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Rapid eye movement (REM) sleep behavior disorder (RBD) was described more than 2 decades ago, but only 1 report on 5 patients and 5 normal subjects has tested the effectiveness of a method by which relevant polysomnographic findings can be quantified. We sought to validate this method in a larger sample of patients and control subjects.
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Introduction: The REM sleep behavior disorder (RBD) screening questionnaire (RBDSQ) has been used as a screening tool for RBD. We investigated the clinical characteristics of probable RBD (pRBD) using the RBDSQ in patients with Parkinson's disease (PD).
Methods: Seventy patients with PD (age: 69.2 ± 8.9 years old, 31 males and 49 females, length of...
Effective therapies for the so-called atypical parkinsonian syndrome (APS) such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), or corticobasal syndrome (CBS) are not available. Dopamine agonists (DA) are not often used in APS because of inefficacy and in a minority of case, their side effects, like dyskinesias, impairment o...
Citations
... Another study using overnight PSG determined patients with PD had more severe insomnia, shorter total sleep time, lower sleep efficiency, and increased REM latency when compared to controls [37]. By observing polysomnographic changes and global cognitive functioning, we can better understand the changes in REM in patients with PD, as well as better understand the associations with heart and breathing rates, brain wave activity, and motor abnormalities [9,38]. ...
The growing incidence of Parkinson’s Disease (PD) is a major burden on the healthcare system. PD is caused by the degeneration of dopaminergic neurons and is known for its effects on motor function and sleep. Sleep is vital for maintaining proper homeostasis and clearing the brain of metabolic waste. Adequate time spent in each sleep stage can help maintain homeostatic function; however, patients with PD appear to exhibit sleep impairments. Although medications enhance the function of remaining dopaminergic neurons and reduce motor symptoms, their potential to improve sleep is still under question. Recently, research has shifted towards exercise protocols to help improve sleep in patients with PD. This review aims to provide an overview of how sleep is impaired in patients with PD, such as experiencing a reduction in time spent in slow-wave sleep, and how exercise can help restore normal sleep function. A PubMed search summarized the relevant research on the effects of aerobic and resistance exercise on sleep in patients with PD. Both high and low-intensity aerobic and resistance exercises, along with exercises related to balance and coordination, have been shown to improve some aspects of sleep. Neurochemically, sleeping leads to an increase in toxin clearance, including α-synuclein. Furthermore, exercise appears to enhance the concentration of brain-derived neurotrophic factors, which has preliminary evidence to suggest correlations to time spent in slow-wave sleep. More research is needed to further elucidate the physiological mechanism pertaining to sleep and exercise in patients with PD.
... s, and keeping the original amplitude criterion. In addition, the overall polysomnographic score introduced by Consens et al 26 as the average of phasic and tonic EMG activity was calculated. Because this score implies a combination of both types of EMG activity, we refer to it henceforth as 'Montreal overall' for the sake of brevity. ...
Background
Isolated rapid eye movement (REM) sleep behaviour disorder (iRBD) is a prodromal state of clinical α-synucleinopathies such as Parkinson’s disease and Lewy body dementia. The lead-time until conversion is unknown. The most reliable marker of progression is reduced striatal dopamine transporter (DAT) binding, but low availability of imaging facilities limits general use. Our prospective observational study aimed to relate metrics of REM sleep without atonia (RWA)—a hallmark of RBD—to DAT-binding ratios in a large, homogeneous sample of patients with RBD to explore the utility of RWA as a marker of progression in prodromal α-synucleinopathies.
Methods
DAT single-photon emission CT (SPECT) and video polysomnography (vPSG) were performed in 221 consecutive patients with clinically suspected RBD.
Results
vPSG confirmed RBD in 176 patients (162 iRBD, 14 phenoconverted, 45 non-synucleinopathies). Specific DAT-binding ratios differed significantly between groups, but showed considerable overlap. Most RWA metrics correlated significantly with DAT-SPECT ratios (eg, Montreal tonic vs most-affected-region: r=−0.525; p<0.001). In patients taking serotonergic/noradrenergic antidepressants or dopaminergic substances or with recent alcohol abuse, correlations were weaker, suggesting a confounding influence, unlike other possible confounders such as beta-blocker use or comorbid sleep apnoea.
