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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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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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Brown EG, Chahine LM, Siderowf A, Gochanour C, Kurth R, Marshall MJ, Caspell‐Garcia C, Brumm MC, Stanley CE, Korell M, McMahon B, Kuhl M, Fabrizio K, Heathers L, Concha‐Marambio L, Soto C, Chowdhury S, Coffey CS, Foroud TM, Simuni T, Marek K, Tanner CM, The Parkinson Progression Marker Initiative. Staged Screening Identifies People with Biomarkers Related to Neuronal Alpha-Synuclein Disease. Ann Neurol 2025; 97:730-740. [PMID: 39719857 PMCID: PMC11889527 DOI: 10.1002/ana.27158] [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: 06/17/2024] [Revised: 11/26/2024] [Accepted: 11/28/2024] [Indexed: 12/26/2024]
Abstract
OBJECTIVE Remote identification of individuals with severe hyposmia may enable scalable recruitment of participants with underlying alpha-synuclein aggregation. We evaluated the performance of a staged screening paradigm using remote smell testing to enrich for abnormal dopamine transporter single-photon emission computed tomography imaging (DAT-SPECT) and alpha-synuclein aggregation. METHODS The Parkinson's Progression Markers Initiative (PPMI) recruited participants for the prodromal cohort who were 60-years and older without a Parkinson's disease diagnosis. Participants were invited to complete a University of Pennsylvania Smell Identification Test (UPSIT) independently through an online portal. Hyposmic participants were invited to complete DAT-SPECT, which determined eligibility for enrollment in longitudinal assessments and further biomarker evaluation including cerebrospinal fluid alpha-synuclein seed amplification assay (aSynSAA). RESULTS As of January 29, 2024, 49,843 participants were sent an UPSIT and 31,293 (63%) completed it. Of UPSIT completers, 8,301 (27%) scored <15th percentile. Of 1,546 who completed DAT-SPECT, 1,060 (69%) had DAT-SPECT binding <100% expected for age and sex. Participants with an UPSIT <10th percentile (n = 1,221) had greater likelihood of low DAT-SPECT binding compared to participants with an UPSIT in the 10th to 15th percentile (odds ratio, 3.01; 95% confidence interval, 1.85-4.91). Overall, 55% (198/363) of cases with UPSIT <15th percentile and DAT-SPECT <100% had positive aSynSAA, which increased to 70% (182/260) when selecting for more severe hyposmia (UPSIT <10th percentile). INTERPRETATION Remote screening for hyposmia and reduced DAT-SPECT binding identifies participants with a high proportion positive aSynSAA. Longitudinal data will be essential to define progression patterns in these individuals to ultimately inform recruitment into disease modification clinical trials. ANN NEUROL 2025;97:730-740.
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Affiliation(s)
- Ethan G. Brown
- Department of Neurology, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | - Lana M. Chahine
- Department of NeurologyUniversity of PittsburghPittsburghPAUSA
| | - Andrew Siderowf
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Caroline Gochanour
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIAUSA
| | - Ryan Kurth
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIAUSA
| | - Micah J. Marshall
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIAUSA
| | | | - Michael C. Brumm
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIAUSA
| | | | - Monica Korell
- Department of Neurology, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCAUSA
| | | | | | | | - Laura Heathers
- Department of Medical and Molecular GeneticsIndiana UniversityIndianapolisINUSA
| | | | - Claudio Soto
- AmprionSan DiegoCAUSA
- Department of NeurologyUniversity of Texas McGovern Medical School at HoustonHoustonTAUSA
| | | | - Christopher S. Coffey
- Department of Biostatistics, College of Public HealthUniversity of IowaIowa CityIAUSA
| | - Tatiana M. Foroud
- Department of Medical and Molecular GeneticsIndiana UniversityIndianapolisINUSA
| | - Tanya Simuni
- Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Kenneth Marek
- Institute for Neurodegenerative DisordersNew HavenCTUSA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for NeurosciencesUniversity of California San FranciscoSan FranciscoCAUSA
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Schenck CH. REM sleep behaviour disorder (RBD): Personal perspectives and research priorities. J Sleep Res 2025; 34:e14228. [PMID: 38782758 DOI: 10.1111/jsr.14228] [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: 02/12/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
The formal identification and naming of rapid eye movement (REM) sleep behaviour disorder (RBD) in 1985-1987 is described; the historical background of RBD from 1966 to 1985 is briefly discussed; and RBD milestones are presented. Current knowledge on RBD is identified with reference to recent comprehensive reviews, allowing for a focus on research priorities for RBD: factors and predictors of neurodegenerative phenoconversion from isolated RBD and patient enrolment in neuroprotective trials; isolated RBD clinical research cohorts; epidemiology of RBD; traumatic brain injury, post-traumatic stress disorder, RBD and neurodegeneration; depression, RBD and synucleinopathy; evolution of prodromal RBD to neurodegeneration; gut microbiome dysbiosis and colonic synuclein histopathology in isolated RBD; other alpha-synuclein research in isolated RBD; narcolepsy-RBD; dreams and nightmares in RBD; phasic REM sleep in isolated RBD; RBD, periodic limb movements, periodic limb movement disorder pseudo-RBD; other neurophysiology research in RBD; cardiac scintigraphy (123I-MIBG) in isolated RBD; brain magnetic resonance imaging biomarkers in isolated RBD; microRNAs as biomarkers in isolated RBD; actigraphic, other automated digital monitoring and machine learning research in RBD; prognostic counselling and ethical considerations in isolated RBD; and REM sleep basic science research. RBD research is flourishing, and is strategically situated at an ever-expanding crossroads of clinical (sleep) medicine, neurology, psychiatry and neuroscience.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
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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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Woo KA, Kim H, Kim R, Jin B, Shin JH, Kim S, Kim YK, Nam H, Jeon B, Lee J. Cholinergic degeneration and early cognitive signs in prodromal Lewy body dementia. Alzheimers Dement 2025; 21:e14584. [PMID: 39985502 PMCID: PMC11846479 DOI: 10.1002/alz.14584] [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: 09/23/2024] [Revised: 12/27/2024] [Accepted: 01/12/2025] [Indexed: 02/24/2025]
Abstract
INTRODUCTION Isolated REM sleep behavior disorder (iRBD) is a strong prodromal marker of Lewy body diseases (LBDs) - Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Cholinergic loss is linked to cognitive decline in these conditions, but its trajectory remains unclear. METHODS In a cohort of 92 iRBD participants with baseline MRI, cholinergic basal forebrain (cBF) volume was measured, with longitudinal changes analyzed in 49 with follow-up scans. Cross-sectional neuropsychological associations were examined across a broader RBD-LBD continuum, including the iRBD cohort plus 65 PD and 15 DLB patients with probable RBD. RESULTS cBF volume declined at comparable rates in iRBD-to-PD and iRBD-to-DLB converters, but atrophy was more severe at DLB phenoconversion. cBF atrophy correlated with attention, executive, and memory deficits. In iRBD, baseline cBF z-score < -1.0 predicted dementia (hazard ratio = 9.57, p = .009). CONCLUSION cBF degeneration evolves from the prodromal iRBD stage of LBDs and predicts dementia, highlighting a window for cholinergic-targeted intervention. HIGHLIGHTS Basal forebrain links to attention, executive function, and memory in the RBD continuum. Basal forebrain atrophy progresses at similar rates in prodromal PD and prodromal DLB. At phenoconversion, basal forebrain atrophy is greater in DLB than in PD converters. Basal forebrain atrophy strongly predicts future dementia in iRBD. Executive dysfunction predicts faster basal forebrain degeneration in iRBD.
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Affiliation(s)
- Kyung Ah Woo
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Heejung Kim
- Department of Nuclear MedicineSeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
- Institute of Radiation MedicineMedical Research CenterSeoul National UniversitySeoulRepublic of Korea
| | - Ryul Kim
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Bora Jin
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Jung Hwan Shin
- Department of NeurologySeoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
| | - Seoyeon Kim
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear MedicineSeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Hyunwoo Nam
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
| | - Beomseok Jeon
- Department of NeurologySeoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
| | - Jee‐Young Lee
- Department of NeurologySeoul Metropolitan Government–Seoul National University Boramae Medical CenterSeoul National University College of MedicineDongjak‐guSeoulRepublic of Korea
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Shan AD, Zhang H, Gao MX, Wang LN, Cao XY, Gan CT, Sun HM, Lu QL, Zhang L, Yuan YS, Zhang KZ. Altered effective connectivity in Parkinson's disease patients with rapid eye movement sleep behavior disorder: a resting-state functional magnetic resonance imaging study and support vector machine analysis. Quant Imaging Med Surg 2025; 15:352-369. [PMID: 39839023 PMCID: PMC11744126 DOI: 10.21037/qims-24-1196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 11/06/2024] [Indexed: 01/23/2025]
Abstract
Background Rapid eye movement sleep behavior disorder (RBD) is associated with pathological α-synuclein deposition and may have different damage directions due to α-synuclein spreading orientations. Recent functional imaging studies of Parkinson's disease (PD) with RBD have identified abnormalities in connectivity, but effective connectivity (EC) for this altered orientation is understudied. Here, we aimed to explore altered intrinsic functional connectivity (FC) and EC in PD patients with probable RBD (pRBD). Methods This was a cross-sectional study. A total of 31 PD patients with pRBD (PD-pRBD), 35 PD without pRBD (PD-npRBD), and 32 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging (RS-fMRI) scans. The voxel-wise degree centrality (DC) calculation was first performed to investigate the inherent connectivity of the PD-pRBD patients. Subsequently, we applied Granger causality analysis (GCA) to probe the causal effects of anomalous brain regions. Finally, the support vector machine (SVM) method was executed to evaluate the DC values in identifying PD-pRBD. Results PD-pRBD patients exhibited reduced z-DC values in the right precentral gyrus relative to PD-npRBD (voxel-level P<0.001, cluster-level P<0.05), as well as decreased z-DC values in the right postcentral gyrus and the superior parietal lobule compared to HCs. Then, our GCA revealed that decreased EC was located predominantly from the right precentral gyrus to the right caudate nucleus in the PD-pRBD group. Additionally, the SVM results revealed that the z-DC values of the right precentral gyrus could discriminate PD-pRBD from the PD-npRBD group [area under the curve (AUC) =0.905]. Conclusions The altered z-DC in the right precentral gyrus and the anomaly causal effects from the precentral motor cortex to the ipsilateral striatum represented by the caudate nucleus might play vital roles in the pathogenesis of PD-pRBD. It was speculated that the attenuation of FC from the precentral motor cortex to the subcortical striatum might be associated with nocturnal muscle dyskinesia and behavioral abnormalities in PD-pRBD patients. This disruption pattern may be a prospective imaging marker in the characterization of PD with pRBD.
