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Bhidayasiri R. Old problems, new solutions: harnessing technology and innovation in Parkinson's disease-evidence and experiences from Thailand. J Neural Transm (Vienna) 2024; 131:721-738. [PMID: 38189972 DOI: 10.1007/s00702-023-02727-1] [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: 11/06/2023] [Accepted: 12/09/2023] [Indexed: 01/09/2024]
Abstract
The prevalence of Parkinson's disease (PD) is increasing rapidly worldwide, but there are notable inequalities in its distribution and in the availability of healthcare resources across different world regions. Low- and middle-income countries (LMICs), including Thailand, bear the highest burden of PD so there is an urgent need to develop effective solutions that can overcome the many regional challenges associated with delivering high-quality, and equitable care to a diverse population with limited resources. This article describes the evolution of healthcare delivery for PD in Thailand, as a case example of a LMIC. The discussions reflect the author's presentation at the Yoshikuni Mizuno Lectureship Award given during the 8th Asian and Oceanian Parkinson's Disease and Movement Disorders Congress in March 2023 for which he was the 2023 recipient. The specific challenges faced in Thailand are reviewed along with new solutions that have been implemented to improve the knowledge and skills of healthcare professionals nationally, the delivery of care, and the outcomes for PD patients. Technology and innovation have played an important role in this process with many new tools and devices being implemented in clinical practice. Without any realistic prospect of a curative therapy in the near future that could halt the current PD pandemic, it will be necessary to focus on preventative lifestyle strategies that can help reduce the risk of developing PD such as good nutrition (EAT), exercise (MOVE), good sleep hygiene (SLEEP), and minimizing environmental risks (PROTECT), which should be initiated and continued (REPEAT) as early as possible.
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Affiliation(s)
- Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, 10330, Thailand.
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Sringean J, Udomsirithamrong O, Bhidayasiri R. Too little or too much nocturnal movements in Parkinson's disease: A practical guide to managing the unseen. Clin Park Relat Disord 2024; 10:100258. [PMID: 38845753 PMCID: PMC11153921 DOI: 10.1016/j.prdoa.2024.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Nocturnal and sleep-related motor disorders in people with Parkinson's disease (PD) have a wide spectrum of manifestations and present a complex clinical picture. Problems can arise due to impaired movement ability (hypokinesias), e.g. nocturnal hypokinesia or early-morning akinesia, or to excessive movement (hyperkinesias), e.g. end-of-the-day dyskinesia, parasomnias, periodic limb movement during sleep and restless legs syndrome. These disorders can have a significant negative impact on the sleep, daytime functional ability, and overall quality of life of individuals with PD and their carers. The debilitating motor issues are often accompanied by a combination of non-motor symptoms, including pain and cramping, which add to the overall burden. Importantly, nocturnal motor disorders encompass a broader timeline than just the period of sleep, often starting in the evening, as well as occurring throughout the night and on awakening, and are not just limited to problems of insomnia or sleep fragmentation. Diagnosis can be challenging as, in many cases, the 'gold standard' assessment method is video polysomnography, which may not be available in all settings. Various validated questionnaires are available to support evaluation, and alternative approaches, using wearable sensors and digital technology, are now being developed to facilitate early diagnosis and monitoring. This review sets out the parameters of what can be considered normal nocturnal movement and describes the clinical manifestations, usual clinical or objective assessment methods, and evidence for optimal management strategies for the common nocturnal motor disorders that neurologists will encounter in people with PD in their clinical practice.
