of tense diaphragmatic muscle(20.79 ± 7.21% and 11.33 ± 2.41%),and increased density of time-dependent diaphragmatic myoelectricity(20.38 ± 5.99% and 9.62 ± 4.15%),the differences were statistically significant(P<0.05).There was no significant difference in TST,SE,SL,N1%,N2%,N3%,REM%,PLMI,PLMI-REM,MAI,MAI-REM,AHI-TST,AHI-REM,AHI-NREM.(P> 0.05).4.Compared with the PD-non RBD group,the iRBD group has an increased REM rapid eye movement index [(106.14 ± 40.00)times / h and(53.06 ± 22.10)times / h],and the density of tonic diaphragm electromyography increases(14.98 ± 4.51).% And11.33 ± 2.41%),and the increase in the density of the temporal diaphragmatic electromyography(14.98 ± 4.51% and 9.62 ± 4.15%),the differences were statistically significant(P<0.05).There was no significant difference in TST,SE,SL,N1%,N2%,N3%,REM%,PLMI,PLMI-REM,MAI,MAI-REM,AHI-TST,AHI-REM(P>0.05).5.Compared with the healthy control group,the iRBD group,PD-RBD group,and PD-non RBD had shorter TST(328.63 ± 71.36 min,288.79 ± 54.18 min,305.03 ±62.35 min v and 377.26 ± 53.33min),and SE decreased(62.43).± 13.15%,52.21 ±10.93%,54.77 ± 10.93%,and 73.80 ± 9.48%),increased tension and time-dependent diaphragm electromyography increased density [(14.98 ± 4.51,20.79 ± 7.21,11.33 ±2.41,5.23 ± 1.99),(15.18 ± 3.60,20.38 ± 5.99,9.62 ± 4.15 and 5.93 ± 1.68)],the differences were statistically significant(P<0.05).Compared with the healthy control group,the PD-RBD group had a lower N1%(24.00 ± 7.99% and 11.70 ± 3.32%),and the difference was statistically significant(P<0.05).In the PD-non RBD group,compared with the healthy control group,the rapid eye movement index decreased[(53.06 ± 22.10)times / h and(87.19 ± 20.16)times / h],and the difference was statistically significant(P<0.05).Conclusions:1.Both iRBD and PD-related RBD patients have changes in sleep structure and sleep quality,which are manifested as decreased total sleep time,increased N1% and reduced sleep efficiency,which are more pronounced in patients with PD-related RBD.2.Compared with patients with PD-related RBD,iRBD has lower tonic and phasic chin EMG density score and higher rapid eye movement index during REM sleep time.EMG density score and rapid eye movement index are important PSG features that distinguish iRBD from PD-related RBD.