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. 2017 May:33:23-29.
doi: 10.1016/j.sleep.2016.03.013. Epub 2016 May 11.

Diagnostic REM sleep muscle activity thresholds in patients with idiopathic REM sleep behavior disorder with and without obstructive sleep apnea

Stuart J McCarter  1 , Erik K St Louis  2 , David J Sandness  1 , Ethan J Duwell  1 , Paul C Timm  1 , Bradley F Boeve  3 , Michael H Silber  3
Affiliations

Diagnostic REM sleep muscle activity thresholds in patients with idiopathic REM sleep behavior disorder with and without obstructive sleep apnea

Stuart J McCarter et al. Sleep Med. 2017 May.

Abstract

Objectives: We aimed to determine whether visual and automated rapid eye movement (REM) sleep without atonia (RSWA) methods could accurately diagnose patients with idiopathic REM sleep behavior disorder (iRBD) and comorbid obstructive sleep apnea (OSA).

Methods: In iRBD patients (n = 15) and matched controls (n = 30) with and without OSA, we visually analyzed RSWA phasic burst durations, phasic, tonic, and "any" muscle activity by 3-s mini-epochs, phasic activity by 30-s (AASM rules) epochs, and automated REM atonia index (RAI). Group RSWA metrics were analyzed with regression models. Receiver operating characteristic (ROC) curves were used to determine the best diagnostic cutoff thresholds for REM sleep behavior disorder (RBD). Both split-night and full-night polysomnographic studies were analyzed.

Results: All mean RSWA phasic burst durations and muscle activities were higher in iRBD patients than in controls (p <0.01). Muscle activity (phasic, "any") cutoffs for 3-s mini-epoch scorings were as follows: submentalis (SM) (15.8%, 19.5%), anterior tibialis (AT) (29.7%, 29.7%), and combined SM/AT (39.5%, 39.5%). The tonic muscle activity cutoff was 0.70% and RAI (SM) cutoff 0.86. The phasic muscle burst duration cutoffs were 0.66 s for SM and 0.71 s for AT. Combining phasic burst durations with RSWA muscle activity improved the sensitivity and specificity of iRBD diagnosis.

Conclusions: This study provides evidence for quantitative RSWA diagnostic thresholds applicable in iRBD patients with OSA. Our findings in this study were very similar to those seen in patients with Parkinson's disease-REM sleep behavior disorder (PD-RBD), consistent with a common mechanism and presumed underlying etiology of synucleinopathy in both groups.

Keywords: Diagnosis; Idiopathic; Obstructive sleep apnea; REM sleep behavior disorder; REM sleep without atonia; Tonic muscle activity.

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Figures

Figure 1
Figure 1. Combined, tonic RSWA muscle activity and REM atonia index
Figure 2
Figure 2. SM and AT durations
SM=submentalis muscle; AT=anterior tibialis muscle
See this image and copyright information in PMC

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