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Affiliation(s)
- Jirada Sringean
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Ornanong Udomsirithamrong
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok 10330, Thailand
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Lee WJ, Baek SH, Im HJ, Lee SK, Yoon JE, Thomas RJ, Wing YK, Shin C, Yun CH. REM Sleep Behavior Disorder and Its Possible Prodromes in General Population: Prevalence, Polysomnography Findings, and Associated Factors. Neurology 2023; 101:e2364-e2375. [PMID: 37816644 PMCID: PMC10752649 DOI: 10.1212/wnl.0000000000207947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the prevalence of REM sleep behavior disorder (RBD) and its possible prodromal conditions, isolated dream enactment behavior (DEB) and isolated REM without atonia (RWA), in a general population sample, and the factors associated with diagnosis and symptom frequency. METHODS From a population-based prospective cohort in Korea, 1,075 participants (age 60.1 ± 7.0 years; range 50-80 years; men 53.7%) completed the RBD screening questionnaire (RBDSQ), a structured telephone interview for the presence and characteristics of repeated DEB, and home polysomnography (PSG). RWA was measured on submentalis EMG, including 30-second epoch-based tonic and phasic activity as well as 3-second mini-epoch-based phasic and any EMG activities. Based on the presence of repeated DEB and any EMG activity of ≥22.3%, we categorized the participants into no RBD, isolated RWA, isolated DEB, and RBD groups. RESULTS RBD was diagnosed in 20 participants, isolated RWA in 133 participants, and isolated DEB in 48 participants. Sex and DEB frequency-adjusted prevalence of RBD was 1.4% (95% CI 1.0%-1.8%), isolated RWA was 12.5% (95% CI 11.3%-13.6%), and isolated DEB was 3.4% (95% CI 2.7%-4.1%). Total RBDSQ score was higher in the RBD and isolated DEB groups than in the isolated RWA and no RBD group (median 5 [interquartile range (IQR) 4-6] for RBD, median 4 [IQR 3-6] for isolated DEB, median 2 [IQR 1-3] for isolated RWA, and median 2 [IQR 1-4] for no RBD groups, p < 0.001). RBDSQ score of ≥5 had good specificity but poor positive predictive value (PPV) for RBD (specificity 84.1% and PPV 7.7%) and its prodromal conditions (specificity 85.2% and PPV 29.1%). Among the RWA parameters, any EMG activity showed the best association with the RBD and its possible prodromes (area under the curve, 0.917). Three-second mini-epoch-based EMG activity and phasic EMG activity were correlated with the frequency of DEB (standardized Jonckheere-Terpstra statistic [std. J-T static] for trend = 0.488, p < 0.001, and std. J-T static = 3.265, p = 0.001, respectively). DISCUSSION This study provides prevalence estimates of RBD and its possible prodromal conditions based on a structured telephone interview and RWA measurement on PSG from the general population.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Shin-Hye Baek
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Hee-Jin Im
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Seung-Ku Lee
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Jee-Eun Yoon
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Robert J Thomas
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Yun-Kwok Wing
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea
| | - Chol Shin
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea.
| | - Chang-Ho Yun
- From the Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (W.-J.L., C.-H.Y.), Seoul National University College of Medicine; Department of Neurology (S.-H.B.), Cheongju Saint Mary's Hospital; Department of Neurology (H.-J.I.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Institute of Human Genomic Study (S.-K.L., C.S.), College of Medicine, Korea University, Seoul; Department of Neurology (J.-E.Y.), Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea; Division of Pulmonary, Critical Care and Sleep Medicine (R.J.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Li Chiu Kong Family Sleep Assessment Unit (Y.K.W.), Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, China; and Biomedical Research Center (C.S.), Korea University Ansan Hospital, South Korea.
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Cesari M, Ruzicka L, Högl B, Ibrahim A, Holzknecht E, Heidbreder A, Bergmann M, Brandauer E, Garn H, Kohn B, Stefani A. Improved automatic identification of isolated rapid eye movement sleep behavior disorder with a 3D time-of-flight camera. Eur J Neurol 2023; 30:2206-2214. [PMID: 37151137 PMCID: PMC10947372 DOI: 10.1111/ene.15822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Automatic 3D video analysis of the lower body during rapid eye movement (REM) sleep has been recently proposed as a novel tool for identifying people with isolated REM sleep behavior disorder (iRBD), but, so far, it has not been validated on unseen subjects. This study aims at validating this technology in a large cohort and at improving its performances by also including an analysis of movements in the head, hands and upper body. METHODS Fifty-three people with iRBD and 128 people without RBD (of whom 89 had sleep disorders considered RBD differential diagnoses) were included in the study. An automatic algorithm identified movements from 3D videos during REM sleep in four regions of interest (ROIs): head, hands, upper body and lower body. The movements were divided into categories according to duration: short (0.1-2 s), medium (2-15 s) and long (15-300 s). For each ROI and duration range, features were obtained from the identified movements. Logistic regression models using as predictors the features from one single ROI or a combination of ROIs were trained and tested in a 10-runs 10-fold cross-validation scheme on the task of differentiating people with iRBD from people without RBD. RESULTS The best differentiation was achieved using short movements in all four ROIs (test accuracy 0.866 ± 0.007, test F1 score = 0.783 ± 0.010). Single group analyses showed that people with iRBD were distinguished successfully from subjects with RBD differential diagnoses. CONCLUSIONS Automatic 3D video analysis might be implemented in clinical routine as a supportive screening tool for identifying people with RBD.
