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Saeda S, Sumi Y, Fujiwara K, Kadotani H. Blunted tachycardia and cardiac sympathetic denervation in isolated rapid eye movement sleep behavior disorder. BMC Neurol 2024; 24:317. [PMID: 39232705 PMCID: PMC11373284 DOI: 10.1186/s12883-024-03822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Isolated rapid eye movement sleep behavior disorder (iRBD) serves as a prodromal phase of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). Blunted tachycardia (BT) during postural changes indicates neurogenic orthostatic hypotension, a marker of autonomic dysfunction. We aimed to investigate whether BT is associated with cardiac sympathetic neurogenic denervation. Additionally, we conducted a preliminary short-term follow-up to examine the potential prognostic significance of BT regarding phenoconversion and mortality. METHODS Forty-three patients with iRBD at Shiga University of Medical Science Hospital underwent active standing tests to identify BT, defined by a specific ratio of decrease in systolic blood pressure to inadequate increase in heart rate after standing, and orthostatic hypotension. 123I-metaiodobenzylguanidine myocardial scintigraphy (123I-MIBG) and dopamine transporter single-photon emission computed tomography (DAT-SPECT) were performed. Participants were followed up for 3.4 ± 2.4 years for phenoconversion and 4.0 ± 2.3 years for mortality assessment, and the risk of events was analyzed using log-rank tests. RESULTS Among the 43 participants (mean age, 72.3 ± 7.9 years; 8 female), 17 met the BT criteria. We found no significant comorbidity-related differences in hypertension or diabetes between the BT(+) and BT(-) groups. Orthostatic hypotension was more prevalent in the BT(+) group than in the BT(-) group (47.1% vs 7.7%, p = 0.003). BT(+) patients were older with a lower early and delayed MIBG uptake; however, no significant differences were observed in DAT accumulation. Phenoconversion was observed in seven (41.2%) BT(+) and seven (26.9%) BT(-) patients. Three deaths were recorded in the BT(+) group (17.6%) and three in the BT(-) group (11.5%). No significant differences were observed in the risk of phenoconversion or mortality between the groups. CONCLUSIONS We have identified the possibility that BT reflects cardiac sympathetic neurogenic denervation in patients with iRBD. Future research is needed to elucidate the potential prognostic value of BT.
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Affiliation(s)
- Shota Saeda
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan
| | - Yukiyoshi Sumi
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
| | - Koichi Fujiwara
- Department of Materials Process Engineering, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, Aichi, 464-8601, Japan.
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Seta Tsukinowa-Cho, Otsu, Shiga, 520-2192, Japan
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Kmiecik MJ, Micheletti S, Coker D, Heilbron K, Shi J, Stagaman K, Filshtein Sonmez T, Fontanillas P, Shringarpure S, Wetzel M, Rowbotham HM, Cannon P, Shelton JF, Hinds DA, Tung JY, Holmes MV, Aslibekyan S, Norcliffe-Kaufmann L. Genetic analysis and natural history of Parkinson's disease due to the LRRK2 G2019S variant. Brain 2024; 147:1996-2008. [PMID: 38804604 PMCID: PMC11146432 DOI: 10.1093/brain/awae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/06/2024] [Indexed: 05/29/2024] Open
Abstract
The LRRK2 G2019S variant is the most common cause of monogenic Parkinson's disease (PD); however, questions remain regarding the penetrance, clinical phenotype and natural history of carriers. We performed a 3.5-year prospective longitudinal online study in a large number of 1286 genotyped LRRK2 G2019S carriers and 109 154 controls, with and without PD, recruited from the 23andMe Research Cohort. We collected self-reported motor and non-motor symptoms every 6 months, as well as demographics, family histories and environmental risk factors. Incident cases of PD (phenoconverters) were identified at follow-up. We determined lifetime risk of PD using accelerated failure time modelling and explored the impact of polygenic risk on penetrance. We also computed the genetic ancestry of all LRRK2 G2019S carriers in the 23andMe database and identified regions of the world where carrier frequencies are highest. We observed that despite a 1 year longer disease duration (P = 0.016), LRRK2 G2019S