Original ArticleREM and NREM sleep enactment behaviors in Parkinson’s disease, Parkinson’s disease dementia, and dementia with Lewy bodies
Introduction
Nocturnal sleep enactment behaviors (SEBs) are frequently reported by bed partners of patients affected by diseases in the clinical spectrum [1] of Parkinson’s disease (PD), dementia associated with PD (PDD), and dementia with Lewy bodies (DLB) [2], [3].
We refer to “SEBs” as an anamnestic category of motor or behavioral sleep-related phenomena which proved to be quite heterogeneous events at video-PSG monitoring. They do not merely consist of REM sleep behavior disorder (RBD), but also of arousal-related episodes arising from NREM or REM sleep or coexistence of NREM and REM-related phenomena (overlap syndrome).
RBD is by far the best-characterized parasomnia in patients with synucleinopathies [4]. It features dream-enacting movements and behaviors occurring against the background of a loss of normal skeletal muscle atonia during REM sleep. It is reported, on average, in around 30% [5] and up to 46% [6] of PD patients, 80–95% of patients with multiple system atrophy [7], and 50–80% of those with DLB [8]. Literature data indicate that RBD is associated with, or predicts, the development of cognitive impairment in PD patients [9], [10], [11].
Little is known about the occurrence and biological significance of Arousal-related Motor-Behavioral Episodes (AMBEs), which have so far been reported only in PD patients [12], [13].
The aim of this study is to investigate patterns of occurrence and the neurobiological significance of the various kinds of SEBs in the context of PD without cognitive decline compared to PDD/DLB patients.
Section snippets
Setting and patient recruitment
The study was approved by the scientific board of the “Casimiro Mondino National Institute of Neurology” Foundation, Pavia, Italy. Patients were recruited among consecutive referrals to the outpatient clinic at the Parkinson’s Disease and Movement Disorders Unit from December 2005 to July 2010.
Patients affected by idiopathic PD diagnosed according to the United Kingdom Parkinson’s Disease Society Brain Bank (UKPDSBB) criteria [14], or fulfilling either the DLB Consortium criteria for probable
Sleep patterns
Patients with PDD/DLB showed patterns of RSWA more frequently than PD patients (75.9% vs. 65.9%), although the difference was not statistically significant.
Patterns of obstructive sleep apnea were found in six patients with PD (14.6%) and in two patients with PDD/DLB (6.8%) (p = ns). No significant difference between the two groups was detected in the AHI or in the oxygen desaturation index (ODI).
There emerged a slightly higher prevalence of PLMs and ALMA in patients with PDD/DLB (41.4%) as
Discussion
Our study shows that SEBs occurred more frequently in patients with PDD/DLB than in those with PD, with 68.4% consisting of isolated RBD and 31.6% encompassing SEBs consisting of arousal-related episodes from NREM and REM sleep, i.e., “Arousal-related Motor Behavioral Episodes” (AMBEs).
Both RBD and AMBEs were more frequent in the PDD/DLB than in the PD group (p = 0.001), with the difference being statistically significant for AMBES (p = 0.002), while a trend emerged for RBD (p = 0.07).
The higher
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2012.04.015.
Acknowledgements
We thank Dr. Piero Perucca for his invaluable advice on statistical analysis conception.
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