利用重复嗅觉测试改善孤立的快速眼动睡眠行为障碍患者α-突触核蛋白病的风险

IF 3.4 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2025-09-18 DOI:10.1016/j.sleep.2025.106812

Irene Dall’Antonia , Jiří Nepožitek , Jan Hlavnička , Jan Rusz , Pavla Peřinová , Simona Dostálová , David Zogala , Veronika Ibarburu Lorenzo y Losada , Ondrej Bezdicek , Tomáš Nikolai , Evžen Růžička , Karel Šonka , Petr Dušek

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引用次数: 0

摘要

目的探讨反复嗅觉测试在孤立性快速眼动睡眠行为障碍（iRBD）患者中预测显性α-突触核蛋白病表型转化的预后价值。方法我们分析了59例iRBD患者（平均年龄：66.9±7.2岁；91.5%为男性），这些患者在基线和两年随访期间接受了宾夕法尼亚大学嗅觉识别测试的嗅觉测试。患者被分为持续性低嗅觉、持续性正常嗅觉和不稳定嗅觉三组。纵向评估临床、认知和多巴胺转运体单光子发射CT （DAT-SPECT）参数。结果大多数患者的甲状腺功能保持稳定。持续低氧组（n = 37, 62.7%）表现出更高的年龄，更差的DAT-SPECT指数，以及两年内MDS-UPDRS III的显著进展。相比之下，持续正常嗅觉组（n = 11, 18.6%）没有出现明显的神经退行性改变，在~ 5年内的表型转化率为0%。20.3%的患者发生表型转化，主要发生在持续性低血症患者（9/12转换者）和不稳定嗅觉组患者（3/12转换者）中。虽然单纯基线低氧不能预测表型转化，但反复低氧显著增加了风险（p < 0.05）。结论反复嗅觉检测有助于iRBD的风险分层。持续的正常血症与较低的表型转化风险相关，而持续的低血症则预示着神经变性。连续嗅觉评估可以作为识别高风险患者和完善神经保护试验招募的经济有效的工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Refining α-synucleinopathy risk in isolated REM sleep behavior disorder patients using repeated olfactory testing

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Refining α-synucleinopathy risk in isolated REM sleep behavior disorder patients using repeated olfactory testing

Objective

This study investigated the prognostic utility of repeated olfactory testing in patients with isolated REM sleep behavior disorder (iRBD) for predicting phenoconversion to overt α-synucleinopathies.

Methods

We analyzed 59 iRBD patients (mean age: 66.9 ± 7.2 years; 91.5 % male) who underwent olfactory testing using the University of Pennsylvania Smell Identification Test at baseline and at a two-year follow-up. Patients were classified into persistent hyposmia, persistent normosmia, or unstable olfactory function groups. Clinical, cognitive, and dopamine transporter single photon emission CT (DAT-SPECT) parameters were assessed longitudinally.

Results

Olfactory function remained stable in most patients. The persistent hyposmia group (n = 37, 62.7 %) exhibited higher age, worse DAT-SPECT indices, and significant progression in MDS-UPDRS III over two years. In contrast, the persistent normosmia group (n = 11, 18.6 %) showed no significant neurodegenerative changes and had a 0 % phenoconversion rate over ∼5 years. Phenoconversion occurred in 20.3 % of patients, predominantly among those with persistent hyposmia (9/12 converters) and in patients from the unstable olfactory group (3/12 converts). While baseline hyposmia alone did not predict phenoconversion, repeated hyposmia significantly increased the risk (p < 0.05).

Conclusion

Repeated olfactory testing improves risk stratification in iRBD. Persistent normosmia is associated with a lower risk of phenoconversion, whereas persistent hyposmia predicts neurodegeneration. Serial olfactory assessments may serve as a cost-effective tool for identifying high-risk patients and refining recruitment for neuroprotective trials.

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.