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Angerbauer R, Stefani A, Zitser J, Ibrahim A, Anselmi V, Süzgün MA, Egger K, Brandauer E, Högl B, Cesari M. Temporal progression of sleep electroencephalography features in isolated rapid eye movement sleep behaviour disorder. J Sleep Res 2025; 34:e14351. [PMID: 39322419 PMCID: PMC12069751 DOI: 10.1111/jsr.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/16/2024] [Accepted: 09/04/2024] [Indexed: 09/27/2024]
Abstract
Previous studies indicated that patients with isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) exhibit alterations in spectral electroencephalographic (EEG), spindle, and slow-wave features. As it is currently unknown how these EEG features evolve over time, this study aimed to evaluate their temporal progression in patients with iRBD in comparison to controls. We included 23 patients with iRBD and 23 controls. Two polysomnographies (baseline and follow-up) were recorded with a mean (standard deviation) interval of 4.0 (2.5) years and were automatically analysed for sleep stages, spectral bandpower, spindles, and slow waves. We used linear models to evaluate differences at each time point, and linear mixed-effects models to analyse differences in temporal progression between the groups. At baseline, patients with iRBD presented EEG slowing both in REM (expressed as significantly reduced α-bandpower and increased δ-bandpower in frontal channels) and in non-REM (NREM) sleep (significantly increased slow-to-fast ratio in central channels). These differences vanished at follow-up. In both REM and NREM sleep, γ-bandpower was increased at follow-up in patients with iRBD, resulting in significantly different temporal progression between groups (in occipital channels during REM sleep and frontal channels during NREM sleep). Relative power of sleep spindles was significantly higher at baseline in patients with iRBD in frontal channels, but we observed a significant reduction over time in central channels. Finally, slow waves were significantly shorter in patients with iRBD at both time-points. Our results underscore the need of considering longitudinal data when analysing sleep EEG features in patients with iRBD. The observed temporal changes as markers of progression of neurodegeneration require further investigations.
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Affiliation(s)
| | - Ambra Stefani
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Jennifer Zitser
- Sleep Center and Movement Disorders Unit, Neurology DepartmentTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Abubaker Ibrahim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Victoria Anselmi
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Kristin Egger
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Birgit Högl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Matteo Cesari
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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Li HX, Liu JY, Wang JY, Tao MX, Xie WY, Jin H, Mao CJ, Shen Y, Liu CF. Motor events during REM sleep are associated with occipital lobe activity in Parkinson's disease. Sleep Med 2025; 130:56-63. [PMID: 40179794 DOI: 10.1016/j.sleep.2025.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2025] [Revised: 03/13/2025] [Accepted: 03/22/2025] [Indexed: 04/05/2025]
Abstract
STUDY OBJECTIVES Abnormal motor events during REM sleep are common in Parkinson's disease (PD), but few studies have evaluated motor events comprehensively. This study aimed to categorize different types of motor events and explore their relationships with clinical symptoms, sleep structure and cortical electrophysiological characteristics. METHODS 116 PD patients (49 women and 67 men) underwent a clinical assessment and video-polysomnography. REM sleep-related motor events were classified into elementary motor events and complex motor events. Patients were categorized into three groups: PD-non motor events (PD-nME), PD-elementary motor events (PD-eME), and PD-complex motor events (PD-cME). Receiver operating characteristic (ROC) curves were used to calculate the predictive value of PSG-EEG for motor events during REM sleep. RESULTS PD-cME group showed prolonged total sleep time, increased REM sleep percentage, and shortened REM latency compared to other groups. Both PD-eME and PD-cME groups exhibited higher theta relative power and lower beta relative power across extensive cortical regions compared to PD-nME group. Additionally, PD-cME group showed reduced alpha relative power in the left occipital lobe compared to other groups. The theta/beta ratio (TBR) in the right occipital lobe demonstrated significant predictive value for both elementary and complex motor events during REM sleep. CONCLUSION Both elementary and complex motor events during REM sleep in PD patients were associated with abnormal cortical activation. The occipital cortex may potentially constitute a component of the neural circuitry underlying REM sleep.
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Affiliation(s)
- Han-Xing Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Jun-Yi Liu
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, 215125, People's Republic of China
| | - Jing-Yi Wang
- Department of Neurology, The First People's Hospital of Kunshan, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, 215300, People's Republic of China
| | - Meng-Xing Tao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Wei-Ye Xie
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Hong Jin
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Cheng-Jie Mao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China.
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, People's Republic of China; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, 215123, People's Republic of China; Department of Neurology, Xiongan Xuanwu Hospital, Xiongan, 071700, People's Republic of China.
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Picard-Deland C, Cesari M, Stefani A, Maranci JB, Hogl B, Arnulf I. The Future of Parasomnias. J Sleep Res 2025:e70090. [PMID: 40387303 DOI: 10.1111/jsr.70090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2025] [Accepted: 04/28/2025] [Indexed: 05/20/2025]
Abstract
Parasomnias are abnormal behaviours or mental experiences during sleep or the sleep-wake transition. As disorders of arousal (DOA) or REM sleep behaviour disorder (RBD) can be difficult to capture in the sleep laboratory and may need to be diagnosed in large communities, new home diagnostic devices are being developed, including actigraphy, EEG headbands, as well as 2D infrared and 3D time of flight home cameras (often with automatic analysis). Traditional video-polysomnographic diagnostic criteria for RBD and DOA are becoming more accurate, and deep learning methods are beginning to accurately classify abnormal polysomnographic signals in these disorders. Big data from vast collections of clinical, cognitive, brain imaging, DNA and polysomnography data have provided new information on the factors that are associated with parasomnia and, in the case of RBD, may predict the individual risk of conversion to an overt neurodegenerative disease. Dream engineering, including targeted reactivation of memory during sleep, combined with image repetition therapy and lucid dreaming, is helping to alleviate nightmares in patients. On a political level, RBD has brought together specialists in abnormal movements and sleep neurologists, and research into nightmares and sleep-wake dissociations has brought together sleep and consciousness scientists.
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Affiliation(s)
- Claudia Picard-Deland
- DreamTeam, Paris Brain Institute, Paris, France
- Center for Advanced Research in Sleep Medicine, Université de Montréal, Montreal, Canada
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jean-Baptiste Maranci
- DreamTeam, Paris Brain Institute, Paris, France
- Sleep Clinic, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Isabelle Arnulf
- DreamTeam, Paris Brain Institute, Paris, France
- Sleep Clinic, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
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During EH, Malkani R, Arnulf I, Kunz D, Bes F, De Cock VC, Ratti PL, Stefani A, Schiess MC, Provini F, Schenck CH, Videnovic A. Symptomatic treatment of REM sleep behavior disorder (RBD): A consensus from the international RBD study group - Treatment and trials working group. Sleep Med 2025; 132:106554. [PMID: 40408791 DOI: 10.1016/j.sleep.2025.106554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 04/19/2025] [Accepted: 05/03/2025] [Indexed: 05/25/2025]
Abstract
Rapid-eye-movement sleep behavior disorder (RBD) is a parasomnia causing motor behaviors and vocalizations during sleep, which can lead to injuries in patients and their bed partners. Adult-onset RBD generally precedes a neurodegenerative synucleinopathy, while other cases can be associated with antidepressant use, neurotrauma and narcolepsy. The management of RBD relies on the systematic identification of etiologic and contributing factors, implementation of safety measures, appropriate pharmacotherapy and counseling, which should be patient-centered. In this manuscript, we summarize the evidence on the management of RBD. We summarize the evidence supporting the use of clonazepam, melatonin, rivastigmine, and pramipexole, the four agents currently recommended by the American Academy of Sleep Medicine. For each agent and for alternative therapies, we discuss efficacy, dosing, adverse effects and indications. We integrate the current knowledge on therapies in RBD in treatment algorithms that can guide providers in choosing the most appropriate initial therapy, and alternative options based on the course of symptoms and comorbidities. There is a large need for additional, well tolerated therapies for reducing RBD symptoms. The last section of this manuscript discusses current challenges and unmet needs, as well as future directions in developing therapies and improving the care of patients with RBD.
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Affiliation(s)
- Emmanuel H During
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Roneil Malkani
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Isabelle Arnulf
- Assistance Publique Hôpitaux de Paris, Service des pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France
| | - Dieter Kunz
- Department of Physiology, Charite, Universitätsmedizin, Berlin, Germany
| | - Frederik Bes
- Department of Physiology, Charite, Universitätsmedizin, Berlin, Germany
| | - Valerie Cochen De Cock
- Sleep and Neurology Department, Beau Soleil Clinic and EuroMov, Digital Health in Motion, University of Montpellier, Montpellier, France
| | - Pietro-Luca Ratti
- Centre Hospitalier de l'Université de Montréal (CHUM) and CHUM Research Centre, Montréal, Canada
| | - Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mya C Schiess
- Department of Neurology, UT Health Houston, Houston, TX, USA
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Abdelfattah M, Zhou L, Sum‐Ping O, Hekmat A, Galati J, Gupta N, Adaimi G, Marwaha S, Parekh A, Mignot E, Alahi A, During E. Automated Detection of Isolated REM Sleep Behavior Disorder Using Computer Vision. Ann Neurol 2025; 97:860-872. [PMID: 39786322 PMCID: PMC12010054 DOI: 10.1002/ana.27170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 11/26/2024] [Accepted: 12/02/2024] [Indexed: 01/12/2025]
Abstract
OBJECTIVE Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is, in most cases, an early stage of Parkinson's disease or related disorders. Diagnosis requires an overnight video-polysomnogram (vPSG), however, even for sleep experts, interpreting vPSG data is challenging. Using a 3D camera, automated analysis of movements has yielded high accuracy. We aimed to replicate and extend prior work using a conventional 2D camera. METHODS The dataset included 172 vPSG recordings from a clinical sleep center, 81 patients with iRBD and 91 non-RBD healthy controls (63 with a range of other sleep disorders and 28 healthy sleepers). An optical flow computer vision algorithm automatically detected movements during rapid eye movement (REM) sleep, from which features of rate, ratio, magnitude and velocity of movements, and ratio of immobility were extracted. RESULTS Patients with iRBD exhibited an increased number of shorter movements and immobility periods. Accuracies for detecting iRBD ranged from 84.9% (with 2 features) to 87.2% (with 5 features). Combining all 5 features but only analyzing short (0.1-2 second duration) movements achieved the highest accuracy at 91.9%. Of the 11 patients with iRBD without noticeable movements during vPSG, 7 were correctly identified. INTERPRETATION This work improves prior art by using a 2D camera routinely used in sleep laboratories and improving performance by adding only 3 features. This approach could be implemented in clinical sleep laboratories to facilitate and improve the diagnosis of iRBD. Coupled with automated detection of REM sleep, it should also be tested in the home environment using conventional infrared cameras to detect and/or monitor RBD. ANN NEUROL 2025;97:860-872.
