Journal of Neurology

, Volume 259, Issue 8, pp 1606–1612 | Cite as

REM sleep behavior disorder in Japanese patients with Parkinson’s disease: a multicenter study using the REM sleep behavior disorder screening questionnaire

  • Yoshihiro Nihei
  • Kazushi Takahashi
  • Atsuo Koto
  • Ban Mihara
  • Yoko Morita
  • Kazuo Isozumi
  • Kouichi Ohta
  • Kazuhiro Muramatsu
  • Jun Gotoh
  • Keiji Yamaguchi
  • Yutaka Tomita
  • Hideki Sato
  • Morinobu Seki
  • Satoko Iwasawa
  • Norihiro Suzuki
Original Communication


REM sleep behavior disorder (RBD) is known to be observed more frequently in patients with an α-synucleinopathy such as Parkinson’s disease (PD) than in the general population. The precise prevalence of RBD in Japanese PD patients is not known. Therefore, we investigated the prevalence and the clinical characteristics of patients with RBD in a large population of Japanese patients with PD. We investigated various clinical features and employed the Japanese version of the RBD screening questionnaire on 469 non-demented Japanese PD patients in this multicenter study. Probable or possible RBD was detected in 146 patients (31.1%) and was significantly associated with longer PD duration, higher Hoehn and Yahr stage, higher Unified Parkinson’s Disease Rating Scale part III subscale (7 items), more motor fluctuations, and a higher levodopa-equivalent daily dose (p < 0.01). As to the major autonomic dysfunctions, severe constipation was significantly more frequent in PD patients with RBD than in those without it (p < 0.01). The RBD symptoms of 53 patients (39.0%) preceded the onset of PD motor symptoms. The median interval from the onset of RBD symptoms to PD motor symptoms was 17.5 years, and 3 patients had intervals of over 50 years. This large-scale multicenter study revealed that RBD is a frequent non-motor symptom in Japanese patients with PD, which may precede the onset of motor symptoms. Moreover, RBD that increases with the duration and severity of PD may be associated with autonomic dysfunction.


Parkinson’s disease Japanese patients REM sleep behavior disorder RBD screening questionnaire Premotor symptoms 


Conflicts of interest


Supplementary material

415_2011_6386_MOESM1_ESM.pdf (85 kb)
Supplementary Table 1 (PDF 84 kb)


