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Wang X, Pan Y, Marcuse LV, Yuan N, Liu Y. Clinical and video-polysomnographic characterization of restless sleep disorder in adult patients. Sleep Biol Rhythms 2024; 22:395-402. [PMID: 38962786 PMCID: PMC11217213 DOI: 10.1007/s41105-024-00524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/06/2024] [Indexed: 07/05/2024]
Abstract
Adults with restless sleep disorder (RSD) have never been studied clinically and polysomnographically. This study aimed to describe the clinical manifestation, duration, and distribution of sleep-related movements in adult patients with restless sleep disorder. Patients who had performed VPSG from Jan 2021 to Jan 2022 and met the diagnosis criteria of RSD were enrolled in the study. Patients' bed partners were also interviewed or telephoned in identifying this disorder. Scoring of movements during sleep was according to the diagnosis criteria of RSD and scoring of large muscle group movements during sleep proposed by the International RLS Study Group in 2020 and 2021, respectively. The clinical manifestation, the distribution of sleep stage as well as the types and duration of the movements were carefully recorded and analyzed. We included ten patients in the study with a mean age of 27.6 years (range 22-38). There was a male prevalence in adults with RSD. The study highlighted the findings from video-polysomnography, which indicated frequent sleep-related movements occurring throughout the Night. These movements were most prominent during N1 and N2 sleep stage, followed by REM sleep, while fewer movements were observed during N3 sleep. Adults with RSD experienced significant daytime functioning impairments, including non-refreshing sleep, daytime fatigue/sleepiness, and mood disturbance. Two of the patients in the study were diagnosed with anxiety and depression, further underscoring the impact of RSD on mental health. Adult patients also suffer from severe RSD, and the RSD that originates in childhood tends to persist into adulthood. In these cases, longer duration of the disease and poor sleep quality may be associated with an increased risk of developing psychiatric comorbidities. Our cases represent an objectively documented type of RSD in younger adult patients. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-024-00524-1.
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Affiliation(s)
- Xiaoli Wang
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yuanhang Pan
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Lara V. Marcuse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1000 10th Avenue, New York, NY 10019 USA
| | - Na Yuan
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yonghong Liu
- Epilepsy and Sleep Disorders Unit, Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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2
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Iranzo A, Cochen De Cock V, Fantini ML, Pérez-Carbonell L, Trotti LM. Sleep and sleep disorders in people with Parkinson's disease. Lancet Neurol 2024:S1474-4422(24)00170-4. [PMID: 38942041 DOI: 10.1016/s1474-4422(24)00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 06/30/2024]
Abstract
Sleep disorders are common in people with Parkinson's disease. These disorders, which increase in frequency throughout the course of the neurodegenerative disease and impair quality of life, include insomnia, excessive daytime sleepiness, circadian disorders, obstructive sleep apnoea, restless legs syndrome, and rapid eye movement (REM) sleep behaviour disorder. The causes of these sleep disorders are complex and multifactorial, including the degeneration of the neural structures that modulate sleep, the detrimental effect of some medications on sleep, the parkinsonian symptoms that interfere with mobility and comfort in bed, and comorbidities that disrupt sleep quality and quantity. The clinical evaluation of sleep disorders include both subjective (eg, questionnaires or diaries) and objective (eg, actigraphy or video polysomnography) assessments. The management of patients with Parkinson's disease and a sleep disorder is challenging and should be individualised. Treatment can include education aiming at changes in behaviour (ie, sleep hygiene), cognitive behavioural therapy, continuous dopaminergic stimulation at night, and specific medications. REM sleep behaviour disorder can occur several years before the onset of parkinsonism, suggesting that the implementation of trials of neuroprotective therapies should focus on people with this sleep disorder.
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Affiliation(s)
- Alex Iranzo
- Sleep Disorders Unit, Neurology Service, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; IDIBAPS, Universitat de Barcelona, Barcelona, Spain; CIBERNED, Universitat de Barcelona, Barcelona, Spain.
| | - Valerie Cochen De Cock
- Sleep and Neurology Department, Beau Soleil Clinic, Montpellier, France; EuroMov Digital Health in Motion, University of Montpellier, IMT Mines Ales, Montpellier, France
| | - María Livia Fantini
- Neurophysiology Unit, Neurology Department, Université Clermont Auvergne, CNRS, Institut Pascal, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Emory Sleep Center, Emory University School of Medicine, Atlanta, GA, USA
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3
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Pérez-Carbonell L, Iranzo A. REM sleep and neurodegeneration. J Sleep Res 2024:e14263. [PMID: 38867555 DOI: 10.1111/jsr.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024]
Abstract
Several brainstem, subcortical and cortical areas are involved in the generation of rapid eye movement (REM) sleep. The alteration of these structures as a result of a neurodegenerative process may therefore lead to REM sleep anomalies. REM sleep behaviour disorder is associated with nightmares, dream-enacting behaviours and increased electromyographic activity in REM sleep. Its isolated form is a harbinger of synucleinopathies such as Parkinson's disease or dementia with Lewy bodies, and neuroprotective interventions are advocated. This link might also be present in patients taking antidepressants, with post-traumatic stress disorder, or with a history of repeated traumatic head injury. REM sleep likely contributes to normal memory processes. Its alteration has also been proposed to be part of the neuropathological changes occurring in Alzheimer's disease.
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Affiliation(s)
- Laura Pérez-Carbonell
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Centre, Hospital Clínic de Barcelona, IDIBAPS, CIBERNED, University of Barcelona, Barcelona, Spain
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4
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Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024; 13:885-906. [PMID: 38720013 PMCID: PMC11136939 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
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Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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5
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2024; 19:490-498. [PMID: 37885093 PMCID: PMC11134986 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage—Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Bramich S, Noyce AJ, King AE, Naismith SL, Kuruvilla MV, Lewis SJG, Roccati E, Bindoff AD, Barnham KJ, Beauchamp LC, Vickers JC, Pérez-Carbonell L, Alty J. Isolated rapid eye movement sleep behaviour disorder (iRBD) in the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study: protocol and baseline characteristics. J Sleep Res 2024; 33:e14109. [PMID: 38014898 DOI: 10.1111/jsr.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a sleep disorder that is characterised by dream enactment episodes during REM sleep. It is the strongest known predictor of α-synuclein-related neurodegenerative disease (αNDD), such that >80% of people with iRBD will eventually develop Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy in later life. More research is needed to understand the trajectory of phenoconversion to each αNDD. Only five 'gold standard' prevalence studies of iRBD in older adults have been undertaken previously, with estimates ranging from 0.74% to 2.01%. The diagnostic recommendations for video-polysomnography (vPSG) to confirm iRBD makes prevalence studies challenging, as vPSG is often unavailable to large cohorts. In Australia, there have been no iRBD prevalence studies, and little is known about the cognitive and motor profiles of Australian people with iRBD. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) Sleep Study will investigate the prevalence of iRBD in Tasmania, an island state of Australia, using validated questionnaires and home-based vPSG. It will also explore several cognitive, motor, olfactory, autonomic, visual, tactile, and sleep profiles in people with iRBD to better understand which characteristics influence the progression of iRBD to αNDD. This paper details the ISLAND Sleep Study protocol and presents preliminary baseline results.
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Affiliation(s)
- Samantha Bramich
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Alastair J Noyce
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
| | - Anna E King
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Simon J G Lewis
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Eddy Roccati
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Aidan D Bindoff
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Kevin J Barnham
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia
| | - Leah C Beauchamp
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
| | - Laura Pérez-Carbonell
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University, London, UK
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
- Department of Neurology, Royal Hobart Hospital, Hobart, Australia
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7
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Ingravallo F, D'Alterio A, Rossetti A, Antelmi E, Plazzi G. Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts' Perspective. Mov Disord Clin Pract 2024; 11:488-495. [PMID: 38341655 PMCID: PMC11078490 DOI: 10.1002/mdc3.13998] [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: 07/24/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated. OBJECTIVES The aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure. METHODS In this qualitative study, semi-structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach. RESULTS We interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video-polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient-tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient-physician relationship, while they had contrasting views regarding patients' previous knowledge. CONCLUSIONS Sleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients' and families' preferences.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Alessandra D'Alterio
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Rossetti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Elena Antelmi
- Department of Engineering and Medicine of Innovation (DIMI)University of VeronaVeronaItaly
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
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8
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Nejad A, de Haan GA, Heutink J, Cornelissen FW. ACE-DNV: Automatic classification of gaze events in dynamic natural viewing. Behav Res Methods 2024; 56:3300-3314. [PMID: 38448726 PMCID: PMC11133063 DOI: 10.3758/s13428-024-02358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/08/2024]
Abstract
Eye movements offer valuable insights for clinical interventions, diagnostics, and understanding visual perception. The process usually involves recording a participant's eye movements and analyzing them in terms of various gaze events. Manual identification of these events is extremely time-consuming. Although the field has seen the development of automatic event detection and classification methods, these methods have primarily focused on distinguishing events when participants remain stationary. With increasing interest in studying gaze behavior in freely moving participants, such as during daily activities like walking, new methods are required to automatically classify events in data collected under unrestricted conditions. Existing methods often rely on additional information from depth cameras or inertial measurement units (IMUs), which are not typically integrated into mobile eye trackers. To address this challenge, we present a framework for classifying gaze events based solely on eye-movement signals and scene video footage. Our approach, the Automatic Classification of gaze Events in Dynamic and Natural Viewing (ACE-DNV), analyzes eye movements in terms of velocity and direction and leverages visual odometry to capture head and body motion. Additionally, ACE-DNV assesses changes in image content surrounding the point of gaze. We evaluate the performance of ACE-DNV using a publicly available dataset and showcased its ability to discriminate between gaze fixation, gaze pursuit, gaze following, and gaze shifting (saccade) events. ACE-DNV exhibited comparable performance to previous methods, while eliminating the necessity for additional devices such as IMUs and depth cameras. In summary, ACE-DNV simplifies the automatic classification of gaze events in natural and dynamic environments. The source code is accessible at https://github.com/arnejad/ACE-DNV .
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Affiliation(s)
- Ashkan Nejad
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands.