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Affiliation(s)
- Ai-Di Shan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng-Xi Gao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Na Wang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing-Yue Cao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cai-Ting Gan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui-Min Sun
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian-Ling Lu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yong-Sheng Yuan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke-Zhong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Aslan-Kara K, Ak AK, Sarıtaş AŞ, Yılmaz H, Metin KM, Çokal BG, Ağan K, Aksu M, Akyıldız UO, Demir AB, Çevik B, Ertürk AY, Karadeniz D, Öztura İ, Sünter G, Tekin S, Tezer İ, Berktaş DT, Totik N, Şenel GB. Validity and reliability of the Turkish version of the Innsbruck RBD-9 diagnostic inventory (IRBD-9-TR). ARQUIVOS DE NEURO-PSIQUIATRIA 2025; 83:1-7. [PMID: 39875164 DOI: 10.1055/s-0044-1800816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2025]
Abstract
BACKGROUND Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by loss of the normal atonia of REM sleep accompanied by repetitive motor and behavior phenomena of dream content. OBJECTIVE To evaluate the reliability and validity of the Turkish version of the original form of the Innsbruck Rapid Eye Movement Sleep Behavior Disorder Diagnostic Inventory (IRBD-9) scale (IRBD-9-TR) and ensure that this screening test can be easily used in the Turkish language. METHODS The present is a multicenter and prospective study involving 184 patients: 51 with iRBD and 133 healthy controls. The iRBD patients were not diagnosed before submitted to video polysomnography (vPSG) and filling out the IRBD-9-TR. RESULTS The optimal cut-off value for the IRBD-9-TR symptom score was of 0.28, with a sensitivity of 0.941 and a specificity of 0.947, and 94.4% of the patients were correctly diagnosed. The rotated factor loadings for the diagnostic accuracy of each individual question showed that the short version of the IRBD-9-TR (questions 1, 2, 3, 6, and 8) presented higher specificity and excellent discrimination of iRBD patients from healthy controls. The Cronbach's α coefficient for the symptom section of the IRBD-9-TR was of 0.857, and the Kappa coefficient, of 0.885. CONCLUSION The short version of the IRBD-9-TR presents good validity and reliability to be used as a screening test to assess iRBD patients. It is convenient and potentially useful in both outpatient clinical and epidemiologic research settings.
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Affiliation(s)
- Kezban Aslan-Kara
- Cukurova University Medical Faculty, Department of Neurology, Division of Clinical Neurophysiology, Adana, Turkey
| | - Ayşın Kısabay Ak
- Celal Bayar University Medical Faculty, Department of Neurology, Manisa, Turkey
| | | | - Hikmet Yılmaz
- Celal Bayar University Medical Faculty, Department of Neurology, Manisa, Turkey
| | - Kübra Mehel Metin
- Ankara Training and Research Hospital, University of Health Sciences, Department of Neurology, Ankara, Turkey
| | - Burcu Gökçe Çokal
- Ankara Training and Research Hospital, University of Health Sciences, Department of Neurology, Ankara, Turkey
| | - Kadriye Ağan
- Marmara University Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Murat Aksu
- Acibadem University Atakent Hospital Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Utku Oğan Akyıldız
- Adnan Menderes University Medical Faculty, Department of Neurology, Aydın, Turkey
| | - Aylin Bican Demir
- Bursa Uludag University Medical Faculty, Department of Neurology, Bursa, Turkey
| | - Betül Çevik
- Tokat Gaziosmanpasa University Medical Faculty, Department of Neurology, Tokat, Turkey
| | - Ahmet Yusuf Ertürk
- Dokuz Eylul University Medical Faculty, Department of Neurology, Izmir, Turkey
| | - Derya Karadeniz
- Istanbul University-Cerrahpasa Faculty of Medicine, Department of Neurology, Division of Clinical Neurophysiology, Istanbul, Turkey
| | - İbrahim Öztura
- Dokuz Eylul University Medical Faculty, Department of Neurology, Izmir, Turkey
| | - Gülin Sünter
- Marmara University Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Selma Tekin
- Pamukkale University Medical Faculty, Department of Neurology, Denizli, Turkey
| | - İrsel Tezer
- Hacettepe University Medical Faculty, Department of Neurology, Ankara, Turkey
| | - Deniz Tuncel Berktaş
- Kahramanmaras Sutcu Imam University Medical Faculty, Department of Neurology, Kahramanmaras, Turkey
| | - Nazlı Totik
- Cukurova University Medical Faculty, Department of Biostatistics, Adana, Turkey
| | - Gülçin Benbir Şenel
- Istanbul University-Cerrahpasa Faculty of Medicine, Department of Neurology, Division of Clinical Neurophysiology, Istanbul, Turkey
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Zhang RY, Li JY, Liu YN, Zhang ZX, Zhao J, Li FJ. The causal relationship between type 2 diabetes mellitus and isolated REM sleep behavior disorder: results from multivariable and network Mendelian randomization analysis. Front Endocrinol (Lausanne) 2024; 15:1408053. [PMID: 39655344 PMCID: PMC11625559 DOI: 10.3389/fendo.2024.1408053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 10/25/2024] [Indexed: 12/12/2024] Open
Abstract
Objectives To investigate the causal relationship between type 2 diabetes mellitus (T2DM, exposure) and isolated REM sleep behavior disorder (iRBD, outcome). Methods Genome-wide association study (GWAS) data for iRBD comprised 9,447 samples, including 1,061 iRBD cases from the International RBD Study Group. Initially, we performed linkage disequilibrium score regression (LDSC) to explore the genetic correlation between T2DM and iRBD. Then the two-sample univariate MR (UVMR) analysis was conducted to examine the effects of T2DM and blood sugar metabolism-related factors on iRBD. Subsequently, we applied multivariable MR (MVMR) methods to further adjust for confounders. Lastly, we executed a network MR analysis, with cytokines and immune cell characteristics as potential mediators, aiming to investigate indirect effect of T2DM on iRBD. Results Results from LDSC suggest a genetic correlation between T2DM and iRBD (rg=0.306, P=0.029). UVMR analysis indicates that both T2DM (Odds Ratio [95% Confidence Interval] = 1.19 [1.03, 1.37], P = 0.017) and high blood glucose levels (1.55 [1.04, 2.30], P = 0.032) are risk factors for iRBD. Even after adjusting for confounders in MVMR, the association between T2DM and iRBD remains robust. Finally, results from network MR analysis suggest that T2DM may indirectly promote the development of iRBD by reducing levels of Stromal Cell-Derived Factor 2 in circulation and by increasing BAFF-receptor expression in IgD- CD38- B cells. Conclusions T2DM may promote the onset of iRBD by influencing immune-inflammatory responses. Our findings provide valuable insights and directions for understanding the pathogenesis of iRBD, identifying high-risk groups, and discovering new therapeutic targets.
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Affiliation(s)
- Ru-Yu Zhang
- Department of Pulmonary and Critical Care Medicine, First People's Hospital of Zigong, Zigong, Sichuan, China
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jin-Yu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu-Ning Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zi-Xuan Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Fu-Jia Li
- Department of Pulmonary and Critical Care Medicine, First People's Hospital of Zigong, Zigong, Sichuan, China
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, China
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10
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Lee DA, Lee WH, Lee HJ, Park KM. Alterations in the multilayer network in patients with rapid eye movement sleep behaviour disorder. J Sleep Res 2024; 33:e14182. [PMID: 38385964 DOI: 10.1111/jsr.14182] [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: 09/13/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
This study aimed to reveal the pathophysiology of isolated rapid eye movement sleep behaviour disorder (RBD) in patients using multilayer network analysis. Participants eligible for isolated RBD were included and verified via polysomnography. Both iRBD patients and healthy controls underwent brain MRI, including T1-weighted imaging and diffusion tensor imaging. Grey matter matrix was derived from T1-weighted images using a morphometric similarity network. White matter matrix was formed from diffusion tensor imaging-based structural connectivity. Multilayer network analysis of grey and white matter was performed using graph theory. We studied 29 isolated RBD patients and 30 healthy controls. Patients exhibited a higher average overlap degree (27.921 vs. 23.734, p = 0.002) and average multilayer clustering coefficient (0.474 vs. 0.413, p = 0.002) compared with controls. Additionally, several regions showed significant differences in the degree of overlap and multilayer clustering coefficient between patients with isolated RBD and healthy controls at the nodal level. The degree of overlap in the left medial orbitofrontal, left posterior cingulate, and right paracentral nodes and the multilayer clustering coefficients in the left lateral occipital, left rostral middle frontal, right fusiform, right inferior posterior parietal, and right parahippocampal nodes were higher in patients with isolated RBD than in healthy controls. We found alterations in the multilayer network at the global and nodal levels in patients with isolated RBD, and these changes may be associated with the pathophysiology of isolated RBD. Multilayer network analysis can be used widely to explore the mechanisms underlying various neurological disorders.
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Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Won Hee Lee
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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11
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Li FJ, Zhang ZX, Li YDY, Li JY, Liu YN, Liu XJ, Zhang RY, Liu X, Zhang W, Xu CY, Cui GY. High bioavailable testosterone levels increase the incidence of isolated REM sleep behavior disorder: Results from multivariable and network Mendelian randomization analysis. Sleep Med 2024; 121:102-110. [PMID: 38959716 DOI: 10.1016/j.sleep.2024.06.024] [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: 02/15/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES To explore the causal relationships between sex hormone levels and incidence of isolated REM sleep behavior disorder (iRBD). METHODS In our study, we utilized Genome-Wide Association Studies (GWAS) data for iRBD, including 9447 samples with 1061 cases of iRBD provided by the International RBD Study Group. Initially, we conducted a two-sample univariate MR analysis to explore the impact of sex hormone-related indicators on iRBD. This was followed by the application of multivariable MR methods to adjust for other hormone levels and potential confounders. Finally, we undertook a network MR analysis, employing brain structure Magnetic Resonance Imaging (MRI) characteristics as potential mediators, to examine whether sex hormones could indirectly influence the incidence of iRBD by affecting brain structure. RESULTS Bioavailable testosterone (BioT) is an independent risk factor for iRBD (Odds Ratio [95 % Confidence Interval] = 2.437 [1.308, 4.539], P = 0.005, corrected-P = 0.020), a finding that remained consistent even after adjusting for other sex hormone levels and potential confounders. Additionally, BioT appears to indirectly increase the risk of iRBD by reducing axial diffusivity and increasing the orientation dispersion index in the left cingulum and cingulate gyrus. CONCLUSIONS Our research reveals that elevated levels of BioT contribute to the development of iRBD. However, the specific impact of BioT on different sexes remains unclear. Furthermore, high BioT may indirectly lead to iRBD by impairing normal pathways in the left cingulum and cingulate gyrus and fostering abnormal pathway formation.
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Affiliation(s)
- Fu-Jia Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Zi-Xuan Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Yang-Dan-Yu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Jin-Yu Li
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Yu-Ning Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Xuan-Jing Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Ru-Yu Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Xu Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Wei Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Chuan-Ying Xu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China
| | - Gui-Yun Cui
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, People's Republic of China.
