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Lee M, Kim TK, Hong JK, Yoon IY. Minimal effect of long-term clonazepam on cognitive function in patients with isolated rapid eye movement sleep behavior disorder. J Clin Sleep Med 2024; 20:1173-1182. [PMID: 38494993 PMCID: PMC11217636 DOI: 10.5664/jcsm.11126] [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: 12/17/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVES Despite its widespread use in patients with isolated rapid eye movement sleep behavior disorder (iRBD), the cognitive effect of clonazepam is uncertain. This study aimed to investigate the effect of cumulative clonazepam on cognitive function in patients with iRBD. METHODS Demographic characteristics, baseline cognitive test, and most recent cognitive test information were collected retrospectively. Based on cumulative clonazepam doses, patients were classified into 4 subgroups: group 1, < 365 mg (1 mg × 1 year); group 2, 365 mg to < 1,095 mg (1 mg × 3 years); group 3, 1,095 mg to < 2,190 mg (1 mg × 6 years); and group 4, 2,190 mg or more. Cognitive test scores were calculated as z scores adjusted for age, education, and sex. RESULTS This study included 101 patients with iRBD (63 males). Groups 1, 2, 3, and 4 had 14, 20, 32, and 35 patients, respectively. In within-group comparisons, follow-up Digit Span Backward test and the Trail Making Test A scores decreased in group 3, and follow-up Trail Making Test A and the Trail Making Test B scores decreased significantly in group 4. In the multiple regression analysis to determine influential factors on cognitive decline, cumulative clonazepam dose did not show a significant correlation with any cognitive domain. Follow-up cognitive function showed significant correlation only with baseline cognitive function. CONCLUSIONS Memory and executive functions tended to decline in patients with iRBD. However, there was no significant effect of cumulative clonazepam. There was no evidence that long-term use of clonazepam was related to cognitive decline in patients with iRBD. CITATION Lee M, Kim TK, Hong JK, Yoon I-Y. Minimal effect of long-term clonazepam on cognitive function in patients with isolated rapid eye movement sleep behavior disorder. J Clin Sleep Med. 2024;20(7):1173-1182.
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Affiliation(s)
- Minji Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tong Keon Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Kyung Hong
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - In-Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Dubessy AL, Arnulf I. Sleepiness in neurological disorders. Rev Neurol (Paris) 2023; 179:755-766. [PMID: 37598089 DOI: 10.1016/j.neurol.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Sleepiness is a frequent and underrecognized symptom in neurological disorders, that impacts functional outcomes and quality of life. Multiple and potentially additive factors might contribute to sleepiness in neurological disorders, including sleep quality alterations, circadian rhythm disorders, drugs, and sleep disorders including sleep apnea or central disorders of hypersomnolence. Physician awareness of the possible symptoms of hypersomnolence, and associated causes is of crucial importance to allow proper identification and treatment of underlying causes. This review first provides a brief overview on clinical aspects of excessive daytime sleepiness, and diagnosis tools, then examines its frequency and mechanisms in various neurological disorders, including neurodegenerative disorders, multiple sclerosis, autoimmune encephalitis, epilepsy, and stroke.
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Affiliation(s)
- A-L Dubessy
- Saint Antoine Hospital, Assistance publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - I Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France
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Ling Y, Zhu J, Yan F, Tse LA, Kinra S, Jiang M. Sleep behaviors and Parkinson's disease: A bidirectional Mendelian randomization analysis. Behav Brain Res 2023; 441:114281. [PMID: 36608706 DOI: 10.1016/j.bbr.2022.114281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/14/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Whether the quantity and quality of sleep are the risk factors for the development of Parkinson's disease remains unclear though it has now been confirmed that the quality of sleep among patients with Parkinson's disease is affected at the prodromal and clinical stages. Accordingly, this study aimed to examine the bidirectional causal relationships of multiple sleep-related phenotypes with Parkinson's disease using a two-sample Mendelian randomization (MR) method. METHODS The summary-level data collected from the published genome-wide association studies was used for analysis. Besides, the genetic relationships between different sleep-related phenotypes, including self-reported and accelerometer measured traits, were estimated for the risk and age at the onset of Parkinson's disease. To conduct MR analysis, inverse variance weighted, weight median, MR-Egger, and MR-PRESSO method were mainly used. Moreover, sensitivity analyses were carried out to examine the pleiotropic effect. RESULTS In general, there was insufficient evidence to support the causal effect of sleep-related phenotypes on risk (N cases/controls = 33,674/449,056) and age at the onset (N cases = 28,568) of Parkinson's disease. However, the results of this study indicated that the later onset age of Parkinson's disease was related to the frequent occurrence of insomnia (OR [95% CI] 1.007 [1.003, 1.011], P < 0.001) after the adjustment for multiple testing. CONCLUSIONS The results of this study suggest that insomnia-associated single nucleotide polymorphisms are more frequent in later onset Parkinson's disease patients compared to earlier onset patients. However, given the limitations of statistical power and potential bias, further validation should be still conducted through larger population research.
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Affiliation(s)
- Yuxiao Ling
- School of Public Health, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Jiahao Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou 310053, China
| | - Feng Yan
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310052, China
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, the Chinese University of Hong Kong, New Territories 999077, Hong Kong
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - MinMin Jiang
- Key Laboratory of Pollution Exposure and Health Intervention of Zhejiang Province, Shulan International Medical College, Zhejiang Shuren University, Hangzhou 310015, China.
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Circadian disruption and sleep disorders in neurodegeneration. Transl Neurodegener 2023; 12:8. [PMID: 36782262 PMCID: PMC9926748 DOI: 10.1186/s40035-023-00340-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
Disruptions of circadian rhythms and sleep cycles are common among neurodegenerative diseases and can occur at multiple levels. Accumulating evidence reveals a bidirectional relationship between disruptions of circadian rhythms and sleep cycles and neurodegenerative diseases. Circadian disruption and sleep disorders aggravate neurodegeneration and neurodegenerative diseases can in turn disrupt circadian rhythms and sleep. Importantly, circadian disruption and various sleep disorders can increase the risk of neurodegenerative diseases. Thus, harnessing the circadian biology findings from preclinical and translational research in neurodegenerative diseases is of importance for reducing risk of neurodegeneration and improving symptoms and quality of life of individuals with neurodegenerative disorders via approaches that normalize circadian in the context of precision medicine. In this review, we discuss the implications of circadian disruption and sleep disorders in neurodegenerative diseases by summarizing evidence from both human and animal studies, focusing on the bidirectional links of sleep and circadian rhythms with prevalent forms of neurodegeneration. These findings provide valuable insights into the pathogenesis of neurodegenerative diseases and suggest a promising role of circadian-based interventions.
