Clinical correlates of rapid eye movement sleep without atonia in Parkinson’s disease

Shen, Yun; Xiong, Kang-Ping; Li, Jie; Mao, Cheng‐Jie; Chen, Jing; He, Pei-Cheng; Huang, Junying; Dai, Yong-Ping; Luo, Weifeng; Liu, Chun‐Feng

doi:10.1016/j.clinph.2014.09.014

Cited by 12 publications

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References 28 publications

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“…In our previous study, we found tonic RSWA was more closely correlated with PD severity than phasic RSWA,[22] which was consistent with the results of this study. Similarly, a case report by Tachibana and Oka[23] described a 60-year-old MSA patient, whose PSGs indicated tonic chin EMG activity that increased as the patient's disease progressed, whereas the patient's phasic chin EMG activity remained relatively suppressed.…”

Section: Discussionsupporting

confidence: 92%

Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease

Wang

Shen

Xiong

et al. 2017

Chinese Medical Journal

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Background:Both Parkinson's disease (PD) and multiple system atrophy (MSA) have associated sleep disorders related to the underlying neurodegenerative pathology. Clinically, MSA with predominant parkinsonism (MSA-P) resembles PD in the manifestation of prominent parkinsonism. Whether the amount of rapid eye movement (REM) sleep without atonia could be a potential marker for differentiating MSA-P from PD has not been thoroughly investigated. This study aimed to examine whether sleep parameters could provide a method for differentiating MSA-P from PD.Methods:This study comprised 24 MSA-P patients and 30 PD patients, and they were of similar age, gender, and REM sleep behavior disorder (RBD) prevalence. All patients underwent clinical evaluation and one night of video-polysomnography recording. The tonic and phasic chin electromyogram (EMG) activity was manually quantified during REM sleep of each patient. We divided both groups in terms of whether they had RBD to make subgroup analysis.Results:No significant difference between MSA-P group and PD group had been found in clinical characteristics and sleep architecture. However, MSA-P patients had higher apnea-hypopnea index (AHI; 1.15 [0.00, 8.73]/h vs. 0.00 [0.00, 0.55]/h, P = 0.024) and higher tonic chin EMG density (34.02 [18.48, 57.18]% vs. 8.40 [3.11, 13.06]%, P < 0.001) as compared to PD patients. Subgroup analysis found that tonic EMG density in MSA + RBD subgroup was higher than that in PD + RBD subgroup (55.04 [26.81, 69.62]% vs. 11.40 [8.51, 20.41]%, P < 0.001). Furthermore, no evidence of any difference in tonic EMG density emerged between PD + RBD and MSA - RBD subgroups (P > 0.05). Both disease duration (P = 0.056) and AHI (P = 0.051) showed no significant differences during subgroup analysis although there was a trend toward longer disease duration in PD + RBD subgroup and higher AHI in MSA - RBD subgroup. Stepwise multiple linear regression analysis identified the presence of MSA-P (β = 0.552, P < 0.001) and RBD (β = 0.433, P < 0.001) as predictors of higher tonic EMG density.Conclusion:Tonic chin EMG density could be a potential marker for differentiating MSA-P from PD.

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Section: Discussionsupporting

confidence: 92%

Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease

Wang

Shen

Xiong

et al. 2017

Chinese Medical Journal

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“…In our study, we observed that 25.8% of patients with iRBD developed PD following a mean of 2.6 + 2.2 years. Age and male gender were reported among risk factors for developing PD associated with RBD . In our study, we found that mean age of patients developing PD was significantly higher than those not developing neurodegenerative disorders.…”

Section: Discussionsupporting

confidence: 49%

“…This temporal sequence of pathology might explain the underlying processes of development of RBD in patients with iRSWA. Recent clinicopathological studies have confirmed an association of synucleinopathy, especially of Lewy body pathology in RSWA; which was interpreted as iRSWA may increase over time due to underlying progressive pathological processes in brainstem structures and might be an electrophysiologic precursor of evolving RBD . Predictive value of RSWA in severity of PD has supported these hypotheses.…”

