title: Comparison Between Automatic and Visual Scorings of REM Sleep Without Atonia for the Diagnosis of REM Sleep Behavior Disorder in Parkinson Disease.
abstract: To compare three different methods, two visual and one automatic, for the quantification of rapid eye movement (REM) sleep without atonia (RSWA) in the diagnosis of REM sleep behavior disorder (RBD) in Parkinson's disease (PD) patients.
  
  
  
  Sixty-two consecutive patients with idiopathic PD underwent video-polysomnographic recording and showed more than 5 minutes of REM sleep. The electromyogram during REM sleep was analyzed by means of two visual methods (Montréal and SINBAR) and one automatic analysis (REM Atonia Index or RAI). RBD was diagnosed according to standard criteria and a series of diagnostic accuracy measures were calculated for each method, as well as the agreement between them.
  
  
  
  RBD was diagnosed in 59.7% of patients. The accuracy (85.5%), receiver operating characteristic (ROC) area (0.833) and Cohen's K coefficient (0.688) obtained with RAI were similar to those of the visual parameters. Visual tonic parameters, alone or in combination with phasic activity, showed high values of accuracy (93.5-95.2%), ROC area (0.92-0.94), and Cohen's K (0.862-0.933). Similarly, the agreement between the two visual methods was very high, and the agreement between each visual methods and RAI was substantial. Visual phasic measures alone performed worse than all the other measures.
  
  
  
  The diagnostic accuracy of RSWA obtained with both visual and automatic methods was high and there was a general agreement between methods. RAI may be used as the first line method to detect RSWA in the diagnosis of RBD in PD, together with the visual inspection of video-recorded behaviors, while the visual analysis of RSWA might be used in doubtful cases.
authors.affiliation: EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France.|Sleep Disorders Center - Neurophysiology Unit, University of Cagliari, Cagliari, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Figorilli
authors.affiliation: Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.affiliation: Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zibetti
authors.affiliation: Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Beudin
authors.affiliation: Sleep Disorders Center - Neurophysiology Unit, University of Cagliari, Cagliari, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Puligheddu
authors.affiliation: Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lopiano
authors.affiliation: Sleep Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicolin
authors.affiliation: EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France.|Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Durif
authors.affiliation: EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France.|Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Ana
authors.initials: A
authors.lastname: Marques
authors.affiliation: EA 7280, Université Clermont Auvergne, Clermont-Ferrand, France.|Department of Neurology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Maria Livia
authors.initials: ML
authors.lastname: Fantini
mesh_terms: D000368:Aged; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia; D010300:Parkinson Disease / Q000150:complications*; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D012372:ROC Curve; D012895:Sleep, REM / Q000502:physiology*; D014741:Video Recording
keywords: Montréal method; Parkinson Disease; REM Sleep Behavior Disorder; REM Sleep without Atonia; REM sleep atonia Index; SINBAR method.