Clinical manifestations of Parkinson disease and the onset of rapid eye movement sleep behavior disorder

Yan Gong; Kang-Ping Xiong; Cheng-Jie Mao; Yun Shen; Wei-Dong Hu; Jun-Ying Huang; Fei Han; Rui Chen; Chun-Feng Liu

doi:10.1016/j.sleep.2013.12.021

Clinical manifestations of Parkinson disease and the onset of rapid eye movement sleep behavior disorder

Sleep Med. 2014 Jun;15(6):647-53. doi: 10.1016/j.sleep.2013.12.021. Epub 2014 Mar 6.

Authors

Yan Gong¹, Kang-Ping Xiong¹, Cheng-Jie Mao¹, Yun Shen¹, Wei-Dong Hu¹, Jun-Ying Huang², Fei Han³, Rui Chen³, Chun-Feng Liu⁴

Affiliations

¹ Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, China.
² Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, China; Sleep Center, Second Affiliated Hospital of Soochow University, Suzhou, China.
³ Sleep Center, Second Affiliated Hospital of Soochow University, Suzhou, China.
⁴ Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, China; Institute of Neuroscience, Soochow University, Suzhou, China. Electronic address: liucf@suda.edu.cn.

PMID: 24841108
DOI: 10.1016/j.sleep.2013.12.021

Abstract

Objective: To identify whether the presence and/or timing of rapid eye movement (REM) sleep behavior disorder (RBD) onset were associated with differences in clinical features and sleep parameters of Parkinson disease (PD).

Methods: In all, 112 PD patients were enrolled and all underwent extensive clinical evaluations and video-polysomnography (PSG). Clinical features and PSG parameters were compared in PD patients with (PD+RBD) or without (PD-RBD) RBD, RBD preceding (RBD>PD), or not (PD⩾RBD) PD onset.

Results: Sixty-three of the 112 PD patients were affected by RBD. Adjusted for age, gender, education, body mass index (BMI), levodopa equivalent daily dose (LED) and PD duration, PD+RBD patients had higher Hoehn & Yahr stage, higher scores for UPDRS parts I, II and III, more dyskinesia, higher ratio of axial/limb manifestations, and more hallucinations. Their cognitive and quality-of-life status was significantly lower (all P<0.05). For PSG, PD+RBD patients exhibited higher percentages of phasic and tonic EMG activities, lower apnea hypopnea (AHI) and oxygen desaturation index (ODI), and less time in arterial oxygen saturation (SaO2) <90% during REM sleep (all P<0.05). PD⩾RBD (n=22) patients did not significantly differ from RBD>PD (n=41) patients in clinical manifestations, whereas the PD⩾RBD subgroup had significantly higher UPDRS part I score, lower PDQ score and lower AHI during REM than the PD-RBD group (all P<0.05), but not RBD>PD subgroup. Correlation analysis showed that worse cognition was associated with shorter interval of RBD preceding PD onset (r=0.297, P=0.018), but not RBD duration (P=0.202).

Conclusions: Clinical manifestations of PD may vary depending on the presence and timing of RBD onset. These findings are compatible with the hypothesis that RBD may be a marker of complex subtypes of PD.

Keywords: Clinical manifestation; Cognition; Parkinson disease; Polysomnography; REM sleep behavior disorder; Sleep parameters.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Aged
Aged, 80 and over
Body Mass Index
Female
Humans
Male
Middle Aged
Parkinson Disease / complications*
Parkinson Disease / physiopathology
Polysomnography
REM Sleep Behavior Disorder / etiology*
REM Sleep Behavior Disorder / physiopathology
Risk Factors
Sex Factors