Compromised Dynamic Cerebral Autoregulation in Patients With Idiopathic Rapid Eye Movement Behavior Disorder: A Case-Control Study Using Transcranial Doppler.

Zhen‐Ni Guo ,Zan Wang,Yi Yang ,Hang Jin,Meiyan Jia,Xin Sun,Fang Deng ,Lv Y ,Shan Lv ,Jia Liu

doi:10.3389/fpsyt.2020.00051

Abstract

BackgroundPatients with idiopathic rapid eye movement behavior disorder (IRBD) have been suggested to exhibit altered cerebral perfusion and abnormal cerebral blood flow, which imply a possibility of cerebral autoregulation (CA) impairment. We aimed to investigate the dynamic CA (dCA) in patients with IRBD during wakefulness and to explore the correlations between dCA parameters and clinical measurements.MethodsWe assessed the dCA capability of 30 patients with IRBD and 36 sex- and age-matched healthy controls by using transcranial Doppler and finger plethysmography. CA function was evaluated by transfer function analysis based on spontaneous oscillation of cerebral blood flow and arterial blood pressure. Transfer function parameters (phase difference and gain) were used to quantify the CA.ResultsNo significant differences were observed between the right and left middle cerebral artery dCA parameters (phase difference and gain) of both groups. Patients with IRBD had significantly lower phase difference than the healthy controls, indicating their impaired CA capability. Besides, the value of gain in patients with IRBD was higher than the healthy controls, but the difference did not reach statistical level.ConclusionsCA function is compromised in patients with IRBD during wakefulness, which might be an intermediate link between IRBD and neurological symptoms.

Highlights

Idiopathic rapid eye movement (REM) sleep behavior disorder (IRBD) is a parasomnia characterized by loss of normal skeletal muscle atonia and dream-enacting behaviors during REM sleep, which affect 0.5% to 2% of the general populations and 5% to 13% of adults older than 60 years [1]
We hypothesized that Cerebral autoregulation (CA) is impaired in the patients with IRBD, which might be an intermediate link between IRBD and neurological symptoms related to cerebral perfusion alteration
The diagnostic criteria of IRBD were according to the International Classification of Sleep Disorders, 3rd Edition: [1] repeated episodes of behavior or vocalization that are either documented by polysomnography (PSG) to arise from REM or are presumed to arise from REM based on reports of dream enactment, and [2] evidence of REM sleep without atonia (RSWA) on PSG [10]

Summary

Introduction

Idiopathic rapid eye movement (REM) sleep behavior disorder (IRBD) is a parasomnia characterized by loss of normal skeletal muscle atonia and dream-enacting behaviors during REM sleep, which affect 0.5% to 2% of the general populations and 5% to 13% of adults older than 60 years [1]. It has been demonstrated that patients with IRBD have abnormal brain perfusion [2,3,4], which is associated with neurological symptoms such as cognitive impairment [5], as well as markers of neurodegeneration [4]. This abnormality probably implies the disorder to maintain the mechanism for cerebral blood flow (CBF). Patients with idiopathic rapid eye movement behavior disorder (IRBD) have been suggested to exhibit altered cerebral perfusion and abnormal cerebral blood flow, which imply a possibility of cerebral autoregulation (CA) impairment. We aimed to investigate the dynamic CA (dCA) in patients with IRBD during wakefulness and to explore the correlations between dCA parameters and clinical measurements

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Conclusion