Abstract
BackgroundRapid eye movement (REM) sleep behavior disorder (RBD) is a common parasomnia in Parkinson’s disease (PD) patients. The current International Classification of Sleep Disorders (ICSD-II) requires a clinical interview combined with video polysomnography (video-PSG) to diagnose. The latter is time consuming and expensive and not always feasible in clinical practice. Here we studied the use of actigraphy as a diagnostic tool for RBD in PD patients.MethodsWe studied 45 consecutive PD patients (66.7% men) with and without complaints of RBD. All patients underwent one night of video-PSG and eight consecutive nights of actigraphy. Based on previous studies, the main outcome measure was the total number of bouts classified as “wake”, compared between patients with (PD + RBD) and without RBD (PD- RBD).Results23 (51.1%) patients had RBD according to the ICSD-II criteria. The total number of wake bouts was significantly higher in RBD patients (PD + RBD 73.2 ± 40.2 vs. PD-RBD 48.4 ± 23.3, p = .016). A cut off of 95 wake bouts per night resulted in a specificity of 95.5%, a sensitivity of 20.1% and a positive predictive value of 85.7%. Seven patients were suspected of RBD based on the interview alone, but not confirmed on PSG; six of whom scored below 95 wake bouts per night on actigraphy.ConclusionPD patients with RBD showed a significantly higher number of bouts scored as “wake” using actigraphy, compared to patients without RBD. In clinical practice, actigraphy has a high specificity, but low sensitivity in the diagnosis of RBD. The combination of actigraphy and previously reported RBD questionnaires may be a promising method to diagnose RBD in patients with PD.
Highlights
Rapid eye movement (REM) sleep behavior disorder (RBD) is a common parasomnia in Parkinson’s disease (PD) patients
At Kempenhaeghe, PD patients with sleep complaints are seen in a dedicated program, including an extensive clinical consultation followed by attended video-PSG that night
Nine patients were excluded from the analysis, one because of technical problems and eight because they had less than 10 minutes of REM sleep during the PSG
Summary
Rapid eye movement (REM) sleep behavior disorder (RBD) is a common parasomnia in Parkinson’s disease (PD) patients. The current International Classification of Sleep Disorders (ICSD-II) requires a clinical interview combined with video polysomnography (video-PSG) to diagnose. Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia that occurs frequently in patients with Parkinson’s disease (PD), with an estimated prevalence of 30-60% [1,2,3]. To make a diagnosis of RBD, the current 2nd edition of the International Classification of Sleep Disorders (ICSD-II) requires the combination of clinical features (either by history or on nocturnal video recordings) and the presence of REM sleep without atonia as an electromyographic (EMG) finding during sleep recordings (Table 1) [5]. Referring every PD patient with complaints of nocturnal restlessness to a sleep medicine
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