Quantification of Electromyographic Activity During REM Sleep in Multiple Muscles in REM Sleep Behavior Disorder

Frauscher, Birgit; Iranzo, Álex; Högl, Birgit; Casanova‐Mollá, Jordi; Salamero, Manel; Gschliesser, Viola; Tolosa, Eduardo; Poewe, Werner; Santamaría, Joan

doi:10.1093/sleep/31.5.724

Cited by 162 publications

(117 citation statements)

References 24 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…A similar pattern was seen for PD patients with RBD, who had significantly increased EMG activity in the tibialis muscle during NREM sleep compared to PD patients without RBD. Most studies on RBD have mainly focused on measuring EMG activity during REM sleep, [19][20][21] and to our knowledge no other studies have addressed EMG activity during NREM sleep in patients with iRBD and Parkinson disease. The increase of EMG activity during both REM and NREM sleep may suggest a general instability of mechanisms regulating atonia, although most pronounced during REM sleep.…”

Section: Discussionmentioning

confidence: 99%

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Zoetmulder

Nikolic

Biernat

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by impaired motor inhibition during REM sleep, and dream-enacting behavior. RBD is especially associated with α-synucleinopathies, such as Parkinson disease (PD). Follow-up studies have shown that patients with idiopathic RBD (iRBD) have an increased risk of developing an α-synucleinopathy in later life. Although abundant studies have shown that degeneration of the nigrostriatal dopaminergic system is associated with daytime motor function in Parkinson disease, only few studies have investigated the relation between this system and electromyographic (EMG) activity during sleep. The objective of this study was to investigate the relationship between the nigrostriatal dopamine system and muscle activity during sleep in iRBD and PD. Methods: 10 iRBD patients, 10 PD patients with PD, 10 PD patients without RBD, and 10 healthy controls were included and assessed with (123)I-N-omegafluoropropyl-2-beta-carboxymethoxy-3beta-(4-iodophenyl) nortropane ((123)I-FP-CIT) Single-photon emission computed tomography (SPECT) scanning ( 123 I-FP-CIT SPECT), neurological examination, and polysomnography. Results: iRBD patients and PD patients with RBD had increased EMG-activity compared to healthy controls.123 I-FP-CIT uptake in the putamen-region was highest in controls, followed by iRBD patients, and lowest in PD patients. In iRBD patients, EMG-activity in the mentalis muscle was correlated to 123 I-FP-CIT uptake in the putamen. In PD patients, EMG-activity was correlated to anti-Parkinson medication. Conclusions: Our results support the hypothesis that increased EMG-activity during REM sleep is at least partly linked to the nigrostriatal dopamine system in iRBD, and with dopamine function in PD. I NTRO DUCTI O NREM sleep behavior disorder (RBD) is a parasomnia characterized by REM sleep without atonia , dream enactment behavior, and vivid (and/or) violent dreams. Longitudinal studies have shown that patients with idiopathic RBD (iRBD) have an increased risk for developing an α-synucleinopathy, such as Parkinson disease (PD).1,2 The high proportion of iRBD patients developing PD may indicate a link between nigrostriatal degeneration and increased night-time motor activity. It is increasingly recognized that the dopaminergic system is associated with sleep-wake disturbances.3,4 Previous studies have shown that basal ganglia structures, such as the substantia nigra pars reticulata and the internal segment of the globus pallidus, have caudal connections to regions that modulate REM sleep atonia. 5 Imaging studies in iRBD patients have shown microstructural changes in substantia nigra, 6 reduced volume of the putamen, 7 as well as reduced density of the striatal dopamine transporter, which decreases in the course of disease progression. 8 In addition monkeys treated sub-chronic with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP), a neurotoxin which specifically targets dopaminergic neurons of the substantia nigra...

show abstract

Section: Discussionmentioning

confidence: 99%

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Zoetmulder

Nikolic

Biernat

et al. 2016

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…Figures 1 and 2 show examples of phasic and tonic muscular activities, respectively, of the musculus mentalis in REM sleep. The musculus mentalis was selected for EMG measurement because a study showed that it has the highest rate of phasic EMG activity out of a set of 13 simultaneously recorded muscles [10]. The musculus mentalis is also recommended for both phasic and tonic muscular activity evaluation by the AASM [4] and ICSD-2 [8].…”

Section: Algorithmmentioning

confidence: 99%

“…To identify RWA, clinicians monitor the electromyographic (EMG) waveform of the musculus mentalis and/or tibialis anterior during PSG recording, to determine the presence of tonic and/ or phasic muscle activity for each 30-second epoch [9][10][11][12][13]. The scoring manual proposed by the American Academy of Sleep Medicine (AASM) [4] is used as criteria for identifying phasic and tonic muscle activities in REM sleep.…”

