Two polysomnographic features of REM sleep behavior disorder: Clinical variations insight for Parkinson's disease |
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| Institution: | 1. Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China;2. Institute of Neuroscience, Soochow University, Suzhou 215123, China;1. Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, San Raffaele Scientific Institute, 20127, Milan, Italy;2. Vita-Salute San Raffaele University, Faculty of Psychology, Milan, Italy;3. Clinical Neurology, University Hospital “Spedali Civili”, 52123, Brescia, Italy;1. Institute of Rheumatology, Prague, Czech Republic, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic;2. Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic;3. Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic;4. Department of Analytical Chemistry, Faculty of Science, Charles University, Prague, Czech Republic;5. Department of Physical and Macromolecular Chemistry, Faculty of Science, Charles University, Prague, Czech Republic;6. Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic;7. Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic;1. National Institute of Clinical Neurosciences, Budapest, Hungary;2. Institute of Behavioral Sciences, Semmelweis University, Hungary;3. Institute of Psychology, University of Debrecen, Hungary |
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| Abstract: | IntroductionLoss of REM sleep muscle atonia (RWA) and dream-enactment behavior (DEB) are two associated features of REM sleep behavior disorder (RBD), which is frequently associated with Parkinson's disease (PD). Few studies have examined both DEB and RWA simultaneously in patients with PD. This study aimed to evaluate relationships between RWA, DEB and clinical characteristics of PD.MethodsWe conducted overnight polysomnography in 145 patients with PD. DEB (motor behaviors and/or vocalizations during REM) and increased RWA (IRWA; tonic and phasic chin EMG density ≥ 30% and ≥15%, respectively) were identified. Patients were categorized as clinical RBD (DEB and IRWA), sub-DEB positive (DEB only), subclinical RBD (IRWA only), or normal REM sleep.ResultsPatients with DEB had higher Hoehn and Yahr (H&Y) stage, Unified Parkinson's Disease Rating Scale (UPDRS) III score, levodopa equivalent dose(LEDs), and worse cognition. RWA was associated with H&Y stage, LEDs, cognition, and sleep structure in all patients. PD duration was associated with RWA, but not DEB. The PD patients who exhibited clinical or subclinical RBD, compared to sub-DEB positive, had higher H&Y stage, UPDRS III score and LEDs, lower cognitive score, worse sleep structure than the PD + cREM group.ConclusionBoth DEB and RWA were associated with severity of PD illness. Subclinical RBD might have different disease progression from sub-DEB positive. DEB symptoms may fluctuate or disappear whereas RWA may continue to develop as PD progresses. Differences in the course of DEB and RWA may reflect the difference in the degeneration process of neurodegenerative disorders. |
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| Keywords: | Parkinson's disease REM sleep muscle atonia Dream-enactment behavior |
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