Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder

Iranzo, Álex; Frauscher, Birgit; Santos, Helena; Gschliesser, Viola; Ratti, Luca; Falkenstetter, Tina; Stürner, Caroline; Salamero, Manel; Tolosa, Eduardo; Poewe, Werner; Santamaría, Joan; Högl, Birgit

doi:10.1016/j.sleep.2010.04.021

Cited by 93 publications

(70 citation statements)

References 13 publications

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“…A similar pattern was seen for PD patients with RBD, who had significantly increased EMG activity in the tibialis muscle during NREM sleep compared to PD patients without RBD. Most studies on RBD have mainly focused on measuring EMG activity during REM sleep, [19][20][21] and to our knowledge no other studies have addressed EMG activity during NREM sleep in patients with iRBD and Parkinson disease. The increase of EMG activity during both REM and NREM sleep may suggest a general instability of mechanisms regulating atonia, although most pronounced during REM sleep.…”

Section: Discussionmentioning

confidence: 99%

“…43,44 As such, our method deviate from previous studies measuring EMG activity only during REM sleep. [19][20][21] Montplaisir et al established cutoff values for EMG activity during REM sleep for a diagnosis of RBD ≥ 30% for tonic activity or ≥ 15% for phasic activity. These authors used 20-s epochs for scoring tonic activity and 2-s mini-epochs for phasic activity.…”

Section: Discussionmentioning

confidence: 99%

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Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Zoetmulder

Nikolic

Biernat

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by impaired motor inhibition during REM sleep, and dream-enacting behavior. RBD is especially associated with α-synucleinopathies, such as Parkinson disease (PD). Follow-up studies have shown that patients with idiopathic RBD (iRBD) have an increased risk of developing an α-synucleinopathy in later life. Although abundant studies have shown that degeneration of the nigrostriatal dopaminergic system is associated with daytime motor function in Parkinson disease, only few studies have investigated the relation between this system and electromyographic (EMG) activity during sleep. The objective of this study was to investigate the relationship between the nigrostriatal dopamine system and muscle activity during sleep in iRBD and PD. Methods: 10 iRBD patients, 10 PD patients with PD, 10 PD patients without RBD, and 10 healthy controls were included and assessed with (123)I-N-omegafluoropropyl-2-beta-carboxymethoxy-3beta-(4-iodophenyl) nortropane ((123)I-FP-CIT) Single-photon emission computed tomography (SPECT) scanning ( 123 I-FP-CIT SPECT), neurological examination, and polysomnography. Results: iRBD patients and PD patients with RBD had increased EMG-activity compared to healthy controls.123 I-FP-CIT uptake in the putamen-region was highest in controls, followed by iRBD patients, and lowest in PD patients. In iRBD patients, EMG-activity in the mentalis muscle was correlated to 123 I-FP-CIT uptake in the putamen. In PD patients, EMG-activity was correlated to anti-Parkinson medication. Conclusions: Our results support the hypothesis that increased EMG-activity during REM sleep is at least partly linked to the nigrostriatal dopamine system in iRBD, and with dopamine function in PD. I NTRO DUCTI O NREM sleep behavior disorder (RBD) is a parasomnia characterized by REM sleep without atonia , dream enactment behavior, and vivid (and/or) violent dreams. Longitudinal studies have shown that patients with idiopathic RBD (iRBD) have an increased risk for developing an α-synucleinopathy, such as Parkinson disease (PD).1,2 The high proportion of iRBD patients developing PD may indicate a link between nigrostriatal degeneration and increased night-time motor activity. It is increasingly recognized that the dopaminergic system is associated with sleep-wake disturbances.3,4 Previous studies have shown that basal ganglia structures, such as the substantia nigra pars reticulata and the internal segment of the globus pallidus, have caudal connections to regions that modulate REM sleep atonia. 5 Imaging studies in iRBD patients have shown microstructural changes in substantia nigra, 6 reduced volume of the putamen, 7 as well as reduced density of the striatal dopamine transporter, which decreases in the course of disease progression. 8 In addition monkeys treated sub-chronic with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP), a neurotoxin which specifically targets dopaminergic neurons of the substantia nigra...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Zoetmulder

