Assessing REM Sleep Behaviour Disorder: From Machine Learning Classification to the Definition of a Continuous Dissociation Index

Objectives: Rapid Eye Movement Sleep Behaviour Disorder (RBD) is regarded as a prodrome of neurodegeneration, with a high conversion rate to α–synucleinopathies such as Parkinson’s Disease (PD). The clinical diagnosis of RBD co–exists with evidence of REM Sleep Without Atonia (RSWA), a parasomnia that features loss of physiological muscular atonia during REM sleep. The objectives of this study are to implement an automatic detection of RSWA from polysomnographic traces, and to propose a continuous index (the Dissociation Index) to assess the level of dissociation between REM sleep stage and atonia. This is performed using Euclidean distance in proper vector spaces. Each subject is assigned a dissociation degree based on their distance from a reference, encompassing healthy subjects and clinically diagnosed RBD patients at the two extremes. Methods: Machine Learning models were employed to perform automatic identification of patients with RSWA through clinical polysomnographic scores, together with variables derived from electromyography. Proper distance metrics are proposed and tested to achieve a dissociation measure. Results: The method proved efficient in classifying RSWA vs. not-RSWA subjects, achieving an overall accuracy, sensitivity and precision of 87%, 93% and 87.5%, respectively. On its part, the Dissociation Index proved to be promising in measuring the impairment level of patients. Conclusions: The proposed method moves a step forward in the direction of automatically identifying REM sleep disorders and evaluating the impairment degree. We believe that this index may be correlated with the patients’ neurodegeneration process; this assumption will undergo a robust clinical validation process involving healthy, RSWA, RBD and PD subjects.

Measurement Methods of Fatigue, Sleepiness, and Sleep Behaviour Aboard Ships: A Systematic Review

Since seafarers are known to be exposed to numerous job-related stress factors that can cause fatigue, sleepiness, and disturbed sleep behaviour, the aim of this review was to provide an overview of the subjective and objective measurement methods of these strains. Using a systematic review, 166 studies were identified within the period of January 2010 to December 2020 using the PubMed database. Of the 21 studies selected, 13 used both subjective and objective measurement methods. Six studies used only subjective and two studies only objective methods. For subjective assessment, 12 different questionnaires could be identified as well as activity and sleeping logs. Actigraphy and reaction time tests (RTT) were the most common objective methods. In single cases, electrooculography (EOG), pupillometry and ambulatory polysomnography (PSG) were used. Measurement-related limitations due to vessel-related impacts were less often reported than expected. No restrictions of daily routines on board were described, and only single-measurement disturbances due to ship movements were mentioned. The present literature review reveals that there are various routines to measure fatigue, sleepiness, and sleep behaviour on board. A combination of subjective and objective methods often appears to be beneficial. The frequent use of actigraphy and RTT on board suggests good feasibility and reliable measurements with these methods. The use of ambulatory PSG in maritime-like contexts suggests that this method would also be feasible on board.

Possible predictors of phenoconversion in isolated REM sleep behaviour disorder: a systematic review and meta-analysis

BackgroundA number of promising biomarkers for predicting imminent α-synucleinopathies have been suggested in isolated rapid eye movement sleep behaviour disorder (iRBD). However, existing evidence is conflicting without quantitative evaluation.MethodsPubMed, Web of Science and ClinicalTrials.gov were searched through June 2021 to identify possible predictors of phenoconversion from iRBD to Parkinson’s disease (PD). The pooled HRs and standardised mean differences (SMDs) with 95% CIs were calculated using fixed-effects or random-effects model.ResultsA total of 123 studies were included in the meta-analysis. Significant motor dysfunction (HR 1.83, 95% CI 1.33 to 2.51, I2=86.8%, p<0.001), constipation (HR 1.52, 95% CI 1.26 to 1.84, I2=8.3%, p=0.365), orthostatic hypotension (HR 1.93, 95% CI 1.05 to 3.53, I2=54.9%, p=0.084), hyposmia (HR 2.78, 95% CI 1.83 to 4.23, I2=23.9%, p=0.255), mild cognitive impairment (HR 2.27, 95% CI 1.58 to 3.27, I2=0%, p=0.681) and abnormal colour vision (SMD −0.34, 95% CI −0.63 to −0.05, I2=45.6%, p=0.087) correlated with susceptibility to PD. The process can also be traced by putaminal dopamine transporter imaging (HR 2.60, 95% CI 1.94 to 3.48, I2=0%, p=0.781) and tonic electromyographic activity (HR 1.50, 95% CI 1.04 to 2.15, I2=70%, p=0.018).ConclusionsThe predictive value of each biomarker was initially highlighted with comprehensive evaluation. Combining specific predictors with high sensitivity is promising for detecting phenoconversion in the prodromal stage. Large-scale and multicentre studies are pivotal to extend our findings.