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Gera A de Haan
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Joost Heutink
- Department of Research and Improvement of Care, Royal Dutch Visio, Huizen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Frans W Cornelissen
- Laboratory for Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Puigròs M, Calderon A, Martín-Ruiz D, Serradell M, Fernández M, Muñoz-Lopetegi A, Mayà G, Santamaria J, Gaig C, Colell A, Tolosa E, Iranzo A, Trullas R. Mitochondrial DNA deletions in the cerebrospinal fluid of patients with idiopathic REM sleep behaviour disorder. EBioMedicine 2024; 102:105065. [PMID: 38502973 PMCID: PMC10963194 DOI: 10.1016/j.ebiom.2024.105065] [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: 09/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Idiopathic rapid eye movement (REM) sleep behaviour disorder (IRBD) represents the prodromal stage of Lewy body disorders (Parkinson's disease (PD) and dementia with Lewy bodies (DLB)) which are linked to variations in circulating cell-free mitochondrial DNA (cf-mtDNA). Here, we assessed whether altered cf-mtDNA release and integrity are already present in IRBD. METHODS We used multiplex digital PCR (dPCR) to quantify cf-mtDNA copies and deletion ratio in cerebrospinal fluid (CSF) and serum in a cohort of 71 participants, including 1) 17 patients with IRBD who remained disease-free (non-converters), 2) 34 patients initially diagnosed with IRBD who later developed either PD or DLB (converters), and 3) 20 age-matched controls without IRBD or Parkinsonism. In addition, we investigated whether CD9-positive extracellular vesicles (CD9-EVs) from CSF and serum samples contained cf-mtDNA. FINDINGS Patients with IRBD, both converters and non-converters, exhibited more cf-mtDNA with deletions in the CSF than controls. This finding was confirmed in CD9-EVs. The high levels of deleted cf-mtDNA in CSF corresponded to a significant decrease in cf-mtDNA copies in CD9-EVs in both IRBD non-converters and converters. Conversely, a significant increase in cf-mtDNA copies was found in serum and CD9-EVs from the serum of patients with IRBD who later converted to a Lewy body disorder. INTERPRETATION Alterations in cf-mtDNA copy number and deletion ratio known to occur in Lewy body disorders are already present in IRBD and are not a consequence of Lewy body disease conversion. This suggests that mtDNA dysfunction is a primary molecular mechanism of the pathophysiological cascade that precedes the full clinical motor and cognitive manifestation of Lewy body disorders. FUNDING Funded by Michael J. Fox Foundation research grant MJFF-001111. Funded by MICIU/AEI/10.13039/501100011033 "ERDF A way of making Europe", grants PID2020-115091RB-I00 (RT) and PID2022-143279OB-I00 (ACo). Funded by Instituto de Salud Carlos III and European Union NextGenerationEU/PRTR, grant PMP22/00100 (RT and ACo). Funded by AGAUR/Generalitat de Catalunya, grant SGR00490 (RT and ACo). MP has an FPI fellowship, PRE2018-083297, funded by MICIU/AEI/10.13039/501100011033 "ESF Investing in your future".
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Affiliation(s)
- Margalida Puigròs
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; Neurophysiology Laboratory, School of Medicine, Institute of Neurosciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Anna Calderon
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Daniel Martín-Ruiz
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Mònica Serradell
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Manel Fernández
- Parkinson's disease and Movement Disorders Unit, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Gerard Mayà
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Anna Colell
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Eduard Tolosa
- Parkinson's disease and Movement Disorders Unit, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, University of Barcelona, 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - Ramon Trullas
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (IIBB-CSIC), 08036, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain; CIBER de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain.
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10
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Sadoc M, Clairembault T, Coron E, Berthomier C, Le Dily S, Vavasseur F, Pavageau A, St Louis EK, Péréon Y, Neunlist M, Derkinderen P, Leclair-Visonneau L. Wake and non-rapid eye movement sleep dysfunction is associated with colonic neuropathology in Parkinson's disease. Sleep 2024; 47:zsad310. [PMID: 38156524 DOI: 10.1093/sleep/zsad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/04/2023] [Indexed: 12/30/2023] Open
Abstract
STUDY OBJECTIVES The body-first Parkinson's disease (PD) hypothesis suggests initial gut Lewy body pathology initially propagates to the pons before reaching the substantia nigra, and subsequently progresses to the diencephalic and cortical levels, a disease course presumed to likely occur in PD with rapid eye movement sleep behavior disorder (RBD). We aimed to explore the potential association between colonic phosphorylated alpha-synuclein histopathology (PASH) and diencephalic or cortical dysfunction evidenced by non-rapid eye movement (NREM) sleep and wakefulness polysomnographic markers. METHODS In a study involving 43 patients with PD who underwent clinical examination, rectosigmoidoscopy, and polysomnography, we detected PASH on colonic biopsies using whole-mount immunostaining. We performed a visual semi-quantitative analysis of NREM sleep and wake electroencephalography (EEG), confirmed it with automated quantification of spindle and slow wave features of NREM sleep, and the wake dominant frequency, and then determined probable Arizona PD stage classifications based on sleep and wake EEG features. RESULTS The visual analysis aligned with the automated quantified spindle characteristics and the wake dominant frequency. Altered NREM sleep and wake parameters correlated with markers of PD severity, colonic PASH, and RBD diagnosis. Colonic PASH frequency also increased in parallel to probable Arizona PD stage classifications. CONCLUSIONS Colonic PASH is strongly associated with widespread brain sleep and wake dysfunction, suggesting an extensive diffusion of the pathologic process in PD. Visual and automated analyses of polysomnography signals provide useful markers to gauge covert brain dysfunction in PD. CLINICAL TRIAL Name: SYNAPark, URL: https://clinicaltrials.gov/study/NCT01748409, registration: NCT01748409.
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Affiliation(s)
- Mathilde Sadoc
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- Department of Neurology, CHU Nantes, Nantes, France
| | - Thomas Clairembault
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Emmanuel Coron
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Inserm, CIC-04, Nantes, France
| | | | | | - Fabienne Vavasseur
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Inserm, CIC-04, Nantes, France
| | - Albane Pavageau
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
| | - Erik K St Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Department of Neurology, Rochester, MN, USA
- Mayo Center for Sleep Medicine, Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Yann Péréon
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- Nantes Université, Nantes, France
| | - Michel Neunlist
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- CHU Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Pascal Derkinderen
- Department of Neurology, CHU Nantes, Nantes, France
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- Inserm, CIC-04, Nantes, France
| | - Laurène Leclair-Visonneau
- Laboratoire d'Explorations Fonctionnelles, CHU Nantes, Nantes, France
- INSERM, TENS The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
- Nantes Université, Nantes, France
- Inserm, CIC-04, Nantes, France
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11
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Jones BM, McCarter SJ. Rapid Eye Movement Sleep Behavior Disorder: Clinical Presentation and Diagnostic Criteria. Sleep Med Clin 2024; 19:71-81. [PMID: 38368071 DOI: 10.1016/j.jsmc.2023.10.004] [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] [Indexed: 02/19/2024]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) classically presents with repetitive complex motor behavior during sleep with associated dream mentation. The diagnosis requires a history of repetitive complex motor behaviors and polysomnographic demonstration of REM sleep without atonia (RSWA) or capturing dream enactment behaviors. RSWA is best evaluated in the chin or flexor digitorum superficialis muscles. The anterior tibialis muscle is insufficiently accurate to be relied upon solely for RBD diagnosis. RBD may present with parkinsonism or cognitive impairment or may present in isolation. Patients should be monitored for parkinsonism, autonomic failure, or cognitive impairment.
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Affiliation(s)
- Brandon M Jones
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Stuart J McCarter
- Department of Neurology; Center for Sleep Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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12
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Leclair-Visonneau L, Feemster JC, Bibi N, Gossard TR, Jagielski JT, Strainis EP, Carvalho DZ, Timm PC, Bliwise DL, Boeve BF, Silber MH, McCarter SJ, St. Louis EK. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med 2024; 20:279-291. [PMID: 37823585 PMCID: PMC10835777 DOI: 10.5664/jcsm.10862] [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: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Accurate diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial due to its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds applicable in varying clinical presentations in a contemporary cohort of patients with iRBD using submentalis (SM) and individual bilateral flexor digitorum superficialis (FDS) and anterior tibialis electromyography limb recordings during polysomnography. METHODS We analyzed RSWA in 20 patients with iRBD and 20 age-, REM-, apnea-hypopnea index-matched controls between 2017 and 2022 for phasic burst durations, density of phasic, tonic, and "any" muscle activity (number of 3-second mini-epochs containing phasic or tonic muscle activity divided by the total number of REM sleep 3-second mini-epochs), and automated Ferri REM atonia index (RAI). Group RSWA metrics were comparatively analyzed. Receiver operating characteristic curves determined optimized area under the curve (AUC) and maximized specificity and sensitivity diagnostic iRBD RSWA thresholds. RESULTS All mean RSWA metrics were higher in patients with iRBD than in controls (P < .05), except for selected anterior tibialis measures. Optimized, maximal specificity AUC diagnostic cutoffs for coprimary outcomes were: SM "any" 6.5%, 14.0% (AUC = 92.5%) and combined SM+FDS "any" 15.1%, 27.4% (AUC = 95.8%), while SM burst durations were 0.72, and 0.72 seconds (AUC 90.2%) and FDS RAI = 0.930, 0.888 (AUC 92.8%). CONCLUSIONS This study provides evidence for current quantitative RSWA diagnostic thresholds in chin and individual 4 limb muscles applicable in different iRBD clinical settings and confirms the key value of SM or SM+FDS to assure accurate iRBD diagnosis. Evolving iRBD recognition underscores the necessity of continuous assessment with future large, prospective, well-harmonized, multicenter polysomnographic analyses. CITATION Leclair-Visonneau L, Feemster JC, Bibi N, et al. Contemporary diagnostic visual and automated polysomnographic REM sleep without atonia thresholds in isolated REM sleep behavior disorder. J Clin Sleep Med. 2024;20(2):279-291.