Section: Discussionmentioning

confidence: 80%

“…Although RSWA constitutes the neurophysiologic substrate of RBD, it is accepted as an isolated or incidental polysomnographic finding without associated dream‐enacting behaviors . Incidence of iRSWA was reported to be about 4.5% in general population .…”

Section: Discussionmentioning

confidence: 99%

“…Predictive value of RSWA in severity of PD has supported these hypotheses. Although relationships among clinical characteristics of PD and RSWA are not yet clear, presence of RSWA was reported to be associated with more severe motor symptoms in patients with PD . These studies have mainly focused on coexistence of PD and RSWA, but still little is known to date about the risk for developing PD or other synucleinopathies, or taupathies, in patients with iRSWA in the absence of dream‐enacting behavior.…”

Section: Discussionmentioning

confidence: 99%

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Rapid eye movement sleep without atonia constitutes increased risk for neurodegenerative disorders

2019

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Objectives REM (rapid eye movement) sleep without atonia (RSWA) is a polysomnographic finding used in diagnosis of REM sleep behavior disorder (RBD). Clinical significance of idiopathic RSWA (iRSWA) unaccompanied by RBD is not known. We designed a prospective study to investigate whether iRSWA constitutes an increased risk for developing neurodegenerative disorders. Materials and methods Between January 2010 and December 2014, a total of 4362 patients underwent a full‐night video‐polysomnography. Upon detailed clinical and polysomnographical examination, patients with iRSWA and idiopathic RBD (iRBD) were enrolled into this study and followed up at every six months for at least 4 years up to 9 years. Results We had a total of 31 patients with iRBD and 67 patients with iRSWA. Mean age was higher in iRBD group than those in iRSWA group (P = .016). Restless legs syndrome/Willis‐Ekbom disease was significantly more common in patients with iRBD than those in patient with iRSWA (P < .001). Eighteen patients with iRSWA (26.8%) developed iRBD after 2.6 + 2.2 years. Six patients with iRSWA (8.9%) developed neurodegenerative disorders following 2.4 + 1.5 years; four were diagnosed as Parkinson's disease (PD) and two developed probable Alzheimer‐type dementia. In patients with iRBD, eight patients (25.8%) developed neurodegenerative disorders—all was Parkinson's disease—following 2.6 + 2.2 years. Development of neurodegenerative diseases was positively correlated with age (P < .001) and periodic leg movements in sleep in both groups (P < .010). Conclusions These results show that iRSWA may also be accepted as a risk factor in the development of PD or neurodegenerative diseases. Advanced age and periodic leg movements in sleep seem to be correlated with higher risk.

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Clinical Significance of REM Sleep Behavior Disorders and Other Non-motor Symptoms of Parkinsonism

et al. 2017

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Rapid eye movement sleep behavior disorder (RBD) is one of the most common non-motor symptoms of parkinsonism, and it may serve as a prodromal marker of neurodegenerative disease. The mechanism underlying RBD is unclear. Several prospective studies have reported that specific non-motor symptoms predict a conversion risk of developing a neurodegenerative disease, including olfactory dysfunction, abnormal color vision, autonomic dysfunction, excessive daytime sleepiness, depression, and cognitive impairment. Parkinson's disease (PD) with RBD exhibits clinical heterogeneity with respect to motor and non-motor symptoms compared with PD without RBD. In this review, we describe the main clinical and pathogenic features of RBD, focusing on its association with other non-motor symptoms of parkinsonism.

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Clinical correlates of rapid eye movement sleep without atonia in Parkinson’s disease

Cited by 12 publications

References 28 publications

Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease

Tonic Electromyogram Density in Multiple System Atrophy with Predominant Parkinsonism and Parkinson's Disease

Rapid eye movement sleep without atonia constitutes increased risk for neurodegenerative disorders

Clinical Significance of REM Sleep Behavior Disorders and Other Non-motor Symptoms of Parkinsonism

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