carriers with PD had similar burden of motor symptoms, yet significantly fewer non-motor symptoms including cognitive difficulties, REM sleep behaviour disorder (RBD) and hyposmia (all P-values ≤ 0.0002). The cumulative incidence of PD in G2019S carriers by age 80 was 49%. G2019S carriers had a 10-fold risk of developing PD versus non-carriers. This rose to a 27-fold risk in G2019S carriers with a PD polygenic risk score in the top 25% versus non-carriers in the bottom 25%. In addition to identifying ancient founding events in people of North African and Ashkenazi descent, our genetic ancestry analyses infer that the G2019S variant was later introduced to Spanish colonial territories in the Americas. Our results suggest LRRK2 G2019S PD appears to be a slowly progressive predominantly motor subtype of PD with a lower prevalence of hyposmia, RBD and cognitive impairment. This suggests that the current prodromal criteria, which are based on idiopathic PD, may lack sensitivity to detect the early phases of LRRK2 PD in G2019S carriers. We show that polygenic burden may contribute to the development of PD in the LRRK2 G2019S carrier population. Collectively, the results should help support screening programmes and candidate enrichment strategies for upcoming trials of LRRK2 inhibitors in early-stage disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Paul Cannon
- 23andMe, Inc., Research, Sunnyvale, CA 94086, USA
| | | | | | - Joyce Y Tung
- 23andMe, Inc., Research, Sunnyvale, CA 94086, USA
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3
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Gu Y, Cao K, Li A, Wang J, Guo Y, Hao Y, Tian L, Jie Y. Association between sleep quality and dry eye disease: a literature review and meta-analysis. BMC Ophthalmol 2024; 24:152. [PMID: 38581010 PMCID: PMC10996221 DOI: 10.1186/s12886-024-03416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE The purpose of this article is to systematically review the association between dry eye and sleep quality. METHODS PubMed, EMBASE, Cochrane, Web of Science, and grey literature databases were searched for observational studies published before April 2023. Meta-analysis was performed using STAT15 software. RESULTS A total of 21 studies with 419,218 participants were included. The results showed that the dry eye subjects had a worse sleep quality than the healthy population, with poorer subjective sleep quality, longer sleep latency, and a higher risk of unhealthy sleep duration such as insufficient sleep or excessive sleep. The Pittsburgh Sleep Quality Index (PSQI) scores of the dry eye subjects were significantly higher than those of the control subjects (WMD = 1.78, 95%CI: 1.06, 2.50, P < 0.001). The dry eye subjects scored higher than the control subjects in sleep quality, sleep latency, and sleep disturbance in PSQI; there was no difference between the dry eye individuals and control subjects in sleep duration, sleep efficiency, daytime dysfunction, and sleep medication scores. The risk of sleep disorders in the dry eye subjects was significantly higher than that in the non-dry eye subjects (RR = 2.20, 95%CI: 1.78, 2.72, P < 0.001); the risk of insufficient sleep in the dry eye subjects was higher than that in the control subjects (RR = 3.76, 95%CI: 3.15, 4.48, P < 0.001), and the prevalence of excessive sleepiness in dry eye subjects was higher than that in the control subjects (RR = 5.53, 95%CI: 3.83, 7.18, P < 0.001). The ESS scores of the dry eye subjects were significantly higher than those of the control subjects (WMD = 3.02, 95%CI: 2.43, 3.60, P < 0.01). CONCLUSION Our meta-analysis suggests that individuals with dry eye have a worse sleep quality than the healthy population, with poorer subjective sleep quality, longer sleep latency, and higher risk of unhealthy sleep duration such as insufficient sleep or excessive sleepiness.
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Affiliation(s)
- Yixuan Gu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, 100730, Beijing, China
| | - Ao Li
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Jingyi Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Yihan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Yiran Hao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China
| | - Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China.
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dong Jiao Min Xiang, Dong Cheng District, 100730, Beijing, China.
