Montserrat Pujol1, Jesús Pujol2, Tomás Alonso3, Araceli Fuentes4, Mercè Pallerola3, Jovita Freixenet4, Ferran Barbé5, Manel Salamero6, Joan Santamaría7, Alex Iranzo8. 1. Neurology Service and Multidisciplinary Sleep Unit, Hospital Universitari Santa Maria, Lleida, Spain. 2. University of Lleida, IRBLleida, Lleida, Spain; Balaguer Primary Care Center, Institut Català de La Salut, Lleida, Spain. 3. Balaguer Primary Care Center, Institut Català de La Salut, Lleida, Spain. 4. Santa Maria Primary Care Center, Institut Català de La Salut, Lleida, Spain. 5. Respiratory Department and Multidisciplinary Sleep Unit, Hospital Universitari Santa Maria, IRBLleida, Lleida, Spain; CIBERES, Madrid, Spain. 6. Psychiatry Service, Hospital Clinic de Barcelona, CIBERES, Medicine Department, University of Barcelona, Barcelona, Spain. 7. Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain. 8. Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain. Electronic address: airanzo@clinic.ub.es.
Abstract
OBJECTIVE: To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers. METHODS: Participants were individuals aged 60 years or older who underwent routine visits in two primary care centers. They underwent a two-stage study; a validated screening single question for IRBD diagnosis (RBD1Q) followed by, in those who endorsed positive answer, clinical assessment by a neurologist plus video-polysomnography (V-PSG). RESULTS: Of 539 individuals (56.4% women, mean age 72.86 ± 8.20 years), 28 (5.2%) endorsed positively the RBD1Q. Four of these 28 refused further assessments. Four of the 24 remaining subjects underwent clinical assessment but refused V-PSG. Of the 20 who underwent clinical assessment plus V-PSG, REM sleep was not recorded in four (20%, all four taking antidepressants). V-PSG ruled out RBD in 12 subjects who had obstructive sleep apnea (n = 9), periodic limb movement disorder in sleep (n = 2) and normal sleep (n = 1). IRBD was diagnosed in four individuals giving an estimated prevalence of 0.74% (95% CI = 0.29-1.89). They were three men and one woman between 74 and 82 years of age who never reported dream-enacting behaviors to their doctors because they thought they represented a normal phenomenon despite suffering sleep-related injuries. These patients had history of violent sleep behaviors with an interval between estimated RBD onset and V-PSG of 4.5 ± 4.2 years. CONCLUSIONS: IRBD is not uncommon in the elderly community and its demographic and clinical profile is similar to those diagnosed in sleep centers.
OBJECTIVE: To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers. METHODS:Participants were individuals aged 60 years or older who underwent routine visits in two primary care centers. They underwent a two-stage study; a validated screening single question for IRBD diagnosis (RBD1Q) followed by, in those who endorsed positive answer, clinical assessment by a neurologist plus video-polysomnography (V-PSG). RESULTS: Of 539 individuals (56.4% women, mean age 72.86 ± 8.20 years), 28 (5.2%) endorsed positively the RBD1Q. Four of these 28 refused further assessments. Four of the 24 remaining subjects underwent clinical assessment but refused V-PSG. Of the 20 who underwent clinical assessment plus V-PSG, REM sleep was not recorded in four (20%, all four taking antidepressants). V-PSG ruled out RBD in 12 subjects who had obstructive sleep apnea (n = 9), periodic limb movement disorder in sleep (n = 2) and normal sleep (n = 1). IRBD was diagnosed in four individuals giving an estimated prevalence of 0.74% (95% CI = 0.29-1.89). They were three men and one woman between 74 and 82 years of age who never reported dream-enacting behaviors to their doctors because they thought they represented a normal phenomenon despite suffering sleep-related injuries. These patients had history of violent sleep behaviors with an interval between estimated RBD onset and V-PSG of 4.5 ± 4.2 years. CONCLUSIONS: IRBD is not uncommon in the elderly community and its demographic and clinical profile is similar to those diagnosed in sleep centers.
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Authors: Ambra Stefani; Anna Heidbreder; Elisabeth Brandauer; Marc Guaita; Lisa-Marie Neier; Thomas Mitterling; Joan Santamaria; Alex Iranzo; Aleksander Videnovic; Claudia Trenkwalder; Friederike Sixel-Döring; Gregor K Wenning; Anabel Chade; Werner Poewe; Oscar S Gershanik; Birgit Högl Journal: Sleep Date: 2018-06-01 Impact factor: 5.849