Increased REM sleep without atonia in Parkinson disease with freezing of gait.
OBJECTIVE
The objective of this cross-sectional study was to test the hypothesis that patients with Parkinson disease (PD) and freezing of gait (PD+FOG) would demonstrate sleep disturbances comparable to those seen in patients with REM sleep behavior disorder (RBD) and these changes would be significantly different from those in PD patients without FOG (PD-FOG) and age-matched controls.


METHODS
We conducted overnight polysomnography studies in 4 groups of subjects: RBD, PD-FOG, PD+FOG, and controls. Tonic and phasic muscle activity during REM sleep were quantified using EMG recordings from the chin, compared among study groups, and correlated with disease metrics.


RESULTS
There were no significant differences in measures of disease severity, duration, or dopaminergic medications between the PD+FOG and PD-FOG groups. Tonic muscle activity was increased significantly (p < 0.007) in the RBD and PD+FOG groups compared to the PD-FOG and control groups. There was no significant difference in tonic EMG between the PD+FOG and RBD group (p = 0.364), or in tonic or phasic EMG between the PD-FOG and control group (p = 0.107). Phasic muscle activity was significantly increased in the RBD group compared to all other groups (p = 0.029) and between the PD+FOG and control group (p = 0.001), but not between the PD+FOG and PD-FOG groups (p = 0.059).


CONCLUSIONS
These findings provide evidence that increased muscle activity during REM sleep is a comorbid feature of patients with PD who exhibit FOG as a motor manifestation of their disease.
From the Departments of Neurology (A.V., C.D.M.) and Physical Therapy and Human Movement Sciences (C.M., L.A., C.D.M.), Northwestern University, Chicago, IL; Doctor of Physical Therapy Program (L.A.), San Diego State University, CA; Departments of Applied Physiology and Kinesiology (P.J.P., D.E.V.), Neurology (D.E.V.), and Biomedical Engineering (D.E.V.), University of Florida, Gainesville; and Department of Neurology (C.D.M.), University of Minnesota, Minneapolis.
A
A
Videnovic
C
C
Marlin
L
L
Alibiglou
P J
PJ
Planetta
D E
DE
Vaillancourt
C D
CD
Mackinnon
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004576:Electromyography / Q000379:methods; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000503:physiopathology; D010300:Parkinson Disease / Q000503:physiopathology*; D017286:Polysomnography / Q000379:methods; D020187:REM Sleep Behavior Disorder / Q000503:physiopathology*; D012895:Sleep, REM / Q000502:physiology*