Conclusions
In this large single-centre prospective observational study, we found evidence that DAT-binding ratios in patients with iRBD can be used to describe a continuum in the neurodegenerative process. Overlap with non-synucleinopathies and clinical α-synucleinopathies, however, precludes the use of DAT-binding ratios as a precise diagnostic marker. The parallel course of RWA metrics and DAT-binding ratios suggests in addition to existing data that RWA, part of the routine diagnostic workup in these patients, may represent a marker of progression. Based on our findings, we suggest ranges of RWA values to estimate whether patients are in an early, medium or advanced state within the prodromal phase of α-synucleinopathies, providing them with important information about time until possible conversion.
... Symptoms of Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) were assessed using the University of Michigan RBD Questionnaire (UMRBDQ; Consens et al., 2005). This 7-item measure asks bed partners to rate the frequency of RBD symptoms in their partners on a 5-point Likert scale. ...
... This 7-item measure asks bed partners to rate the frequency of RBD symptoms in their partners on a 5-point Likert scale. Scores correlate with related polysomnographic RBD measures (ρ = 0.42; Consens et al., 2005) and this measure has demonstrated good internal consistency (α = 0.86; Bliwise et al., 2014). Emotion Regulation Difficulties. ...
Objective
Post-9/11 U.S. veterans and servicemembers are at increased risk for suicide, indicating an important need to identify and mitigate suicidal ideation and behaviors in this population.
Method
Using data modeling techniques, we examined correlates of suicidal ideation and behavior at intake in 261 post-9/11 veterans and servicemembers seeking mental health treatment.
Results
Our sample endorsed high rates of suicidal ideation and behavior. Approximately 40% of our sample scored in a range on the Suicide Behaviors Questionnaire-Revised (SBQ-R), indicating high clinical risk for suicide. Results from multivariate analyses indicate that greater state and/or trait depression severity, greater anger and anger expression, less impulse control, and lower rank were consistently associated with suicidal ideation and behavior across our models. Negative posttraumatic thoughts about the self, gender, and military branch of service were also significantly associated with suicidal ideation and behavior.
Conclusions
Suicidal ideation and behaviors are common in veterans seeking mental health treatment. State and/or trait depression, anger and impulse control were predictors of increased risk for suicidal ideation and behavior across models. Consistencies and differences across models as well as limitations and practical implications for the findings are discussed.
... Sleep stages were manually scored, with the modification of the criteria on atonia to allow increased EMG activity during REM sleep. 18 REM sleep without atonia was automatically scored with a method based on the original description given by Lapierre and Montplaisir, adapted and validated by Consens et al. 19,20 Isolated RBD was present in 209 patients of whom 171 were long-term (≥6 months) treated with melatonin according to our chronobiotic protocol, and 38 were treated with the usual mixture of treatments (Table 1). In total, 14 of 209 patients converted to clinical synucleinopathy. ...
Melatonin is recommended as a first-line treatment in isolated REM sleep behavior disorder (iRBD), although no large patient group has been reported. To assess effects, time-course and confounding factors in the treatment of patients with iRBD using melatonin, 209 consecutive patients were included in this single-center, observational cohort study. 171 patients had taken melatonin according to our chronobiotic protocol (2mg, ≥ 6 months, always-at-the-same-clock-time, 10-11pm, corrected for chronotype), 13 had applied melatonin for about 1-3 months, 25 underwent mixed treatments. In total, 1529 clinical evaluations were performed, including Clinical Global Impression (CGI) and a newly developed RBD-symptom severity scale (Ikelos-RS), analyzed using linear mixed models. Validation of Ikelos-RS showed excellent inter-rater reliability (ρ=0.9, p<0.001), test-retest reliability (ρ=0.9, p<0.001) and convergent validity (ρ=0.9, p<0.001). With melatonin RBD-symptom severity gradually improved over the first 4 weeks of treatment (Ikelos-RS: 6.1 vs. 2.5; CGI-Severity: 5.7 vs. 3.2) and remained stably improved (mean follow-up 4.2±3.1yrs; range: 0.6-21.7yrs). Initial response was slowed to up to 3 months with melatonin suppressing (betablockers) or REM sleep spoiling co-medication (antidepressants) and failed with inadequately timed melatonin intake. When melatonin was discontinued after 6 months, symptoms remained stably improved (mean follow-up after discontinuation 4.9±2.5yrs; range: 0.6-9.2). When administered only 1-3 months, RBD-symptoms gradually returned. Without any melatonin, RBD-symptoms persisted and did not wear off over time. Clock-timed, low dose, long-term melatonin treatment in patients with iRBD appears to be associated with improvement of symptoms. The outlasting improvement over years questions a pure symptomatic effect. Clock-time dependency challenges existing prescription guidelines for melatonin.
