REM Sleep EEG Instability in REM Sleep Behavior Disorder and Clonazepam Effects

Ferri, Raffaele; Rundo, Francesco; Silvani, Alessandro; Zucconi, Marco; Bruni, Oliviero; Ferini‐Strambi, Luigi; Plazzi, Giuseppe; Manconi, Mauro

doi:10.1093/sleep/zsx080

Cited by 38 publications

(56 citation statements)

References 37 publications

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“…Raffaele et al confirmed EEG instability during REM sleep in RBD patients, while the mean EEG power was not significantly affected[2]. The results of this study show that compared with the HC group, the α power in the RBD group during REM sleep was significantly enhanced, inconsistent with the above results.…”

contrasting

confidence: 85%

“…Patients with RBD frequently cause self-injury or injure their bed partner. The proportion of injuries in sleep can reach as high as 32-65% [1] and potential injuries include falling from bed, bruises, fractures, and lacerations, among others [2]. RBD is a relatively common sleep disorder with a population prevalence of 0.4% to 0.5% [3] and the incidence in the elderly population can reach 2-6% [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Secondary RBD can be caused by brain stem injury associated with REM phase muscle loss, such as that secondary to vascular, inflammatory, or neoplastic disease, as well as certain diseases that affect brainstem function, such as narcolepsy and multiple sclerosis [8]. Drug-induced factors can also lead to secondary RBD, such as taking antipsychotics, serotonin reuptake inhibitors, or benzodiazepines, among others [2,9].…”

Section: Introductionmentioning

confidence: 99%

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Electroencephalographic alpha band power enhancement during rapid eye movement sleep in rapid eye movement sleep behavior disorder

Qiu

Zhang

Huang

2020

Preprint

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Objective Rapid eye movement (REM) sleep behavior disorder (RBD) is a common sleep disorder in the elderly. We aim to reveal the physiological mechanism underlying RBD by analyzing changes in the electroencephalographic (EEG) spectrum during REM sleep.Methods Twenty patients with RBD monitored using video polysomnography and 13 age-matched healthy volunteers were enrolled. The EEG signal was acquired using an average reference electrode. A Fourier transform was performed on both EEG data. Furthermore, the absolute power values and relative power values of five different frequency bands were calculated. The range of each frequency band was defined as follow: δ: 0.5–3 Hz, θ: 4–7 Hz, α: 8–13 Hz, β: 14–30 Hz, and γ: 30–35 Hz. The normal distribution of EEG power was tested compared using the t-test.Results The dominant frequency band with the most power on EEG was θ band in both groups. Compared with control group, the RBD group had obvious power enhancement in α band. However, δ/α and θ/α power ratios in the RBD group were significantly lower than those in the control group.Conclusion The cerebral cortex is hyperactive in RBD. This phenomenon may associate with higher power in the alpha band, which is similar to that observed when the skeletal muscle is not atonic. The cerebral cortex is involved in RBD neuropathic disorders as well as skeletal muscle achalasia. Our finding could provide a new method for improving RBD treatment via the moderate inhibition of cerebral cortex hyperactivity.

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confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Electroencephalographic alpha band power enhancement during rapid eye movement sleep in rapid eye movement sleep behavior disorder

Qiu

Zhang

Huang

2020

Preprint

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“…increased slowwave sleep and theta and delta power in the frontal and posterior cortical regions), both in wakefulness and during REM sleep (but without changes on sleep architecture), was associated with cognitive decline in several studies on idiopathic RBD patients, thus providing a potential marker of future α-synucleinopathy. [55][56][57][58][59][60][61] Similar EEG changes have been observed in parkinsonian patients, including those with mild cognitive impairment. 62,63 Nevertheless, given that also RBD patients without cognitive impairment showed EEG alterations during wakefulness, 64 longitudinal studies are warranted to confirm a reliable prediction of neurodegeneration.…”

Section: Literature Backgroundmentioning

confidence: 89%

Facilitatory/inhibitory intracortical imbalance in REM sleep behavior disorder: early electrophysiological marker of neurodegeneration?