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Affiliation(s)
- Mohamed Abdelfattah
- École Polytechnique Fédérale de LausanneENAC IIC Visual Intelligence for TransportationLausanneSwitzerland
| | - Li Zhou
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNY
- Department of Psychiatry, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Oliver Sum‐Ping
- Department of Psychiatry and Behavioral SciencesStanford UniversityPalo AltoCA
| | - Anahid Hekmat
- Department of Psychiatry and Behavioral SciencesStanford UniversityPalo AltoCA
| | - Joanna Galati
- Department of Psychiatry and Behavioral SciencesStanford UniversityPalo AltoCA
| | - Niraj Gupta
- Department of Psychiatry and Behavioral SciencesStanford UniversityPalo AltoCA
| | - George Adaimi
- École Polytechnique Fédérale de Lausanne, Computer and Communications Sciences Department (IC)LausanneSwitzerland
| | - Salonee Marwaha
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Ankit Parekh
- Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral SciencesStanford UniversityPalo AltoCA
| | - Alexandre Alahi
- École Polytechnique Fédérale de LausanneENAC IIC Visual Intelligence for TransportationLausanneSwitzerland
| | - Emmanuel During
- Department of NeurologyIcahn School of Medicine at Mount SinaiNew YorkNY
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6
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Baldelli L, Sambati L, Di Laudo F, Guaraldi P, Giannini G, Cecere A, Loddo G, Mainieri G, Mignani F, Barletta G, Cortelli P, Provini F, Calandra-Buonaura G. Association of Cardiovascular Autonomic Failure With Progression and Phenoconversion in Isolated REM Sleep Behavior Disorder. Neurology 2025; 104:e213470. [PMID: 40112275 PMCID: PMC11927751 DOI: 10.1212/wnl.0000000000213470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 01/15/2025] [Indexed: 03/22/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Isolated REM sleep behavior disorder (iRBD) is a prodromal state of α-synucleinopathies, presenting years before overt neurodegenerative disorders. Autonomic nervous system (ANS) involvement, particularly cardiovascular autonomic failure, may indicate progression. However, its role as a (multidimensional) marker for disease progression and phenoconversion remains unclear. This study aimed to investigate whether cardiovascular autonomic failure and symptoms of autonomic dysfunction serve as multidimensional markers in patients with iRBD. METHODS We conducted a prospective cohort study of patients with iRBD (iRBDs) and controls. Participants underwent cardiovascular reflex tests (CRTs) with beat-to-beat monitoring of blood pressure (BP) and ANS symptom assessments at baseline and annually. Primary outcomes were prevalence and progression of cardiovascular autonomic failure and the risk factors of phenoconversion. Longitudinal changes were evaluated through mixed-effects regression, predictors associated with conversion with Cox regression analysis. RESULTS Sixty-four iRBDs (mean age 68.89 ± 6.75 years, 75% male) and 67 controls (66.57 ± 7.91 years, 68% male) were recruited. At baseline, iRBDs exhibited a prevalent sympathetic cardiovascular dysfunction, with more frequent neurogenic orthostatic hypotension (nOH in 9 iRBDs) and abnormal BP responses to CRTs (pathologic Valsalva maneuver [VM] overshoot in 27 iRBDs). Longitudinal data demonstrated progressive deterioration of sympathetic baroreflex function, with increased prevalence of nOH (7 iRBDs with incident nOH; yearly odds ratio [OR] = 2.44) and deterioration of parasympathetic cardiovagal function. Thirteen patients (20.3%) phenoconverted to α-synucleinopathies. Neurogenic OH (hazard ratio [HR] = 5.05), altered sympathetic baroreflex function (pathologic VM HR = 3.49), and blunted parasympathetic cardiovagal responses (pathologic deep breathing heart rate ratio HR = 3.27) were significant risk factors for phenoconversion; their early appearance 5 years from iRBD onset increased the conversion risk, up to 4-fold. Symptoms of autonomic failure were more prevalent in iRBD and deteriorated over time but failed to predict conversion. DISCUSSION Progressive deterioration of cardiovascular autonomic function is a feature of iRBDs and affects the risk of phenoconversion. Limitations include the relatively short follow-up period and small number of converters. This study highlights the importance of objective cardiovascular autonomic testing as a multidimensional marker for risk stratification in iRBD.
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Affiliation(s)
- Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Luisa Sambati
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Felice Di Laudo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Giulia Giannini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Annagrazia Cecere
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, Italy
| | - Greta Mainieri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Francesco Mignani
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Giorgio Barletta
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; and
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Pérez-Carbonell L, Iranzo A. REM sleep and neurodegeneration. J Sleep Res 2025; 34:e14263. [PMID: 38867555 DOI: 10.1111/jsr.14263] [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: 03/17/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
Several brainstem, subcortical and cortical areas are involved in the generation of rapid eye movement (REM) sleep. The alteration of these structures as a result of a neurodegenerative process may therefore lead to REM sleep anomalies. REM sleep behaviour disorder is associated with nightmares, dream-enacting behaviours and increased electromyographic activity in REM sleep. Its isolated form is a harbinger of synucleinopathies such as Parkinson's disease or dementia with Lewy bodies, and neuroprotective interventions are advocated. This link might also be present in patients taking antidepressants, with post-traumatic stress disorder, or with a history of repeated traumatic head injury. REM sleep likely contributes to normal memory processes. Its alteration has also been proposed to be part of the neuropathological changes occurring in Alzheimer's disease.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Centre, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Spain
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Kang S, Hong JK, Kim CH, Kim JS, Yoon IY. REM sleep without atonia and neurocognitive function in isolated REM sleep behaviour disorder: Cross-sectional and longitudinal study. J Sleep Res 2025; 34:e14336. [PMID: 39255818 DOI: 10.1111/jsr.14336] [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: 02/13/2024] [Revised: 08/01/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024]
Abstract
This study investigated the relationship between rapid eye movement sleep without atonia and cognitive profiles in individuals diagnosed with isolated rapid eye movement sleep behaviour disorder, assesssing both cross-sectional associations and their link to phenoconversion in a longitudinal follow-up. Participants underwent video-polysomnography, neurological examination, neuropsychological tests and structured interviews to confirm isolated rapid eye movement sleep behaviour disorder. Rapid eye movement sleep without atonia was manually scored using the Montreal method, and participants were categorized into either high or low electromyography activity groups, based on their tonic and phasic electromyography activities. The cross-sectional study included 250 patients with isolated rapid eye movement sleep behaviour disorder, revealing that those with high tonic electromyography activity exhibited significantly lower scores in the constructional praxis recall than those with low tonic electromyography activity (p = 0.002). In the longitudinal study, 79 participants (63 isolated rapid eye movement sleep behaviour disorder and 16 phenoconversion), tracked for at least 5 years, demonstrated that high tonic electromyography activity (odds ratio: 6.14; 95% confidence interval: 1.23-30.60; p = 0.027) and lower performance on the Trail Making Test A (odds ratio: 0.23; 95% confidence interval: 0.11-0.70; p = 0.007) were associated with future phenoconversion. These results confirm the link between tonic electromyography activity and neurodegeneration in isolated rapid eye movement sleep behaviour disorder. Combining rapid eye movement sleep without atonia assessment with cognitive evaluation could serve as an early predictive marker for phenoconversion in clinical settings.
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Affiliation(s)
- Sukhoon Kang
- Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan-Hyung Kim
- Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Soo Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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9
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Groenewald K, Warwick J, Dupont P, Ackerman J, Amsterdam O, Carr J. Ictal SPECT Imaging Findings in Parkinson's Disease with Rapid Eye Movement Sleep Behavior Disorder. Mov Disord Clin Pract 2025; 12:437-445. [PMID: 39670503 PMCID: PMC11998692 DOI: 10.1002/mdc3.14307] [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: 11/13/2023] [Accepted: 11/26/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Rapid eye movement sleep behavior disorder (RBD) is an established prodrome and symptom of synucleinopathies. The pathophysiology of this disorder has been well studied but there is a lack of functional imaging data to illustrate the dysfunction in vivo. OBJECTIVES We aimed to investigate the functional changes of RBD, by performing ictal REM sleep SPECT, comparing subjects with Parkinson's Disease (PD) and evidence of RBD to subjects with PD and no RBD. METHODS Participants underwent a targeted clinical assessment, followed by video polysomnography (vPSG). Ictal 99mTc-HMPAO SPECT was performed by injecting the tracer during vPSG confirmed REM sleep in seven cases (PD with RBD) and five controls (PD without RBD). Voxel-wise, whole brain regional relative perfusion changes between both groups were assessed using statistical parametric mapping. RESULTS No difference in relative regional brain perfusion was demonstrated at a family wise error corrected p-value of 0.05 between the case and control groups. At an uncorrected P-value of <0.01, combined with a cluster extent threshold of 300 voxels, four clusters of increased perfusion were identified in the case group compared to the control group. The clusters were seen in the motor, somatosensory association, and prefrontal cortices. The reverse contrast did not show any significant clusters. CONCLUSIONS Increased perfusion of the motor cortex is in keeping with previous publications and motor phenomena seen in RBD. However, clusters included additional cortical regions. These findings demonstrate RBD as a wider sleep network dysfunction, rather than a manifestation of simple pontomedullary interruption.
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Affiliation(s)
- Karolien Groenewald
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
| | - James Warwick
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
| | - Patrick Dupont
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
| | - Jan‐Hendrik Ackerman
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
| | - Olivia Amsterdam
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
| | - Jonathan Carr
- Department of Neurology and Nuclear MedicineUniversity of StellenboschCape TownSouth Africa
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10
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Pounders JD, McCarter SJ. Sleep and Prodromal Synucleinopathies. Semin Neurol 2025. [PMID: 40097019 DOI: 10.1055/a-2544-1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
α-synucleinopathies are a complex group of progressive neurodegenerative disorders with an increasingly recognized long prodromal period, during which sleep dysfunction is a hallmark. Sleep disorders during the prodromal synucleinopathy period, primarily isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and daytime hypersomnolence correlate best with the recently proposed "body-first" Lewy body disease progression. iRBD is the most widely recognized form of prodromal α-synucleinopathy, and patients with iRBD show abnormal α-synuclein in tissues and biofluids even in the absence of cognitive or motor symptoms. More importantly, individuals with iRBD have an elevated risk for near-term development of a clinically diagnosable symptomatic synucleinopathy. Other sleep disorders such as hypersomnia and circadian rhythm dysfunction also occur across the synucleinopathy spectrum, although their prognostic significance is less well understood than iRBD. Finally, isolated REM sleep without atonia may represent an even earlier stage of prodromal synucleinopathy, but further studies are needed.
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Affiliation(s)
- Johnson D Pounders
- Mayo Clinic Department of Neurology, Division of Behavioral Neurology Rochester, Minnesota
| | - Stuart J McCarter
- Mayo Clinic Department of Neurology, Division of Behavioral Neurology Rochester, Minnesota
- Mayo Clinic Center for Sleep Medicine, Division of Pulmonology, Rochester, Minnesota
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11
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van der Aar JF, van Gilst MM, van den Ende DA, van Gorp H, Anderer P, Pijpers A, Fonseca P, Peri E, Overeem S. Hypnogram and Hypnodensity Analysis of REM Sleep Behaviour Disorder Using Both EEG and HRV-Based Sleep Staging Models. J Sleep Res 2025:e70046. [PMID: 40077890 DOI: 10.1111/jsr.70046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 02/10/2025] [Accepted: 03/06/2025] [Indexed: 03/14/2025]
Abstract
Rapid-eye-movement (REM) sleep behaviour disorder (RBD) is a primary sleep disorder strongly associated with Parkinson's disease. Assessing sleep structure in RBD is important for understanding the underlying pathophysiology and developing diagnostic methods. However, the performance of automated sleep stage classification (ASSC) models is considered suboptimal in RBD, for both models utilising neurological signals ("ExG": EEG, EOG, and chin EMG) and heart rate variability combined with body movements (HRVm). Here, we explore this underperformance through the categorical representation of sleep macrostructure (i.e., hypnogram) and a representation that leverages the underlying probability distribution of ASSCs (i.e., hypnodensity). By comparing the RBD population (n = 36) to a sex- and age-matched group of OSA patients chosen for their anticipated similarly decreased sleep stability, we confirm lower 4-stage classification performance in both ExG-based ASSC (RBD: κ = 0.74, OSA: κ = 0.80) and HRVm-based ASSC (RBD: κ = 0.50, OSA: κ = 0.63). Stages showing lower agreement in RBD, namely, N1 + N2 and REM sleep, exhibited elevated ambiguity in the hypnodensity, indicating more ambiguous classification distributions. Limited differences in bout durations between RBD and OSA suggested sleep instability is not necessarily driving lower agreement in RBD. However, stage transitions in OSA showed more abrupt changes in the underlying probability distribution, while RBD transitions had a more continuous profile, possibly complicating classification. Although both ExG-based and HRVm-based automated sleep staging in RBD remain challenging, hypnodensity analysis is informative for the characterisation of (RBD) sleep and can capture potential drivers of classification disagreement.
