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. 2022 Sep 1;18(9):2173-2178.
doi: 10.5664/jcsm.10066.

Isolated REM sleep behavior disorder in North American older adults in an integrated health care system

Isabelle Havis  1 , Trinity Coates  1 , Kara J Wyant  1 , C Chauncey Spears  1 , Mark Garwood  1 , Vikas Kotagal  1   2
Affiliations

Isolated REM sleep behavior disorder in North American older adults in an integrated health care system

Isabelle Havis et al. J Clin Sleep Med. .

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.

Keywords: PSG; diagnosis; iRBD.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the University of Michigan. This study was funded by National Institutes of Health grants R56AG065529 and R01AG065246. Dr. Wyant has received research funding from the National Institutes of Health, the Parkinson Study Group, Eli Lilly, and the Farmer Family Foundation. She also receives royalties from UpToDate. Dr. Garwood receives research funding from the National Institutes of Health. Dr. Kotagal receives research funding from the National Institutes of Health and the VA Healthcare System and from the Movement Disorders Society for associate editor service to the journal Movement Disorders. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Flow chart of patients with iRBD screened for chart review.
ICD = International Classification of Disease, iRBD = isolated rapid eye movement sleep behavior disorder, OSA = obstructive sleep apnea, RBD = rapid eye movement sleep behavior disorder, RSWA = REM sleep without atonia, UM = University of Michigan.
See this image and copyright information in PMC

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