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1.
Neuroepidemiology ; 58(4): 256-263, 2024.
Article in English | MEDLINE | ID: mdl-38325344

ABSTRACT

OBJECTIVE: To examine the associations of excessive daytime sleepiness (EDS) and probable rapid eye movement sleep behavior disorder (pRBD), respectively, with impulsive-compulsive behaviors (ICBs) over a 5-year follow-up in patients with early Parkinson's disease (PD). METHODS: The Parkinson's Progression Markers Initiative is a multicenter cohort study based on an ongoing and open-ended registry. Longitudinal associations of sleep disorders with ICB over 5-year follow-up visits were estimated using generalized linear mixed-effects models among PD participants. RESULTS: A total of 825 PD participants were enrolled at baseline. The study sample had a median baseline age of 63.1 (interquartile range: 55.6-69.3) years and comprised 496 (61.5%) men. Among them, 201 (24.9%) had ICB at baseline. In the generalized mixed-effects models, EDS (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.05, 1.12) and RBD (OR = 1.07, 95% CI 1.03, 1.12) were substantially associated with higher odds of developing ICB over time in PD patients, after multivariate adjustment including age, gender, family history, GDS score, STAI-Y score, MDS-UPDRS part III score, LEDD, and disease duration. Consistent results were observed when stratifying by age at baseline, gender, and PD family history. CONCLUSIONS: The study findings suggest a longitudinal association between EDS and pRBD with an increased risk of developing ICB in patients with PD. The findings emphasize the significance of evaluating and addressing sleep disorders in PD patients as a potential approach to managing ICB.


Subject(s)
Parkinson Disease , Humans , Male , Female , Parkinson Disease/epidemiology , Parkinson Disease/complications , Parkinson Disease/psychology , Middle Aged , Aged , Prospective Studies , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/complications , Sleep Wake Disorders/epidemiology , Compulsive Behavior/epidemiology , Impulsive Behavior , Disorders of Excessive Somnolence/epidemiology , Cohort Studies
2.
J Sleep Res ; 32(1): e13613, 2023 02.
Article in English | MEDLINE | ID: mdl-35474255

ABSTRACT

There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.


Subject(s)
COVID-19 , REM Sleep Behavior Disorder , Adult , Humans , Male , Female , Adolescent , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/complications , Pandemics , COVID-19 Testing , COVID-19/epidemiology , Dreams
3.
Ann Neurol ; 89(2): 293-303, 2021 02.
Article in English | MEDLINE | ID: mdl-33155696

ABSTRACT

OBJECTIVE: The aim was to analyze the timeline, prevalence, and survival of rapid eye movement (REM) sleep behavior disorder (RBD) in patients who developed alpha-synucleinopathies (Parkinson disease, dementia with Lewy bodies, and Parkinson disease dementia) compared with age- and sex-matched controls in a population-based incident-cohort study. METHODS: We used a population-based, 1991 to 2010 incident-cohort study of alpha-synucleinopathies. A movement-disorder specialist reviewed medical records to confirm diagnoses. RBD was diagnosed by reported dream-enactment symptoms or polysomnography. Probable RBD and polysomnographically confirmed RBD were analyzed separately and combined. RESULTS: Among the 444 incident cases of alpha-synucleinopathy, 86 were clinically diagnosed with RBD (19.8%), including 30 (35%) by polysomnography and 56 (65%) as probable. The prevalence of idiopathic RBD at alpha-synucleinopathy diagnosis was 3.4%, increasing to 23.8% after 15 years. Cumulative lifetime incidence was 53 times greater in alpha-synucleinopathy patients than in controls (odds ratio [OR] = 53.1, 95% confidence interval [CI]: 13.0-217.2, p < 0.0001), higher in dementia with Lewy bodies than in Parkinson disease (OR = 2.57, 95% CI: 1.50-4.40, p = 0.0004), and higher in men than in women with Parkinson disease, dementia with Lewy bodies, or Parkinson disease dementia (OR = 3.70, 95% CI: 2.07-6.62, p < 0.0001), but did not increase mortality risk. INTERPRETATION: Our cohort had RBD incidence of 3.4%. Overall RBD increased to 23.8% after 15 years, with an overall incidence of 2.5 cases per 100 person-years. With 53 times greater lifetime incidence in alpha-synucleinopathy patients than in controls, RBD was more likely to develop in dementia with Lewy bodies than in Parkinson disease or Parkinson disease dementia, and in men than in women, but did not increase mortality risk within our cohort. ANN NEUROL 2021;89:293-303.


