Pilot quantitative analyses of rem sleep without atonia in children and adolescents with rem sleep behavior disorder

Hancock, K.; McCarter, Stuart J.; Louis, E. St.; Kotagal, Suresh; Lloyd, Robin M.; Boeve, Bradley F.

doi:10.1016/j.sleep.2013.11.339

Cited by 4 publications

(7 citation statements)

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“…29 Most of the cases presented in the review were associated with narcolepsy, medication use, or anatomical abnormalities of the hindbrain (e.g., tumors or trauma). 5 A handful of cases were attributed to a neurological condition or the neuropsychiatric state of the child, including one case each of juvenile Parkinson disease, autism, Tourette syndrome, Smith-Magenis syndrome, and Moebius syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that phasic muscle density increased with age in their cohort and that the earliest sign of RSWA found was an increase in phasic burst duration in the anterior tibialis. 29 This approach takes an important step toward rigorous study of muscle activity during REM sleep across normal and abnormal development, and future longitudinal examination of these types of measures will further illuminate how abnormalities may relate to pathology.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Gaughan

Buckley

Hommer

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: Polysomnographic investigation of sleep architecture in children presenting with pediatric acute-onset neuropsychiatric syndrome (PANS). Methods: Fifteen consecutive subjects meeting criteria for PANS (mean age = 7.2 y; range 3-10 y) underwent single-night full polysomnography (PSG) read by a pediatric neurologist. Results: Thirteen of 15 subjects (87%) had abnormalities detected with PSG. Twelve of 15 had evidence of rapid eye movement (REM) sleep motor disinhibition, as characterized by excessive movement, laughing, hand stereotypies, moaning, or the continuation of periodic limb movements during sleep (PLMS) into REM sleep. Conclusions: This study shows various forms of REM sleep motor disinhibition present in a population of children with PANS. Keywords: obsessive compulsive disorder, PANS, polysomnography, REM sleep behavior disorder Citation: Gaughan T, Buckley A, Hommer R, Grant P; Williams K, Leckman JF, Swedo SE. Rapid eye movement sleep abnormalities in children with pediatric acute-onset neuropsychiatric syndrome (PANS). J Clin Sleep Med 2016;12(7):1027-1032. I NTRO DUCTI O N Schenck et al.1 were the first to suggest that rapid eye movement (REM) sleep neurobehavioral disorders were a separate category of parasomnia in a 1986 case series of four males aged 67-72 y. Polysomnography (PSG) of these four subjects showed a loss of chin atonia and high limb-twitch activity among other REM sleep pathology, whereas videography showed various REM sleep behaviors including punching, kicking, and dream enactment.1 Since then, REM sleep behavior disorder (RBD) has been recognized across a wide range of ages, sometimes decades prior to the onset of other neurobehavioral changes and often heralding serious neurodegenerative conditions affecting synuclein.2 A recent retrospective study of patients showing REM sleep without atonia on PSG found a majority (73%) of patients had idiopathic RBD, defined as RBD in the absence of known neurological or sleep disorders.3 Recent reports suggest that clinical and subclinical forms of RBD occur in children and adolescents.4 Although pediatric RBD is considered to be a rare occurrence, its prevalence may be underestimated due to limited awareness, overlap with other parasomnias, and the requirement of nocturnal PSG for diagnosis.4,5 Additionally, it is unclear whether or not the adult clinical definitions should pertain to pediatric presentations due to a current lack of neuropathologic studies of childhood RBD.4 Differentiating RBD from other parasomnias in the younger population is significant clinically because of the potential to inform on neuropsychiatric state and therefore guide treatment choices, as evidenced in conditions such as narcolepsy where 60% of patients will have RBD. In adult psychiatric populations, RBD has been associated with the use of psychotropic medications and particularly with serotonin reuptake-blocking antidepressants.3,7 However, a recent study suggests that antidepressants cannot fully explain RBD symptomatology in their psychiat...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Gaughan