... We found the degree of REM sleep atonia in younger (≤ 50 years) psychiatry patients to be very variable, ranging from very low to high degree of impairment. According the literature, there were several cut-offs established from different muscles included in the measurement [19][20][21][22][23]. We quantified the RSWA from mm. submentales and flexores digitorum superficiales, that would be most similar to SINBAR methods with estimated cut-off of 32% of REM sleep [19,24]. ...
Background:
Isolated REM sleep without atonia (RSWA) as a main polysomnograhic feature of REM sleep behaviour disorder (RBD) is thought to be a prodromal or subclinical state of the disease. RSWA/RBD occurence in psychiatric population is much more frequent than in general population but its associated factors are still not known.
Methods:
We invited 88 psychiatry in-patients to undervent video-polysomnography. The visual scoring was focused on RSWA in submentales and flexores digitales superficiales muscles. This parametr was subsequently correlated mainly with age/gender, their medication and mental status.
Results:
The RWSA was mostly still in normal range despite the fact, that selected psychiatry patients (≤ 50 years) were taking several classes of psychoactive medication. 3,6% had convincingly RBD, although 35.7% reported rare lifetime occurence of dream-enacting behaviour and 62.8% sporadic nightmares. We found correlation between RSWA and SNRI medication class (p = 0.015), specifically venlafaxine (p = 0.029) as well as quetiapine (p = 0.030). Another significant associated factors were current anxiety (p < 0.001) and depressive symptoms (p = 0.05), but we found no relation between RSWA and given diagnosis.
Conlucions:
Isolated RSWA in younger psychiatry patients might be a result of multiple factors, including medication and current mental status but these factors are in most cases not sufficient to manifest RBD.
... The reason for the difference in the diagnostic accuracy between tonic and phasic RSWA in our study is not clear, but considering that RBD is considered an early manifestation of alpha-synucleinopathy [24], tonic rather than phasic RSWA may be related more directly to the core clinical features of RBD. However, this interpretation must be evaluated carefully, as other studies showed no difference in diagnostic accuracy between tonic and phasic RSWA [7,17,25]. ...
... In addition, if hypnic jerks might be associated with excitatory glutamatergic as an equal indication of R-stages, they may be equally indicative of increased gamma activity (± 40 ). Nevertheless, such conditions need to be better differentiated and dissociated from PLMD, requiring further PSG verification, although research on the subject may be limited, taking into consideration that EMG patterns have poor normative quantification in sleep medicine research (Consens et al., 2005;Schenck, 2005). The association is however still relevant as hypnic jerks are hypothesized to be activated by instability coming from the brainstem reticular formation. ...
This article presents a theoretical assessment specific to the field of consciousness research, more precisely associated with the study of the Vibrational State (VS) and accompanying states, such as the Out-of-Body Experience (OBE), the former currently being an under-researched state of consciousness when it comes to its neurophysiological correlates. It aims at informally presenting neurophysiological theoretical assumptions gathered over the years studying the VS as well as the OBEs through empirical observations, although briefly presenting current ongoing scientific experimental electroencephalographic research into the VS as well as prospective research and scientifically based neuroscientific theories in preparation, which taken together, may provide recommendations for future research associated with such states. We present succinct preliminary research data of the VS intending to postulate insight into the current limitations of VS studies. The purpose lay forward is that of elaborating a critical framework to technically define the VS as a peculiar neurophysiological state of consciousness, not only as an experiential one. Although this essay is merely speculative and mostly theoretical, it is inferentially based on experimental data, current neuroscience and sleep research knowledge. Nevertheless, it does not pretend to have reached the level of a structured hypothesis based on reproducible scientific evidences at any point, when those are presented. Some of the presented assumptions are certainly disputable and based on inductive, experiential-based, reasoning or limited data analysis. Nonetheless, the insights, taken forward, may provide research implications for the neurophysiological models accompanying future VS and OBEs research, including considerations regarding Isolated Sleep Paralysis (ISP), Lucid Dreaming (LD) and other correlated states. We further assume that such states are associated with the brainstem region, have possible common neurophysiological substrates, even though they are phenomenologically different states of consciousness, presenting state-dependent markers.
... In addition, if hypnic jerks might be associated with excitatory glutamatergic as an equal indication of R-stages, they may be equally indicative of increased gamma activity (± 40 ). Nevertheless, such conditions need to be better differentiated and dissociated from PLMD, requiring further PSG verification, although research on the subject may be limited, taking into consideration that EMG patterns have poor normative quantification in sleep medicine research (Consens et al., 2005;Schenck, 2005). The association is however still relevant as hypnic jerks are hypothesized to be activated by instability coming from the brainstem reticular formation. ...
