Overnight distribution and motor characteristics of REM sleep behaviour disorder episodes in patients with narcolepsy–cataplexy (original) (raw)
Related papers
Diagnosis of REM sleep behavior disorder by video-polysomnographic study: is one night enough?
Sleep, 2008
Clinical features of RBD were typically episodic with limited data on the night-to-night reliability of the diagnostic video-PSGs. We aimed to assess on whether a single night study was adequate. Retrospective review. Sleep laboratory. 55 RBD patients with at least 2 consecutive video-PSGs. N/A. We analyzed 2 consecutive video-PSGs using REM-related EMG activity (REMREEA), REM sleep without atonia (RSWA), and video analysis of motor events. A weak first night effect with increased REM sleep latency, increased stage 1 sleep, and increased arousal index were found. No differences were found in phasic and tonic EMG activity scores between night 1 and night 2. The presence of OSAS, use of CPAP, and clonazepam treatment did not affect the night-to-night variability and diagnostic accuracy. The kappas were 0.64, 0.51, and 0.31 between night 1 and night 2 for 10% REMREEA, RSWA, and video analysis respectively. Over 80% of patients could be diagnosed by various criteria in the first night, ...
Motor-behavioral episodes in REM sleep behavior disorder and phasic events during REM sleep
Sleep, 2009
To investigate if sudden-onset motor-behavioral episodes in REM sleep behavior disorder (RBD) are associated with phasic events of REM sleep, and to explore the potential meaning of such an association. Observational review analysis. Tertiary sleep center. Twelve individuals (11 males; mean age 67.6 +/- 7.4 years) affected by idiopathic RBD, displaying a total of 978 motor-behavioral episodes during nocturnal in-laboratory video-PSG. N/A. The motor activity displayed was primitive in 69.1% and purposeful/semi-purposeful in 30.9% of the motor-behavioral episodes recorded. Sleeptalking was significantly more associated with purposeful/semi-purposeful motor activity than crying and/or incomprehensible muttering (71.0% versus 21.4%, P<0.005). In 58.2% of the motor-behavioral episodes, phasic EEG-EOG events (rapid eye movements [REMs], alpha bursts, or sawtooth waves [STWs]) occurred simultaneously. Each variable (REMs, STWs, alpha bursts) was associated more with purposefullsemi-purp...
2011
REM sleep behavior disorder Narcolepsy-cataplexy Video-PSG recording Simple and complex motor events REM sleep Vocalizations Dream enactment a b s t r a c t Objective: We carried out a systematic video-polysomnographic analysis of the number and type of motor events during REM sleep in narcolepsy-cataplexy patients with REM sleep behavior disorder (NC + RBD) but not clinical RBD (NC À RBD). Methods: Twelve NC + RBD and 10 NC À RBD male patients underwent video-polysomnography (video-PSG). Motor events of different type and complexity (i.e., elementary and complex movements and vocalizations) occurring during REM sleep were visually assessed, and indices of their frequency per hour of REM sleep were calculated. Subsequently, the index values were compared in NC + RBD versus NC À RBD patients. Results: Typical RBD behaviors observed in five NC + RBD patients were not included in any type of motor events. No objective conventional sleep parameter, including visual analysis of chin electromyographic (EMG) activity, significantly differed between the two groups of NC patients. NC + RBD patients showed higher occurrence of elementary movements (p = 0.034) during REM sleep compared with NC À RBD patients, but the occurrence of complex movements did not differ significantly. Conclusions: Video-analysis of motor events during REM sleep may improve the diagnosis of RBD in NC. RBD in NC patients is mainly characterized by elementary rather than complex movements, consistent with the view that RBD with NC patients displays a distinct phenotype with respect to other RBD patients.