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Singh A, Williams S, Calabrese A, Riha R. Tonic
REM
sleep muscle activity is the strongest predictor of phenoconversion risk to neurodegenerative disease in isolated
REM
sleep behaviour disorder. J Sleep Res 2022; 32:e13792. [PMID: 36451603 DOI: 10.1111/jsr.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/15/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
Previous studies have shown that rapid eye movement sleep without atonia during polysomnography can predict the risk of phenoconversion to neurodegenerative disease in patients with isolated rapid eye movement sleep behaviour disorder. Discrepancy remains with regards to the morphology of rapid eye movement sleep without atonia that best predicts phenoconversion risk. This study aimed to ascertain the predictive value of tonic, phasic and mixed rapid eye movement sleep without atonia in patients with isolated rapid eye movement sleep behaviour disorder, at time of diagnosis. Sixty-four patients with polysomnography-confirmed isolated rapid eye movement sleep behaviour disorder, including 19 who phenoconverted during follow-up, were identified from an existing database. Tonic, phasic, mixed and "any" rapid eye movement sleep without atonia activity from the mentalis, tibialis anterior and flexor digitorum superficialis muscles was analysed blind to status using the diagnostic polysomnography. Rapid eye movement sleep without atonia variables were compared between converters and non-converters. Rapid eye movement sleep without atonia cut-offs predicting phenoconversion were established using receiver-operating characteristic analysis. The mean follow-up duration was 5.50 ± 4.73 years. Phenoconverters (n = 19) had significantly higher amounts of tonic (22.2 ± 19.1%, p = 0.0014), mixed (18.1 ± 14.1%, p = 0.0074) and "any" (mentalis muscle; 58.7 ± 28.0%, p = 0.0009) and all muscles (68.0 ± 20.8%, p = 0.0049) rapid eye movement sleep without atonia at diagnosis than non-converters. Optimal rapid eye movement sleep without atonia cut-off values predicting phenoconversion were 5.8% for tonic (73.7% sensitivity; 75.6% specificity), 7.3% for mixed (68.4% sensitivity; 73.3% specificity) and 43.6% for "any" (mentalis muscle; 68.4% sensitivity; 80.0% specificity) activity. "Any" (mentalis muscle) rapid eye movement sleep without atonia had the highest area under the curve (0.809) followed by tonic (0.799). The percentage of tonic rapid eye movement sleep without atonia was the strongest biomarker of phenoconversion in this cohort of patients with isolated rapid eye movement sleep behaviour disorder.
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Affiliation(s)
- Ankur Singh
- Department of Sleep Medicine, Edinburgh Royal Infirmary Royal Infirmary of Edinburgh Scotland UK
| | - Stevie Williams
- Sleep Research Unit The University of Edinburgh Centre for Clinical Brain Sciences Edinburgh UK
| | - Angela Calabrese
- Department of Sleep Medicine, Edinburgh Royal Infirmary Royal Infirmary of Edinburgh Scotland UK
| | - Renata Riha
- Department of Sleep Medicine, Edinburgh Royal Infirmary Royal Infirmary of Edinburgh Scotland UK
- Sleep Research Unit The University of Edinburgh Centre for Clinical Brain Sciences Edinburgh UK
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Lai H, Li XY, Hu J, Li W, Xu F, Zhu J, He R, Weng H, Chen L, Yu J, Li X, Song Y, Wang X, Wang Z, Li W, Kang R, Li Y, Xu J, Deng Y, Ye Q, Wang C. Development and Validation of a Predictive Nomogram for Possible REM Sleep Behavior Disorders. Front Neurol 2022; 13:903721. [PMID: 35847229 PMCID: PMC9277017 DOI: 10.3389/fneur.2022.903721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To develop and validate a predictive nomogram for idiopathic rapid eye movement (REM) sleep behavior disorder (RBD) in a community population in Beijing, China. Methods Based on the validated RBD questionnaire-Hong Kong (RBDQ-HK), we identified 78 individuals with possible RBD (pRBD) in 1,030 community residents from two communities in Beijing. The least absolute shrinkage and selection operator (LASSO) regression was applied to identify candidate features and develop the nomogram. Internal validation was performed using bootstrap resampling. The discrimination of the nomogram was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, and the predictive accuracy was assessed via a calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical value of the model. Results From 31 potential predictors, 7 variables were identified as the independent predictive factors and assembled into the nomogram: family history of Parkinson's disease (PD) or dementia [odds ratio (OR), 4.59; 95% confidence interval (CI), 1.35–14.45; p = 0.011], smoking (OR, 3.24; 95% CI, 1.84–5.81; p < 0.001), physical activity (≥4 times/week) (OR, 0.23; 95% CI, 0.12–0.42; p < 0.001), exposure to pesticides (OR, 3.73; 95%CI, 2.08–6.65; p < 0.001), constipation (OR, 6.25; 95% CI, 3.58–11.07; p < 0.001), depression (OR, 3.66; 95% CI, 1.96–6.75; p < 0.001), and daytime somnolence (OR, 3.28; 95% CI, 1.65–6.38; p = 0.001). The nomogram displayed good discrimination, with original AUC of 0.885 (95% CI, 0.845–0.925), while the bias-corrected concordance index (C-index) with 1,000 bootstraps was 0.876. The calibration curve and DCA indicated the high accuracy and clinical usefulness of the nomogram. Conclusions This study proposed an effective nomogram with potential application in the individualized prediction for pRBD.
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Affiliation(s)
- Hong Lai
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xu-Ying Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Junya Hu
- Department of Neurobiology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurobiology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Fanxi Xu
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Junge Zhu
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Raoli He
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Huidan Weng
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Lina Chen
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Jiao Yu
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
| | - Xian Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yang Song
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Xianling Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Zhanjun Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Rong Kang
- The Xinjiekou Community Health Service Center, Beijing, China
| | - Yuling Li
- The Xinjiekou Community Health Service Center, Beijing, China
| | - Junjie Xu
- The Qinglonghu Community Health Service Center, Beijing, China
| | - Yuanfei Deng
- Department of Geriatric Disease, Peking University Shenzhen Hospital, Shenzhen, China
- Yuanfei Deng
| | - Qinyong Ye
- Department of Neurology, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University Union Hospital, Institute of Neuroscience, Fujian Medical University, Fuzhou, China
- Qinyong Ye
| | - Chaodong Wang
- Department of Neurology, National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital of Capital Medical University, Beijing, China
- *Correspondence: Chaodong Wang
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Postuma RB, Pelletier A, Gagnon JF, Montplaisir J. Evolution of Prodromal Multiple System Atrophy from REM Sleep Behavior Disorder: A Descriptive Study. JOURNAL OF PARKINSON'S DISEASE 2022; 12:983-991. [PMID: 35094998 PMCID: PMC9789475 DOI: 10.3233/jpd-213039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prodromal multiple system atrophy (MSA) has been characterized mainly by retrospective chart reviews. Direct observation and tracking of prodromal markers in MSA have been very limitedObjective:To report the baseline characteristics and evolution of prodromal markers of MSA as they were prospectively measured in patients with idiopathic/isolated REM sleep behavior disorder (iRBD)Methods:Patients with iRBD were evaluated as part of a comprehensive protocol repeated annually. The protocol included assessment of motor, sleep, psychiatric, and autonomic symptoms supplemented by motor examination, quantitative motor testing, neuropsychological examination, orthostatic blood pressure measurement, and tests of olfaction and color vision. Patients who eventually developed MSA were described and compared with those who phenoconverted to Lewy body disease (Parkinson's disease and dementia with Lewy bodies). RESULTS Of 67 phenocoverters, 4 developed MSA-P and 63 developed Lewy body disease. An additional 2 MSA-C patients were seen at baseline, already with cerebellar signs. Compared to those with Lewy body disease, those with MSA-P were younger, had less severe loss of tonic REM sleep atonia, more insomnia symptoms, and better olfaction. Clinically-evident autonomic dysfunction was not invariable in prodromal stages, often developing proximate to or after motor phenoconversion. Of the autonomic symptoms, genitourinary dysfunction was the first to develop in all cases. Olfaction and cognition remained normal throughout the prodromal and clinical disease course, in clear contrast to patients with Lewy body disease. CONCLUSION Prodromal MSA progresses rapidly, often without substantial autonomic dysfunction, and with preserved olfaction and cognition throughout its prodromal course.
