Die REM-Schlafverhaltensstörung bei neurodegenerativen Erkrankungen

Zusammenfassung

Eine REM-Schlafverhaltensstörung wird polysomnografisch durch Nachweis eines Verlustes der physiologischen Muskelatonie im REM-Schlaf mit sichtbaren REM-assoziierten motorischen Verhaltensauffälligkeiten oder entsprechenden anamnestischen Hinweisen diagnostiziert. In ihrer idiopathischen Form führt sie bei vielen Betroffenen nach im Mittel 14 Jahren zur Manifestation einer neurodegenerativen Erkrankung. Neuropathologisch lag bei 94% einer autopsierten Kohorte eine Synukleinopathie vor. In einer großen Gruppe von de novo Parkinson-Patienten konnte allerdings nur in 25% der Fälle eine REM-Schlafverhaltensstörung gemäß den derzeit gültigen Diagnosekriterien gesichert werden. Eine Korrelation zu einem spezifischen Parkinson-Phänotyp ergab sich nicht. Im Verlauf der Erkrankung nimmt die Manifestation der REM-Schlafverhaltensstörung zu: In einer großen Kohorte schlafgestörter Parkinson-Patienten unter fortlaufender dopaminerger Behandlung zeigten 46% eine REM-Schlafverhaltensstörung, die somit eine wichtige Differenzialdiagnose nächtlicher Verhaltensauffälligkeiten darstellt und wahrscheinlich den Eintritt in eine fortgeschrittenere Phase der Erkrankung signalisiert. Therapieempfehlungen umfassen derzeit Aufklärung und Modifikation der Schlafumgebung, sowie den Einsatz von Clonazepam und Melatonin.

Abstract

REM sleep behaviour disorder (RBD) is diagnosed with polysomnography that detects loss of physiological muscle atonia during REM sleep and the presence of REM-associated abnormal motor behaviours either seen on the video or reported by patients or bed partners. Idiopathic RBD carries the inherent risk of developing neurodegenerative disease after a mean of 14 years. Autopsy results showed synucleinopathy in 94% of cases. However, in a large cohort of de novo patients with Parkinson’s disease, only 25% met the diagnostic criteria of RBD without any correlation to a specific Parkinsonian phenotype at the early stage of motor manifestation. The frequency of RBD apparently increases with disease progression. Analysis of a large cohort of patients with Parkinson’s disease under dopaminergic treatment and experiencing sleep disturbances showed that 46% were affected by RBD. Thus, RBD is not only an important differential diagnosis for abnormal nocturnal behaviours in patients with Parkinson’s disease but may also indicate progression to a more advanced stage of the disease. Apart from information and modification of sleep surroundings, clonazepam and melatonin are recommended for therapy.

Schlüsselwörter

REM-Schlafverhaltensstörung - Diagnosekriterien - Pathophysiologie - neurodegenerative Erkrankungen - Therapieempfehlungen

Key words

REM sleep behaviour disorder - diagnostic criteria - pathophysiology - neurodegenerative disease - therapy

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