Section: Introductionmentioning

confidence: 99%

Automatic Quantification of Muscular Activity in Rapid Eye Movement Sleep

Yoshino

Kimura

Iyama

et al. 2015

ABE

View full text Add to dashboard Cite

Atonia during rapid eye movement (REM) sleep is absent in patients with REM sleep behavior disorder (RBD), a phenomenon called REM sleep without atonia (RWA). RBD patients have symptoms in common with neurodegenerative diseases, and data from follow-up studies on idiopathic RBD patient indicate that RBD predicts development of neurodegenerative diseases, particularly Parkinson s disease (PD). Therefore, early diagnosis of RWA can help identify and possibly prevent neurodegenerative diseases. Currently, RWA assessment by visual analysis of polysomnogram (PSG) is only moderately reliable and extremely time-consuming, making it dif cult to obtain objective, quanti able results. We developed an algorithm to automatically quantify tonic and phasic electromyographic (EMG) activities of the musculus mentalis during REM sleep using the scoring manual proposed by the American Academy of Sleep Medicine. Hilbert transform and average recti cation were used to calculate the amplitudes of phasic and tonic muscular activities, respectively. Parameter values in the algorithm were optimized by cross-referencing the classi cation result obtained from the algorithm with the result from epoch-by-epoch visual inspection by a neurologist. A total of 2315 REM epochs from 24 PD patients were analyzed. We calculated the optimal parameter set, at which the sum of sensitivity and speci city was the highest, as well as the area under the receiver operating characteristic (ROC) curve (AUC). Veri cation tests showed good detection accuracy (phasic: sensitivity = 88%, speci city = 82%, AUC = 0.92; tonic: sensitivity = 88%, speci city = 85%, AUC = 0.93). Thus, this automated RWA detection algorithm is potentially useful for rapid and accurate diagnosis of RBD.

show abstract

“…measured phasic activity in 3-s epochs in 13 different muscles and Iranzo et al in 5 muscles (mentalis, right and left flexor digitorum superficialis, and right and left extensor digitorum brevis). 25,26 A number of computerized scoring methods have been developed to analyze increased muscle activity in REM sleep. [27][28][29][30] However, the validity of these methods has not yet been tested.…”

Section: Brief Summarymentioning

confidence: 99%

“…39 Recent studies have suggested using EMG recordings from several different muscle groups to increase the sensitivity for detecting RBD. 25 Unfortunately, such recordings were not performed at our institution at the time.…”

Section: 2829mentioning

confidence: 99%

Loss of Rapid Eye Movement Sleep Atonia in Patients with REM Sleep Behavioral Disorder, Narcolepsy, and Isolated Loss of REM Atonia

Khalil

Wright

Walker

et al. 2013

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: To compare the amounts of REM sleep without atonia (RSWA) between patients with REM sleep behavior disorder (RBD), "isolated loss of REM atonia," narcolepsy, and control subjects and determine if there were threshold values for the amount of RSWA that differentiate each group from controls. Methods: Retrospective analyses of polysomnography (PSG) records were used employing strict quantitative criteria for the measurement of phasic and tonic EMG activity during REM sleep. The PSG recordings of 47 individuals were analyzed (RBD 16, isolated loss of REM atonia 11, narcolepsy 10, control 10). Results: Patients with the diagnosis of isolated loss of REM atonia had signifi cantly lower levels of EMG activity during REM sleep than those with RBD but higher than control subjects. RSWA was higher in narcolepsy than in loss of REM atonia but lower than for RBD patients. Receiver operating characteristic (ROC) curves provided threshold values with high specifi city and sensitivity in all patient groups with a cutoff value ≥ 1.22% (100% correctly classifi ed) for phasic and ≥ 3.17% for tonic (92% correctly classifi ed) EMG activity in RBD. Conclusion S C I E N T I F I C I N V E S T I G A T I O N SR EM sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal muscle atonia during REM sleep with abnormal motor activity that is proposed to be associated with dream content.1 RBD is associated with neurodegenerative disorders and in particular with synucleinopathies such as Parkinson disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA) (secondary RBD). Long-term follow-up studies have shown that a large proportion (38% to 65%) of patients with presumed idiopathic RBD develop Parkinsonism and/or dementia.2,3 EEG and neuropsychological tests have also revealed early evidence of CNS dysfunction in idiopathic RBD patients.4-7 Furthermore, diffusion tensor imaging has uncovered microstructural abnormalities in the brain areas responsible for REM sleep regulation in idiopathic RBD patients. In addition to neurodegenerative disease, RBD is also associated with other sleep disorders. Periodic limb movements of sleep (PLMS) are highly prevalent (70%) in patients with RBD.5 In addition, RBD is frequently seen in patients with narcolepsy.9,10 REM sleep without atonia (RSWA) in narcolepsy was fi rst described in 1992.10 RBD and/or RSWA are thought to be common in narcolepsy with cataplexy and rare in narcolepsy without cataplexy. 11,12It has been proposed that hypocretin defi ciency plays an essential role for both RBD and cataplexy in narcolepsy. Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London UKIsolated loss of REM atonia or RSWA is a condition usually identifi ed incidentally in patients during polysomnography. The loss of REM atonia is an electrophysiological fi nding without accompanying abnormal motor behavior during REM sleep. Although the condition may represent "subclinical" or "preclinical" RBD in some cases, 14 there are no ...

show abstract

Quantification of Electromyographic Activity During REM Sleep in Multiple Muscles in REM Sleep Behavior Disorder

Abstract: Simultaneous recording of the mentalis, flexor digitorum superficialis, and extensor digitorum brevis muscles provided the highest rates of REM sleep phasic EMG activity in subjects with RBD.

Cited by 162 publications

References 24 publications

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Automatic Quantification of Muscular Activity in Rapid Eye Movement Sleep

Loss of Rapid Eye Movement Sleep Atonia in Patients with REM Sleep Behavioral Disorder, Narcolepsy, and Isolated Loss of REM Atonia

Contact Info

Product

Resources

About