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Affiliation(s)
- Jaap F van der Aar
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Philips Sleep and Respiratory Care, Eindhoven, the Netherlands
| | - Merel M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Center for Sleep Medicine Kempenhaeghe, Heeze, the Netherlands
| | - Daan A van den Ende
- Philips Innovation & Strategy, Department of Innovation Engineering, Eindhoven, the Netherlands
| | - Hans van Gorp
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Philips Sleep and Respiratory Care, Eindhoven, the Netherlands
| | - Peter Anderer
- The Siesta Group Schlafanalyse Gmbh, Vienna, Austria
| | | | - Pedro Fonseca
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Philips Sleep and Respiratory Care, Eindhoven, the Netherlands
| | - Elisabetta Peri
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Center for Sleep Medicine Kempenhaeghe, Heeze, the Netherlands
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12
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Joza S, Pelletier A, Gagnon JF, Montplaisir JY, Bertram D, Bozek K, Postuma RB, Sommerauer M. Validation of RBDtector: An Open-Source Automated Software for Scoring REM Sleep Without Atonia. J Sleep Res 2025:e70037. [PMID: 40077920 DOI: 10.1111/jsr.70037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 02/11/2025] [Accepted: 02/28/2025] [Indexed: 03/14/2025]
Abstract
Accurate quantification of REM sleep without atonia (RSWA) is essential in the diagnosis of idiopathic/isolated REM sleep behaviour disorder (iRBD). This study aims to validate RBDtector, a free and open-source tool for automated RSWA quantification using the Sleep Innsbruck Barcelona (SINBAR) scoring method, by comparing its performance against human visual scoring in a large independent cohort of subjects with iRBD and healthy controls. Muscle activity from 118 iRBD participants and 37 healthy controls that underwent polysomnography was analysed by RBDtector and compared with human visual scoring. Diagnostic performance was evaluated using receiver operating characteristic curves, and optimal cut-offs for iRBD screening and diagnosis were determined. The results of RSWA quantification were applied to survival analyses of time to phenoconversion. RBDtector showed excellent agreement with human visual scoring, particularly in 'any' RSWA activity (Pearson's correlation = 0.89, R2 = 0.79, p < 0.001). RBDtector identified iRBD subjects with 95.6% sensitivity and 95.5% specificity by using a cutoff of 33.0% for combined 'any' RSWA activity in the submentalis and flexor digitorum superficialis muscles, with each muscle in isolation providing comparable results. In iRBD patients, each 10% increase in submentalis 'any' activity was associated with a 23% increase in the risk of phenoconversion (HR = 1.23, 95% CI [1.06, 1.44], p = 0.008), while no associations were observed with increased activity in the flexor digitorum superficialis or tibialis anterior. RBDtector provides accurate, automated RSWA quantification comparable to human visual scoring, offering a reliable and efficient method to support the diagnosis of iRBD and identify iRBD at a higher risk of phenoconversion.
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Affiliation(s)
- Stephen Joza
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Centre for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Centre for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Jacques Y Montplaisir
- Centre for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - David Bertram
- Centre for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Institute for Biomedical Informatics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Kasia Bozek
- Centre for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Institute for Biomedical Informatics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Ronald B Postuma
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada
- Centre for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Michael Sommerauer
- Centre of Neurology, Department of Parkinson, Sleep and Movement Disorders, University Hospital Bonn, Bonn, Germany
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13
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Baldelli L, Calandra-Buonaura G. Shedding Light on REM Sleep Behavior Disorder in Progressive Supranuclear Palsy: Window Into Neurodegeneration or Diagnostic Challenge? Neurology 2025; 104:e213449. [PMID: 39951677 DOI: 10.1212/wnl.0000000000213449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 01/06/2025] [Indexed: 02/16/2025] Open
Affiliation(s)
- Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy; and
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Italy; and
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
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14
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Levendowski DJ, Chahine LM, Lewis SJG, Finstuen TJ, Galbiati A, Berka C, Mosovsky S, Parikh H, Anderson J, Walsh CM, Lee-Iannotti JK, Neylan TC, Strambi LF, Boeve BF, St. Louis EK. Validation of automated detection of REM sleep without atonia using in-laboratory and in-home recordings. J Clin Sleep Med 2025; 21:583-592. [PMID: 39569509 PMCID: PMC11874090 DOI: 10.5664/jcsm.11488] [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: 09/05/2024] [Revised: 11/14/2024] [Accepted: 11/14/2024] [Indexed: 11/22/2024]
Abstract
STUDY OBJECTIVES To evaluate the concordance between visual scoring and automated detection of rapid eye movement sleep without atonia (RSWA) and the validity and reliability of in-home automated-RSWA detection in patients with rapid eye movement sleep behavior disorder (RBD) and a control group. METHODS Sleep Profiler signals were acquired during simultaneous in-laboratory polysomnography in 24 isolated patients with RBD. Chin and arm RSWA measures visually scored by an expert sleep technologist were compared to algorithms designed to automate RSWA detection. In a second cohort, the accuracy of automated-RSWA detection for discriminating between RBD and control group (n = 21 and 42, respectively) was assessed in multinight in-home recordings. RESULTS For the in-laboratory studies, agreement between visual and auto-scored RSWA from the chin and arm were excellent, with intraclass correlations of 0.89 and 0.95, respectively, and substantial, based on Kappa scores of 0.68 and 0.74, respectively. For classification of patients with iRBD vs controls, specificities derived from auto-detected RSWA densities obtained from in-home recordings were 0.88 for the chin, 0.93 for the arm, and 0.90 for the chin or arm, while the sensitivities were 0.81, 0.81, and 0.86, respectively. The night-to-night consistencies of the respective auto-detected RSWA densities were good based on intraclass correlations of 0.81, 0.79, and 0.84, however some night-to-night disagreements in abnormal RSWA detection were observed. CONCLUSIONS When compared to expert visual RSWA scoring, automated RSWA detection demonstrates promise for detection of RBD. The night-to-night reliability of chin- and arm-RSWA densities acquired in-home were equivalent. CITATION Levendowski DJ, Chahine LM, Lewis SJG, et al. Validation of automated detection of REM sleep without atonia using in-laboratory and in-home recordings. J Clin Sleep Med. 2025;21(3):583-592.
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Affiliation(s)
| | | | | | | | | | - Chris Berka
- Advanced Brain Monitoring, Carlsbad, California
| | | | - Hersh Parikh
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jack Anderson
- University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | | | - Bradley F. Boeve
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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15
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Dagay A, Katzav S, Wasserman D, Gnoni V, Mirelman A, Tauman R. Cyclic Alternating Pattern Dynamics in Individuals at Risk for Developing Parkinson's Disease. Ann Neurol 2025. [PMID: 39981867 DOI: 10.1002/ana.27217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 01/05/2025] [Accepted: 02/05/2025] [Indexed: 02/22/2025]
Abstract
OBJECTIVE The objective of this study was to investigate the differences in cyclic alternating patterns (CAP) metrics, a non-rapid eye movement (NREM) sleep physiological rhythm, among recently diagnosed patients with Parkinson's disease (PD), and individuals at high and low risk for developing PD based on genetic and prodromal risk. METHODS In this cross-sectional exploratory study, participants underwent clinical, cognitive, and motor evaluation to compute risk based on the Movement Disorder Society (MDS) prodromal criteria and a standard overnight polysomnography. CAP rate, CAP index, A index subtypes, number of CAP sequences, and CAP sequence duration were computed from the electroencephalogram (EEG) signal. RESULTS The study included 30 patients with early PD (mean age = 62.80 ± 7.69, disease duration = 1.10 ± 1.09), 26 participants at risk for PD (age = 64.88 ± 10.09), and 36 participants with low risk for PD (age = 56.83 ± 7.41). Despite comparable macrosleep architecture, most CAP measures were significantly lower in patients with PD compared with the low-risk group, whereas the at-risk group showed transitional values between PD and the low-risk group. The A2 index was significantly lower in both the at-risk and PD groups from the low-risk group (at risk = 7.59 ± 4.59; PD = 7.71 ± 5.83; and low risk = 12.85 ± 8.63; p = 0.010). Lower CAP rate and lower CAP index were associated with greater disease severity (r = -0.23 and - 0.24, respectively). INTERPRETATION Patients with early clinical PD exhibit alterations in CAP dynamics despite having comparable macrosleep architecture. Alterations of the NREM microsleep structure may occur early in the neurodegenerative process and the A2 index may be an early event in the evolution of the disease with the potential to serve as an early marker for disease progression. ANN NEUROL 2025.
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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
| | - Shlomit Katzav
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, 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
| | - Danielle Wasserman
- Department of Neurology and Sleep Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Pia Fondazione Cardinale G. Panico", Tricase, Italy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - 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
| | - 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
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16
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Stotz S, Bes F, Kunz D. Ikelos-Rating Scale: Validation of a Behavioural Severity Marker in REM Sleep Behaviour Disorder. J Sleep Res 2025:e70019. [PMID: 39957343 DOI: 10.1111/jsr.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 01/29/2025] [Accepted: 02/05/2025] [Indexed: 02/18/2025]
Abstract
The Ikelos-Rating Scale (Ikelos-RS) is a new, expert-interviewed and bedpartner-reported severity marker assessing frequency and expression of isolated REM sleep behaviour disorder (iRBD), a precursor of clinical α-synucleinopathies. This study aimed to validate the Ikelos-RS in 180 patients with three-night PSG-confirmed iRBD (68.4 ± 8.3 years; 139 m). Inter-rater (n = 45) and test-retest reliabilities (n = 25; 174 Ikelos-RS) were evaluated. For construct validity, correlation analyses were performed with: (1) Clinical Global Impressions-Severity (CGI-S; n = 151), (2) REM sleep without atonia (RWA) within videometry (n = 20), (3) RWA at initial diagnosis (n = 131) and changes over time (n = 36), (4) dopamine transporter scintigraphy (DaT-SPECT) at baseline and changes over time (n = 75). RWA- and DaT-SPECT-analyses were conducted for the whole sample ('all') and after excluding confounders ('cleaned'). Correlation analyses indicated high inter-rater (rs = 0.865, p < 0.001) and test-retest reliabilities (rs = 0.900, p < 0.001). Construct validity was supported by associations of Ikelos-RS with (1) CGI-S (rs = 0.845, p < 0.001), (2) RWA within videometric analysis (rs = 0.592, p = 0.006) and at baseline ('all': rs = 0.274, p = 0.002), (3) DaT-binding (z-scores) at baseline in right anterior putamen (AP) ('all': rs = -0.319, p = 0.005) and changes over time, most pronounced in right anterior putamen (AP) ('all': rs = -0.243, p = 0.035; 'cleaned': rs = -0.374, p = 0.008) and left posterior putamen (PP) ('all': rs = -0.259, p = 0.025; 'cleaned': rs = -0.319, p = 0.024). Given its high reliability and construct validity, demonstrated by associations with the best available severity markers DaT-binding ratios and RWA, Ikelos-RS appears to represent a reliable, valid and easy-to-use tool for measuring the severity of iRBD. Thus, Ikelos-RS may prove beneficial in research. Its suitability as a screening tool in older at-risk populations needs to be proven in future studies.