Subject(s)
REM Sleep Behavior Disorder/epidemiology , Synucleinopathies/epidemiology , Aged , Aged, 80 and over , Case-Control Studies , Disease Progression , Female , Humans , Incidence , Lewy Body Disease/epidemiology , Lewy Body Disease/physiopathology , Male , Mortality , Parkinson Disease/epidemiology , Parkinson Disease/physiopathology , Polysomnography , Prevalence , REM Sleep Behavior Disorder/physiopathology , Sex Distribution , Synucleinopathies/physiopathology
4.
Acta Neurol Scand ; 145(3): 348-359, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34816426

ABSTRACT

OBJECTIVES: Minor hallucinations (MH) are psychotic symptoms that can occur anywhere between prodromal to early Parkinson's disease and after onset of motor problems. MH include visual illusions, presence hallucinations, and passage hallucinations. Isolated rapid eye movement sleep behavior disorder (RBD) is a harbinger of neurodegenerative diseases. We conducted a retrospective cohort study to investigate the clinical characteristics of isolated RBD with MH and the risk of phenoconversion. MATERIALS AND METHODS: We retrospectively analyzed the data of 36 patients with isolated RBD (four females; median age, 75.0 years). We defined cases reporting at least one minor hallucination as RBD with MH. Demographic data and cognitive function were compared between patients with and without MH, and Cox proportional hazards models estimated the risk of phenoconversion. RESULTS: We included 10 (27.8%) patients with MH and 26 (72.2%) without MH. Patients with MH were older, had less dopamine transporter accumulation, more severe autonomic dysfunction, more depressive symptoms, and lower verbal fluency and symbol coding test scores than patients without MH. After follow-up (median, 2.50 years), 13.9% (5/36) of all patients developed phenoconversion (Parkinson's disease, two patients; dementia with Lewy bodies, three patients). The rate of phenoconversion was significantly higher in patients with MH (40.0% vs. 3.8%, p = .005). The Cox proportional hazards model adjusted for age, sex, and disease duration revealed that MH was a significant risk factor for phenoconversion (hazard ratio, 14.72; 95% confidence interval, 1.35-160.5). CONCLUSIONS: Minor hallucinations may be utilized as early clinical markers for prodromal estimation of neurodegenerative diseases.


Subject(s)
Parkinson Disease , REM Sleep Behavior Disorder , Aged , Female , Hallucinations/epidemiology , Humans , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Retrospective Studies , Risk Factors
5.
Neurol Sci ; 43(12): 6919-6928, 2022 Dec.
Article in English | MEDLINE | ID: mdl-36087148

ABSTRACT

Most patients with idiopathic REM sleep behavior disorder (iRBD) will develop an overt α-synucleinopathy over time, with a rate of phenoconversion of 73.5% after 12 years from diagnosis. Several markers of phenoconversion were identified; however, most studies investigated biomarkers separately, with retrospective study designs, in small cohorts or without standardized data collection methods. The risk FActoRs PREdictive of phenoconversion in idiopathic REM sleep behavior disorder: the Italian STudy (FARPRESTO) is a multicentric longitudinal retrospective and prospective study with a cohort of incident (prospective recruitment) and prevalent (retrospective recruitment) iRBD patients, whose primary aim is to stratify the risk of phenoconversion, through the systematic collection by means of electronic case report forms of different biomarkers. Secondary aims are to (1) describe the sociodemographic and clinical characteristics of patients with iRBD; (2) collect longitudinal data about the development of α-synucleinopathies; (3) monitor the impact of iRBD on quality of life and sleep quality; (4) assess the correlation between phenoconversion, cognitive performance, and loss of normal muscle atony during REM sleep; (5) identify RBD phenotypes through evaluating clinical, biological, neurophysiological, neuropsychological, and imaging biomarkers; and (6) validate vPSG criteria for RBD diagnosis. The FARPRESTO study will collect a large and harmonized dataset, assessing the role of different biomarkers providing a unique opportunity for a holistic, multidimensional, and personalized approach to iRBD, with several possible application and impact at different levels, from basic to clinical research, and from prevention to management. The FARPRESTO has been registered at clinicaltrials.gov (NCT05262543).