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Affiliation(s)
- Ronald B. Postuma
- Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada,
Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,Correspondence to: Dr. Ronald B. Postuma, MD, Department of Neurology, Montreal Neurological Institute, 3801 University Avenue NW107, Montreal, H3A 2B4, Canada. E-mail:
| | - Amelie Pelletier
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Gagnon
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,
Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Jaccques Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada,
Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
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Wang C, Chen F, Li Y, Liu J. Possible predictors of phenoconversion in isolated REM sleep behaviour disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2022; 93:395-403. [PMID: 34937751 DOI: 10.1136/jnnp-2021-328062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/07/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND A number of promising biomarkers for predicting imminent α-synucleinopathies have been suggested in isolated rapid eye movement sleep behaviour disorder (iRBD). However, existing evidence is conflicting without quantitative evaluation. METHODS PubMed, Web of Science and ClinicalTrials.gov were searched through June 2021 to identify possible predictors of phenoconversion from iRBD to Parkinson's disease (PD). The pooled HRs and standardised mean differences (SMDs) with 95% CIs were calculated using fixed-effects or random-effects model. RESULTS A total of 123 studies were included in the meta-analysis. Significant motor dysfunction (HR 1.83, 95% CI 1.33 to 2.51, I2=86.8%, p<0.001), constipation (HR 1.52, 95% CI 1.26 to 1.84, I2=8.3%, p=0.365), orthostatic hypotension (HR 1.93, 95% CI 1.05 to 3.53, I2=54.9%, p=0.084), hyposmia (HR 2.78, 95% CI 1.83 to 4.23, I2=23.9%, p=0.255), mild cognitive impairment (HR 2.27, 95% CI 1.58 to 3.27, I2=0%, p=0.681) and abnormal colour vision (SMD -0.34, 95% CI -0.63 to -0.05, I2=45.6%, p=0.087) correlated with susceptibility to PD. The process can also be traced by putaminal dopamine transporter imaging (HR 2.60, 95% CI 1.94 to 3.48, I2=0%, p=0.781) and tonic electromyographic activity (HR 1.50, 95% CI 1.04 to 2.15, I2=70%, p=0.018). CONCLUSIONS The predictive value of each biomarker was initially highlighted with comprehensive evaluation. Combining specific predictors with high sensitivity is promising for detecting phenoconversion in the prodromal stage. Large-scale and multicentre studies are pivotal to extend our findings.
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Affiliation(s)
- Chunyi Wang
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangzheng Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Li
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China .,CAS Center for Excellence in Brain Science & Intelligence Technology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregneration, Nantong University, Nantong, China
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Van Den Berge N, Ulusoy A. Animal models of brain-first and body-first Parkinson's disease. Neurobiol Dis 2022; 163:105599. [DOI: 10.1016/j.nbd.2021.105599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
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Yao CW, Pelletier A, Fereshtehnejad SM, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med 2022; 18:345-359. [PMID: 34314348 PMCID: PMC8804990 DOI: 10.5664/jcsm.9562] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and sleep-maintenance insomnia. METHODS We included those aged 45-85 years, living in 1 of 10 Canadian provinces between 2012 and 2015 (at the baseline), recruited via 3 population-based sampling methods. Insomnia symptoms were assessed using questions adapted/modified from the Pittsburgh Sleep Quality Index. A panel of potential prodromal neurodegenerative markers including self-reported symptoms and objective gait motor, cognitive, and autonomic variables were assessed cross sectionally. We compared those who endorsed insomnia symptoms ≥ 3 times per week to controls, adjusting for age, sex, and education via logistic regression. RESULTS Overall, 2,051/30,097 people screened positive for sleep-onset insomnia alone and 4,333 for sleep-maintenance insomnia alone, while 2,371 endorsed both subtypes. On objective gait tests, participants with sleep-onset insomnia, but not sleep-maintenance insomnia, had worse balance (odds ratio [OR] = 1.33, 95% confidence interval = [1.16, 1.52]) and slower gait speed (OR = 1.52 [1.34, 1.73]). Although participants with any insomnia subtype endorsed more motor symptoms, these were more severe in those with sleep-onset insomnia (OR onset vs maintenance = 1.13 [1.07, 1.18]). On objective cognitive tests, those with sleep-maintenance insomnia scored normally. However, participants with sleep-onset insomnia performed worse on tests of verbal fluency (OR = 1.24 [1.06, 1.43]), immediate memory (OR = 1.23 [1.08, 1.41]), and prospective memory task (OR = 1.29 [1.11, 1.50]). The sleep-onset insomnia group also had lower heart rate variability (OR = 1.23 [1.07, 1.43]). Secondary analyses found generally similar results in young vs older age of insomnia development. CONCLUSIONS Compared to maintenance insomnia, those with sleep-onset insomnia have more motor, cognitive, and autonomic signs/symptoms. When evaluating neurodegenerative risk, differentiating insomnia subtypes may increase precision. CITATION Yao CW, Pelletier A, Fereshtehnejad S-M, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. J Clin Sleep Med. 2022;18(2):345-359.
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Affiliation(s)
- Chun W Yao
- Integrated Program in Neuroscience, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Nathan Cross
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Thanh Dang-Vu
- Institut Universitaire de Gériatrie de Montréal and CRIUGM, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- PERFORM Centre, Center for Studies in Behavioral Neurobiology, Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Ronald B Postuma
- Research Center of the Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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11
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Shao Y, Dai XJ, Wang J, Wang Y. Association Between Sleep Duration and Parkinson's Disease Varied Across Related Orphan Receptor A rs2028122 Genotypes. Front Neurosci 2022; 16:902895. [PMID: 35769699 PMCID: PMC9235404 DOI: 10.3389/fnins.2022.902895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of the study was to examine the association of long and short sleep duration with risk of Parkinson's disease (PD) across RORA rs2028122 genotypes. Methods In the present prospective study with a large sized UK Biobank cohort, we performed multivariate logistic regression analyses, generalized additive model, interaction terms, stratification analysis, and mediation analysis to evaluate the association of long and short sleep duration with risk of PD across RORA rs2028122 genotypes. Results The GG genotype [1.16 (1.01, 1.33)], a short sleep duration [1.23 (1.10, 1.37)], and a long sleep duration [1.19 (1.03, 1.37)] were identified as the independent risk factors for PD. Sleep duration exhibited a curvilinear U-shaped correlation with the risk of PD; first, the risk of PD gradually decreased as the length of sleep increase, but then, the risk began to increase as the length of sleep increase. Among habitual long sleepers, AG carriers had a higher risk of PD compared with AA carriers [1.67 (1.09, 2.55)]. Among AG carriers, both habitual short [1.28 (1.09, 1.50)] and long [1.38 (1.13, 1.69)] sleepers increased the risk of PD compared with habitual normal sleepers. Among GG carriers, habitual short sleepers have a higher risk of PD [1.26 (1.06, 1.50)] compared with habitual normal sleepers. A mediation model suggested that the rs2028122 genotype partially mediated the causal pathway of sleep duration leading to the development of PD on a positive effect. Conclusion Our study demonstrated that the association between sleep duration and PD risk varied across different RORA rs2028122 genotypes. Our findings could help individuals to identify their potential risk profile and take timely actions to prevent the PD.