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Affiliation(s)
- Laurène Leclair-Visonneau
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical Neurophysiology, CHU de Nantes, Nantes, France
- Nantes Université, INSERM, TENS, The Enteric Nervous System in Gut and Brain Diseases, Nantes, France
| | - John C. Feemster
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Noor Bibi
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Thomas R. Gossard
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Jack T. Jagielski
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Emma P. Strainis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Diego Z. Carvalho
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Paul C. Timm
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Donald L. Bliwise
- Emory Sleep Center and Department of Neurology, Emory University, Atlanta, Georgia
| | - Bradley F. Boeve
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Michael H. Silber
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Stuart J. McCarter
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Erik K. St. Louis
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, Minnesota
- Mayo Center for Sleep Medicine, Rochester, Minnesota
- Department of Neurology, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
- Department of Clinical and Translational Science, Mayo Clinic Health System Southwest Wisconsin, La Crosse, Wisconsin
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13
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Perinova P, Nepozitek J, Dostalova S, Bezdicek O, Ruzicka E, Dusek P, Sonka K. Comparison of quantitative REM without atonia parameters in isolated REM sleep behavior disorder and early untreated Parkinson's disease. Sleep Med 2024; 114:290-296. [PMID: 38295508 DOI: 10.1016/j.sleep.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To analyze REM sleep without atonia (RWA) metrics in patients with isolated REM sleep behavior disorder (iRBD), Parkinson's disease (PD) and healthy subjects and compare them in terms of degree of presumed brainstem damage. METHODS Forty-nine iRBD patients, 62 PD patients and 38 healthy controls were included into the analysis. Detailed polysomnographic and clinical data including motor, olfactory, autonomic, and cognitive assessment were obtained in all participants and subsequently compared within groups without RBD (i.e., healthy controls, PD-RBD-) and with RBD (i.e., iRBD, PD-RBD+). SINBAR criteria were used to score RWA. RESULTS Twenty-one PD patients (33.8 %) had RBD. When comparing PD-RBD-patients and controls, RWA tonic (p = 0.001) and RWA mixed (p = 0.03) were higher in PD-RBD-group. PD-RBD-patients had worse olfactory function than controls (p < 0.001); no significant difference in autonomic or cognitive function was registered. There were no significant differences in RWA parameters when comparing iRBD and PD-RBD + groups. iRBD patients had better olfactory function than PD-RBD+ (p = 0.006); no significant difference in autonomic or cognitive function was registered. PD-RBD + had worse autonomic (p = 0.006) and olfactory (p = 0.001) but not motor and cognitive function compared to PD-RBD-. CONCLUSIONS Untreated de-novo PD patients without RBD have increased RWA metrics compared to healthy subjects indicating subclinical degeneration of brainstem nuclei responsible for RWA. iRBD patients do not differ in RWA metrics from untreated de-novo PD patients with premotor RBD suggesting a similar level of brainstem degeneration caudal to substantia nigra in both groups. Groups with RBD are associated with autonomic dysfunction.
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Affiliation(s)
- Pavla Perinova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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14
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Bergmann M, Högl B, Stefani A. Clinical neurophysiology of REM parasomnias: Diagnostic aspects and insights into pathophysiology. Clin Neurophysiol Pract 2024; 9:53-62. [PMID: 38328386 PMCID: PMC10847011 DOI: 10.1016/j.cnp.2023.10.003] [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: 05/22/2023] [Revised: 09/17/2023] [Accepted: 10/22/2023] [Indexed: 02/09/2024] Open
Abstract
Parasomnias are due to a transient unstable state dissociation during entry into sleep, within sleep, or during arousal from sleep, and manifest with abnormal sleep related behaviors, perceptions, emotions, dreams, and autonomic nervous system activity. Rapid eye movement (REM) parasomnias include REM sleep behavior disorder (RBD), isolated recurrent sleep paralysis and nightmare disorder. Neurophysiology is key for diagnosing these disorders and provides insights into their pathophysiology. RBD is very well characterized from a neurophysiological point of view, also thank to the fact that polysomnography is needed for the diagnosis. Diagnostic criteria are provided by the American Academy of Sleep Medicine and video-polysomnography guidelines for the diagnosis by the International REM Sleep Behavior Disorder Study Group. Differences between the two sets of criteria are presented and discussed. Availability of polysomnography in RBD provides data on sleep electroencephalography (EEG), electrooculography (EOG) and electromyography (EMG). Sleep EEG in RBD shows e.g. changes in delta and theta power, in sleep spindles and K complexes. EMG during REM sleep is essential for RBD diagnosis and is an important neurodegeneration biomarker. RBD patients present alterations also in wake EEG, autonomic function, evoked potentials, and transcranial magnetic stimulation. Clinical neurophysiological data on recurrent isolated sleep paralysis and nightmare disorder are scant. The few available data provide insights into the pathophysiology of these disorders, demonstrating a state dissociation in recurrent isolated sleep paralysis and suggesting alterations in sleep macro- and microstructure as well as autonomic changes in nightmare disorder.
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Affiliation(s)
- Melanie Bergmann
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Sleep Laboratory, Medical University Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, USA
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15
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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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16
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Wang J, Lam SP, Huang B, Liu Y, Zhang J, Yu MWM, Tsang JCC, Zhou L, Chau SWH, Chan NY, Chan JWY, Schenck CH, Li SX, Mok VCT, Ma KKY, Chan AYY, Wing YK. Familial α-synucleinopathy spectrum features in patients with psychiatric REM sleep behaviour disorder. J Neurol Neurosurg Psychiatry 2023; 94:893-903. [PMID: 37399287 DOI: 10.1136/jnnp-2022-330922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/28/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behaviour disorder (RBD) is one of the earliest and most specific prodromes of the α-synucleinopathies including Parkinson's disease (PD). It remains uncertain whether RBD occurring in the context of psychiatric disorders (psy-RBD), although very common, is merely a benign epiphenomenon of antidepressant treatment, or whether it harbours an underlying α-synucleinopathy. We hypothesised that patients with psy-RBD demonstrate a familial predisposition to an α-synucleinopathy. METHODS In this case-control-family study, a combination of family history and family study method was used to measure the α-synucleinopathy spectrum features, which included RBD, neurodegenerative prodromal markers and clinical diagnoses of neurodegenerative disorders. We compared the risk of α-synucleinopathy spectrum features in the first-degree relatives (FDRs) of patients with psy-RBD, psychiatric controls and healthy controls. RESULTS There was an increase of α-synucleinopathy spectrum features in the psy-RBD-FDRs, including possible and provisional RBD (adjusted HR (aHR)=2.02 and 6.05, respectively), definite RBD (adjusted OR=11.53) and REM-related phasic electromyographic activities, prodromal markers including depression (aHR=4.74) and probable subtle parkinsonism, risk of prodromal PD and clinical diagnosis of PD/dementia (aHR=5.50), as compared with healthy-control-FDRs. When compared with psychiatric-control-FDRs, psy-RBD-FDRs consistently presented with a higher risk for the diagnosis and electromyographic features of RBD, diagnosis of PD/dementia (aHR=3.91) and risk of prodromal PD. In contrast, psychiatric controls only presented with a familial aggregation of depression. CONCLUSION Patients with psy-RBD are familially predisposed to α-synucleinopathy. The occurrence of RBD with major depression may signify a subtype of major depressive disorders with underlying α-synucleinopathy neurodegeneration. TRIAL REGISTRATION NUMBER NCT03595475.
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Affiliation(s)
- Jing Wang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Bei Huang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mandy W M Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessie C C Tsang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Li Zhou
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Steven W H Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey W Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Shirley X Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent C T Mok
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Karen Ka Yan Ma
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Yin Yan Chan
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Townsend LTJ, Anderson KN, Boeve BF, McKeith I, Taylor JP. Sleep disorders in Lewy body dementia: Mechanisms, clinical relevance, and unanswered questions. Alzheimers Dement 2023; 19:5264-5283. [PMID: 37392199 DOI: 10.1002/alz.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions.
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Affiliation(s)
- Leigh T J Townsend
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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18
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Sadoc M, Clairembault T, Coron E, Berthomier C, Le Dily S, Vavasseur F, Pavageau A, St Louis EK, Péréon Y, Neunlist M, Derkinderen P, Leclair-Visonneau L. Wake and non-rapid eye movement sleep dysfunction is associated with colonic neuropathology in Parkinson's disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.03.23296499. [PMID: 37873268 PMCID: PMC10593030 DOI: 10.1101/2023.10.03.23296499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Study Objectives The body-first Parkinson's disease (PD) hypothesis suggests initial gut Lewy body pathology that propagates to the pons before reaching the substantia nigra, and subsequently progresses to the diencephalic and cortical levels. This disease course may also be the most likely in PD with rapid eye movement sleep behavior disorder (RBD). Objectives We aimed to explore the potential association between colonic phosphorylated alpha-synuclein histopathology (PASH) and diencephalic or cortical dysfunction evidenced by non-rapid eye movement (NREM) sleep and wakefulness polysomnographic markers. Methods In a study involving 43 patients with PD who underwent clinical examination, rectosigmoidoscopy, and polysomnography, we detected PASH on colonic biopsies using whole-mount immunostaining. We performed a visual semi-quantitative and automated quantification of spindle and slow wave features of NREM sleep, and the wake dominant frequency, and then determined Braak and Arizona stage classifications for PD severity based on sleep and wake electroencephalographic features. Results The visual analysis aligned with the automated quantified spindle characteristics and the wake dominant frequency. Altered NREM sleep and wake parameters correlated with markers of PD severity, colonic PASH, and RBD diagnosis. Colonic PASH frequency also increased in parallel to presumed PD Braak and Arizona stage classifications. Conclusions Colonic PASH in PD is strongly associated with widespread brain sleep and wake dysfunction, pointing toward likely extensive diffusion of the pathological process in the presumptive body-first PD phenotype. Visual and automated analyses of polysomnography signals provide useful markers to gauge covert brain dysfunction in PD. Statement of Significance The presence of gut synucleinopathy in Parkinson's disease can be linked to the body-first hypothesis in its pathophysiology. This study, performed in a cohort of 43 patients with Parkinson's disease that underwent clinical assessment, rectosigmoidoscopy and polysomnography, provides evidence that colonic neuropathology in Parkinson's disease is associated with widespread brain dysfunction, as evaluated by wake and non-rapid eye movement sleep polysomnographic markers. Our results support the assumption of an extensive diffusion of the pathological process to diencephalic and neocortical structures in the presumptive body-first phenotype. They also suggest the use of routine polysomnography in phenotyping patients with Parkinson's disease. Future studies should investigate the brain diffusion pattern and its sleep markers in the hypothesized brain-first phenotype of Parkinson's disease.