Subject(s)
Parkinson Disease , REM Sleep Behavior Disorder , Synucleinopathies , Humans , Biomarkers , Parkinson Disease/diagnosis , Prospective Studies , Quality of Life , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Retrospective Studies , Risk Factors
6.
Aging Clin Exp Res ; 34(1): 159-166, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34021898

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the association between clinically possible rapid eye movement (REM) sleep behavioral disorder (pRBD) and orthostatic hypotension (OH) in PD patients, as well as to explore the mechanisms underlying the association. METHODS: PD patients (n = 116) were assigned to a group with OH (PD-OH) or without OH (PD-NOH). General demographic and clinical data were collected. A series of scales were used to assess the clinical symptoms in the two groups. RESULTS: A total of 27 patients (23.3%) had OH. The PD-OH group showed significantly higher H-Y staging score and significantly higher frequencies of pRBD, anxiety, depression, and cognitive impairment than the PD-NOH group. Binary logistic regression analysis identified the following factors as independently associated with PD-OH: H-Y staging [odds ratio (OR) 2.565, 95% confidence interval (CI) 1.160-5.673; P = 0.020], RBD (OR 7.680, 95% CI 1.944-30.346; P = 0.004), UPDRS II (OR 1.021, 95% CI 0.980-1.063; P = 0.020), depression (OR 7.601, 95% CI 1.492-38.718; P = 0.015), and cognitive impairment (OR 0.824, 95% CI 0.696-0.976; P = 0.025). CONCLUSIONS: Our results suggest that pRBD is an independent risk factor for OH in patients with PD. We speculate that there may be a close relationship between RBD and OH, which requires attention. Early diagnosis of RBD may help predict the appearance of OH in PD patients.


Subject(s)
Hypotension, Orthostatic , Parkinson Disease , REM Sleep Behavior Disorder , Humans , Hypotension, Orthostatic/complications , Hypotension, Orthostatic/epidemiology , Parkinson Disease/complications , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/epidemiology , Risk Factors , Sleep, REM
7.
Ann Neurol ; 88(4): 759-770, 2020 10.
Article in English | MEDLINE | ID: mdl-32468593

ABSTRACT

OBJECTIVE: To assess the association between rapid eye movement sleep behavior disorder (RBD) and other determinants and incident impulse control disorder behaviors (ICBs) in patients with early Parkinson disease (PD) using longitudinal data from the Parkinson's Progression Markers Initiative. METHODS: Four hundred one newly diagnosed PD patients were prospectively evaluated at baseline (BL), month 6, and annually for 5 years. Probable RBD (pRBD) was assessed with the RBD Screening Questionnaire (RBDSQ) and dichotomized using a cutoff value of ≥6. The association of BL and time-dependent (TD) pRBD and other covariates with the development of ICB symptoms was evaluated using Cox proportional hazards regression and general estimating equation logistic regression. Models considered adjustment for age, sex, Movement Disorders Society Unified Parkinson's Disease Rating Scale part III, Geriatric Depression Scale (GDS-15), RBD medication use, total levodopa equivalent daily dose, and dopamine agonist (DA) and antidepressant medication use. RESULTS: Both BL pRBD and TD pRBD were not associated with an increased risk for incident ICB symptoms after adjustment for covariates (adjusted hazard ratio [HR] = 1.17, p = 0.458 and HR = 1.27, p = 0.257, respectively). In a modified TD pRBD model (ie, considering subjects as pRBD onward from the first time point with RBDSQ score ≥ 6), the risk for incident ICB symptoms was higher in pRBD in unadjusted (HR = 1.48, p = 0.038) but not adjusted (HR = 1.29, p = 0.203) models. TD DA use (HR = 1.64, p = 0.039), TD GDS-15 score (HR = 1.12, p < 0.001), and male sex (year 3: HR = 2.10, p = 0.009; year 4: HR = 3.04, p = 0.006; year 5: HR = 4.40, p = 0.007) were associated with increased ICB symptom risk. INTERPRETATION: pRBD is not clearly associated with ICB symptom development in early PD, in contrast to DA use, depression, and male sex. ANN NEUROL 2020;88:759-770.


Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Parkinson Disease/complications , REM Sleep Behavior Disorder/epidemiology , Aged , Disruptive, Impulse Control, and Conduct Disorders/etiology , Female , Humans , Incidence , Male , Middle Aged , REM Sleep Behavior Disorder/etiology , Risk Factors
8.
J Neurol Neurosurg Psychiatry ; 92(3): 271-281, 2021 03.
Article in English | MEDLINE | ID: mdl-33436502

ABSTRACT

Olfactory impairment and rapid eye movement sleep behaviour disorder (RBD) are prodromal symptoms of Parkinson's disease (PD) that may be associated with each other. This review aims to investigate the significance of olfaction in the diagnosis and prognosis of patients with RBD and to assess moderating factors affecting olfactory performance. We searched articles on olfaction in RBD and PD in five electronic databases. We identified 32 studies for the systematic review and used 28 of those, including 2858 participants for meta-analysis. Results revealed significant deficits in odour identification (g=-1.80; 95% CI: -2.17 to -1.43), threshold (g=-1.29; 95% CI: -1.67 to -0.91), discrimination (g=-1.08; 95% CI: -1.28 to -0.87) and overall olfactory function (g=-1.64; 95% CI: -1.94 to -1.35) in patients with RBD. Except for the Unified Parkinson's Disease Rating Scale Part III scores, none of the known moderating variables (including age, sex, disease duration and years of education) accounted for the olfactory function heterogeneity in patients with RBD. We identified similar olfactory impairments in patients with RBD and patients with PD (either with or without underlying RBD). These findings suggest that olfactory impairment may be a sensitive and stable diagnostic biomarker of RBD and appears to be useful for identifying patients with idiopathic RBD at high risk for early conversion to PD.