Nikolic

Biernat

et al. 2016

Journal of Clinical Sleep Medicine

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“…Według zaleceń Amerykańskiej Akademii Medycyny Snu u pacjentów z podejrzeniem RBD oprócz odprowadzeń EMG znad mięś-ni podbródkowych oraz mięśni piszczelowych przednich lewego i prawego powinny być stosowane dodatkowe odprowadzenia EMG znad mięśni zginaczy powierzchownych palców [18]. Większa liczba odprowadzeń EMG wyraźnie, bo o ok. 60% zwiększa wskaźniki fazowej czynności EMG widocznej podczas epizodu RBD w stosunku do aktywności EMG rejestrowanej jedynie z mięśni podbródkowych [19]. Badanie v-PSG często pozwala na zarejestrowanie epizodu klinicznego RBD.…”

Section: Komentarzunclassified

“…According to the recommendations of the American Academy of Sleep Medicine, in patients with suspected RBD, in addition to EMG of the mental and both anterior tibialis muscles, additional EMG of both flexor digitorum superficialis muscles should be used [18]. An increased number of EMG channels significantly, by approximately 60%, increases the indices of EMG phase activity seen during the RBD episode compared to EMG activity recorded only from chin muscles [19]. V-PSG often makes it possible to record a clinical episode of RBD.…”

Section: Komentarzmentioning

confidence: 99%

REM behaviour sleep disorder – case study

Wierzbicka¹,

Szaulińska²,

Poradowska³

et al. 2017

ppn

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Purpose: REM behaviour sleep disorder (RBD) is a parasomnia and involves sudden movements and/or vocalizations that reflect the dream content. This disorder is a common symptom of neurodegenerative diseases or their prodromal symptom. Until recently, clonazepam was the most commonly used drug to relieve symptoms of RBD. The aim of the article is to describe successful RBD treatment with melatonin. Case description: A case of a 56-year-old man with a history of symptoms characteristic for RBD was presented. The initial diagnosis was confirmed by video-polysomnography in the course of which clinical episodes and periods of muscle atonia during REM sleep were recorded. The cause of RBD was not identified, an idiopathic form of the disorder was diagnosed. Melatonin was used for treatment in the target dose of 5 mg/day with a satisfactory result. Due to an increased risk of a neurodegenerative disease, the patient remained under care of a neurologist. Comment: Due to more frequently reported effectiveness of melatonin in RBD treatment with a low risk of adverse reactions and interactions with other drugs, it is worth considering its use before the decision to administer clonazepam, especially in the elderly. Key words: REM behaviour sleep disorders, melatonin, polysomnography. StreszczenieCel: Zaburzenia zachowania w czasie snu REM (RBD) należą do parasomnii i mają charakter gwałtownych ruchów i/lub wokalizacji, odzwierciedlających treść marzeń sennych. Zaburzenie to jest częstym objawem chorób neurozwyrodnieniowych lub ich objawem prodromalnym. Najczęściej stosowanym lekiem łagodzącym RBD był do niedawna klonazepam. Celem artykułu jest opis skutecznego leczenia RBD melatoniną. Opis przypadku: Przedstawiono przypadek 56-letniego mężczyzny z wywiadem objawów charakterystycznych dla RBD. Wstępne rozpoznanie potwierdzono badaniem polisomnograficznym z rejestracją wideo, w którym zarejestrowano epizody kliniczne oraz okresy atonii mięśniowej podczas snu REM. Nie ustalono przyczyny RBD, rozpoznano postać idiopatyczną zaburzenia. Zastosowano leczenie melatoniną w dawce docelowej 5 mg/dobę z zadowalającym efektem. W związku ze zwiększonym ryzykiem zachorowania na chorobę neurozwyrodnieniową pacjent pozostał pod opieką neurologa.Komentarz: Ze względu na coraz częściej opisywaną skuteczność melatoniny w leczeniu RBD, przy niskim ryzyku działań niepożą-danych i interakcji z innymi lekami, warto rozważać jej zastosowanie przed podjęciem decyzji o podawaniu klonazepamu, zwłaszcza u osób starszych. Słowa kluczowe: zaburzenia zachowania w czasie snu REM, melatonina, polisomnografia.

