Impact of rapid eye movement sleep behavior disorder and autonomic disorders on Parkinson's disease: a review

ABSTRACT Parkinson's disease (PD) has heterogeneous clinical manifestations and prognoses. It is accompanied by a group of motor and non-motor symptoms ranging from independence to total disability, limiting work and personal care activities. Currently, disease subtype markers for informing prognosis remain elusive. However, some studies have reported an association between rapid eye movement (REM) sleep behavior disorder (RBD) and faster motor and non-motor symptom progression, including autonomic dysfunction and cognitive decline. Moreover, since autonomic dysfunction has been described in idiopathic forms of RBD, and they share some central regulatory pathways, it remains unclear whether they have a primary association or if they are more severe in patients with PD and RBD, and thus are a disease subtype marker. This article aimed at critically reviewing the literature on the controversies about the prevalence of RBD in PD, the higher incidence of PD non-motor symptoms associated with RBD, the evidence of faster motor worsening in parkinsonian patients with this parasomnia, and the main pathophysiological hypotheses that support these findings.

摘要 帕金森病（Parkinson's disease, PD）具有异质性的临床表现与预后，伴随一组涵盖从生活自理至完全失能的运动与非运动症状，对患者的工作及个人生活照料活动造成显著限制。当前，用于指导临床预后判断的疾病亚型标志物仍未明确。既往多项研究指出，快速眼动睡眠行为障碍（rapid eye movement sleep behavior disorder, RBD）与更快的运动及非运动症状进展存在显著关联，包括自主神经功能障碍及认知衰退。此外，鉴于特发性快速眼动睡眠行为障碍患者已被报道存在自主神经功能障碍，且二者共享部分中枢调控通路，目前仍无法明确二者是否存在原发性关联，亦或是合并RBD的PD患者症状更为严重，进而使其成为潜在的疾病亚型标志物。本文旨在批判性回顾相关文献，探讨PD患者中RBD患病率相关争议、合并RBD的PD患者非运动症状发生率更高的现象、此类睡眠异态患者帕金森症状运动恶化更快的相关证据，以及支撑上述发现的主要病理生理学假说。