This article presents a theoretical assessment specific to the field of consciousness research, more precisely associated with the study of the Vibrational State (VS) and accompanying states, such as the Out-of-Body Experience (OBE), the former currently being an under-researched state of consciousness when it comes to its neurophysiological correlates. It aims at informally presenting neurophysiological theoretical assumptions gathered over the years studying the VS as well as the OBEs through empirical observations, although briefly presenting current ongoing scientific experimental electroencephalographic research into the VS as well as prospective research and scientifically based neuroscientific theories in preparation, which taken together, may provide recommendations for future research associated with such states. We present succinct preliminary research data of the VS intending to postulate insight into the current limitations of VS studies. The purpose lay forward is that of elaborating a critical framework to technically define the VS as a peculiar neurophysiological state of consciousness, not only as an experiential one. Although this essay is merely speculative and mostly theoretical, it is inferentially based on experimental data, current neuroscience and sleep research knowledge. Nevertheless, it does not pretend to have reached the level of a structured hypothesis based on reproducible scientific evidences at any point, when those are presented. Some of the presented assumptions are certainly disputable and based on inductive, experiential-based, reasoning or limited data analysis. Nonetheless, the insights, taken forward, may provide research implications for the neurophysiological models accompanying future VS and OBEs research, including considerations regarding Isolated Sleep Paralysis (ISP), Lucid Dreaming (LD) and other correlated states. We further assume that such states are associated with the brainstem region, have possible common neurophysiological substrates, even though they are phenomenologically different states of consciousness, presenting state-dependent markers.
... A questionnaire that bed partners use to rate the severity of RBD was developed and used in the development of the RBD Polysomnographic Score among individuals affected by synucleinopathies. 61 Potential participants with positive screens will need to undergo vPSG to determine if they fulfil criteria for RBD. Due to the low prevalence of RBD compared with the relatively high on October 6, 2020 by guest. ...
... However, we would not recommend this method alone, as it relies on the presence of a bed partner and, once present, is also influenced by external factors such as arousal threshold of the bed partner, sleeping in separate bedrooms and so on. A questionnaire that bed partners use to rate the severity of RBD was developed and used in the development of the RBD Polysomnographic Score among individuals affected by synucleinopathies, 61 yet it has not been employed so far to our knowledge for symptom monitoring in ecological settings in clinical trials. ...
The rapid eye movement sleep behavioural disorder (RBD) population is an ideal study population for testing disease-modifying treatments for synucleinopathies, since RBD represents an early prodromal stage of synucleinopathy when neuropathology may be more responsive to treatment. While clonazepam and melatonin are most commonly used as symptomatic treatments for RBD, clinical trials of symptomatic treatments are also needed to identify evidence-based treatments. A comprehensive framework for both disease-modifying and symptomatic treatment trials in RBD is described, including potential treatments in the pipeline, cost-effective participant recruitment and selection, study design, outcomes and dissemination of results. For disease-modifying treatment clinical trials, the recommended primary outcome is phenoconversion to an overt synucleinopathy, and stratification features should be used to select a study population at high risk of phenoconversion, to enable more rapid clinical trials. For symptomatic treatment clinical trials, objective polysomnogram-based measurement of RBD-related movements and vocalisations should be the primary outcome measure, rather than subjective scales or diaries. Mobile technology to enable objective measurement of RBD episodes in the ambulatory setting, and advances in imaging, biofluid, tissue, and neurophysiological biomarkers of synucleinopathies, will enable more efficient clinical trials but are still in development. Increasing awareness of RBD among the general public and medical community coupled with timely diagnosis of these diseases will facilitate progress in the development of therapeutics for RBD and associated neurodegenerative disorders.
... Some other authors reporting EMG quantification among patients with RBD have also aimed at identifying cut-off values to label abnormal muscle tone during REM sleep indicative of a diagnosis of RBD. 22 Postuma et al. suggest that the amount of RWA appears to predict the development of PD, showing that idiopathic RBD patients who developed PD had baseline abnormal tonic chin muscle activity of 73% compared to 41% of those who remained disease free. They also reported high RWA rates (54%) among those suffering from Lewy body dementia. ...
Background:
Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects.
Methods:
A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period.
Results:
Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects.
Conclusion:
We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.