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Affiliation(s)
- Sophia Stotz
- Clinic for Sleep & Chronomedicine, St. Hedwig-Hospital, Berlin, Germany
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité Universitätsmedizin, Berlin, Germany
| | - Frederik Bes
- Clinic for Sleep & Chronomedicine, St. Hedwig-Hospital, Berlin, Germany
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité Universitätsmedizin, Berlin, Germany
| | - Dieter Kunz
- Clinic for Sleep & Chronomedicine, St. Hedwig-Hospital, Berlin, Germany
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité Universitätsmedizin, Berlin, Germany
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17
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Stefani A, Antelmi E, Arnaldi D, Arnulf I, During E, Högl B, Hu MMT, Iranzo A, Luke R, Peever J, Postuma RB, Videnovic A, Gan-Or Z. From mechanisms to future therapy: a synopsis of isolated REM sleep behavior disorder as early synuclein-related disease. Mol Neurodegener 2025; 20:19. [PMID: 39934903 PMCID: PMC11817540 DOI: 10.1186/s13024-025-00809-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 02/05/2025] [Indexed: 02/13/2025] Open
Abstract
Parkinson disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy are synucleinopathies, characterized by neuronal loss, gliosis and the abnormal deposition of α-synuclein in vulnerable areas of the nervous system. Neurodegeneration begins however several years before clinical onset of motor, cognitive or autonomic symptoms. The isolated form of REM sleep behavior disorder (RBD), a parasomnia with dream enactment behaviors and excessive muscle activity during REM sleep, is an early stage synucleinopathy. The neurophysiological hallmark of RBD is REM sleep without atonia (RWSA), i.e. the loss of physiological muscle atonia during REM sleep. RBD pathophysiology is not fully clarified yet, but clinical and basic science suggest that ɑ-syn pathology begins in the lower brainstem where REM atonia circuits are located, including the sublaterodorsal tegmental/subcoeruleus nucleus and the ventral medulla, then propagates rostrally to brain regions such as the substantia nigra, limbic system, cortex. Genetically, there is only a partial overlap between RBD, PD and DLB, and individuals with iRBD may represent a specific subpopulation. A genome-wide association study identified five loci, which all seem to revolve around the GBA1 pathway. iRBD patients often show subtle motor, cognitive, autonomic and/or sensory signs, neuroimaging alterations as well as biofluid and tissue markers of neurodegeneration (in particular pathologic α-synuclein aggregates), which can be useful for risk stratification. Patients with iRBD represent thus the ideal population for neuroprotective/neuromodulating trials. This review provides insights into these aspects, highlighting and substantiating the central role of iRBD in treatment development strategies for synucleinopathies.
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Affiliation(s)
| | - Elena Antelmi
- DIMI Department of Engineering and Medicine of Innovation, University of Verona, Verona, Italy
| | - Dario Arnaldi
- Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | - Isabelle Arnulf
- Sleep Clinic, Pitié-Salpêtrière Hospital, APHP - Sorbonne University, Paris, France
- Paris Brain Institute, Paris, France
| | - Emmanuel During
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Högl
- Medical University Innsbruck, Innsbruck, Austria
| | - Michele M T Hu
- Division of Neurology, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Alex Iranzo
- Sleep Unit, Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Universitat de Barcelona,, Barcelona, Spain
| | - Russell Luke
- Department of Cell and System Biology, University of Toronto, Toronto, ON, Canada
| | - John Peever
- Department of Cell and System Biology, University of Toronto, Toronto, ON, Canada
| | - Ronald B Postuma
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- The Neuro (Montreal Neurological Institute-Hospital), Montreal, QC, Canada
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ziv Gan-Or
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
- The Neuro (Montreal Neurological Institute-Hospital), Montreal, QC, Canada.
- Department of Human Genetics, McGill University, Montreal, QC, Canada.
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18
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Mariño N, Serradell M, Gaig C, Mayà G, Montini A, Matos N, Pont-Sunyer C, Uscamaita K, Marrero-González P, Buongiorno M, Iranzo A. Audiovisual analysis of the diagnostic video polysomnography in patients with isolated REM sleep behavior disorder. J Neurol 2025; 272:146. [PMID: 39812859 DOI: 10.1007/s00415-024-12761-y] [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: 07/15/2024] [Revised: 09/15/2024] [Accepted: 10/29/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND The diagnosis of isolated REM sleep behavior disorder (IRBD) requires video polysomnography (V-PSG) showing increased muscle activity and abnormal behaviors in REM sleep. OBJECTIVE To describe in IRBD the behavioral manifestations occurring during REM sleep in the diagnostic V-PSG. METHODS This is a systematic audiovisual V-PSG analysis of consecutive IRBD patients. According to the International RBD Study Group recommendations, REM sleep movements and vocalizations were classified into categories and severity. RESULTS We analyzed the V-PSG of 62 IRBD patients with a mean age of 67.6 ± 8.1 years. Of 6,330 30-s epochs of REM sleep, 55.1% epochs exhibited motor events, 5.5% contained vocalizations and 39.4% were silent. Among the epochs with motor manifestations, 66.1% contained simple minor movements, 25.0% simple major and 8.9% complex movements. Motor severity of the epochs was mild in 82.2%, moderate in 13.2% and severe in 4.6%. Most movements were bilateral (62.4%) and located in the upper limbs (42.5%). Of the epochs with vocalizations, 61.5% were simple minor, 20.7% complex and 17.8% simple major of mild (72.7%), moderate (23.0%) and severe (4.3%) severity. Complex movements occurred in 87.1% of the patients and complex vocalizations in 38.7%. CONCLUSIONS In IRBD, the most common manifestations in REM sleep are simple minor movements and vocalizations of mild intensity. Complex movements are observed during REM sleep in most patients but are much less frequent than simple minor and major motor events. These findings should be considered for the routine diagnosis of IRBD when reviewing the V-PSG studies.
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Affiliation(s)
- Nathalie Mariño
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Mónica Serradell
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Carles Gaig
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Gerard Mayà
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Angelica Montini
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Nuria Matos
- Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
- Facultat de Medicina, Universitat de Vic-Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Claustre Pont-Sunyer
- Movement Disorders Unit, Neurology Service, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Karol Uscamaita
- Neurology Service, Sleep Disorders Unit, Hospital Universitari Sagrat Cor, Grupo Quirónsalud, Barcelona, Spain
| | - Paula Marrero-González
- Neurology Department, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral Barcelona Spain, Barcelona, Spain
| | - Mariateresa Buongiorno
- Neurodegenerative Unit, Neurology Service, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Iranzo
- Sleep Unit, Neurology Service, Hospital Clínic Barcelona, IDIBAPS, CIBERNED, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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19
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Ghorpade KB, Agrawal S, Havelikar U. WITHDRAWN: Biomarker Detection and Therapy of Parkinson's and Alzheimer's disease using upconversion based approach: A Comprehensive Review. Ageing Res Rev 2025:102656. [PMID: 39788432 DOI: 10.1016/j.arr.2025.102656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 01/03/2025] [Accepted: 01/03/2025] [Indexed: 01/12/2025]
Abstract
This article has been withdrawn at the request of the author(s). The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Kabirdas B Ghorpade
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER) - Raebareli, Lucknow 226002 (Uttar Pradesh), India.
| | - Shivanshu Agrawal
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER) - Raebareli, Lucknow 226002 (Uttar Pradesh), India
| | - Ujwal Havelikar
- Department of Pharmaceutics, NIMS Institute of Pharmacy, NIMS University, Jaipur 303121, Rajasthan, India
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20
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Possti D, Oz S, Gerston A, Wasserman D, Duncan I, Cesari M, Dagay A, Tauman R, Mirelman A, Hanein Y. Semi automatic quantification of REM sleep without atonia in natural sleep environment. NPJ Digit Med 2024; 7:341. [PMID: 39609533 PMCID: PMC11605064 DOI: 10.1038/s41746-024-01354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 11/20/2024] [Indexed: 11/30/2024] Open
Abstract
Polysomnography, the gold standard diagnostic tool in sleep medicine, is performed in an artificial environment. This might alter sleep and may not accurately reflect typical sleep patterns. While macro-structures are sensitive to environmental effects, micro-structures remain more stable. In this study we applied semi-automated algorithms to capture REM sleep without atonia (RSWA) and sleep spindles, comparing lab and home measurements. We analyzed 107 full-night recordings from 55 subjects: 24 healthy adults, 28 Parkinson's disease patients (15 RBD), and three with isolated Rem sleep behavior disorder (RBD). Sessions were manually scored. An automatic algorithm for quantifying RSWA was developed and tested against manual scoring. RSWAi showed a 60% correlation between home and lab. RBD detection achieved 83% sensitivity, 79% specificity, and 81% balanced accuracy. The algorithm accurately quantified RSWA, enabling the detection of RBD patients. These findings could facilitate more accessible sleep testing, and provide a possible alternative for screening RBD.
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Affiliation(s)
| | - Shani Oz
- X-trodes, Herzelia, Israel
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Iain Duncan
- Sleep Disorders Centre, St. Thomas' and Guy's Hospital, GSTT NHS, London, UK
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrew Dagay
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Riva Tauman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sieratzki-Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Hanein
- X-trodes, Herzelia, Israel.
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv, Israel.
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21
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Papakonstantinou A, Klemming J, Haberecht M, Kunz D, Bes F. Ikelos-RWA. Validation of an Automatic Tool to Quantify REM Sleep Without Atonia. Clin EEG Neurosci 2024; 55:657-664. [PMID: 37192675 PMCID: PMC11459856 DOI: 10.1177/15500594231175320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/09/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
Study Objectives. To present and evaluate an automatic scoring algorithm for quantification of REM-sleep without atonia (RWA) in patients with REM-sleep behaviour disorder (RBD) based on a generally accepted, well-validated visual scoring method, ("Montreal" phasic and tonic) and a recently developed, concise scoring method (Ikelos-RWA). Methods. Video-polysomnographies of 20 RBD patients (68.2 ± 7.2 years) and 20 control patients with periodic limb movement disorder (65.9 ± 6.7 years) were retrospectively analysed. RWA was estimated from chin electromyogram during REM-sleep. Visual and automated RWA scorings were correlated, and agreement (a) and Cohen's Kappa (k) calculated for 1735 minutes of REM-sleep of the RBD patients. Discrimination performance was evaluated with receiver operating characteristic (ROC) analysis. The algorithm was then applied on the polysomnographies of a cohort of 232 RBD patients (total analysed REM-sleep: 17,219 minutes) and evaluated, while correlating the different output parameters. Results. Visual and computer-derived RWA scorings correlated significantly (tonic Montreal: rTM = 0.77; phasic Montreal: rPM = 0.78; Ikelos-RWA: rI = 0.97; all p < 0.001) and showed good to excellent Kappa coefficients (kTM = 0.71; kPM = 0.79; kI = 0.77). The ROC analysis showed high sensitivities (95%-100%) and specificities (84%-95%) at the optimal operation points, with area under the curve (AUC) of 0.98, indicating high discriminating capacity. The automatic RWA scorings of 232 patients correlated significantly (rTM{I} = 0.95; rPM{I} = 0.91, p < 0.0001). Conclusions. The presented algorithm is an easy-to-use and valid tool for automatic RWA scoring in patients with RBD and may prove effective for general use being publicly available.
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Affiliation(s)
- Alexandra Papakonstantinou
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Jannis Klemming
- Department of Ophthalmology, University Medical Center Goettingen, Göttingen, Germany
| | - Martin Haberecht
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Dieter Kunz
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Frederik Bes
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
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22
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Falup-Pecurariu C, Muntean ML, Ungureanu L, Murasan I, Popławska-Domaszewicz K, Chaudhuri KR, Diaconu S. Pharmacological and non-pharmacological management of sleep disturbances in Parkinson's disease: if when and how. Expert Opin Pharmacother 2024; 25:2135-2149. [PMID: 39535843 DOI: 10.1080/14656566.2024.2422004] [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: 08/26/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Sleep dysfunction occurs in various forms and is a bothersome and intrusive non-motor symptom of Parkinson's disease (PD). Frequently undiagnosed, their poor management can have a great impact on the quality of life of PD patients and their caregivers. AREAS COVERED This article covers the safety and efficacy of pharmacological strategies for the management of the most frequent sleep disturbances in Parkinson's disease. Non-pharmacological aspects are also discussed, but these are not the main focus. Literature searches using electronic databases (Medline, Cochrane Library) and systematic checking of references from review articles/other reports were performed. EXPERT OPINION Melatonin and clonazepam are the most commonly used therapies for the management of REM sleep behavior disorder (RBD). The most used pharmacological wake-promoting agents in the treatment of excessive daytime sleepiness (EDS) are modafinil and caffeine. Poor nocturnal sleep quality is usually linked to EDS, thus proper sleep hygiene is recommended. As nocturnal motor symptoms are commonly associated with sleep fragmentation and early morning off, optimization of dopaminergic treatment during nighttime is highly recommended for the proper management of insomnia. Further interventions include eszopiclone and melatonin for the management of insomnia. Therapeutic options for restless legs syndrome (RLS) include calcium channel alpha-2-delta ligands and low-dose dopamine agonists (DA). Further confirmatory evidence is needed before the general recommendation of these treatments.
