Prevalence and determinants of rapid eye movement sleep behavior disorder in the general population

Abstract

Study Objectives: Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with neurodegenerative synucleinopathies. Its prevalence is largely unknown. This study determined the prevalence and characteristics of RBD in the general population using gold-standard polysomnography.Methods: Full polysomnographic data from 1,997 participants (age = 59 ± 11.1 years, 53.6% women) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Sleep-related complaints and habits were investigated using various sleep measures including the Munich Parasomnia Screening (MUPS) questionnaire, which includes two questions evaluating complex motor behaviors suggestive of RBD. Full polysomnography was performed at home. For participants screening positive for RBD, muscle activity during REM sleep was quantified to diagnose RBD.Results: Three hundred sixty-eight participants endorsed dream-enactment behavior on either of the two MUPS questions, and 21 fulfilled polysomnographic criteria for RBD, resulting in an estimated prevalence of 1.06% (95% CI = 0.61-1.50), with no difference between men and women. Compared with RBD− participants, RBD+ took more frequently antidepressants and antipsychotics (23.8% vs. 5.4%, p = .005; 14.3% vs. 1.5%, p = .004, respectively) and were more frequently smokers or exsmokers (85% vs. 56.6%, p = .011). On polysomnography, RBD+ had more stage N2 sleep (52 ± 11.5% vs. 46.3 ± 10.2%, p = .024) and less REM sleep (18 ± 6.4% vs. 21.9 ± 6.2%, p = .007), lower apnea-hypopnea index in REM sleep (3.8 ± 5.2 vs. 8.9 ± 13/hour, p = .035), and lower autonomic arousal index (31 ± 14.9 vs. 42.6 ± 19.5/hour, p = .002). Conclusions:In our middle-to-older age population-based sample, the prevalence of RBD was 1.06%, with no difference between men and women. RBD was associated with antidepressant and antipsychotic use and with minor differences in sleep structure.Key words: polysomnography; synucleinopathies; parasomnia; sleep; REM sleep without atonia Statement of SignificanceRapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia frequently associated or preceding neurodegenerative diseases such as synucleinopathies. Its occurrence in the general population is largely unknown. Analyzing data from 1,997 participants to the population-based HypnoLaus study who completed the Munich Parasomnia Screening questionnaire and had a complete polysomnography at home, we estimate the prevalence of RBD at 1.06%, with no significant difference between men and women. RBD was associated with antidepressant and antipsychotic use, and with minor differences in sleep structure. Knowing the prevalence and characteristics of RBD has important implications, as people with RBD can be ideal candidates for neuroprotective approaches, and can help us to better understand the progression of neurodegenerative disorders.

Prodromal Parkinson's Disease: The Decade Past, the Decade to Come

“…Studies found that even long‐term disease‐free survivors had numerous clinical or biomarkers suggestive of ongoing neurodegeneration . Prevalence of idiopathic RBD was finally estimated definitively in three population‐based studies, all of which found a population prevalence of approximately 1% …”

Polysomnographic and neuropsychological characteristics of rapid eye movement sleep behavior disorder patients

“…Thus, the age of a subject should be considered in regard to the differing results. In addition, a recent study showed that 21 RBD patients demonstrated more stage N2 sleep, less REM sleep, and a lower AHI during REM sleep than 1,629 RBD negative subjects (Haba‐Rubio et al, ). There have also been some studies with small sample sizes that did not find differences between iRBD patients and controls in polysomnographic characteristics, except in the PLMI (Fantini et al, ; Ferini‐Strambi et al, ) and sleep duration (Massicotte‐Marquez et al, ).…”

External validation of a data‐driven algorithm for muscular activity identification during sleep

“…The algorithm described in Frauscher et al. () has been recently applied to a big dataset (Haba‐rubio et al., ), but a formal validation on this dataset is lacking. Only the REM atonia index (RAI) has been externally validated on different datasets and in different clinics from the one where it was developed (Ferri, Fulda, Cosentino, Pizza, & Plazzi, ; Ferri, Gagnon, Postuma, Rundo, & Montplaisir, ; Ferri et al., ; Figorilli et al., ; McCarter et al., , ).…”