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Oz S, Dagay A, Katzav S, Wasserman D, Tauman R, Gerston A, Duncan I, Hanein Y, Mirelman A. Monitoring sleep stages with a soft electrode array: Comparison against vPSG and home-based detection of REM sleep without atonia. J Sleep Res 2023; 32:e13909. [PMID: 37132065 DOI: 10.1111/jsr.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 05/04/2023]
Abstract
Sleep disorders are symptomatic hallmarks of a variety of medical conditions. Accurately identifying the specific stage in which these disorders occur is particularly important for the correct diagnosis of non-rapid eye movement and rapid eye movement parasomnias. In-lab polysomnography suffers from limited availability and does not reflect habitual sleep conditions, which is especially important in older adults and those with neurodegenerative diseases. We aimed to explore the feasibility and validity of a new wearable system for accurately measuring sleep at home. The system core technology is soft, printed dry electrode arrays and a miniature data acquisition unit with a cloud-based data storage for offline analysis. The positions of the electrodes allow manual scoring following the American Association of Sleep Medicine guidelines. Fifty participants (21 healthy subjects, mean age 56.6 ± 8.4 years; and 29 patients with Parkinson's disease, 65.4 ± 7.6 years) underwent a polysomnography evaluation with parallel recording with the wearable system. Total agreement between the two systems reached Cohen's kappa (k) of 0.688 with agreement in each stage of: wake k = 0.701; N1 = 0.224; N2 = 0.584; N3 = 0.410; and rapid eye movement = 0.723. Moreover, the system reliably detected rapid eye movement sleep without atonia with a sensitivity of 85.7%. Additionally, a comparison between sleep as measured in the sleep lab with data collected from a night at home showed significantly lower wake after sleep onset at home. The results demonstrate that the system is valid, accurate and allows for the exploration of sleep at home. This new system offers an opportunity to help detect sleep disorders on a larger scale than possible today, fostering better care.
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Affiliation(s)
- Shani Oz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Andrew Dagay
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- The Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Iain Duncan
- Sleep Disorders Centre, St Thomas' and Guy's Hospital, GSTT NHS, London, UK
| | - Yael Hanein
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Electrical Engineering, Tel Aviv University, Tel Aviv, Israel
- X-trodes, Herzelia, Israel
- Tel Aviv University Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Figorilli M, Meloni F, Lecca R, Tamburrino L, Mascia MG, Cocco V, Meloni M, Marques AR, Vidal T, Congiu P, Defazio G, Durif F, Lanza G, Ferri R, Schenck CH, Fantini ML, Puligheddu M. Severity of REM sleep without atonia correlates with measures of cognitive impairment and depressive symptoms in REM sleep behaviour disorder. J Sleep Res 2023; 32:e13880. [PMID: 36998161 DOI: 10.1111/jsr.13880] [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: 01/12/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 04/01/2023]
Abstract
This study aimed to correlate REM sleep without atonia (RSWA) and neuropsychological data in patients with idiopathic/isolated REM sleep behaviour disorder (iRBD) and those with RBD associated with Parkinson's disease (PDRBD), in order to assess whether higher degrees of RSWA are related to poorer cognitive performance. A total of 142 subjects were enrolled: 48 with iRBD, 55 with PDRBD, and 39 PD without RBD (PDnoRBD). All participants underwent video-polysomnographic recording, clinical and neuropsychological assessment. RSWA was quantified according to two manual scoring methods (Montréal, SINBAR) and one automated (REM atonia index, RAI). Mild cognitive impairment (MCI) was diagnosed according to diagnostic criteria for MCI in Parkinson's disease. The relationship between neuropsychological scores and RSWA metrics was explored by multiple linear regression analysis and logistic regression models. Patients with iRBD showed significantly lower visuospatial functions and working memory, compared with the others. More severe RSWA was associated with a higher risk of reduced visuospatial abilities (OR 0.15), working memory (OR 2.48), attention (OR 2.53), and semantic fluency (OR 0.15) in the iRBD. In the whole group, a greater RSWA was associated with an increased risk for depressive symptoms (OR 3.6). A total of 57(40%) MCI subjects were found (17 iRBD, 26 PDRBD, and 14 PDnoRBD). Preserved REM-atonia was associated with a reduced odds of multi-domain MCI in the whole study population (OR 0.54). In conclusion, a greater severity of RSWA was associated with an increased risk for poor cognitive performance and depressive mood in patients with RBD. Moreover, higher RAI was associated with a lower risk of multi-domain MCI.
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Affiliation(s)
- Michela Figorilli
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Federico Meloni
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosamaria Lecca
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ludovica Tamburrino
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Viola Cocco
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Meloni
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Ana Raquel Marques
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Tiphaine Vidal
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Patrizia Congiu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Defazio
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
| | - Frank Durif
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Giuseppe Lanza
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Troina, Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Livia Fantini
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurophysiology Department, Clermont-Ferrand, France
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, Cagliari, Italy
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Schenck CH, Cochen de Cock V, Lewis SJG, Tachibana N, Kushida C, Ferri R. Partial endorsement of: "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" by the World Sleep Society. Sleep Med 2023; 110:137-145. [PMID: 37579534 DOI: 10.1016/j.sleep.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
Updated guidelines for the video-polysomnography (vPSG) procedures for diagnosing rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages have recently been proposed by the Neurophysiology Working Group of the International RBD Study Group (IRBDSG). These guidelines were selected for review by a World Sleep Society (WSS) Parasomnias Task Force and the WSS International Sleep Medicine Guidelines Committee. A survey was completed by sleep society leaders and prominent sleep clinicians and researchers in 31 WSS member countries across six continents, focused on sleep technologist training and certification; extent of public/private health insurance coverage for the vPSG evaluation of RBD; extent of hospital-based sleep-technologist-attended overnight vPSG studies; availability of video during PSG studies; and sufficient specification of PSG machines to record and analyze REM sleep without atonia. The findings from this survey indicated that most health systems and medical communities across WSS member countries would not be capable of implementing the proposed more stringent guidelines, which would then strongly interfere with the diagnosis of RBD in a large portion of patients who would not be able to receive the required (often repeated) vPSG evaluation. Therefore, the WSS can only partially endorse the updated guidelines and concludes that the current International Classification of Sleep Disorders-3rd edition diagnostic criteria for RBD should still be retained as the standard reference for the diagnosis of RBD, and that further discussion across all members of the IRBDSG should take place to ensure the feasibility of any future proposed changes.
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Affiliation(s)
- Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, USA.
| | | | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW, 2050, Australia.
| | | | - Clete Kushida
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford University, Stanford, CA, USA.
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Montini A, Iranzo A, Cortelli P, Gaig C, Muñoz-Lopetegi A, Provini F, Santamaria J. Scoring sleep in neurodegenerative diseases: A pilot study in the synucleinopathies. Sleep Med 2023; 110:268-286. [PMID: 37678074 DOI: 10.1016/j.sleep.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the stages previously applied in dementia with Lewy Bodies (DLB), anti-IgLON5 disease, and fatal insomnia, and to test it in patients with alpha-synucleinopathies. METHODS Video-polysomnographies (VPSG) of nine patients (DLB:3, Parkinson's disease (PD):3, and multiple system atrophy (MSA):3) selected for their difficulty in applying standard rules were scored independently by two authors, using additional Sleep/Wake stages. These included Abnormal Wake, Subwake, Undifferentiated NREM sleep (UNREM), Poorly structured N2 (P-S N2) and abnormal REM sleep including REM without atonia (RWA), REM without low-amplitude, mixed-frequency EEG activity (RWL) and REM without rapid eye movements (RWR). RESULTS Patients (4 females) had a median age of 74 (range 63-85). Six patients (all with PD or DLB) had abnormal EEG awake and Subwake stage. UNREM sleep was present in all patients, typically at sleep onset, and was the most common sleep stage in five. P-S N2 was recorded only in the three patients with MSA. Periods of normal and abnormal NREM coexisted in three patients. RWA was the predominant REM subtype, RWR occurred mainly in patients with MSA and RWL in those with DLB. Six patients had brief REM episodes into NREM sleep which we termed "Encapsulated RBD". CONCLUSION Our scoring system allows an accurate description of the complex sleep-wake changes in patients with alpha-synucleinopathies.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain.
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Joan Santamaria
- Emeritus Consultant and Researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS), Spain.
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Park K, Shin YW, Hwang S, Jeong E, Kim TJ, Jun JS, Shin JW, Byun JI, Sunwoo JS, Kim HJ, Schenck CH, Jung KY. Quantitative measurement of motor activity during sleep in isolated REM sleep behavior disorder patients using actigraphy before and after treatment with clonazepam. Sleep 2023; 46:zsad132. [PMID: 37155675 DOI: 10.1093/sleep/zsad132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
STUDY OBJECTIVES We conducted a prospective study to quantify motor activity during sleep measured by actigraphy before and after 3 months of treatment with clonazepam in patients with video-polysomnography (vPSG) confirmed isolated rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS The motor activity amount (MAA) and the motor activity block (MAB) during sleep were obtained from actigraphy. Then, we compared quantitative actigraphic measures with the results of the REM sleep behavior disorder questionnaire for the previous 3-month period (RBDQ-3M) and of the Clinical Global Impression-Improvement scale (CGI-I), and analyzed correlations between baseline vPSG measures and actigraphic measures. RESULTS Twenty-three iRBD patients were included in the study. After medication treatment, large activity MAA dropped in 39% of patients, and the number of MABs decreased in 30% of patients when applying 50% reduction criteria. 52% of patients showed more than 50% improvement in either one. On the other hand, 43% of patients answered "much or very much improved" on the CGI-I, and RBDQ-3M was reduced by more than half in 35% of patients. However, there was no significant association between the subjective and objective measures. Phasic submental muscle activity during REM sleep was highly correlated with small activity MAA (Spearman's rho = 0.78, p < .001) while proximal and axial movements during REM sleep correlated with large activity MAA (rho = 0.47, p = .030 for proximal movements, rho = 0.47, p = .032 for axial movements). CONCLUSIONS Our findings imply that quantifying motor activity during sleep using actigraphy can objectively assess therapeutic response in drug trials in patients with iRBD.
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Affiliation(s)
- Kyoungeun Park
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Yong Woo Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Sungeun Hwang
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - El Jeong
- Interdisciplinary Program in Bioengineering, College of Engineering, Seoul National University, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Yin Z, Ma R, An Q, Xu Y, Gan Y, Zhu G, Jiang Y, Zhang N, Yang A, Meng F, Kühn AA, Bergman H, Neumann WJ, Zhang J. Pathological pallidal beta activity in Parkinson's disease is sustained during sleep and associated with sleep disturbance. Nat Commun 2023; 14:5434. [PMID: 37669927 PMCID: PMC10480217 DOI: 10.1038/s41467-023-41128-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
Parkinson's disease (PD) is associated with excessive beta activity in the basal ganglia. Brain sensing implants aim to leverage this biomarker for demand-dependent adaptive stimulation. Sleep disturbance is among the most common non-motor symptoms in PD, but its relationship with beta activity is unknown. To investigate the clinical potential of beta activity as a biomarker for sleep quality in PD, we recorded pallidal local field potentials during polysomnography in PD patients off dopaminergic medication and compared the results to dystonia patients. PD patients exhibited sustained and elevated beta activity across wakefulness, rapid eye movement (REM), and non-REM sleep, which was correlated with sleep disturbance. Simulation of adaptive stimulation revealed that sleep-related beta activity changes remain unaccounted for by current algorithms, with potential negative outcomes in sleep quality and overall quality of life for patients.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany
- Exzellenzcluster - NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel Canada (IMRIC), Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Neurostimulation, Beijing, China.