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Affiliation(s)
- Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | | | - Larisa Ungureanu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Iulia Murasan
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Karolina Popławska-Domaszewicz
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Kallol Ray Chaudhuri
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Stefania Diaconu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
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23
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Mancini R, Mattioli P, Famà F, Giorgetti L, Calizzano F, Nikolic M, Frandsen R, Jennum P, Morbelli S, Pardini M, Arnaldi D. Automatic quantification of REM sleep without atonia reliably identifies patients with REM sleep behavior disorder: a possible screening tool? Neurol Sci 2024; 45:4837-4846. [PMID: 38775861 PMCID: PMC11422455 DOI: 10.1007/s10072-024-07532-6] [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: 02/24/2024] [Accepted: 04/11/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND REM Sleep Behavior Disorder (RBD) is characterized by absence of physiological muscle atonia during REM sleep (REM sleep without atonia, RWA). Nigro-striatal dopaminergic impairment is a feature of Parkinson disease (PD) and can be identified in prodromal stages as well, such as idiopathic RBD (iRBD). Aims of this study are to explore the efficacy of an automatic RWA quantification in identifying RBD patients and the correlation between RWA and nigro-striatal dopaminergic function. METHODS Forty-five iRBD, 46 PD with RBD, 24 PD without RBD patients and 11 healthy controls were enrolled in the Genoa Center (group A) and 25 patients with iRBD (group B) were enrolled in the Danish Center. Group A underwent brain [123I]FP-CIT-SPECT and group B underwent brain [18F]PE2I-PET as measures of nigro-striatal dopaminergic function. Chin muscle activity was recorded in all subjects and analyzed by applying a published automatic algorithm. Correlations between RWA and nigro-striatal dopaminergic function were explored. RESULTS The automatic quantification of RWA significantly differentiated RBD from non-RBD subjects (AUC = 0.86), although with lower accuracy compared with conventional visual scoring (AUC = 0.99). No significant correlation was found between RWA and nigro-striatal dopaminergic function. CONCLUSION The automatic quantification of RWA is a reliable tool to identify subjects with RBD and may be used as a first-line screening tool, but without correlations with nigro-striatal dopaminergic functioning.
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Affiliation(s)
- Raffaele Mancini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
- Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Francesco Famà
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Laura Giorgetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesco Calizzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Miki Nikolic
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Rune Frandsen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Silvia Morbelli
- Nuclear Medicine Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Clinica Neurologica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Neurofisiopatologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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24
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Date S, Sumi Y, Fujiwara K, Imai M, Ogawa K, Kadotani H. Polysomnographic features prior to dream enactment behaviors in isolated rapid eye movement sleep behavior disorder. Clin Neurophysiol 2024; 166:74-86. [PMID: 39128209 DOI: 10.1016/j.clinph.2024.07.013] [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: 12/16/2023] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE This study aimed to identify electroencephalogram correlates of dream enactment behaviors (DEBs) and elucidate their cortical dynamics in patients with isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS This cross-sectional study included 15 patients with iRBD. Two REM sleep periods in routine polysomnography were compared: the 60 s preceding the DEBs ("pre-representative behavior" [preR]), and the 60 s with the least submental electromyogram activity ("background" [BG]). Six EEG frequency bands and electrooculogram were analyzed; power spectra, coherence and phase-locking values in four 15-s periods were examined to assess trends. These indices were also compared between preR and BG. RESULTS Compared with BG, significantly higher delta power in the F3 channel and gamma power in the F4 and O2 channels were observed during preR. For functional connectivity, the widespread beta-band connectivity was significantly increased during preR than BG. CONCLUSION Before notable REM sleep behaviors, uneven distributed higher EEG spectral power in both very low and high frequencies, and increased wide-range beta band functional connectivity, were observed over 60 s, suggesting cortical correlates to subsequent DEBs. SIGNIFICANCE This study may shed light on the pathological mechanisms underlies RBD through the routine vPSG analysis, leading to detection of DEBs.
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Affiliation(s)
- Shumpei Date
- Department of Materials Process Engineering, Nagoya University, Nagoya, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Koichi Fujiwara
- Department of Materials Process Engineering, Nagoya University, Nagoya, Japan.
| | - Makoto Imai
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan; Shiga Sleep Clinic, Shiga, Japan
| | - Keiko Ogawa
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
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25
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Iranzo A, Cochen De Cock V, Fantini ML, Pérez-Carbonell L, Trotti LM. Sleep and sleep disorders in people with Parkinson's disease. Lancet Neurol 2024; 23:925-937. [PMID: 38942041 DOI: 10.1016/s1474-4422(24)00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 06/30/2024]
Abstract
Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity. The clinical evaluation of sleep disorders include both subjective (eg, questionnaires or diaries) and objective (eg, actigraphy or video polysomnography) assessments. The management of patients with Parkinson's disease and a sleep disorder is challenging and should be individualised. Treatment can include education aiming at changes in behaviour (ie, sleep hygiene), cognitive behavioural therapy, continuous dopaminergic stimulation at night, and specific medications. REM sleep behaviour disorder can occur several years before the onset of parkinsonism, suggesting that the implementation of trials of neuroprotective therapies should focus on people with this sleep disorder.
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Affiliation(s)
- Alex Iranzo
- Sleep Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBERNED, Universitat de Barcelona, Barcelona, Spain.
| | - Valerie Cochen De Cock
- Sleep and Neurology Department, Beau Soleil Clinic, Montpellier, France; EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - María Livia Fantini
- Neurophysiology Unit, Neurology Department, Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Emory Sleep Center, Emory University School of Medicine, Atlanta, GA, USA
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26
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Cesari M, Portscher A, Stefani A, Angerbauer R, Ibrahim A, Brandauer E, Feuerstein S, Egger K, Högl B, Rodriguez-Sanchez A. Machine Learning Predicts Phenoconversion from Polysomnography in Isolated REM Sleep Behavior Disorder. Brain Sci 2024; 14:871. [PMID: 39335367 PMCID: PMC11430259 DOI: 10.3390/brainsci14090871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/19/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024] Open
Abstract
Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is a prodromal stage of alpha-synucleinopathies. This study aimed at developing a fully-automated machine learning framework for the prediction of phenoconversion in patients with iRBD by using data recorded during polysomnography (PSG). A total of 66 patients with iRBD were included, of whom 18 converted to an overt alpha-synucleinopathy within 2.7 ± 1.0 years. For each patient, a baseline PSG was available. Sleep stages were scored automatically, and time and frequency domain features were derived from electromyography (EMG) and electroencephalography (EEG) signals in REM and non-REM sleep. Random survival forest was employed to predict the time to phenoconversion, using a four-fold cross-validation scheme and by testing several combinations of features. The best test performances were obtained when considering EEG features in REM sleep only (Harrel's C-index: 0.723 ± 0.113; Uno's C-index: 0.741 ± 0.11; integrated Brier score: 0.174 ± 0.06). Features describing EEG slowing had high importance for the machine learning model. This is the first study employing machine learning applied to PSG to predict phenoconversion in patients with iRBD. If confirmed in larger cohorts, these findings might contribute to improving the design of clinical trials for neuroprotective treatments.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Andrea Portscher
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Computer Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Raphael Angerbauer
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Simon Feuerstein
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Department of Computer Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Kristin Egger
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Rosinvil T, Postuma RB, Rahayel S, Bellavance A, Daneault V, Montplaisir J, Lina JM, Carrier J, Gagnon JF. Clinical symptoms and neuroanatomical substrates of daytime sleepiness in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:149. [PMID: 39122721 PMCID: PMC11316005 DOI: 10.1038/s41531-024-00734-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/07/2024] [Indexed: 08/12/2024] Open
Abstract
Clinical and neuroanatomical correlates of daytime sleepiness in Parkinson's disease (PD) remain inconsistent in the literature. Two studies were conducted here. The first evaluated the interrelation between non-motor and motor symptoms, using a principal component analysis, associated with daytime sleepiness in PD. The second identified the neuroanatomical substrates associated with daytime sleepiness in PD using magnetic resonance imaging (MRI). In the first study, 77 participants with PD completed an extensive clinical, cognitive testing and a polysomnographic recording. In the second study, 29 PD participants also underwent MRI acquisition of T1-weighted images. Vertex-based cortical and subcortical surface analysis, deformation-based morphometry, and voxel-based morphometry were performed to assess the association between daytime sleepiness severity and structural brain changes in participants. In both studies, the severity of daytime sleepiness and the presence of excessive daytime sleepiness (EDS; total score >10) were measured using the Epworth Sleepiness Scale. We found that individuals with EDS had a higher score on a component including higher dosage of dopamine receptor agonists, motor symptoms severity, shorter sleep latency, and greater sleep efficiency. Moreover, increased daytime sleepiness severity was associated with a larger surface area in the right insula, contracted surfaces in the right putamen and right lateral amygdala, and a larger surface in the right posterior amygdala. Hence, daytime sleepiness in PD was associated with dopaminergic receptor agonists dosage, motor impairment, and objective sleep measures. Moreover, neuroanatomical changes in cortical and subcortical regions related to vigilance, motor, and emotional states were associated with more severe daytime sleepiness.
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Affiliation(s)
- Thaïna Rosinvil
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Research Center, Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Ronald B Postuma
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Neurology, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Shady Rahayel
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Amélie Bellavance
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Research Center, Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
- Department of Electrical Engineering, École de Technologie Supérieure, Montreal, QC, Canada
- Centre de Recherches Mathématiques, Université de Montréal, Montreal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada.
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.
- Research Center, Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada.
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada.
- Department of Psychology, Université de Montréal, Montreal, QC, Canada.
- Research Center, Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada.
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.
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28
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Jones MB, Schenck CH, Azarian M, Jorge RE, Sharafkhaneh A, Razjouyan J. Validation of electronic diagnostic codes for rapid eye movement sleep behavior disorder. J Clin Sleep Med 2024; 20:1387-1389. [PMID: 38661648 PMCID: PMC11294125 DOI: 10.5664/jcsm.11190] [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: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024]
Abstract
We investigated the accuracy of International Classification of Diseases (ICD) codes for the identification of veterans with rapid eye movement sleep behavior disorder. The charts of 139 randomly sampled veterans with ≥ 1 ICD-9 and ICD-10 code(s) for rapid eye movement sleep behavior disorder were reviewed for documentation of a suspected, previous, or current diagnosis; clinical symptoms; and/or empiric treatments for this disorder. Notably, 71 (51.1%) patients with rapid eye movement sleep behavior disorder electronic diagnoses had not undergone polysomnography, and 29 (20.9%) had polysomnography reports without commentary on rapid eye movement sleep without atonia. Sleep centers are therefore encouraged to include a brief sentence in polysomnography report templates commenting on the presence/absence of rapid eye movement sleep without atonia. CITATION Jones MB, Schenck CH, Azarian M, Jorge RE, Sharafkhaneh A, Razjouyan J. Validation of electronic diagnostic codes for rapid eye movement sleep behavior disorder. J Clin Sleep Med. 2024;20(8);1387-1389.
