REM Sleep Behavior Disorder and Its Possible Prodromes in General Population

Abstract

Objective: To evaluate the prevalence of REM sleep behavior disorder (RBD) and its possible prodromal conditions, isolated dream-enactment behavior (DEB) and isolated REM without atonia (RWA), in a general population sample, and the factors associated with diagnosis and symptom frequency. Methods: From a population-based prospective cohort in Korea, 1,075 subjects (age 60.1±7.0 years; range 50–80 years; men 53.7%) completed the RBD screening questionnaire (RBDSQ), a structured telephone-interview for the presence and characteristics of repeated DEB, and home polysomnography. REM without atonia (RWA) was measured on submentalis EMG, including 30-second epoch based tonic and phasic activity as well as 3-second mini-epoch based phasic and any EMG activities. Based on the presence of repeated DEB and any EMG activity of ≥22.3%, we categorized the subjects into no RBD, isolated RWA, isolated DEB, and RBD groups. Results: RBD was diagnosed in 20, isolated RWA in 133 subjects, and isolated DEB in 48 subjects. Sex and DEB frequency-adjusted prevalence of RBD was 1.4% (95% confidence interval [CI] 1.0–1.8%), isolated RWA 12.5% (95% CI 11.3–13.6%), and isolated DEB 3.4% (95% CI 2.7–4.1%). Total RBDSQ score was higher in the RBD and isolated DEB groups than in the isolated RWA and no RBD group (median 5, interquartile range [IQR 4–6] for RBD, median 4 [IQR 3–6] for isolated DEB, median 2 [IQR 1–3] for isolated RWA and median 2 [IQR 1–4] for no RBD groups, P<0.001). RBDSQ score of ≥5 had good specificity but poor positive predictive value (PPV) for RBD (specificity 84.1% and PPV 7.7%) and its prodromal conditions (specificity 85.2% and PPV 29.1%). Among the RWA parameters, any EMG activity showed the best association with the RBD and its possible prodromes (area under the curve, 0.917). 3-second mini-epoch based any EMG activity and phasic EMG activity were correlated with the frequency of DEB (standardized Jonckheere-Terpstra Statistic [std. J-T static] for trend =0.488, P<0.001 and std. J-T static=3.265, P=0.001, respectively). Conclusions: This study provides prevalence estimates of RBD and its possible prodromal conditions based on a structured telephone-interview and RWA measurement on PSG from the general population.

Gender Difference in REM Sleep Behavior Disorder in Japanese Population: Polysomnography and Sleep Questionnaire Study

“…The prevalence of RBD in the general population is approximately 0.74-2.01% [13][14][15][16][17]. A male predominance in the presentation of RBD has often been reported with a higher prevalence of RBD in male patients.…”

REM sleep behavior disorder and Prodromal Parkinson’s Disease in patients with Essential Tremor

“…Several studies have shown an increased prevalence of REM sleep behavior disorder [ [3] , [4] , [5] , [6] , [7] ], a parasomnia characterized by dream enactment behavior associated with loss of muscle atonia during REM sleep. Although its prevalence seems to be lower than in some neurodegenerative disorders, both questionnaire [ 3 , 4 ] as well as polysomnography based [ [5] , [6] , [7] ] studies have shown a prevalence of RBD in ET (26.3 %–43.5 % and 8.7 %–18.5 %, respectively) which is significantly higher than what is found in the general aged population (from 0.26 to 1.6 1 % [ [8] , [9] , [10] , [11] ]). Some studies have shown RBD in ET to be associated with autonomic dysfunction [ 3 ] symptoms, mild parkinsonian signs [ 6 ] and rest tremor [ 7 ], which has raised the suspicion that ET-RBD patients could constitute a sub-group of patients within the ET population sharing a common physiopathology with parkinsonian syndromes, given that RBD is exceedingly common in PD, Lewy Body Dementia (LBD) and Multiple System Atrophy [ 12 ].…”

Prodromal Status of Rapid Eye Movement Sleep Behavior Disorder: Clinical Significance and Future Perspectives

“…REM, rapid eye movement; RWA, REM without atonia; RBD, REM sleep behavior disorder; DEB, dream enacting behavior; PSG, polysomnography 연구진이 안산 장기 코호트를 기반으로 시행한 연구이다 9. 이 isolated RWA 그룹보다 chin phasic 30-s activity, chinphasic 3-s activity가 높았고, isolated DEB 그룹이 정상군에 비해 chin any activity가 높았던 것을 제외하면, 각 군을 구 별지을만한 RWA parameter의 뚜렷한 차이는 없었다.…”