Lanza

Aricò

Lanuzza

et al. 2019

Sleep

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Study Objectives Previous studies found an early impairment of the short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) to transcranial magnetic stimulation (TMS) in Parkinson’s disease. However, very little is known on the TMS correlates of rapid eye movement (REM) sleep behavior disorder (RBD), which can precede the onset of a α-synucleinopathy. Methods The following TMS measures were obtained from 14 de novo patients with isolated RBD and 14 age-matched healthy controls: resting motor threshold, cortical silent period, latency and amplitude of the motor evoked potentials, SICI, and ICF. A cognitive screening and a quantification of subjective sleepiness (Epworth Sleepiness Scale [ESS]) and depressive symptoms were also performed. Results Neurological examination, global cognitive functioning, and mood status were normal in all participants. ESS score was higher in patients, although not suggestive of diurnal sleepiness. Compared to controls, patients exhibited a significant decrease of ICF (median 0.8, range 0.5–1.4 vs. 1.9, range 1.4–2.3; p < 0.01) and a clear trend, though not significant, towards a reduction of SICI (median 0.55, range 0.1–1.4 vs. 0.25, range 0.1–0.3), with a large effect size (Cohen’s d: −0.848). REM Sleep Atonia Index significantly correlated with SICI. Conclusions In still asymptomatic patients for a parkinsonian syndrome or neurodegenerative disorder, changes of ICF and, to a lesser extent, SICI (which are largely mediated by glutamatergic and GABAergic transmission, respectively) might precede the onset of a future neurodegeneration. SICI was correlated with the muscle tone alteration, possibly supporting the proposed RBD model of retrograde influence on the cortex from the brainstem.

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“…In iRBD subjects, subtle changes found in EEG during sleep ( 111 ) and wakefulness ( 112 – 114 ) suggest abnormalities. EEG slowing, according to a follow-up EEG study in iRBD, seems a promising marker of neurodegeneration in iRBD patients ( 114 ).…”

Section: Diagnostic Accuracy Of Clinical Measures For Predicting Convmentioning

confidence: 99%

Accuracy of Rating Scales and Clinical Measures for Screening of Rapid Eye Movement Sleep Behavior Disorder and for Predicting Conversion to Parkinson’s Disease and Other Synucleinopathies

et al. 2018

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Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by repeated episodes of REM sleep-related vocalizations and/or complex motor behaviors. Definite diagnosis of RBD is based on history and polysomnography, both of which are less accessible due to the lack of trained specialists and high cost. While RBD may be associated with disorders like narcolepsy, focal brain lesions, and encephalitis, idiopathic RBD (iRBD) may convert to Parkinson’s disease (PD) and other synucleinopathies in more than 80% of patients and it is to date the most specific clinical prodromal marker of PD. Identification of individuals at high risk for development of PD is becoming one of the most important topics for current PD-related research as well as for future treatment trials targeting prodromal PD. Furthermore, concomitant clinical symptoms, such as subtle motor impairment, hyposmia, autonomic dysfunction, or cognitive difficulties, in subjects with iRBD may herald its phenoconversion to clinically manifest parkinsonism. The assessment of these motor and non-motor symptoms in iRBD may increase the sensitivity and specificity in identifying prodromal PD subjects. This review evaluates the diagnostic accuracy of individual rating scales and validated single items for screening of RBD and the role and accuracy of available clinical, electrophysiological, imaging, and tissue biomarkers in predicting the phenoconversion from iRBD to clinically manifest synucleinopathies.

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REM Sleep EEG Instability in REM Sleep Behavior Disorder and Clonazepam Effects

Cited by 38 publications

References 37 publications

Electroencephalographic alpha band power enhancement during rapid eye movement sleep in rapid eye movement sleep behavior disorder

Electroencephalographic alpha band power enhancement during rapid eye movement sleep in rapid eye movement sleep behavior disorder

Facilitatory/inhibitory intracortical imbalance in REM sleep behavior disorder: early electrophysiological marker of neurodegeneration?

Accuracy of Rating Scales and Clinical Measures for Screening of Rapid Eye Movement Sleep Behavior Disorder and for Predicting Conversion to Parkinson’s Disease and Other Synucleinopathies

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