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Affiliation(s)
- Melissa B. Jones
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | | | - Ricardo E. Jorge
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Amir Sharafkhaneh
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | - Javad Razjouyan
- Michael E. DeBakey VA Medical Center, Houston, Texas
- Baylor College of Medicine, Houston, Texas
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29
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Wang X, Pan Y, Marcuse LV, Yuan N, Liu Y. Clinical and video-polysomnographic characterization of restless sleep disorder in adult patients. Sleep Biol Rhythms 2024; 22:395-402. [PMID: 38962786 PMCID: PMC11217213 DOI: 10.1007/s41105-024-00524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 07/05/2024]
Abstract
Adults with restless sleep disorder (RSD) have never been studied clinically and polysomnographically. This study aimed to describe the clinical manifestation, duration, and distribution of sleep-related movements in adult patients with restless sleep disorder. Patients who had performed VPSG from Jan 2021 to Jan 2022 and met the diagnosis criteria of RSD were enrolled in the study. Patients' bed partners were also interviewed or telephoned in identifying this disorder. Scoring of movements during sleep was according to the diagnosis criteria of RSD and scoring of large muscle group movements during sleep proposed by the International RLS Study Group in 2020 and 2021, respectively. The clinical manifestation, the distribution of sleep stage as well as the types and duration of the movements were carefully recorded and analyzed. We included ten patients in the study with a mean age of 27.6 years (range 22-38). There was a male prevalence in adults with RSD. The study highlighted the findings from video-polysomnography, which indicated frequent sleep-related movements occurring throughout the Night. These movements were most prominent during N1 and N2 sleep stage, followed by REM sleep, while fewer movements were observed during N3 sleep. Adults with RSD experienced significant daytime functioning impairments, including non-refreshing sleep, daytime fatigue/sleepiness, and mood disturbance. Two of the patients in the study were diagnosed with anxiety and depression, further underscoring the impact of RSD on mental health. Adult patients also suffer from severe RSD, and the RSD that originates in childhood tends to persist into adulthood. In these cases, longer duration of the disease and poor sleep quality may be associated with an increased risk of developing psychiatric comorbidities. Our cases represent an objectively documented type of RSD in younger adult patients. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-024-00524-1.
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Affiliation(s)
- Xiaoli Wang
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yuanhang Pan
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Lara V. Marcuse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY 10019 USA
| | - Na Yuan
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yonghong Liu
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Feuerstein S, Stefani A, Angerbauer R, Egger K, Ibrahim A, Holzknecht E, Hogl B, Rodriguez-Sanchez A, Cesari M. Sleep structure discriminates patients with isolated REM sleep behavior disorder: a deep learning approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2024; 2024:1-4. [PMID: 40039123 DOI: 10.1109/embc53108.2024.10782600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a disorder characterized by increased muscle tone and dream-enactment behaviors in REM sleep. In its isolated form (iRBD), it is a prodromal stage of neurodegenerative diseases. Currently, diagnosis of RBD requires time-consuming and subjective visual inspection of polysomnography (PSG). We propose a novel fast and objective deep learning model to identify patients with iRBD based on their sleep structure. A total of 86 iRBD and 81 controls, who underwent PSG, were included in the study. A validated algorithm was used to generate hypnodensity graphs (i.e., probabilistic representations of sleep structure). A ResNet-18 model was trained on five datasets consisting of whole night hypnodensities (with and without augmentation), and shorter segments (4 hours, 2 hours, and 30 minutes) to discriminate iRBD from controls. Using entire-night hypnodensity had notable benefits in terms of performance compared to shorter length segments, leading to a mean macro F1 score of 0.717 (per-segment), and of 0.784 (per-subject). Our findings show that sleep structure is important for iRBD classification and could potentially help clinicians.
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31
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Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024; 13:885-906. [PMID: 38720013 PMCID: PMC11136939 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
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Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [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: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Bramich S, Noyce AJ, King AE, Naismith SL, Kuruvilla MV, Lewis SJG, Roccati E, Bindoff AD, Barnham KJ, Beauchamp LC, Vickers JC, Pérez-Carbonell L, Alty J. Isolated rapid eye movement sleep behaviour disorder (iRBD) in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study: protocol and baseline characteristics. J Sleep Res 2024; 33:e14109. [PMID: 38014898 DOI: 10.1111/jsr.14109] [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: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a sleep disorder that is characterised by dream enactment episodes during REM sleep. It is the strongest known predictor of α-synuclein-related neurodegenerative disease (αNDD), such that >80% of people with iRBD will eventually develop Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy in later life. More research is needed to understand the trajectory of phenoconversion to each αNDD. Only five 'gold standard' prevalence studies of iRBD in older adults have been undertaken previously, with estimates ranging from 0.74% to 2.01%. The diagnostic recommendations for video-polysomnography (vPSG) to confirm iRBD makes prevalence studies challenging, as vPSG is often unavailable to large cohorts. In Australia, there have been no iRBD prevalence studies, and little is known about the cognitive and motor profiles of Australian people with iRBD. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study will investigate the prevalence of iRBD in Tasmania, an island state of Australia, using validated questionnaires and home-based vPSG. It will also explore several cognitive, motor, olfactory, autonomic, visual, tactile, and sleep profiles in people with iRBD to better understand which characteristics influence the progression of iRBD to αNDD. This paper details the ISLAND Sleep Study protocol and presents preliminary baseline results.
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Affiliation(s)
- Samantha Bramich
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Simon J G Lewis
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Kevin J Barnham
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Leah C Beauchamp
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Laura Pérez-Carbonell
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia
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34
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Ingravallo F, D'Alterio A, Rossetti A, Antelmi E, Plazzi G. Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts' Perspective. Mov Disord Clin Pract 2024; 11:488-495. [PMID: 38341655 PMCID: PMC11078490 DOI: 10.1002/mdc3.13998] [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: 07/24/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated. OBJECTIVES The aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure. METHODS In this qualitative study, semi-structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach. RESULTS We interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video-polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient-tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient-physician relationship, while they had contrasting views regarding patients' previous knowledge. CONCLUSIONS Sleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients' and families' preferences.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Alessandra D'Alterio
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Rossetti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Elena Antelmi
- Department of Engineering and Medicine of Innovation (DIMI)University of VeronaVeronaItaly
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
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Nejad A, de Haan GA, Heutink J, Cornelissen FW. ACE-DNV: Automatic classification of gaze events in dynamic natural viewing. Behav Res Methods 2024; 56:3300-3314. [PMID: 38448726 PMCID: PMC11133063 DOI: 10.3758/s13428-024-02358-8] [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] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
Eye movements offer valuable insights for clinical interventions, diagnostics, and understanding visual perception. The process usually involves recording a participant's eye movements and analyzing them in terms of various gaze events. Manual identification of these events is extremely time-consuming. Although the field has seen the development of automatic event detection and classification methods, these methods have primarily focused on distinguishing events when participants remain stationary. With increasing interest in studying gaze behavior in freely moving participants, such as during daily activities like walking, new methods are required to automatically classify events in data collected under unrestricted conditions. Existing methods often rely on additional information from depth cameras or inertial measurement units (IMUs), which are not typically integrated into mobile eye trackers. To address this challenge, we present a framework for classifying gaze events based solely on eye-movement signals and scene video footage. Our approach, the Automatic Classification of gaze Events in Dynamic and Natural Viewing (ACE-DNV), analyzes eye movements in terms of velocity and direction and leverages visual odometry to capture head and body motion. Additionally, ACE-DNV assesses changes in image content surrounding the point of gaze. We evaluate the performance of ACE-DNV using a publicly available dataset and showcased its ability to discriminate between gaze fixation, gaze pursuit, gaze following, and gaze shifting (saccade) events. ACE-DNV exhibited comparable performance to previous methods, while eliminating the necessity for additional devices such as IMUs and depth cameras. In summary, ACE-DNV simplifies the automatic classification of gaze events in natural and dynamic environments. The source code is accessible at https://github.com/arnejad/ACE-DNV .
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Affiliation(s)
- Ashkan Nejad
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands.
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Gera A de Haan
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Joost Heutink
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Puigròs M, Calderon A, Martín-Ruiz D, Serradell M, Fernández M, Muñoz-Lopetegi A, Mayà G, Santamaria J, Gaig C, Colell A, Tolosa E, Iranzo A, Trullas R. Mitochondrial DNA deletions in the cerebrospinal fluid of patients with idiopathic REM sleep behaviour disorder. EBioMedicine 2024; 102:105065. [PMID: 38502973 PMCID: PMC10963194 DOI: 10.1016/j.ebiom.2024.105065] [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: 09/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Idiopathic rapid eye movement (REM) sleep behaviour disorder (IRBD) represents the prodromal stage of Lewy body disorders (Parkinson's disease (PD) and dementia with Lewy bodies (DLB)) which are linked to variations in circulating cell-free mitochondrial DNA (cf-mtDNA). Here, we assessed whether altered cf-mtDNA release and integrity are already present in IRBD. METHODS We used multiplex digital PCR (dPCR) to quantify cf-mtDNA copies and deletion ratio in cerebrospinal fluid (CSF) and serum in a cohort of 71 participants, including 1) 17 patients with IRBD who remained disease-free (non-converters), 2) 34 patients initially diagnosed with IRBD who later developed either PD or DLB (converters), and 3) 20 age-matched controls without IRBD or Parkinsonism. In addition, we investigated whether CD9-positive extracellular vesicles (CD9-EVs) from CSF and serum samples contained cf-mtDNA. FINDINGS Patients with IRBD, both converters and non-converters, exhibited more cf-mtDNA with deletions in the CSF than controls. This finding was confirmed in CD9-EVs. The high levels of deleted cf-mtDNA in CSF corresponded to a significant decrease in cf-mtDNA copies in CD9-EVs in both IRBD non-converters and converters. Conversely, a significant increase in cf-mtDNA copies was found in serum and CD9-EVs from the serum of patients with IRBD who later converted to a Lewy body disorder. INTERPRETATION Alterations in cf-mtDNA copy number and deletion ratio known to occur in Lewy body disorders are already present in IRBD and are not a consequence of Lewy body disease conversion. This suggests that mtDNA dysfunction is a primary molecular mechanism of the pathophysiological cascade that precedes the full clinical motor and cognitive manifestation of Lewy body disorders. FUNDING Funded by Michael J. Fox Foundation research grant MJFF-001111. Funded by MICIU/AEI/10.13039/501100011033 "ERDF A way of making Europe", grants PID2020-115091RB-I00 (RT) and PID2022-143279OB-I00 (ACo). Funded by Instituto de Salud Carlos III and European Union NextGenerationEU/PRTR, grant PMP22/00100 (RT and ACo). Funded by AGAUR/Generalitat de Catalunya, grant SGR00490 (RT and ACo). MP has an FPI fellowship, PRE2018-083297, funded by MICIU/AEI/10.13039/501100011033 "ESF Investing in your future".
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Affiliation(s)
- Margalida Puigròs
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; Neurophysiology Laboratory, School of Medicine, Institute of Neurosciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Anna Calderon
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Daniel Martín-Ruiz
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Mònica Serradell
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Manel Fernández
- Parkinson's disease and Movement Disorders Unit, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Gerard Mayà
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Anna Colell
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Eduard Tolosa
- Parkinson's disease and Movement Disorders Unit, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Ramon Trullas
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain.