Buckley

Hommer

et al. 2016

Journal of Clinical Sleep Medicine

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“…15 Rapid eye movement sleep behavior disorder usually onsets in the fifth or sixth decade, although it may be seen in younger patients with antidepressant use, narcolepsy, autoimmunity, or developmental disorders. 15,18–21 Risk factors for RBD are similar to Parkinson disease (PD), including lower educational level, previous head injury, occupational pesticide exposure, and farming, yet some distinct risk factors have also been reported, including smoking, ischemic heart disease, and inhaled corticosteroids, 22,23 whereas caffeine use and smoking are not protective in RBD.…”

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confidence: 99%

“…10,12,15,18,21,23–32 In both idiopathic and symptomatic categories, RBD is strongly associated with neurodegenerative diseases, especially synucleinopathies including PD, dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and pure autonomic failure. 1,10,12,24–28,31,33–41 Rapid eye movement sleep behavior disorder may manifest initially as an idiopathic prodromal state that occurs years to decades before the evolution of overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy.…”

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confidence: 99%

REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

Louis

Boeve

2017

Mayo Clinic Proceedings

161

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Rapid eye movement sleep behavior disorder (RBD) is diagnosed by a clinical history of dream enactment accompanied by polysomnographic rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia). Rapid eye movement sleep behavior disorder is strongly associated with neurodegenerative disease, especially synucleinopathies such as Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. A history of RBD may begin several years to decades before onset of any clear daytime symptoms of motor, cognitive, or autonomic impairments, suggesting that RBD is the presenting manifestation of a neurodegenerative process. Evidence that RBD is a synlucleinopathy includes the frequent presence of subtle prodromal neurodegenerative abnormalities including hyposmia, constipation, and orthostatic hypotension, as well as abnormalities on various neuroimaging, neurophysiological, and autonomic tests. Up to 90.9% of patients with idiopathic RBD ultimately develop a defined neurodegenerative disease over longitudinal follow-up, although the prognosis for younger patients and antidepressant-associated RBD is less clear. Patients with RBD should be treated with either melatonin 3 to 12 mg or clonazepam 0.5 to 2.0 mg to reduce injury potential. Prospective outcome and treatment studies of RBD are necessary to enable accurate prognosis and better evidence for symptomatic therapy and future neuroprotective strategies.

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“…When RBD is unassociated with other overt neurological impairments, it is known as idiopathic RBD. RBD may also be symptomatic and related to several underlying definable etiologies including synucleinopathies and other neurodegenerative diseases, autoimmune/inflammatory disorders, brain lesions, or medication‐induced cases . RBD is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and pure autonomic failure (PAF) .…”

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confidence: 99%

REMSleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies

2017

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Rapid eye movement sleep behavior disorder is characterized by dream enactment and complex motor behaviors during rapid eye movement sleep and rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia) during polysomnography. Rapid eye movement sleep behavior disorder may be idiopathic or symptomatic and in both settings is highly associated with synucleinopathy neurodegeneration, especially Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. Rapid eye movement sleep behavior disorder frequently manifests years to decades prior to overt motor, cognitive, or autonomic impairments as the presenting manifestation of synucleinopathy, along with other subtler prodromal "soft" signs of hyposmia, constipation, and orthostatic hypotension. Between 35% and 91.9% of patients initially diagnosed with idiopathic rapid eye movement sleep behavior disorder at a sleep center later develop a defined neurodegenerative disease. Less is known about the long-term prognosis of community-dwelling younger patients, especially women, and rapid eye movement sleep behavior disorder associated with antidepressant medications. Patients with rapid eye movement sleep behavior disorder are frequently prone to sleep-related injuries and should be treated to prevent injury with either melatonin 3-12 mg or clonazepam 0.5-2.0 mg to limit injury potential. Further evidence-based studies about rapid eye movement sleep behavior disorder are greatly needed, both to enable accurate prognostic prediction of end synucleinopathy phenotypes for individual patients and to support the application of symptomatic and neuroprotective therapies. Rapid eye movement sleep behavior disorder as a prodromal synucleinopathy represents a defined time point at which neuroprotective therapies could potentially be applied for the prevention of Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, and pure autonomic failure. © 2017 International Parkinson and Movement Disorder Society.

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Pilot quantitative analyses of rem sleep without atonia in children and adolescents with rem sleep behavior disorder

Cited by 4 publications

References 0 publications

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)

REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

REMSleep Behavior Disorder in Parkinson's Disease and Other Synucleinopathies

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