REM sleep behavior disorder and REM sleep without atonia in patients with progressive supranuclear palsy.
OBJECTIVE
To compare sleep characteristics, rapid eye movement (REM) sleep without atonia, and REM sleep behavior disorder (RBD) in patients with progressive supranuclear palsy (tauopathy), patients with Parkinson's disease (a synucleinopathy), and control subjects.


METHODS
Sleep interview, overnight polysomnography, and Multiple Sleep Latency Tests.


METHODS
Forty-five age- and sex-matched patients with probable progressive supranuclear palsy, (n=15, aged 68 +/- 8 years, 7 men), patients with Parkinson disease (n=15), and control subjects (n=15).


METHODS
Tertiary-care academic hospital.


METHODS
N/A.


RESULTS
Compared to the 2 other groups, patients with progressive supranuclear palsy had a longer duration of wakefulness after sleep onset and twice as much sleep fragmentation and percentage of stage 1 sleep but had similar apnea-hypopnea indexes, periodic leg movements indexes, and mean daytime sleep latencies. REM sleep percentage was as low in patients with progressive supranuclear palsy (8% +/- 6% of total sleep time) as in patients with Parkinson disease (10% +/- 4%), versus 20% +/- 6% in controls (analysis of variance, P < .0001). Interestingly, patients with progressive supranuclear palsy had percentages of REM sleep without atonia (chin muscle activity: 33% +/- 36% of REM sleep) similar to those of patients with Parkinson disease (28% +/- 35%) and dramatically higher than those of controls (0.5% +/- 1%, analysis of variance, P = .008). Four (27%) patients with progressive supranuclear palsy had more than 50% REM sleep without atonia (as did a similar number of patients with Parkinson disease), and 2 of them (13%, vs 20% of patients with Parkinson disease) had clinical RBD. The four patients with progressive supranuclear palsy with excessive daytime sleepiness slept longer at night than the 11 patients with progressive supranuclear palsy who were alert (442 +/- 14 minutes vs 312 +/- 74 minutes, student t tests, P = .004), suggesting a primary nonnarcoleptic hypersomnia.


CONCLUSIONS
REM sleep without atonia and RBD were as frequent in patients with progressive supranuclear palsy as in patients with Parkinson disease. It suggests that the downstream cause of parkinsonism, rather than its primary neuropathology (synucleinopathy vs tauopathy), is a key factor for REM sleep behavior disorder.
Arnulf
Isabelle
I
Fédération des Pathologies du Sommeil and Upres EA 2397, Paris, France. isabelle.amulf@psl.ap-hop-paris.fr
Merino-Andreu
Milagros
M
Bloch
Frédéric
F
Konofal
Eric
E
Vidailhet
Marie
M
Cochen
Valérie
V
Derenne
Jean-Philippe
JP
Agid
Yves
Y
D000368:Aged; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D009123:Muscle Hypotonia; D018482:Muscle, Skeletal / Q000502:physiology*; D010300:Parkinson Disease / Q000453:epidemiology; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D013494:Supranuclear Palsy, Progressive / Q000453:epidemiology*