摘要：

目的: 总结特发性快速眼动睡眠期行为障碍(iRBD)患者认知功能特点和睡眠结构，并探讨二者之间的相关性。方法: 共纳入2018年8月至2021年8月就诊于福建医科大学附属协和医院的73例iRBD患者，均进行神经心理学测验和多导睡眠图监测，采用Pearson相关分析和偏相关分析探讨认知功能与睡眠结构参数的相关性。结果: (1) 神经心理学测验：iRBD患者简易智能状态检查量表(MMSE)评分(t = - 3.703，P = 0.000)、蒙特利尔认知评价量表(MoCA)评分(t = - 4.811，P = 0.000)、词语流畅性测验(VFT)-词汇正确个数(t = - 2.171，P = 0.032)低于对照者，连线测验(TMT)-A(t = 2.500，P = 0.014)、TMT - B(t = 2.430，P = 0.016)和Stroop色词测验(SCWT)- A(t = 2.507，P = 0.013)、SCWT - B(t = 15.042，P = 0.000)、SCWT-C(t = 27.228，P = 0.000)完成时间长于对照者。(2)多导睡眠图监测：iRBD患者总睡眠时间(t = 2.699，P = 0.008)、睡眠效率(Z = - 2.103，P = 0.035)、睡眠分期转换次数(t = 3.965，P = 0.000)、非快速眼动睡眠期1期(N1期)占总睡眠时间比例(t = 2.887，P = 0.005)、睡眠期周期性肢体运动指数(PLMSI；t = - 2.917，P = 0.004)、周期性肢体运动相关微觉醒指数(Z = - 2.291，P = 0.022)、微觉醒总指数(Z = - 2.609，P = 0.009)高于对照者，入睡后清醒时间短于对照者(t = - 2.230，P = 0.027)。(3)认知功能与睡眠结构参数相关性：MoCA评分与N1期占比呈负相关(r = - 0.184，P = 0.035)，与N2期占比呈正相关(r = 0.173，P = 0.049)；SCWT-B完成时间与觉醒次数呈负相关(r = - 0.186，P = 0.033)；SCWT-C完成时间与睡眠分期转换次数(r = 0.212，P = 0.015)和N1期占比(r = 0.181，P = 0.039)呈正相关；VFT-词汇正确个数与清醒期周期性肢体运动指数(PLMWI；r = - 0.216，P = 0.018)呈负相关；中文Rey听觉-词汇学习测验(C-RAVLT)即刻回忆正确个数与快速眼动睡眠期潜伏期呈正相关(r = 0.183，P = 0.045)；C-RAVLT延迟回忆正确个数与PLMWI (r = - 0.196，P = 0.032)和PLMSI (r = - 0.180，P = 0.049)呈负相关；画钟测验评分与入睡潜伏期(r = 0.192，P = 0.035)和快速眼动睡眠期潜伏期(r = 0.199，P = 0.029)呈正相关，而与快速眼动睡眠期占比呈负相关(r = - 0.189，P = 0.038)；Beck抑郁量表评分与总睡眠时间(r = 0.347，P = 0.000)、睡眠效率(r = 0.319，P = 0.000)、快速眼动睡眠期占比(r = 0.204，P = 0.026)呈正相关，而与入睡后清醒时间(r = - 0.280，P = 0.002)、N1期占比(r = - 0.299，P = 0.001)呈负相关。结论: iRBD患者存在以注意力、执行功能、语言功能下降为主要表现的认知功能障碍，而睡眠结构紊乱可能影响此类患者的认知功能。

关键词: REM睡眠行为障碍, 多道睡眠描记术, 认知障碍, 睡眠结构, 神经心理学测验

Abstract:

Objective: To summarize the characteristics of cognitive function and sleep structure in patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) and to explore the correlation between them. Methods: Total 73 patients with iRBD who visited Fujian Medical University Union Hospital from August 2018 to August 2021 were included, all of whom underwent neuropsychological tests and polysomnography monitoring. Pearson and partial correlation analyses were used to explore correlation between cognitive function and sleep structure parameters. Results: 1) Neuropsychological tests: iRBD patients had lower Mini - Mental State Examination (MMSE; t = - 3.703, P = 0.000), Montreal Cognitive Assessment (MoCA; t = - 4.811, P = 0.000), Verbal Fluency Test (VFT)-number of correct words (t = - 2.171, P = 0.032) than control group. Trail Making Test (TMT) - A (t = 2.500, P = 0.014), TMT -B (t = 2.430, P = 0.016) and Stroop Color Word Test (SCWT)-A (t = 2.507, P = 0.013), SCWT-B (t = 15.042, P = 0.000), SCWT- C (t = 27.228, P = 0.000) completion times were longer than control group. 2) Polysomnography monitoring: total sleep time (t = 2.699, P = 0.008), sleep efficiency (Z = - 2.103, P = 0.035), number of sleep stage transitions (t = 3.965, P = 0.000), proportion of non - rapid eye movement sleep stage 1 (N1 stage) to total sleep time (t = 2.887, P = 0.005), periodic limb movement of sleep index (PLMSI; t = - 2.917, P = 0.004), periodic limb movement-related arousal index (Z = - 2.291, P = 0.022), and total arousal index (Z = - 2.609, P = 0.009) were higher than those in control group, and the time of wakefulness after sleep was less than those in control group (t = - 2.230, P = 0.027). 3) Correlation between cognitive function and sleep structure parameters: MoCA score was negatively correlated with the percentage of N1 stage (r = - 0.184, P = 0.035), and positively correlated with the percentage of N2 stage (r = 0.173, P = 0.049); SCWT-B completion time was negatively correlated with the number of awakenings (r = - 0.186, P = 0.033); SCWT-C completion time was positively correlated with the number of sleep phase transitions (r = 0.212, P = 0.015) and the percentage of N1 stage (r = 0.181, P = 0.039); VFT-number of correct words was negatively correlated with the periodic limb movement of wake index (PLMWI; r = - 0.216, P = 0.018); the number of correct China-Rey Auditory Verbal Learning Test (C - RAVLT) immediate recall was positively correlated with the rapid eye movement (REM) sleep latency (r = 0.183, P = 0.045); the number of correct C - RAVLT delay recall was negatively correlated with the PLMWI (r = - 0.196, P = 0.032) and PLMSI (r = - 0.180, P = 0.049); the Clock Drawing Test was positively correlated with sleep latency (r = 0.192, P = 0.035) and REM sleep latency (r = 0.199, P = 0.029), and negatively correlated with the percentage of REM sleep (r = - 0.189, P = 0.038). The Beck Depression Inventory (BDI) score was positively correlated with total sleep time (r = 0.347, P = 0.000), sleep efficiency (r = 0.319, P = 0.000) and the percentage of REM sleep (r = 0.204, P = 0.026), and negatively correlated with the time of wakefulness after sleep (r = - 0.280, P = 0.002) and the percentage of N1 stage (r = - 0.299, P = 0.001). Conclusions: Patients with iRBD have cognitive dysfunction mainly manifested by decreased attention, executive function and language function, and sleep structural disorders may affect the cognitive function of such patients.

Key words: REM sleep behavior disorder, Polysomnography, Cognition disorders, Sleep structure, Neuropsychological tests