Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD

Puligheddu, Monica; Figorilli, Michela; Congiu, Patrizia; Lecca, Rosamaria; Casaglia, Elisa; Tamburrino, Ludovica; Orrù, Riccardo; Meloni, Federico; Ferri, Raffaele

doi:10.1016/j.smrv.2023.101745

Cited by 10 publications

(7 citation statements)

References 66 publications

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“…Mathematically, RAI can vary from 0 (the complete absence of EMG atonia), to 1 (stable EMG atonia). RAI correlates significantly with the percentage of epochs of REM sleep without atonia detected by the method by Lapierre and Montplaisir 21,22 and performs comparably to other visual methods to quantify RSWA 7,22 …”

Section: Methodsmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

“…3,4 The diagnosis of the disorder, therefore, requires polysomnography (PSG) for the evaluation of RSWA, a required neurophysiological sign of RBD, characterized by persistent muscle tone during REM sleep (resulting in excessive tonic activity), or intermittent excessive activity in REM sleep (phasic), or both 5 ; RSWA can be assessed by visual or automatic quantification methods, such as the REM sleep atonia index (RAI). 6,7 From a neurophysiological point of view, the current evidence indicates that muscle atonia during REM sleep seems to be due both to the inhibition and to the reduced activation of motor neurons (inhibited by GABA and glycinergic neurons, located in the ventromedial medulla and probably by spinal interneurons), and to the reduction or loss of excitability of motor neurons of the sublaterodorsal tegmental nucleus or subcoeruleus nucleus (due to reduction of glutamatergic, noradrenergic, dopaminergic and hypocretinergic activity). 3,6,8,9 Beside the effects of a dysfunction within the above neurophysiological pathways leading to RSWA, the behaviors observed in patients are often violent and the dream content is unpleasant and fearful; therefore, the complex dysfunctional network underlying the onset of RBD episodes might also involve the cortical limbic system.…”

Section: Introductionmentioning

confidence: 92%

“…RAI correlates significantly with the percentage of epochs of REM sleep without atonia detected by the method by Lapierre and Montplaisir 21,22 and performs comparably to other visual methods to quantify RSWA. 7,22 In order to classify the severity of RBD episodes, we evaluated motor behavior events during REM sleep on vPSG recordings and graded them visually and polysomnographically on an event-toevent basis, by means of the REM sleep behavior disorder severity scale (RBDSS). 23 According to this scale, the location of movements was categorized as follows: "0" = no visible movement; "1" = slight movements or jerks "2" = movements involving proximal extremities, including violent behavior; "3" = axial involvement including bed falls.…”

Section: Video Psgmentioning

confidence: 99%

“…The diagnosis of the disorder, therefore, requires polysomnography (PSG) for the evaluation of RSWA, a required neurophysiological sign of RBD, characterized by persistent muscle tone during REM sleep (resulting in excessive tonic activity), or intermittent excessive activity in REM sleep (phasic), or both 5 ; RSWA can be assessed by visual or automatic quantification methods, such as the REM sleep atonia index (RAI). 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

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Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Mogavero,

Ferri,

Marelli

et al. 2024

CNS Neurosci Ther

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AimsAlthough clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained‐release MLT, alone or in combination, and in a group of drug‐free iRBD patients.MethodsA total of 96 patients were enrolled: 43 drug‐free, 21 with CLO (0.5–2 mg), 20 with sustained‐release MLT (1–4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected.ResultsAlthough clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture.ConclusionThese results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.

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Section: Methodsmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 92%

Section: Video Psgmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Mogavero,

Ferri,

Marelli

et al. 2024

CNS Neurosci Ther

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Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early‐Stage Parkinson's Disease

Dodet,

Houot,

Leu‐Semenescu

et al. 2024

Movement Disorders

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BackgroundIn early‐stage Parkinson's disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) predicts poor cognitive and motor outcome. However, the baseline significance and disease evolution associated with isolated REM sleep without atonia (iRWA, ie, enhanced muscle tone during 8.7% of REM sleep, but no violent behavior) are not well understood.ObjectivesThe objective is to determine whether iRWA was a mild form of RBD and progressed similarly over time.MethodsParticipants with early PD (<4 years from medical diagnosis) were included from 2014 to 2021 in a longitudinal study. They underwent interviews and examinations in the motor, cognitive, autonomous, psychiatric, sensory, and sleep domains every year for 4 years along with a video polysomnography and magnetic resonance imaging examination of the locus coeruleus/subcoeruleus complex (LC/LsC) at baseline. The clinical characteristics were compared between groups with normal REM sleep, with iRWA and with RBD, at baseline and for 4 years.ResultsAmong 159 PD participants, 25% had RBD, 25% had iRWA, and 50% had normal REM sleep. At baseline, the non‐motor symptoms were less prevalent and the LC/LsC signal intensity was more intense in participants with iRWA than with RBD. Over 4 years, participants with normal REM sleep and with iRWA had a similar cognitive and motor trajectory, whereas participants with RBD had greater cognitive and motor decline.ConclusionsWe demonstrated that iRWA is frequent in early PD, but is not a milder form of RBD. Both groups have distinct baseline characteristics and clinical trajectories. They should be distinguished in clinical routine and research protocols. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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EEG-Based Detection of REM Sleep Behaviour Disorder: Towards a Stage-Agnostic Approach

Giarrusso,

Rechichi,

Olmo

2024

Lecture Notes in Computer Science

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Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD

Cited by 10 publications

References 66 publications

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early‐Stage Parkinson's Disease

EEG-Based Detection of REM Sleep Behaviour Disorder: Towards a Stage-Agnostic Approach

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