Subject(s)
Olfaction Disorders/epidemiology , Parkinson Disease/complications , Parkinson Disease/diagnosis , REM Sleep Behavior Disorder/epidemiology , Humans , Olfaction Disorders/diagnosis , REM Sleep Behavior Disorder/diagnosis
9.
Neuroepidemiology ; 55(2): 141-153, 2021.
Article in English | MEDLINE | ID: mdl-33780948

ABSTRACT

INTRODUCTION: The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. METHODS: All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson's disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer's, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. RESULTS: In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. CONCLUSIONS: A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.


Subject(s)
Multiple System Atrophy , Parkinson Disease , REM Sleep Behavior Disorder , Humans , Morbidity , REM Sleep Behavior Disorder/epidemiology , Sleep, REM
10.
J Neural Transm (Vienna) ; 128(2): 191-198, 2021 02.
Article in English | MEDLINE | ID: mdl-33502592

ABSTRACT

Detection of REM sleep behavior disorder (RBD) with polysomnography (PSG) is relevant for the diagnosis of α-synucleinopathies. However, some patients referred for suspicion of RBD do not present REM sleep at PSG (NoREMSusRBD), rendering the study inconclusive. Our objective was to investigate disorders possibility associated with REM sleep absence in patients referred to PSG for investigation of RBD, in particular α-synucleinopathies. A sleep-lab database was revised to select NoREMSusRBD (n = 15) and patients: with no REM sleep referred for suspicion of other sleep disorder (NoREMSusOther, n = 28); referred for RBD suspicion with negative PSG (NegativeRBD, n = 24); α-synucleinopathies with no REM sleep (NoREMα, n = 23) and idiopathic RBD (iRBD, n = 26). NoREMSusRBD patients were compared with the other groups regarding PSG data and the emergence of prodromal features or established criteria for α-synucleinopathy. Severe Obstructive Sleep Apnea (OSA) was significantly more frequent in the NoREMsusRBD compared to the NoREMα and iRBD groups. No patient in the NoREMSusRBD developed a α-synucleinopathy (2 cases on the iRBD group). The prevalence of prodromal features in NoREMSusRBD (n = 7, 46.7%) was similar to that of iRBD (n = 18, 69.2%) and significantly higher than in the other groups. Apnea-Hypopnea Indices (AHI) were significantly higher in the NoREMSusRBD compared with iRBD and NoREMα. Our study suggests that the absence of REM sleep in NoREMSusRBD could be caused by OSA but does not exclude the possibility of underlying α- synucleinopathy, suggested by an increased prevalence of prodromal features. These data support the need for excluding OSA in patients suspected for RBD and recommends follow-up of NoREMSusRBD patients to uncover a possible α- synucleinopathy.


Subject(s)
REM Sleep Behavior Disorder , Sleep Apnea, Obstructive , Sleep Wake Disorders , Humans , Polysomnography , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Sleep, REM
11.
J Geriatr Psychiatry Neurol ; 34(2): 142-149, 2021 03.
Article in English | MEDLINE | ID: mdl-32233817

ABSTRACT

Previous studies have shown the therapeutic effects of clonazepam for rapid eye movement sleep behavior disorder (RBD), but they had several limitations such as the lack of clear definition of treatment outcomes and little information about adjuvant therapy. The aims of this study were to evaluate the treatment outcomes with clonazepam and to explore possible determinants of treatment response. We performed a retrospective medical chart review of 171 patients with RBD. All the participants underwent overnight polysomnography and completed questionnaires. The positive treatment response was defined as the absence of disruptive behaviors causing sleep-related injuries during the last year of follow-up. Among the 171 patients presented with disruptive behaviors, 155 (90.6%) experienced positive treatment responses. Of the responders, 18 (11.6%) received adjunctive medication due to insufficient therapeutic effect of clonazepam monotherapy. After adjusted analysis, an earlier age of diagnosis (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.64-0.86, P < .001) and comorbid periodic limb movement during sleep (OR = 4.96, 95% CI = 1.05-23.33, P = .043) were related to poor treatment response. Clinicians should recognize the predictors of poor treatment response and consider combination therapy for better prevention of sleep-related injuries in those who show unsatisfactory responses to clonazepam monotherapy.


