REM sleep without atonia in middle-aged and older psychiatric patients and Lewy body disease: a case series

Abstract Background Isolated REM sleep without atonia (RSWA) as a main polysomnograhic feature of REM sleep behaviour disorder (RBD) is thought to be a prodromal or subclinical state of the disease. RSWA/RBD occurence in psychiatric population is much more frequent than in general population but its associated factors are still not known. Methods We invited 88 psychiatry in-patients to undervent video-polysomnography. The visual scoring was focused on RSWA in submentales and flexores digitales superficiales muscles. This parametr was subsequently correlated mainly with age/gender, their medication and mental status. Results The RWSA was mostly still in normal range despite the fact, that selected psychiatry patients (≤ 50 years) were taking several classes of psychoactive medication. 3,6% had convincingly RBD, although 35.7% reported rare lifetime occurence of dream-enacting behaviour and 62.8% sporadic nightmares. We found correlation between RSWA and SNRI medication class (p = 0.015), specifically venlafaxine (p = 0.029) as well as quetiapine (p = 0.030). Another significant associated factors were current anxiety (p < 0.001) and depressive symptoms (p = 0.05), but we found no relation between RSWA and given diagnosis. Conlucions Isolated RSWA in younger psychiatry patients might be a result of multiple factors, including medication and current mental status but these factors are in most cases not sufficient to manifest RBD.

Download Full-text

Relationship of substantia nigra hyperechogenicity to risk of Lewy body disease in idiopathic REM sleep behavior disorder patients: a longitudinal study

Sleep Medicine ◽

10.1016/j.sleep.2019.09.008 ◽

2020 ◽

Vol 68 ◽

pp. 31-34

Author(s):

Masayuki Miyamoto ◽

Tomoyuki Miyamoto

Keyword(s):

Longitudinal Study ◽

Substantia Nigra ◽

Rem Sleep ◽

Lewy Body ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Lewy Body Disease ◽

Sleep Behavior ◽

Substantia Nigra Hyperechogenicity ◽

Relationship Of

Download Full-text

1127 Utility of Quantitative EEG During Sleep as a Potential Biomarker of Lewy Body Disease Progression

SLEEP ◽

10.1093/sleep/zsaa056.1121 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A429-A429

Author(s):

E Matar ◽

K A Ehgoetz Martens ◽

R R Grunstein ◽

A D’Rozario ◽

S J Lewis

Keyword(s):

Rem Sleep ◽

Lewy Body ◽

Sleep Disturbances ◽

Rem Sleep Behavior Disorder ◽

Lewy Body Disease ◽

Quantitative Eeg ◽

Sleep Regulation ◽

Disease Spectrum ◽

Potential Biomarker ◽

Increased Risk

Abstract Introduction Sleep disturbances are common among patients with Lewy body disorders. Idiopathic REM sleep behavior disorder (iRBD) has been identified as a prodromal Lewy body condition with a significantly increased risk of conversion to either Parkinson’s disease (PD) or Dementia with Lewy Bodies (DLB). Pathological involvement of thalamic and brainstem structures involved in sleep regulation has been reported in these disorders, especially in later stages. We hypothesized that progression along the Lewy body disease spectrum may be associated with unique changes in spindle density and EEG power spectra during sleep reflecting involvement of these deep brain structures. Methods A cross-sectional design was used. 9 polysomnography confirmed iRBD, 18 early PD, 23 DLB and 13 controls underwent overnight polysomnography, neurological and neuropsychological assessment. Power spectrum analysis during NREM and REM sleep was undertaken using a previously validated quantitative EEG algorithm and compared between groups. Following artefact and outlier removal, results were analysed using the Cz derivation. Groups were statistically compared with a non-parametric Jonckheree-Terpstra test for ordered alternatives, controlling for age and sex. Results We found a significant and ordered reduction in power in the spindle frequency band (12-15 Hz) in NREM sleep across the Lewy body disease spectrum compared to controls (Controls > iRBD > early PD > DLB; TJT = 521.00, z = -2.902. p<0.001). In REM sleep we found a shift in power to slower frequencies with increased power in the theta (4.5-8 Hz) band in order of disease severity (DLB > early PD > iRBD > Controls; TJT = 950.00, z = 2.253. p=0.024). No differences were found across the other frequency bands in NREM or REM sleep. Conclusion There is a significant and progressive reduction in spindle density and corresponding slowing in REM sleep frequencies during sleep with clinical Lewy body staging. Thus, such measures have the potential to be useful biomarkers of progression towards Lewy body dementia from prodromal stages. Support This work was supported by a NHMRC Dementia Team Grant (#1095127), the NHMRC Postgraduate Scholarship and the University of Sydney Research Excellence Initiative 2020 grant.

Download Full-text