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Eckhardt C, Fanciulli A, Högl B, Heidbreder A, Eschlböck S, Raccagni C, Krismer F, Leys F, Kiechl S, Ransmayr G, Frauscher B, Seppi K, Wenning G, Stefani A. Analysis of sleep, daytime sleepiness, and autonomic function in multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med 2023; 19:63-71. [PMID: 36004744 PMCID: PMC9806784 DOI: 10.5664/jcsm.10268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Sleep disorders, daytime sleepiness, and autonomic dysfunction are commonly reported among patients with multiple system atrophy and Parkinson disease (PD). We aimed to assess sleep and autonomic function in these patients to evaluate the relationships between sleep disorders, excessive daytime sleepiness, and autonomic function. METHODS Twenty patients with multiple system atrophy (n = 7) and PD (n = 13) underwent clinical assessment including questionnaires for autonomic function and sleep. Cardiovascular autonomic function tests and 2-night video-polysomnography were followed by administration of the Multiple Sleep Latency Test. Rapid eye movement sleep without atonia was quantified in the chin, flexor digitorum superficialis, tibial anterior, and sternocleidomastoid muscles. RESULTS Rapid eye movement sleep behavior disorder was associated with orthostatic hypotension (P = .017) and constipation (P = .019) in PD. Patients with orthostatic hypotension had higher rapid eye movement sleep without atonia indices than those without orthostatic hypotension (P < .001). The Sleep Innsbruck Barcelona rapid eye movement sleep without atonia index ("any" chin and/or flexor digitorum superficialis) correlated with systolic/diastolic blood pressure fall upon tilt-table examination in patients with multiple system atrophy (P < .05) and with gastrointestinal (P = .010), urinary (P = .022), and total Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction scores (P = .006) in all patients. Patients with a pathological deep breathing ratio showed higher Sleep Innsbruck Barcelona indices (P = .031). Objective daytime sleepiness was exclusively present in PD (P = .034) and correlated with levodopa-equivalent dosage (P = .031). CONCLUSIONS The relationship of autonomic dysfunction with rapid eye movement sleep without atonia in PD and multiple system atrophy is accounted for by shared brainstem neuropathology and likely identifies patients in a more advanced stage of disease. Excessive daytime sleepiness is found exclusively in PD and may be secondary to levodopa treatment and not related to α-synuclein disease. CITATION Eckhardt C, Fanciulli A, Högl B, et al. Analysis of sleep, daytime sleepiness, and autonomic function and multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med. 2023;19(1):63-71.
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Affiliation(s)
- Christine Eckhardt
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabine Eschlböck
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Regional Hospital of Bolzano, Bolzano, Italy
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | | | - Birgit Frauscher
- Analytical Neurophysiology Lab and Epilepsy Program, Montreal Neurological Institute and Hospital, McGill University, Montreal H3A 2B4, Quebec, Canada
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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5
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Mora-Munoz L, Alsheikhtaha Z, Foldvary-Schaefer N. Differential Diagnosis of Complex Nocturnal Behaviors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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6
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Riboldi GM, Russo MJ, Pan L, Watkins K, Kang UJ. Dysautonomia and REM sleep behavior disorder contributions to progression of Parkinson's disease phenotypes. NPJ Parkinsons Dis 2022; 8:110. [PMID: 36042235 PMCID: PMC9427762 DOI: 10.1038/s41531-022-00373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/02/2022] [Indexed: 02/06/2023] Open
Abstract
Non-motor symptoms of Parkinson's disease (PD) such as dysautonomia and REM sleep behavior disorder (RBD) are recognized to be important prodromal symptoms that may also indicate clinical subtypes of PD with different pathogenesis. Unbiased clustering analyses showed that subjects with dysautonomia and RBD symptoms, as well as early cognitive dysfunction, have faster progression of the disease. Through analysis of the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we tested the hypothesis that symptoms of dysautonomia and RBD, which are readily assessed by standard questionnaires in an ambulatory care setting, may help to independently prognosticate disease progression. Although these two symptoms associate closely, dysautonomia symptoms predict severe progression of motor and non-motor symptoms better than RBD symptoms across the 3-year follow-up period. Autonomic system involvement has not received as much attention and may be important to consider for stratification of subjects for clinical trials and for counseling patients.