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Affiliation(s)
- Yuan Shao
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Xi-Jian Dai
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Jian Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yongjun Wang
- Shenzhen Mental Health Centre, Shenzhen Kangning Hospital, Shenzhen, China
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12
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Jo H, Kim D, Song J, Choi S, Joo E. Sleep Disturbances and Phenoconversion in Patients with REM Sleep Behavior Disorder. J Clin Med 2021; 10:jcm10204709. [PMID: 34682832 PMCID: PMC8536960 DOI: 10.3390/jcm10204709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/01/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: We aimed to investigate relationships between sleep disturbances and phenoconversion to neurodegenerative diseases in patients with REM sleep behavior disorder (RBD). Method: Using a comprehensive sleep database in a university-affiliated hospital between December 2014 and March 2021, we reviewed the data of 226 patients with RBD (182 patients with idiopathic RBD (iRBD) and 44 patients with symptomatic RBD (sRBD) with a neurodegenerative disease). Results: Among 226 patients with RBD (male, 61.5%), the mean age at RBD onset and mean disease duration were 59.4 ± 10.5 and 5.9 ± 5.6 years, respectively. Further, 111 (49.1%) patients had periodic limb movements during sleep (PLMS, PLM index ≥ 15/h), while 110 patients (48.7%) had comorbid obstructive sleep apnea (OSA, respiratory disturbance index ≥ 15/h). There was a positive correlation between age at RBD onset and the apnea-hypopnea index and Pittsburgh Sleep Quality Index. Compared to patients with iRBD, patients with sRBD showed a lower N3 sleep (3.3 ± 5.0 vs. 1.6 ± 3.1%, p = 0.004) and higher periodic limb movement index (36.3 ± 31.8 vs. 56.9 ± 47.5/h, p = 0.021) at the baseline. Among the 186 patients with iRBD, 18 (8.0%) developed neurodegenerative diseases (converters, mean follow-up duration: 2.5 ± 1.6 years) and 164 did not (non-converters, mean follow-up 2.4 ± 2.2 years). There was no significant between-group difference in the demographics and baseline clinical features. Continuous positive airway pressure (CPAP) therapy was prescribed in 101 patients with OSA; among them, 71 (70%) patients agreed to use it. CPAP improved dream enactment behaviors. Conclusion: In our study, 8.0% of patients with iRBD showed phenoconversion within a mean follow-up duration of 2.5 years. Polysomnographic parameters could not predict phenoconversion to neurodegenerative disease. However, approximately half of the patients with RBD presented with significant sleep disorders, including OSA or PLMS. CPAP therapy may alleviate RBD symptoms in patients with RBD-OSA.
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Affiliation(s)
- Hyunjin Jo
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (H.J.); (D.K.); (J.S.)
| | - Dongyeop Kim
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (H.J.); (D.K.); (J.S.)
| | - Jooyeon Song
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (H.J.); (D.K.); (J.S.)
| | - Sujung Choi
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul 06351, Korea;
| | - Eunyeon Joo
- Department of Neurology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (H.J.); (D.K.); (J.S.)
- Correspondence: or ; Tel.: +82-2-3410-3597; Fax: +82-2-3410-0052
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13
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Gallazzi M, Mauri M, Bianchi ML, Riboldazzi G, Princiotta Cariddi L, Carimati F, Rebecchi V, Versino M. Selegiline reduces daytime sleepiness in patients with Parkinson's disease. Brain Behav 2021; 11:e01880. [PMID: 33759401 PMCID: PMC8119812 DOI: 10.1002/brb3.1880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/20/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Excessive daytime sleepiness (EDS) affects a large percentage of Parkinson's disease (PD) patients, and it is enhanced by dopamine agonist drugs. Currently, there is no treatment of choice for EDS in PD. Our aim was to check the clinical impression that some patients who were given selegiline, a selective inhibitor of monoamine oxidase B, experienced an improvement in their daytime somnolence. METHODS In the present study, we retrospectively identified 45 Parkinson's disease patients (21 females and 24 males) among those referred to the PD Center in Varese that (a) showed excessive daytime sleepiness, usually developed after the introduction of a dopamine agonist, (b) were given selegiline 10 mg to improve their treatment schedule independently of excessive sleepiness, and (c) in whom the Epworth Sleepiness Scale (ESS) and the Parkinson's Disease Sleep Scale (PDSS) scores were available both before and 3 months after the introduction of selegiline. RESULTS We compared the corresponding scores (ESS, PDSS, and UPDRS III) evaluated before and 3 months after the introduction of selegiline by the nonparametric Mann-Whitney U test: The differences showed a statistically significant improvement of somnolence but no change in the UPDRS III scores. CONCLUSION Despite some limitations, our data suggest that selegiline may be a valuable add-on therapy in PD patients to reduce their daytime somnolence.
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Affiliation(s)
- Marco Gallazzi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Marco Mauri
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | | | - Giulio Riboldazzi
- Neurologia e Stroke Unit, ASST Valle Olona, Ospedale S. Antonio Abate, Gallarate, Italy
| | - Lucia Princiotta Cariddi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
| | - Federico Carimati
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Valentina Rebecchi
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy
| | - Maurizio Versino
- Neurologia e Stroke Unit, ASST Sette Laghi, Ospedale di Circolo di Varese, Italy.,Università dell'Insubria, Varese, Italy
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14
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Asah C, Frandsen R, Ibsen R, Kjellberg J, Jennum P. Morbidity, Mortality, and Conversion to Neurodegenerative Diseases in Patients with REM Sleep Behavior Disorder and REM Sleep without Atonia. Neuroepidemiology 2021; 55:141-153. [PMID: 33780948 DOI: 10.1159/000514175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. METHODS All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson's disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer's, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. RESULTS In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. CONCLUSIONS A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.
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Affiliation(s)
- Cresta Asah
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rune Frandsen
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Faculty of Health Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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15
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Wang X, Liu F, Bi Y, Shen X, Xu W, Wang J, Tan L, Yu J. Associations of sleep characteristics with alpha-synuclein in cerebrospinal fluid in older adults. Ann Clin Transl Neurol 2020; 7:2026-2034. [PMID: 32949229 PMCID: PMC7545588 DOI: 10.1002/acn3.51204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Sleep disorders as a preclinical symptom of synucleinopathies become more prevalent in older adults. Synucleinopathies might be caused by the abnormal aggregation of alpha-synuclein in the brain, which was indicated by alpha-synuclein levels in cerebrospinal fluid (CSF). We aimed to investigate associations of sleep characteristics with CSF alpha-synuclein in older adults. METHODS Our study recruited 536 cognitively intact individuals (aged between 40 and 90 years old) from the Chinese Alzheimer's Biomarker and Lifestyle study. Sleep behaviors were assessed by Pittsburgh Sleep Quality Index and total alpha-synuclein in CSF was measured by enzyme-linked immune-sorbent assay. We used multiple linear and non-linear regression models for research. RESULTS Significant non-linear associations of CSF alpha-synuclein with sleep time and duration were revealed. Individuals who went to bed and fell asleep too early or late tended to have lower CSF alpha-synuclein (reflection point for time to bed and fall asleep were 10:26 p.m. and 10:40 p.m.). Lower CSF alpha-synuclein was also observed in individuals with either excessive or insufficient sleep duration (reflection point: 7.24 hours). Besides, overall poor sleep quality (β = -0.0621; P = 0.0242), longer sleep latency (β = -0.0415; P = 0.0174) and lower sleep efficiency (β = 0.0036; P = 0.0017) showed linear associations with lower CSF alpha-synuclein. Sleep disturbances and daytime dysfunction were not significantly associated with CSF alpha-synuclein. INTERPRETATION Poor sleep was associated with lower levels of CSF alpha-synuclein in older adults, which may provide new insight into the prevention of synucleinopathies.
