Frequency of REM sleep behavior disorders in patients with Parkinson’s disease
Abstract
Background/Aim. Sleep is prompted by natural cycles of activity in the brain and consists of two basic states: rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. REM sleep behavior disorder (RBD) is characterized by violent motor and vocal behavior during REM sleep which represents dream enactment. The normal loss of muscle tone, with the exception of respiratory, sphincter, extra ocular and middle ear muscles, is absent in patients with RBD. The origin of RBD is frequently unknown, but can be associated with degenerative neurological disorders, such as Parkinson’s disease (PD). PD patients do not necessarily express features of RBD, which is identified in approximately third to a half of them. The aim of this study was to estimate the prevalence of RBD in a cohort of PD patients, as well as to identify risk-factors for its development. Methods. In the period from December 2010 to September 2011 we recruited 97 consecutive PD outpatients, treated in the Institute of Neurology, Clinical Center of Serbia, Belgrade. After establishing the diagnosis, all the patients filled out a specially constructed questionnaire with the following items: actual age, sex, age at disease onset, disease duration, form of the disease, type of treatment, duration of treatment, the presence of constipation, lessening of smell sense, and family history of PD. At entring the study, patients disability was scored using the Unified Parkinson’s Disease Rating Scale (motor part – UPDRS). Cognitive abilities were assessed by the Mini Mental Status Examination (MMSE) scale, and depression symptoms by the 21-item Hamilton Depression Rating Scale (HDRS). The patients with PD were dichotomized to those with and without RBD using the RBD Questionnaire – Hong Kong (RBDQ-HK) in the manner of an interview. Forms of PD, mode of treatment, sex, constipation and family history were investigated using the Fishers χ2 test. Symptoms and treatment duration, the presence of smell disturbances, MMSE score, UPDRS motor score and HDRS score were analyzed by implementation of the Z-test. Actual age and age at disease onset were evaluated by the unpaired t-test. Results. The RBD-positive group contained 15 (15.5%) patients, while in the rest of them (82/97), RBD was not identified (non-RBD group). There was no difference between the two groups considering gender distribution (p = 0.847), age (p = 0.577), age at disease onset (p = 0.141), duration of PD (p = 0.069), family history (p = 0.591), type of initial symptoms (p = 0.899), constipation (p = 0.353), olfaction (p = 0.32) and MMSE scores (p = 0.217). The duration of treatment in the RBD group was longer than in the non-RBD group (9.4 ± 5.3 and 6.3 ± 3.9 years, respectively; p = 0.029), and the UPDRS motor score in the RBD group was higher (19.1 ± 9.4 and 12.7 ± 8.2, respectively; p = 0.013). Also, HDRS scores were higher in patients expressing RBD (10.1 ± 6.0 and 6.4 ± 4.5, respectively; p = 0.019). Conclusion. We found that 15.5% of the consecutive PD patients had RBD, and that the patients with RBD differed from the non-RBD ones regarding duration of treatment, disease and depressive symptoms severity.
References
Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Termi-nology and Technical Specifications. Westchester, Ill: American Academy of Sleep Medicine; 2007.
Schenck CH, Bundlie SR, Patterson AL, Mahowald MW. Rapid eye movement sleep behavior disorder. A treatable parasomnia af-fecting older adults. JAMA 1987; 257(13): 1786−9.
Chokroverty IS. An Overview of normal sleep. In: Chokroverty IS, editor. Sleep disorders medicine. 3rd. Philadelphia: Sounders Elsevier; 2009. p. 5−8.
Yoritaka A, Ohizumi H, Tanaka S, Hattori N. Parkinson's disease with and without REM sleep behaviour disorder: are there any clinical differences. Eur Neurol 2009; 61(3): 164−70.
Braak H, del Tredici K, Rüb U, de Vos RA, Jansen SE, Braak E. Staging of brain pathology related to sporadic Parkinson's dis-ease. Neurobiol Aging 2003; 24(2): 197−211.
Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 1988; 51(6): 745−52.
Zetusky WJ, Jankovic J, Pirozzolo FJ. The heterogeneity of Parkin-son's disease: clinical and prognostic implications. Neurology 1985; 35(4): 522−6.
Doty RL. The Smell Identification Test Administration Manual. Haddon Heights, NJ: Sensonics, Inc; 1989.
