Femke Dijkstra1, Mineke Viaene2, Ilse De Volder3, Erik Fransen4, Patrick Cras5, David Crosiers5. 1. Department of Neurology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Laboratory for Sleep Disorders and Department of Neurology, St.-Dimpna Regional Hospital, J.-B. Stessensstraat 2, 2440 Geel, Belgium. Electronic address: Femke.Dijkstra@uza.be. 2. Laboratory for Sleep Disorders and Department of Neurology, St.-Dimpna Regional Hospital, J.-B. Stessensstraat 2, 2440 Geel, Belgium. 3. Department of Neurology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Psychiatry, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Multidisciplinary Sleep Disorders Center, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. 4. StatUa Center for Statistics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium. 5. Department of Neurology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Faculty of Medicine and Health Sciences, Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Institute Born-Bunge, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Abstract
OBJECTIVE: Isolated REM sleep without atonia (iRSWA) is regarded as a prodromal phase of REM sleep behavior disorder and synucleinopathies. In iRSWA patients, we investigated the polysomnographic characteristics that are known to be altered in (prodromal) Parkinson's disease (PD): periodic limb movements of sleep [PLMS] (increased), REM density (reduced), and heart rate variability ([HRV] (reduced). METHODS: We compared video-polysomnographic studies of 49 iRSWA subjects with 41 controls. RSWA and PLMS were scored visually. REM density (REM/hour) and HRV were calculated automatically. RESULTS: We found a higher median total (15.90 vs 7.20; p = 0.001), REM (21.80 vs 11.0; p < 0.001) and non-REM (11.75 vs 5.72; p = 0.027) PLMS index, and a higher mean REM density (342.45 vs 275.96; p = 0.010) in the iRSWA group, with a significant positive correlation between RSWA severity and these variables (r = 0.39; p < 0.00, r = 0.48; p < 0.001, r = 0.24; p = 0.021, r = 0.28; p = 0.012). We found no significant difference in HRV between groups. CONCLUSIONS: Our results suggest an association between RWSA and REM density and PLMS, but not HRV. The positive correlation between these variabilities may imply overlapping pathophysiological processes. SIGNIFICANCE: The evidence of higher REM density and normal HRV weakens the hypothesis that iRWSA is a prodromal PD stage. An alternative interpretation is, however, that REM density and HRV change during caudal-rostral neurodegeneration.
OBJECTIVE:Isolated REM sleep without atonia (iRSWA) is regarded as a prodromal phase of REM sleep behavior disorder and synucleinopathies. In iRSWA patients, we investigated the polysomnographic characteristics that are known to be altered in (prodromal) Parkinson's disease (PD): periodic limb movements of sleep [PLMS] (increased), REM density (reduced), and heart rate variability ([HRV] (reduced). METHODS: We compared video-polysomnographic studies of 49 iRSWA subjects with 41 controls. RSWA and PLMS were scored visually. REM density (REM/hour) and HRV were calculated automatically. RESULTS: We found a higher median total (15.90 vs 7.20; p = 0.001), REM (21.80 vs 11.0; p < 0.001) and non-REM (11.75 vs 5.72; p = 0.027) PLMS index, and a higher mean REM density (342.45 vs 275.96; p = 0.010) in the iRSWA group, with a significant positive correlation between RSWA severity and these variables (r = 0.39; p < 0.00, r = 0.48; p < 0.001, r = 0.24; p = 0.021, r = 0.28; p = 0.012). We found no significant difference in HRV between groups. CONCLUSIONS: Our results suggest an association between RWSA and REM density and PLMS, but not HRV. The positive correlation between these variabilities may imply overlapping pathophysiological processes. SIGNIFICANCE: The evidence of higher REM density and normal HRV weakens the hypothesis that iRWSA is a prodromal PD stage. An alternative interpretation is, however, that REM density and HRV change during caudal-rostral neurodegeneration.
Authors: Jeong Hun Yang; Sang Ho Choi; Mi Hyun Lee; Seong Min Oh; Jae-Won Choi; Jee Eun Park; Kwang Suk Park; Yu Jin Lee Journal: J Clin Sleep Med Date: 2021-03-01 Impact factor: 4.062