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25
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Bradicich M, Siciliano M, Donfrancesco F, Cherneva R, Ferraz B, Testelmans D, Sánchez-de-la-Torre M, Randerath W, Schiza S, Cruz J. Sleep and Breathing Conference highlights 2023: a summary by ERS Assembly 4. Breathe (Sheff) 2023; 19:230168. [PMID: 38020339 PMCID: PMC10644110 DOI: 10.1183/20734735.0168-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
This paper presents some of the highlights of the Sleep and Breathing Conference 2023 https://bit.ly/46MxJml.
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Affiliation(s)
- Matteo Bradicich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Department of Internal Medicine, Spital Zollikerberg, Zollikerberg, Switzerland
| | - Matteo Siciliano
- Università Cattolica del Sacro Cuore, Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- These authors contributed equally
| | - Federico Donfrancesco
- Università Cattolica del Sacro Cuore, Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- These authors contributed equally
| | - Radostina Cherneva
- Medical University, University Hospital “Ivan Rilski”, Respiratory Intensive Care Unit, Sofia, Bulgaria
- These authors contributed equally
| | - Beatriz Ferraz
- Pulmonology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- These authors contributed equally
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- These authors contributed equally
| | - Manuel Sánchez-de-la-Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, IRB Lleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Winfried Randerath
- Institute of Pneumology, University Cologne, Bethanien Hospital, Solingen, Germany
- These authors contributed equally
| | - Sophia Schiza
- Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- These authors contributed equally
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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Tall P, Qamar MA, Rosenzweig I, Raeder V, Sauerbier A, Heidemarie Z, Falup-Pecurariu C, Chaudhuri KR. The Park Sleep subtype in Parkinson's disease: from concept to clinic. Expert Opin Pharmacother 2023; 24:1725-1736. [PMID: 37561080 DOI: 10.1080/14656566.2023.2242786] [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: 04/10/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The heterogeneity of Parkinson's disease (PD) is evident from descriptions of non-motor (NMS) subtypes and Park Sleep, originally identified by Sauerbier et al. 2016, is one such clinical subtype associated with the predominant clinical presentation of sleep dysfunctions including excessive daytime sleepiness (EDS), along with insomnia. AREAS COVERED A literature search was conducted using the PubMed, Medline, Embase, and Web of Science databases, accessed between 1 February 2023 and 28 March 2023. In this review, we describe the clinical subtype of Park Sleep and related 'tests' ranging from polysomnography to investigational neuromelanin MRI brain scans and some tissue-based biological markers. EXPERT OPINION Cholinergic, noradrenergic, and serotonergic systems are dominantly affected in PD. Park Sleep subtype is hypothesized to be associated primarily with serotonergic deficit, clinically manifesting as somnolence and narcoleptic events (sleep attacks), with or without rapid eye movement behavior disorder (RBD). In clinic, Park Sleep recognition may drive lifestyle changes (e.g. driving) along with therapy adjustments as Park Sleep patients may be sensitive to dopamine D3 active agonists, such as ropinirole and pramipexole. Specific dashboard scores based personalized management options need to be implemented and include pharmacological, non-pharmacological, and lifestyle linked advice.
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Affiliation(s)
- Phoebe Tall
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Mubasher A Qamar
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPpn), King's College London, London, UK
- Sleep Disorder Centre, Nuffield House, Guy's Hospital, London, UK
| | - Vanessa Raeder
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Germany
| | - Anna Sauerbier
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Zach Heidemarie
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Cristian Falup-Pecurariu
- Faculty of Medicine, Transilvania University of Braşov, Brașov, Romania
- Department of Neurology, County Clinic Hospital, Braşov, Romania
| | - Kallol Ray Chaudhuri
- Department of Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience (IoPpn), King's College London, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital NHS Foundation Trust, London, UK
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27
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During EH, Hernandez B, Miglis MG, Sum-Ping O, Hekmat A, Cahuas A, Ekelmans A, Yoshino F, Mignot E, Kushida CA. Sodium oxybate in treatment-resistant rapid-eye-movement sleep behavior disorder. Sleep 2023; 46:zsad103. [PMID: 37052688 PMCID: PMC10424170 DOI: 10.1093/sleep/zsad103] [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: 12/12/2022] [Revised: 03/14/2023] [Indexed: 04/14/2023] Open
Abstract
STUDY OBJECTIVES Symptomatic therapies for rapid-eye-movement (REM) sleep behavior disorder (RBD) are limited. Sodium oxybate (SXB), a gamma-aminobutyric acid (GABA)-B agonist, could be effective but has not been evaluated against placebo. METHODS This double-blind, parallel-group, randomized, placebo-controlled trial in 24 participants was conducted at the Stanford Sleep Center. Patients were adults with definite iRBD or Parkinson's disease and probable RBD (PD-RBD), and persistence of ≥ 2 weekly episodes despite standard therapy. Patients were randomized 1:1 to receive SXB during a 4-week titration followed by a 4-week stable dosing period. Primary outcome was number of monthly RBD episodes according to a diary filled by patients and partners. Secondary outcomes were severity, number of severe RBD episodes, and objective RBD activity on video polysomnography. RESULTS Twelve iRBD and 12 PD-RBD participated (mean 65.8 years), and 22 (n = 10 SXB, 12 placebo) completed the study. Although no significant between-group difference was found, SXB showed reduction of monthly RBD episodes by 23.1 (95% CI -36.0, -10.2; p = 0.001) versus 10.5 with placebo (95% CI, -22.6, 1.6; p = 0.087). Improvement from baseline was similarly observed for RBD overall severity burden (each episode weighted for severity), number of severe episodes, and objective RBD activity per video-polysomnography. Two participants receiving SXB withdrew due to anxiety and dizziness. The majority of adverse events are otherwise resolved with dose adjustment. CONCLUSION SXB could reduce RBD symptoms; however, response was inconsistent and a large placebo effect was observed across patient-reported outcomes. Larger studies using objective endpoints are needed. CLINICAL TRIAL Treatment of REM Sleep Behavior Disorder (RBD) With Sodium Oxybate https://clinicaltrials.gov/ct2/show/NCT04006925 ClinicalTrials.gov identifier: NCT04006925.
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Affiliation(s)
- Emmanuel H During
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
- Department of Neurology, Division of Movement Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mitchell G Miglis
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Oliver Sum-Ping
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Anahid Hekmat
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ana Cahuas
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Adrian Ekelmans
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Fuyumi Yoshino
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Department of Medicine, Osaka University, Osaka, Japan
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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28
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Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023; 29:1092-1116. [PMID: 37590824 DOI: 10.1212/con.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.
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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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30
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Kunz D, Stotz S, de Zeeuw J, Papakonstantinou A, Dümchen S, Haberecht M, Plotkin M, Bes F. Prognostic biomarkers in prodromal α-synucleinopathies: DAT binding and REM sleep without atonia. J Neurol Neurosurg Psychiatry 2023; 94:532-540. [PMID: 36725328 PMCID: PMC10314035 DOI: 10.1136/jnnp-2022-330048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a prodromal state of clinical α-synucleinopathies such as Parkinson's disease and Lewy body dementia. The lead-time until conversion is unknown. The most reliable marker of progression is reduced striatal dopamine transporter (DAT) binding, but low availability of imaging facilities limits general use. Our prospective observational study aimed to relate metrics of REM sleep without atonia (RWA)-a hallmark of RBD-to DAT-binding ratios in a large, homogeneous sample of patients with RBD to explore the utility of RWA as a marker of progression in prodromal α-synucleinopathies. METHODS DAT single-photon emission CT (SPECT) and video polysomnography (vPSG) were performed in 221 consecutive patients with clinically suspected RBD. RESULTS vPSG confirmed RBD in 176 patients (162 iRBD, 14 phenoconverted, 45 non-synucleinopathies). Specific DAT-binding ratios differed significantly between groups, but showed considerable overlap. Most RWA metrics correlated significantly with DAT-SPECT ratios (eg, Montreal tonic vs most-affected-region: r=-0.525; p<0.001). In patients taking serotonergic/noradrenergic antidepressants or dopaminergic substances or with recent alcohol abuse, correlations were weaker, suggesting a confounding influence, unlike other possible confounders such as beta-blocker use or comorbid sleep apnoea. CONCLUSIONS In this large single-centre prospective observational study, we found evidence that DAT-binding ratios in patients with iRBD can be used to describe a continuum in the neurodegenerative process. Overlap with non-synucleinopathies and clinical α-synucleinopathies, however, precludes the use of DAT-binding ratios as a precise diagnostic marker. The parallel course of RWA metrics and DAT-binding ratios suggests in addition to existing data that RWA, part of the routine diagnostic workup in these patients, may represent a marker of progression. Based on our findings, we suggest ranges of RWA values to estimate whether patients are in an early, medium or advanced state within the prodromal phase of α-synucleinopathies, providing them with important information about time until possible conversion.
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Affiliation(s)
- Dieter Kunz
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Sophia Stotz
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Jan de Zeeuw
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Alexandra Papakonstantinou
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Susanne Dümchen
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Martin Haberecht
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Michail Plotkin
- Institute of Nuclear Medicine, Vivantes Hospitals, Berlin, Germany
| | - Frederik Bes
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- & Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
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Brink-Kjaer A, Winer J, Zeitzer JM, Sorensen HBD, Jennum P, Mignot E, During E. Fully Automated Detection of Isolated Rapid-Eye-Movement Sleep Behavior Disorder Using Actigraphy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083699 DOI: 10.1109/embc40787.2023.10341133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) is caused by motor disinhibition during REM sleep and is a strong early predictor of Parkinson's disease. However, screening questionnaires for iRBD lack specificity due to other sleep disorders that mimic the symptoms. Nocturnal wrist actigraphy has shown promise in detecting iRBD by measuring sleep-related motor activity, but it relies on sleep diary-defined sleep periods, which are not always available. Our aim was to precisely detect iRBD using actigraphy alone by combining two actigraphy-based markers of iRBD - abnormal nighttime activity and 24-hour rhythm disruption. In a sample of 42 iRBD patients and 42 controls (21 clinical controls with other sleep disorders and 21 community controls) from the Stanford Sleep Clinic, the nighttime actigraphy model was optimized using automated detection of sleep periods. Using a subset of 38 iRBD patients with daytime data and 110 age-, sex-, and body-mass-index-matched controls from the UK Biobank, the 24-hour rhythm actigraphy model was optimized. Both nighttime and 24-hour rhythm features were found to distinguish iRBD from controls. To improve the accuracy of iRBD detection, we fused the nighttime and 24-hour rhythm disruption classifiers using logistic regression, which achieved a sensitivity of 78.9%, a specificity of 96.4%, and an AUC of 0.954. This study preliminarily validates a fully automated method for detecting iRBD using actigraphy in a general population.Clinical relevance- Actigraphy-based iRBD detection has potential for large-scale screening of iRBD in the general population.
