Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder.
BACKGROUND
Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is important because it can be the first manifestation of a neurodegenerative disease, it may lead to serious injury, and it is a well-treatable disorder. We evaluated the electromyographic (EMG) activity in the Sleep Innsbruck Barcelona (SINBAR) montage (mentalis, flexor digitorum superficialis, extensor digitorum brevis) and other muscles to obtain normative values for the correct diagnosis of RBD for clinical practice.


METHODS
Two university hospital sleep disorder centers.


METHODS
Thirty RBD patients (15 idiopathic [iRBD], 15 with Parkinson disease [PD]) and 30 matched controls recruited from patients with effectively treated sleep related breathing disorders.


METHODS
Not applicable.


RESULTS
Participants underwent video-polysomnography, including registration of 11 body muscles. Tonic, phasic, and "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity was blindly quantified for each muscle. When choosing a specificity of 100%, the 3-sec miniepoch cutoff for a diagnosis of RBD was 18% for "any" EMG activity in the mentalis muscle (area under the curve [AUC] 0.990). Discriminative power was higher in upper limb (100% specificity, AUC 0.987-9.997) than in lower limb muscles (100% specificity, AUC 0.813-0.852). The combination of "any" EMG activity in the mentalis muscle with both phasic flexor digitorum superficialis muscles yielded a cutoff of 32% (AUC 0.998) for patients with iRBD and with PD-RBD.


CONCLUSIONS
For the diagnosis of iRBD and RBD associated with PD, we recommend a polysomnographic montage quantifying "any" (any type of EMG activity, irrespective of whether it consisted of tonic, phasic or a combination of both) EMG activity in the mentalis muscle and phasic EMG activity in the right and left flexor digitorum superficialis muscles in the upper limbs with a cutoff of 32%, when using 3-sec miniepochs.
Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. birgit.ho@i-med.ac.at
Birgit
B
Frauscher
Alex
A
Iranzo
Carles
C
Gaig
Viola
V
Gschliesser
Marc
M
Guaita
Verena
V
Raffelseder
Laura
L
Ehrmann
Nuria
N
Sola
Manel
M
Salamero
Eduardo
E
Tolosa
Werner
W
Poewe
Joan
J
Santamaria
Birgit
B
Högl
D000368:Aged; D016022:Case-Control Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000503:physiopathology; D012016:Reference Values; D012895:Sleep, REM / Q000502:physiology*