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Affiliation(s)
- Xiao‐Tong Wang
- Department of NeurologyQingdao Municipal HospitalQingdao UniversityQingdaoChina
| | - Feng‐Tao Liu
- Department of Neurology and Institute of NeurologyHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yan‐Lin Bi
- Department of AnesthesiologyQingdao Municipal HospitalQingdao UniversityChina
| | - Xue‐Ning Shen
- Department of Neurology and Institute of NeurologyHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wei Xu
- Department of NeurologyQingdao Municipal HospitalQingdao UniversityQingdaoChina
| | - Jian Wang
- Department of Neurology and Institute of NeurologyHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
| | - Lan Tan
- Department of NeurologyQingdao Municipal HospitalQingdao UniversityQingdaoChina
| | - Jin‐Tai Yu
- Department of Neurology and Institute of NeurologyHuashan HospitalShanghai Medical CollegeFudan UniversityShanghaiChina
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16
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Feng H, Chen L, Liu Y, Chen X, Wang J, Yu MWM, Huang B, Li SX, Chau SWH, Chan JWY, Chen J, Mok VCT, Wing YK, Zhang J. Rest‐Activity Pattern Alterations in Idiopathic
REM
Sleep Behavior Disorder. Ann Neurol 2020; 88:817-829. [DOI: 10.1002/ana.25853] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Hongliang Feng
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Lauren Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yaping Liu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Xinru Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jing Wang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Mandy Wai Man Yu
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Bei Huang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Shatin, Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong, Pokfulam Hong Kong China
| | - Steven Wai Ho Chau
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Joey Wing Yan Chan
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jie Chen
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Vincent Chung Tong Mok
- Margaret K.L. Cheung Research Centre in Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Division of Neurology, Department of Medicine and Therapeutics The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Yun Kwok Wing
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
| | - Jihui Zhang
- Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Shatin, Hong Kong China
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Guangzhou Guangdong China
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17
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Zhang Y, Ren R, Yang L, Sanford LD, Tang X. Polysomnographically measured sleep changes in idiopathic REM sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2020; 54:101362. [PMID: 32739826 DOI: 10.1016/j.smrv.2020.101362] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies conducted to explore sleep changes in idiopathic rapid eye movement sleep behavior disorder (iRBD) have not established clear relationships between sleep disturbances and iRBD. To explore the polysomnographic differences between iRBD patients and healthy controls and their associated factors, an electronic literature search was conducted in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO inception to December 2019.34 studies were identified for systematic review, 33 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time (SMD = -0.212, 95%CI: -0.378 to -0.046), sleep efficiency (SMD = -0.194, 95%CI: -0.369 to -0.018), apnea hypopnea index (SMD = -0.440, 95%CI: -0.780 to -0.101), and increases in sleep latency (SMD = 0.340, 95%CI: 0.074 to 0.606), and slow wave sleep (SMD = 0.294, 95%CI: 0.064 to 0.523) in iRBD patients compared with controls. Furthermore, electroencephalogram frequency components during REM sleep were altered in iRBD patients compared with controls; however, the specific changes could not be determined. Our findings suggest that polysomnographic sleep is abnormal in iRBD patients. Further studies are needed on underlying mechanisms and associations with neurodegenerative diseases.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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18
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Cognitive Impairments and Self-Reported Sleep in Early-Stage Parkinson's Disease with Versus without Probable REM Sleep Behavior Disorder. Brain Sci 2019; 10:brainsci10010009. [PMID: 31877713 PMCID: PMC7016995 DOI: 10.3390/brainsci10010009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
Parkinson’s disease (PD) is associated with cognitive and sleep impairments. The presence of rapid eye movement (REM) sleep behavior disorder (RBD) symptoms may represent a worse disease prognosis for PD individuals. We investigated cognitive functioning and self-reported sleep in early-stage PD individuals with (n = 19) or without (n = 31) probable RBD. Probable RBD was defined as >5 on the REM Sleep Behavior Disorder Screening Questionnaire. Inhibition, visuospatial cognitive abilities, working memory, sustained visual attention, verbal fluency, and episodic memory were assessed. Sleep impairments were assessed using the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and Patient-Reported Outcomes Measurement Information System questionnaires. Chi-squared, Mann-Whitney U, and independent sample t-tests were employed to assess group differences. Participants with PD and probable RBD performed significantly worse on word reading and switching verbal fluency tasks than PD participants without probable RBD (p < 0.05). No significant differences were found in mood, PD severity, or sleep measures between PD individuals with or without probable RBD. Cognitive tasks that involve verbal or switching components may be most impaired in PD individuals with probable RBD. Larger samples are needed to determine whether other cognitive domains and sleep features are significantly associated with RBD in PD.
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19
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New Frontiers in Parkinson's Disease: From Genetics to the Clinic. J Neurosci 2019; 38:9375-9382. [PMID: 30381429 DOI: 10.1523/jneurosci.1666-18.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 12/30/2022] Open
Abstract
The greatest unmet therapeutic need in Parkinson's disease (PD) is a treatment that slows the relentless progression of the symptoms and the neurodegenerative process. This review highlights the utility of genetics to understand the pathogenic mechanisms and develop novel therapeutic approaches for PD. The focus is on strategies provided by genetic studies: notably via the reduction and clearance of α-synuclein, inhibition of LRRK2 kinase activity, and modulation of glucocerebrosidase-related substrates. In addition, the critical role of precompetitive public-private partnerships in supporting trial design optimization, overall drug development, and regulatory approvals is illustrated. With these great advances, the promise of developing transformative therapies that halt or slow disease progression is a tangible goal.
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20
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Dijkstra F, Viaene M, Crosiers D, De Volder I, Cras P. Frequency and characteristic features of REM sleep without atonia. Clin Neurophysiol 2019; 130:1825-1832. [DOI: 10.1016/j.clinph.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/24/2019] [Accepted: 07/12/2019] [Indexed: 01/19/2023]
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21
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Lysen TS, Darweesh SKL, Ikram MK, Luik AI, Ikram MA. Sleep and risk of parkinsonism and Parkinson's disease: a population-based study. Brain 2019; 142:2013-2022. [PMID: 31038176 PMCID: PMC6911221 DOI: 10.1093/brain/awz113] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
Sleep disturbances may signal presence of prodromal parkinsonism, including Parkinson's disease. Whether general sleep quality or duration in otherwise healthy subjects is related to the risk of parkinsonism remains unclear. We hypothesized that both worse self-reported sleep quality and duration, as well as a longitudinal deterioration in these measures, are associated with the risk of parkinsonism, including Parkinson's disease. In the prospective population-based Rotterdam Study, we assessed sleep quality and duration with the Pittsburgh Sleep Quality Index in 7726 subjects (mean age 65 years, 57% female) between 2002 and 2008, and again in 5450 subjects between 2009 and 2014. Participants were followed until 2015 for a diagnosis of parkinsonism and Parkinson's disease. Outcomes were assessed using multiple modalities: interviews, physical examination, and continuous monitoring of pharmacy records and medical records of general practitioners. We used Cox regression to associate sleep, and changes in sleep over time, with incident parkinsonism and Parkinson's disease, adjusting for age, sex, education and smoking status. Over 64 855 person-years in 13 years of follow-up (mean: 8.4 years), 75 participants developed parkinsonism, of whom 47 developed Parkinson's disease. We showed that within the first 2 years of follow-up, worse sleep quality {hazard ratio (HR) 2.38 per standard deviation increase [95% confidence interval (CI 0.91-6.23)]} and shorter sleep duration [HR 0.61 per standard deviation increase (95% CI 0.31-1.21)] related to a higher risk of parkinsonism. Associations of worse sleep quality [HR 3.86 (95% CI 1.19-12.47)] and shorter sleep duration [HR 0.48 (95% CI 0.23-0.99)] with Parkinson's disease were more pronounced, and statistically significant, compared to parkinsonism. This increased risk disappeared with longer follow-up duration. Worsening of sleep quality [HR 1.76 per standard deviation increase (95% CI 1.12-2.78)], as well as shortening of sleep duration [HR 1.72 per standard deviation decrease (95% CI 1.08-2.72)], were related to Parkinson's disease risk in the subsequent 6 years. Therefore, we argue that in the general population, deterioration of sleep quality and duration are markers of the prodromal phase of parkinsonism, including Parkinson's disease.