REM sleep behaviour disorder (RBD) and its associations in young patients
Sleep Medicine, 2009
REM behaviour disorder RBD Narcolepsy Overlap parasomnia disorder Rem loss atonia Idiopathic RBD Secondary RBD a b s t r a c t Study objectives: To retrospectively examine the characteristics of a population of patients <50 years of age with clinical and polysomnographic features diagnostic for RBD. Methods: Review of our sleep centre's database for patients with RBD diagnosed over the last 7 years. Ninety-one patients were separated into two groups according to their age at the time of diagnosis (<50 y and P50 y). Clinical and polysomnographic data were reviewed. Results: Sixty-two were male; mean age was 52 ± 19 y. Thirty-nine were <50 y. In the group <50 y there was a male predominance but in a smaller proportion (M:F = 1.4:1) compared with the group P50 (M:F = 3:1). Seventy-six patients complained of abnormal behaviour (AB) during sleep, 12 with narcolepsy complained of excessive daytime sleepiness (EDS) with the AB being elicited only during consultation, and three complained of both EDS and AB. All patients, except one in the group P50, described AB related to vivid dreams with violent content. The majority of the patients had the idiopathic form of RBD in both groups (51.2% group <50, 63.4% group P50). The secondary form was associated with narcolepsy in 38.4% of patients in the group <50 y and with a synucleinopathy in 28.8% of patients in the group P50. A strong association was noted between RBD and non-REM parasomnias. Conclusions: In a population of patients with RBD presenting to a regional sleep laboratory, more than one-third of patients were <50 y at time of diagnosis. The commonest associated disorder was narcolepsy in patients <50 y, and synucleinopathy in those P50 y. The coexistence of RBD with a NREM parasomnia was not uncommon in cases of idiopathic RBD affecting patients <50 y.
Annals of the New York Academy of Sciences, 2010
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia manifested by vivid, often frightening dreams associated with simple or complex motor behavior during REM sleep. The polysomnographic features of RBD include increased electromyographic tone +/− dream enactment behavior during REM sleep. Management with counseling and pharmacologic measures is usually straightforward and effective. In this review, the terminology, clinical and polysomnographic features, demographic and epidemiologic features, diagnostic criteria, differential diagnosis, and management strategies are discussed. Recent data on the suspected pathophysiologic mechanisms of RBD are also reviewed. The literature and our institutional experience on RBD are next discussed, with an emphasis on the RBD-neurodegenerative disease association and particularly the RBD-synucleinopathy association. Several issues relating to evolving concepts, controversies, and future directions are then reviewed, with an emphasis on idiopathic RBD representing an early feature of a neurodegenerative disease and particularly an evolving synucleinopathy. Planning for future therapies that impact patients with idiopathic RBD is reviewed in detail.
Sleep Medicine, 2012
Objectives: Dreams are commonly described as violent, threatening, and aggressive in patients with REM behavior disorder (RBD), but very few studies have directly investigated dream content in this population. We systematically assessed dreams in subjects with a confirmed diagnosis of idiopathic RBD (iRBD) and explored psychological traits within the group with specific focus on aggressiveness. Methods: A total of 129 dream reports was collected, of which 77 belonged to 12 iRBD patients and 52 belonged to 12 control subjects. Transcripts were analyzed with measures of both form and content. The Thematic Apperception Test was used to assess patients' personality traits and to yield information on formal aspects of waking thought processes. Results: No statistically significant differences were found between the dreams of iRBD patients and those of normal controls in any of the applied measures. In wakefulness, passivity was found to differ between the two populations and was being higher in the iRBD group (F 9,14 = 4.84, p < 0.05). Conclusions: Our results do not support the anecdotal view that dreams of RBD patients contain more aggressive elements than those of the general population. However, over 80% of the patients were on treatment at the time of data collection. The ''mild'' waking temperament could be interpreted as an early subtle sign of the apathy that is commonly described in the context of neurodegenerative disorders.