Fahn S, Elton RL. Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne D, Goldstein M, editors. Recent devel-opments in Parkinson’s disease. Florham Park (NJ): Macmillan Health Care Information; 1987. p. 153−63.
Marshal F, Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of pa-tients for the clinician. J Psychiatr Res 1975; 12(3): 189−98.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56−62.
Li SX, Wing YK, Lam SP, Zhang J, Yu MW, Ho CK, et al. Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK). Sleep Med 2010; 11(1): 43−8.
International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2. Westchester: American Academy of Sleep Medicine; 2005.
Vibha D, Shukla G, Goyal V, Singh S, Srivastava AK, Behari M. RBD in Parkinson's disease: a clinical case control study from North India. Clin Neurol Neurosurg 2011; 113(6): 472−6.
Comella CL, Nardine TM, Diederich NJ, Stebbins GT. Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson's disease. Neurology 1998; 51(2): 526−9.
Simuni T, Sethi K. Nonmotor manifestations of Parkinson's disease. Ann Neurol 2008; 64 Suppl 2: S65−80.
Arnulf I. REM sleep behavior disorder: motor manifestations and pathophysiology. Mov Disord 2012; 27(6): 677−89.
Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep be-haviour disorder: demographic, clinical and laboratory find-ings in 93 cases. Brain 2000; 123(Pt 2): 331−9.
Shenck CH, Hurwitz TD, Mahowald MW. Symposium: Normal and abnormal REM sleep regulation: REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res 1993; 2(4): 224–31.
Kandiah N, Narasimhalu K, Lau P, Seah S, Au WL, Tan LC. Cognitive decline in early Parkinson's disease. Mov Disord 2009; 24(4): 605−8.
Romenets SR, Gagnon J, Latreille V, Panniset M, Chouinard S, Montplaisir J, Postuma RB. Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease. Mov Disord 2012; 27(8): 996−1003.
Sixel-Doring F, Trautmann E, Mollenhauer B, Trenkwalder C. As-sociated factors for REM sleep behavior disorder in Parkin-son disease. Neurology 2007; 77(11): 1048−54.
Unger MM, Belke M, Menzler K, Heverhagen JT, Keil B, Stiasny-Kolster K, et al. Diffusion tensor imaging in idiopathic REM sleep behavior disorder reveals microstructural changes in the brainstem, substantia nigra, olfactory region, and other brain regions. Sleep 2010; 33(6): 767−73.
Burn DJ, Anderson K. To sleep, perchance to dement: RBD and cognitive decline in Parkinson's disease. Mov Disord 2012; 27(6): 671−3.
Forsaa EB, Larsen JP, Wentzel-Larsen T, Goetz CG, Stebbins GT, Aarsland D, et al. A 12-year population-based study of psy-chosis in Parkinson disease. Arch Neurol 2010; 67(8): 996−1001.
Postuma RB, Gagnon J, Vendette M, Charland K, Montplaisir J. Manifestations of Parkinson disease differ in association with REM sleep behavior disorder. Mov Disord 2008; 23(12): 1665−72.
Lavault S, Leu-Semenescu S, Tezenas du Montcel S, Cochen de Cock V, Vidailhet M, Arnulf I. Does clinical rapid eye movement behavior disorder predict worseoutcomes in Parkinson's dis-ease? J Neurol 2010; 257(7): 1154−9.
Gjerstad MD, Boeve B, Wentzel-Larsen T, Aarsland D, Larsen JP. Occurrence and clinical correlates of REM sleep behaviour disorder in patients with Parkinson's disease over time. J Neurol Neurosurg Psychiatr 2008; 79(4): 387−91.
Magerkurth C, Schnitzer R, Braune S. Symptoms of autonomic failure in Parkinson's disease: prevalence and impact on daily life. Clin Auton Res 2005; 15(2): 76−82.
Schenck CH, Hurwitz TD, Mahowald MW. Symposium: Normal and abnormal REM sleep regulation: REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res 1993; 2(4): 224−31.
Boeve BF. REM sleep behavior disorder: Updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci 2010; 1184: 15−4.
Postuma RB, Bertrand J, Montplaisir J, Desjardins C, Vendette M, Rios RS, et al. Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson's disease: a prospective study. Mov Disord 2012; 27(6): 720−6.