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12
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Park JA, Yoon JE, Liu X, Chang Y, Maiolino G, Pengo MF, Lin GM, Kwon Y. Cardiovascular Implications of Sleep Disorders Beyond Sleep Apnea. CURRENT SLEEP MEDICINE REPORTS 2024; 10:320-328. [PMID: 39281064 PMCID: PMC11391919 DOI: 10.1007/s40675-024-00302-y] [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] [Accepted: 04/30/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE OF REVIEW Sleep is crucial for human health and life. There is still limited attention to the association between sleep disorders beyond sleep apnea and cardiovascular (CV) health. We investigated the current evidence between non-respiratory sleep disorders and CV health. RECENT FINDINGS Current evidence suggests an important association between sleep duration, circadian rhythm, insomnia, disorders of hypersomnolence and CV health. Sleep-related movement disorders exhibit a moderate association with CV health. Further research is needed to explore the effects of each sleep disorder on CV health. SUMMARY Given the close association between non-respiratory sleep disorders and CV health, it is crucial to recognize and address sleep disorders in patients with a high CV risk.
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Affiliation(s)
- Jung-A Park
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jee-Eun Yoon
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Xiaoyue Liu
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - Yoonhee Chang
- Staff Physician, Sleep Medicine, Evergreen Health, Kirkland, WA, USA
| | - Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gen-Min Lin
- Department of Medicine, Hualien-Armed Forces General Hospital, Hualien, Taiwan
| | - Younghoon Kwon
- Department of Medicine, University of Washington, Seattle, WA, USA
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13
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Barone DA. Secondary RBD: Not just neurodegeneration. Sleep Med Rev 2024; 76:101938. [PMID: 38657360 DOI: 10.1016/j.smrv.2024.101938] [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: 01/16/2024] [Revised: 03/20/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
Rapid eye movement sleep behavior disorder is a parasomnia characterized by excessive muscle activity during rapid eye movement sleep (rapid eye movement sleep without atonia), along with dream enactment behavior. Isolated rapid eye movement sleep behavior disorder tends to occur in older males and is of concern due to the known link to Parkinson's disease and other synucleinopathies. When rapid eye movement sleep behavior disorder occurs in association with other neurological or general medical conditions, or resulting from the use of various substances, it is called secondary rapid eye movement sleep behavior disorder; the most common cause is neurodegenerative illness, specifically the synucleinopathies. Here, the focus will be on the subset of secondary rapid eye movement sleep behavior disorder in which there is no neurodegenerative disease.
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Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, 425 East 61st Street, New York, NY, 10065, USA.
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14
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Canever JB, Zurman G, Vogel F, Sutil DV, Diz JBM, Danielewicz AL, Moreira BDS, Cimarosti HI, de Avelar NCP. Worldwide prevalence of sleep problems in community-dwelling older adults: A systematic review and meta-analysis. Sleep Med 2024; 119:118-134. [PMID: 38669835 DOI: 10.1016/j.sleep.2024.03.040] [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: 01/30/2024] [Revised: 03/09/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
The understanding of the prevalence of sleep problems in older adults can provide a broad and reliable perspective into the occurrence of such issues among older adults. This systematic review and meta-analysis aimed to estimate the worldwide prevalence of sleep problems in community-dwelling older adults. Studies that provide information on the prevalence of sleep problems in community-dwelling older adults (≥60 years) were screened between December 2022 and March 2023. A total of 20,379 studies were identified in database searches, from which 252 were included in this review. These studies covered the last 35 years (from 1988 to 2023) and pooled a sample of 995,544 participants from 36 countries. The most frequent sleep problem worldwide was obstructive sleep apnea (46.0%), followed by poor sleep quality (40.0%), other sleep problems (37.0%), insomnia (29.0%), and excessive daytime sleepiness (19.0%). No significant difference in the prevalence estimates of all sleep problems was observed between the sexes. This systematic review and meta-analysis showed a high prevalence of some sleep problems, mainly obstructive sleep apnea, poor sleep quality, and other sleep problems. Our estimates can be useful for managers and policymakers in planning healthcare strategies for sleep problems aimed at the older population.
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Affiliation(s)
- Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil; Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | - Gabriela Zurman
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Felipe Vogel
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daiana Vieira Sutil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Ana Lúcia Danielewicz
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helena Iturvides Cimarosti
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, Araranguá, Santa Catarina, Urussanguinha, 320188906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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15
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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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16
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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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17
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Mano M, Nomura A, Sasanabe R. Gender Difference in REM Sleep Behavior Disorder in Japanese Population: Polysomnography and Sleep Questionnaire Study. J Clin Med 2024; 13:914. [PMID: 38337608 PMCID: PMC10856381 DOI: 10.3390/jcm13030914] [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: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is generally common among males and is an established risk factor for neurodegenerative diseases. As the population ages, the prevalence of α-synucleinopathy (such as Parkinson's disease) is increasing. Additionally, the number of female patients is increasing in Japan. Therefore, we aimed to clarify the clinical characteristics of RBD from the perspective of gender differences in the Japanese population. The proportion of male RBD patients (65.2%) was significantly higher than that of female patients (34.8%). Additionally, female patients (70.5 ± 8.2 years) were significantly older than male patients (67.9 ± 8.0 years, p < 0.05). The mean score on the RBD Screening Questionnaire was significantly higher in male patients than in female (8.6 ± 2.9 vs. 7.7 ± 3.1, p < 0.05), while the mean score on the Pittsburgh Sleep Quality Index was significantly higher in males (5.9 ± 3.8 vs. 7.2 ± 3.600, p < 0.001). The Self-rating Depression Scale in females was 41.7 ± 8.5, and they were more likely to show depressive tendencies than males. In polysomnography, higher rates of obstructive sleep apnea and longer duration of stage N1 sleep were detected in males. After adjusting for age, BMI, and polysomnographic parameters, we found that female RBD patients had significantly worse sleep quality and rates of depression compared to male patients.
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Affiliation(s)
- Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University, Nagakute 480-1195, Japan; (A.N.); (R.S.)
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18
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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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Schaeffer E, Yilmaz R, St. Louis EK, Noyce AJ. Ethical Considerations for Identifying Individuals in the Prodromal/Early Phase of Parkinson's Disease: A Narrative Review. JOURNAL OF PARKINSON'S DISEASE 2024; 14:S307-S319. [PMID: 38995800 PMCID: PMC11492008 DOI: 10.3233/jpd-230428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/14/2024]
Abstract
The ability to identify individuals in the prodromal phase of Parkinson's disease has improved in recent years, raising the question of whether and how those affected should be informed about the risk of future disease. Several studies investigated prognostic counselling for individuals with isolated REM sleep behavior disorder and have shown that most patients want to receive information about prognosis, but autonomy and individual preferences must be respected. However, there are still many unanswered questions about risk disclosure or early diagnosis of PD, including the impact on personal circumstances, cultural preferences and specific challenges associated with different profiles of prodromal symptoms, genetic testing or biomarker assessments. This narrative review aims to summarize the current literature on prognostic counselling and risk disclosure in PD, as well as highlight future perspectives that may emerge with the development of new biomarkers and their anticipated impact on the definition of PD.
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Affiliation(s)
- Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel and Kiel University, Kiel, Germany
| | - Rezzak Yilmaz
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Brain Research Center, Ankara, Turkey
| | - Erik K. St. Louis
- Mayo Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Alastair J. Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Elliott JE, Bryant-Ekstrand MD, Keil AT, Ligman BR, Lim MM, Zitser J, During EH, Gagnon JF, St Louis EK, Fields JA, Huddleston DE, Bliwise DL, Avidan AY, Schenck CH, McLeland J, Criswell SR, Davis AA, Videnovic A, Lee-Iannotti JK, Postuma R, Boeve BF, Ju YES, Miglis MG. Frequency of Orthostatic Hypotension in Isolated REM Sleep Behavior Disorder. Neurology 2023; 101:e2545-e2559. [PMID: 37857496 PMCID: PMC10791057 DOI: 10.1212/wnl.0000000000207883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although orthostatic hypotension (OH) can be an early feature of autonomic dysfunction in isolated REM sleep behavior disorder (iRBD), no large-scale studies have examined the frequency of OH in iRBD. In this study, we prospectively evaluated the frequency of OH in a large multicenter iRBD cohort. METHODS Participants 18 years or older with video polysomnogram-confirmed iRBD were enrolled through the North American Prodromal Synucleinopathy consortium. All participants underwent 3-minute orthostatic stand testing to assess the frequency of OH, and a Δ heart rate/Δ systolic blood pressure (ΔHR/ΔSBP) ratio <0.5 was used to define reduced HR augmentation, suggestive of neurogenic OH. All participants completed a battery of assessments, including the Scales for Outcomes in Parkinson Disease-Autonomic Dysfunction (SCOPA-AUT) and others assessing cognitive, motor, psychiatric, and sensory domains. RESULTS Of 340 iRBD participants (65 ± 10 years, 82% male), 93 (27%) met criteria for OH (ΔHR/ΔSBP 0.37 ± 0.28; range 0.0-1.57), and of these, 72 (77%) met criteria for OH with reduced HR augmentation (ΔHR/ΔSBP 0.28 ± 0.21; range 0.0-0.5). Supine hypertension (sHTN) was present in 72% of those with OH. Compared with iRBD participants without OH, those with OH were older, reported older age of RBD symptom onset, and had worse olfaction. There was no difference in autonomic symptom scores as measured by SCOPA-AUT. DISCUSSION OH and sHTN are common in iRBD. However, as patients may have reduced autonomic symptom awareness, orthostatic stand testing should be considered in clinical evaluations. Longitudinal studies are needed to clarify the relationship between OH and phenoconversion risk in iRBD. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov: NCT03623672; North American Prodromal Synucleinopathy Consortium.