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“…measured phasic activity in 3-s epochs in 13 different muscles and Iranzo et al in 5 muscles (mentalis, right and left flexor digitorum superficialis, and right and left extensor digitorum brevis). 25,26 A number of computerized scoring methods have been developed to analyze increased muscle activity in REM sleep. [27][28][29][30] However, the validity of these methods has not yet been tested.…”

Section: Brief Summarymentioning

confidence: 99%

Loss of Rapid Eye Movement Sleep Atonia in Patients with REM Sleep Behavioral Disorder, Narcolepsy, and Isolated Loss of REM Atonia

Khalil

Wright

Walker

et al. 2013

Journal of Clinical Sleep Medicine

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Study Objectives: To compare the amounts of REM sleep without atonia (RSWA) between patients with REM sleep behavior disorder (RBD), "isolated loss of REM atonia," narcolepsy, and control subjects and determine if there were threshold values for the amount of RSWA that differentiate each group from controls. Methods: Retrospective analyses of polysomnography (PSG) records were used employing strict quantitative criteria for the measurement of phasic and tonic EMG activity during REM sleep. The PSG recordings of 47 individuals were analyzed (RBD 16, isolated loss of REM atonia 11, narcolepsy 10, control 10). Results: Patients with the diagnosis of isolated loss of REM atonia had signifi cantly lower levels of EMG activity during REM sleep than those with RBD but higher than control subjects. RSWA was higher in narcolepsy than in loss of REM atonia but lower than for RBD patients. Receiver operating characteristic (ROC) curves provided threshold values with high specifi city and sensitivity in all patient groups with a cutoff value ≥ 1.22% (100% correctly classifi ed) for phasic and ≥ 3.17% for tonic (92% correctly classifi ed) EMG activity in RBD. Conclusion S C I E N T I F I C I N V E S T I G A T I O N SR EM sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal muscle atonia during REM sleep with abnormal motor activity that is proposed to be associated with dream content.1 RBD is associated with neurodegenerative disorders and in particular with synucleinopathies such as Parkinson disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA) (secondary RBD). Long-term follow-up studies have shown that a large proportion (38% to 65%) of patients with presumed idiopathic RBD develop Parkinsonism and/or dementia.2,3 EEG and neuropsychological tests have also revealed early evidence of CNS dysfunction in idiopathic RBD patients.4-7 Furthermore, diffusion tensor imaging has uncovered microstructural abnormalities in the brain areas responsible for REM sleep regulation in idiopathic RBD patients. In addition to neurodegenerative disease, RBD is also associated with other sleep disorders. Periodic limb movements of sleep (PLMS) are highly prevalent (70%) in patients with RBD.5 In addition, RBD is frequently seen in patients with narcolepsy.9,10 REM sleep without atonia (RSWA) in narcolepsy was fi rst described in 1992.10 RBD and/or RSWA are thought to be common in narcolepsy with cataplexy and rare in narcolepsy without cataplexy. 11,12It has been proposed that hypocretin defi ciency plays an essential role for both RBD and cataplexy in narcolepsy. Department of Clinical and Experimental Epilepsy, Institute of Neurology, UCL, London UKIsolated loss of REM atonia or RSWA is a condition usually identifi ed incidentally in patients during polysomnography. The loss of REM atonia is an electrophysiological fi nding without accompanying abnormal motor behavior during REM sleep. Although the condition may represent "subclinical" or "preclinical" RBD in some cases, 14 there are no ...

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Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder

Cited by 93 publications

References 13 publications

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Increased Motor Activity During REM Sleep Is Linked with Dopamine Function in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

REM behaviour sleep disorder – case study

Loss of Rapid Eye Movement Sleep Atonia in Patients with REM Sleep Behavioral Disorder, Narcolepsy, and Isolated Loss of REM Atonia

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