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Edlinger F, Böck M, Seidel S, Trimmel K. Loss of rapid eye movement atonia in rapid eye movement sleep behaviour disorder and narcolepsy. J Sleep Res 2025; 34:e14322. [PMID: 39168479 PMCID: PMC11744237 DOI: 10.1111/jsr.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/30/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
A reduction of physiological muscle atonia during rapid eye movement sleep is characteristic in patients with rapid eye movement sleep behaviour disorder, however, it can also be found in narcolepsy patients. We evaluated rapid eye movement sleep associated electromyographic activity to set cut-off values of rapid eye movement sleep without atonia, differentiating rapid eye movement sleep behaviour disorder and narcolepsy patients from controls to enable more precise future diagnostic criteria for these disorders. We retrospectively analysed polysomnography recordings of 16 rapid eye movement sleep behaviour disorder patients, 15 narcolepsy patients, and 19 controls. The combination of phasic and tonic electromyographic activity was recorded in the mentalis and tibialis anterior muscles and analysed in 3 second miniepochs. The cut-off value for a diagnosis of rapid eye movement sleep behaviour disorder was 17.07% (100% sensitivity, 94.7% specificity, area under the curve 0.997). For the diagnosis of narcolepsy, we yielded a cut-off value of 8.4% (86.4% sensitivity, 68.4% specificity, area under the curve 0.850). Rapid eye movement sleep without atonia significantly (p = 0.046) increased in the second night half in rapid eye movement sleep behaviour disorder patients, while it remained moderately increased in the narcolepsy group. Polysomnographic evaluation proves significantly higher rates of rapid eye movement sleep without atonia in rapid eye movement sleep behaviour disorder than in narcolepsy patients, allowing differentiation from controls with high sensitivity and specificity. An increase throughout the night is characteristic for rapid eye movement sleep behaviour disorder, whereas a consistent elevation is typical in narcolepsy patients.
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Affiliation(s)
| | - Marion Böck
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Stefan Seidel
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Karin Trimmel
- Department of NeurologyMedical University of ViennaViennaAustria
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2
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Dodet P, Houot M, Leu-Semenescu S, Gaurav R, Mangone G, Corvol JC, Lehéricy S, Vidailhet M, Roze E, Arnulf I. Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early-Stage Parkinson's Disease. Mov Disord 2024; 39:1190-1202. [PMID: 38666582 DOI: 10.1002/mds.29813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND In early-stage Parkinson's disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) predicts poor cognitive and motor outcome. However, the baseline significance and disease evolution associated with isolated REM sleep without atonia (iRWA, ie, enhanced muscle tone during 8.7% of REM sleep, but no violent behavior) are not well understood. OBJECTIVES The objective is to determine whether iRWA was a mild form of RBD and progressed similarly over time. METHODS Participants with early PD (<4 years from medical diagnosis) were included from 2014 to 2021 in a longitudinal study. They underwent interviews and examinations in the motor, cognitive, autonomous, psychiatric, sensory, and sleep domains every year for 4 years along with a video polysomnography and magnetic resonance imaging examination of the locus coeruleus/subcoeruleus complex (LC/LsC) at baseline. The clinical characteristics were compared between groups with normal REM sleep, with iRWA and with RBD, at baseline and for 4 years. RESULTS Among 159 PD participants, 25% had RBD, 25% had iRWA, and 50% had normal REM sleep. At baseline, the non-motor symptoms were less prevalent and the LC/LsC signal intensity was more intense in participants with iRWA than with RBD. Over 4 years, participants with normal REM sleep and with iRWA had a similar cognitive and motor trajectory, whereas participants with RBD had greater cognitive and motor decline. CONCLUSIONS We demonstrated that iRWA is frequent in early PD, but is not a milder form of RBD. Both groups have distinct baseline characteristics and clinical trajectories. They should be distinguished in clinical routine and research protocols. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Pauline Dodet
- Service des Pathologies du Sommeil et Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance Publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
| | - Marion Houot
- Center of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France
| | - Smaranda Leu-Semenescu
- Service des Pathologies du Sommeil et Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance Publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
| | - Rahul Gaurav
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
- Department of Neuroradiology, Assistance Publique Hôpitaux de Paris, Hôpital Pitié -Salpêtrière, Paris, France
| | - Graziella Mangone
- Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
- Center of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphane Lehéricy
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
- Department of Neuroradiology, Assistance Publique Hôpitaux de Paris, Hôpital Pitié -Salpêtrière, Paris, France
| | - Marie Vidailhet
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
- Center of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Roze
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
- Center of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil et Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance Publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France
- Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
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3
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Leclair-Visonneau L, Feemster JC, Bibi N, Gossard TR, Jagielski JT, Strainis EP, Carvalho DZ, Timm PC, Bliwise DL, Boeve BF, Silber MH, McCarter SJ, St. Louis EK. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med 2024; 20:279-291. [PMID: 37823585 PMCID: PMC10835777 DOI: 10.5664/jcsm.10862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Accurate diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial due to its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds applicable in varying clinical presentations in a contemporary cohort of patients with iRBD using submentalis (SM) and individual bilateral flexor digitorum superficialis (FDS) and anterior tibialis electromyography limb recordings during polysomnography. METHODS We analyzed RSWA in 20 patients with iRBD and 20 age-, REM-, apnea-hypopnea index-matched controls between 2017 and 2022 for phasic burst durations, density of phasic, tonic, and "any" muscle activity (number of 3-second mini-epochs containing phasic or tonic muscle activity divided by the total number of REM sleep 3-second mini-epochs), and automated Ferri REM atonia index (RAI). Group RSWA metrics were comparatively analyzed. Receiver operating characteristic curves determined optimized area under the curve (AUC) and maximized specificity and sensitivity diagnostic iRBD RSWA thresholds. RESULTS All mean RSWA metrics were higher in patients with iRBD than in controls (P < .05), except for selected anterior tibialis measures. Optimized, maximal specificity AUC diagnostic cutoffs for coprimary outcomes were: SM "any" 6.5%, 14.0% (AUC = 92.5%) and combined SM+FDS "any" 15.1%, 27.4% (AUC = 95.8%), while SM burst durations were 0.72, and 0.72 seconds (AUC 90.2%) and FDS RAI = 0.930, 0.888 (AUC 92.8%). CONCLUSIONS This study provides evidence for current quantitative RSWA diagnostic thresholds in chin and individual 4 limb muscles applicable in different iRBD clinical settings and confirms the key value of SM or SM+FDS to assure accurate iRBD diagnosis. Evolving iRBD recognition underscores the necessity of continuous assessment with future large, prospective, well-harmonized, multicenter polysomnographic analyses. CITATION Leclair-Visonneau L, Feemster JC, Bibi N, et al. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med. 2024;20(2):279-291.
