RBD in Parkinson's disease: a clinical case control study from North India

Objectives

Sleep related complaints and rapid eye movement (REM) behavior disorder (RBD) are commonly reported in patients with Parkinson's disease (PD). The study aimed to compare the characteristics of patients with PD with RBD versus those without RBD.

Methods

Consecutive patients with PD were evaluated with detailed clinical history, examination and questionnaire on sleep RBD over a two year period. Clinical scores included Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr Stage (H & Y), Schwab and England (S & E) scale, Mini Mental Status Examination (MMSE), EuroQol, Parkinson's disease Sleep Scale (PDSS) and Epworth Sleep Scale (ESS). The qualitative data was analyzed using chi square/Fischer's exact test and continuous variables were analyzed using Student's t-test.

Results

The study included a total of 134 patients. RBD was present in 26 (19.4%) patients. There was increased occurrence of hallucinations in patients with RBD. None of the patients had familial PD. Patients with RBD had significantly higher prevalence of insomnia, nocturnal awakening, early morning awakenings and snoring. Most clinical events were brief and confined to vocalization or limb movements.

Conclusion

RBD may precede or follow PD onset. RBD has association with higher occurrence of hallucinations and other nocturnal problems; although most of these episodes were brief, had static course and were not associated with violent behavior.