Subject(s)
REM Sleep Behavior Disorder , Clonazepam/therapeutic use , GABA Modulators/therapeutic use , Humans , Polysomnography , REM Sleep Behavior Disorder/drug therapy , REM Sleep Behavior Disorder/epidemiology , Retrospective Studies
12.
Curr Neurol Neurosci Rep ; 21(5): 23, 2021 03 22.
Article in English | MEDLINE | ID: mdl-33754217

ABSTRACT

PURPOSE OF THE REVIEW: Patients diagnosed with essential tremor (ET) report frequent sleep complaints. This review focuses on the main findings of studies addressing sleep features in patients diagnosed with ET, updating previously reported information. Bad quality of sleep and excessive daytime somnolence are very frequent in patients with ET, although the effects of the drugs used for the therapy of ET could contribute to these complaints. REM sleep behavior disorder, restless legs, insomnia, and nocturia are frequent complaints as well. There is a lack of studies addressing polysomnographic features of ET.


Subject(s)
Disorders of Excessive Somnolence , Essential Tremor , REM Sleep Behavior Disorder , Restless Legs Syndrome , Sleep Wake Disorders , Essential Tremor/complications , Essential Tremor/epidemiology , Humans , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/etiology , Restless Legs Syndrome/complications , Restless Legs Syndrome/drug therapy , Restless Legs Syndrome/epidemiology , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/etiology
13.
Neurol Sci ; 42(3): 961-968, 2021 Mar.
Article in English | MEDLINE | ID: mdl-32676757

ABSTRACT

OBJECTIVE: Impaired rapid eye movement sleep is common among patients with Parkinson's disease (PD). However, information on rapid eye movement density (REM) among PD patients is currently lacking. The current study sought to characterize REM density in PD patients and to examine the associations between REM density sleep parameters and clinical manifestations. PARTICIPANTS AND METHODS: We retrospectively recruited 172 PD patients. All participants were assessed with a two-night polysomnography, and REM density was calculated. Clinical assessments were completed in PD patients before polysomnography. RESULTS: Rapid eye movement sleep behavior disorder (RBD) was observed in 93 patients (54.1%). The disease duration, UPDRS part III score, Hoehn and Yahr (H-Y) stage, and HAMA, HAMD, PDQ-39 scores, and REM density in the Parkinson's disease patients with rapid eye movement sleep behavior disorder (RBD) were significantly higher than in the patients without RBD (P < 0.05). However, NREM sleep stage 3 time (N3 time) and percentage of N3 time of total sleep time (N3%) were significantly lower in the RBD patients than in the patients without RBD (P < 0.05). The forward binary logistic regression model showed that REM density, UPDRS-III score, and N3 sleep time were associated with RBD in the PD patients. CONCLUSIONS: Our results confirm the high prevalence of RBD in patients with PD. Increased REM density was the main risk factor of RBD.


Subject(s)
Parkinson Disease , REM Sleep Behavior Disorder , China , Humans , Parkinson Disease/complications , Parkinson Disease/epidemiology , REM Sleep Behavior Disorder/epidemiology , Retrospective Studies , Sleep, REM
14.
Neurol Sci ; 42(1): 47-60, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33025325

ABSTRACT

OBJECTIVE: Parkinson's disease (PD) is usually accompanied by rapid eye movement sleep behavior disorder (RBD). A systematic review has concluded that motor manifestations are associated with RBD in PD patients, but whether the same is true of non-motor symptoms is unclear. METHODS: A systematic review and meta-analysis was conducted by searching studies related to PD and RBD in PubMed, Web of Science, Embase, and Cochrane databases. Data were pooled where appropriate and used to calculate odds ratios (ORs), mean differences (MDs), or standardized mean differences (SMDs) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. RESULTS: PD patients with RBD were more likely to be male (OR 1.26, 95% CI 1.14-1.40) and older (MD 1.70 years, 95% CI 1.24-2.16) than those of patients without RBD. Patients with RBD were at a higher risk of non-motor symptoms such as constipation (OR 1.94, 95% CI 1.57-2.38), hallucination (OR 2.62, 95% CI 2.01-3.41), depression (SMD 0.39, 95% CI 0.25-0.53), and cognitive impairment (SMD - 0.29, 95% CI - 0.42 to - 0.17) based on standardized questionnaire scores. Similarly, PD patients with RBD suffered more severe motor symptoms and required higher doses of levodopa therapy. CONCLUSIONS: The available evidence suggests that PD patients with RBD suffer severer non-motor and motor symptoms than those without RBD. A potential explanation is that PD patients with RBD present more diffuse neurodegeneration.