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Affiliation(s)
- Laurène Leclair-Visonneau
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France
- Nantes Université, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - John C. Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Noor Bibi
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Thomas R. Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Jack T. Jagielski
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Emma P. Strainis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Diego Z. Carvalho
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Paul C. Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Donald L. Bliwise
- Emory Sleep Center and Department of Neurology, Emory University, Atlanta, Georgia
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Stuart J. McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Erik K. St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical and Translational Science, Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
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Senzaki K, Okura M, Ohnishi Y. [Abnormal nocturnal behavior mimicking REM sleep behavior disorder episodes in a patient with periodic limb movement disorder]. Rinsho Shinkeigaku 2023; 63:760-764. [PMID: 37880117 DOI: 10.5692/clinicalneurol.cn-001865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Periodic limb movement disorder (PLMD) is a condition in which patients experience frequent periodic limb movements of sleep (PLMS). Synchronized arousal responses cause sleep fragmentation, resulting in insomnia, daytime sleepiness, and fatigue. A 59-year-old man was identified as having intense sleep-talking and body movements, suggesting rapid eye movement (REM) sleep behavior disorder (RBD). Attended video-polysomnography (PSG) revealed that sleep-talking and body movements occurred only during non-REM sleep and were associated with PLMS-induced arousals (periodic leg movement arousal index, 53.2/h). Pramipexole administration improved events during sleep and daytime sleepiness, and the PSG findings and clinical course led to a diagnosis of PLMD. This case demonstrates that PLMD mimics the symptoms of RBD and that a detailed analysis of monitored video PSG is crucial to confirm the diagnosis of RBD and to identify or exclude other causes of sleep talking and behavior.
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Affiliation(s)
- Kaoru Senzaki
- Division of Clinical Laboratory, Tenri Municipal Medical Center
| | - Mutsumi Okura
- Department of Internal Medicine, Division of General Medicine, Asahi University School of Dentistry
- Center for Sleep Medicine, Asahi University Hospital
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Tellenbach N, Schmidt MH, Alexiev F, Blondiaux E, Cavalloni F, Bassetti CL, Heydrich L, Bargiotas P. REM sleep and muscle atonia in brainstem stroke: A quantitative polysomnographic and lesion analysis study. J Sleep Res 2023; 32:e13640. [PMID: 35609965 DOI: 10.1111/jsr.13640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Important brainstem regions are involved in the regulation of rapid eye movement sleep. We hypothesized that brainstem stroke is associated with dysregulated rapid eye movement sleep and related muscle activity. We compared quantitative/qualitative polysomnography features of rapid eye movement sleep and muscle activity (any, phasic, tonic) between 15 patients with brainstem stroke (N = 46 rapid eye movement periods), 16 patients with lacunar/non-brainstem stroke (N = 40 rapid eye movement periods), 15 healthy controls (N = 62 rapid eye movement periods), and patients with Parkinson's disease and polysomnography-confirmed rapid eye movement sleep behaviour disorder. Further, in the brainstem group, we performed a magnetic resonance imaging-based lesion overlap analysis. The mean ratio of muscle activity to rapid eye movement sleep epoch in the brainstem group ("any" muscle activity 0.09 ± 0.15; phasic muscle activity 0.08 ± 0.14) was significantly lower than in the lacunar group ("any" muscle activity 0.17 ± 0.2, p < 0.05; phasic muscle activity 0.16 ± 0.19, p < 0.05), and also lower than in the control group ("any" muscle activity 0.15 ± 0.17, p < 0.05). Magnetic resonance imaging-based lesion analysis indicated an area of maximum overlap in the medioventral pontine region for patients with reduced phasic muscle activity index. For all groups, mean values of muscle activity were significantly lower than in the patients with Parkinson's disease and polysomnography-confirmed REM sleep behaviour disorder group ("any" activity 0.51 ± 0.26, p < 0.0001 for all groups; phasic muscle activity 0.42 ± 0.21, p < 0.0001 for all groups). For the tonic muscle activity in the mentalis muscle, no significant differences were found between the groups. In the brainstem group, contrary to the lacunar and the control groups, "any" muscle activity index during rapid eye movement sleep was significantly reduced after the third rapid eye movement sleep phase. This study reports on the impact of brainstem stroke on rapid eye movement atonia features in a human cohort. Our findings highlight the important role of the human brainstem, in particular the medioventral pontine regions, in the regulation of phasic muscle activity during rapid eye movement sleep and the ultradian distribution of rapid eye movement-related muscle activity.