REM sleep characteristics in narcolepsy and REM sleep behavior disorder
To assess the presence of polysomnographic characteristics of REM sleep behavior disorder (RBD) in narcolepsy; and to quantify REM sleep parameters in patients with narcolepsy, in patients with "idiopathic" RBD, and in normal controls. Design: Sleep laboratory study Participants: Sixteen patients with narcolepsy and cataplexy matched for age and sex with 16 patients with "idiopathic" RBD and with 16 normal controls were studied. Measurements and Results: Higher percentages of REM sleep without atonia, phasic electromyographic (EMG) activity, and REM density were found in patients with narcolepsy than normal controls. In contrast, RBD patients had a higher percentage of REM sleep without atonia but a lower REM density than patients with narcolepsy and normal controls. Based on a threshold of 80% for percentage of REM sleep with atonia, 50% of narcoleptics and 87.5% of RBD patients had abnormal REM sleep muscle activity. No significant behavioral manifestation in REM sleep was noted in either narcoleptics or controls. We also found a higher frequency of periodic leg movements during wake (PLMW) and during sleep (PLMS) in narcoleptic patients compared to controls. Conclusions: The present study demonstrates abnormalities in REM sleep motor regulation with an increased frequency of REM sleep without atonia, phasic EMG events and PLMS in narcoleptic patients when compared to controls. These abnormalities were seen more prominently in patients with RBD than in narcoleptics, with the exception of the PLMS index. We proposed that dysfunctions in hypocretin/dopaminergic system may lead to motor dyscontrol in REM sleep that results in dissociated sleep/wake states.
Sleep Medicine
REM sleep behavior disorder Narcolepsy-cataplexy Video-PSG recording Simple and complex motor events REM sleep Vocalizations Dream enactment a b s t r a c t Objective: We carried out a systematic video-polysomnographic analysis of the number and type of motor events during REM sleep in narcolepsy-cataplexy patients with REM sleep behavior disorder (NC + RBD) but not clinical RBD (NC À RBD). Methods: Twelve NC + RBD and 10 NC À RBD male patients underwent video-polysomnography (video-PSG). Motor events of different type and complexity (i.e., elementary and complex movements and vocalizations) occurring during REM sleep were visually assessed, and indices of their frequency per hour of REM sleep were calculated. Subsequently, the index values were compared in NC + RBD versus NC À RBD patients. Results: Typical RBD behaviors observed in five NC + RBD patients were not included in any type of motor events. No objective conventional sleep parameter, including visual analysis of chin electromyographic (EMG) activity, significantly differed between the two groups of NC patients. NC + RBD patients showed higher occurrence of elementary movements (p = 0.034) during REM sleep compared with NC À RBD patients, but the occurrence of complex movements did not differ significantly. Conclusions: Video-analysis of motor events during REM sleep may improve the diagnosis of RBD in NC. RBD in NC patients is mainly characterized by elementary rather than complex movements, consistent with the view that RBD with NC patients displays a distinct phenotype with respect to other RBD patients.
A motor signature of REM sleep behavior disorder
Movement Disorders, 2012
Background: The purpose of this study was to determine if there was a common pattern in movements during REM sleep behavior disorder (RBD). Methods: We blindly compared video-monitored movements during RBD (n 5 136 clips) and wakefulness/arousal (n 5 53 clips) in patients with Parkinson's disease (n 5 29) and without parkinsonism (idiopathic RBD, n 5 31; narcolepsy, n 5 5). Results: The scorers accurately guessed the sleep/ wake stage of 94% of video clips. Compared with wake movements, RBD movements were faster and more often repeated, jerky, and pseudohallucinatory, not self-centered, never associated with tremor, and rarely involved the environment in an appropriate manner. A specific posture of the hand (limp wrist with flexed digits) during grasping movements was evidenced during RBD in 48% of patients, reminiscent of hand-babbling in babies. Conclusions: These characteristics of movements were found in the 3 conditions (Parkinson's disease, idiopathic RBD, and primary narcolepsy), delineating a common motor signature of RBD. V C 2011 Movement Disorder Society