Objective: To compare the intensity of non-motor symptoms between REM sleep behavioral disorder (RBD) patients with and without Obstructive Sleep Apnea (OSA).

Background: In RBD patients, non-motor symptoms have been considered an harbinger for the appearance or worsening of neurodegenerative disorders like Parkinson’s disease (PD). Some studies have suggested that OSA is more common in patients with RBD. Both RBD and OSA are associated with cognitive dysfunction, dysautonomic symptoms and hypersomnolence. Because both RBD and OSA can manifest with similar symptoms, and given the increased probability of RBD to present also with OSA, it is important to understand the influence of OSA in the clinical manifestations of RBD.

Methods: A total of 32 RBD cases (14 idiopathic and 18 PD) were consecutively selected from  a tertiary  hospital out-patient clinic and underwent polysomnography.  RBD was diagnosed according to the ICSD III criteria. Patients were divided in two groups according to the presence of moderate to severe OSA, defined as an Apnea Hypopnea Index (AHI) > 14 (RBD-OSA vs. RBD-non-OSA). Motor function was evaluated with the Unified Parkinson’s Disease Rating Scale. Non-motor symptoms were assessed with Montreal Cognitive Assessment Scale and the Non-Motor Symptom assessment scale for Parkinson’ s Disease. Data are expressed as median (range).

Results: There were no significant demographic differences between RBD-OSA (n=10) and RBD-non-OSA (n=22) groups. RBD-OSA patients showed significantly higher scores regarding SCOPA-Sleep Daytime (6.00 (16) vs. 2.00 (8), p= 0.040) and NMSS Attention/Memory (12.00 (22) vs. 4.50 (28), p=0.026), Gastrointestinal (5.0 (13) vs. 0.00 (9), p=0.001) and Urinary complaints (11.0 (36) vs. 0.25 (25), p=0.033). Except for AHI, there were no significant differences in polysomnographic data between the two groups.

Conclusions: Our data suggests that sleep disturbed breathing influences the clinical presentation of RBD. RBD-OSA patients presented worse symptoms in cognitive, urinary and daytime sleepiness domains. We can thus hypothesize that OSA contributes to these RBD associated symptoms, which should be taken in account when evaluating these patients, as they could be potentially reversible by adequate ventilatory treatment. The strong relation between OSA and gastro-intestinal complaints (which includes dysphagia) could suggest  a common disturbance of bulbar motor control.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-influence-of-sleep-disordered-breathing-in-rem-sleep-behavior-disorder-associated-symptoms/