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Affiliation(s)
- Nathalie Tellenbach
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Filip Alexiev
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.,Neurology Clinic, St Anna University Hospital, Sofia, Bulgaria
| | - Eva Blondiaux
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, Faculty of Life Sciences, Swiss Federal institute of Technology (EPFL), Geneva, Switzerland
| | - Fabian Cavalloni
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Lukas Heydrich
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Panagiotis Bargiotas
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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6
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Dagay A, Oz S, Katzav S, Wasserman D, Tauman R, Thaler A, Giladi N, Mirelman A. Overnight Distribution of REM Sleep Features in People with Parkinson's Disease (PD) and Non-PD Controls. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1213-1223. [PMID: 37807787 PMCID: PMC10657693 DOI: 10.3233/jpd-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behavior disorder (RBD) is a leading predictor of Parkinson's disease (PD). Diagnosis is performed in the sleep laboratory by detecting pathological REM sleep without atonia (RSWA). The evidence on the overnight distribution of RSWA% is conflicting. OBJECTIVE To investigate the temporal distribution of the number of ocular movements per REM sleep minute (REM density), and RSWA% in people with PD and non-PD controls. METHODS All participants underwent a single overnight evaluation in a sleep laboratory. Clinical evaluation was performed on a separate day. REM density and RSWA% were compared between PD and controls both across four sleep periods and individual REM cycles. RESULTS A total of 51 participants with recorded RSWA in polysomnography laboratory were included, 28 with PD aged 64±9 years with a disease duration of 3.3±2.9 years, and 23 controls aged 55±8 years. People with PD had lower REM density and higher RSWA% compared to controls. As expected, REM density was higher towards the morning. In contrast, RSWA% was equally distributed across the night, for both PD and controls. CONCLUSIONS PD pathology affects REM sleep features, but not the overnight distribution of those features. While REM density increased towards the end of the night, RSWA% was equally distributed across the night for both PD and controls. Our findings have clinical implications for diagnosing RBD, as quantification of RSWA% in any sleep cycle is sufficient for reliably evaluating total RSWA% and reduced REM density may be a marker of PD.
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Affiliation(s)
- Andrew Dagay
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
| | - Shani Oz
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Thaler
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Huang B, Zhang J, Wang J, Chau SWH, Chan JWY, Yu MWM, Li SX, Zhou L, Mok V, Wing YK, Liu Y. Isolated dream‐enactment behaviours as a prodromal hallmark of rapid eye movement sleep behaviour disorder. J Sleep Res 2022; 32:e13791. [PMID: 36410741 DOI: 10.1111/jsr.13791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022]
Abstract
Recurrent dream-enactment behaviours (DEB) and rapid eye movement (REM) sleep without atonia (RSWA) are two diagnostic hallmarks of REM sleep behaviour disorder (RBD), a specific prodrome of α-synucleinopathy. Whilst isolated RSWA (without DEB) was suggested as a prodrome of RBD, the implication of 'isolated' recurrent DEB remains under-investigated. In this cross-sectional study, we sought to investigate neurodegenerative markers amongst the first-degree relatives (FDRs, aged >40 years) of patients with RBD who underwent clinical assessment for DEB, neurodegenerative markers, and video-polysomnography assessment. Isolated recurrent DEB was defined as: (i) three or more episodes of DEB, (ii) had a DEB episode in the past 1 year, and (iii) subthreshold RSWA. We identified 29 FDRs (mean [SD] age 53.4 [8.3] years, 55.2% male) with isolated recurrent DEB and 98 age and sex-matched FDRs as controls. Isolated DEB was associated with nightmare (27.6% versus 11.2%, p = 0.02), and the DEB group had a higher rate of current smoking (27.6% versus 3.1%, p = 0.006), type 2 diabetes mellitus (24.1% versus 10.2%, p = 0.003), anxiety disorder (24.1% versus 11.2%, p = 0.02), and constipation (hard lump of stool, 31.0% versus 7.1%, p < 0.001) than the control group. The present findings revealed that family relatives of patients with RBD with isolated recurrent DEB have increased risk of RBD and neurodegenerative features, which adds to the emerging data that isolated DEB is a prodromal feature of RBD and α-synucleinopathy neurodegeneration.
