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. 2023 Nov 3;10(12):1769-1776.
doi: 10.1002/mdc3.13908. eCollection 2023 Dec.

The Increasing Prevalence of REM Sleep Behavior Disorder with Parkinson's Disease Progression: A Polysomnography-Supported Study

Friederike Sixel-Döring  1   2 , Maria-Lucia Muntean  1 , Daina Petersone  3 , Andreas Leha  4 , Elisabeth Lang  1 , Brit Mollenhauer  1   5 , Claudia Trenkwalder  1   6
Affiliations

The Increasing Prevalence of REM Sleep Behavior Disorder with Parkinson's Disease Progression: A Polysomnography-Supported Study

Friederike Sixel-Döring et al. Mov Disord Clin Pract. .

Abstract

Objectives: Rapid eye movement (REM) sleep behavior disorder (RBD) is proposed as an early diagnostic marker in Parkinson's disease (PD). We investigated the frequency of RBD during the progression of PD in the advanced stages and identified potential risk factors for developing RBD earlier or later.

Patients and methods: We performed a retrospective analysis and determined the frequency of RBD in all PD in-patients (Hoehn and Yahr stages ≥3) with motor fluctuations who had undergone video-polysomnography (vPSG) for a sleep complaint or daytime sleepiness. To correct for selection bias, we analyzed the prevalence of RBD in PD patients from the DeNoPa cohort. PD patients with RBD were compared with PD without RBD. To identify potential risk factors, we performed multiple regression modeling.

Results: A total of 504 PD patients had vPSG. 37 were excluded due to missing REM or artifacts during REM. RBD was present in 406/467 (86.9%) PD patients. PD + RBD patients were older than PDnonRBD (69 ± 7.7 vs. 64 ± 9.2 years, P < 0.01), were more likely to have postural instability [234 (59.1%) vs. 19 (33.9%), P < 0.01], and were treated more often with antidepressants (other than SSRIs) [141 (34.7%) vs. 7 (13%), P < 0.01]. Multiple regression modeling identified predictors of RBD with an AUC of 0.78.

Conclusion: The prevalence of RBD in patients with advanced PD is high and increases with disease severity, motor deficits, postural instability, orthostatic symptoms, and age. This suggests RBD is a progression marker of PD in patients with sleep complaints.

Keywords: Parkinson‘s; RBD; marker; polysomnography; prodromal.

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Figures

FIG. 1
FIG. 1
Study tree of the population of PD with motor fluctuations. PD, Parkinson's disease; REM sleep, Rapid eye movement; RBD, REM sleep behavior disorder; RBE, REM Sleep behavioral events; vPSG, video‐polysomnography.
FIG. 2
FIG. 2
Model predictions on the training data. Panel A shows the model predictions separately in both groups. Panel B shows the discrimination performance using an ROC curve. PD, Parkinson‘s disease; RBD, REM sleep behavior disorder.
See this image and copyright information in PMC

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