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Stefani A, Serradell M, Holzknecht E, Gaig C, Ibrahim A, Marrero P, Cesari M, Pérez-Carbonell L, Brandauer E, Fernández-Arcos A, Bergmann M, Matos N, Santamaria J, Högl B, Iranzo A. Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods. Mov Disord 2023; 38:1000-1007. [PMID: 37147274 DOI: 10.1002/mds.29407] [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: 01/04/2023] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. OBJECTIVE The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. METHODS In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. RESULTS Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. CONCLUSIONS RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ambra Stefani
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monica Serradell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Evi Holzknecht
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Abubaker Ibrahim
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paula Marrero
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Matteo Cesari
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Pérez-Carbonell
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Elisabeth Brandauer
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ana Fernández-Arcos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Melanie Bergmann
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuria Matos
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Joan Santamaria
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Birgit Högl
- Sleep Disorders Clinic, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
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Papakonstantinou A, Klemming J, Haberecht M, Kunz D, Bes F. Ikelos-RWA. Validation of an Automatic Tool to Quantify REM Sleep Without Atonia. Clin EEG Neurosci 2023:15500594231175320. [PMID: 37192675 DOI: 10.1177/15500594231175320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Study Objectives. To present and evaluate an automatic scoring algorithm for quantification of REM-sleep without atonia (RWA) in patients with REM-sleep behaviour disorder (RBD) based on a generally accepted, well-validated visual scoring method, ("Montreal" phasic and tonic) and a recently developed, concise scoring method (Ikelos-RWA). Methods. Video-polysomnographies of 20 RBD patients (68.2 ± 7.2 years) and 20 control patients with periodic limb movement disorder (65.9 ± 6.7 years) were retrospectively analysed. RWA was estimated from chin electromyogram during REM-sleep. Visual and automated RWA scorings were correlated, and agreement (a) and Cohen's Kappa (k) calculated for 1735 minutes of REM-sleep of the RBD patients. Discrimination performance was evaluated with receiver operating characteristic (ROC) analysis. The algorithm was then applied on the polysomnographies of a cohort of 232 RBD patients (total analysed REM-sleep: 17,219 minutes) and evaluated, while correlating the different output parameters. Results. Visual and computer-derived RWA scorings correlated significantly (tonic Montreal: rTM = 0.77; phasic Montreal: rPM = 0.78; Ikelos-RWA: rI = 0.97; all p < 0.001) and showed good to excellent Kappa coefficients (kTM = 0.71; kPM = 0.79; kI = 0.77). The ROC analysis showed high sensitivities (95%-100%) and specificities (84%-95%) at the optimal operation points, with area under the curve (AUC) of 0.98, indicating high discriminating capacity. The automatic RWA scorings of 232 patients correlated significantly (rTM{I} = 0.95; rPM{I} = 0.91, p < 0.0001). Conclusions. The presented algorithm is an easy-to-use and valid tool for automatic RWA scoring in patients with RBD and may prove effective for general use being publicly available.
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Affiliation(s)
- Alexandra Papakonstantinou
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Jannis Klemming
- Department of Ophthalmology, University Medical Center Goettingen, Göttingen, Germany
| | - Martin Haberecht
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Dieter Kunz
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
| | - Frederik Bes
- Sleep Research & Clinical Chronobiology, Institute of Physiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freien Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Clinic for Sleep- and Chronomedicine, St. Hedwig-Krankenhaus, Berlin, Germany
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Gadoth A, Devine MF, Pittock SJ, McKeon A, Tobin WO, Gossard TR, Cattaneo EFD, McCarter SJ, St Louis EK. Sleep disturbances associated with DPPX autoantibodies: a case series. J Neurol 2023:10.1007/s00415-023-11698-y. [PMID: 37024733 DOI: 10.1007/s00415-023-11698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
STUDY OBJECTIVES To describe a case series of patients with prominent sleep disturbances and their polysomnography findings in six patients with dipeptidyl-peptidase-like protein-6 (DPPX) autoimmunity syndrome. METHODS Of 13 patients with DPPX autoimmunity evaluated at Mayo Clinic, 6 were seen by Sleep Medicine with polysomnography and were assessed with blood and cerebrospinal fluid, neuroimaging, neuropsychological testing, and evaluation tailored to clinical presentation. RESULTS Median age of our six DPPX autoimmunity patients was 57 (range 27-70) years, with one woman. All patients had prominent gastrointestinal disturbances, most with prominent and early weight loss, and a spectrum of neuropsychiatric disturbances including cognitive impairment, myoclonus, exaggerated startle, and dysautonomia. Sleep disturbances included insomnia and obstructive sleep apnea in six patients, periodic leg movements of sleep in four, and REM sleep behavior disorder in two. Polysomnography demonstrated REM sleep-atonia loss in four patients, and ambiguous sleep with status dissociatus (mixed features of wakefulness, non-rapid eye movement [NREM], and REM sleep) appeared in one patient. Five of six patients showed neurological improvement with immunotherapy, including three with at least partial improvement in sleep disturbances. CONCLUSION Our patients with DPPX autoimmunity syndrome had prominent sleep disturbances including sleep-disordered breathing, REM sleep behavior disorder, and abnormal NREM sleep architecture with highly variable clinical presentations. DPPX autoimmunity should be considered in cases with a triad of sleep disturbance, neurological features of hyperexcitability, and systemic symptoms of gastrointestinal disturbance and weight loss. Future prospective studies of DPPX autoimmunity syndrome including detailed sleep evaluation and follow-up are necessary.
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Affiliation(s)
- Avi Gadoth
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Encephalitis Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Michelle F Devine
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- Olmsted Medical Center, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Thomas R Gossard
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- St. Olaf College, Northfield, MN, USA
| | - Elena F D Cattaneo
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
- The University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Stuart J McCarter
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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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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Bušková J, Miletínová E, Králová R, Dvořáková T, Tefr Faridová A, Heřman H, Hrdličková K, Šebela A. Parasomnias in Pregnancy. Brain Sci 2023; 13:brainsci13020357. [PMID: 36831900 PMCID: PMC9954207 DOI: 10.3390/brainsci13020357] [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: 11/29/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES Pregnancy is often associated with reduced sleep quality and an increase in sleep disorders, such as restless leg syndrome, obstructive sleep apnea, and insomnia. There are few studies investigating the prevalence of parasomnias in pregnancy, although they may be expected to be a significant problem, as disturbed sleep in this time period in addition to these sleep disorders may trigger parasomnia episodes. METHODS We conducted a survey using an online questionnaire focusing on a comparison of the prevalence of parasomnias in three time periods: 3 months before pregnancy, during pregnancy, and 3 months after delivery. We also inquired about psychiatric and neurological comorbidities, current anxiety and depression symptoms, and pregnancy complications. RESULTS A total of 325 women (mean age 30.3 ± 5.3 years) participated in the online survey. The overall number of reported parasomnias increased during pregnancy compared to the 3 months before pregnancy (p < 0.001) and decreased after childbirth (p < 0.001). Specifically, we found a significant increase in sleepwalking (p = 0.02) and night terrors (p < 0.001), as well as in vivid dreams (p < 0.001) and nightmares (p < 0.001) during pregnancy. A similar significant increase during pregnancy was reported for head explosion (p < 0.011). In contrast, the number of episodes of sleep paralysis increased after delivery (p = 0.008). At the individual level, an increase in the severity/frequency of individual parasomnia episodes was also observed during pregnancy. Participants whose vivid dreams/nightmares persisted after delivery had higher BDI-II and STAI-T scores. Our data also suggest a significant impact of migraines and other chronic pain, as well as complications during pregnancy, on the presence of parasomnia episodes in our cohort. CONCLUSIONS We have shown that the prevalence of parasomnias increases during pregnancy and needs to be targeted, especially by non-pharmacological approaches. At the same time, it is necessary to inquire about psychiatric and neurological comorbidities and keep in mind that more sleep disorders may be experienced by mothers who have medical complications during pregnancy.
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Affiliation(s)
- Jitka Bušková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
- Correspondence: ; Tel.: +420-732325637
| | - Eva Miletínová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Radana Králová
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Tereza Dvořáková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
| | - Adéla Tefr Faridová
- The Institute for the Care of Mother and Child, 147 10 Prague, Czech Republic
- Second Faculty of Medicine, Charles University, 150 06 Prague, Czech Republic
| | - Hynek Heřman
- The Institute for the Care of Mother and Child, 147 10 Prague, Czech Republic
| | - Kristýna Hrdličková
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Faculty of Arts, Charles University, 116 38 Prague, Czech Republic
| | - Antonín Šebela
- National Institute of Mental Health, Topolová 748, 250 67 Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
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New Paradigm in the Management of REM Sleep Behavior Disorder. CURRENT SLEEP MEDICINE REPORTS 2023. [DOI: 10.1007/s40675-023-00248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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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. Polysomnographic diagnosis of REM sleep behavior disorder: a change is needed. Sleep 2023; 46:6909026. [PMID: 36519899 DOI: 10.1093/sleep/zsac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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, Norway
| | - Geert Mayer
- Department of Neurology, Philipps-University, Marburg, Germany.,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, Boston, MA, USA.,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 Neurology, Kangbuk Samsung 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.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Ferri R, Lewis SJG, De Cock VC, Tachibana N, Kushida CA, Schenck CH. The polysomnographic diagnosis of REM sleep behavior disorder: to change or not to change, that is the question. Sleep 2023; 46:6874791. [PMID: 36472560 DOI: 10.1093/sleep/zsac261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Research Institute, IRCCS, Troina, Italy
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia
| | - Valérie Cochen De Cock
- Sleep and Neurology Department, Beau Soleil Clinic and EuroMov, Digital Health in Motion, University of Montpellier, Montpellier, France
| | - Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Department of Neurology and Center for Sleep-related Disorders, Kansai Electric Power Hospital, Osaka, Japan
| | - Clete A Kushida
- Department of Psychiatry/Sleep Medicine, Stanford University School of Medicine, 450 Broadway Street, MC 5704 Pavilion C, 2nd Floor, Redwood City, CA, 94063, USA
| | - Carlos H Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
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Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD. Sleep Med Rev 2023; 68:101745. [PMID: 36640617 DOI: 10.1016/j.smrv.2023.101745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The present review focuses on REM sleep without atonia (RSWA) scoring methods. In consideration of the numerous papers published in the last decade, that used different methods for the quantification of RSWA, their systematic revision is an emerging need. We made a search using the PubMed, Embase, Scopus and Web of Science Databases, from 2010 until December 2021, combining the search term "RSWA" with "scoring methods", "IRBD", "alfasyn disease", and "neurodegenerative disease", and with each of the specific sleep disorders, diagnosed according to current criteria, with the identification of the references of interest for the topic. Furthermore, a Meta-analysis of the diagnostic performance of RSWA scoring methods, in terms of sensitivity and specificity, was carried out. The comparison of the hierarchical summary receiver-operating characteristic curves obtained for visual methods and that obtained for the automated REM sleep atonia index (RAI), shows substantially similar prediction areas indicating a comparable performance. This systematic review and meta-analysis support the validity of a series of visual methods and of the automated RAI in the quantification of RSWA with the purpose to guide clinicians in the interpretation of their results and their correct and efficient use within the diagnostic work-up for REM sleep behavior disorder.