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Affiliation(s)
- Bei Huang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Jing Wang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Steven Wai Ho Chau
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Joey Wing Yan Chan
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Mandy Wai Man Yu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong China
| | - Li Zhou
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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Ferri R, Schenck CH. Assessing the performance of quantified rapid eye movement sleep without atonia methods for the diagnosis of rapid eye movement sleep behavior disorder: a dog biting its tail. Sleep 2022; 45:6639434. [DOI: 10.1093/sleep/zsac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS , Troina , Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School , Minneapolis, MN , USA
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Liu Y, Zhang J, Chau SW, Man Yu MW, Chan NY, Chan JW, Li SX, Huang B, Wang J, Feng H, Zhou L, Mok V, Wing YK. Evolution of Prodromal REM Sleep Behavior Disorder to Neurodegeneration: A Retrospective, Longitudinal Case-control Study. Neurology 2022; 99:e627-e637. [PMID: 35550550 DOI: 10.1212/wnl.0000000000200707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with a history of recurrent dream-enactment behaviors, but with subthreshold REM sleep without atonia levels for REM sleep behavior disorder (RBD) diagnosis, are currently classified to have prodromal RBD (pRBD). However, the REM sleep elevated EMG diagnostic cut-off, progression trajectory, and long-term neurodegenerative outcome of pRBD are not well understood. This study aimed to delineate the evolution of REM sleep EMG levels, determine the EMG cut-off score for diagnosing pRBD, and examine the risk for neurodegenerative diseases of pRBD. METHODS This retrospective longitudinal case-control study recruited pRBD patients and age, sex, and follow-up duration matched controls who were free of neurodegenerative disease at baseline in the Sleep Assessment Unit, the Chinese University of Hong Kong from 1997 to 2018. Patients and controls underwent clinical and video-polysomnography assessments at baseline and follow-up(s). REM sleep EMG activity level on mentalis and anterior tibialis (AT) muscles on video-polysomnography at each visit was scored. The diagnosis of neurodegenerative diseases was confirmed by a neurologist. RESULTS 44 patients (67.4 ± 8.2 years old, 6 females) and 44 controls were recruited. The combined REM sleep EMG level on mentalis and AT muscles of pRBD patients significantly increased during 8.2 ± 3.3 years of follow-up (from 19.3 ± 9.7% to 47.3 ± 27.4% with estimated annual increase of 3.9%), yielding 29 pRBD patients (66%) meeting the full-blown RBD diagnostic criteria. Baseline REM sleep mentalis and AT muscles EMG activity of patients who developed full-blown RBD could favourably differentiate pRBD from controls (6.3% for mentalis 'any' and 9.1% for combination of mentalis 'any' and bilateral AT muscles phasic EMG with AUC of 0.88 [0.78-0.98] and 0.97 [0.92-1.00] respectively). pRBD patients had a higher risk for neurodegenerative diseases (9 developed Parkinson's disease and 3 developed dementia with Lewy bodies) when compared to controls (5 developed Alzheimer's disease, adjusted hazard ratio = 2.95, 95% CI = 1.02-8.54). CONCLUSIONS pRBD has a predictive progression in both pathophysiology and neurodegenerative outcome. This finding has significant implications to the nosological status of pRBD, the current REM sleep-related EMG diagnostic criteria, spectrum concept of RBD and future neuroprotective intervention. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EMG activity during REM sleep predicts the development of prodromal REM sleep behavior disorder.
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Affiliation(s)
- Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Steven Wh Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Mandy Wai Man Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Bei Huang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Jing Wang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Hongliang Feng
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li Zhou
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Vincent Mok
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Wo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
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10
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Prevalence and predictors of REM sleep without atonia in a sleep clinic population. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Systematic video-analysis of motor events during REM sleep in idiopathic REM sleep behavior disorder, follow-up and DAT-SPECT. Sleep Med 2021; 83:132-144. [PMID: 33993030 DOI: 10.1016/j.sleep.2021.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/19/2020] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Abnormal motor manifestations in REM sleep are the most visible feature of idiopathic REM sleep behavior disorder (iRBD), which precedes the overt alpha-synucleinopathy. The aim of this study was to perform a systematic visual analysis of the motor events (ME) captured during video-polysomnography, and clarify their relation to the disease severity. Thirty-four iRBD patients (5 women, 29 men; age 67.7 ± 7.2) with a mean follow-up duration 2.9 ± 1.1 years. and 33 controls (10 women, 23 men; age 61.5 ± 8.2) were examined. The ME captured during REM sleep were classified into four categories, previously defined by Frauscher et al. according to clinical severity: minor/simple jerks, major, complex and violent. An average frequency of 110.8 ± 75.2 ME per hour were identified in iRBD, 7.5 ± 11.6 in the controls (p < 0.001). Of these ME, 68.4% were classified as minor/simple jerks, 9.3% as major, 21.7% as complex and 0.7% as violent. The ME frequency was negatively associated with tracer binding on dopamine transporter single-photon emission computed tomography (DAT-SPECT); the association was stronger for caudate nucleus compared to putamen. During follow-up seven patients (24.1%) phenoconverted, yielding a yearly phenoconversion rate 8.3%. Violent ME were associated with increased hazard ratio for phenoconversion in frequency (p = 0.012) and total duration (p = 0.007). Patients with higher amounts of violent ME had a greater risk of phenoconversion; therefore, their role as a predictor should be considered. Additionally, ME were associated with nigrostriatal degeneration, according to DAT-SPECT. These findings indicate that the degree of the clinical severity of motor manifestations in iRBD reflects the severity of the disease.
