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. 2022 Nov 5;8(11):e11425.
doi: 10.1016/j.heliyon.2022.e11425. eCollection 2022 Nov.

The treatment efficacy of pharmacotherapies for rapid eye movement sleep behavior disorder with polysomnography evaluation: A systematic review and meta-analysis

Zhiqiang Que  1   2   3 , Cuifeng Zheng  1   2   3 , Zhenhua Zhao  4 , Yanhong Weng  1   2   3 , Zhibao Zhu  1   2   3 , Yuqi Zeng  1   2   3 , Qinyong Ye  1   2   3 , Fabin Lin  1   2   3 , Guoen Cai  1   2   3
Affiliations

The treatment efficacy of pharmacotherapies for rapid eye movement sleep behavior disorder with polysomnography evaluation: A systematic review and meta-analysis

Zhiqiang Que et al. Heliyon. .

Abstract

Clonazepam and melatonin are commonly used as first-line medications for the treatment of rapid eye movement (REM) sleep behavior disorder (RBD), with other medications used in the clinic including pramipexole, ramelteon, and rotigotine. We performed a systematic review and meta-analysis of randomized and non-randomized controlled trials to assess the efficacy of these treatment options in RBD patients with polysomnography. We systematically retrieved results of randomized and non-randomized controlled trials using the PubMed, Embase, and Cochrane databases. Of the 454 studies identified, 13 were considered eligible for inclusion in the study. In comparison to baseline, clonazepam was found to significantly decrease the percentage of stage 2 sleep [4.00 (95% CI = 0.90 to 7.10)] in RBD patients. Melatonin was found to significantly improve patients' sleep efficiency [2.51(95% CI = 0.75 to 4.28)], significantly reduce the time spent in bed (TIB) [-11.71(95% CI = -23.05 to -0.37)], phasic activity[-25.79(95% CI = -42.13 to -9.46)] and tonic activity[-10.44(95% CI = -12.24 to -8.64)]. RWA[-5.87 (95% CI = -8.25 to -3.50)] significantly improve with the use of ramelteon. Pramipexole was found to significantly increase the total sleep time (TST) [27.17 (95% CI = 0.06 to 54.29)], and significantly reduce the periodic limb movements of sleep (PLMS) index [-11.42(95% CI = -21.38 to -1.47)]. We also found that pramipexole had different effects on idiopathic RBD (iRBD) and secondary RBD (sRBD). These results will help to guide the clinical use of medication in patients with RBD.

Keywords: Meta-analysis; Rapid eye movement; Rapid eye movement sleep behavior disorder; Treatment efficacy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The study flow diagram.
Figure 2
Figure 2
Meta-analysis risk of bias summary and graph.
Figure 3
Figure 3
Forest plot of the meta-analysis showing the effect of different drugs on total sleep time (TST).
Figure 4
Figure 4
Forest plot of the meta-analysis showing the effect of different drugs on the periodic limb movements of sleep (PLMS) index.
Figure 5
Figure 5
Forest plot of the meta-analysis showing the effect of different drugs on sleep efficiency.
Figure 6
Figure 6
Forest plot of the meta-analysis showing the effect of different drugs on percentage of stage 2 sleep.
Figure 7
Figure 7
Forest plot of the meta-analysis showing the effect of different drugs on time in bed (TIB).
Figure 8
Figure 8
Forest plot of the meta-analysis showing the effect of different drugs on tonic activity.
Figure 9
Figure 9
Forest plot of the meta-analysis showing the effect of different drugs on phasic activity.
Figure 10
Figure 10
Forest plot of the meta-analysis showing the effect of different drugs on REM sleep without atonia (RWA).
Figure 11
Figure 11
Forest plot of the meta-analysis showing the effect of pramipexole on TST in different types of RBD.
Figure 12
Figure 12
Forest plot of the meta-analysis showing the effect of pramipexole on sleep efficiency in different types of RBD.
Figure 13
Figure 13
Forest plot of the meta-analysis showing the effect of melatonin on TIB in different types of RBD.
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