REM-Schlafverhaltensstörung als Frühsymptom neurodegenerativer Erkrankungen

Zusammenfassung

Die REM-Schlafverhaltensstörung (RBD) ist häufig das erste für den Betroffenen lebensbeeinträchtigende Symptom einer neurodegenerativen Erkrankung. Es konnte gezeigt werden, dass 81%–90% der Patienten mit einer RBD innerhalb von zehn Jahren eine Alpha-Synukleopathie (Morbus Parkinson, Lewy-Körperchen-Demenz, Multisystematrophie) entwickeln. Durch das Fehlen der normalerweise auftretenden Suppression der motorischen Aktivität während des REM-Schlafes, kommt es zum Ausagieren von Träumen. Die Diagnosesicherung erfolgt mittels Polysomnografie. Meist tritt die RBD zwischen dem 50. und 60. Lebensjahr erstmals auf. Männer sind wahrscheinlich häufiger betroffen als Frauen. Bei Patienten mit RBD fallen oft schon früh subtile Veränderungen wie Hyposmie, Obstipation oder Veränderungen der Motorik oder Kognition auf, die weitere Zeichen einer beginnenden neurodegenerativen Erkrankung sein können. Das gleichzeitige Auftreten der RBD bei bekannter, neurodegenerativer Erkrankung, ist häufig mit einem schwereren Verlauf verbunden. Neben Bettsicherungsmaßnahmen kommen zur medikamentösen Behandlung am häufigsten Clonazepam oder hochdosiertes Melatonin zum Einsatz. Die RBD stellt als Prodomalstadium einer neurodegenerativen Erkrankung einen zentralen Ansatzpunkt für die Entwicklung und Untersuchung einer neuroprotektiven, krankheitsmodulierenden Therapie dar.

Summary

REM-sleep behavior disorder (RBD) is often the first symptom for a neurodegenerative disorder that directly impairs a patient’s life. It has been shown that 81–90% of all patients with RBD develop an alpha synucleinopathy (Parkinson’s Disease, Dementia with Lewy Bodies, Multiple System Atrophy) within 10 years. By loosing the physiological suppression of muscle tone during REM-sleep patients act out their dreams. Polysomnography is applied to secure the diagnosis. RBD often starts between the age of 50–60 years. At the time of diagnosis patients usually show subtile signs of neurodegeneration like hyposmia, constipation or changes in motoric and cognition. The simultaneous manifestation of RBD with a neurodegenerative disorder is often associated with a severe course of disease. Recommended therapy includes a save bed surrounding, a medication with clonazepam, or melatonin. RBD is a prodromal state of neurodegenerative disorders and therefore represents the crucial starting point for the development of neuroprotective, disease modifying therapies.

Schlüsselwörter

REM-Schlaf - Neurodegneration - REM ohne Atonie

Keywords

REM-Sleep - neurodegeneration - REM without atonia

• Literatur

• 1 American Academy of Sleep Medicine. International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2014
• 2 Howell MJ, Schenck CH. Rapid eye movement sleep behavior disorder and neurodegenerative disease. JAMA Neurol 2015; 72: 707-712
• 3 Boeve BF. REM sleep behavior disorder: updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease associaton, evolving concepts, controversies, and future directions. Ann N Y Acad Sci 2010; 1184: 15-54.
• 4 Iranzo A, Valldeoriola F, Lomena F. et al. Serial dopamine transporter imaging of nigrostriatal function in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prostective study. Lancet Neurol 2011; 10 (09) 797-805.
• 5 Hanyu H, Inoue Y, Sakurai H. et al. Regional cerebral blood flow changes in patients with idiopathic REM sleep behavior disorder. Eur J Neurol 2011; 18: 784-788.
• 6 Vendette M, Gagnon JF, Sourcy JP. et al. Brain perfusion and markers of neurodegeneration in rapid eye movement sleep behavior disorder. Mov Disord 2011; 26: 1717-24.
• 7 Sasai T, Matsuura M, Inoue Y. Eletroencephalograhic findings related with mild cognitive impairment in idiopathic rapid eye movement sleep behavior disorder. Sleep 2013; 36: 1893-1899.
• 8 Gagnon JF, Vendette M, Postuma RB. et al. Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson’s disease. Ann Neurol 2009; 66: 39-47.
• 9 Postuma RB, Gagnon JF, Tuineaig M. et al. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal?. Sleep 2013; 36: 1579-1585.
• 10 Chiu HKF, Wing YK, Lam LCW. et al. Sleep related injury in the elderly- an epidemilogical study in Hong Kong. Sleep 2000; 23: 513-17.
• 11 Kang SH, Yoon I Y, Lee SD, Han JQ, Kim TH, Kim KW. REM sleep behavior disorder in Korean elderly population: prevalence and clinical characteristics. Sleep 2013; 36: 1147-52.
• 12 Nihei Y, Takahashi K, Koto A. et al. REM sleep behavior disorder in Japanese patients with Parkinson’s disease: a mulitcenter study using the REM sleep behavior disorder screening questionaire. J Neurol 2012; 259: 1606-1612.
• 13 Schenck CH, Boeve BF. The strong presence of REM sleep beahavior disorder in PD: clinical and research implications. Neurology 2011; 77: 1030-1032.
• 14 Schenck CH, Boeve BF, Mahowald NW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idipathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med 2013; 14: 744-748.
• 15 Iranzo A, Fernándes-Arcos A, Tolosa E. et al. Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients. PLoS One 2014; 9: e89741.
• 16 Videnovic A, Marlin C, Alibiglou L, Planetta PJ, Vaillancourt DE, Mackinnon CD. Increased REM sleep without atonia in Parkinson disease with freezing of gait. Neurology 2013; 81: 1030-1035.
• 17 McDade EM, Boot BP, Christianson TJ. et al. Subtle gait changes in patients with REM sleep behavior disorder. Mov Disord 2013; 28: 1847-1853.
• 18 Postuma RB, Gagnon JF, Vendette M, Desjardins C, Montplaisir JY. Olfaction and color vision identify impending neurodegeneration in rapid eye movement sleep behavior disorder. Ann Neurol 2011; 69: 811-818.
• 19 Postuma RB, Bertrand JA, Montplaisir J. et al. Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson’s disease: a prostective study. Mov Disord 2012; 27: 720-726.
• 20 Fernádez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic REM sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep 2016; 39: 121-123.
• 21 McCharter SJ, Boswell CL, St Louis EK. et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med 2013; 14: 237-242.
• 22 Kunz D, Mahlberg R. A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder. J Sleep Res 2010; 19: 591-596.
• 23 Sprenger FS, Stefanova N, Gelpi E. et al. Enteric nervous system α-synuclein immunoreactivity in idiopathic REM sleep behavior disorder. Neurology 2015; 85: 1761-68.