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12
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Sasai-Sakuma T, Takeuchi N, Asai Y, Inoue Y, Inoue Y. Prevalence and clinical characteristics of REM sleep behavior disorder in Japanese elderly people. Sleep 2021; 43:5737933. [PMID: 32064524 DOI: 10.1093/sleep/zsaa024] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/03/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the prevalence and clinical characteristics of isolated REM sleep behavior disorder (iRBD) among a general population of elderly Japanese people. METHODS This epidemiological study targeted 2714 elderly residents (76.0 ± 8.0 years, 52.9% female) of a rural community. Questionnaires including the REM sleep behavior disorder single question and demographic information were distributed. All respondents with the question positive were interviewed by telephone. Respondents suspected of having iRBD proceeded to face-to-face interviews and underwent video-polysomnography and neurological/neuropsychological examination. These results were compared to those of previously diagnosed clinical iRBD patients in our sleep clinic. RESULTS Of 1464 respondents to the questionnaire, 18 respondents were diagnosed as iRBD (1.23 [0.66-1.79]%), including eight respondents who satisfied diagnostic criteria with REM sleep without atonia (RWA) above the cut-off value (0.54 [0.17-0.92]%) and 10 respondents who had clear dream enactment behaviors but not RWA above the cut-off (provisionally diagnosed iRBD; p-iRBD) (0.69 [0.26-1.11]%). Severity of RBD and RWA of the population-based iRBD were compatible with those of the clinical iRBD. Half of the population-based iRBD showed orthostatic hypotension and they showed lower olfactory function than population-based p-iRBD and non-RBD. However, their olfactory and cognitive functions were higher than those in the clinical iRBD patients. CONCLUSIONS Prevalence of iRBD in Japanese elderly people was comparable with the rate reported from other countries. Population-based iRBD/p-iRBD showed lower neurodegenerative loading than clinical iRBD in spite of comparable disease duration of RBD, that may indicate their lower risk of future neurodegeneration.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Faculty of Medical Technique, Department of Clinical Laboratory Science, Teikyo University, Tokyo, Japan.,Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Noboru Takeuchi
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | | | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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13
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Feemster JC, Jung Y, Timm PC, Westerland SM, Gossard TR, Teigen LN, Buchal LA, Cattaneo EFD, Imlach CA, Mccarter SJ, Smith KL, Boeve BF, Silber MH, St Louis EK. Normative and isolated rapid eye movement sleep without atonia in adults without REM sleep behavior disorder. Sleep 2020; 42:5581967. [PMID: 31587043 DOI: 10.1093/sleep/zsz124] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/26/2019] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES Values for normative REM sleep without atonia (RSWA) remain unclear. Older age and male sex are associated with greater RSWA, and isolated elevated RSWA has been reported. We aimed to describe normative RSWA and characterize isolated RSWA frequency in adults without REM sleep behavior disorder (RBD). METHODS We visually quantified phasic, "any," and tonic RSWA in the submentalis (SM) and anterior tibialis (AT) muscles, and the automated Ferri REM Atonia Index during polysomnography in adults without RBD aged 21-88. We calculated RSWA percentiles across age and sex deciles and compared RSWA in older (≥ 65) versus younger (<65) men and women. Isolated RSWA (exceeding diagnostic RBD cutoffs, or >95th percentile) frequency was also determined. RESULTS Overall, 95th percentile RSWA percentages were SM phasic, any, tonic = 8.6%, 9.1%, 0.99%; AT phasic and "any" = 17.0%; combined SM/AT phasic, "any" = 22.3%, 25.5%; and RAI = 0.85. Most phasic RSWA burst durations were ≤1.0 s (85th percentiles: SM = 1.07, AT = 0.86 seconds). Older men had significantly higher AT RSWA than older women and younger patients (all p < 0.04). Twenty-nine (25%, 18 men) had RSWA exceeding the cohort 95th percentile, while 17 (14%, 12 men) fulfilled diagnostic cutoffs for phasic or automated RBD RSWA thresholds. CONCLUSIONS RSWA levels are highest in older men, mirroring the demographic characteristics of RBD, suggesting that older men frequently have altered REM sleep atonia control. These data establish normative adult RSWA values and thresholds for determination of isolated RSWA elevation, potentially aiding RBD diagnosis and discussions concerning incidental RSWA in clinical sleep medicine practice.
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Affiliation(s)
- John C Feemster
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Youngsin Jung
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Paul C Timm
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Sarah M Westerland
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Thomas R Gossard
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Luke N Teigen
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Lauren A Buchal
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Elena F D Cattaneo
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Charlotte A Imlach
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Stuart J Mccarter
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Kevin L Smith
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bradley F Boeve
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael H Silber
- Mayo Clinic Sleep Behavior and Neurophysiology Laboratory, Mayo Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN
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14
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McCarter SJ, Tabatabai GM, Jong HY, Sandness DJ, Timm PC, Johnson KL, McCarter AR, Savica R, Vemuri P, Machulda MM, Kantarci K, Mielke MM, Boeve BF, Silber MH, St Louis EK. REM sleep atonia loss distinguishes synucleinopathy in older adults with cognitive impairment. Neurology 2019; 94:e15-e29. [PMID: 31831602 DOI: 10.1212/wnl.0000000000008694] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/28/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To determine whether quantitative polysomnographic REM sleep without atonia (RSWA) distinguishes between cognitive impairment phenotypes. BACKGROUND Neurodegenerative cognitive impairment in older adults predominantly correlates with tauopathy or synucleinopathy. Accurate antemortem phenotypic diagnosis has important prognostic and treatment implications; additional clinical tools might distinguish between dementia syndromes. METHODS We quantitatively analyzed RSWA in 61 older adults who underwent polysomnography including 46 with cognitive impairment (20 probable synucleinopathy), 26 probable non-synucleinopathy (15 probable Alzheimer disease, 11 frontotemporal lobar dementia), and 15 age- and sex-matched controls. Submentalis and anterior tibialis RSWA metrics and automated REM atonia index were calculated. Group statistical comparisons and regression were performed, and receiver operating characteristic curves determined diagnostic RSWA thresholds that best distinguished synucleinopathy phenotype. RESULTS Submentalis-but not anterior tibialis RSWA-was greater in synucleinopathy than nonsynucleinopathy; several RSWA diagnostic thresholds distinguished synucleinopathy with excellent specificity including submentalis tonic, 5.6% (area under the curve [AUC] 0.791); submentalis any, 15.0% (AUC 0.871); submentalis phasic, 10.8% (AUC 0.863); and anterior tibialis phasic, 31.4% (AUC 0.694). In the subset of patients without dream enactment behaviors, submentalis RSWA was also greater in patients with synucleinopathy than in those without synucleinopathy. RSWA was detected more frequently by quantitative than qualitative methods (p = 0.0001). CONCLUSION Elevated submentalis RSWA distinguishes probable synucleinopathy from probable nonsynucleinopathy in cognitively impaired older adults, even in the absence of clinical dream enactment symptoms. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that quantitative RSWA analysis is useful for distinguishing cognitive impairment phenotypes. Further studies with pathologic confirmation of dementia diagnoses are needed to confirm the diagnostic utility of RSWA in dementia.