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Affiliation(s)
- Thom S Lysen
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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22
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Chang X, Wang J, Jiang H, Shi L, Xie J. Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels: An Emerging Role in Neurodegenerative Diseases. Front Mol Neurosci 2019; 12:141. [PMID: 31231190 PMCID: PMC6560157 DOI: 10.3389/fnmol.2019.00141] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
Neurodegenerative diseases such as Parkinson's disease (PD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), and spinal muscular atrophy (SMA) are chronic, progressive, and age-associated neurological disorders characterized by neuronal deterioration in specific brain regions. Although the specific pathological mechanisms underlying these disorders have remained elusive, ion channel dysfunction has become increasingly accepted as a potential mechanism for neurodegenerative diseases. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are encoded by the HCN1-4 gene family and conduct the hyperpolarization-activated current (I h). These channels play important roles in modulating cellular excitability, rhythmic activity, dendritic integration, and synaptic transmission. In the present review, we first provide a comprehensive picture of the role of HCN channels in PD by summarizing their role in the regulation of neuronal activity in PD-related brain regions. Dysfunction of I h may participate in 1-methyl-4-phenylpyridinium (MPP+)-induced toxicity and represent a pathogenic mechanism in PD. Given current reports of the critical role of HCN channels in neuroinflammation and depression, we also discussed the putative contribution of HCN channels in inflammatory processes and non-motor symptoms in PD. In the second section, we summarize how HCN channels regulate the formation of β-amyloid peptide in AD and the role of these channels in learning and memory. Finally, we briefly discuss the effects of HCN channels in ALS and SMA based on existing discoveries.
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Affiliation(s)
- Xiaoli Chang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Jun Wang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Hong Jiang
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Limin Shi
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
| | - Junxia Xie
- Department of Physiology, Shandong Provincial Key Laboratory of Pathogenesis and Prevention of Neurological Disorders and State Key Disciplines: Physiology, Medical College of Qingdao University, Qingdao, China
- Institute of Brain Science and Disease, Qingdao University, Qingdao, China
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23
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Electromyography activity level in rapid eye movement sleep predicts neurodegenerative diseases in idiopathic rapid eye movement sleep behavior disorder: a 5-year longitudinal study. Sleep Med 2019; 56:128-134. [DOI: 10.1016/j.sleep.2019.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/20/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022]
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24
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Yao C, Fereshtehnejad SM, Keezer MR, Wolfson C, Pelletier A, Postuma RB. Risk factors for possible REM sleep behavior disorder: A CLSA population-based cohort study. Neurology 2019; 92:e475-e485. [PMID: 30587514 PMCID: PMC6369902 DOI: 10.1212/wnl.0000000000006849] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess sociodemographic, socioeconomic, and clinical correlates of idiopathic REM sleep behavior disorder (RBD) in a 30,097-person national cohort. METHODS Participants 45 to 85 years of age in Canada were collected as part of the Canadian Longitudinal Study on Aging. Possible RBD (pRBD) was screened with the REM Sleep Behavior Disorder Single-Question Screen, a questionnaire with 94% specificity and 87% sensitivity. To improve diagnostic accuracy, those screening positive for apnea or non-REM parasomnia (young-onset pRBD) and those self-reporting dementia or Parkinson disease were excluded. A series of sociodemographic, lifestyle, and mental health variables were analyzed cross-sectionally. Potential correlates were assessed via multivariable logistic regression. RESULTS Of 30,097 participants, 958 (3.2%) were identified as having pRBD. Male sex (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.78-2.44) and lower education (OR 0.95, 95% CI 0.92-0.98) were associated with pRBD. Participants with pRBD had smoked more (pack-years OR 1.01, 95% CI 1.00-1.01) and were more likely to be moderate to heavy drinkers (OR 1.25, 95% CI 1.04-1.51). There was a strong association between pRBD and self-reported antidepressant treatment for depression (OR 2.77, 95% CI 2.23-3.45), psychological distress (OR 1.61, 95% CI 1.44-1.80), mental illness (OR 2.09, 95% CI 1.75-2.49), and posttraumatic stress disorder (OR 2.68, 95% CI 1.97-3.65). CONCLUSIONS Our study replicated previous reported associations between pRBD and smoking, low education, and male sex and found previously unreported links with alcohol use and psychological distress. Risk factors for pRBD differ from those previously defined for neurodegenerative synucleinopathies.
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Affiliation(s)
- Chun Yao
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada
| | - Seyed-Mohammad Fereshtehnejad
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada
| | - Mark R Keezer
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada
| | - Christina Wolfson
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada
| | - Amélie Pelletier
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada
| | - Ronald B Postuma
- From the Integrated Program in Neuroscience (C.Y.), Department of Neurology and Neurosurgery (S.-M.F., R.B.P.), Department of Epidemiology and Biostatistics and Occupational Health (C.W.), and Department of Medicine (C.W., A.P.), McGill University; Centre de Recherche du Centre hospitalier de l'Université de Montréal (M.R.K.); and Research Institute of the McGill University Health Centre (C.W., A.P.), Montreal, Quebec, Canada.
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25
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Stephenson D, Hill D, Cedarbaum JM, Tome M, Vamvakas S, Romero K, Conrado DJ, Dexter DT, Seibyl J, Jennings D, Nicholas T, Matthews D, Xie Z, Imam S, Maguire P, Russell D, Gordon MF, Stebbins GT, Somer E, Gallagher J, Roach A, Basseches P, Grosset D, Marek K. The Qualification of an Enrichment Biomarker for Clinical Trials Targeting Early Stages of Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2019; 9:553-563. [PMID: 31306141 PMCID: PMC6700608 DOI: 10.3233/jpd-191648] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 12/12/2022]
Abstract
As therapeutic trials target early stages of Parkinson's disease (PD), appropriate patient selection based purely on clinical criteria poses significant challenges. Members of the Critical Path for Parkinson's Consortium formally submitted documentation to the European Medicines Agency (EMA) supporting the use of Dopamine Transporter (DAT) neuroimaging in early PD. Regulatory documents included a comprehensive literature review, a proposed analysis plan of both observational and clinical trial data, and an assessment of biomarker reproducibility and reliability. The research plan included longitudinal analysis of the Parkinson Research Examination of CEP-1347 Trial (PRECEPT) and the Parkinson's Progression Markers Initiative (PPMI) study to estimate the degree of enrichment achieved and impact on future trials in subjects with early motor PD. The presence of reduced striatal DAT binding based on visual reads of single photon emission tomography (SPECT) scans in early motor PD subjects was an independent predictor of faster decline in UPDRS Parts II and III as compared to subjects with scans without evidence of dopaminergic deficit (SWEDD) over 24 months. The EMA issued in 2018 a full Qualification Opinion for the use of DAT as an enrichment biomarker in PD trials targeting subjects with early motor symptoms. Exclusion of SWEDD subjects in future clinical trials targeting early motor PD subjects aims to enrich clinical trial populations with idiopathic PD patients, improve statistical power, and exclude subjects who are unlikely to progress clinically from being exposed to novel test therapeutics.