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Affiliation(s)
- Giulietta Maria Riboldi
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA
| | - Marco J Russo
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA
| | - Ling Pan
- NYU Langone Neurosurgery Associates, New York, NY, 10016, USA
| | | | - Un Jung Kang
- Department of Neurology, the Marlene and Paolo Fresco Institute for Parkinson's Disease and Movement Disorders, New York University Langone Health, New York, NY, 10017, USA.
- Department of Neuroscience and Physiology, Neuroscience Institute, The Parekh Center for Interdisciplinary Neurology, New York University Grossman School of Medicine, New York, NY, 10016, USA.
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7
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Ma H, Yan J, Sun W, Jiang M, Zhang Y. Melatonin Treatment for Sleep Disorders in Parkinson's Disease: A Meta-Analysis and Systematic Review. Front Aging Neurosci 2022; 14:784314. [PMID: 35185525 PMCID: PMC8855052 DOI: 10.3389/fnagi.2022.784314] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
Objective The efficacy of melatonin on sleep disorders in Parkinson's disease (PD) is still unclear. The purpose of this study was to investigate the efficacy of melatonin on sleep disorders in PD by summarizing evidence from randomized clinical trials (RCTs). Methods PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched for studies published before 20 August 2021. Results were analyzed using Review Manager 5.2 software. We used Trial Sequential Analysis (TSA) software to avoid false-positive results caused by random errors. Results We included 7 studies in this systematic review and meta-analysis. The results of the meta-analysis showed that compared with placebo, the subjective sleep quality of patients with PD significantly improved after melatonin treatment (MD = −2.19, 95% CI: −3.53 to −0.86, P = 0.001). In the systematic review, we qualitatively analyzed the efficacy of melatonin on the objective sleep quality of patients with PD, and the results showed that melatonin exerted a positive effect with good safety and tolerability. However, there was no significant improvement in excessive daytime sleepiness assessed by the Epworth Sleepiness Scale (ESS). Conclusion We found that melatonin can significantly improve the subjective and objective sleep quality of patients with PD with good safety and tolerability. Melatonin could be considered an effective treatment for insomnia in patients with PD.
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Affiliation(s)
- Hongxia Ma
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Junqiang Yan
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- Department of Neurology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
- *Correspondence: Junqiang Yan
| | - Wenjie Sun
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Menghan Jiang
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yongjiang Zhang
- Key Laboratory of Neuromolecular Biology, The First Affiliated Hospital, College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Valomon A, Riedner BA, Jones SG, Nakamura KP, Tononi G, Plante DT, Benca RM, Boly M. A high-density electroencephalography study reveals abnormal sleep homeostasis in patients with rapid eye movement sleep behavior disorder. Sci Rep 2021; 11:4758. [PMID: 33637812 PMCID: PMC7910582 DOI: 10.1038/s41598-021-83980-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by disrupting motor enactments during REM sleep, but also cognitive impairments across several domains. In addition to REM sleep abnormalities, we hypothesized that RBD patients may also display EEG abnormalities during NREM sleep. We collected all-night recordings with 256-channel high-density EEG in nine RBD patients, predominantly early-onset medicated individuals, nine sex- and age- matched healthy controls, and nine additional controls with matched medications and comorbidities. Power spectra in delta to gamma frequency bands were compared during both REM and NREM sleep, between phasic and tonic REM sleep, and between the first versus last cycle of NREM sleep. Controls, but not RBD patients, displayed a decrease in beta power during phasic compared to tonic REM sleep. Compared to controls, RBD patients displayed a reduced decline in SWA from early to late NREM sleep. Overnight changes in the distribution of the amplitude of slow waves were also reduced in RBD patients. Without suppression of beta rhythms during phasic REM sleep, RBD patients might demonstrate heightened cortical arousal, favoring the emergence of behavioral episodes. A blunted difference between REM sleep sub-stages may constitute a sensitive biomarker for RBD. Moreover, reduced overnight decline in SWA suggests a reduced capacity for synaptic plasticity in RBD patients, which may favor progression towards neurodegenerative diseases.
