Risk factors for probable REM sleep behavior disorder

Wong, Janice; Li, Junjuan; Pavlova, Milena; Chen, Shuohua; Wu, Xia; Wu, Shouling; Gao, Xiang

doi:10.1212/wnl.0000000000002414

Cited by 83 publications

(64 citation statements)

References 40 publications

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“…[9][10][11] In a previous cross-sectional study, we also found that individuals with probable RBD (pRBD) had higher odds of several concurrent stroke risk factors, such as diabetes and hyperlipidemia. 12 However, whether RBD predicts subsequent stroke risk remains unknown to date. RBD might have a different effect on different stroke types.…”

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confidence: 99%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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Objective: To examine whether probable REM sleep behavior disorder (pRBD) was associated with increased risk of developing stroke in a community-based cohort. Methods:The study included 12,003 participants (mean age 54.0 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury at baseline (2012). We determined pRBD using a validated REM sleep behavior disorder (RBD) questionnaire in 2012. Incident stroke cases were confirmed by review of medical records. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke according to pRBD status, adjusting for several sleep measures (i.e., insomnia, daytime sleepiness, sleep duration, snoring, and use of hypnotics) and other potential confounders.Results: During 3 years of follow-up, we documented 159 incident stroke cases. Relative to participants without pRBD at the baseline, those with pRBD had a 157% higher risk (95% CI 59%-313%) of developing stroke. Presence of pRBD was associated with increased risk of both stroke types-the adjusted HR was 1.93 (95% CI 1.07-3.46) for ischemic stroke and 6.61 (95% CI 2.27-19.27) for hemorrhagic stroke.Conclusions: Presence of pRBD was associated with a higher risk of developing stroke, including both ischemic and hemorrhagic types. Future studies with clinically confirmed RBD and a longer follow-up would be appropriate to further investigate this association. Neurology ® 2017;88:1849-1855 GLOSSARY AIS 5 Athens Insomnia Scale; BMI 5 body mass index; CI 5 confidence interval; ESS 5 Epworth Sleepiness Scale; HDL-C 5 high-density lipoprotein cholesterol; HR 5 hazard ratio; ICD-10 5 International Classification of Diseases-10; LDL-C 5 lowdensity lipoprotein cholesterol; OR 5 odds ratio; OSA 5 obstructive sleep apnea; PD 5 Parkinson disease; pRBD 5 probable REM sleep behavior disorder; RBD 5 REM sleep behavior disorder; RBDQ-HK 5 RBD questionnaire-Hong Kong; RMB 5 renminbi.REM sleep behavior disorder (RBD) is associated with synucleinopathies, and a large proportion of individuals with RBD may already have or later develop Parkinson disease (PD), dementia with Lewy bodies, or multiple system atrophy. [1][2][3] Synucleinopathies were often associated with symptoms of autonomic dysfunction, such as impaired blood pressure control and reduced heart rate variability. 4,5 Consistently, individuals with idiopathic RBD experienced worse autonomic function, including cardiovascular, gastrointestinal, and urinary domains, relative to control participants. 6,7 The autonomic nervous system may have a role in the prepathologic state or contribute to the precipitating factors of the acute phase of stroke, such as atherosclerosis and sympathetic hyperactivity. 8 Some case reports suggested that stroke may cause RBD. 9-11 In a previous cross-sectional study, we also found that individuals with probable RBD (pRBD) had higher odds of several concurrent stroke risk factors, such as diabetes and hyperlipidemia. 12 However, whether RBD predicts subsequ...

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confidence: 99%

Probable REM sleep behavior disorder and risk of stroke

Pavlova

Liu

et al. 2017

Neurology

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“…Alcohol consumption was reported in association with higher risk of RBD or probable RBD (pRBD),4, 5, 6 though in some of the studies,4, 5 this association did not reach statistical significance. However, most studies to date were either relatively small or not specifically intended to evaluate the dose and type of alcohol beverage used 4, 5, 6. Alcohol has a strong effect on sleep, and thus may affect risk of sleep disorders.…”

Section: Introductionmentioning

confidence: 88%

“…As detailed elsewhere,5, 12 participants of this study included 12,990 Chinese adults (10,725 men and 2265 women), who were free of Parkinson disease and dementia, a subset of an ongoing Chinese cohort, the Kailuan Study 5, 12, 13. In the current analysis, we further excluded 987 participants with a prior history of stroke, cancer, and head injury and 98 participants who did not provide information on alcohol intake or RBD, leaving 11,905 participants (9776 men and 2129 women).…”