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41
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Eckhardt C, Fanciulli A, Högl B, Heidbreder A, Eschlböck S, Raccagni C, Krismer F, Leys F, Kiechl S, Ransmayr G, Frauscher B, Seppi K, Wenning G, Stefani A. Analysis of sleep, daytime sleepiness, and autonomic function in multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med 2023; 19:63-71. [PMID: 36004744 PMCID: PMC9806784 DOI: 10.5664/jcsm.10268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Sleep disorders, daytime sleepiness, and autonomic dysfunction are commonly reported among patients with multiple system atrophy and Parkinson disease (PD). We aimed to assess sleep and autonomic function in these patients to evaluate the relationships between sleep disorders, excessive daytime sleepiness, and autonomic function. METHODS Twenty patients with multiple system atrophy (n = 7) and PD (n = 13) underwent clinical assessment including questionnaires for autonomic function and sleep. Cardiovascular autonomic function tests and 2-night video-polysomnography were followed by administration of the Multiple Sleep Latency Test. Rapid eye movement sleep without atonia was quantified in the chin, flexor digitorum superficialis, tibial anterior, and sternocleidomastoid muscles. RESULTS Rapid eye movement sleep behavior disorder was associated with orthostatic hypotension (P = .017) and constipation (P = .019) in PD. Patients with orthostatic hypotension had higher rapid eye movement sleep without atonia indices than those without orthostatic hypotension (P < .001). The Sleep Innsbruck Barcelona rapid eye movement sleep without atonia index ("any" chin and/or flexor digitorum superficialis) correlated with systolic/diastolic blood pressure fall upon tilt-table examination in patients with multiple system atrophy (P < .05) and with gastrointestinal (P = .010), urinary (P = .022), and total Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction scores (P = .006) in all patients. Patients with a pathological deep breathing ratio showed higher Sleep Innsbruck Barcelona indices (P = .031). Objective daytime sleepiness was exclusively present in PD (P = .034) and correlated with levodopa-equivalent dosage (P = .031). CONCLUSIONS The relationship of autonomic dysfunction with rapid eye movement sleep without atonia in PD and multiple system atrophy is accounted for by shared brainstem neuropathology and likely identifies patients in a more advanced stage of disease. Excessive daytime sleepiness is found exclusively in PD and may be secondary to levodopa treatment and not related to α-synuclein disease. CITATION Eckhardt C, Fanciulli A, Högl B, et al. Analysis of sleep, daytime sleepiness, and autonomic function and multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med. 2023;19(1):63-71.
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Affiliation(s)
- Christine Eckhardt
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabine Eschlböck
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Regional Hospital of Bolzano, Bolzano, Italy
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | | | - Birgit Frauscher
- Analytical Neurophysiology Lab and Epilepsy Program, Montreal Neurological Institute and Hospital, McGill University, Montreal H3A 2B4, Quebec, Canada
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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42
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Brink-Kjaer A, Gupta N, Marin E, Zitser J, Sum-Ping O, Hekmat A, Bueno F, Cahuas A, Langston J, Jennum P, Sorensen HBD, Mignot E, During E. Ambulatory Detection of Isolated Rapid-Eye-Movement Sleep Behavior Disorder Combining Actigraphy and Questionnaire. Mov Disord 2023; 38:82-91. [PMID: 36258659 PMCID: PMC10092688 DOI: 10.1002/mds.29249] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is in most cases a prodrome of neurodegenerative synucleinopathies, affecting 1% to 2% of middle-aged and older adults; however, accurate ambulatory diagnostic methods are not available. Questionnaires lack specificity in nonclinical populations. Wrist actigraphy can detect characteristic features in individuals with RBD; however, high-frequency actigraphy has been rarely used. OBJECTIVE The aim was to develop a machine learning classifier using high-frequency (1-second resolution) actigraphy and a short patient survey for detecting iRBD with high accuracy and precision. METHODS The method involved analysis of home actigraphy data (for seven nights and more) and a nine-item questionnaire (RBD Innsbruck inventory and three synucleinopathy prodromes of subjective hyposmia, constipation, and orthostatic dizziness) in a data set comprising 42 patients with iRBD, 21 sleep clinic patients with other sleep disorders, and 21 community controls. RESULTS The actigraphy classifier achieved 95.2% (95% confidence interval [CI]: 88.3-98.7) sensitivity and 90.9% (95% CI: 82.1-95.8) precision. The questionnaire classifier achieved 90.6% accuracy and 92.7% precision, exceeding the performance of the Innsbruck RBD Inventory and prodromal questionnaire alone. Concordant predictions between actigraphy and questionnaire reached a specificity and precision of 100% (95% CI: 95.7-100.0) with 88.1% sensitivity (95% CI: 79.2-94.1) and outperformed any combination of actigraphy and a single question on RBD or prodromal symptoms. CONCLUSIONS Actigraphy detected iRBD with high accuracy in a mixed clinical and community cohort. This cost-effective fully remote procedure can be used to diagnose iRBD in specialty outpatient settings and has potential for large-scale screening of iRBD in the general population. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Andreas Brink-Kjaer
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark.,Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Niraj Gupta
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Eric Marin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Jennifer Zitser
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Movement Disorders Unit, Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Oliver Sum-Ping
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Anahid Hekmat
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Flavia Bueno
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Ana Cahuas
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - James Langston
- Department of Pathology, Stanford University, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Poul Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet, Denmark
| | - Helge B D Sorensen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Redwood City, California, USA
| | - Emmanuel During
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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43
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Dagay A, Oz S, Katzav S, Wasserman D, Tauman R, Thaler A, Giladi N, Mirelman A. Overnight Distribution of REM Sleep Features in People with Parkinson's Disease (PD) and Non-PD Controls. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1213-1223. [PMID: 37807787 PMCID: PMC10657693 DOI: 10.3233/jpd-230116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Rapid eye movement (REM) sleep behavior disorder (RBD) is a leading predictor of Parkinson's disease (PD). Diagnosis is performed in the sleep laboratory by detecting pathological REM sleep without atonia (RSWA). The evidence on the overnight distribution of RSWA% is conflicting. OBJECTIVE To investigate the temporal distribution of the number of ocular movements per REM sleep minute (REM density), and RSWA% in people with PD and non-PD controls. METHODS All participants underwent a single overnight evaluation in a sleep laboratory. Clinical evaluation was performed on a separate day. REM density and RSWA% were compared between PD and controls both across four sleep periods and individual REM cycles. RESULTS A total of 51 participants with recorded RSWA in polysomnography laboratory were included, 28 with PD aged 64±9 years with a disease duration of 3.3±2.9 years, and 23 controls aged 55±8 years. People with PD had lower REM density and higher RSWA% compared to controls. As expected, REM density was higher towards the morning. In contrast, RSWA% was equally distributed across the night, for both PD and controls. CONCLUSIONS PD pathology affects REM sleep features, but not the overnight distribution of those features. While REM density increased towards the end of the night, RSWA% was equally distributed across the night for both PD and controls. Our findings have clinical implications for diagnosing RBD, as quantification of RSWA% in any sleep cycle is sufficient for reliably evaluating total RSWA% and reduced REM density may be a marker of PD.
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Affiliation(s)
- Andrew Dagay
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
| | - Shani Oz
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Katzav
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Danielle Wasserman
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Riva Tauman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Thaler
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Giladi
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sieratzki Sagol Institute for Sleep Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mirelman
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Laboratory for Early Markers of Neurodegeneration (LEMON), Neurological Institute, Tel Aviv Sourasky Medical, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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44
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REM sleep behaviour disorder: the importance of early identification in primary care. Br J Gen Pract 2023; 73:40-42. [PMID: 36543550 PMCID: PMC9799336 DOI: 10.3399/bjgp23x731721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
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45
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Röthenbacher A, Cesari M, Doppler CEJ, Okkels N, Willemsen N, Sembowski N, Seger A, Lindner M, Brune C, Stefani A, Högl B, Bialonski S, Borghammer P, Fink GR, Schober M, Sommerauer M. RBDtector: an open-source software to detect REM sleep without atonia according to visual scoring criteria. Sci Rep 2022; 12:20886. [PMID: 36463304 PMCID: PMC9719467 DOI: 10.1038/s41598-022-25163-9] [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: 07/15/2022] [Accepted: 11/25/2022] [Indexed: 12/07/2022] Open
Abstract
REM sleep without atonia (RSWA) is a key feature for the diagnosis of rapid eye movement (REM) sleep behaviour disorder (RBD). We introduce RBDtector, a novel open-source software to score RSWA according to established SINBAR visual scoring criteria. We assessed muscle activity of the mentalis, flexor digitorum superficialis (FDS), and anterior tibialis (AT) muscles. RSWA was scored manually as tonic, phasic, and any activity by human scorers as well as using RBDtector in 20 subjects. Subsequently, 174 subjects (72 without RBD and 102 with RBD) were analysed with RBDtector to show the algorithm's applicability. We additionally compared RBDtector estimates to a previously published dataset. RBDtector showed robust conformity with human scorings. The highest congruency was achieved for phasic and any activity of the FDS. Combining mentalis any and FDS any, RBDtector identified RBD subjects with 100% specificity and 96% sensitivity applying a cut-off of 20.6%. Comparable performance was obtained without manual artefact removal. RBD subjects also showed muscle bouts of higher amplitude and longer duration. RBDtector provides estimates of tonic, phasic, and any activity comparable to human scorings. RBDtector, which is freely available, can help identify RBD subjects and provides reliable RSWA metrics.
