Sleepiness in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease

Abstract

Objective: To determine whether patients with idiopathic and symptomatic RBD were sleepier than controls, and if sleepiness in idiopathic RBD predicted earlier conversion to Parkinson disease.

Methods: The Epworth Sleepiness Scale (ESS) and its determinants were compared at the time of a video-polysomnography for an RBD diagnosis in patients with idiopathic RBD, in patients with Parkinson disease, and in controls. Whether sleepiness at time of RBD diagnosis predicted an earlier conversion to neurodegenerative diseases was retrospectively analyzed in the followed-up patients.

Results: The 75 patients with idiopathic RBD were sleepier (ESS: 7.8 ± 4.6) at the time of RBD diagnosis than 74 age- and sex-matched controls (ESS: 5.0 ± 3.6, P < 0.0001). They reached the levels of 114 patients with Parkinson disease (ESS: 8.7 ± 4.8), whether they had (n = 78) or did not have (n = 36) concomitant RBD. The severity of sleepiness in idiopathic RBD correlated with younger age, but not with sleep measures. Among the 69 patients with idiopathic RBD who were followed up for a median 3 years (1-15 years), 16 (23.2%) developed parkinsonism (n = 6), dementia (n = 6), dementia plus parkinsonism (n = 2), and multiple system atrophy (n = 2). An ESS greater than 8 at time of RBD diagnosis predicted a shorter time to phenoconversion to parkinsonism and dementia, from RBD onset, and from RBD diagnosis (when adjusted for age and time between RBD onset and diagnosis).

Conclusions: Sleepiness is associated with idiopathic REM sleep behavior disorder and predicts more rapid conversion to parkinsonism and dementia, suggesting it is an early marker of neuronal loss in brainstem arousal systems.

Keywords: dementia; hypersomnolence; parkinsonism; synucleinopathy.

Figure 1

Sleepiness in idiopathic REM sleep behavior disorder (RBD), controls, and Parkinson disease. The triangles correspond to the score of each patient at the Epworth Sleepiness Scale (mean: red horizontal line, median: red cross).

Figure 2

Flow chart of conversion towards parkinsonism and dementia in the patients with idiopathic RBD.

Figure 3

The rate of conversion from idiopathic RBD to parkinsonism/dementia onset is influenced by initial sleepiness. Survival curve of patients with idiopathic RBD, as the time from the onset RBD of symptoms to the onset of parkinsonism or dementia, in patients scoring ≥ 8 (in red) or < 8 (in blue) on the Epworth Sleepiness Scale at the time of RBD diagnosis. Censored measures are represented as circles.