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Rapid eye movement sleep behavior disorder and subtypes of Parkinson's disease§

Authors

  • Silvia Rios Romenets MD,

    1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
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  • Jean-Francois Gagnon PhD,

    1. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
    2. Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
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  • Véronique Latreille PhD,

    1. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
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  • Michel Panniset MD,

    1. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
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  • Sylvain Chouinard MD,

    1. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
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  • Jacques Montplaisir MD, PhD,

    1. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
    2. Department of Psychiatry, Universite de Montreal, Montreal, Quebec, Canada
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  • Ronald B. Postuma MD, MSc

    Corresponding author
    1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada
    2. Centre d'Études Avancées en Médecine du Sommeill, Hôpital du Sacré-cœur de Montréal, Montréal, Quebec, Canada
    • Department of Neurology, L7-312 Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G1A4
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  • Funding agencies: This study was supported by grants from the Canadian Institutes of Health Research, the Parkinson Society of Canada, and by the Fonds de la Recherche en Santé du Québec.

  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • §

    Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Numerous studies have explored the potential relationship between rapid eye movement sleep behavior disorder (RBD) and manifestations of PD. Our aim was to perform an expanded extensive assessment of motor and nonmotor manifestations in PD to identify whether RBD was associated with differences in the nature and severity of these manifestations. PD patients underwent polysomnography (PSG) to diagnose the presence of RBD. Participants then underwent an extensive evaluation by a movement disorders specialist blinded to PSG results. Measures of disease severity, quantitative motor indices, motor subtypes, therapy complications, and autonomic, psychiatric, visual, and olfactory dysfunction were assessed and compared using regression analysis, adjusting for disease duration, age, and sex. Of 98 included patients, 54 had RBD and 44 did not. PD patients with RBD were older (P = 0.034) and were more likely to be male (P < 0.001). On regression analysis, the most consistent links between RBD and PD were a higher systolic blood pressure (BP) change while standing (−23.9 ± 13.9 versus −3.5 ± 10.9; P < 0.001), a higher orthostatic symptom score (0.89 ± 0.82 versus 0.44 ± 0.66; P = 0.003), and a higher frequency of freezing (43% versus14%; P = 0.011). A systolic BP drop >10 could identify PD patients with RBD with 81% sensitivity and 86% specificity. In addition, there was a probable relationship between RBD and nontremor predominant subtype of PD (P = 0.04), increased frequency of falls (P = 0.009), and depression (P = 0.009). Our results support previous findings that RBD is a multifaceted phenomenon in PD. Patients with PD who have RBD tend to have specific motor and nonmotor manifestations, especially orthostatic hypotension. © 2012 Movement Disorder Society

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