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Sadoc M, Clairembault T, Coron E, Berthomier C, Le Dily S, Vavasseur F, Pavageau A, St Louis EK, Péréon Y, Neunlist M, Derkinderen P, Leclair-Visonneau L. Wake and non-rapid eye movement sleep dysfunction is associated with colonic neuropathology in Parkinson's disease. Sleep 2024; 47:zsad310. [PMID: 38156524 DOI: 10.1093/sleep/zsad310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/04/2023] [Indexed: 12/30/2023] Open
Abstract
STUDY OBJECTIVES The body-first Parkinson's disease (PD) hypothesis suggests initial gut Lewy body pathology initially propagates to the pons before reaching the substantia nigra, and subsequently progresses to the diencephalic and cortical levels, a disease course presumed to likely occur in PD with rapid eye movement sleep behavior disorder (RBD). We aimed to explore the potential association between colonic phosphorylated alpha-synuclein histopathology (PASH) and diencephalic or cortical dysfunction evidenced by non-rapid eye movement (NREM) sleep and wakefulness polysomnographic markers. METHODS In a study involving 43 patients with PD who underwent clinical examination, rectosigmoidoscopy, and polysomnography, we detected PASH on colonic biopsies using whole-mount immunostaining. We performed a visual semi-quantitative analysis of NREM sleep and wake electroencephalography (EEG), confirmed it with automated quantification of spindle and slow wave features of NREM sleep, and the wake dominant frequency, and then determined probable Arizona PD stage classifications based on sleep and wake EEG features. RESULTS The visual analysis aligned with the automated quantified spindle characteristics and the wake dominant frequency. Altered NREM sleep and wake parameters correlated with markers of PD severity, colonic PASH, and RBD diagnosis. Colonic PASH frequency also increased in parallel to probable Arizona PD stage classifications. CONCLUSIONS Colonic PASH is strongly associated with widespread brain sleep and wake dysfunction, suggesting an extensive diffusion of the pathologic process in PD. Visual and automated analyses of polysomnography signals provide useful markers to gauge covert brain dysfunction in PD. CLINICAL TRIAL Name: SYNAPark, URL: https://clinicaltrials.gov/study/NCT01748409, registration: NCT01748409.
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Affiliation(s)
- Mathilde Sadoc
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- Department of Neurology, CHU Nantes, Nantes, France
| | - Thomas Clairembault
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Emmanuel Coron
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Inserm, CIC-04, Nantes, France
| | | | | | - Fabienne Vavasseur
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Inserm, CIC-04, Nantes, France
| | - Albane Pavageau
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
| | - Erik K St Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Department of Neurology, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Yann Péréon
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- Nantes Université, Nantes, France
| | - Michel Neunlist
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Pascal Derkinderen
- Department of Neurology, CHU Nantes, Nantes, France
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- Inserm, CIC-04, Nantes, France
| | - Laurène Leclair-Visonneau
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- Inserm, CIC-04, Nantes, France
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38
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Jones BM, McCarter SJ. Rapid Eye Movement Sleep Behavior Disorder: Clinical Presentation and Diagnostic Criteria. Sleep Med Clin 2024; 19:71-81. [PMID: 38368071 DOI: 10.1016/j.jsmc.2023.10.004] [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: 02/19/2024]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) classically presents with repetitive complex motor behavior during sleep with associated dream mentation. The diagnosis requires a history of repetitive complex motor behaviors and polysomnographic demonstration of REM sleep without atonia (RSWA) or capturing dream enactment behaviors. RSWA is best evaluated in the chin or flexor digitorum superficialis muscles. The anterior tibialis muscle is insufficiently accurate to be relied upon solely for RBD diagnosis. RBD may present with parkinsonism or cognitive impairment or may present in isolation. Patients should be monitored for parkinsonism, autonomic failure, or cognitive impairment.
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Affiliation(s)
- Brandon M Jones
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Stuart J McCarter
- Department of Neurology; Center for Sleep Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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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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Perinova P, Nepozitek J, Dostalova S, Bezdicek O, Ruzicka E, Dusek P, Sonka K. Comparison of quantitative REM without atonia parameters in isolated REM sleep behavior disorder and early untreated Parkinson's disease. Sleep Med 2024; 114:290-296. [PMID: 38295508 DOI: 10.1016/j.sleep.2024.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To analyze REM sleep without atonia (RWA) metrics in patients with isolated REM sleep behavior disorder (iRBD), Parkinson's disease (PD) and healthy subjects and compare them in terms of degree of presumed brainstem damage. METHODS Forty-nine iRBD patients, 62 PD patients and 38 healthy controls were included into the analysis. Detailed polysomnographic and clinical data including motor, olfactory, autonomic, and cognitive assessment were obtained in all participants and subsequently compared within groups without RBD (i.e., healthy controls, PD-RBD-) and with RBD (i.e., iRBD, PD-RBD+). SINBAR criteria were used to score RWA. RESULTS Twenty-one PD patients (33.8 %) had RBD. When comparing PD-RBD-patients and controls, RWA tonic (p = 0.001) and RWA mixed (p = 0.03) were higher in PD-RBD-group. PD-RBD-patients had worse olfactory function than controls (p < 0.001); no significant difference in autonomic or cognitive function was registered. There were no significant differences in RWA parameters when comparing iRBD and PD-RBD + groups. iRBD patients had better olfactory function than PD-RBD+ (p = 0.006); no significant difference in autonomic or cognitive function was registered. PD-RBD + had worse autonomic (p = 0.006) and olfactory (p = 0.001) but not motor and cognitive function compared to PD-RBD-. CONCLUSIONS Untreated de-novo PD patients without RBD have increased RWA metrics compared to healthy subjects indicating subclinical degeneration of brainstem nuclei responsible for RWA. iRBD patients do not differ in RWA metrics from untreated de-novo PD patients with premotor RBD suggesting a similar level of brainstem degeneration caudal to substantia nigra in both groups. Groups with RBD are associated with autonomic dysfunction.
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Affiliation(s)
- Pavla Perinova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Bergmann M, Högl B, Stefani A. Clinical neurophysiology of REM parasomnias: Diagnostic aspects and insights into pathophysiology. Clin Neurophysiol Pract 2024; 9:53-62. [PMID: 38328386 PMCID: PMC10847011 DOI: 10.1016/j.cnp.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/17/2023] [Accepted: 10/22/2023] [Indexed: 02/09/2024] Open
Abstract
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity. Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology. RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation. Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
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Lee WJ, Baek SH, Im HJ, Lee SK, Yoon JE, Thomas RJ, Wing YK, Shin C, Yun CH. REM Sleep Behavior Disorder and Its Possible Prodromes in General Population: Prevalence, Polysomnography Findings, and Associated Factors. Neurology 2023; 101:e2364-e2375. [PMID: 37816644 PMCID: PMC10752649 DOI: 10.1212/wnl.0000000000207947] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the prevalence of REM sleep behavior disorder (RBD) and its possible prodromal conditions, isolated dream enactment behavior (DEB) and isolated REM without atonia (RWA), in a general population sample, and the factors associated with diagnosis and symptom frequency. METHODS From a population-based prospective cohort in Korea, 1,075 participants (age 60.1 ± 7.0 years; range 50-80 years; men 53.7%) completed the RBD screening questionnaire (RBDSQ), a structured telephone interview for the presence and characteristics of repeated DEB, and home polysomnography (PSG). RWA was measured on submentalis EMG, including 30-second epoch-based tonic and phasic activity as well as 3-second mini-epoch-based phasic and any EMG activities. Based on the presence of repeated DEB and any EMG activity of ≥22.3%, we categorized the participants into no RBD, isolated RWA, isolated DEB, and RBD groups. RESULTS RBD was diagnosed in 20 participants, isolated RWA in 133 participants, and isolated DEB in 48 participants. Sex and DEB frequency-adjusted prevalence of RBD was 1.4% (95% CI 1.0%-1.8%), isolated RWA was 12.5% (95% CI 11.3%-13.6%), and isolated DEB was 3.4% (95% CI 2.7%-4.1%). Total RBDSQ score was higher in the RBD and isolated DEB groups than in the isolated RWA and no RBD group (median 5 [interquartile range (IQR) 4-6] for RBD, median 4 [IQR 3-6] for isolated DEB, median 2 [IQR 1-3] for isolated RWA, and median 2 [IQR 1-4] for no RBD groups, p < 0.001). RBDSQ score of ≥5 had good specificity but poor positive predictive value (PPV) for RBD (specificity 84.1% and PPV 7.7%) and its prodromal conditions (specificity 85.2% and PPV 29.1%). Among the RWA parameters, any EMG activity showed the best association with the RBD and its possible prodromes (area under the curve, 0.917). Three-second mini-epoch-based EMG activity and phasic EMG activity were correlated with the frequency of DEB (standardized Jonckheere-Terpstra statistic [std. J-T static] for trend = 0.488, p < 0.001, and std. J-T static = 3.265, p = 0.001, respectively). DISCUSSION This study provides prevalence estimates of RBD and its possible prodromal conditions based on a structured telephone interview and RWA measurement on PSG from the general population.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Shin-Hye Baek
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Hee-Jin Im
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Seung-Ku Lee
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Jee-Eun Yoon
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Robert J Thomas
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Yun-Kwok Wing
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Chol Shin
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea.
| | - Chang-Ho Yun
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea.
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Wang J, Lam SP, Huang B, Liu Y, Zhang J, Yu MWM, Tsang JCC, Zhou L, Chau SWH, Chan NY, Chan JWY, Schenck CH, Li SX, Mok VCT, Ma KKY, Chan AYY, Wing YK. Familial α-synucleinopathy spectrum features in patients with psychiatric REM sleep behaviour disorder. J Neurol Neurosurg Psychiatry 2023; 94:893-903. [PMID: 37399287 DOI: 10.1136/jnnp-2022-330922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/28/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behaviour disorder (RBD) is one of the earliest and most specific prodromes of the α-synucleinopathies including Parkinson's disease (PD). It remains uncertain whether RBD occurring in the context of psychiatric disorders (psy-RBD), although very common, is merely a benign epiphenomenon of antidepressant treatment, or whether it harbours an underlying α-synucleinopathy. We hypothesised that patients with psy-RBD demonstrate a familial predisposition to an α-synucleinopathy. METHODS In this case-control-family study, a combination of family history and family study method was used to measure the α-synucleinopathy spectrum features, which included RBD, neurodegenerative prodromal markers and clinical diagnoses of neurodegenerative disorders. We compared the risk of α-synucleinopathy spectrum features in the first-degree relatives (FDRs) of patients with psy-RBD, psychiatric controls and healthy controls. RESULTS There was an increase of α-synucleinopathy spectrum features in the psy-RBD-FDRs, including possible and provisional RBD (adjusted HR (aHR)=2.02 and 6.05, respectively), definite RBD (adjusted OR=11.53) and REM-related phasic electromyographic activities, prodromal markers including depression (aHR=4.74) and probable subtle parkinsonism, risk of prodromal PD and clinical diagnosis of PD/dementia (aHR=5.50), as compared with healthy-control-FDRs. When compared with psychiatric-control-FDRs, psy-RBD-FDRs consistently presented with a higher risk for the diagnosis and electromyographic features of RBD, diagnosis of PD/dementia (aHR=3.91) and risk of prodromal PD. In contrast, psychiatric controls only presented with a familial aggregation of depression. CONCLUSION Patients with psy-RBD are familially predisposed to α-synucleinopathy. The occurrence of RBD with major depression may signify a subtype of major depressive disorders with underlying α-synucleinopathy neurodegeneration. TRIAL REGISTRATION NUMBER NCT03595475.
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Affiliation(s)
- Jing Wang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 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, Hong Kong SAR, China
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mandy W M Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessie C C Tsang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Zhou
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Steven W H Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 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, Hong Kong SAR, China
| | - Joey W Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Shirley X Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent C T Mok
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Karen Ka Yan Ma
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Yin Yan Chan
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 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, Hong Kong SAR, China
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Townsend LTJ, Anderson KN, Boeve BF, McKeith I, Taylor JP. Sleep disorders in Lewy body dementia: Mechanisms, clinical relevance, and unanswered questions. Alzheimers Dement 2023; 19:5264-5283. [PMID: 37392199 DOI: 10.1002/alz.13350] [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: 12/21/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions.