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Affiliation(s)
- Matteo Cesari
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Laurenz Ruzicka
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Birgit Högl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Abubaker Ibrahim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Evi Holzknecht
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Melanie Bergmann
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Heinrich Garn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Bernhard Kohn
- Competence Unit Sensing and Vision SolutionsAIT Austrian Institute of Technology GmbHViennaAustria
| | - Ambra Stefani
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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Stefani A, Trenkwalder C, Arnulf I, Bliwise DL, Boeve BF, Inoue Y, Iranzo A, Lewis SJ, Provini F, Schenck C, Wenning GK, Wing YK, Hogl B, Videnovic A. Isolated rapid eye movement sleep behaviour disorder: clinical and research implications. J Neurol Neurosurg Psychiatry 2023:jnnp-2022-330913. [PMID: 36977554 DOI: 10.1136/jnnp-2022-330913] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/05/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia Trenkwalder
- Paracelsus Elena Klinik, Kassel, Germany
- Neurologische Klinik, Georg August Universität, Göttingen, Germany
| | - Isabelle Arnulf
- Assistance Publique Hôpitaux de Paris, Service des pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France
- UMR S 1127, CNRS UMR 7225, ICM, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Donald L Bliwise
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Simon Jg Lewis
- Healthy Brain Ageing Clinic, University of Sydney, Sydney, New South Wales, Australia
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences and IRCCS Institute of Neurosciences, Bologna, University of Bologna, Bologna, Italy
| | - Carlos Schenck
- Dept. of Psychiatry and Sleep Disorders Center, Minnesota Regional Sleep Disorders Center and University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Yun Kwok Wing
- Psychiatry, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
| | - Birgit Hogl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cesari M, Heidbreder A, Gaig C, Bergmann M, Brandauer E, Iranzo A, Holzknecht E, Santamaria J, Högl B, Stefani A. Automatic analysis of muscular activity in the flexor digitorum superficialis muscles: a fast screening method for rapid eye movement sleep without atonia. Sleep 2023; 46:zsab299. [PMID: 34984464 PMCID: PMC9995778 DOI: 10.1093/sleep/zsab299] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To identify a fast and reliable method for rapid eye movement (REM) sleep without atonia (RWA) quantification. METHODS We analyzed 36 video-polysomnographies (v-PSGs) of isolated REM sleep behavior disorder (iRBD) patients and 35 controls' v-PSGs. Patients diagnosed with RBD had: i) RWA, quantified with a reference method, i.e. automatic and artifact-corrected 3-s Sleep Innsbruck Barcelona (SINBAR) index in REM sleep periods (RSPs, i.e. manually selected portions of REM sleep); and ii) v-PSG-documented RBD behaviors. We quantified RWA with other (semi)-automated methods requiring less human intervention than the reference one: the indices proposed by the SINBAR group (the 3-s and 30-s phasic flexor digitorum superficialis (FDS), phasic/"any"/tonic mentalis), and the REM atonia, short and long muscle activity indices (in mentalis/submentalis/FDS muscles). They were calculated in whole REM sleep (i.e. REM sleep scored following international guidelines), in RSPs, with and without manual artifact correction. Area under curves (AUC) discriminating iRBD from controls were computed. Using published cut-offs, the indices' sensitivity and specificity for iRBD identification were calculated. Apnea-hypopnea index in REM sleep (AHIREM) was considered in the analyses. RESULTS RWA indices from FDS muscles alone had the highest AUCs and all of them had 100% sensitivity. Without manual RSP selection and artifact correction, the "30-s phasic FDS" and the "FDS long muscle activity" had the highest specificity (85%) with AHIREM < 15/h. RWA indices were less reliable when AHIREM≥15/h. CONCLUSIONS If AHIREM<15/h, FDS muscular activity in whole REM sleep and without artifact correction is fast and reliable to rule out RWA.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Evi Holzknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
- Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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7
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Kohn B, Ruzicka L, Hogl B, Ibrahim A, Garn H, Heidbreder A, Bergmann M, Brandauer E, Holzknecht E, Stefani A, Cesari M. TeaSpam: A Novel Method of TEmporal And SPAtial Movement Encoding during Sleep. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4222-4225. [PMID: 36085969 DOI: 10.1109/embc48229.2022.9871521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Movements during sleep characterize sleep disorders, which can disturb sleep or its onset, impacting sleep quantity and quality. Video-polysomnography is the current gold standard to assess movements during sleep, but its availability is limited. Using data recorded with a 3D time of flight sensor, we developed a novel method of encoding temporal and spatial information of automatically identified movements during sleep. In a cohort of 20 insomnia patients and 18 controls, we showed that this novel method holds important information able to discriminate the groups. Future studies will explore the methodology in the context of other sleep disorders.