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Affiliation(s)
- Annika Röthenbacher
- grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich, Jülich, Germany
| | - Matteo Cesari
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christopher E. J. Doppler
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Niels Okkels
- grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Neurology, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nele Willemsen
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nora Sembowski
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Aline Seger
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Marie Lindner
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Corinna Brune
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ambra Stefani
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephan Bialonski
- grid.434081.a0000 0001 0698 0538Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Jülich, Germany ,grid.434081.a0000 0001 0698 0538Institute for Data-Driven Technologies, FH Aachen University of Applied Sciences, Jülich, Germany
| | - Per Borghammer
- grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Gereon R. Fink
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany
| | - Martin Schober
- grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich, Jülich, Germany
| | - Michael Sommerauer
- grid.411097.a0000 0000 8852 305XDepartment of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.8385.60000 0001 2297 375XInstitute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Leo-Brandt-Str. 5, 52425 Jülich, Germany ,grid.154185.c0000 0004 0512 597XDepartment of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Knipe M, Embersics C, Dickinson P. Electroencephalography of rapid eye movement sleep behavior disorder in a dog with generalized tetanus. Vet Med (Auckl) 2022; 37:277-281. [PMID: 36457276 PMCID: PMC9889692 DOI: 10.1111/jvim.16585] [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: 09/08/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022]
Abstract
CASE SUMMARY A 3-month-old Airedale dog with clinically diagnosed generalized tetanus was investigated for the occurrence of excessive paddling and chewing movements when sleeping. Electroencephalogram (EEG) with time-locked video over 31 hours determined occurrence of the abnormal movements to be within 20 to 180 seconds of the onset of rapid eye movement (REM) sleep, but not at any other stage of wakefulness or sleep. No epileptiform activity was noted. Clinical signs of generalized tetanus resolved over 8 weeks with antimicrobial and symptomatic treatment, and sleep-associated movements resolved 6 weeks after presentation. CLINICAL RELEVANCE Rapid eye movement sleep behavior disorder (RBD) has been suspected in dogs with generalized tetanus but not confirmed by correlation of repeated episodes of vocalization or motor behaviors or both with REM sleep defined by an EEG. The case further defines RBD in dogs with tetanus, and highlights the value of EEG to differentiate among different parasomnias and epileptiform activity.
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Affiliation(s)
- Marguerite Knipe
- Department of Surgical and Radiological Sciences, School of Veterinary MedicineUniversity of California, DavisDavisCaliforniaUSA
| | - Colleen Embersics
- UC Davis William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary MedicineUniversity of California, DavisDavisCaliforniaUSA
| | - Peter Dickinson
- Department of Surgical and Radiological Sciences, School of Veterinary MedicineUniversity of California, DavisDavisCaliforniaUSA
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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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Huang B, Zhang J, Wang J, Chau SWH, Chan JWY, Yu MWM, Li SX, Zhou L, Mok V, Wing YK, Liu Y. Isolated dream‐enactment behaviours as a prodromal hallmark of rapid eye movement sleep behaviour disorder. J Sleep Res 2022; 32:e13791. [PMID: 36410741 DOI: 10.1111/jsr.13791] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/19/2022] [Accepted: 11/03/2022] [Indexed: 11/23/2022]
Abstract
Recurrent dream-enactment behaviours (DEB) and rapid eye movement (REM) sleep without atonia (RSWA) are two diagnostic hallmarks of REM sleep behaviour disorder (RBD), a specific prodrome of α-synucleinopathy. Whilst isolated RSWA (without DEB) was suggested as a prodrome of RBD, the implication of 'isolated' recurrent DEB remains under-investigated. In this cross-sectional study, we sought to investigate neurodegenerative markers amongst the first-degree relatives (FDRs, aged >40 years) of patients with RBD who underwent clinical assessment for DEB, neurodegenerative markers, and video-polysomnography assessment. Isolated recurrent DEB was defined as: (i) three or more episodes of DEB, (ii) had a DEB episode in the past 1 year, and (iii) subthreshold RSWA. We identified 29 FDRs (mean [SD] age 53.4 [8.3] years, 55.2% male) with isolated recurrent DEB and 98 age and sex-matched FDRs as controls. Isolated DEB was associated with nightmare (27.6% versus 11.2%, p = 0.02), and the DEB group had a higher rate of current smoking (27.6% versus 3.1%, p = 0.006), type 2 diabetes mellitus (24.1% versus 10.2%, p = 0.003), anxiety disorder (24.1% versus 11.2%, p = 0.02), and constipation (hard lump of stool, 31.0% versus 7.1%, p < 0.001) than the control group. The present findings revealed that family relatives of patients with RBD with isolated recurrent DEB have increased risk of RBD and neurodegenerative features, which adds to the emerging data that isolated DEB is a prodromal feature of RBD and α-synucleinopathy neurodegeneration.
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Affiliation(s)
- Bei Huang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Jing Wang
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical University Guangzhou China
| | - Steven Wai Ho Chau
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Joey Wing Yan Chan
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Mandy Wai Man Yu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Shirley Xin Li
- Department of Psychology The University of Hong Kong Hong Kong China
- The State Key Laboratory of Brain and Cognitive Sciences The University of Hong Kong Hong Kong China
| | - Li Zhou
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Vincent Mok
- Department of Medicine and Therapeutics, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
| | - Yaping Liu
- Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
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Byun JI, Yang TW, Sunwoo JS, Shin WC, Kwon OY, Jung KY. Comparison of rapid eye movement without atonia quantification methods to diagnose rapid eye movement sleep behavior disorder: a systematic review. Sleep 2022; 45:6650261. [DOI: 10.1093/sleep/zsac150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/23/2022] [Indexed: 01/02/2023] Open
Abstract
Abstract
Study Objectives
Rapid eye movement (REM) sleep without atonia (RWA) is essential for diagnosing REM sleep behavior disorder (RBD). Manual and automatic quantifications of RWA that use different criteria have been validated. This study compared the RWA quantification methods for diagnosing RBD.
Methods
The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systemically searched for studies published from inception to December 2021. The inclusion criteria were cohort, cross-sectional, and case-control studies assessing the sensitivity and specificity of RWA quantification methods. Pooled estimates of the sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were determined. Risk of bias and certainty of evidence was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool and the Grading of Recommendations, Assessment, Development, and Evaluations framework, respectively.
Results
Fourteen articles including 402 patients with RBD met the inclusion criteria. Manual methods evaluating any chin and phasic flexor digitorum superficialis (FDS) activity had the highest DOR (138.8, 95% CI = 21.8% to 881.7%) and AUC (0.9686). The automatic REM atonia index (RAI) showed similar or higher sensitivity (89.1%, 95% CI = 84.6% to 92.7%) but a lower specificity (73.5%), DOR (43.1), and AUC (0.9369) than the manual techniques.
Conclusions
In this meta-analysis, manual RWA quantification that employed chin or phasic FDS activity had the best RBD diagnostic performance. The automatic RAI method may be useful for screening patients with RBD. The results should be interpreted carefully because of the high risk of bias in patient selection and significant heterogeneity among the studies.
PROSPERO Registration number
CRD42021276445.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine , Seoul , Republic of Korea
| | - Tae-Won Yang
- Department of Neurology, Gyeongsang National University College of Medicine , Jinju , Korea
- Department of Neurology, Gyeongsang National University Changwon Hospital , Changwon , Korea
- Institute of Health Science, Gyeongsang National University College of Medicine , Jinju , Korea
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital , Seoul , Korea
| | - Won Chul Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine , Seoul , Republic of Korea
| | - Oh-Young Kwon
- Department of Neurology, Gyeongsang National University College of Medicine , Jinju , Korea
- Institute of Health Science, Gyeongsang National University College of Medicine , Jinju , Korea
- Department of Neurology, Gyeongsang National University Hospital , Jinju , Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea
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Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. Isolated REM sleep behavior disorder in North American older adults in an integrated health care system. J Clin Sleep Med 2022; 18:2173-2178. [PMID: 35678069 PMCID: PMC9435338 DOI: 10.5664/jcsm.10066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVE Identifying individuals with isolated rapid eye movement sleep behavioral disorder (iRBD) is an important clinical research priority for future synucleinopathy trials. Nevertheless, little is known about the breadth of clinical settings where diagnoses of iRBD are initially made. METHODS We conducted a retrospective cohort study using the electronic medical record system at the University of Michigan to identify patients aged ≥ 60 years with new diagnoses of iRBD between 2015 and 2020. We focused specifically on patients receiving primary care at the University of Michigan so that we might use the university's electronic medical record system to capture the full scope of their multispecialty care interactions and diagnoses in this integrated health care system. We used International Classification of Diseases, Ninth Revision and Tenth Revision, diagnosis codes to identify the time of initial clinical diagnosis. RESULTS We found that 62/105 (59.0%) diagnoses were made by a sleep specialist, 9 (8.6%) by neurologists, and 30 (29.5%) by generalists or primary care (29.5%) providers. In addition, 67/105 (63.8%) diagnoses were made in the context of having available polysomnography results, while the remainder was made on the basis of clinical symptoms alone. The prognostic implications of iRBD were documented in 40/105 (38.1%) encounter notes and were more likely to occur in sleep clinic settings (chi-square = 12.74; P < .001) than in other contexts. CONCLUSIONS Initial iRBD diagnoses occur in varied clinical settings in an integrated health care system and are often made without a confirmatory polysomnogram. Documented prognostic counseling is seen most often in sleep medicine clinics. Synucleinopathy prevention trials may be best designed around a sleep clinic-focused recruitment approach. CITATION Havis I, Coates T, Wyant KJ, Spears CC, Garwood M, Kotagal V. Isolated REM sleep behavior disorder in North American older adults in an integrated health care system. J Clin Sleep Med. 2022;18(9):2173-2178.
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Affiliation(s)
- Isabelle Havis
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Trinity Coates
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kara J. Wyant
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | | | - Mark Garwood
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Vikas Kotagal
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Ann Arbor Healthcare System and Veterans Affairs Ann Arbor Healthcare System Geriatric Research Education and Clinical Center, Ann Arbor, Michigan
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