Comorbid neuropsychiatric and autonomic features in REM sleep behavior disorder

Abstract

Objective Our aim is to define the extent of comorbidities in order to improve clinical care of patients with idiopathic rapid eye movement sleep behavior disorder (iRBD) utilizing the REM Sleep Behavior Disorder Associations with Parkinson's Disease Study (RAPiDS) cohort. Methods Consecutive adult study participants with iRBD confirmed on polysomnogram (PSG) were prospectively recruited from the Weill Cornell Center for Sleep Medicine. Evaluations comprised multiple facets of sleep, neurological, autonomic, and psychiatric function. Results Participants evaluated included 30 individuals with iRBD, with mean 1.5 ± 2.3 years from PSG to neuropsychiatric evaluation. Mean age was 59.5 ± 16.0 years at time of PSG, and 6/30 were women. Urinary difficulties were reported in 14/30 (47%): slight 7 (23%), mild 4 (13%), moderate 2 (7%), and severe 1 (3.0%). Ten out of 29 (34%) had abnormal Montreal Cognitive Assessment (MoCA) scores and the mean was 26.5 ± 3.2. The distribution of MoCA scores was significantly associated with urinary problems insofar as the more severe urinary problems were, the lower the MoCA scores (p = 0.04). Conclusions In this RAPiDS cohort, we detected an unexpectedly high occurrence of non-motor dysfunction. Our results point to the need for screening patients with iRBD for complaints that are actionable, for example those affecting mood, cognition, urinary function, and bowel function. We propose the term RBD+ to be used to identify such individuals. For the quality of life in patients diagnosed with RBD, a closer look by the clinician should be enacted, with appropriate referrals and workup.

Neurologic and psychiatric features of impending neurodegeneration in iRBD

“…The findings of our cohort lend credence to the notion that subjects with iRBD are not all the same; the presence of additional signs and symptoms (i.e. “RBD+” as was previously described [5] ) may aid in future efforts to determine which of these subjects might benefit the most from potential neuroprotection.…”

“…1. ) on the psychiatric, autonomic, and sleep impact of iRBD in a cross-sectional fashion [5] ; here, we prospectively evaluate ( Table 1 ) neurologic and psychiatric aspects of patients with iRBD, in an attempt to determine what factors are prominent in those who undergo phenoconversion as opposed to those who do not. The aim is to add to the current literature, and to establish a more robust understanding of what signs and symptoms may be particularly important in both clinical and research settings.…”

“…We analyzed data from the “REM Sleep Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS)” cohort (described previously [5] ) both at baseline and then at follow-up evaluations utilizing multiple neurologic batteries. Our report complements the current literature by confirming the utility of said batteries, examining the usage of additional, inexpensive testing, and demonstrating the unique differences among subjects with iRBD.…”

Sleep apnea and autonomic dysfunction in patients with dementia

“…Sleep related hypertension secondary to bruxism is thought to be due to ongoing microarousals, leading to increased sympathetic activity ( Lee et al, 2016 ; Postuma et al, 2019 ). Hypertension in narcolepsy patients is due to unknown causes but may be due to ongoing sleep arousals or deficiency in orexin, leading to changes in autonomic regulation ( Ferini-Strambi et al, 2005 ; Kolla and Mansukhani, 2014 ; Barone et al, 2020 ).…”

Dream enactment behavior—a real nightmare: a review of post-traumatic stress disorder, REM sleep behavior disorder, and trauma-associated sleep disorder

“…9 Of particular importance is that medications such as selective serotonin reuptake inhibitors, selective norepinephrine reuptake inhibitors, and tricyclic antidepressants are frequently used in patients with PTSD and TBI, and at this time it is not clear if the higher rate of RSWA and RBD in PTSD and TASD is independent of antidepressants or not. Expanded studies looking into the relationship between PTSD and RBD, and RBD in general, 69,70 will help answer this question.…”