A community-based study of risk factors for probable rapid eye movement sleep behavior disorder

Fang, Jianzhang; Qiao, Ye; Gao, Xiang; Liang, Liang; Liu, Xiao Li; Li, Dun Hui; Tang, Hui; Chen, Sheng Di

doi:10.1016/j.sleep.2016.06.027

Cited by 39 publications

(33 citation statements)

References 44 publications

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“…8 Significant association between cardiovascular risk factors and pRBD was observed in 2 previous cross-sectional studies. 12,32 However, in the current study, after we controlled for these cardiovascular factors, the significant association between pRBD and stroke persisted, suggesting that pRBD could be a risk factor for stroke beyond these conventional factors. Furthermore, this increased risk may come from RBD itself or possibly from another comorbid sleep disorder, such as OSA.…”

Section: Insomniacontrasting

confidence: 57%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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Objective: To examine whether probable REM sleep behavior disorder (pRBD) was associated with increased risk of developing stroke in a community-based cohort. Methods:The study included 12,003 participants (mean age 54.0 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury at baseline (2012). We determined pRBD using a validated REM sleep behavior disorder (RBD) questionnaire in 2012. Incident stroke cases were confirmed by review of medical records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke according to pRBD status, adjusting for several sleep measures (i.e., insomnia, daytime sleepiness, sleep duration, snoring, and use of hypnotics) and other potential confounders.Results: During 3 years of follow-up, we documented 159 incident stroke cases. Relative to participants without pRBD at the baseline, those with pRBD had a 157% higher risk (95% CI 59%-313%) of developing stroke. Presence of pRBD was associated with increased risk of both stroke types-the adjusted HR was 1.93 (95% CI 1.07-3.46) for ischemic stroke and 6.61 (95% CI 2.27-19.27) for hemorrhagic stroke.Conclusions: Presence of pRBD was associated with a higher risk of developing stroke, including both ischemic and hemorrhagic types. Future studies with clinically confirmed RBD and a longer follow-up would be appropriate to further investigate this association. Neurology ® 2017;88:1849-1855 GLOSSARY AIS 5 Athens Insomnia Scale; BMI 5 body mass index; CI 5 confidence interval; ESS 5 Epworth Sleepiness Scale; HDL-C 5 high-density lipoprotein cholesterol; HR 5 hazard ratio; ICD-10 5 International Classification of Diseases-10; LDL-C 5 lowdensity lipoprotein cholesterol; OR 5 odds ratio; OSA 5 obstructive sleep apnea; PD 5 Parkinson disease; pRBD 5 probable REM sleep behavior disorder; RBD 5 REM sleep behavior disorder; RBDQ-HK 5 RBD questionnaire-Hong Kong; RMB 5 renminbi.REM sleep behavior disorder (RBD) is associated with synucleinopathies, and a large proportion of individuals with RBD may already have or later develop Parkinson disease (PD), dementia with Lewy bodies, or multiple system atrophy. [1][2][3] Synucleinopathies were often associated with symptoms of autonomic dysfunction, such as impaired blood pressure control and reduced heart rate variability. 4,5 Consistently, individuals with idiopathic RBD experienced worse autonomic function, including cardiovascular, gastrointestinal, and urinary domains, relative to control participants. 6,7 The autonomic nervous system may have a role in the prepathologic state or contribute to the precipitating factors of the acute phase of stroke, such as atherosclerosis and sympathetic hyperactivity. 8 Some case reports suggested that stroke may cause RBD. 9-11 In a previous cross-sectional study, we also found that individuals with probable RBD (pRBD) had higher odds of several concurrent stroke risk factors, such as diabetes and hyperlipidemia. 12 However, whether RBD predicts subsequ...

