Alex Iranzo1, Joan Santamaría. 1. Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèndiques August Pi i Sunyer, Barcelona, Spain. airanzo@clinic.ub.es
Abstract
OBJECTIVE: To describe the clinical and video-polysomnographic (VPSG) features of a group of subjects with severe obstructive sleep apnea/hypopnea (OSAH) mimicking the symptoms of REM sleep behavior disorder (RBD). DESIGN: Evaluation of clinical and VPSG data. SETTING: University hospital sleep laboratory unit. PARTICIPANTS: Sixteen patients that were identified during routine first evaluation visits. Patients' PSG measures were compared with those of 20 healthy controls and 16 subjects with idiopathic RBD of similar age and sex distribution and apnea/hypopnea index lower than 10. INTERVENTIONS: NA. RESULTS: Sixteen subjects were identified presenting with dream-enacting behaviors and unpleasant dreams suggesting the diagnosis of RBD, in addition to snoring and excessive daytime sleepiness. VPSG excluded RBD showing REM sleep with atonia and without increased phasic EMG activity, and was diagnostic of severe OSAH with a mean apnea-hypopnea index of 67.5 +/- 18.7 (range, 41-105) demonstrating that the reported abnormal sleep behaviors occurred only during apnea-induced arousals. Continuous positive airway pressure therapy eliminated the abnormal behaviors, unpleasant dreams, snoring and daytime hypersomnolence. CONCLUSIONS: Our study shows that severe OSAH may mimick the symptoms of RBD and that VPSG is mandatory to establish the diagnosis of RBD, and identify or exclude other causes of dream-enacting behaviors.
OBJECTIVE: To describe the clinical and video-polysomnographic (VPSG) features of a group of subjects with severe obstructive sleep apnea/hypopnea (OSAH) mimicking the symptoms of REM sleep behavior disorder (RBD). DESIGN: Evaluation of clinical and VPSG data. SETTING: University hospital sleep laboratory unit. PARTICIPANTS: Sixteen patients that were identified during routine first evaluation visits. Patients' PSG measures were compared with those of 20 healthy controls and 16 subjects with idiopathic RBD of similar age and sex distribution and apnea/hypopnea index lower than 10. INTERVENTIONS: NA. RESULTS: Sixteen subjects were identified presenting with dream-enacting behaviors and unpleasant dreams suggesting the diagnosis of RBD, in addition to snoring and excessive daytime sleepiness. VPSG excluded RBD showing REM sleep with atonia and without increased phasic EMG activity, and was diagnostic of severe OSAH with a mean apnea-hypopnea index of 67.5 +/- 18.7 (range, 41-105) demonstrating that the reported abnormal sleep behaviors occurred only during apnea-induced arousals. Continuous positive airway pressure therapy eliminated the abnormal behaviors, unpleasant dreams, snoring and daytime hypersomnolence. CONCLUSIONS: Our study shows that severe OSAH may mimick the symptoms of RBD and that VPSG is mandatory to establish the diagnosis of RBD, and identify or exclude other causes of dream-enacting behaviors.
Authors: Ronald B Postuma; Isabelle Arnulf; Birgit Hogl; Alex Iranzo; Tomoyuki Miyamoto; Yves Dauvilliers; Wolfgang Oertel; Yo-El Ju; Monica Puligheddu; Poul Jennum; Amelie Pelletier; Christina Wolfson; Smaranda Leu-Semenescu; Birgit Frauscher; Masayuki Miyamoto; Valerie Cochen De Cock; Marcus M Unger; Karin Stiasny-Kolster; Maria Livia Fantini; Jacques Y Montplaisir Journal: Mov Disord Date: 2012-05-30 Impact factor: 10.338
Authors: Brendon P Boot; Bradley F Boeve; Rosebud O Roberts; Tanis J Ferman; Yonas E Geda; V Shane Pankratz; Robert J Ivnik; Glenn E Smith; Eric McDade; Teresa J H Christianson; David S Knopman; Eric G Tangalos; Michael H Silber; Ronald C Petersen Journal: Ann Neurol Date: 2012-01 Impact factor: 10.422
Authors: Hatice Kumru; Alex Iranzo; Eva Carrasco; Francesc Valldeoriola; Maria José Marti; Joan Santamaria; Eduard Tolosa Journal: Sleep Date: 2008-10 Impact factor: 5.849