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Affiliation(s)
- Jonathan E Elliott
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Mohini D Bryant-Ekstrand
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Allison T Keil
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Brittany R Ligman
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Miranda M Lim
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Jennifer Zitser
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Emmanuel H During
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Jean-Francois Gagnon
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Erik K St Louis
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Julie A Fields
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Daniel E Huddleston
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Donald L Bliwise
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Alon Y Avidan
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Carlos H Schenck
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Jennifer McLeland
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Susan R Criswell
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Albert A Davis
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Aleksandar Videnovic
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Joyce K Lee-Iannotti
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Ronald Postuma
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Bradley F Boeve
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Yo-El S Ju
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
| | - Mitchell G Miglis
- Department of Neurology (J.E.E., M.M.L.), Oregon Health & Science University; Research Service (J.E.E., M.D.B.-E., A.T.K., B.R.L.), Mental Illness Research Education and Clinical Center (M.M.L.), Department of Neurology (M.M.L.), and National Center for Rehabilitative Auditory Research (M.M.L.), VA Portland Health Care System; Department of Behavioral Neuroscience (M.M.L.), Oregon Health & Science University; Oregon Institute of Occupational Health Sciences (M.M.L.), Oregon Health & Science University, Portland; Tel Aviv Sourasky Medical Center (J.Z.), Israel; Department of Psychiatry and Behavioral Sciences (E.H.D., M.G.M.), Stanford University Medical Center, Redwood City; Department of Neurology & Neurological Sciences (E.H.D., M.G.M.), Stanford University, Palo Alto, CA; Department of Psychology (J.-F.G., R.P.), Université du Québec à Montréal; Center for Advanced Research in Sleep Medicine (J.-F.G.), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada; Mayo Clinic College of Medicine and Science (E.K.S.L., J.A.F., B.F.B.), Rochester, MN; Department of Neurology (D.E.H., D.L.B.), Emory University, Atlanta, GA; Sleep Medicine Program (A.Y.A.), Department of Neurology, David Geffen School of Medicine, University of California Los Angeles; Department of Psychiatry (C.H.S.), University of Minnesota Medical School, Minneapolis; Department of Neurology (J.M., S.R.C., A.A.D., Y.-E.S.J.), Washington University School of Medicine, St. Louis, MO; Movement Disorders Unit (A.V.), Division of Sleep Medicine, Massachusetts General Hospital; Neurological Clinical Research Institute (A.V.), Harvard Medical School, Boston, MA; Department of Neurology (J.K.L.-I.), Banner University Medical Center, Phoenix, AZ; Banner Sun Health Research Institute (J.K.L.-I.), Sun City, AZ; and Montréal Neurologique Institute (R.P.), McGill Université, Québec, Canada
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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: 10] [Impact Index Per Article: 5.0] [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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22
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Feuerstein JS, Amara A. REM Behavior Disorder: Implications for PD Therapeutics. Curr Neurol Neurosci Rep 2023; 23:727-734. [PMID: 37831394 DOI: 10.1007/s11910-023-01310-1] [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] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia that occurs during REM sleep, characterized by REM sleep without atonia (RSWA) and dream enactment behavior (DEB). RBD is associated with several diseases and medications but most notably is a prodromal feature of synucleinopathies, including Parkinson's disease (PD). This article reviews RBD, its treatments, and implications for PD therapeutics. RECENT FINDINGS Recent research recognizes RBD as a prodromal marker of PD, resulting in expansion of basic science and clinical investigations of RBD. Current basic science research investigates the pathophysiology of RBD and explores animal models to allow therapeutic development. Clinical research has focused on natural history observation, as well as potential RBD treatments and their impact on sleep and phenoconversion to neurodegenerative disease. RBD serves as a fresh access point to develop both neuroprotective and symptomatic therapies in PD. These types of investigations are novel and will benefit from the more established basic science infrastructure to develop new interventions.
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Affiliation(s)
- Jeanne S Feuerstein
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Neurology, Rocky Mountain Regional VA Medical Center, 12631 E. 17th Ave Room 5508, Mail Stop B185, Aurora, CO, 80045, USA.
| | - Amy Amara
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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23
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Dodet P. REM behavior disorder: When Parkinson's disease meets Morpheus. Rev Neurol (Paris) 2023; 179:667-674. [PMID: 37598085 DOI: 10.1016/j.neurol.2023.08.005] [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: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by the absence of normal muscle atonia during REM sleep, resulting in excessive motor activity while dreaming. RBD can be classified as isolated which is the strongest clinical marker of prodromal synucleinopathy, or secondary, associated with other neurological diseases, mainly Parkinson's disease (PD) and dementia with Lewy bodies. The diagnosis of RBD must be systematically documented by a video polysomnography in the case of isolated RBD. PD associated with RBD may represent a distinct phenotype compared to PD without RBD, indicating a more severe and widespread synucleinopathy. Clinically, it is associated with poorer motor and cognitive performance, more severe non-motor symptoms, and faster disease progression. Imaging studies have revealed broader brain damage and significant alterations in cerebral metabolism and neurotransmission in PD patients with RBD. The management of RBD involves safety precautions and pharmacotherapy. Safety measures aim to minimize the risk of injury during RBD episodes and include creating a safe sleeping environment and separating the patient from their bed partner if necessary. Pharmacotherapy options include clonazepam and melatonin. Clonazepam must be cautiously prescribed in older patients due to potential side effects.
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Affiliation(s)
- P Dodet
- Service des Pathologies du Sommeil, Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France; Paris Brain Institute (ICM), Sorbonne University, Inserm U1227, CNRS 7225, Paris, France.
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24
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Nepozitek J, Varga Z, Dostalova S, Perinova P, Keller J, Robinson S, Ibarburu V, Prihodova I, Bezdicek O, Ruzicka E, Sonka K, Dusek P. Magnetic susceptibility changes in the brainstem reflect REM sleep without atonia severity in isolated REM sleep behavior disorder. NPJ Parkinsons Dis 2023; 9:112. [PMID: 37452075 PMCID: PMC10349141 DOI: 10.1038/s41531-023-00557-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
REM sleep without atonia (RWA) is the hallmark of isolated REM sleep behavior disorder (iRBD) and is caused by neurodegeneration of brainstem structures. Previously, quantitative susceptibility mapping (QSM) was shown to detect microstructural tissue changes in neurodegenerative diseases. The goal of the study was to compare brainstem magnetic susceptibility (MS) in iRBD and controls using the voxel-based QSM approach and to examine the association between brainstem MS and severity of RWA in iRBD. Sixty iRBD patients and 41 healthy controls were included in the study. Phasic, tonic, mixed RWA and SINBAR score was quantified. QSM maps were reconstructed with QSMbox software from a multi-gradient-echo sequence acquired at 3T MRI system and normalized using a custom T1 template. Voxel-based analysis with age and gender as covariates was performed using a two-sample t-test model for between-group comparison and using a linear regression model for association with the RWA parameters. Statistical maps were generated using threshold free cluster enhancement with p-value p < 0.05, corrected for family wise error. Compared to controls, the iRBD group had higher MS in bilateral substantia nigra (SN), red nucleus and the ventral tegmental area. MS positively correlated with iRBD duration in the right pedunculotegmental nucleus and white matter of caudal mesencephalic and pontine tegmentum and with phasic RWA in bilateral SN. QSM was able to detect MS abnormalities in several brainstem structures in iRBD. Association of MS levels in the brainstem with the intensity of RWA suggests that increased iron content in SN is related to RWA severity.
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Affiliation(s)
- Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Zsoka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Simona Dostalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavla Perinova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Keller
- Radiodiagnostic Department, Na Homolce Hospital, Prague, Czech Republic
| | - Simon Robinson
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Veronika Ibarburu
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iva Prihodova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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25
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Levendowski DJ, Neylan TC, Lee-Iannotti JK, Timm PC, Guevarra C, Angel E, Shprecher D, Mazeika G, Walsh CM, Boeve BF, St Louis EK. The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder. Nat Sci Sleep 2023; 15:323-331. [PMID: 37162799 PMCID: PMC10164388 DOI: 10.2147/nss.s396853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
Purpose This study aimed to establish the diagnostic accuracy of a previously validated sleep staging system in patients with probable isolated REM sleep behavior disorder (iRBD), and to compare physicians' diagnoses of iRBD based on REM sleep without atonia (RSWA) to non-REM hypertonia (NRH), a sleep measure independently associated with Parkinsonian spectrum disorders. Patients and Methods Twenty-six patients with a history of dream enactment behavior underwent a diagnostic PSG with simultaneous Sleep Profiler (SP) acquisition at two sites. PSG and SP records were sleep staged, and two sleep neurologists independently diagnosed iRBD based on the presence or absence of polysomnographic identified RSWA. Comparisons for PSG vs SP sleep staging and the qualitative presence or absence of PSG-based RSWA vs automated SP-detected NRH was performed using kappa coefficients (k), positive and negative percent agreements (PPA and NPA), and chi-square tests. Results The kappa scores from Sites-1 and -2 for PSG vs SP staging were different for Wake (k=0.82 vs 0.65), N2 (k=0.63 vs 0.72) and REM (k=0.83 vs.0.72). The by-site kappa values for stage N3 increased from 0.72 and 0.37 to 0.88 and 0.74 after PSG records were reedited. The kappa values for between-physician agreement in iRBD diagnoses were fair (k = 0.22). The agreement between each physician's iRBD diagnoses and NRH were also fair (k=0.29 and 0.22). Abnormal NRH agreed with at least one physician's iRBD diagnosis in 83% of the records. The PPA resulting from between-physician iRBD agreement was stronger and the NPA weaker than the values obtained from comparison of each physician's iRBD diagnosis and abnormal NRH. Conclusion The potential utility of RSWA and stage N3 as neurodegenerative disorder biomarkers was influenced by between-site variability in visual scoring. The degree to which NRH was associated with iRBD was similar to the between-physician agreement in their diagnosis of iRBD using RSWA.
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Affiliation(s)
- Daniel J Levendowski
- Sleep and Respiratory Research, Advanced Brain Monitoring, Inc, Carlsbad, CA, USA
| | - Thomas C Neylan
- Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Joyce K Lee-Iannotti
- Department of Neurology and Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - Paul C Timm
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cyrus Guevarra
- Department of Neurology and Medicine, Banner University Medical Center, Phoenix, AZ, USA
| | - Elise Angel
- Sleep and Respiratory Research, Advanced Brain Monitoring, Inc, Carlsbad, CA, USA
| | | | - Gandis Mazeika
- Sleep and Respiratory Research, Advanced Brain Monitoring, Inc, Carlsbad, CA, USA
| | - Christine M Walsh
- Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Lee DA, Lee HJ, Park KM. Involvement of limbic structures in patients with isolated rapid eye movement sleep behavior disorder. Sleep Biol Rhythms 2023; 21:233-240. [PMID: 38469290 PMCID: PMC10899988 DOI: 10.1007/s41105-022-00440-2] [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: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate the alterations in limbic structure volumes and limbic covariance network in patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and to compare them with healthy controls. We retrospectively enrolled 35 patients with iRBD and 35 healthy controls who underwent three-dimensional T1-weighted brain MRI. Volumetric analysis of subcortical limbic structures, including the hippocampus, amygdala, thalamus, mammillary body, hypothalamus, basal forebrain, septal nuclei, fornix, and nucleus accumbens, was performed. Furthermore, the limbic covariance network was examined using graph theory based on the limbic structure volumes. Some of the limbic structure volumes differed significantly. The right amygdala and hypothalamus volumes were lower in the patients with iRBD than in the healthy controls (0.101% vs. 0.114%, p = 0.016, and 0.027% vs. 0.030%, p = 0.045, respectively). However, there were no significant differences in the limbic covariance network between the groups. This study demonstrated that the volumes of the right amygdala and hypothalamus are lower in patients with iRBD, even without cognitive impairments, than in healthy controls. However, there were no significant differences in the limbic covariance network between the groups. The involvements of the limbic structures could be related to the conversion to neurodegenerative diseases in patients with iRBD.