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Affiliation(s)
- Stuart J McCarter
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Grace M Tabatabai
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Ho-Yann Jong
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - David J Sandness
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Paul C Timm
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Katie L Johnson
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Allison R McCarter
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Rodolfo Savica
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Prashanthi Vemuri
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Mary M Machulda
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Kejal Kantarci
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Michelle M Mielke
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Bradley F Boeve
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Michael H Silber
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.)
| | - Erik K St Louis
- From the Mayo Center for Sleep Medicine (S.J.M., G.M.T., D.J.S., P.C.T., K.L.J., A.R.M., R.S., M.M.M., B.F.B., M.H.B., E.K.S.L.) and Departments of Neurology (S.J.M., P.V., B.F.B., M.H.S., E.K.S.L.), Health Science Research (R.S., M.M.M.), Psychology (M.M.M.), Radiology (K.K.), and Medicine (E.K.S.L.), Mayo Clinic and Foundation, Rochester, MN; Department of Neurology (H.-Y.J.), Providence Neurological Specialties-West, Portland, OR; and University of Minnesota Duluth (A.R.M.).
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Dijkstra F, Viaene M, Crosiers D, De Volder I, Cras P. Frequency and characteristic features of REM sleep without atonia. Clin Neurophysiol 2019; 130:1825-1832. [DOI: 10.1016/j.clinph.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/24/2019] [Accepted: 07/12/2019] [Indexed: 01/19/2023]
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16
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Liu Y, Zhang J, Lam SP, Zhou J, Yu MWM, Li SX, Chan JWY, Postuma RB, Mok VCT, Wing YK. A case-control-family study of idiopathic rapid eye movement sleep behavior disorder. Ann Neurol 2019; 85:582-592. [PMID: 30761606 DOI: 10.1002/ana.25435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 02/05/2023]
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.
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Affiliation(s)
- Yaping Liu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jihui Zhang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Siu Ping Lam
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Junying Zhou
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mandy Wai Man Yu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Shirley Xin Li
- Department of Psychology and State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Joey Wing Yan Chan
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yun Kwok Wing
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China
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Ferri R, Aricò D, Cosentino FII, Lanuzza B, Chiaro G, Manconi M. REM sleep without atonia with REM sleep–related motor events: broadening the spectrum of REM sleep behavior disorder. Sleep 2018; 41:5098401. [DOI: 10.1093/sleep/zsy187] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Giacomo Chiaro
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
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18
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Bliwise DL, Fairley J, Hoff S, Rosenberg RS, Rye DB, Schulman DA, Trotti LM. Inter-rater agreement for visual discrimination of phasic and tonic electromyographic activity in sleep. Sleep 2018; 41:4990779. [DOI: 10.1093/sleep/zsy080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Donald L Bliwise
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Jacqueline Fairley
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Scott Hoff
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | | | - David B Rye
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - David A Schulman
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
| | - Lynn Marie Trotti
- Emory Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA
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Högl B, Stefani A, Videnovic A. Idiopathic REM sleep behaviour disorder and neurodegeneration - an update. Nat Rev Neurol 2018; 14:40-55. [PMID: 29170501 DOI: 10.1038/nrneurol.2017.157] [Citation(s) in RCA: 371] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
So-called idiopathic rapid eye movement (REM) sleep behaviour disorder (RBD), formerly seen as a rare parasomnia, is now recognized as the prodromal stage of an α-synucleinopathy. Given the very high risk that patients with idiopathic RBD have of developing α-synucleinopathies, such as Parkinson disease (PD), PD dementia, dementia with Lewy bodies or multiple system atrophy, and the outstandingly high specificity and very long interval between the onset of idiopathic RBD and the clinical manifestations of α-synucleinopathies, the prodromal phase of this disorder represents a unique opportunity for potentially disease-modifying intervention. This Review provides an update on classic and novel biomarkers of α-synuclein-related neurodegeneration in patients with idiopathic RBD, focusing on advances in imaging and neurophysiological, cognitive, autonomic, tissue-specific and other biomarkers. We discuss the strengths, potential weaknesses and suitability of these biomarkers for identifying RBD and neurodegeneration, with an emphasis on predicting progression to overt α-synucleinopathy. The role of video polysomnography in providing quantifiable and potentially treatment-responsive biomarkers of neurodegeneration is highlighted. In light of all these advances, and the now understood role of idiopathic RBD as an early manifestation of α-synuclein disease, we call for idiopathic RBD to be reconceptualized as isolated RBD.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 600, Boston, Massachusetts 02114, USA
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20
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Sasai-Sakuma T, Nishio Y, Yokoi K, Mori E, Inoue Y. Pareidolias in REM Sleep Behavior Disorder: A Possible Predictive Marker of Lewy Body Diseases? Sleep 2017; 40:2666487. [PMID: 28364496 DOI: 10.1093/sleep/zsw045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/14/2022] Open
Abstract
