Objective: We aimed to identify factors that predict the occurrence of REM Sleep Behaviour disorder (RBD) in  Parkinson’s Disease (PD) patients by modelling data from PD patients with advanced, fluctuating disease.

Background: RBD is known as a preclinical marker for PD. Previous studies have shown that the prevalence of RBD increases with PD progression.

Method: PD in-patients with fluctuating PD, stage Hoehn&Yahr ≥3 who underwent a one-night-videopolysomnography (vPSG) between Jan.2010 and Dec. 2018 as part of their diagnostic work-up for a sleep disturbance and/or non-restorative sleep were included. We determined the presence or absence of RBD. We correlated our findings to demographic factors, PD subtypes, motor and non-motor symptoms, disease duration, cognitive and physical impairment, medication and comorbidities and performed multiple model analyses to assess risk factors for RBD.

Results: 504 vPSGs of PD patients with advanced disease and motor fluctuations were analysed. 37 patients were excluded due to either too many artifacts during REM sleep (n=16) or  an insufficient amount of REM sleep (n=21). 5 patients showed  REM Sleep Behavioral Events (RBEs) and were not included in the  analysis.  RBD was present in 406 (86,9 %) patients (PD+RBD), 56 PD patients were without RBD (PDnonRBD).  PD+RBD patients compared to  PDnonRBD were older (69±7.7years vs 64±9.2years, p< 0.01),  showed more frequently posture abnormalities (UPDRS III, “posture” >=2) (234(59.1%) vs 19(33.9%), p< 0.01), presented more frequently orthostatic dyregulation (75(22.6%) vs 3(7.1%), p=0.02), were treated with higher LEDD (1027±498mg vs 924±386mg, p=0,05) and used more frequently nonSSRIs (141(34.7%) vs 7(13%), p< 0.01). PDnonRBD patients tended to be have a more stable posture than PD+RBD (19(33.9%) vs 95(23.9%), p=0.09).
A model consisting of  seven factors (age, abnormal posture, antidepressant  medication nonSSRI, dementia, orthostatic dysregulation, LEDD, and postural stability) reached an AUC of 0.78[0.68; 0.89] to predict the presence of RBD in PD patients.

Conclusion: We found a  prevalence of RBD of 86.9% in advanced stages of PD, thus implying RBD as a progression marker of PD. Age, postural abnormalities, postural instability, dementia, orthostatic dysregulation, LEDD and the use of nonSSRI antidepressants can predict the presence of RBD in PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/what-predicts-rbd-in-pd-patients-video-polysomnographycally-supported-data-from-advanced-fluctuating-parkinsons-disease/