Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson’s disease: a case-controlled study using the rapid eye movement sleep behavior disorder screening questionnaire

Abstract

BackgroundIncreasing evidence provides a clear association between rapid eye movement sleep behavior disorders (RBD) and Parkinson’s disease (PD), but the clinical features that determine the co-morbidity of RBD and PD are not yet fully understood.MethodsWe evaluated the characteristics of nocturnal disturbances and other motor and non-motor features related to RBD in patients with PD and the impact of RBD on their quality of life. Probable RBD (pRBD) was evaluated using the Japanese version of the RBD screening questionnaire (RBDSQ-J).ResultsA significantly higher frequency of pRBD was observed in PD patients than in the controls (RBDSQ-J ≥ 5 or ≥ 6: 29.0% vs. 8.6%; 17.2% vs. 2.2%, respectively). After excluding restless legs syndrome and snorers in the PD patients, the pRBD group (RBDSQ-J≥5) showed higher scores compared with the non-pRBD group on the Parkinson’s disease sleep scale-2 (PDSS-2) total and three-domain scores. Early morning dystonia was more frequent in the pRBD group. The Parkinson’s Disease Questionnaire (PDQ-39) domain scores for cognition and emotional well-being were higher in the patients with pRBD than in the patients without pRBD. There were no differences between these two groups with respect to the clinical subtype, disease severity or motor function. When using a cut-off of RBDSQ-J = 6, a similar trend was observed for the PDSS-2 and PDQ-39 scores. Patients with PD and pRBD had frequent sleep onset insomnia, distressing dreams and hallucinations. The stepwise linear regression analysis showed that the PDSS-2 domain “motor symptoms at night”, particularly the PDSS sub-item 6 “distressing dreams”, was the only predictor of RBDSQ-J in PD.ConclusionOur results indicate a significant impact of RBD co-morbidity on night-time disturbances and quality of life in PD, particularly on cognition and emotional well-being. RBDSQ may be a useful tool for not only screening RBD in PD patients but also predicting diffuse and complex clinical PD phenotypes associated with RBD, cognitive impairment and hallucinations.

Parkinson’s disease and REM sleep behavior disorder result in increased non-motor symptoms

“…yRBD experienced more depressive symptoms including loss of pleasure, crying, indecisiveness, and fatigue. A recent study by Suzuki et al[28] reported that PD patients who met the subjective criteria for RBD (using the Japanese version of the RBDSQ [23]) scored significantly higher on the BDI-II compared to a healthy control group but there were no differences between their RBD groups (including those with an RBDSQ≥5 but with no objective findings) on this measure. Nonetheless, in their study the RBD group reported significantly poorer emotional well-being on the subscale of the PDQ-39.…”

Validation of the rapid eye movement sleep behavior disorder screening questionnaire in China

“…Thus, iRBD has been increasingly recognized as a precursor for other symptoms of neurodegenerative processes. Moreover, the frequency of RBD is reported to be up to 60% and some studies have shown a significant association between RBD and nighttime disturbances as well as quality of life in PD patients [4,5]. Given the potential risks that are associated with RBD and the available treatment options, it is recommended that screening for RBD should be performed as early as possible.…”

Effects of various factors on sleep disorders and quality of life in Parkinson’s disease

“…Some investigations [23,24] found that up to 75% of patients with REM sleep disorder developed a Parkinson-like disorder, or probable PD, which indirectly confirmed that very disturbed sleep quality may be a risk factor for the development of PD. In addition, the frequent coexistence of PD, RLS and PLM was observed in some patients, which is supported by the fact that we treat these disorders with the same or similar drugs [25].…”

“…In many studies [22,23], researchers found a correlation between REM SD and the consequent development of PD. Some investigations [23,24] found that up to 75% of patients with REM sleep disorder developed a Parkinson-like disorder, or probable PD, which indirectly confirmed that very disturbed sleep quality may be a risk factor for the development of PD.…”