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Affiliation(s)
- Amandine Valomon
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA.
| | - Brady A Riedner
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Stephanie G Jones
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Giulio Tononi
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA
| | - David T Plante
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruth M Benca
- University of California Irvine, Psychiatry and Human Behavior, Irvine, CA, USA
| | - Melanie Boly
- Psychiatry - Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, 6001 Research Park Boulevard, Madison, WI, 53719, USA
- Neurology, University of Wisconsin-Madison, Madison, WI, USA
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9
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Ashraf-Ganjouei A, Moradi K, Aarabi M, Abdolalizadeh A, Kazemi SZ, Kasaeian A, Vahabi Z. The Association Between REM Sleep Behavior Disorder and Autonomic Dysfunction in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:747-755. [PMID: 33579870 DOI: 10.3233/jpd-202134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND REM behavior disorder (RBD) can occur in the context of neurodegenerative alpha-synucleinopathies, such as Parkinson's disease (PD). PD patients with RBD (PD-pRBD) represent more severe symptoms and signs compared with those without RBD (PD-nRBD). On another note, autonomic dysfunction in PD patients is categorized as one of the most prominent non-motor symptoms and has been lately the field of interest in research. OBJECTIVE In the current study, we longitudinally studied autonomic dysfunction in PD-pRBD and PD-nRBD groups. METHOD This study was conducted on 420 drug-naïve PD patients selected from the Parkinson's Progression Markers Initiative database. The RBD Screening Questionnaire was used to define the presence of probable RBD. SCOPA-AUT was used to assess autonomic dysfunction. Additionally, dopamine transporter deficits on [123I] FP-CIT SPECT imaging was performed for all of the patients. RESULTS Out of 420 PD patients, 158 individuals (37.6%) were considered to have probable RBD (PD-pRBD) and others without RBD (PD-nRBD). Except for pupillomotor function, all the autonomic symptoms were significantly more severe in PD-pRBD group. In PD-nRBD group, caudate striatal binding ratio was negatively correlated with SCOPA-AUT scores, while no significant correlation was observed in PD-pRBD group. Finally, there was a significant difference considering the longitudinal changes of SCOPA-AUT total between PD-pRBD and PD-nRBD groups, suggesting a more severe autonomic decline in PD-pRBD patients. CONCLUSION Our results indicate that PD-pRBD patients have more severe autonomic dysfunction. These results support the theory that PD patients can be categorized based on the clinical presentation, possibly representing differences in the disease pathophysiology.
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Affiliation(s)
- Amir Ashraf-Ganjouei
- Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kamyar Moradi
- Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadhadi Aarabi
- Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyedeh Zahra Kazemi
- Students Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Inflammation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Department of Geriatric Medicine, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Memory and Behavioral Neurology Division, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
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10
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Autonomic impairment in REM sleep behavior disorder: a potential biomarker of phenoconversion? Clin Auton Res 2020; 30:189-190. [DOI: 10.1007/s10286-020-00688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
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11
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Zhang F, Niu L, Liu X, Liu Y, Li S, Yu H, Le W. Rapid Eye Movement Sleep Behavior Disorder and Neurodegenerative Diseases: An Update. Aging Dis 2020; 11:315-326. [PMID: 32257544 PMCID: PMC7069464 DOI: 10.14336/ad.2019.0324] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/20/2019] [Indexed: 12/11/2022] Open
Abstract
Rapid eye movement sleep behavior disorder (RBD) is a sleep behavior disorder characterized by abnormal behaviors and loss of muscle atonia during rapid eye movement (REM) sleep. RBD is generally considered to be associated with synucleinopathies, such as Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA), and usually precedes years before the first symptom of these diseases. It is believed that RBD predicts the neurodegeneration in synucleinopathy. However, increasing evidences have shown that RBD is also found in non-synucleinopathy neurodegenerative diseases, including Alzheimer’s disease (AD), Huntington’s disease (HD), amyotrophic lateral sclerosis (ALS), etc. Sleep disturbance such as RBD may be an early sign of neurodegeneration in these diseases, and also serve as an assessment of cognitive impairments. In this review, we updated the clinical characteristics, diagnosis, and possible mechanisms of RBD in neurogenerative diseases. A better understanding of RBD in these neurogenerative diseases will provide biomarkers and novel therapeutics for the early diagnosis and treatment of the diseases.
