Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease

Jun 27, 2012Movement disorders : official journal of the Movement Disorder Society

REM Sleep Behavior Disorder and Different Types of Parkinson's Disease

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Abstract

Of 98 Parkinson's disease patients, 54 had rapid eye movement sleep behavior disorder (RBD).

Patients with RBD were older and predominantly male compared to those without RBD.
A significant difference in systolic blood pressure change while standing was observed, with RBD patients showing a larger drop.
RBD was associated with a higher orthostatic symptom score and an increased frequency of freezing episodes.
A systolic blood pressure drop greater than 10 mmHg could effectively identify patients with RBD.
There may be a relationship between RBD and the nontremor predominant subtype of Parkinson's disease, along with increased frequency of falls and depression.

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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.

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Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease

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