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Investigating rapid eye movement sleep without atonia in Parkinson's disease using the rapid eye movement sleep behavior disorder screening questionnaire

Authors

  • Samuel J. Bolitho M.B.B.S,

    1. Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
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  • Sharon L. Naismith DPsych,

    1. Healthy Brain Aging Clinic, Aging Brain Centre, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
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  • Zoe Terpening DPsych,

    1. Healthy Brain Aging Clinic, Aging Brain Centre, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
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  • Ron R. Grunstein PhD,

    1. Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
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  • Kerri Melehan MRespSc,

    1. Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
    2. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW, Australia
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  • Brendon J. Yee PhD,

    1. Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
    2. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW, Australia
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  • Alessandra Coeytaux MD,

    1. Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
    2. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, NSW, Australia
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  • Moran Gilat MSc,

    1. Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
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  • Simon J.G. Lewis MD

    Corresponding author
    1. Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, Camperdown, NSW, Australia
    • Correspondence to: A/Prof. Simon J.G. Lewis, Parkinson's Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, 94-100 Mallett Street, Camperdown, NSW 2050, Australia; simonl@med.usyd.edu.au

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  • 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

Rapid eye movement (REM) sleep behavior disorder (RBD) is frequently observed in patients with Parkinson's disease (PD). Accurate diagnosis is essential for managing this condition. Furthermore, the emergence of idiopathic RBD in later life can represent a premotor feature, heralding the development of PD. Reliable, accurate methods for identifying RBD may offer a window for early intervention. This study sought to identify whether the RBD screening questionnaire (RBDSQ) and three questionnaires focused on dream enactment were able to correctly identify patients with REM without atonia (RWA), the neurophysiological hallmark of RBD. Forty-six patients with PD underwent neurological and sleep assessment in addition to completing the RBDSQ, the RBD single question (RBD1Q), and the Mayo Sleep Questionnaire (MSQ). The REM atonia index was derived for all participants as an objective measure of RWA. Patients identified to be RBD positive on the RBDSQ did not show increased RWA on polysomnography (80% sensitivity and 55% specificity). However, patients positive for RBD on questionnaires specific to dream enactment correctly identified higher degrees of RWA and improved the diagnostic accuracy of these questionnaires. This study suggests that the RBDSQ does not accurately identify RWA, essential for diagnosing RBD in PD. Furthermore, the results suggest that self-report measures of RBD need to focus questions on dream enactment behavior to better identify RWA and RBD. Further studies are needed to develop accurate determination and quantification of RWA in RBD to improve management of patients with PD in the future. © 2014 International Parkinson and Movement Disorder Society

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