特发性快速眼动睡眠行为障碍患者的眼动异常分析

doi:10.3785/j.issn.1008-9292.2020.08.14

浙江大学学报（医学版）

2020, Vol. 49

Issue (4): 447-454 DOI: 10.3785/j.issn.1008-9292.2020.08.14

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特发性快速眼动睡眠行为障碍患者的眼动异常分析

杨怡^1,²(

),李斐³,潘瑜²,谢非^1,²,陈婕²,孙毅²,胡兴越^1,²,张力三^1,^2,*(

)

1. 浙江大学医学院附属邵逸夫医院神经内科, 浙江杭州 310016
2. 浙江大学医学院附属邵逸夫医院睡眠中心, 浙江杭州 310016
3. 海军军医大学附属上海长征医院神经内科, 上海 200003

Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder

YANG Yi^1,²(

),LI Fei³,PAN Yu²,XIE Fei^1,²,CHEN Jie²,SUN Yi²,HU Xingyue^1,²,ZHANG Lisan^1,^2,*(

)

1. Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
2. Sleeping Disorder Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
3. Department of Neurology, Shanghai Changzheng Hospital, Navy Military Medical University, Shanghai 200003, China

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摘要：

目的: 探讨特发性快速眼动睡眠行为障碍（iRBD）患者的眼动异常特点。方法: 纳入2017年1月至2019年5月在浙江大学医学院附属邵逸夫医院就诊的iRBD患者22例，对照组20例，收集临床资料并完成视频眼震图检查。比较iRBD组和对照组视频眼震图检查结果差异，并采用Logistic回归分析一般情况（包括年龄、性别、病程、体质指数等）及多导睡眠图各睡眠生理参数与视频眼震图异常结果的相关性。结果: iRBD组与对照组自发眼震、方波急跳、不自主眼动、凝视眼震、扫视、视动性眼震试验结果差异均无统计学意义（均P>0.05）。在0.4~0.5 Hz及0.6~0.7 Hz频率平稳跟踪时，iRBD组Ⅰ和Ⅱ型曲线比例低于对照组，Ⅲ型和Ⅳ型曲线比例高于对照组，差异有统计学意义（χ²分别为5.177和5.301，均P < 0.05）。Logistic分析结果提示，平稳跟踪0.4~0.5 Hz曲线分型异常与患者N3期睡眠减少有一定相关性（OR=0.963，P < 0.05）。Ⅲ~Ⅳ型曲线患者N3期睡眠时间明显少于Ⅰ~Ⅱ型曲线患者[分别为（52±28）min与（76±23）min，t=2.197，P < 0.05]。结论: iRBD患者平稳跟踪异常的比例明显升高，提示iRBD的发病机制可能与平稳跟踪通路异常具有一定相关性。

关键词： REM睡眠行为障碍; 视频眼震图; 眼扫视; 平稳跟踪

Abstract:

Objective: To analyze the characteristics of eye movements in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD). Methods: Twenty two patients with iRBD and 20 controls were enrolled between January 2017 and May 2019 from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Clinical data including polysomnogram (PSG) results were collected. Videonystagmography (VNG) including spontaneous nystagmus, gaze, saccade, tracking and optokinetic test were performed. The difference of VNG results between iRBD patients and controls were analyzed. The factors related to the abnormal VNG results were analyzed by using logistic regression analysis. Results: No significant differences were found between the iRBD and control groups in the spontaneous nystagmus, gaze nystagmus, square wave jerk, involuntary eye movement, saccade and optokinetic nystagmus (all P>0.05). In smooth pursuit of 0.4-0.5 Hz and 0.6-0.7 Hz, iRBD patients had more type Ⅲ-Ⅳ curve than controls (χ²=5.177 and 5.301, both P < 0.05). Logistic regression analysis indicated that less sleep time of N3 stage was related to the abnormal results in smooth pursuit of 0.4-0.5 Hz (OR=0.963, P < 0.05). iRBD patients with Ⅲ-Ⅳ type curve in smooth pursuit of 0.4-0.5 Hz had less N3 sleep time than iRBD patients with Ⅰ-Ⅱ type curve (52±28 min vs. 76±23 min, t=2.197, P < 0.05). Conclusion: Abnormal smooth pursuit was found in iRBD patients, which might be related to the pathological mechanism of iRBD.