Study Objectives To investigate conditions and clinical significance of pareidolias in patients with idiopathic rapid eyemovent (REM) sleep behavior disorder (iRBD). Methods This cross-sectional study examined 202 patients with iRBD (66.8 ± 8.0 yr, 58 female) and 46 healthy control subjects (64.7 ± 5.8 years, 14 females). They underwent the Pareidolia test, a newly developed instrument for evoking pareidolias, video polysomnography, olfactory tests, and Addenbrooke's cognitive examination-revised. Results Results show that 53.5% of iRBD patients exhibited one or more pareidolic responses: The rate was higher than control subjects showed (21.7%). The pictures evoking pareidolic responses were more numerous for iRBD patients than for control subjects (1.2 ± 1.8 vs. 0.4 ± 0.8, p < .001). Subgroup analyses revealed that iRBD patients with pareidolic responses had higher amounts of REM sleep without atonia (RWA), with lower sleep efficiency, lower cognitive function, and older age than subjects without pareidolic responses. Results of multivariate analyses show the number of pareidolic responses as a factor associated with decreased cognitive function in iRBD patients with better predictive accuracy. Morbidity length and severity of iRBD, olfactory function, and the amount of RWA were not factors associated with better predictive accuracy. Conclusions Half or more of the iRBD patients showed pareidolic responses. The responses were proven to be associated more intimately with their cognitive decline than clinical or physiological variables related to RBD. Pareidolias in iRBD are useful as a predictive marker of future development of Lewy body diseases.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Division of Biomedical Laboratory Sciences, Department of Life Sciences and Bio-informatics, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Kayoko Yokoi
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan.,Department of Occupational Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University School of Medicine, Sendai, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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21
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Zhang J, Li SX, Lam SP, Wing YK. Epidemiology of REM sleep behavior disorder: both study design and measurement tool count. Sleep Med 2017; 40:122-123. [PMID: 29129579 DOI: 10.1016/j.sleep.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Siu Ping Lam
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
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22
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Högl B. What the "man in the moon" can tell us about the future of our brains. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:358. [PMID: 28936452 DOI: 10.21037/atm.2017.06.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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23
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Fujishiro H, Okuda M, Iwamoto K, Miyata S, Otake H, Noda A, Iritani S, Ozaki N. REM sleep without atonia in middle-aged and older psychiatric patients and Lewy body disease: a case series. Int J Geriatr Psychiatry 2017; 32:397-406. [PMID: 27108917 DOI: 10.1002/gps.4477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Rapid eye movement (REM) sleep behavior disorder (RBD) is commonly associated with Lewy body disease, narcolepsy, or depression. In contrast, the relationship between REM sleep without atonia (RWA), which is a hallmark of RBD on polysomnography, and clinical characteristics remains unclear. The purpose of this study is to investigate the clinical features of psychiatric patients exhibiting RWA and its relevance to Lewy body disease. METHODS Of 55 consecutive patients who underwent polysomnography at the psychiatric ward, 25 patients with sleep apnea syndrome were excluded, and 12 patients exhibiting RWA were identified. The clinical profiles were compared between the groups with and without RWA. RESULTS The mean age and the frequency of neurocognitive disorders were significantly higher in 12 patients with RWA than in 18 without. Only five of the 12 patients exhibiting RWA had episodes of dream-enactment behavior, and fulfilled the clinical criteria for RBD. Two young patients were diagnosed with narcolepsy, while the other middle-aged and older patients fulfilled the clinical criteria for Parkinson's disease (n = 1), dementia with Lewy bodies (n = 4), idiopathic RBD (n = 2), and major depressive disorder (MDD) (n = 3). The patients with MDD exhibited constipation and/or olfactory dysfunction. Moreover, neuroimaging examinations in the patients with MDD revealed isolated occipital hypoperfusion in three patients and mild dopamine transporter deficit in one patient. CONCLUSIONS Rapid eye movement sleep without atonia itself may be associated with specific clinical profiles, even when dream-enactment behavior is absent. Continued follow-up of the patients with MDD exhibiting RWA is warranted to determine if they represent the prodromal Parkinson's disease/dementia with Lewy bodies. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hiroshige Fujishiro
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Okuda
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiko Miyata
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironao Otake
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Noda
- Department of Biomedical Science, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
| | - Shuji Iritani
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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24
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Munechika T, Fujishiro H, Okuda M, Iwamoto K, Torii Y, Iritani S, Ozaki N. Rapid eye movement sleep without atonia may help diagnose Lewy body disease in middle-aged and older patients with somatic symptom disorder. Psychogeriatrics 2017; 17:61-69. [PMID: 26757172 DOI: 10.1111/psyg.12181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/27/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lewy body disease (LBD), including Parkinson's disease (PD) and dementia with Lewy bodies (DLB), is defined pathologically as degeneration in the central and peripheral nervous system associated with Lewy bodies. Somatic symptom disorder often predates the clinical diagnosis of PD and DLB. It is crucial to make an initial diagnosis of LBD in patients with psychiatric symptoms because administering psychotropic drugs often causes or exacerbates extrapyramidal signs. Given the close association between rapid eye movement (REM) sleep behaviour disorder and LBD, REM sleep without atonia on polysomnography may help to diagnose LBD in middle-aged and older patients with somatic symptom disorder. METHODS We reviewed the clinical profiles of five patients with an initial diagnosis of somatic symptom disorder who exhibited REM sleep without atonia on polysomnography. There were three men and two women, with a mean age of 68.4 years (range: 55.0-78.0 years). The mean Mini-Mental State Examination score was 26 (range: 22-30). RESULTS Only two patients had a clinical history of dream-enacting behaviour and fulfilled the clinical criteria for REM sleep behaviour disorder, but clinical conditions in the other three patients corresponded to subclinical REM sleep behaviour disorder. Final clinical diagnoses were made as probable DLB in three patients; two patients did not meet the clinical criteria for PD or DLB. Neurological examinations revealed mild extrapyramidal signs in these two patients, and their scores on the motor component of the Unified Parkinson's Disease Rating Scale were 8 and 5 points, and their Mini-Mental State Examination scores were 30 points. Neither patient exhibited dream-enacting behaviour, but both had constipation. Cardiac 123 I-metaiodobenzylguanidine scintigraphy revealed mild increased washout rates. DISCUSSION REM sleep without atonia may provide an opportunity to identify LBD in patients with somatic symptom disorder, even before they fulfil the clinical criteria for PD or DLB. Continued follow-up will be needed to determine whether these psychiatric patients are in the prodromal stage of PD or DLB.
