Objective: To investigate the development of REM sleep behavior disorder (RBD) and REM sleep without atonia (RWA) in Parkinson’s disease (PD) patients from the de novo state to 6 years follow-up.

Background: On video-supported polysomnography (vPSG) in 158 de novo PD patients (DeNoPa cohort), we previously identified 40 subjects with RBD (25%) and 41 subjects with minor motor behaviors during REM not fulfilling diagnostic criteria for RBD named REM behavioral events(RBE) (26%) (1). We analyzed RBD and RWA at 6 years follow-up (FU).

Method: Diagnosis of RBD was established with vPSG according to international (ICSD-2) (2). For measurement of RWA surface EMG activity of mentalis muscle was quantified according to the SINBAR method (3) and compared in PD+RBD at baseline and after 6 years. The influence of time, age, gender, levodopa equivalent daily dose (LEDD), UPDRS score and benzodiazepines on RWA was investigated.

Results: After 6 years vPSG was available from 98 patients. Altogether 51/98 (52%) patients showed RBD at follow-up. In the initial group of 40 PD+RBD patients, all 23 valid patients were confirmed with RBD after 6 years. Out of 17 non-valid patients, 8 patients had died, 4 patients dropped out, 3 patients refused vPSG, 1 patient couldn’t sleep on the vPSG night, 1 patient had no REM sleep. In the RBD group RWA increased from 38+21 % (16-99%) at baseline to 48+24 % (12-90%) at FU (p=.01). Mean age was 67+8 (44-82) years at baseline and 70+7(50-79) years at FU. The influence of age on RWA increase was significant (p=.034). UPDRS scores, LEDD, and benzodiazepine use did not enhance RWA. In those 41 PD patients diagnosed with RBE at baseline, 5 patients had died, 7 patients dropped out, 4 patients refused PSG, 2 patients couldn’t sleep, and 2 patients had no REM sleep. Fifteen of the 21 remaining patients (71%) had converted to RBD at FU, 5 patients now showed normal REM (24%) and 1 patient retained RBE.

Conclusion: All patients identified with RBD at baseline retained RBD at FU with a significant further increase of RWA. Patients with RBE progressed to RBD in 71% over 6 years confirming RBE as a prodromal state. The frequency of RBD in PD doubles from baseline to 6 years FU with age as an independent factor enhancing RWA. RBD and its prodromal state RBE reflect disease progression in PD patients. An influence of dopaminergics or benzodiazepines could not be shown.

References: 1. Sixel-Döring F, Trautmann E, Mollenhauer B, Trenkwalder C. Rapid eye movement sleep behavioral events: a new marker for neuerodegeneration in early Parkinson disease? Sleep 2014; 37:431-8 2. American Academy of Sleep Medicine. International Classification of Sleep Disorders 2nd ed. Westchester, IL: American Academy of Sleep Medicine, 2005 3. Frauscher B, Iranzo A, Gaig C, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 2012; 35: 835-47

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rem-sleep-behavior-disorder-and-rem-sleep-without-atonia-is-a-progression-marker-in-parkinsons-disease-a-report-from-the-denopa-cohort/