Subject(s)
Parkinson Disease , REM Sleep Behavior Disorder , Female , Humans , Male , Parkinson Disease/complications , Parkinson Disease/drug therapy , Parkinson Disease/epidemiology , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/epidemiology , Surveys and Questionnaires
15.
Eur Neurol ; 84(5): 368-374, 2021.
Article in English | MEDLINE | ID: mdl-34134116

ABSTRACT

OBJECTIVES: Studies documenting the association between rapid eye movement sleep behavior disorder (RBD) and subtypes of multiple system atrophy (MSA) are rare. In this study, we investigated the presence of clinical RBD in MSA patients and compared the prevalence and severity of RBD in patients with MSA-P and MSA-C subtypes. METHODS: We evaluated 54 consecutive patients presenting with MSA and hospitalized in the neurology ward of Beijing Hospital from February 2012 to June 2020. The healthy control (HC) group consisted of 100 healthy individuals who came to our hospital for physical examination. The clinical diagnosis of RBD was based on the minimal diagnostic criteria of International Classification of Sleep Disorders, revised. The severity of clinical RBD was rated on a digital scale from 0 to 3. The patients were divided into 2 subgroups: MSA-P and MSA-C. The MSA and HC groups were compared in terms of frequency of clinical RBD. The MSA-P and MSA-C subgroups were compared with each other for age, sex, onset age, disease duration, and features of clinical RBD. The correlation between severity of clinical RBD and clinical characteristics of MSA was analyzed in the patient groups. RESULTS: The frequency of clinical RBD in MSA and HC groups was 70.4% (38/54) and 5% (5/100), respectively. The difference between 2 groups was significant (χ2 = 74.453, p = 0.000). Among the patients, 57.4% (31/54) had the MSA-P subtype. There were no significant differences between MSA-P and MSA-C subtypes in the prevalence (χ2 = 1.734, p = 0.188) and severity (χ2 = 1.776, p = 0.412) of clinical RBD. The onset of clinical RBD during the premotor period was not different between the subtypes of MSA, either in patients' number of preceding the onset of motor symptoms (χ2 = 0.581, p = 0.446) or the preceding time (Z = -0.550, p = 0.582). For the MSA-C patients, there was a negative correlation between the score of severity of the RBD scale and RBD preceding motor symptoms (r = -0.482, p = 0.020). CONCLUSION: In our study, the prevalence of clinical RBD is unrelated to the subtypes of MSA. The onset of clinical RBD during the premotor period was not different between subtypes of MSA. However, we found that the severity of RBD occurring before the motor symptoms was more than that occurring after the motor symptoms in MSA-C patients. Our results showed that MSA-P and MSA-C patients may have a probable indicator for the similar pathologic mechanism of the disease and its sleep problems.


Subject(s)
Multiple System Atrophy , REM Sleep Behavior Disorder , Humans , Multiple System Atrophy/complications , Multiple System Atrophy/epidemiology , Prevalence , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Surveys and Questionnaires
16.
BMC Geriatr ; 21(1): 606, 2021 10 27.
Article in English | MEDLINE | ID: mdl-34702166

ABSTRACT

BACKGROUND: The objective was to investigate the individual effect and potential interactions of probable rapid eye movement sleep behavior disorder (pRBD) and sleep insufficiency on fall risk among a Chinese elderly population. METHODS: Community-dwelling population aged 55 years or above were recruited from the Beijing Longitudinal Study on Aging II cohort from 2010 to 2011. Odds ratio (ORs) and 95% confidence intervals (CIs) were estimated using multivariate logistic regression models. Multiplicative and additive interactions between pRBD and sleep insufficiency were examined using likelihood ratio tests and relative excess risk due to interaction (RERI), respectively. RESULTS: Among 6891 included participants, 479 experienced at least once fall. pRBD and sleep insufficiency were both independently associated with elevated fall risk. Compared to the elderly without pRBD or sleep insufficiency, pRBD and sleep insufficiency was each associated with a 2.57-fold (OR = 2.57, 95%CI: 1.46-4.31) and 1.45-fold (OR = 1.45, 95%CI: 1.11-1.88) risk of falls individually, while their coexistence was associated with a less-than-additive 17% (OR = 1.17, 95%CI: 0.43-2.63) increased risk of falls. The combination of these two factors demonstrated evidence of a negative interaction on both multiplicative (ratio of ORs = 0.31, 95%CI: 0.10, 0.86) and additive (RERI = - 1.85, 95%CI: - 3.61, - 0.09) scale. CONCLUSIONS: Our study has provided robust evidence for the adverse effect of pRBD and sleep insufficiency, as well as their negative interaction on increasing fall risk in a Chinese elderly population.