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Högl B, Arnulf I, Bergmann M, Cesari M, Gan-Or Z, Heidbreder A, Iranzo A, Krohn L, Luppi PH, Mollenhauer B, Provini F, Santamaria J, Trenkwalder C, Videnovic A, Stefani A. Rapid eye movement sleep behaviour disorder: Past, present, and future. J Sleep Res 2022; 31:e13612. [PMID: 35470494 PMCID: PMC9541438 DOI: 10.1111/jsr.13612] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
This manuscript presents an overview of REM sleep behaviour disorder (RBD) with a special focus on European contributions. After an introduction examining the history of the disorder, we address the pathophysiological and clinical aspects, as well as the diagnostic issues. Further, implications of RBD diagnosis and biomarkers are discussed. Contributions of European researchers to this field are highlighted.
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Isabelle Arnulf
- Service des Pathologies du Sommeil, Hôpital Pitié-Salpêtrière, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - Melanie Bergmann
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Anna Heidbreder
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Alex Iranzo
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Lynne Krohn
- Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada.,Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada.,Department of Human Genetics, McGill University, Montréal, Québec, Canada
| | - Pierre-Hervé Luppi
- Centre of Neuroscience of Lyon, UMR 5292 CNRS/U1028 INSERM, Lyon, France.,Centre Hospitalier Le Vinatier, Bron, France
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany.,Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Federica Provini
- IRCCS Institute of Neurological Sciences, UOC NeuroMet, Bellaria Hospital, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Joan Santamaria
- Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED:CB06/05/0018-ISCIII) Barcelona, University of Barcelona, Barcelona, Spain
| | - Claudia Trenkwalder
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.,Department of Neurosurgery, University Medical Center, Göttingen, Germany
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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9
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Cesari M, Heidbreder A, St Louis EK, Sixel-Döring F, Bliwise DL, Baldelli L, Bes F, Fantini ML, Iranzo A, Knudsen-Heier S, Mayer G, McCarter S, Nepozitek J, Pavlova M, Provini F, Santamaria J, Sunwoo JS, Videnovic A, Högl B, Jennum P, Christensen JAE, Stefani A. Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: guidelines from the International RBD Study Group. Sleep 2022; 45:6409886. [PMID: 34694408 DOI: 10.1093/sleep/zsab257] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Video-polysomnography (v-PSG) is essential for diagnosing rapid eye movement (REM) sleep behavior disorder (RBD). Although there are current American Academy of Sleep Medicine standards to diagnose RBD, several aspects need to be addressed to achieve harmonization across sleep centers. Prodromal RBD is a stage in which symptoms and signs of evolving RBD are present, but do not yet meet established diagnostic criteria for RBD. However, the boundary between prodromal and definite RBD is still unclear. As a common effort of the Neurophysiology Working Group of the International RBD Study Group, this manuscript addresses the need for comprehensive and unambiguous v-PSG recommendations to diagnose RBD and identify prodromal RBD. These include: (1) standardized v-PSG technical settings; (2) specific considerations for REM sleep scoring; (3) harmonized methods for scoring REM sleep without atonia; (4) consistent methods to analyze video and audio recorded during v-PSGs and to classify movements and vocalizations; (5) clear v-PSG guidelines to diagnose RBD and identify prodromal RBD. Each section follows a common template: The current recommendations and methods are presented, their limitations are outlined, and new recommendations are described. Finally, future directions are presented. These v-PSG recommendations are intended for both practicing clinicians and researchers. Classification and quantification of motor events, RBD episodes, and vocalizations are however intended for research purposes only. These v-PSG guidelines will allow collection of homogeneous data, providing objective v-PSG measures and making future harmonized multicentric studies and clinical trials possible.
