Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease.
Numerous studies have explored the potential relationship between rapid eye movement sleep behavior disorder (RBD) and manifestations of PD. Our aim was to perform an expanded extensive assessment of motor and nonmotor manifestations in PD to identify whether RBD was associated with differences in the nature and severity of these manifestations. PD patients underwent polysomnography (PSG) to diagnose the presence of RBD. Participants then underwent an extensive evaluation by a movement disorders specialist blinded to PSG results. Measures of disease severity, quantitative motor indices, motor subtypes, therapy complications, and autonomic, psychiatric, visual, and olfactory dysfunction were assessed and compared using regression analysis, adjusting for disease duration, age, and sex. Of 98 included patients, 54 had RBD and 44 did not. PD patients with RBD were older (P = 0.034) and were more likely to be male (P < 0.001). On regression analysis, the most consistent links between RBD and PD were a higher systolic blood pressure (BP) change while standing (-23.9 ± 13.9 versus -3.5 ± 10.9; P < 0.001), a higher orthostatic symptom score (0.89 ± 0.82 versus 0.44 ± 0.66; P = 0.003), and a higher frequency of freezing (43% versus 14%; P = 0.011). A systolic BP drop >10 could identify PD patients with RBD with 81% sensitivity and 86% specificity. In addition, there was a probable relationship between RBD and nontremor predominant subtype of PD (P = 0.04), increased frequency of falls (P = 0.009), and depression (P = 0.009). Our results support previous findings that RBD is a multifaceted phenomenon in PD. Patients with PD who have RBD tend to have specific motor and nonmotor manifestations, especially orthostatic hypotension.
Department of Neurology, McGill University, Montreal General Hospital, 1650 Cedar Avenue,Montreal, Quebec, Canada.
Silvia Rios
SR
Romenets
Jean-Francois
JF
Gagnon
Véronique
V
Latreille
Michel
M
Panniset
Sylvain
S
Chouinard
Jacques
J
Montplaisir
Ronald B
RB
Postuma
D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D003118:Color Perception; D005260:Female; D006212:Hallucinations / Q000209:etiology / Q000523:psychology; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D009068:Movement; D009460:Neurologic Examination; D010300:Parkinson Disease / Q000145:classification / Q000150:complications* / Q000523:psychology; D017286:Polysomnography; D011597:Psychomotor Performance; D020187:REM Sleep Behavior Disorder / Q000150:complications* / Q000523:psychology; D012903:Smell; D012959:Socioeconomic Factors
D000978:Antiparkinson Agents; D007980:Levodopa