Two polysomnographic features of REM sleep behavior disorder: Clinical variations insight for Parkinson's disease

Shen, Yun; Dai, Yong-Ping; Wang, Yi; Li, Jie; Xiong, Kang-Ping; Mao, Cheng‐Jie; Huang, Junying; Luo, Weifeng; Liu, Chun‐Feng

doi:10.1016/j.parkreldis.2017.09.003

Cited by 16 publications

(14 citation statements)

References 35 publications

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“…[14] Concerning sleep structure changes, TST, SE, N3, NREM, REM, and REM% in the PD group were significantly reduced, while TWT was elevated [Table 4]. These findings were consistent with most reports, [20,21] suggesting that patient with PD sleep abnormalities might result from nerve nuclei degeneration and a subsequent imbalance in neurotransmitters, which further disrupts the physiological sleep-wake cycle. Also, decreased slow-wave sleep may be related to reduced high-amplitude low-frequency δ waves in night-time sleep EEGs caused by the disease.…”

Section: Discussionsupporting

confidence: 77%

Sleep fragmentation as an important clinical characteristic of sleep disorders in Parkinson's disease

Cai

Luo

Chen

et al. 2019

Chinese Medical Journal

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Background:Sleep disorders are one of the earliest non-motor symptoms of Parkinson's disease (PD). Sleep disorders could, therefore, have value for recognition and diagnosis in PD. However, no unified classification and diagnostic criteria exist to evaluate sleep disorders by polysomnography (PSG). Utilizing PSG to monitor sleep processes of patients with PD and analyze sleep disorder characteristics and their relationship with demographic parameters could aid in bridging this gap. This preliminary study aimed to evaluate the clinical characteristic of sleep disorders in PD using PSG.Methods:PSG was used to evaluate sleep disorders in 27 patients with PD and 20 healthy volunteers between August 2015 and July 2018 in Fujian Medical University Union Hospital. Total sleep time (TST), sleep efficiency (SE), total wake time, and other parameters were compared between the two groups. Finally, the correlation between sleep disorders and age, disease duration, Unified Parkinson's Disease Rating Scale-III scores, Hoehn-Yahr stage, and levodopa dose were analyzed. The main statistical methods included Chi-square test, two independent samples t test, Fisher exact test, and Pearson correlation.Results:Sleep fragmentation in the PD group was significantly increased (74.1%) while difficulty falling asleep and early awakening were not, as compared to healthy controls. No significant differences were found in time in bed, sleep latency (SL), non-rapid eye movement (NREM) stage 1 (N1), N1%, N2, N2%, N3%, and NREM% between PD and control groups; but TST (327.96 ± 105.26 min vs. 414.67 ± 78.31 min, P = 0.003), SE (63.26% ± 14.83% vs. 76.8% ± 11.57%, P = 0.001), R N3 (20.00 [39.00] min vs. 61.50 [48.87] min, P = 0.001), NREM (262.59 ± 91.20 min vs. 337.17 ± 63.47 min, P = 0.003), rapid-eye-movement (REM) (32.50 [33.00] min vs. 85.25 [32.12] min, P < 0.001), REM% (9.56 ± 6.01 vs. 15.50 ± 4.81, P = 0.001), REM sleep latency (157.89 ± 99.04 min vs. 103.47 ± 71.70 min, P = 0.034) were significantly reduced in PD group.Conclusion:This preliminary study supported that sleep fragmentation was an important clinical characteristic of sleep disorders in PD. Whether sleep fragmentation is a potential quantifiable marker in PD needs to be further investigated in the future study.

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Section: Discussionsupporting

confidence: 77%

Sleep fragmentation as an important clinical characteristic of sleep disorders in Parkinson's disease

Cai

Luo

Chen

et al. 2019

Chinese Medical Journal

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“…The objective sleep parameters of this early PD cohort were similar to our studies before[ 21 22 ] as TST was 352.6 ± 108.3 min, SE was 60.9% ± 18.3%, SL was 30.6 ± 52.0 min, awakenings (n) was 20.5 ± 9.4, NREM1 was 29.6% ± 18.5%, NREM2 was 42.9% ± 16.0%, NREM3 was 13.1% ± 11.6%, REM was 14.4% ± 9.1%, PLMSI was 31.5 ± 50.1/h, AHI was 9.2 ± 13.5/h, AI was 6.2 ± 11.1/h, HI was 3.0 ± 5.4/h, ODI was 8.6 ± 12.5/h, minimal SaO 2 (%) was 89.3% ± 3.9%, the percentage of time spent at SaO 2 <90% (%) was 1.7% ± 4.2%, and arousal with respiratory events during sleep was 2.5 ± 6.3/h.…”