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Affiliation(s)
| | | | | | - Maria Tome
- European Medicines Agency, Amsterdam, Netherlands
| | | | | | | | | | - John Seibyl
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | | | | | | | | | - Syed Imam
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
| | | | - David Russell
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | | | | | | | | | | | | | | | - Kenneth Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - on behalf of the Critical Path for Parkinson’s Consortium
- Critical Path Institute, Tucson, AZ, USA
- University College London, UK
- Biogen, Cambridge, MA, USA
- European Medicines Agency, Amsterdam, Netherlands
- Parkinson’s UK, London, UK
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
- Denali Therapeutics, San Francisco, CA, USA
- Pfizer, Groton, CT, USA
- ADM Diagnostics, Northbrook, IL, USA
- UCB, Brussels, Belgium
- CPP Scientific Advisor, PA, USA
- GE Healthcare, London, UK
- Merck & Co., Philadelphia, PA, USA
- University of Glasgow, Scotland
- Rush University, Chicago, IL, USA
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, USA
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26
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Del Rey NLG, Quiroga-Varela A, Garbayo E, Carballo-Carbajal I, Fernández-Santiago R, Monje MHG, Trigo-Damas I, Blanco-Prieto MJ, Blesa J. Advances in Parkinson's Disease: 200 Years Later. Front Neuroanat 2018; 12:113. [PMID: 30618654 PMCID: PMC6306622 DOI: 10.3389/fnana.2018.00113] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
When James Parkinson described the classical symptoms of the disease he could hardly foresee the evolution of our understanding over the next two hundred years. Nowadays, Parkinson’s disease is considered a complex multifactorial disease in which genetic factors, either causative or susceptibility variants, unknown environmental cues, and the potential interaction of both could ultimately trigger the pathology. Noteworthy advances have been made in different fields from the clinical phenotype to the decoding of some potential neuropathological features, among which are the fields of genetics, drug discovery or biomaterials for drug delivery, which, though recent in origin, have evolved swiftly to become the basis of research into the disease today. In this review, we highlight some of the key advances in the field over the past two centuries and discuss the current challenges focusing on exciting new research developments likely to come in the next few years. Also, the importance of pre-motor symptoms and early diagnosis in the search for more effective therapeutic options is discussed.
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Affiliation(s)
- Natalia López-González Del Rey
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ana Quiroga-Varela
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Neuroscience, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Elisa Garbayo
- Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Iria Carballo-Carbajal
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rubén Fernández-Santiago
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Laboratory of Parkinson Disease and other Neurodegenerative Movement Disorders, Department of Neurology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Department of Anatomy, Histology and Neuroscience, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Inés Trigo-Damas
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - María J Blanco-Prieto
- Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier Blesa
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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27
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Iranzo A, Serradell M, Santamaria J. Excessive Daytime Sleepiness Does Not Predict Neurodegeneration in Idiopathic REM Sleep Behavior Disorder. Sleep 2018; 40:4583933. [PMID: 29294136 DOI: 10.1093/sleep/zsx161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Monica Serradell
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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28
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Zhou J, Zhang J, Lam SP, Li SX, Tang X, Wing YK. Any Prediction of Neurodegeneration by Excessive Daytime Sleepiness in Idiopathic RBD? Sleep 2018; 40:4584015. [PMID: 29294137 DOI: 10.1093/sleep/zsx185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Junying Zhou
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jihui Zhang
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Siu Ping Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun Kwok Wing
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
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29
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Shen Y, Huang JY, Li J, Liu CF. Excessive Daytime Sleepiness in Parkinson's Disease: Clinical Implications and Management. Chin Med J (Engl) 2018; 131:974-981. [PMID: 29664059 PMCID: PMC5912065 DOI: 10.4103/0366-6999.229889] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Excessive daytime sleepiness (EDS) is one of the most common sleep abnormalities in patients with Parkinson's disease (PD), yet its multifactorial etiology complicates its treatment. This review summarized recent studies on the epidemiology, etiology, clinical implications, associated features, and evaluation of EDS in PD. The efficacy of pharmacologic and non-pharmacologic treatments for EDS in PD was also reviewed. Data Sources English language articles indexed in PubMed and Cochrane databases and Chinese-language papers indexed in Wanfang and National Knowledge Infrastructure databases that were published between January 1987 and November 2017 were located using the following search terms: "sleepiness", "sleep and Parkinson's disease", and "Parkinson's disease and treatment". Study Selection Original research articles and critical reviews related to EDS in PD were selected. Results EDS is a major health hazard and is associated with many motor and nonmotor symptoms of PD. Its causes are multifactorial. There are few specific guidelines for the treatment of EDS in PD. It is first necessary to identify and treat any possible factors causing EDS. Recent studies showed that some nonpharmacologic (i.e., cognitive behavioral therapy, light therapy, and repetitive transcranial magnetic stimulation) and pharmacologic (i.e., modafinil, methylphenidate, caffeine, istradefylline, sodium oxybate, and atomoxetine) treatments may be effective in treating EDS in PD. Conclusions EDS is common in the PD population and can have an immensely negative impact on quality of life. Its causes are multifactorial, which complicates its treatment. Further investigations are required to determine the safety and efficacy of potential therapies and to develop novel treatment approaches for EDS in PD.
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Affiliation(s)
- Yun Shen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Jun-Ying Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Jie Li
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004, China
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215004; Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, Jiangsu 215123, China
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30
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Koo DL, Lee JY, Nam H. Difference in severity of sleep apnea in patients with rapid eye movement sleep behavior disorder with or without parkinsonism. Sleep Med 2018; 49:99-104. [PMID: 30093262 DOI: 10.1016/j.sleep.2018.05.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Rapid eye movement sleep behavior disorder (RBD) is a common sleep disturbance in patients with neurodegenerative disorders. We aimed to compare sleep parameters among the different types of RBD patients. METHODS A total of 122 patients with dream enactment behavior were screened. Of these, 92 patients who were diagnosed with RBD by polysomnography were included in this study. Enrolled patients with RBD were classified into four groups based on the following diagnoses: idiopathic RBD (iRBD); RBD with Parkinson disease (PD-RBD); multiple system atrophy (MSA) with RBD (MSA-RBD); and dementia with Lewy bodies (DLB) with RBD (DLB-RBD). Various clinical and polysomnographic parameters were compared. RESULTS Among the 92 patients with RBD, 35 had iRBD, 25 had PD-RBD, 17 had MSA-RBD, and 15 had DLB-RBD. The mean apnea-hypopnea index of atypical parkinsonism with RBD (AP-RBD) group was 16.2 ± 17.7 events/h (MSA-RBD, 14.0 ± 16.6; DLB-RBD, 18.8 ± 19.1), which was significantly higher than the other groups (p < 0.05). The proportion of patients with 100% supine sleep in the AP-RBD group (44%) was higher than that in the iRBD group (14%; p = 0.030). The proportion of OSA with 100% supine sleep position was significantly higher in the MSA-RBD and DLB-RBD groups than in the iRBD group (p = 0.042 and p = 0.029, respectively). CONCLUSION Our study demonstrated that patients in the MSA-RBD and DLB-RBD groups had a tendency to sleeping in the supine position and a higher vulnerability to OSA compared to other RBD groups. Further cohort studies are needed to evaluate the influence of these factors on the development of parkinsonism.