Subject(s)
REM Sleep Behavior Disorder , Aged , Humans , Independent Living , Longitudinal Studies , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Risk , Sleep Deprivation
17.
Ann Neurol ; 85(4): 582-592, 2019 04.
Article in English | MEDLINE | ID: mdl-30761606

ABSTRACT

OBJECTIVE: To determine the familial aggregation of idiopathic rapid eye movement sleep behavior disorder (iRBD), neurodegenerative diseases, and related biomarkers. METHODS: A total of 404 and 387 first-degree relatives of 102 patients with iRBD and of 89 controls were recruited, respectively. Among them, 204 and 208 relatives of patients and controls underwent face-to-face clinical assessment, whereas 97 and 75 relatives underwent further video-polysomnographic assessment, respectively. RESULTS: Compared with relatives of controls, relatives of patients demonstrated higher levels of RBD features, including chin tonic electromyography activity (mean = 1.5 ± 7.5 vs 0.3 ± 1.0, p = 0.04) and behavioral events (n [weighted %] = 12 [11.3] vs 2 [1.9], adjusted hazard ratio [aHR] = 7.69, 95% confidence interval [CI] = 1.54-33.33, p = 0.009) during rapid eye movement sleep, probable diagnosis (n [%] = 57 [14.9] vs 20 [4.9], aHR = 3.45, 95% CI = 1.96-6.25, p < 0.001), and definite diagnosis (n [weighted %] = 10 [8.4] vs 2 [1.4], aHR = 5.56, 95% CI = 1.16-25.00, p = 0.03). They also had higher risks of Parkinson disease (3.1% vs 0.5%, aHR = 5.88, 95% CI = 1.37-25.00, p = 0.02), dementia (6.9% vs 2.6%, aHR = 2.44, 95% CI = 1.15-5.26, p = 0.02), constipation (8.3% vs 2.4%, adjusted odds ratio = 4.21, 95% CI = 1.34-13.17, p = 0.01), and motor dysfunction (Movement Disorders Society Unified Parkinson's Disease Rating Scale part III motor score, mean = 1.9 ± 3.2 vs 0.9 ± 2.3, p = 0.002). The unaffected relatives of patients demonstrated a higher likelihood ratio of prodromal Parkinson disease (median [interquartile range] = 0.27 [1.19] vs 0.22 [0.51], p = 0.03). INTERPRETATION: iRBD is familially aggregated from isolated features to full-blown sleep disorder. Relatives of patients carry a higher risk of alpha-synucleinopathy in terms of neurodegenerative diseases and prodromal markers, suggesting a familial aggregation and staging pathology of alpha-synucleinopathy. Ann Neurol 2019;85:582-592.


Subject(s)
Neurodegenerative Diseases/epidemiology , Neurodegenerative Diseases/genetics , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/genetics , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cohort Studies , Female , Hong Kong/epidemiology , Humans , Male , Middle Aged , Neurodegenerative Diseases/diagnosis , REM Sleep Behavior Disorder/diagnosis
18.
Mov Disord ; 35(11): 2077-2085, 2020 11.
Article in English | MEDLINE | ID: mdl-32744735

ABSTRACT

BACKGROUND: The risk of neurodegenerative disorders in idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with residual injurious symptoms (RIS) after symptomatic treatment with clonazepam and/or melatonin is unclear. OBJECTIVE: The objective of this study was to determine the rate and correlates of RIS and its association with the risk of neurodegenerative diseases in patients with iRBD. METHODS: This was a retrospective cohort study. RIS was defined by the RBD Questionnaire-Hong Kong (RBDQ-HK) as the presence of residual sleep-related injuries or potential injurious behaviors for at least once a month after at least 1 year of treatment. RESULTS: A total of 15 out of 133 (11.3%) patients with iRBD (age at diagnosis = 66.5 ± 7.3 years, 77.4% male) had RIS after 2.7 years of treatment. Patients with RIS were younger at both onset and polysomnography-confirmed diagnosis of iRBD (years, mean ± standard deviation, 56.3 ± 6.9 vs. 61.8 ± 7.6, P = 0.01; 61.2 ± 4.2 vs. 67.2 ± 7.4, P < 0.001, respectively), had more severe behavioral symptoms at diagnosis (both RBDQ-HK total score and behavioral subscore, P = 0.01), and used a higher maximum dose of clonazepam (mg; median [interquartile range], 1.5 [1.0] vs. 1.0 [1.0], P = 0.01). RIS was probably associated with a higher risk of developing dementia with Lewy bodies (adjusted hazard ratio [95% confidence interval], 5.47 [1.71-17.46], adjusted for onset age of RBD), but not Parkinsons's disease in the follow-up. CONCLUSION: RIS is not uncommon in patients with iRBD despite long-term medication treatment. An earlier onset and more severe clinical profile are associated with RIS. The prediction of RIS toward dementia with Lewy bodies but not PD suggests that RIS may probably help to identify the specific risk of different subtypes of α-synucleinopathy. © 2020 International Parkinson and Movement Disorder Society.


