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  • 1
    Online Resource
    Online Resource
    Isolated dream‐enactment behaviours as a prodromal hallmark of rapid eye movement sleep behaviour disorder
    Wiley ; 2023
    In:  Journal of Sleep Research Vol. 32, No. 3 ( 2023-06)
    Details
    In: Journal of Sleep Research, Wiley, Vol. 32, No. 3 ( 2023-06)
    Abstract: Recurrent dream‐enactment behaviours (DEB) and rapid eye movement (REM) sleep without atonia (RSWA) are two diagnostic hallmarks of REM sleep behaviour disorder (RBD), a specific prodrome of α‐synucleinopathy. Whilst isolated RSWA (without DEB) was suggested as a prodrome of RBD, the implication of ‘isolated’ recurrent DEB remains under‐investigated. In this cross‐sectional study, we sought to investigate neurodegenerative markers amongst the first‐degree relatives (FDRs, aged 〉 40 years) of patients with RBD who underwent clinical assessment for DEB, neurodegenerative markers, and video‐polysomnography assessment. Isolated recurrent DEB was defined as: (i) three or more episodes of DEB, (ii) had a DEB episode in the past 1 year, and (iii) subthreshold RSWA. We identified 29 FDRs (mean [SD] age 53.4 [8.3]  years, 55.2% male) with isolated recurrent DEB and 98 age and sex‐matched FDRs as controls. Isolated DEB was associated with nightmare (27.6% versus 11.2%, p  = 0.02), and the DEB group had a higher rate of current smoking (27.6% versus 3.1%, p  = 0.006), type 2 diabetes mellitus (24.1% versus 10.2%, p  = 0.003), anxiety disorder (24.1% versus 11.2%, p  = 0.02), and constipation (hard lump of stool, 31.0% versus 7.1%, p   〈  0.001) than the control group. The present findings revealed that family relatives of patients with RBD with isolated recurrent DEB have increased risk of RBD and neurodegenerative features, which adds to the emerging data that isolated DEB is a prodromal feature of RBD and α‐synucleinopathy neurodegeneration.
    Type of Medium: Online Resource
    ISSN: 0962-1105 , 1365-2869
    URL: Issue
    URL: Article
    DOI: 10.1111/jsr.v32.3
    DOI: 10.1111/jsr.13791
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2007459-1
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  • 2
    Online Resource
    Online Resource
    Rest‐Activity Pattern Alterations in Idiopathic REM Sleep Behavior Disorder
    Wiley ; 2020
    In:  Annals of Neurology Vol. 88, No. 4 ( 2020-10), p. 817-829
    Details
    In: Annals of Neurology, Wiley, Vol. 88, No. 4 ( 2020-10), p. 817-829
    Abstract: The purpose of this study was to investigate the differences in actigraphy‐measured rest‐activity patterns (eg, sleep–wake cycle, circadian rest‐activity rhythm, and physical activity) across different stages of α‐synucleinopathy. Methods We compared alterations in 7‐day actigraphy‐measured rest‐activity patterns among patients with clinically diagnosed α‐synucleinopathies (n = 44), and their age‐, sex‐, and body mass index (BMI)‐matched patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD, n = 88), and non‐rapid eye movement (REM) sleep behavior disorder (RBD) controls (n = 44) in a case–control study (study 1) and between convertors (n = 22) and their age‐, sex‐, BMI‐, iRBD‐duration, and follow‐up duration‐matched non‐convertors (n = 66) in a prospective nested case–control study (study 2). Results In study 1, there were significant increases (all p values were adjusted by false discovery rate 〈  0.01) in probable napping behaviors (percentage, duration, and episodes), activity fragmentation (estimated by k AR ), and physical inactivity during active periods across controls, and iRBD, to clinically diagnosed α‐synucleinopathies. In study 2, higher levels (all p values were adjusted by false discovery rate 〈  0.05) of baseline objective probable napping, activity fragmentation, and physical inactivity during active periods were associated with the conversion of patients with iRBD into clinically diagnosed α‐synucleinopathies at 2 years of follow‐up with medium to large effect sizes (Cohen's d: 0.56 to 0.80). These findings were further supported by functional linear modeling analyses. Interpretation Rest‐activity pattern alterations, mainly objective probable napping behaviors, activity fragmentation, and physical inactivity during active period, emerge as early as at the stage of iRBD, which serves as early and robust prodromal markers of the conversion of iRBD into clinically diagnosed α‐synucleinopathies. ANN NEUROL 2020;88:817–829