  1. 1.
    Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW (1986) Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 9:293–308PubMedGoogle Scholar
  2. 2.
    Ohayon MM, Schenck CH (2010) Violent behavior during sleep: prevalence, comorbidity and consequences. Sleep Med 11:941–946PubMedCrossRefGoogle Scholar
  3. 3.
    Ohayon MM, Caulet M, Priest RG (1997) Violent behavior during sleep. J Clin Psychiatry 58:369–376PubMedCrossRefGoogle Scholar
  4. 4.
    Chiu HF, Wing YK, Lam LC et al (2000) Sleep-related injury in the elderly: an epidemiological study in Hong Kong. Sleep 23:513–517PubMedGoogle Scholar
  5. 5.
    Gagnon JF, Postuma RB, Mazza S et al (2006) Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 5:424–432PubMedCrossRefGoogle Scholar
  6. 6.
    Boeve BF, Silber MH, Saper CB et al (2007) Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 130:2770–2788PubMedCrossRefGoogle Scholar
  7. 7.
    Gagnon JF, Bedard MA, Fantini ML et al (2002) REM sleep behavior disorder and REM sleep without atonia in Parkinson’s disease. Neurology 59:585–589PubMedCrossRefGoogle Scholar
  8. 8.
    Postuma RB, Gagnon JF, Vendette M et al (2009) Idiopathic REM sleep behavior disorder in the transition to degenerative disease. Mov Disord 15:2225–2232CrossRefGoogle Scholar
  9. 9.
    Claassen DO, Josephs KA, Ahrlskog JE, Silber MH, Tippmann-Peikert M, Boeve BF (2010) REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology 75:494–499PubMedCrossRefGoogle Scholar
  10. 10.
    Schenck CH, Budlie SR, Mahowald MW (2003) REM behavior disorder (RBD): delayed emergence of parkinsonism and/or dementia in 65% of older men initially diagnosed with idiopathic RBD, and analysis of the minimum and maximum tonic and/or phasic electromyographic abnormalities found during REM sleep. Sleep 26:A316Google Scholar
  11. 11.
    Iranzo A, Molinuevo JL, Santamaria J, Serradell M, Marti MJ et al (2006) Rapid-eye movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 5:572–577PubMedCrossRefGoogle Scholar
  12. 12.
    Schenck CH, Bundlie SR, Mahowald MW (1996) Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology 46:388–393PubMedCrossRefGoogle Scholar
  13. 13.
    Olson EJ, Boeve BF, Silber MH (2000) Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123:331–339PubMedCrossRefGoogle Scholar
  14. 14.
    American Academy of Sleep Medicine (2005) International classification of sleep disorders, 2nd edn. Diagnostic and coding manual. Westchester, Illinois, pp 177–180Google Scholar
  15. 15.
    Stiasny-Kolster K, Mayer G, Schäfer S et al (2007) The REM sleep behavior disorder screening questionnaire: a new diagnostic instrument. Mov Disord 22:2386–2393PubMedCrossRefGoogle Scholar
  16. 16.
    Miyamoto T, Miyamoto M, Iwanami M et al (2009) The REM sleep behavior disorder screening questionnaire: validation study of Japanese version. Sleep Med 10:1151–1154PubMedCrossRefGoogle Scholar
  17. 17.
    American Psychiatric Association Committee on Nomenclature, Statistics (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  18. 18.
    Hughes AJ, Daniel SE, Kilford L et al (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinio–pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184PubMedCrossRefGoogle Scholar
  19. 19.
    Stacy M, Hauser R (2007) Development of a patient questionnaire to facilitate recognition of motor and non-motor wearing-off in Parkinson’s disease. J Neural Transm 114:211–217PubMedCrossRefGoogle Scholar
  20. 20.
    Comella CL, Nardine TM, Diederich NJ, Stebbins GT (1998) Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson’s disease. Neurology 51:526–529PubMedCrossRefGoogle Scholar
  21. 21.
    Scaglione C, Vignatelli L, Plazzi G, Marchese R, Negrotti A, Bologna, Genova, Parma and Pisa Universities group for the study of REM sleep behavior disorder in Parkinson’s disease et al (2005) REM sleep behaviour disorder in Parkinson’s disease: a questionnaire-based study. Neurol Sci 25:316–321PubMedCrossRefGoogle Scholar
  22. 22.
    Sixel-Döring F, Trautmann E, Mollenhauer B, Trenkwalder C (2011) Associated factors for REM sleep behavior disorder in Parkinson disease. Neurology 77:1048–1054PubMedCrossRefGoogle Scholar
  23. 23.
    Ozekmekçi S, Apaydin H, Kiliç E (2005) Clinical features of 35 patients with Parkinson’s disease displaying REM behavior disorder. Clin Neurol Neurosury 107:306–309CrossRefGoogle Scholar
  24. 24.
    Postuma RB, Gagnon JF, Vendette M, Charland K, Montplaisir J (2008) REM sleep behaviour disorder in Parkinson’s disease is associated with specific motor features. J Neurol Neurosurg Psychiatry 79:1117–1121PubMedCrossRefGoogle Scholar
  25. 25.
    Sinforiani E, Pacchetti C, Zangaglia R, Pasotti C, Manni R, Nappi G (2008) REM behavior disorder, hallucinations and cognitive impairment in Parkinson’s disease: a two-year follow up. Mov Disord 23:1441–1445PubMedCrossRefGoogle Scholar
  26. 26.