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Affiliation(s)
- Leigh T J Townsend
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Sadoc M, Clairembault T, Coron E, Berthomier C, Le Dily S, Vavasseur F, Pavageau A, St Louis EK, Péréon Y, Neunlist M, Derkinderen P, Leclair-Visonneau L. Wake and non-rapid eye movement sleep dysfunction is associated with colonic neuropathology in Parkinson's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296499. [PMID: 37873268 PMCID: PMC10593030 DOI: 10.1101/2023.10.03.23296499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Study Objectives The body-first Parkinson's disease (PD) hypothesis suggests initial gut Lewy body pathology that propagates to the pons before reaching the substantia nigra, and subsequently progresses to the diencephalic and cortical levels. This disease course may also be the most likely in PD with rapid eye movement sleep behavior disorder (RBD). Objectives We aimed to explore the potential association between colonic phosphorylated alpha-synuclein histopathology (PASH) and diencephalic or cortical dysfunction evidenced by non-rapid eye movement (NREM) sleep and wakefulness polysomnographic markers. Methods In a study involving 43 patients with PD who underwent clinical examination, rectosigmoidoscopy, and polysomnography, we detected PASH on colonic biopsies using whole-mount immunostaining. We performed a visual semi-quantitative and automated quantification of spindle and slow wave features of NREM sleep, and the wake dominant frequency, and then determined Braak and Arizona stage classifications for PD severity based on sleep and wake electroencephalographic features. Results The visual analysis aligned with the automated quantified spindle characteristics and the wake dominant frequency. Altered NREM sleep and wake parameters correlated with markers of PD severity, colonic PASH, and RBD diagnosis. Colonic PASH frequency also increased in parallel to presumed PD Braak and Arizona stage classifications. Conclusions Colonic PASH in PD is strongly associated with widespread brain sleep and wake dysfunction, pointing toward likely extensive diffusion of the pathological process in the presumptive body-first PD phenotype. Visual and automated analyses of polysomnography signals provide useful markers to gauge covert brain dysfunction in PD. Statement of Significance The presence of gut synucleinopathy in Parkinson's disease can be linked to the body-first hypothesis in its pathophysiology. This study, performed in a cohort of 43 patients with Parkinson's disease that underwent clinical assessment, rectosigmoidoscopy and polysomnography, provides evidence that colonic neuropathology in Parkinson's disease is associated with widespread brain dysfunction, as evaluated by wake and non-rapid eye movement sleep polysomnographic markers. Our results support the assumption of an extensive diffusion of the pathological process to diencephalic and neocortical structures in the presumptive body-first phenotype. They also suggest the use of routine polysomnography in phenotyping patients with Parkinson's disease. Future studies should investigate the brain diffusion pattern and its sleep markers in the hypothesized brain-first phenotype of Parkinson's disease.
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Oz S, Dagay A, Katzav S, Wasserman D, Tauman R, Gerston A, Duncan I, Hanein Y, Mirelman A. Monitoring sleep stages with a soft electrode array: Comparison against vPSG and home-based detection of REM sleep without atonia. J Sleep Res 2023; 32:e13909. [PMID: 37132065 DOI: 10.1111/jsr.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 05/04/2023]
Abstract
Sleep disorders are symptomatic hallmarks of a variety of medical conditions. Accurately identifying the specific stage in which these disorders occur is particularly important for the correct diagnosis of non-rapid eye movement and rapid eye movement parasomnias. In-lab polysomnography suffers from limited availability and does not reflect habitual sleep conditions, which is especially important in older adults and those with neurodegenerative diseases. We aimed to explore the feasibility and validity of a new wearable system for accurately measuring sleep at home. The system core technology is soft, printed dry electrode arrays and a miniature data acquisition unit with a cloud-based data storage for offline analysis. The positions of the electrodes allow manual scoring following the American Association of Sleep Medicine guidelines. Fifty participants (21 healthy subjects, mean age 56.6 ± 8.4 years; and 29 patients with Parkinson's disease, 65.4 ± 7.6 years) underwent a polysomnography evaluation with parallel recording with the wearable system. Total agreement between the two systems reached Cohen's kappa (k) of 0.688 with agreement in each stage of: wake k = 0.701; N1 = 0.224; N2 = 0.584; N3 = 0.410; and rapid eye movement = 0.723. Moreover, the system reliably detected rapid eye movement sleep without atonia with a sensitivity of 85.7%. Additionally, a comparison between sleep as measured in the sleep lab with data collected from a night at home showed significantly lower wake after sleep onset at home. The results demonstrate that the system is valid, accurate and allows for the exploration of sleep at home. This new system offers an opportunity to help detect sleep disorders on a larger scale than possible today, fostering better care.
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Affiliation(s)
- Shani Oz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Andrew Dagay
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Iain Duncan
- Sleep Disorders Centre, St Thomas' and Guy's Hospital, GSTT NHS, London, UK
| | - Yael Hanein
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- X-trodes, Herzelia, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Figorilli M, Meloni F, Lecca R, Tamburrino L, Mascia MG, Cocco V, Meloni M, Marques AR, Vidal T, Congiu P, Defazio G, Durif F, Lanza G, Ferri R, Schenck CH, Fantini ML, Puligheddu M. Severity of REM sleep without atonia correlates with measures of cognitive impairment and depressive symptoms in REM sleep behaviour disorder. J Sleep Res 2023; 32:e13880. [PMID: 36998161 DOI: 10.1111/jsr.13880] [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: 01/12/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to correlate REM sleep without atonia (RSWA) and neuropsychological data in patients with idiopathic/isolated REM sleep behaviour disorder (iRBD) and those with RBD associated with Parkinson's disease (PDRBD), in order to assess whether higher degrees of RSWA are related to poorer cognitive performance. A total of 142 subjects were enrolled: 48 with iRBD, 55 with PDRBD, and 39 PD without RBD (PDnoRBD). All participants underwent video-polysomnographic recording, clinical and neuropsychological assessment. RSWA was quantified according to two manual scoring methods (Montréal, SINBAR) and one automated (REM atonia index, RAI). Mild cognitive impairment (MCI) was diagnosed according to diagnostic criteria for MCI in Parkinson's disease. The relationship between neuropsychological scores and RSWA metrics was explored by multiple linear regression analysis and logistic regression models. Patients with iRBD showed significantly lower visuospatial functions and working memory, compared with the others. More severe RSWA was associated with a higher risk of reduced visuospatial abilities (OR 0.15), working memory (OR 2.48), attention (OR 2.53), and semantic fluency (OR 0.15) in the iRBD. In the whole group, a greater RSWA was associated with an increased risk for depressive symptoms (OR 3.6). A total of 57(40%) MCI subjects were found (17 iRBD, 26 PDRBD, and 14 PDnoRBD). Preserved REM-atonia was associated with a reduced odds of multi-domain MCI in the whole study population (OR 0.54). In conclusion, a greater severity of RSWA was associated with an increased risk for poor cognitive performance and depressive mood in patients with RBD. Moreover, higher RAI was associated with a lower risk of multi-domain MCI.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Federico Meloni
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Viola Cocco
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Ana Raquel Marques
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Tiphaine Vidal
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Frank Durif
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Giuseppe Lanza
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Livia Fantini
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
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Schenck CH, Cochen de Cock V, Lewis SJG, Tachibana N, Kushida C, Ferri R. Partial endorsement of: "Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: Guidelines from the International RBD Study Group" by the World Sleep Society. Sleep Med 2023; 110:137-145. [PMID: 37579534 DOI: 10.1016/j.sleep.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
Updated guidelines for the video-polysomnography (vPSG) procedures for diagnosing rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages have recently been proposed by the Neurophysiology Working Group of the International RBD Study Group (IRBDSG). These guidelines were selected for review by a World Sleep Society (WSS) Parasomnias Task Force and the WSS International Sleep Medicine Guidelines Committee. A survey was completed by sleep society leaders and prominent sleep clinicians and researchers in 31 WSS member countries across six continents, focused on sleep technologist training and certification; extent of public/private health insurance coverage for the vPSG evaluation of RBD; extent of hospital-based sleep-technologist-attended overnight vPSG studies; availability of video during PSG studies; and sufficient specification of PSG machines to record and analyze REM sleep without atonia. The findings from this survey indicated that most health systems and medical communities across WSS member countries would not be capable of implementing the proposed more stringent guidelines, which would then strongly interfere with the diagnosis of RBD in a large portion of patients who would not be able to receive the required (often repeated) vPSG evaluation. Therefore, the WSS can only partially endorse the updated guidelines and concludes that the current International Classification of Sleep Disorders-3rd edition diagnostic criteria for RBD should still be retained as the standard reference for the diagnosis of RBD, and that further discussion across all members of the IRBDSG should take place to ensure the feasibility of any future proposed changes.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, USA.
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia.
| | | | - Clete Kushida
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, Stanford, CA, USA.
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Montini A, Iranzo A, Cortelli P, Gaig C, Muñoz-Lopetegi A, Provini F, Santamaria J. Scoring sleep in neurodegenerative diseases: A pilot study in the synucleinopathies. Sleep Med 2023; 110:268-286. [PMID: 37678074 DOI: 10.1016/j.sleep.2023.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the stages previously applied in dementia with Lewy Bodies (DLB), anti-IgLON5 disease, and fatal insomnia, and to test it in patients with alpha-synucleinopathies. METHODS Video-polysomnographies (VPSG) of nine patients (DLB:3, Parkinson's disease (PD):3, and multiple system atrophy (MSA):3) selected for their difficulty in applying standard rules were scored independently by two authors, using additional Sleep/Wake stages. These included Abnormal Wake, Subwake, Undifferentiated NREM sleep (UNREM), Poorly structured N2 (P-S N2) and abnormal REM sleep including REM without atonia (RWA), REM without low-amplitude, mixed-frequency EEG activity (RWL) and REM without rapid eye movements (RWR). RESULTS Patients (4 females) had a median age of 74 (range 63-85). Six patients (all with PD or DLB) had abnormal EEG awake and Subwake stage. UNREM sleep was present in all patients, typically at sleep onset, and was the most common sleep stage in five. P-S N2 was recorded only in the three patients with MSA. Periods of normal and abnormal NREM coexisted in three patients. RWA was the predominant REM subtype, RWR occurred mainly in patients with MSA and RWL in those with DLB. Six patients had brief REM episodes into NREM sleep which we termed "Encapsulated RBD". CONCLUSION Our scoring system allows an accurate description of the complex sleep-wake changes in patients with alpha-synucleinopathies.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain.
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Joan Santamaria
- Emeritus Consultant and Researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS), Spain.
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Park K, Shin YW, Hwang S, Jeong E, Kim TJ, Jun JS, Shin JW, Byun JI, Sunwoo JS, Kim HJ, Schenck CH, Jung KY. Quantitative measurement of motor activity during sleep in isolated REM sleep behavior disorder patients using actigraphy before and after treatment with clonazepam. Sleep 2023; 46:zsad132. [PMID: 37155675 DOI: 10.1093/sleep/zsad132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
STUDY OBJECTIVES We conducted a prospective study to quantify motor activity during sleep measured by actigraphy before and after 3 months of treatment with clonazepam in patients with video-polysomnography (vPSG) confirmed isolated rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS The motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphy. Then, we compared quantitative actigraphic measures with the results of the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I), and analyzed correlations between baseline vPSG measures and actigraphic measures. RESULTS Twenty-three iRBD patients were included in the study. After medication treatment, large activity MAA dropped in 39% of patients, and the number of MABs decreased in 30% of patients when applying 50% reduction criteria. 52% of patients showed more than 50% improvement in either one. On the other hand, 43% of patients answered "much or very much improved" on the CGI-I, and RBDQ-3M was reduced by more than half in 35% of patients. However, there was no significant association between the subjective and objective measures. Phasic submental muscle activity during REM sleep was highly correlated with small activity MAA (Spearman's rho = 0.78, p < .001) while proximal and axial movements during REM sleep correlated with large activity MAA (rho = 0.47, p = .030 for proximal movements, rho = 0.47, p = .032 for axial movements). CONCLUSIONS Our findings imply that quantifying motor activity during sleep using actigraphy can objectively assess therapeutic response in drug trials in patients with iRBD.
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Affiliation(s)
- Kyoungeun Park
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Yong Woo Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sungeun Hwang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - El Jeong
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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