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Affiliation(s)
- D. A. Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108 Republic of Korea
| | - H. J. Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-gu, Busan Republic of Korea
| | - K. M. Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108 Republic of Korea
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27
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Solla P, Wang Q, Frau C, Floris V, Loy F, Sechi LA, Masala C. Olfactory Impairment Is the Main Predictor of Higher Scores at REM Sleep Behavior Disorder (RBD) Screening Questionnaire in Parkinson’s Disease Patients. Brain Sci 2023; 13:brainsci13040599. [PMID: 37190564 DOI: 10.3390/brainsci13040599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Olfactory impairment and REM sleep behavior disorder (RBD) are common non-motor symptoms in Parkinson’s disease (PD) patients, often preceding the onset of the specific motor symptoms and, thus, crucial for strategies directed to anticipate PD diagnosis. In this context, the specific interaction between olfactory impairment and RBD has not been clearly defined. Objective: The aim of this study was to determine the possible role of olfactory impairment and other clinical characteristics as possible predictors of higher scores at RBD screening questionnaire (RBDSQ) in a large population of PD patients. Methods: In this study, 590 PD patients were included from the Parkinson’s Progression Markers Initiative. Demographic and clinical features were registered. All participants completed motor and non-motor evaluations at the baseline visit. For motor assessments, the disease severity was evaluated by the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) pars III. Regarding non-motor symptoms assessment, Montreal Cognitive Assessments (MoCA), University of Pennsylvania Smell Identification Test (UPSIT) and RBD screening questionnaire (RBDSQ) were registered. Results: Among 590 PD patients included in this study, 111 patients with possible RBD were found (18.8%). RBD was less frequent in female PD patients (p ≤ 0.011). Among patients with or without possible RBD diagnosis, statistically significant differences in MDS-UPDRS III (23.3 ± 11.4 vs. 19.7 ± 9.1, respectively, p ≤ 0.002) and in UPSIT score (19.7 ± 8.3 vs. 22.6 ± 8.0, respectively, p ≤ 0.001) were found. Moreover, significant correlations between RBDSQ versus UPDRS III score and versus UPSIT score were observed. Multivariate linear regression analysis showed that UPSIT was the most significant predictor of higher scores at RBDSQ, while the other significant predictors were UPDRS III and age. Conclusions: The severity of olfactory impairment appears tightly correlated to RBD symptoms, highlighting the role of these biomarkers for PD patients. Additionally, according to this large study, our data confirmed that RBD in PD patients exhibits peculiar gender differences.
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Affiliation(s)
- Paolo Solla
- Neurological Unit, AOU Sassari, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
| | - Qian Wang
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
| | - Claudia Frau
- Neurological Unit, AOU Sassari, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
| | - Valentina Floris
- Neurological Unit, AOU Sassari, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
| | - Francesco Loy
- Department of Biomedical Sciences, University of Cagliari, SP 8 Cittadella Universitaria, 09042 Monserrato, Italy
| | - Leonardo Antonio Sechi
- Department of Biomedical Sciences, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, SP 8 Cittadella Universitaria, 09042 Monserrato, Italy
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Marras C, Alcalay RN, Siderowf A, Postuma RB. Challenges in the study of individuals at risk for Parkinson disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:219-229. [PMID: 36796944 DOI: 10.1016/b978-0-323-85538-9.00014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Identifying individuals at high risk for developing neurodegenerative disease opens the possibility of conducting clinical trials that intervene at an earlier stage of neurodegeneration than has been possible to date, and in doing so hopefully improves the odds of efficacy for interventions aimed at slowing or stopping the disease process. The long prodromal phase of Parkinson disease presents opportunities and challenges to establishing cohorts of at-risk individuals. Recruiting people with genetic variants conferring increased risk and people with REM sleep behavior disorder currently constitutes the most promising strategies, but multistage screening of the general population may also be feasible capitalizing on known risk factors and prodromal features. This chapter discusses the challenges involved in identifying, recruiting, and retaining these individuals, and provides insights into possible solutions using examples from studies to date.
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Affiliation(s)
- Connie Marras
- The Edmond J Safra Program in PD, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| | - Roy N Alcalay
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States; Division of Movement Disorders, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Andrew Siderowf
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Ronald B Postuma
- Department of Neurology, McGill University, Montreal, QC, Canada
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29
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Zhidik AG, Kozhokaru AB. [Alternative methods of therapy for comorbid sleep disorders as a method of choice in adult patients with epilepsy]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:42-48. [PMID: 37655409 DOI: 10.17116/jnevro202312308142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Systematization and generalization of data from domestic and foreign literature on alternative methods of treatment of sleep disorders in epilepsy. MATERIAL AND METHODS The search for data from domestic and foreign literary sources was carried out in the electronic databases Medline (PubMed), Scopus, Web of Science, eLibrary, CyberLeninka, Google Scholar. RESULTS The data of modern randomized trials, meta-analyzes on the effectiveness of various non-traditional methods as a method of choice for epilepsy with comorbid sleep disorders have been analyzed. CONCLUSIONS Complementary (alternative) treatments have many advantages over the classical pharmacotherapy of sleep disorders in epilepsy, in the form of non-invasiveness, low incidence of side-effects, ease of use, and lack of a dose-dependent effect. Of course, the targets of most of the above methods are not focused and not very specific, and the sample size is too small to obtain impartial and meaningful clinical conclusions, but this once again emphasizes the urgent need for large-scale clinical trials, which is necessary to develop evidence-based treatments for comorbid sleep disorders in epilepsy.
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Affiliation(s)
- A G Zhidik
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
| | - A B Kozhokaru
- State Research Center - Burnasyan Federal Medical Biophysical Center, Moscow, Russia
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
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30
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Brink-Kjaer A, Gupta N, Marin E, Zitser J, Sum-Ping O, Hekmat A, Bueno F, Cahuas A, Langston J, Jennum P, Sorensen HBD, Mignot E, During E. Ambulatory Detection of Isolated Rapid-Eye-Movement Sleep Behavior Disorder Combining Actigraphy and Questionnaire. Mov Disord 2023; 38:82-91. [PMID: 36258659 PMCID: PMC10092688 DOI: 10.1002/mds.29249] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is in most cases a prodrome of neurodegenerative synucleinopathies, affecting 1% to 2% of middle-aged and older adults; however, accurate ambulatory diagnostic methods are not available. Questionnaires lack specificity in nonclinical populations. Wrist actigraphy can detect characteristic features in individuals with RBD; however, high-frequency actigraphy has been rarely used. OBJECTIVE The aim was to develop a machine learning classifier using high-frequency (1-second resolution) actigraphy and a short patient survey for detecting iRBD with high accuracy and precision. METHODS The method involved analysis of home actigraphy data (for seven nights and more) and a nine-item questionnaire (RBD Innsbruck inventory and three synucleinopathy prodromes of subjective hyposmia, constipation, and orthostatic dizziness) in a data set comprising 42 patients with iRBD, 21 sleep clinic patients with other sleep disorders, and 21 community controls. RESULTS The actigraphy classifier achieved 95.2% (95% confidence interval [CI]: 88.3-98.7) sensitivity and 90.9% (95% CI: 82.1-95.8) precision. The questionnaire classifier achieved 90.6% accuracy and 92.7% precision, exceeding the performance of the Innsbruck RBD Inventory and prodromal questionnaire alone. Concordant predictions between actigraphy and questionnaire reached a specificity and precision of 100% (95% CI: 95.7-100.0) with 88.1% sensitivity (95% CI: 79.2-94.1) and outperformed any combination of actigraphy and a single question on RBD or prodromal symptoms. CONCLUSIONS Actigraphy detected iRBD with high accuracy in a mixed clinical and community cohort. This cost-effective fully remote procedure can be used to diagnose iRBD in specialty outpatient settings and has potential for large-scale screening of iRBD in the general population. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark.,Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Niraj Gupta
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Eric Marin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Jennifer Zitser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Movement Disorders Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Oliver Sum-Ping
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Anahid Hekmat
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Flavia Bueno
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Ana Cahuas
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - James Langston
- Department of Pathology, Stanford University, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Emmanuel During
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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31
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Walsh SM, Forward CL, Flaherty GT. Parasomnias during trans-meridian and long-distance travel: Critical literature review and clinical practice recommendations. J Sleep Res 2022; 31:e13672. [PMID: 35726362 PMCID: PMC9786733 DOI: 10.1111/jsr.13672] [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: 03/04/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Parasomnias are undesirable events that occur during sleep. They can be classified into rapid eye movement parasomnias and non-rapid eye movement parasomnias. Those who experience parasomnias may be anxious about travel for many reasons, including the occurrence of unwanted events during the trip, increased exposure to environmental trigger factors, and the propensity for harm to occur due to unfamiliar surroundings while travelling. There is a paucity of literature examining this area. This review summarizes the relevant literature and the clinical experience of the authors to compile clinical practice recommendations. The clinical features of parasomnias and how they relate to trans-meridian and long-distance travel are described. Triggers for non-rapid eye movement parasomnias, particularly the use of sedative hypnotic drugs, alcohol, drug withdrawal, sleep deprivation, emotional stress and environmental stimulations, are described. Management of parasomnias whilst travelling is reviewed, with a particular focus on trigger minimalization. The role for clonazepam and melatonin is outlined. At the pre-travel health consultation, the physician is strongly advised to screen the traveller for co-morbid sleep conditions, which exacerbate parasomnias. Areas for further research are explored, including the extent to which these sleep disorders impact on the travel experience.
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Affiliation(s)
- Sinead M. Walsh
- School of MedicineNational University of Ireland GalwayGalwayIreland,Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Cameron L. Forward
- Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Gerard T. Flaherty
- School of MedicineNational University of Ireland GalwayGalwayIreland,School of MedicineInternational Medical UniversityKuala LumpurMalaysia
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32
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Huang B, Zhang J, Wang J, Chau SWH, Chan JWY, Yu MWM, Li SX, Zhou L, Mok V, Wing YK, Liu Y. Isolated dream‐enactment behaviours as a prodromal hallmark of rapid eye movement sleep behaviour disorder. J Sleep Res 2022; 32:e13791. [PMID: 36410741 DOI: 10.1111/jsr.13791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022]
Abstract
Recurrent dream-enactment behaviours (DEB) and rapid eye movement (REM) sleep without atonia (RSWA) are two diagnostic hallmarks of REM sleep behaviour disorder (RBD), a specific prodrome of α-synucleinopathy. Whilst isolated RSWA (without DEB) was suggested as a prodrome of RBD, the implication of 'isolated' recurrent DEB remains under-investigated. In this cross-sectional study, we sought to investigate neurodegenerative markers amongst the first-degree relatives (FDRs, aged >40 years) of patients with RBD who underwent clinical assessment for DEB, neurodegenerative markers, and video-polysomnography assessment. Isolated recurrent DEB was defined as: (i) three or more episodes of DEB, (ii) had a DEB episode in the past 1 year, and (iii) subthreshold RSWA. We identified 29 FDRs (mean [SD] age 53.4 [8.3] years, 55.2% male) with isolated recurrent DEB and 98 age and sex-matched FDRs as controls. Isolated DEB was associated with nightmare (27.6% versus 11.2%, p = 0.02), and the DEB group had a higher rate of current smoking (27.6% versus 3.1%, p = 0.006), type 2 diabetes mellitus (24.1% versus 10.2%, p = 0.003), anxiety disorder (24.1% versus 11.2%, p = 0.02), and constipation (hard lump of stool, 31.0% versus 7.1%, p < 0.001) than the control group. The present findings revealed that family relatives of patients with RBD with isolated recurrent DEB have increased risk of RBD and neurodegenerative features, which adds to the emerging data that isolated DEB is a prodromal feature of RBD and α-synucleinopathy neurodegeneration.