Subject(s)
REM Sleep Behavior Disorder , Clonazepam/therapeutic use , Female , Follow-Up Studies , Humans , Male , Polysomnography , REM Sleep Behavior Disorder/epidemiology , REM Sleep Behavior Disorder/etiology , Retrospective Studies
19.
Eur J Neurol ; 27(5): 757-763, 2020 05.
Article in English | MEDLINE | ID: mdl-32065438

ABSTRACT

BACKGROUND AND PURPOSE: The aim was to investigate whether probable rapid eye movement sleep behavior disorder (pRBD) is associated with impulse control disorders (ICDs) in drug-naïve patients with Parkinson's disease (PD) and whether baseline pRBD is associated with a higher incidence of ICDs during follow-up. METHODS: The Parkinson's Progression Markers Initiative is an international, multicenter, prospective cohort study to identify biomarkers of PD progression. In all, 423 drug-naïve patients with early-stage PD were included in the cross-sectional analysis, and 320 patients who screened negative for any ICDs or related behaviors at baseline were included in the longitudinal analysis. RESULTS: In the cross-sectional analysis, a significant correlation was found between pRBD and ICDs in drug-naïve patients whilst controlling for potential confounders [odds ratio 2.56, 95% confidence interval (CI) 1.38-4.76, P = 0.003]. In the longitudinal analysis, baseline pRBD was an independent predictor of ICD development over time [hazard ratio (HR) 1.648, 95% CI 1.054-2.576; P = 0.028]. Other significant predictors of ICDs included younger age of onset (HR = 0.973, 95% CI = 0.950-0.997; P = 0.026) and greater State-Trait Anxiety Inventory score (HR = 1.040, 95% CI = 1.020-1.061; P < 0.001). CONCLUSION: Our data suggest that identifying baseline pRBD in early-stage PD may help clinicians to choose a better therapeutic strategy so as to prevent or limit neuropsychiatric complications.


Subject(s)
Disruptive, Impulse Control, and Conduct Disorders/complications , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Parkinson Disease/complications , Parkinson Disease/epidemiology , REM Sleep Behavior Disorder/complications , REM Sleep Behavior Disorder/epidemiology , Cross-Sectional Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies
20.
Clin Auton Res ; 30(3): 239-245, 2020 06.
Article in English | MEDLINE | ID: mdl-31832904

ABSTRACT

OBJECTIVE: The aim of this study was to investigate the prevalence of rapid eye movement behavior disorder (RBD) in Chinese patients with multiple system atrophy (MSA) and to compare motor and non-motor symptoms and sleep disturbance of MSA patients with and without RBD. METHODS: A total of 55 patients who were consecutively admitted to West China Hospital of Sichuan University from 2016 to 2019 and subsequently diagnosed with probable MSA were enrolled in this cross-sectional study. The diagnosis of RBD was based on the results of video polysomnography (PSG) and a history of abnormal sleep-related behaviors. The patients were divided into two groups: those with RBD and those without. These two groups were then compared in terms of severity of motor symptoms (Unified Multiple System Arophy Rating Scale) and non-motor symptoms (Non-Motor Symptoms Scale, Mini-Mental State Examination score, Epworth Sleepiness Scale, Fatigue Severity Scale, Pittsburgh Sleep Quality Index, REM Sleep Behavior Disorder Screening Questionnaire, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale) and sleep parameters as recorded on PSG. RESULTS: Of the 55 patients (35 males), 18 (33%, 13 males) were diagnosed with RBD. Patients with or without RBD did not differ in demographic characteristics, clinical features, or sleep parameters based on PSG. CONCLUSION: There was no difference in motor and non-motor symptoms between MSA patients with or without RBD, indicating that the presence of RBD may not be significantly associated with the severity of motor or non-motor dysfunction in MSA.


Subject(s)
Multiple System Atrophy , REM Sleep Behavior Disorder , China/epidemiology , Cross-Sectional Studies , Humans , Male , Multiple System Atrophy/complications , Multiple System Atrophy/diagnosis , Multiple System Atrophy/epidemiology , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/epidemiology , Sleep, REM
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