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Affiliation(s)
- Feng Zhang
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Long Niu
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Xinyao Liu
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yufei Liu
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Song Li
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Huan Yu
- 3Sleep and Wake Disorders Center and Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weidong Le
- 1Center for Clinical Research on Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China.,2Liaoning Provincial Key Laboratory for Research on the Pathogenic Mechanisms of Neurological Diseases, the First Affiliated Hospital, Dalian Medical University, Dalian, China
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12
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Abstract
Hypertension is a major determinant of cardiovascular morbidity and mortality and is highly prevalent in the general population. While the relationship between sleep apnea and increased blood pressure has been well documented, less recognized is emerging evidence linking sleep-related movement disorders such as restless legs syndrome/periodic limb movements of sleep and sleep-related bruxism with blood pressure (BP) dysregulation and hypertension. There is also recent literature linking narcolepsy-cataplexy with elevated BP and altered pressor responses, and there are data suggesting abnormal BP control in rapid eye movement sleep behavior disorder. It is thought that neural circulatory mechanisms, sympathetic activation in particular, comprise the predominant mediator underlying elevated BP in these neurological sleep disorders. There is very limited evidence that treating these sleep disorders may be beneficial in lowering BP primarily because this question has received very little attention. In this review, we discuss the potential pathophysiologic mechanisms underlying elevated BP in restless legs syndrome/periodic limb movements of sleep, sleep-related bruxism, narcolepsy-cataplexy, and rapid eye movement sleep behavior disorder. We also examine the relationship between these sleep disorders and elevated BP and the impact of treatment of these conditions on BP control. Last, we discuss gaps in the literature evaluating the associations between these sleep disorders and elevated BP and identify areas for further research.
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Affiliation(s)
- Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Naima Covassin
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Virend K. Somers
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
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13
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Yu X, Guo H, Liu X, Wang G, Min Y, Chen SHS, Han SS, Chang RT, Zhao X, Hsing A, Zhu S, Yao K. Dry eye and sleep quality: a large community-based study in Hangzhou. Sleep 2019; 42:5532656. [PMID: 31310315 DOI: 10.1093/sleep/zsz160] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Study Objectives
To investigate the relationship between dry eye and sleep quality in a large community-based Chinese population.
Methods
A total of 3,070 participants aged 18–80 were recruited from a community-based study in Hangzhou, China during 2016–2017. Sleep quality was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), and dry eye was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Multivariable linear regression and logistic regression models were used to investigate the associations, adjusting for age, smoking, drinking, season, and other potential confounders.
Results
Overall, CPSQI score and sleep dysfunction were significantly associated with mild, moderate, and severe dry eye (ORs for CPSQI score: 1.07, 1.13, 1.14, all p < 0.001; for sleep dysfunction: 1.31, 1.73, 1.66, all p < 0.05). Furthermore, worse OSDI score was presented in participants with worse CPSQI score or sleep dysfunction (CPSQI score > 7) (β: 0.13, 0.54; all p < 0.001). In addition, six of the seven components of CPSQI showed significant associations with dry eye (all p < 0.001), except for the component of sleep medication use. Moreover, we observed significant associations of dry eye in all three subscales of OSDI with CPSQI score and sleep dysfunction.
Conclusion
Our large, community-based study showed a strong association between poor sleep quality and an increased severity of dry eye, suggesting that preventing either one of the discomforts might alleviate the other.