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Affiliation(s)
- Takayuki Munechika
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan.,Department of Sleep Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Masato Okuda
- Department of Sleep Medicine, Nagoya University School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan
| | - Youta Torii
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan
| | - Shuji Iritani
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University School of Medicine, Nagoya, Japan
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25
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Stefani A, Gabelia D, Högl B, Mitterling T, Mahlknecht P, Stockner H, Poewe W, Frauscher B. Long-Term Follow-up Investigation of Isolated Rapid Eye Movement Sleep Without Atonia Without Rapid Eye Movement Sleep Behavior Disorder: A Pilot Study. J Clin Sleep Med 2015; 11:1273-9. [PMID: 26156949 DOI: 10.5664/jcsm.5184] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/02/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) is a harbinger of synuclein-mediated neurodegenerative diseases. It is unknown if this also applies to isolated REM sleep without atonia (RWA). We performed a long-term follow-up investigation of subjects with isolated RWA. METHODS Participants were recruited from 50 subjects with isolated RWA who were identified at the sleep laboratory of the Department of Neurology at the Medical University of Innsbruck between 2003 and 2005. Eligible subjects underwent follow-up clinical examination, polysomnography, and assessment of neurodegenerative biomarkers (cognitive impairment, finger speed deficit, impaired color vision, olfactory dysfunction, orthostatic hypotension, and substantia nigra hyperechogenicity). RESULTS After a mean of 8.6 ± 0.9 y, 1 of 14 participating subjects (7.3%) progressed to RBD. Ten of 14 RWA subjects (71.4%) were positive for at least one neurodegenerative biomarker. Substantia nigra hyperechogenicity and presence of mild cognitive impairment were both present in 4 of 14 subjects with isolated RWA. Electromyographic activity measures increased significantly from baseline to follow-up polysomnography ("any" mentalis and both anterior tibialis muscles: 32.5 ± 9.4 versus 52.2 ± 16.6%; p = 0.004). CONCLUSION This study provides first evidence that isolated RWA is an early biomarker of synuclein-mediated neurodegeneration. These results will have to be replicated in larger studies with longer observational periods. If confirmed, these disease findings have implications for defining at-risk cohorts for Parkinson disease.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Gabelia
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Heike Stockner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Sasai-Sakuma T, Kinoshita A, Inoue Y. Polysomnographic Assessment of Sleep Comorbidities in Drug-Naïve Narcolepsy-Spectrum Disorders--A Japanese Cross-Sectional Study. PLoS One 2015; 10:e0136988. [PMID: 26322978 PMCID: PMC4556112 DOI: 10.1371/journal.pone.0136988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/11/2015] [Indexed: 01/01/2023] Open
Abstract
This is a large cross-sectional study which aimed to investigate comorbidity rate, degree of sleep-related breathing disorder, polysomnigraphically diagnosible rapid eye movement sleep behavior disorder/rapid eye movement sleep without atonia and periodic limb movements during sleep in Japanese drug-naïve patients with narcolepsy-spectrum disorders. A total of 158 consecutive drug naïve patients with narcolepsy with cataplexy, 295 patients with narcolepsy without cataplexy and 395 patients with idiopathic hypersomnia without long sleep time were enrolled. From retrospectively analyzed data of nocturnal polysomnography and multiple sleep latency test, higher rates of periodic limb movements during sleep (> = 15 h-1) (10.2%) and polysomnographically diagnosable rapid eye movement sleep behavior disorder (1.9%) were found in patients with narcolepsy with cataplexy. They had more severe periodic limb movements during sleep especially during rapid eye movement sleep and higher percentages of rapid eye movement sleep without atonia than the other two patient groups. In the present large sample study, Japanese drug naïve patients with narcolepsy with cataplexy showed the highest comorbidity rates of periodic limb movements during sleep, polysomnographically diagnosable rapid eye movement sleep behavior disorder and rapid eye movement sleep without atonia among those with the other narcolepsy-spectrum disorders; the rates were lower than those for Western patients.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Akihiko Kinoshita
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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27
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28
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Quantitative EMG criteria for diagnosing idiopathic REM sleep behavior disorder. Sleep Breath 2014; 19:685-91. [DOI: 10.1007/s11325-014-1077-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 09/25/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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