Section: Methodsmentioning

confidence: 99%

“…Information on education level, occupation, income level, smoking status, and physical activity was collected in 2006 via questionnaires, as detailed elsewhere 5. Weight and height were measured by trained field‐workers.…”

Section: Methodsmentioning

confidence: 99%

“…From recent epidemiological studies of potential risk factors for RBD,3, 4, 5, 6 several identified risk factors are related to neurodegenerative diseases (e.g., head injury and olfactory dysfunction) and cardiovascular diseases (e.g., hyperlipidemia and physical inactivity) 3, 4, 5, 64, 5, 6 though in some of the studies,4, 5 this association did not reach statistical significance. However, most studies to date were either relatively small or not specifically intended to evaluate the dose and type of alcohol beverage used 4, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

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Alcohol consumption and probable rapid eye movement sleep behavior disorder

Pavlova

et al. 2018

Ann Clin Transl Neurol

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ObjectiveTo systematically examine the association between alcohol intake and likelihood of having probable rapid eye movement sleep behavior disorder (pRBD) 6 years later.MethodsThe study included 11,905 participants (mean age: 47.7 years) of the Kailuan Study, free of stroke, cancer, Parkinson disease, dementia, and head injury in 2006. We determined pRBD using a validated RBD questionnaire–Hong Kong in 2012. Amounts and types of alcohol intake were collected with questionnaire. Participants were categorized into: nondrinkers, light (women: 0–0.4 servings/day; men: 0–0.9 servings/day), moderate (women: 0.5–1.0 servings/day; men: 1–2 servings/day), and heavy drinkers(women: >1 serving/day; men: >2 servings/day). To examine the alcohol‐pRBD relationship, we used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic characteristics, smoking, hypertension, diabetes, physical activity, body mass index, and plasma concentrations of lipids and urate.ResultsCompared with nondrinkers, current drinkers had a 23% higher likelihood of having pRBD (adjusted OR 1.23, 95% CI 1.07–1.59). Both moderate (adjusted OR: 1.53, 95% CI 1.01–2.30) and heavy drinkers (adjusted OR: 1.29, 95% CI 1.00–1.66), but not light drinkers (adjusted OR: 1.16, 95% CI 0.94–1.44), had a significantly higher likelihood of having pRBD, relative to nondrinkers. There was a nonsignificant trend between consumption of each individual alcoholic beverages (i.e., beer, wine, or hard liquor) and higher likelihood of having pRBD (adjusted ORs ranged from 1.11 to 1.49).ConclusionsAlcohol consumption was associated with a higher likelihood of having pRBD. Future prospective studies with clinically confirmed RBD, large sample size for information on types of alcoholic beverage are warranted.

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Plasma urate concentrations and possible REM sleep behavior disorder

Shen

Schwarzschild

et al. 2019

Ann Clin Transl Neurol

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ObjectiveTo examine how urate concentrations are related to the risk of having possible REM sleep behavior disorder (pRBD) in a community‐based cohort.MethodsThe study included 12,923 Chinese adults of the Kailuan Study, free of Parkinson disease (PD) and dementia. Plasma urate concentrations were measured in 2006, 2008, and 2010. Cumulative average urate concentration was used as primary exposure. In 2012, we determined pRBD status using a validated RBD questionnaire‐Hong Kong (RBDQ‐HK). Logistic regression analysis was performed to estimate the association between urate concentrations during 2006–2010 and odds of having pRBD in 2012 or pRBD case with symptom onset within 1 year.ResultsHigher average urate concentrations were associated with a lower odds of pRBD (P‐trend <0.001). The adjusted odds ratio (OR), for the highest versus lowest urate quintiles, was 0.43 (95% confidence intervals (CIs) 0.32–0.57). Significant association was consistently observed when we examined the association of a single urate assessment (2006 or 2010) or the rate of change in urate concentrations during 2006–2010 with pRBD (P‐trend <0.001 for all). However, restricting to pRBD onset during 2011–2012, we observed a nonsignificant trend between high urate concentration and high odds of pRBD (P‐trend = 0.09).InterpretationHigher average urate concentrations were associated with a lower likelihood of having pRBD, but not new‐onset pRBD. Because of its observational study design, the result should be interpreted with caution due to the possibility of residual confounding.

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Risk factors for probable REM sleep behavior disorder

Cited by 83 publications

References 40 publications

Probable REM sleep behavior disorder and risk of stroke

Probable REM sleep behavior disorder and risk of stroke

Alcohol consumption and probable rapid eye movement sleep behavior disorder

Plasma urate concentrations and possible REM sleep behavior disorder

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