Key words: REM sleep behavior disorder Videonystagmography Saccades Smooth pursuit

收稿日期: 2020-02-27 出版日期: 2020-09-27

R741.044

基金资助: 浙江省医药卫生科技计划(2018KY107);国家自然科学基金(81601101)

通讯作者: 张力三 E-mail: yangyi_srrsh@zju.edu.cn;zls09@zju.edu.cn

作者简介: 杨怡(1985-), 女, 博士, 主治医师, 主要从事神经内科及睡眠、眩晕疾病的研究; E-mail:yangyi_srrsh@zju.edu.cn; https://orcid.org/0000-0002-0029-9845

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引用本文:

杨怡,李斐,潘瑜,谢非,陈婕,孙毅,胡兴越,张力三. 特发性快速眼动睡眠行为障碍患者的眼动异常分析[J]. 浙江大学学报（医学版）, 2020, 49(4): 447-454.

YANG Yi,LI Fei,PAN Yu,XIE Fei,CHEN Jie,SUN Yi,HU Xingyue,ZHANG Lisan. Abnormal eye movements in patients with idiopathic rapid eye movement sleep behavior disorder. J Zhejiang Univ (Med Sci), 2020, 49(4): 447-454.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.08.14 或 http://www.zjujournals.com/med/CN/Y2020/V49/I4/447

表 1 iRBD组与对照组自发及凝视性眼震试验结果比较

表 2 iRBD组与对照组扫视试验结果比较

表 3 iRBD组与对照组平稳跟踪试验结果比较

表 4 iRBD组与对照组视动性眼震试验结果比较

组别	n	年龄(岁)	性别 (男/女，例)	病程(年)	体质指数 (kg/m²)		总睡眠时间(min)	睡眠效率(%)		AHI	最低血氧浓度(%)
“—”：无相关数据.iRBD：特发性快速眼动睡眠行为障碍; AHI：睡眠呼吸暂停低通气指数.N1~N3期为非快速眼动分期；REM期：快速眼动期.
Ⅰ~Ⅱ型曲线组	13	64±7	12/1	4±2	23±2		405±82	71±9		5.5±5.1	92±3
Ⅲ~Ⅳ型曲线组	9	69±10	8/1	4±6	24±4		382±78	69±13		9.7±6.8	89±4
P值	—	＞0.05	＞0.05	＞0.05	＞0.05		＞0.05	＞0.05		＞0.05	＞0.05
OR值	—	1.092	1.500	1.036	1.027		0.996	0.978		1.173	0.824
95%CI	—	0.992~1.201	0.121~18.540	0.877~1.225	0.834~1.265		0.987~1.006	0.915~1.046		0.973~1.414	0.645~1.052

组别	n	微觉醒次数	睡眠期潜伏期(min)					睡眠期时间(min)
组别	n	微觉醒次数	N1期	N2期	N3期	REM期		觉醒期	N1期	N2期	N3期	REM期
Ⅰ~Ⅱ型曲线组	13	67±29	30±25	36±28	79±60	93±44		89±57	41±20	215±73	76±23	73±44
Ⅲ~Ⅳ型曲线组	9	115±90	31±32	35±33	139±111	100±75		117±65	51±27	223±68	52±28	56±31
P值	—	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05		＞0.05	＞0.05	＞0.05	＜0.05	＞0.05
OR值	—	1.025	1.000	0.999	1.008	1.002		1.008	1.022	1.002	0.963	0.986
95%CI	—	0.997~1.055	0.975~ 1.026	0.975~1.024	0.999~ 1.017	0.990~1.014		0.995~ 1.021	0.985~1.060	0.991~ 1.013	0.930~0.996	0.966~ 1.007