Section: R Esultssupporting

confidence: 75%

Increased Serum Cystatin C in Early Parkinson's Disease with Objective Sleep Disturbances

Xiong

Dai

Chen

et al. 2018

Chinese Medical Journal

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Background:Sleep disturbance is one of the major non-motor symptoms which cause the disability of Parkinson's disease (PD) patients. Cystatin C (CysC) is a more sensitive biomarker than serum creatinine or estimated glomerular filtration rate. Previous studies have reported altered CysC levels in neurodegenerative disorders and sleep disorders. This study aimed to explore the correlations of serum CysC levels and objective sleep disturbances in early PD.Methods:We recruited 106 early PD patients and 146 age- and sex-matched controls. All participants underwent clinical investigation and video-polysomnography. Sleep parameters and serum levels of CysC were measured. Then, we investigated the relationships between CysC and clinical variables and objective sleep disturbances in early PD patients.Results:The mean serum level of CysC was significantly higher in patients with early PD (1.03 ± 0.19 mg/L) compared to controls (0.96 ± 0.15 mg/L, P = 0.009). There were significantly positive correlations between serum CysC levels and age (r = 0.334, P < 0.001), gender (r = 0.264, P = 0.013), and creatinine levels (r = 0.302, P = 0.018) in early PD patients. Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index (AHI) (r = 0.231, P = 0.017), especially hypopnea index (r = 0.333, P < 0.001). In early PD patients, elevated serum CysC levels were positively correlated with oxygen desaturation index (r = 0.223, P = 0.021), percentage of time spent at oxygen saturation (SaO2) <90% (r = 0.644, P < 0.001), arousal with respiratory event during sleep (r = 0.247, P = 0.013). On the contrary, the elevated serum CysC levels were negatively correlated with mean and minimal SaO2 (r = −0.323, −0.315, both P = 0.001) in PD patients.Conclusions:The level of serum CysC was higher in early PD patients. PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation. Therefore, the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.

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“…In our study, 26.8% of patients with iRSWA developed iRBD after a mean of 2.6 + 2.2 years; and one patient in this group developed PD two years after RBD. Our findings support that iRSWA may be associated with specific clinical profiles, even in the absence of dream‐enacting behaviors …”

Section: Discussionsupporting

confidence: 82%

Rapid eye movement sleep without atonia constitutes increased risk for neurodegenerative disorders

2019

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Objectives REM (rapid eye movement) sleep without atonia (RSWA) is a polysomnographic finding used in diagnosis of REM sleep behavior disorder (RBD). Clinical significance of idiopathic RSWA (iRSWA) unaccompanied by RBD is not known. We designed a prospective study to investigate whether iRSWA constitutes an increased risk for developing neurodegenerative disorders. Materials and methods Between January 2010 and December 2014, a total of 4362 patients underwent a full‐night video‐polysomnography. Upon detailed clinical and polysomnographical examination, patients with iRSWA and idiopathic RBD (iRBD) were enrolled into this study and followed up at every six months for at least 4 years up to 9 years. Results We had a total of 31 patients with iRBD and 67 patients with iRSWA. Mean age was higher in iRBD group than those in iRSWA group (P = .016). Restless legs syndrome/Willis‐Ekbom disease was significantly more common in patients with iRBD than those in patient with iRSWA (P < .001). Eighteen patients with iRSWA (26.8%) developed iRBD after 2.6 + 2.2 years. Six patients with iRSWA (8.9%) developed neurodegenerative disorders following 2.4 + 1.5 years; four were diagnosed as Parkinson's disease (PD) and two developed probable Alzheimer‐type dementia. In patients with iRBD, eight patients (25.8%) developed neurodegenerative disorders—all was Parkinson's disease—following 2.6 + 2.2 years. Development of neurodegenerative diseases was positively correlated with age (P < .001) and periodic leg movements in sleep in both groups (P < .010). Conclusions These results show that iRSWA may also be accepted as a risk factor in the development of PD or neurodegenerative diseases. Advanced age and periodic leg movements in sleep seem to be correlated with higher risk.

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Two polysomnographic features of REM sleep behavior disorder: Clinical variations insight for Parkinson's disease

Cited by 16 publications

References 35 publications

Sleep fragmentation as an important clinical characteristic of sleep disorders in Parkinson's disease

Sleep fragmentation as an important clinical characteristic of sleep disorders in Parkinson's disease

Increased Serum Cystatin C in Early Parkinson's Disease with Objective Sleep Disturbances

Rapid eye movement sleep without atonia constitutes increased risk for neurodegenerative disorders

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