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Affiliation(s)
- Bei Huang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Jing Wang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Steven Wai Ho Chau
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Joey Wing Yan Chan
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Mandy Wai Man Yu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong China
| | - Li Zhou
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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33
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Fasiello E, Scarpelli S, Gorgoni M, Alfonsi V, De Gennaro L. Dreaming in Parasomnias: REM Sleep Behavior Disorder as a Model. J Clin Med 2022; 11:6379. [PMID: 36362607 PMCID: PMC9654698 DOI: 10.3390/jcm11216379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 10/01/2023] Open
Abstract
Sleep parasomnias have drawn the interest of sleep experts because they represent a valuable window to directly monitor dream activity and sleep mentation associated with nocturnal events. Indeed, parasomnias and their manifestations are helpful in investigating dream activity and features, overcoming methodological limits that affect dream study. Specifically, REM sleep Behavior Disorder (RBD) is a parasomnia characterized by enacted dream episodes during Rapid Eye Movements (REM) sleep, caused by the loss of physiological atonia. Patients suffering from RBD report a peculiar oneiric activity associated with motor episodes characterized by high Dream Recall Frequency (DRF) and vivid dreams. Additionally, isolated RBD (iRBD) represents a prodromal stage of neurodegeneration preceding the development of α-synucleinopathies. This narrative review aims to combine evidence describing dream activity in RBD and similarities and differences with other NREM parasomnias. Moreover, a special focus has been reserved for those conditions in which RBD is associated with α-synucleinopathies to clarify the potential role of dreams in neurodegenerative processes.
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Affiliation(s)
- Elisabetta Fasiello
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab IRCCS Fondazione Santa Lucia Foundation, 00179 Rome, Italy
| | - Valentina Alfonsi
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab IRCCS Fondazione Santa Lucia Foundation, 00179 Rome, Italy
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34
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Cha EJ, Jeon HJ. The effect of COVID-19 pandemic on sleep-related problems in adults and elderly citizens: An infodemiology study using relative search volume data. PLoS One 2022; 17:e0271059. [PMID: 35819941 PMCID: PMC9275680 DOI: 10.1371/journal.pone.0271059] [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: 01/21/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
COVID-19 has had a substantial national impact in South Korea, causing negative psychological responses including sleep-related problems. Literature indicates sleep problems among the general population have been reported to be as high as around 35.7% during the first 8 months of COVID-19. Therefore, the aim of this study was to investigate the impact of COVID-19 pandemic on sleep problems among the general population using relative search volume (RSV) data, and whether there are any differences by age and time periods spanning before and during the pandemic. RSV data was collected from the most commonly used search engine in South Korea, NAVER. Search terms were grouped into 4 categories: insomnia, other sleep disorders, sleeping pills, and sleeping pill side effects. Time points were divided into 4 periods, each 7 months long: 7 months before COVID-19 (T0), first confirmed COVID-19 case to 7 months after (T1), 7 to 14 months (T2), and 14 to 21 months (T3). A 2x4 factorial Analysis of Variance was conducted to investigate main effects and interactions between age and time periods. Main effects and interaction effects of age and time periods were significant for all search term groups. For all search terms, both age groups showed dramatic increase from T0 to T1. In age group 60 or above, RSV continued to increase for other sleep disorders and sleeping pill. Insomnia and sleeping pill side effects showed decreasing trend at T3. In general, sudden increase in RSV after occurrence of COVID-19 followed by slow decline were observed. However, for age group 60 or above, RSV values of other sleep disorders and sleeping pills continued to increase, suggesting slower recovery of psychological impact with increasing age. Overall, the results underscore the importance of implementing preventive measures for monitoring sleep problems during the pandemic, especially in the elderly.
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Affiliation(s)
- Eun Jung Cha
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Korea
| | - Hong Jun Jeon
- Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Korea
- * E-mail:
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35
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Valli M, Uribe C, Mihaescu A, Strafella AP. Neuroimaging of rapid eye movement sleep behavior disorder and its relation to Parkinson's disease. J Neurosci Res 2022; 100:1815-1833. [DOI: 10.1002/jnr.25099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/10/2022] [Accepted: 06/08/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Mikaeel Valli
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
| | - Carme Uribe
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Medical Psychology Unit, Department of Medicine, Institute of Neuroscience University of Barcelona Barcelona Spain
| | - Alexander Mihaescu
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
| | - Antonio P. Strafella
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health University of Toronto Toronto Ontario Canada
- Division of Brain, Imaging and Behaviour – Systems Neuroscience, Krembil Brain Institute, UHN University of Toronto Toronto Ontario Canada
- Institute of Medical Science University of Toronto Toronto Ontario Canada
- Edmond J. Safra Parkinson Disease Program & Morton and Gloria Shulman Movement Disorder Unit, Neurology Division, Department of Medicine, Toronto Western Hospital, UHN University of Toronto Toronto Ontario Canada
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36
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Ralls F, Cutchen L, Grigg-Damberger MM. What Is the Prognostic Significance of Rapid Eye Movement Sleep Without Atonia in a Polysomnogram? J Clin Neurophysiol 2022; 39:346-355. [PMID: 35239559 DOI: 10.1097/wnp.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Freud said we are lucky to be paralyzed during sleep, so we cannot act out our dreams. Atonia of skeletal muscles normally present during rapid eye movement sleep prevents us from acting out our dreams. Observing rapid eye movement sleep without atonia in a polysomnogram in older adults first and foremost warrants consideration of rapid eye movement behavior disorder. Seventy-five to 90% of older adults with isolated rapid eye movement behavior disorder will develop a neurodegenerative disease within 15 years, most often a synucleinopathy. Rapid eye movement sleep without atonia in those younger than 50 years is commonly found in individuals with narcolepsy and those taking antidepressant medications.
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Affiliation(s)
- Frank Ralls
- New Mexico Sleep Labs, Rio Rancho, New Mexico, U.S.A
| | - Lisa Cutchen
- Omni Sleep, Albuquerque, New Mexico, U.S.A.; and
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37
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Lai H, Li XY, Hu J, Li W, Xu F, Zhu J, He R, Weng H, Chen L, Yu J, Li X, Song Y, Wang X, Wang Z, Li W, Kang R, Li Y, Xu J, Deng Y, Ye Q, Wang C. Development and Validation of a Predictive Nomogram for Possible REM Sleep Behavior Disorders. Front Neurol 2022; 13:903721. [PMID: 35847229 PMCID: PMC9277017 DOI: 10.3389/fneur.2022.903721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To develop and validate a predictive nomogram for idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) in a community population in Beijing, China. Methods Based on the validated RBD questionnaire-Hong Kong (RBDQ-HK), we identified 78 individuals with possible RBD (pRBD) in 1,030 community residents from two communities in Beijing. The least absolute shrinkage and selection operator (LASSO) regression was applied to identify candidate features and develop the nomogram. Internal validation was performed using bootstrap resampling. The discrimination of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, and the predictive accuracy was assessed via a calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical value of the model. Results From 31 potential predictors, 7 variables were identified as the independent predictive factors and assembled into the nomogram: family history of Parkinson's disease (PD) or dementia [odds ratio (OR), 4.59; 95% confidence interval (CI), 1.35–14.45; p = 0.011], smoking (OR, 3.24; 95% CI, 1.84–5.81; p < 0.001), physical activity (≥4 times/week) (OR, 0.23; 95% CI, 0.12–0.42; p < 0.001), exposure to pesticides (OR, 3.73; 95%CI, 2.08–6.65; p < 0.001), constipation (OR, 6.25; 95% CI, 3.58–11.07; p < 0.001), depression (OR, 3.66; 95% CI, 1.96–6.75; p < 0.001), and daytime somnolence (OR, 3.28; 95% CI, 1.65–6.38; p = 0.001). The nomogram displayed good discrimination, with original AUC of 0.885 (95% CI, 0.845–0.925), while the bias-corrected concordance index (C-index) with 1,000 bootstraps was 0.876. The calibration curve and DCA indicated the high accuracy and clinical usefulness of the nomogram. Conclusions This study proposed an effective nomogram with potential application in the individualized prediction for pRBD.
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Affiliation(s)
- Hong Lai
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xu-Ying Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Junya Hu
- Department of Neurobiology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurobiology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Fanxi Xu
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Junge Zhu
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Raoli He
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Huidan Weng
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Lina Chen
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Jiao Yu
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Xian Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yang Song
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xianling Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zhanjun Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Rong Kang
- The Xinjiekou Community Health Service Center, Beijing, China
| | - Yuling Li
- The Xinjiekou Community Health Service Center, Beijing, China
| | - Junjie Xu
- The Qinglonghu Community Health Service Center, Beijing, China
| | - Yuanfei Deng
- Department of Geriatric Disease, Peking University Shenzhen Hospital, Shenzhen, China
- Yuanfei Deng
| | - Qinyong Ye
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
- Qinyong Ye
| | - Chaodong Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- *Correspondence: Chaodong Wang
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38
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Mutlu B, Topcu MT. Investigation of the Relationship between Vestibular Disorders and Sleep Disturbance. Int Arch Otorhinolaryngol 2022; 26:e688-e696. [PMID: 36405483 PMCID: PMC9668417 DOI: 10.1055/s-0042-1742763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Vestibular pathologies cause physical and psychological symptoms, as well as cognitive problems.
Objective
To evaluate the deterioration in sleep quality associated with vestibular pathologies.
Methods
The Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Limits of Stability test (LOS) were applied to the participants.
Results
We included 25 patients with Meniere's disease (MD), 22 patients with benign paroxysmal positional vertigo (BPPV), 21 patients with unilateral peripheral vestibular loss (UPVL), 23 patients with vestibular migraine (VM), and 43 controls. The total PSQI scores of the controls were better than those of the MD (
p
= 0.014), VM (
p
< 0.001), BPPV (
p
= 0.003), and UPVL (
p
= 0.001) groups. The proportion of poor sleepers in the MD (
p
= 0.005), BPPV (
p
= 0.018), and UPVL (
p
< 0.001) groups was significantly higher than that of the controls. The highest total DHI score (45.68 ± 25.76) was found among the MD group, and it was significantly higher than the scores of the BPPV (
p
= 0.007) and control (
p
< 0.001) groups. The highest BDI score was obtained in the VM group, and it was significantly higher than the scores of the BPPV (
p
= 0.046) and control (
p
< 0.001) groups. Moreover, the BDI scores of the MD (
p
= 0.001) and UPVL groups were also significantly worse than the score of the controls (
p
= 0.001).
Conclusion
The present study showed thatpatients with vestibular symptoms have physical and functional complaints, as well as increased psychosocial stress and decreased sleep quality. Evaluating multiple parameters of quality of life may contribute to a better understanding of vestibular physiology and symptoms, and may help establish a more effective therapeutic approach.