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v88.4
    DOI: 10.1002/ana.25853
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2037912-2
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  • 3
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    Online Resource
    Prevalence and correlates of REM sleep behaviour disorder in patients with major depressive disorder: a two-phase study
    BMJ ; 2022
    In:  Journal of Neurology, Neurosurgery & Psychiatry Vol. 93, No. 9 ( 2022-09), p. 1010-1017
    Details
    In: Journal of Neurology, Neurosurgery & Psychiatry, BMJ, Vol. 93, No. 9 ( 2022-09), p. 1010-1017
    Abstract: To investigate the prevalence and clinical correlates of video polysomnography (vPSG)-confirmed rapid eye movement sleep behaviour disorder (RBD) in patients with major depressive disorder (MDD). Methods This is a clinic-based two-phase epidemiological study. In phase 1, patients with MDD were screened by a validated questionnaire, RBD Questionnaire-Hong Kong (RBDQ-HK). In phase 2, a subsample of both the screen-positive (RBDQ-HK 〉 20) and screen–negative patients with MDD underwent further clinical and sleep assessment (vPSG) to confirm the diagnosis of RBD (MDD+RBD). Poststratification weighting method was used to estimate the prevalence of MDD+RBD. The total likelihood ratio and the probability of prodromal Parkinson’s disease (PD) were calculated from prodromal markers and risk factors, as per the Movement Disorder Society research criteria. Results A total of 455 patients with MDD were screened (median age (IQR)=52.66 (15.35) years, 77.58% woman, 43.74% positive). Eighty-one patients underwent vPSG and 12 of them were confirmed MDD+RBD. The prevalence of MDD+RBD was estimated to be 8.77% (95% CI: 4.33% to 16.93%), with possibly male predominance. MDD+RBD were associated with colour vision and olfaction deficit and a higher probability for prodromal PD. Conclusions Almost 9% of patients with MDD in the psychiatric outpatient clinic has vPSG-confirmed RBD. Comorbid MDD+RBD may represent a subtype of MDD with underlying α-synucleinopathy neurodegeneration. Systematic screening of RBD symptoms and necessity of vPSG confirmation should be highlighted for capturing this MDD subtype with a view to enhance personalised treatment and future neuroprotection to prevent neurodegeneration.
    Type of Medium: Online Resource
    ISSN: 0022-3050 , 1468-330X
    URL: Article
    DOI: 10.1136/jnnp-2021-327460
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1480429-3
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  • 4
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    Online Resource
    Residual Injurious Symptoms and Its Association With Neurodegenerative Outcomes in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Retrospective, Longitudinal Follow‐up Study
    Wiley ; 2020
    In:  Movement Disorders Vol. 35, No. 11 ( 2020-11), p. 2077-2085
    Details
    In: Movement Disorders, Wiley, Vol. 35, No. 11 ( 2020-11), p. 2077-2085
    Abstract: The risk of neurodegenerative disorders in idiopathic rapid eye movement sleep behavior disorder (iRBD) patients with residual injurious symptoms (RIS) after symptomatic treatment with clonazepam and/or melatonin is unclear. Objective The objective of this study was to determine the rate and correlates of RIS and its association with the risk of neurodegenerative diseases in patients with iRBD. Methods This was a retrospective cohort study. RIS was defined by the RBD Questionnaire–Hong Kong (RBDQ‐HK) as the presence of residual sleep‐related injuries or potential injurious behaviors for at least once a month after at least 1 year of treatment. Results A total of 15 out of 133 (11.3%) patients with iRBD (age at diagnosis = 66.5 ± 7.3 years, 77.4% male) had RIS after 2.7 years of treatment. Patients with RIS were younger at both onset and polysomnography‐confirmed diagnosis of iRBD (years, mean ± standard deviation, 56.3 ± 6.9 vs. 61.8 ± 7.6, P = 0.01; 61.2 ± 4.2 vs. 67.2 ± 7.4, P   〈  0.001, respectively), had