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Section: Insomniacontrasting

confidence: 57%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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“…We focused here on RBD in part because it is the strongest prodromal marker of α‐synucleinopathies, and we wanted to explore the idea that ET‐plus may be a prediagnostic phase of PD or other neurodegenerative disease . We found that pRBD was present in 20.5% of ET‐plus patients and 8.3% of ET patients, and these prevalence were higher than the prevalence of RBD in the general Chinese population (2.70%) or the prevalence of pRBD in the general population (5.5%) . Theses finding brings doubt whether RBD should be regarded as a soft sign?…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of patients with essential tremor or essential tremor plus

et al. 2020

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Background The International Parkinson and Movement Disorder Society introduced the category of essential tremor (ET)‐plus in its new ET classification scheme, but how the clinical correlates of ET‐plus differ from those of “pure” ET is unclear. By comparing the clinical characteristics of ET and ET‐plus patients, we expect to better understand the impact and invoked questions of the new classification on clinical practice. Methods We reviewed the medical records of 280 ET syndrome patients in an ongoing cross‐sectional study in a Chinese population and reclassified them according to the new criteria. Clinico‐demographic characteristics were compared between ET and ET‐plus patients. Risk factors of diagnosis of ET‐plus were explored using logistic regression. Results A total of 121 patients (50.8%) were reclassified as having ET and 117 as having ET‐plus. ET‐plus group was significantly older at tremor onset, less educated, and more likely to have cranial tremor, depression symptom, anxiety symptom, and probable REM sleep behavior disorder. ET‐plus group also showed more severe upper limb tremor and cognition impairment. Regression analysis identified four independent risk factors associated with ET‐plus: late tremor onset (OR 3.04, 95%CI 1.60‐5.79), less educated (OR 0.91, 95%CI 0.85‐0.97), severe upper limb tremor (OR 2.46, 95%CI 1.30‐4.62), and presence of cranial tremor (OR 2.30, 95%CI 1.20‐4.41). Conclusions The new classification scheme emphasized that ET syndrome is heterogeneous. ET‐plus cannot be seen as a subtype or a diagnosis of ET syndrome, but rather as a placeholder, representing an area of current scientific uncertainty.

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“…However, in a hospital-based case-control study, RBD cases were more likely to smoke (adjusted OR = 1.43, p = 0.028), although nonsmoking status has been consistently linked with risk of PD. [32] In addition, two recent community-based cross-sectional studies [33, 34] showed that smoking was not a significant risk factor for probable RBD. For example, in our previous study based on 12,784 Chinese participants of the Kailuan study, the adjusted ORs for probable RBD was 0.91(95% CI: 0.74-1.1) for current smoking and 1.17 (95% CI: 0.85–1.6) for past smoking, compared with non-smokers [33].…”

Section: Introductionmentioning

confidence: 99%

Nicotine from cigarette smoking and diet and Parkinson disease: a review

Liu

Neumann

et al. 2017

Transl Neurodegener

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Evidence from epidemiological studies suggest a relationship between cigarette smoking and low risk of Parkinson disease (PD). As a major component of tobacco smoke, nicotine has been proposed to be a substance for preventing against PD risk, with a key role in regulating striatal activity and behaviors mediated through the dopaminergic system. Animal studies also showed that nicotine could modulate dopamine transmission and reduce levodopa-induced dyskinesias. However, previous clinical trials yield controversial results regarding nicotine treatment. In this review, we updated epidemiological, preclinical and clinical data, and studies on nicotine from diet. We also reviewed interactions between genetic factors and cigarette smoking. As a small amount of nicotine can saturate a substantial portion of nicotine receptors in the brain, nicotine from other sources, such as diet, could be a promising therapeutic substance for protection against PD.

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A community-based study of risk factors for probable rapid eye movement sleep behavior disorder

Cited by 39 publications

References 44 publications

Probable REM sleep behavior disorder and risk of stroke

Probable REM sleep behavior disorder and risk of stroke

Clinical characteristics of patients with essential tremor or essential tremor plus

Nicotine from cigarette smoking and diet and Parkinson disease: a review

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