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. 2023 Dec 4;101(23):e2364-e2375.
doi: 10.1212/WNL.0000000000207947.

REM Sleep Behavior Disorder and Its Possible Prodromes in General Population: Prevalence, Polysomnography Findings, and Associated Factors

Woo-Jin Lee  1 , Shin-Hye Baek  1 , Hee-Jin Im  1 , Seung-Ku Lee  1 , Jee-Eun Yoon  1 , Robert J Thomas  1 , Yun-Kwok Wing  1 , Chol Shin  2 , Chang-Ho Yun  2
Affiliations

REM Sleep Behavior Disorder and Its Possible Prodromes in General Population: Prevalence, Polysomnography Findings, and Associated Factors

Woo-Jin Lee et al. Neurology. .

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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Conflict of interest statement

W.-J. Lee, S.-H. Baek, H.-J. Im, S.-K. Lee, and J.-E. Yoon have no disclosures relevant to the manuscript. R.J. Thomas is coinventor and patent holder of the ECG-derived sleep spectrogram, which may be used to phenotype sleep quality and central/complex sleep apnea. The technology is licensed by Beth Israel Deaconess Medical Center to MyCardio, LLC, and he receives royalties per institutional policies. R.J. Thomas is also coinventor and patent holder of the Positive Airway Pressure Gas Modulator, being developed for treatment of central/complex sleep apnea. R.J. Thomas was a consultant in software development for DeVilbiss-Drive. Y.-K. Wing received personal fees from Eisai Co., Ltd. for lecture, travel support from Lundbeck HK Limited, which are outside the submitted work. C. Shin has no disclosures relevant to the manuscript. C.-H. Yun is a member of advisory board for Ybrain, Inc., and ARPI, Inc., South Korea. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Flowchart Illustrating the Process for Defining the Study Population
DEB = dream enactment behavior; PSG = polysomnography; RBD = REM sleep behavior disorder; RBDSQ = RBD screening questionnaire.
Figure 2
Figure 2. ROC Curves of REM Sleep Behavior Disorder Questionnaire and RWA Parameters for the Detection of RBD and Its Possible Prodromal Conditions
ROC curves for RBD (panel A) and RBD and its possible prodromal conditions (isolated RWA and isolated DEB, panel B). AUC = area under the ROC curve; DEB = dream enactment behavior; RBD = REM sleep behavior disorder; RBDSQ = RBD screening questionnaire; ROC = receiver operating characteristic; RWA = REM without atonia.
Figure 3
Figure 3. Association of RBDSQ Cut-Off Values With the Detection RBD and Its Possible Prodromal Conditions
Association of RBDSQ score of ≥5 with the RBD (panel A) and RBD and its possible prodromal conditions (isolated RWA and isolated DEB, panel B). DEB = dream enactment behavior; RBD = REM sleep behavior disorder; RBDSQ = RBD screening questionnaire; RWA = REM without atonia.
Figure 4
Figure 4. Correlation of the RWA Parameters With the Symptom Frequency of RBD
Association trend of any EMG activity (panel A), phasic EMG 3-second activity (panel B), tonic EMG activity (panel C), and phasic EMG 30-second activity (panel D). ANOVA = analysis of variance; DEB = dream enactment behavior; RBD = REM sleep behavior disorder. p Values are derived from Jonckheere-Terpstra tests for trend. Vertical bars indicate standard error. *p < 0.05, **p < 0.01 from the ANOVA analyses.
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References

    1. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep. 1986;9(2):293-308. doi:10.1093/sleep/9.2.293 - DOI - PubMed
    1. Schenck CH, Milner DM, Hurwitz TD, Bundlie SR, Mahowald MW. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry. 1989;146(9):1166-1173. doi:10.1176/ajp.146.9.1166 - DOI - PubMed
    1. Fernandez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep. 2016;39(1):121-132. doi:10.5665/sleep.5332 - DOI - PMC - PubMed
    1. Iranzo A, Santamaria J, Tolosa E. Idiopathic rapid eye movement sleep behaviour disorder: diagnosis, management, and the need for neuroprotective interventions. Lancet Neurol. 2016;15(4):405-419. doi:10.1016/S1474-4422(16)00057-0 - DOI - PubMed
    1. Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology. 1996;46(2):388-393. doi:10.1212/wnl.46.2.388 - DOI - PubMed

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