Objective: 1) Polysomnography (PSG) assessment of sleep in Dementia with Lewy Bodies (DLB). 2) Correlation between PSG data, fluctuations and hypersomnolence. 3) Comparison of PSG data between DLB , Parkinson’s Disease (PD) and idiopathic REM sleep behavior disorder (RBD).

Background: RBD and fluctuations and hypersomnolence are core and supportive diagnostic features for DLB, respectively. PSG data has been frequently reported in PD and idiopathic RBD (iRBD), but there are few studies in DLB patients. Objective measurement of sleep and comparison with patients with other alfa-synucleinopathies are essential for understanding the pathophysiology of sleep symptoms in DLB.

Methods: Participants: 18 DLB, 41 PD and 18 iRBD patients. DLB clinical features, as described in the consensus report criteria, were collected from patients files. Patients underwent one-night video-PSG. Sleep staging, REM sleep muscular tone, periodic limb movements of sleep, breathing parameters and RBD were scored according to the AASM and ICSD III recommendations. Vídeo analysis of REM sleep motor events was performed. PSG data was compared between 1) PD and DLB; 2) DLB with/without fluctuations or hypersomnolence; 3)DLB with RBD (DLB-RBD), PD with RBD (PD-RBD), and iRBD.

Results: Compared to normative data, DCL presented with decreased total sleep time (237.86±89.39 min) sleep efficiency (47.64 % ±17.43) and REM sleep duration (6.87 % ±7.80) and increased sleep latency (82.86±102.89 min) and N2 (71.37±11.93 %) duration. DLB patients presented significantly higher sleep latency compared to PD (no other significant differences). REM sleep latency was lower in DLB patients with fluctuations (n=6) than in those without. There were no significant differences regarding the presence of hypersomnolence (n=9 patients). RBD was detected in 8 DLB and 20 PD patients (REM sleep was absent in 6 DLB and 5 PD cases). Severity of motor events was worse in iRBD v.s. PD-RBD and DLB-RBD (no significant differences between PD-RBD and DLB-RBD).

Conclusions: DLB patients present a reduction of sleep efficiency and REM sleep duration and an increase in superficial sleep. These alterations are similar or worse than in PD patients, possibly reflecting a common neurodegenerative pathophysiology. Fluctuations were related to a significant reduction in REM sleep latency, implying a possible connection between vigilance and REM sleep regulation. Severity of motor events was worse in IRBD compared to the other two RBD groups, possibly reflecting an attenuation of RBD clinical manifestations as neurodegeneration progresses.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/polysomnographic-data-in-dementia-with-lewy-bodies-correlation-with-clinical-features-and-comparison-with-other-alfa-synucleinopathies/