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Affiliation(s)
- Xiaoning Yu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Guo
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guowei Wang
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Min
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shih-Hua Sarah Chen
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Summer S Han
- Department of Neurosurgery, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Robert T Chang
- Department of Ophthalmology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Xueyin Zhao
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ann Hsing
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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14
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Baumann CR. Sleep–wake and circadian disturbances in Parkinson disease: a short clinical guide. J Neural Transm (Vienna) 2019; 126:863-869. [DOI: 10.1007/s00702-019-02039-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/21/2019] [Indexed: 01/23/2023]
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15
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Palma JA, Gileles-Hillel A, Norcliffe-Kaufmann L, Kaufmann H. Chemoreflex failure and sleep-disordered breathing in familial dysautonomia: Implications for sudden death during sleep. Auton Neurosci 2019; 218:10-15. [PMID: 30890343 DOI: 10.1016/j.autneu.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/11/2019] [Indexed: 01/04/2023]
Abstract
Familial dysautonomia (Riley-Day syndrome, hereditary sensory and autonomic neuropathy type III) is a rare autosomal recessive disease characterized by impaired development of primary sensory and autonomic neurons resulting in a severe neurological phenotype, which includes arterial baroreflex and chemoreflex failure with high frequency of sleep-disordered breathing and sudden death during sleep. Although a rare disease, familial dysautonomia represents a unique template to study the interactions between sleep-disordered breathing and abnormal chemo- and baroreflex function. In patients with familial dysautonomia, ventilatory responses to hypercapnia are reduced, and to hypoxia are almost absent. In response to hypoxia, these patients develop paradoxical hypoventilation, hypotension, bradycardia, and potentially, death. Impaired ventilatory control due to chemoreflex failure acquires special relevance during sleep when conscious control of respiration withdraws. Overall, almost all adult (85%) and pediatric (95%) patients have some degree of sleep-disordered breathing. Obstructive apnea events are more frequent in adults, whereas central apnea events are more severe and frequent in children. The annual incidence rate of sudden death during sleep in patients with familial dysautonomia is 3.4 per 1000 person-year, compared to 0.5-1 per 1000 person-year of sudden unexpected death in epilepsy. This review summarizes recent developments in the understanding of sleep-disordered breathing in patients with familial dysautonomia, the risk factors for sudden death during sleep, and the specific interventions that could prevent it.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States of America
| | - Alex Gileles-Hillel
- Departments of Pediatrics, Pediatric Pulmonology and Sleep, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States of America
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States of America.
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Shustak S, Inzelberg L, Steinberg S, Rand D, David Pur M, Hillel I, Katzav S, Fahoum F, De Vos M, Mirelman A, Hanein Y. Home monitoring of sleep with a temporary-tattoo EEG, EOG and EMG electrode array: a feasibility study. J Neural Eng 2019; 16:026024. [DOI: 10.1088/1741-2552/aafa05] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Palma JA. Autonomic dysfunction in sleep disorders: introduction to the series. Clin Auton Res 2018; 28:507-508. [PMID: 30328032 DOI: 10.1007/s10286-018-0571-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, USA.