组别	n	睡眠期比例(%)						睡眠期次数
组别	n	N1期	N2期	N3期	REM期			觉醒期	N1期	N2期	N3期	REM期
Ⅰ~Ⅱ型曲线组	13	10±4	53±10	20±8	18±9			4.9±2.6	7.2±2.8	10.2±3.6	3.6±1.5	3.7±1.9
Ⅲ~Ⅳ型曲线组	9	14±8	58±10	14±8	15±7			6.2±3.6	9.1±3.3	11.4±3.0	3.0±1.2	3.2±1.2
P值	—	＞0.05	＞0.05	＞0.05	＞0.05			＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
OR值	—	1.120	1.057	0.910	0.950			1.152	1.240	1.141	0.689	0.804
95%CI	—	0.953~1.317	0.978~ 1.142	0.823~1.006	0.863~ 1.045			0.899~1.477	0.953~ 1.612	0.898~1.450	0.383~1.240	0.490~1.319

表 5 iRBD患者在0.4~0.5 Hz频率时平稳跟踪异常的相关因素回归分析结果

组别	n	年龄(岁)	性别 (男/女，例)	病程(年)	体质指数 (kg/m²)		总睡眠时间(min)	睡眠效率(%)		AHI	最低血氧浓度(%)
“—”：无相关数据.iRBD：特发性快速眼动睡眠行为障碍; AHI：睡眠呼吸暂停低通气指数.N1~N3期为非快速眼动分期；REM期：快速眼动期.
Ⅰ~Ⅱ型曲线组	12	62±7	11/1	4±2	23±2		407±90	73±9		5.2±5.0	92±3
Ⅲ~Ⅳ型曲线组	10	68±9	9/1	4±5	24±4		386±72	68±118		8.9±6.6	90±4
P值	—	＞0.05	＞0.05	＞0.05	＞0.05		＞0.05	＞0.05		＞0.05	＞0.05
OR值	—	1.107	0.947	1.027	1.070		0.996	0.963		1.187	0.820
95%CI	—	0.994~1.234	0.076~11.870	0.860~1.226	0.848~1.351		0.987~1.006	0.897~1.033		0.953~1.478	0.627~1.072

组别	n	微觉醒次数	睡眠期潜伏期(min)					睡眠期时间(min)
组别	n	微觉醒次数	N1期	N2期	N3期	REM期		觉醒期	N1期	N2期	N3期	REM期
Ⅰ~Ⅱ型曲线组	12	62±17	33±26	39±29	76±54	95±39		38±12	214±79	77±25	78±43	38±12
Ⅲ~Ⅳ型曲线组	10	106±82	29±30	34±30	126±104	97±71		51±29	222±64	58±27	57±35	51±29
P值	—	＞0.05	＞0.05	＞0.05	＞0.05	＞0.05		＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
OR值	—	1.031	0.996	0.995	1.008	1.001		1.032	1.002	0.967	0.984	1.032
95%CI	—	0.999~1.065	0.970~1.023	0.970~1.021	0.998~1.018	0.988~1.014		0.985~1.080	0.990~1.013	0.935~1.001	0.962~1.006	0.985~1.080

组别	n	睡眠期比例(%)						睡眠期次数
组别	n	N1期	N2期	N3期	REM期			觉醒期	N1期	N2期	N3期	REM期
Ⅰ~Ⅱ型曲线组	12	10±3	52±10	20±8	18±8			4.9±2.9	7.2±2.8	10.7±3.9	3.7±1.6	4.2±1.8
Ⅲ~Ⅳ型曲线组	10	13±8	57±10	15±8	15±8			5.9±3.2	8.7±3.3	10.7±3.1	3.1±1.2	2.9±1.2
P值	—	＞0.05	＞0.05	＞0.05	＞0.05			＞0.05	＞0.05	＞0.05	＞0.05	＞0.05
OR值	—	1.146	1.058	0.922	0.939			1.135	1.210	1.030	0.678	0.563
95%CI	—	0.943~1.392	0.973~1.015	0.834~1.020	0.849~1.038			0.872~1.477	0.917~1.596	0.812~1.305	0.368~1.251	0.311~1.019

表 6 iRBD患者在0.6~0.7 Hz频率时平稳跟踪异常的睡眠相关因素回归分析结果

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