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Affiliation(s)
- Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Research, Mayo Clinic Health System Southwest Wisconsin, La Crosse, WI, USA
| | - Friederike Sixel-Döring
- Paracelsus Elena Klinik, Kassel, Germany.,Department of Neurology, Philipps-University, Marburg, Germany
| | - Donald L Bliwise
- Sleep Center, Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Frederik Bes
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Maria Livia Fantini
- NPsy-Sydo, Clermont-Ferrand University Hospital, Neurology Department, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Stine Knudsen-Heier
- Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Department of Rare disorders, Oslo University Hospital, Oslo, Norway
| | - Geert Mayer
- Department of Neurology, Philipps-University, Marburg, Germany.,Department of Neurology, Hephata Klinik, Schwalmstadt, Germany
| | - Stuart McCarter
- Mayo Center for Sleep Medicine, Departments of Neurology and Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Milena Pavlova
- Department of Neurology, Brigham and Women's Hospital; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Aleksandar Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark
| | - Julie A E Christensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Denmark.,Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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10
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Hanein Y, Mirelman A. The Home-Based Sleep Laboratory. JOURNAL OF PARKINSON'S DISEASE 2022; 11:S71-S76. [PMID: 33682729 PMCID: PMC8385505 DOI: 10.3233/jpd-202412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
Sleep disturbances are prevalent in neurodegenerative diseases in general, and in Parkinson's disease (PD) in particular. Recent evidence points to the clinical value of sleep in disease progression and improving quality of life. Therefore, monitoring sleep quality in an ongoing manner at the convenience of one's home has the potential to improve clinical research and to contribute to significantly better personalized treatment. Further, precise mapping of sleep patterns of each patient can contribute to a better understanding of the disease, its progression and the appropriate medical treatment. Here we review selective, state-of-the-art, home-based devices for assessing sleep and sleep related disorders. We highlight the large potential as well as the main challenges. In particular, we discuss medical validity, standardization and regulatory concerns that currently impede widespread clinical adoption of existing devices. Finally, we propose a roadmap with the technological and scientific steps that are required to impact PD research and treatment.
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Affiliation(s)
- Yael Hanein
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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11
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Gilat M, Marshall NS, Testelmans D, Buyse B, Lewis SJG. A critical review of the pharmacological treatment of REM sleep behavior disorder in adults: time for more and larger randomized placebo-controlled trials. J Neurol 2022; 269:125-148. [PMID: 33410930 PMCID: PMC8739295 DOI: 10.1007/s00415-020-10353-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022]
Abstract
Rapid Eye Movement sleep behavior disorder (RBD) is a parasomnia causing sufferers to physically act out their dreams. These behaviors can disrupt sleep and sometimes lead to injuries in patients and their bed-partners. Clonazepam and melatonin are the first-line pharmacological treatment options for RBD based on direct uncontrolled clinical observations and very limited double-blind placebo-controlled trials. Given the risk for adverse outcomes, especially in older adults, it is of great importance to assess the existing level of evidence for the use of these treatments. In this update, we therefore critically review the clinical and scientific evidence on the pharmacological management of RBD in people aged over 50. We focus on the first-line treatments, and provide an overview of all other alternative pharmacological agents trialed for RBD we could locate as supplementary materials. By amalgamating all clinical observations, our update shows that 66.7% of 1,026 RBD patients reported improvements from clonazepam and 32.9% of 137 RBD patients reported improvements from melatonin treatment on various outcome measures in published accounts. Recently, however, three relatively small randomized placebo-controlled trials did not find these agents to be superior to placebo. Given clonazepam and melatonin are clinically assumed to majorly modify or eliminate RBD in nearly all patients-there is an urgent need to test whether this magnitude of treatment effect remains intact in larger placebo-controlled trials.
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Affiliation(s)
- Moran Gilat
- Neurorehabilitation Research Group (eNRGy), Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, box 1501, 3001, Leuven, Belgium.