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Affiliation(s)
- Dae Lim Koo
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Jee Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Hyunwoo Nam
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea.
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31
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Skorvanek M, Feketeova E, Kurtis MM, Rusz J, Sonka K. 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. Front Neurol 2018; 9:376. [PMID: 29887829 PMCID: PMC5980959 DOI: 10.3389/fneur.2018.00376] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by repeated episodes of REM sleep-related vocalizations and/or complex motor behaviors. Definite diagnosis of RBD is based on history and polysomnography, both of which are less accessible due to the lack of trained specialists and high cost. While RBD may be associated with disorders like narcolepsy, focal brain lesions, and encephalitis, idiopathic RBD (iRBD) may convert to Parkinson's disease (PD) and other synucleinopathies in more than 80% of patients and it is to date the most specific clinical prodromal marker of PD. Identification of individuals at high risk for development of PD is becoming one of the most important topics for current PD-related research as well as for future treatment trials targeting prodromal PD. Furthermore, concomitant clinical symptoms, such as subtle motor impairment, hyposmia, autonomic dysfunction, or cognitive difficulties, in subjects with iRBD may herald its phenoconversion to clinically manifest parkinsonism. The assessment of these motor and non-motor symptoms in iRBD may increase the sensitivity and specificity in identifying prodromal PD subjects. This review evaluates the diagnostic accuracy of individual rating scales and validated single items for screening of RBD and the role and accuracy of available clinical, electrophysiological, imaging, and tissue biomarkers in predicting the phenoconversion from iRBD to clinically manifest synucleinopathies.
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Affiliation(s)
- Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Eva Feketeova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Monica M. Kurtis
- Movement Disorders Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Jan Rusz
- Department of Neurology, Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Karel Sonka
- Department of Neurology, Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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Kasanuki K, Ferman TJ, Murray ME, Heckman MG, Pedraza O, Hanna Al-Shaikh FS, Mishima T, Diehl NN, van Gerpen JA, Uitti RJ, Wszolek ZK, Graff-Radford NR, Dickson DW. Daytime sleepiness in dementia with Lewy bodies is associated with neuronal depletion of the nucleus basalis of Meynert. Parkinsonism Relat Disord 2018; 50:99-103. [PMID: 29429645 DOI: 10.1016/j.parkreldis.2018.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/22/2018] [Accepted: 02/02/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Excessive daytime sleepiness is a commonly reported clinical feature of dementia with Lewy bodies (DLB) that can occur early in the disease. Cholinergic depletion is known to be severe in DLB, even when dementia severity is mild. The nucleus basalis of Meynert serves as a primary source of cortical acetylcholine, and has a role in facilitating cortical activation and arousal. We sought to determine whether daytime sleepiness at the initial evaluation of patients with DLB was associated with neuronal loss in the nucleus basalis of Meynert. METHODS Autopsy-confirmed patients who met clinical criteria for probable DLB at their initial evaluation and who were administered the informant-completed Epworth Sleepiness Scale were included in the study (n = 40). Each patient had a dementia at baseline (80% with mild severity) and two or more features of parkinsonism, visual hallucinations, fluctuations, or probable REM sleep behavior disorder. Quantitative digital pathology of the nucleus basalis of Meynert was performed in the DLB group and in 20 non-DLB autopsy controls. RESULTS DLB had greater neuronal depletion in the nucleus basalis of Meynert (p < 0.0001) than pathologic controls. Sleepiness was present in 58% of the DLB group and those with daytime sleepiness had significantly lower neuron counts in the nucleus basalis of Meynert than their non-sleepy counterparts (p = 0.001). Regression modeling revealed that sleepiness was a stronger predictor of neuronal loss in the nucleus basalis of Meynert than visual hallucinations, fluctuations or dementia severity (p = 0.003). CONCLUSIONS Excessive daytime sleepiness in early DLB is indicative of a more profound loss of basal forebrain cholinergic integrity.
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Affiliation(s)
- Koji Kasanuki
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States.
| | - Melissa E Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Takayasu Mishima
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Jay A van Gerpen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Ryan J Uitti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | | | | | - Dennis W Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
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33
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Seong MJ, Jung AR, Park HR, Choi SJ, Joo EY. Dream Recall Frequency and Sleep in Patients with Rapid Eye Movement Sleep Behavior Disorder. ACTA ACUST UNITED AC 2017. [DOI: 10.13078/jsm.17008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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34
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Byun JI, Shin YY, Chung SE, Shin WC. Neuropsychiatric Symptoms in Patients with Idiopathic Rapid Eye Movement Sleep Behavior Disorder. SLEEP MEDICINE RESEARCH 2017. [DOI: 10.17241/smr.2017.00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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The influence of sleep disordered breathing in REM sleep behavior disorder. Sleep Med 2017; 37:210-215. [PMID: 28673760 DOI: 10.1016/j.sleep.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/BACKGROUND Because both REM sleep behavior disorder (RBD) and Obstructive Sleep Apnea (OSA) can present with similar symptoms, it is important to understand the influence of OSA in the clinical manifestations of RBD and whether RBD modulates OSA severity. Our objectives were to compare: 1. the intensity of non-motor symptoms between RBD patients with (RBD-OSA) and without OSA (RBD-non-OSA), and 2. polysomnographic features between RBD-OSA and OSA without RBD (OSA-non-RBD) patients. METHODS 32 RBD cases were divided in two groups according to the presence of moderate to severe OSA [Apnea Hypopnea Index (AIH) > 14] (RBD-OSA vs. RBD-non-OSA). Non-motor symptoms were assessed with Montreal Cognitive Assessment Scale, SCOPA-Sleep and the Non-Motor Symptom Scale (NMSS) for Parkinson's disease. RBD-OSA patients were compared to 20 OSA-non-RBD patients matched for age, AHI and gender. RESULTS Compared to RBD-non-OSA (n = 22) patients, RBD-OSA patients (n = 10) showed significantly higher scores in SCOPA-Sleep Daytime and NMSS Attention/Memory, Gastrointestinal and Urinary domains, as well as higher sleep fragmentation, more oxygen desaturation and higher AIH in NREM sleep. RBD-OSA patients presented with less O2 desaturation, snoring, and BMI when compared to OSA-non-RBD patients. DISCUSSION Our data suggests that OSA contributes to hypersomnolence, gastro-intestinal, memory, and urinary complaints in RBD patients. RBD patients seem to have a milder OSA phenotype (possible reflecting a protective role conferred by the maintenance of muscle tone during REM sleep) and to be less prone to obesity and snoring than non-RBD patients.
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Al-Qassabi A, Fereshtehnejad SM, Postuma RB. Sleep Disturbances in the Prodromal Stage of Parkinson Disease. Curr Treat Options Neurol 2017; 19:22. [DOI: 10.1007/s11940-017-0458-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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