title: Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder.
abstract: OBJECTIVE
  In a previous study we showed that simultaneous electromyographic (EMG) recording of the mentalis, flexor digitorum superficialis and extensor digitorum brevis (SINBAR EMG montage) detected the highest rates of rapid eye movement (REM) sleep phasic EMG activity in subjects with REM sleep behavior disorder (RBD). As a next step, in the present study we evaluated the usefulness of the SINBAR EMG montage to detect the movements and vocalizations occurring in RBD.
  
  
  METHODS
  Polysomnographic studies with synchronized audiovisual monitoring of 11 patients with idiopathic RBD were analyzed. Phasic EMG activity in REM sleep was scored and quantified in 3-s mini-epochs while the video was reviewed to detect motor events and vocalizations.
  
  
  RESULTS
  A total of 64.8% (11,562 out of 17,848) of all mini-epochs contained phasic EMG activity, whereas 28.8% (5135 out of 17,848) contained movements or vocalizations. Using the SINBAR EMG montage, 94.4% of the mini-epochs containing behavioral events were linked to phasic EMG activity. The sensitivity of the SINBAR EMG montage was 94.4%, specificity was 47.2%, negative predictive value was 95.4% and positive predictive value was 41.9%. Isolated EMG recording of the mentalis did not show phasic EMG activity in 35.5% of the behavioral events seen in the video.
  
  
  CONCLUSIONS
  The SINBAR EMG montage is a useful approach for the diagnosis of RBD showing that simultaneous EMG recording of the mentalis, flexor digitorum superficialis and extensor digitorum brevis muscles detected the majority (94.4%) of the motor and vocal manifestations occurring in RBD. For clinical purposes, this means that it is efficient to screen the video when increased phasic EMG activity is seen on the polysomnography.
authors.affiliation: Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Iranzo
authors.forename: Birgit
authors.initials: B
authors.lastname: Frauscher
authors.forename: Helena
authors.initials: H
authors.lastname: Santos
authors.forename: Viola
authors.initials: V
authors.lastname: Gschliesser
authors.forename: Luca
authors.initials: L
authors.lastname: Ratti
authors.forename: Tina
authors.initials: T
authors.lastname: Falkenstetter
authors.forename: Caroline
authors.initials: C
authors.lastname: Stürner
authors.forename: Manel
authors.initials: M
authors.lastname: Salamero
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tolosa
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Joan
authors.initials: J
authors.lastname: Santamaria
authors.forename: Birgit
authors.initials: B
authors.lastname: Högl
mesh_terms: D000368:Aged; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D009069:Movement Disorders / Q000175:diagnosis / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000502:physiology; D017286:Polysomnography; D011237:Predictive Value of Tests; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D012895:Sleep, REM / Q000502:physiology*; D014743:Videotape Recording; D014831:Voice / Q000502:physiology*