| | - Nathaniel S. Marshall
- grid.1013.30000 0004 1936 834XWoolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Dries Testelmans
- grid.5596.f0000 0001 0668 7884Centre for Sleep and Wake Disorders (LUCS), Department of Pneumology, Leuven University, UZ Leuven, Leuven, Belgium
| | - Bertien Buyse
- grid.5596.f0000 0001 0668 7884Centre for Sleep and Wake Disorders (LUCS), Department of Pneumology, Leuven University, UZ Leuven, Leuven, Belgium
| | - Simon J. G. Lewis
- grid.1013.30000 0004 1936 834XForefront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, Australia
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12
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Cesari M, Kohn B, Holzknecht E, Ibrahim A, Heidbreder A, Bergmann M, Brandauer E, Hogl B, Garn H, Stefani A. Automatic 3D Video Analysis of Upper and Lower Body Movements to Identify Isolated REM Sleep Behavior Disorder: A Pilot Study . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7050-7053. [PMID: 34892726 DOI: 10.1109/embc46164.2021.9630011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment, abnormal jerks and movements during REM sleep. Isolated RBD (iRBD) is recognized as the early stage of alpha-synucleinopathies, i.e. dementia with Lewy bodies, Parkinson's disease and multiple system atrophy. The certain diagnosis of iRBD requires video-polysomnography, evaluated by experts with time-consuming visual analyses. In this study, we propose automatic analysis of movements detected with 3D contactless video as a promising technology to assist sleep experts in the identification of patients with iRBD. By using automatically detected upper and lower body movements occurring during REM sleep with a duration between 4s and 5s, we could discriminate 20 iRBD patients from 24 patients with sleep-disordered breathing with an accuracy of 0.91 and F1-score of 0.90. This pilot study shows that 3D contactless video can be successfully used as a non-invasive technology to assist clinicians in identifying abnormal movements during REM sleep, and therefore to recognize patients with iRBD. Future investigations in larger cohorts are needed to validate the proposed technology and methodology.
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13
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Lechat B, Scott H, Naik G, Hansen K, Nguyen DP, Vakulin A, Catcheside P, Eckert DJ. New and Emerging Approaches to Better Define Sleep Disruption and Its Consequences. Front Neurosci 2021; 15:751730. [PMID: 34690688 PMCID: PMC8530106 DOI: 10.3389/fnins.2021.751730] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/16/2021] [Indexed: 01/07/2023] Open
Abstract
Current approaches to quantify and diagnose sleep disorders and circadian rhythm disruption are imprecise, laborious, and often do not relate well to key clinical and health outcomes. Newer emerging approaches that aim to overcome the practical and technical constraints of current sleep metrics have considerable potential to better explain sleep disorder pathophysiology and thus to more precisely align diagnostic, treatment and management approaches to underlying pathology. These include more fine-grained and continuous EEG signal feature detection and novel oxygenation metrics to better encapsulate hypoxia duration, frequency, and magnitude readily possible via more advanced data acquisition and scoring algorithm approaches. Recent technological advances may also soon facilitate simple assessment of circadian rhythm physiology at home to enable sleep disorder diagnostics even for “non-circadian rhythm” sleep disorders, such as chronic insomnia and sleep apnea, which in many cases also include a circadian disruption component. Bringing these novel approaches into the clinic and the home settings should be a priority for the field. Modern sleep tracking technology can also further facilitate the transition of sleep diagnostics from the laboratory to the home, where environmental factors such as noise and light could usefully inform clinical decision-making. The “endpoint” of these new and emerging assessments will be better targeted therapies that directly address underlying sleep disorder pathophysiology via an individualized, precision medicine approach. This review outlines the current state-of-the-art in sleep and circadian monitoring and diagnostics and covers several new and emerging approaches to better define sleep disruption and its consequences.
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Affiliation(s)
- Bastien Lechat
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Hannah Scott
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Ganesh Naik
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Kristy Hansen
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Duc Phuc Nguyen
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Peter Catcheside
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
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14
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REM sleep behavior disorder: Mimics and variants. Sleep Med Rev 2021; 60:101515. [PMID: 34186416 DOI: 10.1016/j.smrv.2021.101515] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia with dream-enactment behaviors occurring during REM sleep and associated with the lack of the physiological REM sleep muscle atonia. It can be isolated and secondary to other neurological or medical conditions. Isolated RBD heralds in most cases a neurodegenerative condition due to an underlying synucleinopathy and consequently its recognition is crucial for prognostic implications. REM sleep without atonia on polysomnography is a mandatory diagnostic criterion. Different conditions may mimic RBD, the most frequent being obstructive sleep apnea during sleep, non-REM parasomnia, and sleep-related hypermotor epilepsy. These diseases might also be comorbid with RBD, challenging the evaluation of disease severity, the treatment choices and the response to treatment evaluation. Video-PSG is the gold standard for a correct diagnosis and will distinguish between different or comorbid sleep disorders. Careful history taking together with actigraphy may give important clues for the differential diagnosis. The extreme boundaries of RBD might also be seen in more severe and complex conditions like status dissociatus or in the sleep disorders' scenario of anti IgLON5 disease, but in the latter both clinical and neurophysiological features will differ. A step-by-step approach is suggested to guide the differential diagnosis.