more severe behavioral symptoms at diagnosis (both RBDQ‐HK total score and behavioral subscore, P = 0.01), and used a higher maximum dose of clonazepam (mg; median [interquartile range], 1.5 [1.0] vs. 1.0 [1.0], P = 0.01). RIS was probably associated with a higher risk of developing dementia with Lewy bodies (adjusted hazard ratio [95% confidence interval], 5.47 [1.71–17.46] , adjusted for onset age of RBD), but not Parkinsons's disease in the follow‐up. Conclusion RIS is not uncommon in patients with iRBD despite long‐term medication treatment. An earlier onset and more severe clinical profile are associated with RIS. The prediction of RIS toward dementia with Lewy bodies but not PD suggests that RIS may probably help to identify the specific risk of different subtypes of α‐synucleinopathy. © 2020 International Parkinson and Movement Disorder Society
    Type of Medium: Online Resource
    ISSN: 0885-3185 , 1531-8257
    URL: Issue
    URL: Article
    DOI: 10.1002/mds.v35.11
    DOI: 10.1002/mds.28210
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2041249-6
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  • 5
    Online Resource
    Online Resource
    Evolution of Prodromal REM Sleep Behavior Disorder to Neurodegeneration : A Retrospective Longitudinal Case-Control Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Neurology Vol. 99, No. 6 ( 2022-08-9), p. e627-e637
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 99, No. 6 ( 2022-08-9), p. e627-e637
    Abstract: Individuals with a history of recurrent dream-enactment behaviors, but with subthreshold REM sleep without atonia levels for REM sleep behavior disorder (RBD) diagnosis, are currently classified to have prodromal RBD (pRBD). However, the REM sleep–elevated EMG diagnostic cutoff, progression trajectory, and long-term neurodegenerative outcome of pRBD are not well understood. This study aimed to delineate the evolution of REM sleep EMG levels, determine the EMG cutoff score for diagnosing pRBD, and examine the risk for neurodegenerative diseases of pRBD. Methods This retrospective longitudinal case-control study recruited patients with pRBD and age-matched, sex-matched, and follow-up duration–matched controls who were free of neurodegenerative disease at baseline in the Sleep Assessment Unit, the Chinese University of Hong Kong from 1997 to 2018. Patients and controls underwent clinical and video-polysomnography (PSG) assessments at baseline and follow-up(s). REM sleep EMG activity level on mentalis and anterior tibialis (AT) muscles on video-PSG at each visit was scored. The diagnosis of neurodegenerative diseases was confirmed by a neurologist. Results A total of 44 patients (age 67.4 ± 8.2 years, 6 females) and 44 controls were recruited. The combined REM sleep EMG level on mentalis and AT muscles of patients with pRBD significantly increased during 8.2 ± 3.3 years of follow-up (from 19.3% ± 9.7% to 47.3% ± 27.4% with estimated annual increase of 3.9%), yielding 29 patients with pRBD (66%) meeting the full-blown RBD diagnostic criteria. Baseline REM sleep mentalis and AT muscles EMG activity of patients who developed full-blown RBD could favorably differentiate pRBD from controls (6.3% for mentalis “any” and 9.1% for combination of mentalis any and bilateral AT muscles phasic EMG with an area under the curve of 0.88 [0.78–0.98] and 0.97 [0.92–1.00] , respectively). Patients with pRBD had a higher risk for neurodegenerative diseases (9 developed Parkinson disease and 3 developed dementia with Lewy bodies) when compared with controls (5 developed Alzheimer disease, adjusted hazard ratio = 2.95, 95% CI = 1.02–8.54). Discussion pRBD has a predictive progression in both pathophysiology and neurodegenerative outcome. This finding has significant implications to the nosological status of pRBD, the current REM sleep-related EMG diagnostic criteria, spectrum concept of RBD, and future neuroprotective intervention. Classification of Evidence This study provides Class III evidence that EMG activity during REM sleep predicts the development of pRBD.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000200707
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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