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Affiliation(s)
- Basak Mutlu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Merve Torun Topcu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
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39
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Sandness DJ, McCarter SJ, Dueffert LG, Shepard PW, Enke AM, Fields J, Mielke MM, Boeve BF, Silber MH, St. Louis EK. Cognition and driving ability in isolated and symptomatic REM sleep behavior disorder. Sleep 2022; 45:zsab253. [PMID: 34958375 PMCID: PMC8996024 DOI: 10.1093/sleep/zsab253] [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: 02/12/2021] [Revised: 04/28/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES To analyze cognitive deficits leading to unsafe driving in patients with REM Sleep Behavior Disorder (RBD), strongly associated with cognitive impairment and synucleinopathy-related neurodegeneration. METHODS Twenty isolated RBD (iRBD), 10 symptomatic RBD (sRBD), and 20 age- and education-matched controls participated in a prospective case-control driving simulation study. Group mean differences were compared with correlations between cognitive and driving safety measures. RESULTS iRBD and sRBD patients were more cognitively impaired than controls in global neurocognitive functioning, processing speeds, visuospatial attention, and distractibility (p < .05). sRBD patients drove slower with more collisions than iRBD patients and controls (p < .05), required more warnings, and had greater difficulty following and matching speed of a lead car during simulated car-following tasks (p < .05). Driving safety measures were similar between iRBD patients and controls. Slower psychomotor speed correlated with more off-road accidents (r = 0.65) while processing speed (-0.88), executive function (-0.90), and visuospatial impairment (0.74) correlated with safety warnings in sRBD patients. Slower stimulus recognition was associated with more signal-light (0.64) and stop-sign (0.56) infractions in iRBD patients. CONCLUSIONS iRBD and sRBD patients have greater selective cognitive impairments than controls, particularly visuospatial abilities and processing speed. sRBD patients exhibited unsafe driving behaviors, associated with processing speed, visuospatial awareness, and attentional impairments. Our results suggest that iRBD patients have similar driving-simulator performance as healthy controls but that driving capabilities regress as RBD progresses to symptomatic RBD with overt signs of cognitive, autonomic, and motor impairment. Longitudinal studies with serial driving simulator evaluations and objective on-road driving performance are needed.
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Affiliation(s)
- David J Sandness
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Lucas G Dueffert
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Park Nicollet Rehabilitation, Maple Grove, MN, USA
| | - Paul W Shepard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Ashley M Enke
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
| | - Julie Fields
- Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Rochester, MN, USA
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
- Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
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Yuan Y, Shrestha S, Luo Z, Li C, Plassman BL, Parks CG, Hofmann JN, Beane Freeman LE, Sandler DP, Chen H. High Pesticide Exposure Events and Dream‐Enacting Behaviors Among US Farmers. Mov Disord 2022; 37:962-971. [PMID: 35152487 PMCID: PMC9524747 DOI: 10.1002/mds.28960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dream-enacting behavior is a characteristic feature of rapid eye movement sleep behavior disorder, the most specific prodromal marker of synucleinopathies. Pesticide exposure may be associated with dream-enacting behaviors, but epidemiological evidence is limited. OBJECTIVES To examine high pesticide exposure events in relation to dream-enacting behaviors among farmers in the Agricultural Health Study. METHODS We conducted multivariable logistic regression analyses to examine high pesticide exposure events reported from 1993 to 1997 in relation to dream-enacting behaviors assessed from 2013 to 2015 among 11,248 farmers (age 47 ± 11 years). RESULTS A history of dream-enacting behaviors was reported by 939 (8.3%) farmers. Compared with farmers who did not report any high pesticide exposure event, those who reported were more likely to endorse dream-enacting behaviors 2 decades later (odds ratio = 1.75; 95% confidence interval [CI], 1.49-2.05). The association appeared stronger when there was a long delay in washing with soap and water after the event (2.63 [95% CI, 1.62-4.27] for waiting >6 hours vs. 1.71 [95% CI, 1.36-2.15] for washing within 30 minutes) and when the exposure involved the respiratory or digestive tract (2.04 [95% CI, 1.62-2.57] vs. 1.58 [95% CI, 1.29-1.93] for dermal contact only). In the analyses of specific pesticides involved, we found positive associations with two organochlorine insecticides (dichlorodiphenyltrichloroethane and lindane), four organophosphate insecticides (phorate, ethoprop, terbufos, and parathion), two herbicides (alachlor and paraquat), and fungicides as a group. CONCLUSIONS This study provides the first epidemiological evidence that high pesticide exposures may be associated with a higher risk of dream-enacting behaviors. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Yaqun Yuan
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
| | - Srishti Shrestha
- The Memory Impairment and Neurodegenerative Dementia Center University of Mississippi Medical Center Jackson Mississippi USA
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
| | - Chenxi Li
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
| | - Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences Duke University Medical Center Durham North Carolina USA
| | - Christine G. Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences Research Triangle Park North Carolina USA
| | - Jonathan N. Hofmann
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA
| | - Laura E. Beane Freeman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics National Cancer Institute Rockville Maryland USA
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences Research Triangle Park North Carolina USA
| | - Honglei Chen
- Department of Epidemiology and Biostatistics, College of Human Medicine Michigan State University East Lansing Michigan USA
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Pavelka L, Rauschenberger A, Landoulsi Z, Pachchek S, Marques T, Gomes CP, Glaab E, May P, Krüger R, on behalf of the NCER-PD Consortium. Body-First Subtype of Parkinson's Disease with Probable REM-Sleep Behavior Disorder Is Associated with Non-Motor Dominant Phenotype. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2561-2573. [PMID: 36245388 PMCID: PMC9837682 DOI: 10.3233/jpd-223511] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The hypothesis of body-first vs. brain-first subtype of PD has been proposed with REM-Sleep behavior disorder (RBD) defining the former. The body-first PD presumes an involvement of the brainstem in the pathogenic process with higher burden of autonomic dysfunction. OBJECTIVE To identify distinctive clinical subtypes of idiopathic Parkinson's disease (iPD) in line with the formerly proposed concept of body-first vs. brain-first subtypes in PD, we analyzed the presence of probable RBD (pRBD), sex, and the APOEɛ4 carrier status as potential sub-group stratifiers. METHODS A total of 400 iPD patients were included in the cross-sectional analysis from the baseline dataset with a completed RBD Screening Questionnaire (RBDSQ) for classifying as pRBD by using the cut-off RBDSQ≥6. Multiple regression models were applied to explore (i) the effect of pRBD on clinical outcomes adjusted for disease duration and age, (ii) the effect of sex on pRBD, and (iii) the association of APOEɛ4 and pRBD. RESULTS iPD-pRBD was significantly associated with autonomic dysfunction (SCOPA-AUT), level of depressive symptoms (BDI-I), MDS-UPDRS I, hallucinations, and constipation, whereas significantly negatively associated with quality of life (PDQ-39) and sleep (PDSS). No significant association between sex and pRBD or APOE ɛ4 and pRBD in iPD was found nor did we determine a significant effect of APOE ɛ4 on the PD phenotype. CONCLUSION We identified an RBD-specific PD endophenotype, characterized by predominant autonomic dysfunction, hallucinations, and depression, corroborating the concept of a distinctive body-first subtype of PD. We did not observe a significant association between APOE ɛ4 and pRBD suggesting both factors having an independent effect on cognitive decline in iPD.
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Affiliation(s)
- Lukas Pavelka
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Armin Rauschenberger
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Zied Landoulsi
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Sinthuja Pachchek
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Taina Marques
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Clarissa P.C. Gomes
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Enrico Glaab
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Patrick May
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
| | - Rejko Krüger
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - on behalf of the NCER-PD Consortium
- Parkinson’s Research Clinic, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg
- Transversal Translational Medicine, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
- Biomedical Data Science Group, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Bioinformatics Core, Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Loddo G, Fragiacomo F, Mainieri G, Mondini S, Buzzi G, Calandra-Buonaura G, Provini F. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med 2022; 18:129-136. [PMID: 34180806 PMCID: PMC8807889 DOI: 10.5664/jcsm.9516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To describe clinical and video-polysomnographic features of disorders of arousal (DoA) in older adults. METHODS Four consecutive male patients with nocturnal motor behaviors underwent a clinical interview, neurologic examination, laboratory tests, brain magnetic resonance imaging, and nocturnal in-laboratory or 24- to 48-hour home video polysomnography. The patients repeated an evaluation after 6 months of follow-up, including a 48-hour home video polysomnography in 2 patients. RESULTS The patients were aged 65-72 years, and 1 patient has Parkinson disease. Sleep-related behavioral episodes had begun from 12-55 years before our observation. Three patients presented with a positive family history for DoA. Sleep motor episodes were described as suddenly raising the head or trunk, sitting in bed, screaming, speaking, gesturing, and sleepwalking (in 1 patient). When questioned, all patients seemed confused, rarely reporting any dream-like content. We recorded 25 DoA episodes of different intensity and complexity arising from nonrapid eye movement sleep. The semiology of the episodes was similar to that described in younger patients, consisting of sleep terrors and confusional arousals. All patients presented with physiological rapid eye movement sleep muscle atonia. Medication therapy reduced the frequency of the episodes in 2/4 patients. CONCLUSIONS DoA may begin in adulthood and persist or arise in older adults, sometimes causing sleep-related injuries. Motor patterns of DoA in older adults are similar to those of younger patients. A combined clinical examination and video polysomnography recording are crucial in establishing a definitive diagnosis of nocturnal motor behavior in all older adults and especially in those affected by neurodegenerative diseases. CITATION Loddo G, Fragiacomo F, Mainieri G, et al. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med. 2022;18(1):129-136.
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Affiliation(s)
| | - Federica Fragiacomo
- U.O. Neurologia, Ospedale Castelfranco Veneto, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Greta Mainieri
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giovanna Calandra-Buonaura
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy,Address correspondence to: Federica Provini, MD, PhD, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Via Altura, 3, 40139 Bologna, Italy; Tel: ++ 39 051 4966829;
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Jayasekara R, Smith I. Proton pump inhibitors associated with rapid eye movement sleep behaviour disorder. BMJ Case Rep 2021; 14:e246469. [PMID: 34972777 PMCID: PMC8720946 DOI: 10.1136/bcr-2021-246469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 65-year-old woman diagnosed with rapid eye movement sleep behaviour disorder (REMBD) based on typical symptoms and confirmed with an inpatient polysomnogram. She was prescribed clonazepam and later temazepam but continued to have intrusive symptoms. She subsequently recalled that the onset of dream enactment coincided with starting high-dose omeprazole for acid reflux. With this insight, she stopped the omeprazole. Within days, the dream enactment and nocturnal movements subsided. She stopped taking the temazepam and was symptom free for a few months. However, she was started on lansoprazole for recurrent dyspepsia. Once again she experienced violent movements in sleep. This is the first time an association between proton pump inhibitors (PPIs) and REMBD has been reported. PPIs have many effects on the central nervous system and should be considered as a possible provoking factor in people presenting with REMBD.