Qualidade do sono de escolares saudáveis: registro de cinco casos

Introdução: a qualidade do sono é um aspecto fundamental do desenvolvimento infantil, pois quando prejudicada, pode ter como consequência eventos patológicos que acometem a qualidade de vida e o desenvolvimento da criança. Objetivo: apresentar o registro de dados da poligrafia durante o sono de um grupo de escolares hígidos. Metodologia: relatou-se o registro de cinco casos de escolares saudáveis que foram avaliados por meio de poligrafia noturna domiciliar (PND) e o questionário Sleep Behaviour Questionaire (SBQ). Também foi realizada antropometria, espirometria e aplicado o questionário International Study of Asthma and Allergies in Childhood (ISAAC). Resultados: A idade média dos casos analisados foi de 10,8±1,78 anos (1 menino) e o índice de massa corporal (IMC) 18,94±2,45 cm/m2. O tempo médio de registro na PND foi de 430 minutos (7,1 horas), com média de saturação de pulso de oxigênio de 95,8%, e frequência cardíaca de 64,3 bpm. O índice de apneia e hipopneia (IAH) variou entre 2 e 4,3 por hora (média de 2,9/hora) e, quando analisados somente os eventos na posição supina, a média do IAH foi de 3,38/hora. Todas as crianças apresentaram ronco noturno, com grande variação entre elas (4-63 episódios de roncos/ noite) e o SBQ pontuou valor sugestivo de distúrbio respiratório do sono (DRS) de caráter leve (média de 42,8 pontos). Conclusão: os escolares hígidos analisados manifestaram sintomas e indicativos de DRS, como apneia do sono leve, segundo os instrumentos utilizados.

Proton pump inhibitors associated with rapid eye movement sleep behaviour disorder

We present the case of a 65-year-old woman diagnosed with rapid eye movement sleep behaviour disorder (REMBD) based on typical symptoms and confirmed with an inpatient polysomnogram. She was prescribed clonazepam and later temazepam but continued to have intrusive symptoms. She subsequently recalled that the onset of dream enactment coincided with starting high-dose omeprazole for acid reflux. With this insight, she stopped the omeprazole. Within days, the dream enactment and nocturnal movements subsided. She stopped taking the temazepam and was symptom free for a few months. However, she was started on lansoprazole for recurrent dyspepsia. Once again she experienced violent movements in sleep. This is the first time an association between proton pump inhibitors (PPIs) and REMBD has been reported. PPIs have many effects on the central nervous system and should be considered as a possible provoking factor in people presenting with REMBD.

Efficacy and safety of treatments for REM sleep behaviour disorder in Parkinson’s disease: a systematic review and Bayesian network meta-analysis protocol

IntroductionSleep disorders are the main non-motor characteristics of Parkinson’s disease (PD). The quality of life is significantly impacted by rapid eye movement sleep behaviour disorder (RBD). It is not clearly evidenced in the literature that some medications can reduce the dream activities of patients with PD and RBD and improve sleep quality. And, they have side effects that may increase the severity of this disease. To further understand which medication has better efficacy and fewer adverse effects for patients with PD and RBD, it is necessary to perform a network meta-analysis.Methods and analysisThis protocol is performed accordingly to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook.A thorough literature selection will be conducted up to September 2021 using PubMed, Cochrane Library (The Cochrane Database of Systematic Reviews) and Embase. We will not only include randomised controlled trials, but prospective, retrospective cohort, case–control, nested case–control, case–cohort, cross-sectional and case series. We will use the Cochrane Collaboration tool to assess the risk of bias. Pairwise and network meta-analyses will be conducted using the R netmeta package and Stata V.14.0. The relative ranking probability of the best intervention will be estimated using the surface under the cumulative ranking curve. Additionally, sensitivity analysis, subgroup analysis, quality assessment and publication bias analysis will be performed.Ethics and disseminationNo research ethics approval is required for this systematic review, as no confidential patient data will be used. We will disseminate our findings through publication in a peer-reviewed journal and conference presentations, and our review will support development of a BMJ Rapid Recommendations providing contextualised clinical guidance based on this body of evidence.PROSPERO registration numberCRD42020206958.