    Onofrj M, Thomas A, D’Andreamatteo G, Iacono D, Luciano AL, Di Rollo A, Di Mascio R, Ballone E, Di Iorio A (2002) Incidence of RBD and hallucination in patients affected by Parkinson’s disease: 8-year follow-up. Neurol Sci 23(Suppl 2):S91–S94PubMedCrossRefGoogle Scholar
  27. 27.
    Pacchetti C, Manni R, Zangaglia R, Mancini F, Marchioni E, Tassorelli C, Terzaghi M, Ossola M, Martignoni E, Moglia A, Nappi G (2005) Relationship between hallucinations, delusions, and rapid eye movement sleep behavior disorder in Parkinson’s disease. Mov Disord 20:1439–1448PubMedCrossRefGoogle Scholar
  28. 28.
    Orimo S, Ozawa E, Nakade S, Sugimoto T, Mizusawa H (1999) 123I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson’s disease. J Neurol Neurosurg Psychiatry 67:189–194PubMedCrossRefGoogle Scholar
  29. 29.
    Miyamoto T, Miyamoto M, Inoue Y, Usui Y, Suzuki K, Hirata K (2006) Reduced cardiac 123I-MIBG scintigraphy in idiopathic REM sleep behavior disorder. Neurology 67:2236–2238PubMedCrossRefGoogle Scholar
  30. 30.
    Kashihara K, Imamura T, Shinya T (2010) Cardiac 123I-MIBG uptake is reduced more markedly in patients with REM sleep behavior disorder than in those with early stage Parkinson’s disease. Parkinsonism Relat Disord 16:252–255PubMedCrossRefGoogle Scholar
  31. 31.
    Kashihara K, Imamura T (2007) Reduced myocardial 123I-MIBG uptake in a patient with idiopathic rapid eye movement sleep behavior disorder. Mov Disord 22:150–151PubMedCrossRefGoogle Scholar
  32. 32.
    Koyama S, Tachibana N, Masaoka Y, Homma I, Kawamura M (2007) Decreased myocardial 123I-MIBG uptake and impaired facial expression recognition in a patient with REM sleep behavior disorder. Mov Disord 22:746–747PubMedCrossRefGoogle Scholar
  33. 33.
    Lanfranchi PA, Fradette L, Gagnon JF, Colombo R, Montplaisir J (2007) Cardiac autonomic regulation during sleep in idiopathic REM sleep behavior disorder. Sleep 30:1019–1025PubMedGoogle Scholar
  34. 34.
    Postuma RB, Lanfranchi PA, Blais H, Gagnon JF, Montplaisir JY (2010) Cardiac autonomic dysfunction in idiopathic REM sleep behavior disorder. Mov Disord 25:2304–2310PubMedCrossRefGoogle Scholar
  35. 35.
    Haapaniemi TH, Pursiainen V, Korpelainen JT, Huikuri HV, Sotaniemi KA, Myllyla VV (2001) Ambulatory ECG and analysis of heart rate variability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 70:305–310PubMedCrossRefGoogle Scholar
  36. 36.
    Postuma RB, Gagnon JF, Vendette M, Charland K, Montplaisir J (2008) Manifestations of Parkinson disease differ in association with REM sleep behavior disorder. Mov Disord 23:1665–1672PubMedCrossRefGoogle Scholar
  37. 37.
    Ferini-Strambi L, Oldani A, Zucconi M, Smirne S (1996) Cardiac autonomic activity during wakefulness and sleep in REM sleep behavior disorder. Sleep 19:367–369PubMedGoogle Scholar
  38. 38.
    Fantini ML, Michaud M, Gosselin N, Lavigne G, Montplaisir J (2002) Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 59:1889–1894PubMedCrossRefGoogle Scholar
  39. 39.
    Braak H, Del Tredici K, Rub U et al (2003) Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 24:197–211PubMedCrossRefGoogle Scholar
  40. 40.
    Schenck CH, Mahowald MW (1990) Polysomnographic, neurologic, psychiatric, and clinical outcome report on 70 consecutive cases with REM sleep behavior disorder (RBD): sustained clonazepam efficacy in 89.5% of 57 treated patients. Clevel Clin J Med 57:S9–S23Google Scholar
  41. 41.
    Lin FC, Lai CL, Huang P, Liu CK, Hsu CY (2009) The rapid-eye-movement sleep behavior disorder in Chinese–Taiwanese patients. Psychiatry Clin Neurosci 63:557–562PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Yoshihiro Nihei
    • 1
  • Kazushi Takahashi
    • 1
  • Atsuo Koto
    • 2
  • Ban Mihara
    • 3
  • Yoko Morita
    • 4
  • Kazuo Isozumi
    • 5
  • Kouichi Ohta
    • 6
  • Kazuhiro Muramatsu
    • 7
  • Jun Gotoh
    • 8
  • Keiji Yamaguchi
    • 9
  • Yutaka Tomita
    • 10
  • Hideki Sato
    • 11
  • Morinobu Seki
    • 1
  • Satoko Iwasawa
    • 12
  • Norihiro Suzuki
    • 1
  1. 1.Department of NeurologyKeio University School of MedicineTokyoJapan
  2. 2.Department of NeurologyYomiuri Land Keiyu HospitalTokyoJapan
  3. 3.Department of NeurologyMihara Memorial HospitalIsesakiJapan
  4. 4.Department of NeurologyNational Hospital Organization Tokyo Medical CenterTokyoJapan
  5. 5.Department of NeurologyAshikaga Red Cross HospitalAshikagaJapan
  6. 6.Department of NeurologyTachikawa HospitalTokyoJapan
  7. 7.Department of NeurologySaiseikai Yokohama-city Eastern HospitalYokohamaJapan
  8. 8.Department of NeurologySaiseikai Central HospitalTokyoJapan
  9. 9.Department of NeurologyMito Red Cross HospitalMitoJapan
  10. 10.Department of NeurologyTomita HospitalOkazakiJapan
  11. 11.Department of NeurologySaitama Municipal HospitalMidori-kuJapan
  12. 12.Department of Preventive Medicine and Public HealthKeio University School of MedicineTokyoJapan

Personalised recommendations