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Affiliation(s)
- Ruwanthi Jayasekara
- Respiratory Support and Sleep Centre (RSSC), Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ian Smith
- Respiratory Support and Sleep Centre (RSSC), Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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44
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Feemster JC, Steele TA, Palermo KP, Ralston CL, Tao Y, Bauer DA, Edgar L, Rivera S, Walters-Smith M, Gossard TR, Teigen LN, Timm PC, Richardson JW, Robert Auger R, Kolla B, McCarter SJ, Boeve BF, Silber MH, St. Louis EK. Abnormal rapid eye movement sleep atonia control in chronic post-traumatic stress disorder. Sleep 2021; 45:6484914. [PMID: 34958372 PMCID: PMC8919203 DOI: 10.1093/sleep/zsab259] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Post-traumatic stress disorder (PTSD) and rapid eye movement (REM) sleep behavior disorder (RBD) share some common features including prominent nightmares and sleep disturbances. We aimed to comparatively analyze REM sleep without atonia (RSWA) between patients with chronic PTSD with and without dream enactment behavior (DEB), isolated RBD (iRBD), and controls. METHODS In this retrospective study, we comparatively analyzed 18 PTSD with DEB (PTSD+DEB), 18 PTSD without DEB, 15 iRBD, and 51 controls matched for age and sex. We reviewed medical records to determine PTSD clinical features and quantitatively analyzed RSWA. We used nonparametric analyses to compare clinical and polysomnographic features. RESULTS PTSD patients, both with and without DEB, had significantly higher RSWA than controls (all p < .025, excepting submentalis phasic duration in PTSD+DEB). Most RSWA measures were also higher in PTSD+DEB than in PTSD without DEB patients (all p < .025). CONCLUSIONS PTSD patients have higher RSWA than controls, whether DEB is present or not, indicating that REM sleep atonia control is abnormal in chronic PTSD. Further prospective studies are needed to determine whether neurodegenerative risk and disease markers similar to RBD might occur in PTSD patients.
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Affiliation(s)
- John C Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Tyler A Steele
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Kyle P Palermo
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Christy L Ralston
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - Yumeng Tao
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Cornell College, Mount Vernon, IA, USA
| | - David A Bauer
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Liam Edgar
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,St. Olaf College, Northfield, MN, USA
| | - Sonia Rivera
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Maxwell Walters-Smith
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas R Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Luke N Teigen
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Paul C Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Jarrett W Richardson
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - R Robert Auger
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bhanuprakash Kolla
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Psychiatry, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Stuart J McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Bradley F Boeve
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Michael H Silber
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Erik K St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Mayo Center for Sleep Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Division of Pulmonary and Critical Care Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Medicine, Mayo Clinic and Foundation, Rochester, MN, USA,Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA,Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA,Corresponding author. Erik K. St. Louis, Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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Williams SR, Henzler N, Peřinová P, Morrison IA, Ellis JG, Riha RL. Trauma Immediately Preceding REM-Behavior Disorder: A Valuable Prognostic Marker? Front Neurol 2021; 12:710584. [PMID: 34899555 PMCID: PMC8653876 DOI: 10.3389/fneur.2021.710584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background: The definition of rapid eye movement (REM) sleep behavior disorder (RBD) has varied over the years. Rapid eye movement sleep behavior disorder can be considered isolated or idiopathic or can occur in the context of other disorders, including trauma-associated sleep disorder (TSD) and overlap parasomnia. However, whether trauma in RBD carries any prognostic specificity is currently unknown. Study Objectives: To test the hypothesis that RBD secondary to trauma is less likely to result in the development of neurodegeneration compared to idiopathic RBD (iRBD) without trauma in the general population. Methods: A retrospective cohort study of 122 consecutive RBD patients (103 males) at two tertiary sleep clinics in Europe between 2005 and 2020 was studied. Patients were diagnosed as having iRBD by video polysomnography (vPSG) and had a semi-structured interview at presentation, including specifically eliciting any history of trauma. Patients with secondary RBD to recognized causes were excluded from the study. Patients with iRBD were categorized into three groups according to reported trauma history: (1) No history of trauma, (2) traumatic experience at least 12 months prior to RBD symptom onset, and (3) traumatic experience within 12 months of RBD symptom onset. Idiopathic RBD duration was defined as the interval between estimated onset of RBD symptoms and last hospital visit or death. Follow-up duration was defined as the interval between iRBD diagnosis and last hospital visit or death. Results: In a follow-up period of up to 18 years, no patient who experienced trauma within 12 months preceding their iRBD diagnosis received a diagnosis of a neurodegenerative disorder (n = 35), whereas 38% of patients without trauma within the 12 months of symptom onset developed a neurodegenerative illness. These patients were also significantly more likely to have a family history of α-synucleinopathy or tauopathy. Conclusions: The development of RBD within 12 months of experiencing a traumatic life event, indistinguishable clinically from iRBD, did not lead to phenoconversion to a neurodegenerative disorder even after 18 years (mean follow up 6 years). We suggest that a sub-type of RBD be established and classified as secondary RBD due to trauma. Additionally, we advocate that a thorough psychological and trauma history be undertaken in all patients presenting with dream enactment behaviors (DEB).
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Affiliation(s)
- Stevie R Williams
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Nelly Henzler
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Pavla Peřinová
- The Department of Neurology and Clinical Sciences, Charles University, Prague, Czechia
| | - Ian A Morrison
- Department of Neurology, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, United Kingdom
| | - Renata L Riha
- Sleep Research Unit, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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46
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Araji F, Khan SS. REM Sleep Parasomnias and REM Behavior Disorder: Clinical Features, Diagnosis, and Management. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20211112-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
What are the effects of sleep disturbance and changes of sleep on aging women in the short and long term? Most research that has been done in recent years evaluates how sleep disorders and sleep disturbance may change mortality and outcomes of this population. Many confounding factors may be playing a role, including comorbid conditions. This article reviews sleep disorders including insomnia, circadian sleep-wake rhythm disorders, restless legs syndrome, disorders of hypersomnia, and sleep-disordered breathing in women aged 65 and older; prevalence of these disorders; and recommended treatment options.
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Affiliation(s)
- Wahida Akberzie
- Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA
| | - Lynn Kataria
- Sleep Laboratory, Department of Neurology, George Washington University School of Medicine, Washington DC VA Medical Center, 3B-103, 50 Irving Street Northwest, Washington, DC 20422, USA.
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Application of machine learning analysis based on diffusion tensor imaging to identify REM sleep behavior disorder. Sleep Breath 2021; 26:633-640. [PMID: 34236578 DOI: 10.1007/s11325-021-02434-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE We evaluated the feasibility of machine learning analysis using diffusion tensor imaging (DTI) parameters to identify patients with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD). We hypothesized that patients with idiopathic RBD could be identified via machine learning analysis based on DTI. METHODS We enrolled 20 patients with newly diagnosed idiopathic RBD at a tertiary hospital. We also included 20 healthy subjects as a control group. All of the subjects underwent DTI. We obtained the conventional DTI parameters and structural connectomic profiles from the DTI. We investigated the differences in conventional DTI measures and structural connectomic profiles between patients with idiopathic RBD and healthy controls. We then used machine learning analysis using a support vector machine (SVM) algorithm to identify patients with idiopathic RBD using conventional DTI and structural connectomic profiles. RESULTS Several regions showed significant differences in conventional DTI measures and structural connectomic profiles between patients with idiopathic RBD and healthy controls. The SVM classifier based on conventional DTI measures revealed an accuracy of 87.5% and an area under the curve of 0.900 to identify patients with idiopathic RBD. Another SVM classifier based on structural connectomic profiles yielded an accuracy of 75.0% and an area under the curve of 0.833. CONCLUSION Our findings demonstrate the feasibility of machine learning analysis based on DTI to identify patients with idiopathic RBD. The conventional DTI parameters might be more important than the structural connectomic profiles in identifying patients with idiopathic RBD.
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Cicero CE, Giuliano L, Luna J, Zappia M, Preux PM, Nicoletti A. Prevalence of idiopathic REM behavior disorder: a systematic review and meta-analysis. Sleep 2021; 44:6060057. [PMID: 33388771 DOI: 10.1093/sleep/zsaa294] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To provide an overall estimate of the prevalence of idiopathic REM Sleep Behavior Disorder (iRBD). METHODS Two investigators have independently searched the PubMed and Scopus databases for population-based studies assessing the prevalence of iRBD. Data about type of diagnosis (polysomnographic diagnosis, defined iRBD [dRBD]; clinical diagnosis, probable RBD [pRBD]), continent, age range of the screened population, quality of the studies, sample size, screening questionnaires, and strategies have been gathered. A random-effect model was used to estimate the pooled prevalence. Heterogeneity was investigated with subgroup analysis and meta-regression. RESULTS From 857 articles found in the databases, 19 articles were selected for the systematic review and meta-analysis. According to the type of diagnosis, five studies identified dRBD cases given a pooled prevalence of 0.68% (95% confidence interval [CI] 0.38-1.05) without significant heterogeneity (Cochran's Q p = 0.11; I2 = 46.43%). Fourteen studies assessed the prevalence of pRBD with a pooled estimate of 5.65% (95% CI 4.29-7.18) and a significant heterogeneity among the studies (Cochran's Q p < 0.001; I2 = 98.21%). At the subgroup analysis, significant differences in terms of prevalence were present according to the quality of the studies and, after removing two outlaying studies, according to the continents and the screening questionnaire used. Meta-regression did not identify any significant effect of the covariates on the pooled estimates. CONCLUSION Prevalence estimates of iRBD are significantly impacted by diagnostic level of certainty. Variations in pRBD prevalence are due to methodological differences in study design and screening questionnaires employed.
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Affiliation(s)
- Calogero Edoardo Cicero
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Loretta Giuliano
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Jaime Luna
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Mario Zappia
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
| | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Alessandra Nicoletti
- Department of Medical, Surgical and Advanced technologies G.F. Ingrassia, Section of Neurosciences, University of Catania, Catania, Italy
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Giannini G, Provini F, Cortelli P, Calandra-Buonaura G. REM Sleep Behaviour Disorder in Multiple System Atrophy: From Prodromal to Progression of Disease. Front Neurol 2021; 12:677213. [PMID: 34194385 PMCID: PMC8238043 DOI: 10.3389/fneur.2021.677213] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
A higher frequency of motor and breathing sleep-related disorders in multiple system atrophy (MSA) populations is reported. REM sleep behaviour disorder (RBD) is one of the most robust markers of an underlying alpha-synucleinopathy. Although a large corpus of literature documented the higher prevalence of RBD in MSA, few studies have systematically investigated the prevalence of RBD as mode of disease onset and its role in disease progression. Moreover, there has been increasing interest in phenoconversion into synucleinopathies of cohorts of patients with isolated RBD (iRBD). Finally, some studies investigated RBD as predictive factor of conversion in isolated autonomic failure, a synucleinopathy presenting with autonomic failure as the sole clinical manifestation that could convert to a manifest central nervous system synucleinopathy. As the field of neurodegenerative disorders moves increasingly towards developing disease-modifying therapies, detecting individuals in the prodromal stage of these synucleinopathies becomes crucial. The aims of this review are to summarise (1) the prevalence of RBD during the course of MSA and as presenting feature of MSA (iRBD), (2) the RBD features in MSA, (3) MSA progression and prognosis in the subgroup of patients with RBD predating disease onset, and (4) the prevalence of MSA conversion in iRBD cohorts. Moreover, we summarise previous results on the role of RBD in the context of isolated autonomic failure as marker of phenoconversion to other synucleinopathies and, in particular, to MSA.
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Affiliation(s)
- Giulia Giannini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Complessa (UOC) Clinica Neurologica Rete Metropolitana NEUROMET, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Federica Provini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Complessa (UOC) Clinica Neurologica Rete Metropolitana NEUROMET, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Complessa (UOC) Clinica Neurologica Rete Metropolitana NEUROMET, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità Operativa Complessa (UOC) Clinica Neurologica Rete Metropolitana NEUROMET, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
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