Guiding Light: The Architecture of Sleep for Dementia

<p>Disruptive sleeping behaviours are a key symptom of dementia that accelerates transition from the home towards full time institutional care. For thousands of families in New Zealand, respite facilities offer a temporary relief from this symptom in an attempt to prolong care at home. However the predominant use of pharmaceutical therapy coupled with unstimulating care environments leads to sleeping behaviours deteriorating upon returning home. In order to provide an alternative approach to pharmaceutical therapy and research towards treating disruptive sleep behaviour, this thesis addresses pre-existing inter-disciplinary literature, field trips, international precedents and an iterative method of design to investigate: How can the architecture of a respite facility improve sleeping behaviours and instigate meaningful environmental research within dementia care? Environmental strategies involving light, movement and community were identified as key objectives towards improving sleep behaviour within the design. Introducing a shared courtyard with the public that facilitated continuous movement alongside the circadian rhythms of the sun, allowed a design that would engage with all three objectives in order to improve sleep behaviour of residents with mild symptoms of dementia. As symptoms progress, the adoption of an artificial lighting environment in a purpose built sleep lab allowed a space for scientific enquiry to the nature and treatment of sleep for those with later stages of dementia. The final design integrates both natural and artificial environments into a single respite facility, strengthening its therapeutic potential to prolong home care for the thousands of families affected by dementia in New Zealand.</p>

Guiding Light: The Architecture of Sleep for Dementia

<p>Disruptive sleeping behaviours are a key symptom of dementia that accelerates transition from the home towards full time institutional care. For thousands of families in New Zealand, respite facilities offer a temporary relief from this symptom in an attempt to prolong care at home. However the predominant use of pharmaceutical therapy coupled with unstimulating care environments leads to sleeping behaviours deteriorating upon returning home. In order to provide an alternative approach to pharmaceutical therapy and research towards treating disruptive sleep behaviour, this thesis addresses pre-existing inter-disciplinary literature, field trips, international precedents and an iterative method of design to investigate: How can the architecture of a respite facility improve sleeping behaviours and instigate meaningful environmental research within dementia care? Environmental strategies involving light, movement and community were identified as key objectives towards improving sleep behaviour within the design. Introducing a shared courtyard with the public that facilitated continuous movement alongside the circadian rhythms of the sun, allowed a design that would engage with all three objectives in order to improve sleep behaviour of residents with mild symptoms of dementia. As symptoms progress, the adoption of an artificial lighting environment in a purpose built sleep lab allowed a space for scientific enquiry to the nature and treatment of sleep for those with later stages of dementia. The final design integrates both natural and artificial environments into a single respite facility, strengthening its therapeutic potential to prolong home care for the thousands of families affected by dementia in New Zealand.</p>

Current Treatment Options for REM Sleep Behaviour Disorder

The symptomatic treatment of REM sleep behaviour disorder (RBD) is very important to prevent sleep-related falls and/or injuries. Though clonazepam and melatonin are usually considered the first-line symptomatic therapy for RBD, their efficiency has not been proven by randomized clinical trials. The role of dopamine agonists in improving RBD symptoms is controversial, and rivastigmine, memantine, 5-hydroxytryptophan, and the herbal medicine yokukansan have shown some degree of efficacy in short- and medium-term randomized clinical trials involving a low number of patients. The development of potential preventive therapies against the phenoconversion of isolated RBD to synucleinopathies should be another important aim of RBD therapy. The design of long-term, multicentre, randomized, placebo-controlled clinical trials involving a large number of patients diagnosed with isolated RBD with polysomnographic confirmation, directed towards both symptomatic and preventive therapy for RBD, is warranted.