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18
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Daytime autonomic activity in idiopathic rapid eye movement sleep behavior disorder: a preliminary study. Sleep Med 2018; 52:163-167. [PMID: 30359891 DOI: 10.1016/j.sleep.2018.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/30/2018] [Accepted: 08/27/2018] [Indexed: 11/20/2022]
Abstract
OJECTIVE To investigate cardiovascular and sudomotor autonomic functions in patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) during wakefulness compared to patients with Parkinson's disease (PD) and healthy subjects. METHODS Drug-naïve iRBD patients, PD patients and healthy controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. Heart rate variability (HRV) analysis was performed in the frequency domain using an autoregressive algorithm in the rest supine condition and during HUTT. Sudomotor function was assessed through Sudoscan. RESULTS Fourteen iRBD patients, 17 PD patients and 12 healthy controls were included in the study. In the supine resting condition, the baseline values of systolic and diastolic blood pressure and heart rate were comparable in all groups. At Valsalva maneuver, iRBD patients and PD patients showed an overshoot which was significantly lower than controls. In addition, iRBD patients showed a significant reduction of sinus arrhythmia at deep breathing compared to controls. Cardiovascular responses to cold face were similar in the three groups while isometric handgrip was significantly reduced in PD patients with respect to healthy subjects. Spectral analysis of HRV showed no significant differences among iRBD, PD patients and controls in the supine resting condition; whereas during HUTT the low-frequency (LF) component of HRV was significantly higher in controls with respect to iRBD and the high-frequency (HF) component was significantly higher in iRBD patients compared to controls. In addition, a significant increase in the LF/HF ratio in healthy subjects was detected compared to iRBD. Finally, four out of 14 iRBD patients (29%) and nine of 17 PD patients (53%) had a sudomotor dysfunction. CONCLUSIONS Our findings obtained in de novo iRBD and PD patients indicate that some alterations of the autonomic nervous system are shared by both groups of patients, reinforcing the close link between the two pathologies, and show an autonomic fragility during wakefulness in iRBD that mainly arises under stress conditions.
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Autonomic regulation during sleep and wakefulness: a review with implications for defining the pathophysiology of neurological disorders. Clin Auton Res 2018; 28:509-518. [PMID: 30155794 DOI: 10.1007/s10286-018-0560-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023]
Abstract
Cardiovascular and respiratory parameters change during sleep and wakefulness. This observation underscores an important, albeit incompletely understood, role for the central nervous system in the differential regulation of autonomic functions. Understanding sleep/wake-dependent sympathetic modulations provides insights into diseases involving autonomic dysfunction. The purpose of this review was to define the central nervous system nuclei regulating sleep and cardiovascular function and to identify reciprocal networks that may underlie autonomic symptoms of disorders such as insomnia, sleep apnea, restless leg syndrome, rapid eye movement sleep behavior disorder, and narcolepsy/cataplexy. In this review, we examine the functional and anatomical significance of hypothalamic, pontine, and medullary networks on sleep, cardiovascular function, and breathing.
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Barone DA, Henchcliffe C. Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol 2018; 129:1551-1564. [PMID: 29883833 DOI: 10.1016/j.clinph.2018.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/10/2018] [Accepted: 05/18/2018] [Indexed: 01/09/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) involves REM sleep without atonia in conjunction with a recurrent nocturnal dream enactment behavior, with vocalizations such as shouting and screaming, and motor behaviors such as punching and kicking. Secondary RBD is well described in association with neurological disorders including Parkinson's disease (PD), multiple system atrophy (MSA), and other conditions involving brainstem structures such as tumors. However, RBD alone is now considered to be a potential harbinger of later development of neurodegenerative disorders, in particular PD, MSA, dementia with Lewy bodies (DLB), and pure autonomic failure. These conditions are linked by their underpinning pathology of alpha-synuclein protein aggregation. In RBD, it is therefore important to recognize the potential risk for later development of an alpha-synucleinopathy, and to investigate for other potential causes such as medications. Other signs and symptoms have been described in RBD, such as orthostatic hypotension, or depression. While it is important to recognize these features to improve patient management, they may ultimately provide clinical clues that will lead to risk stratification for phenoconversion. A critical need is to improve our ability to counsel patients, particularly with regard to prognosis. The ability to identify who, of those with RBD, is at high risk for later neurodegenerative disorders will be paramount, and would in addition advance our understanding of the prodromal stages of the alpha-synucleinopathies. Moreover, recognition of at-risk individuals for neurodegenerative disorders may ultimately provide a platform for the testing of possible neuroprotective agents for these neurodegenerative disorders.
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Palma JA. Autonomic dysfunction in Parkinson's disease and other synucleinopathies: Introduction to the series. Mov Disord 2018; 33:347-348. [PMID: 29436737 PMCID: PMC5840012 DOI: 10.1002/mds.27347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York
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