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15
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Iranzo A, Ramos LA, Novo S. The Isolated Form of Rapid Eye Movement Sleep Behavior Disorder: The Upcoming Challenges. Sleep Med Clin 2021; 16:335-348. [PMID: 33985658 DOI: 10.1016/j.jsmc.2021.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnosis of rapid eye movement (REM) sleep behavior disorder (SBD) requires videopolysomnography detection of excessive electromyographic activity during REM sleep, which is time consuming and difficult. An easier, faster, reliable, and reproducible methodology is needed for its diagnosis. The isolated form of RBD represents an early manifestation of the synucleinopathies Parkinson disease and dementia with Lewy bodies. There is a need to find neuroprotective drugs capable of preventing parkinsonism and dementia onset in isolated RBD. Clonazepam and melatonin ameliorate the RBD symptoms, but therapeutic alternatives are needed when these medications fail or show produce side effects.
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Affiliation(s)
- Alex Iranzo
- Neurology Service, Sleep Disorders Center, Hospital Clinic de Barcelona, CIBERNED, IDIBAPS, University of Barcelona, Spain.
| | - Lina Agudelo Ramos
- Neurology Service, Instituto Neurológico de Colombia (INDEC), Calle 55, 46-36, Medellín 050012, Colombia
| | - Sabela Novo
- Instituto de Investigaciones del Sueño, Calle Padre Damián, 44, Madrid 28036, Spain; Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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16
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Abstract
Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization, polysomnographic description, pathophysiologic understanding, and treatment took place. Parkinson disease encompasses the whole spectrum of sleep medicine: every category of sleep disorder can be observed in these patients. Video polysomnography frequently is indicated, sometimes followed by multiple sleep latency/maintenance of wakefulness tests. Additional studies may include actigraphy, cardiorespiratory polygraphy, and dim light melatonin assessment. Treatment needs to be specific to the underlying sleep disorder and can include medications and nondrug treatments, for example, behavioral therapy and light therapy.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria.
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17
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Stefani A, Santamaria J, Iranzo A, Hackner H, Schenck CH, Högl B. Nelotanserin as symptomatic treatment for rapid eye movement sleep behavior disorder: a double-blind randomized study using video analysis in patients with dementia with Lewy bodies or Parkinson's disease dementia. Sleep Med 2021; 81:180-187. [PMID: 33714847 DOI: 10.1016/j.sleep.2021.02.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVES Rapid eye movement sleep behavior disorder (RBD) is frequent in dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), and poses a risk of injury to patients and their bed partners. We assessed the efficacy of nelotanserin, a selective 5-HT (2A) inverse agonist, for symptomatic treatment of RBD using systematic video analysis. METHODS This was a phase 2 multicenter study in DLB or PDD with video polysomnography (vPSG)-confirmed RBD. After a single-blind placebo run-in period, patients meeting eligibility criteria entered a 4-week double-blind treatment period (1:1 ratio with nelotanserin 80 mg/placebo). Whole-night vPSG was conducted during the run-in and at the end of the treatment period. Videos of all rapid eye movement (REM) sleep periods were analysed for RBD behaviors (movements and vocalizations) using the Innsbruck classification system by two of the central reviewers, and a third reviewer adjudicated ambiguous cases. RESULTS 34 patients (N = 26 DLB, N = 8 PDD; 85.3% men; mean age 71.3 ± 6.36 years) were included in the analyses. Two (5.9%) patients were excluded due to protocol deviation in treatment compliance. Systematic video analysis demonstrated no difference between nelotanserin and placebo in RBD behaviors. Bland-Altman plot showed high interrater reliability. CONCLUSIONS Despite negative results, this is the first randomized, placebo-controlled study on symptomatic RBD treatment using objective outcome measures based on systematic video analysis. This study provides a new method for outcome research in RBD and proves that movement analysis is a feasible and meaningful outcome for studies evaluating changes in RBD severity. CLINICAL TRIAL INFORMATION ClinicalTrials.gov. NCT Number NCT02708186. https://clinicaltrials.gov/ct2/show/NCT02708186.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain
| | - Heinz Hackner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, USA.
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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