Validation of the Beijing Version of the REM Sleep Behavior Disorder Questionnaire (RBDQ-Beijing) in a Mainland Chinese Cohort

Abstract

REM sleep behavior disorder (RBD) is one type of parasomnia characterized by nocturnal complex motor activity associated with dream mentation. Growing evidence has indicated that RBD is a preclinical stage of neurodegenerative diseases. Therefore screening RBD patient is becoming important. The RBD Questionnaire-Hong Kong (RBDQ-HK) is an effective questionnaire to screen RBD patients. However, it is hard to distinguish RBD with the questionnaire from severe OSAS patients, who could mimic some symptoms of RBD patients. Therefore, we made RBDQ-Beijing by adding two screening questions for OSAS into original RBDQ-HK, including habitual loud snoring and witnessed apnea during sleep. To validate and compare these two questionnaires, 224 subjects were enrolled and screened with these questionnaires, and consequently analyzed with video-polysomnography. Receiver-operator characteristics curve analysis was conducted to attain the best cut-off values of the RBDQ-HK and RBDQ-Beijing. For the RBDQ-HK, the sensitivity was 97.1% and the specificity was 83.2%. More than half of misclassified RBD patients were proved to be severe OSAS patients. For the RBDQ-Beijing, the sensitivity was 95.8% and specificity was 94.3%, indicating that our questionnaire is able to distinguish RBD from severe OSAS patients. In conclusion, RBDQ-Beijing is of help to improve the specificity in RBD screening without excluding the patients with RBD combined OSAS. Therefore the RBDQ-Beijing may be a better screening and preliminary diagnostic tool for RBD than the RBDQ-HK. Moreover, the RBDQ-Beijing would be important for early diagnosis of neurodegenerative diseases and for prevention of injuries to the patient or the patient's bed partner.

A case–control–family study of idiopathic rapid eye movement sleep behavior disorder

“…There is a considerable discrepancy among the various cutoffs used, ranging from 10 to 45% for overall and 0.7 to 30% for tonic chin EMG activity, in differentiating RBD cases from controls . Despite possible inter‐rater or intercenter variability, there may be a potential cross‐ethnic difference in EMG activity level, as RBD studies from Asian populations seem to report lower EMG activity levels than those reported in Caucasian subjects . Thus, in this study, we employed a lower cutoff of 10% in our community population (this cutoff was also reported by Consens et al) …”

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

“…The RBDQ-HK was developed to evaluate the presence, but also the frequency and severity of RBD ( 13 ). A modified version with added screening questions on severe OSA ( 14 ) and validated language translations are available ( 15 ). The scale covers occurrence and frequency of dreams and nightmares, dream content, vocalizations during sleep, motor behaviors during sleep, injuries during sleep, and sleep disruptions.…”

“…Shen et al ( 16 ) reported superior diagnostic accuracy of Factor 2 score compared to total RBDQ score in their total RBD sample as well as in PD and OSA patients. Also, adding two items related to OSA in the modified RBDQ-Beijing scale ( 14 ) resulted in improved specificity and PPV, while excellent sensitivity and negative predictive value (NPV) were retained.…”

Clinical Manifestation of Parkinson's Disease in Association with Rapid Eye Movement Sleep Behavior Disorder Onset

“…We used RBDQ-HK to determine the occurrence of RBD instead of PSG. However, in order to test the compatibility of RBDQ-HK to the mainland Chinese, a study was carried out at our Sleep Disorder Clinic with 118 PSG-confirmed RBD and 106 non-RBD subjects, and RBDQ-HK gave a sensitivity of 97.1% and specificity of 83.2% [29] . As recall bias cannot be avoided in retrospective studies, especially with regard to nocturnal sleep behaviors, bed partners and caregivers are encouraged to co-answer the questionnaire.…”