Autonomic symptoms in idiopathic REM behavior disorder: a multicentre case–control study
- 843 Downloads
Patients with idiopathic REM sleep behavior disorder (iRBD) are at very high risk of developing neurodegenerative synucleinopathies, which are disorders with prominent autonomic dysfunction. Several studies have documented autonomic dysfunction in iRBD, but large-scale assessment of autonomic symptoms has never been systematically performed. Patients with polysomnography-confirmed iRBD (318 cases) and controls (137 healthy volunteers and 181 sleep center controls with sleep diagnoses other than RBD) were recruited from 13 neurological centers in 10 countries from 2008 to 2011. A validated scale to study the disorders of the autonomic nervous system in Parkinson's disease (PD) patients, the SCOPA-AUT, was administered to all the patients and controls. The SCOPA-AUT consists of 25 items assessing the following domains: gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual dysfunction. Our results show that compared to control subjects with a similar overall age and sex distribution, patients with iRBD experience significantly more problems with gastrointestinal, urinary, and cardiovascular functioning. The most prominent differences in severity of autonomic symptoms between our iRBD patients and controls emerged in the gastrointestinal domain. Interestingly, it has been reported that an altered gastrointestinal motility can predate the motor phase of PD. The cardiovascular domain SCOPA-AUT score in our study in iRBD patients was intermediate with respect to the scores reported in PD patients by other authors. Our findings underline the importance of collecting data on autonomic symptoms in iRBD. These data may be used in prospective studies for evaluating the risk of developing neurodegenerative disorders.
KeywordsREM sleep behavior disorder Autonomic function Parasomnia
Conflicts of interest
The authors report no disclosures relevant to the manuscript. L. Ferini-Strambi has received honoraria for serving on scientific advisory boards from UCB, Mundipharma, Menarini. Full financial disclosure for the previous 12 months W. Oertel has received honoraria for consultancy and for serving on scientific advisory boards; travel support from UCB; and honoraria for consultancy and lecture fees from Teva, Novartis, GlaxoSmithKline, Boehringer Ingelheim, Orion Pharma, and Merck Serono. Y. Dauvilliers has received funds for speaking and board engagements with UCB, Cephalon, Jazz, and Bioprojet. R.B. Postuma has received research funds from the Canadian Institute of Health Research, Fonds de la Recherche en Sante Quebec, The Webster Foundation, and the Drummond Foundation, as well as funds for travel and speaker fees from Novartis Canada and Teva Neurosciences. A. Iranzo had speaking and board engagements with UCB and Sanofi-Synthelabo. I Arnulf received honoraria for a speaking engagement and board from UCB Pharma. I. Arnulf received honoraria from UCB Pharma and Jazz for a speaking engagement and consultancy. B. Hogl has received honoraria for speaking, serving on an advisory board, or consulting from UCB, Mundipharma, BI, GSK, Respironics, Sanofi, Lundbeck, and Jazz; and a grant to institution from UCB, and travel support from Habel Medizintechnik and Vivisol, Austria. K. Sonka served on a scientific advisory board for UCB Pharma, received lecture fees from Ipsen, Pfizer, UCB Pharma, and GlaxoSmithKline, and participated in clinical trials managed by UCB Pharma, Bioprojet, and Eisai; and received research support from Charles University in Prague (PRVOUK P26/LF1/4). B. Frauscher has had speaking engagements with UCB and received a competitive research grant from the Austrian Science Fund (KLI 236), grant of the Nationalbank of Austria (15127). M. Unger received grants from the Micheal J. Fox Foundation for Parkinson’s Research and from the International Parkinson Fonds Germany. K. Stiasny-Kolster has received honoraria for serving on the scientific advisory boards for Boehringer Ingelheim, and UCB, and has received honoraria for speaking engagements sponsored by UCB and Boehringer Ingelheim. J. Montplaisir received funds from Merck and GlaxoSmithKline, and has received honoraria for consultancy from Jazz, Merck, Valeant, Servier, and Impac laboratories. S. Marelli, R. Manni, T. Miyamoto, M.L. Fantini, M. Puligheddu, P. Jennum, J. Santamaria, M. Zucconi, M.V·P. Rancoita, S. Leu-Semenesceu, M. Terzaghi, M. Miyamoto, A. Desautels, C. Wolfson, and A. Pelletier have nothing to disclose.
Each sleep center obtained approval from its local institutional review board.
- 4.Iranzo A, Tolosa E, Gelpi E, Molinuevo JL, Valldeoriola F, Serradell M, Sanchez-Valle R, Vilaseca I, Lomeña F, Vilas D, Lladó A, Gaig C, Santamaria J (2013) Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol 12:443–453CrossRefPubMedGoogle Scholar
- 13.American Academy of Sleep Disorders (2005) International Classification of Sleep Disorders–2. American Academy of Sleep Disorders, WestchesterGoogle Scholar
- 25.Labate A, Salsone M, Novellino F, Morelli M, Sturniolo M, Gambardella A, Quattrone A (2011) Combined use of cardiac m-i123-iodobenzylguanidine scintigraphy and (1)(2)(3)I-fp-cit single photon emission computed tomography in older adults with rapid eye movement sleep behavior disorder. J Am Geriatr Soc 59:928–929CrossRefPubMedGoogle Scholar
- 34.Nihei K, Takahashi A, Koto B, Mihara B, Morita Y, Isozumi K, Ohta K, Muramatsu K, Gotoh J, Yamaguchi K, Tomita Y, Sato H, Seki M, Iwasawa S, Suzuki N (2012) REM sleep behavior disorder in Japanese patients with Parkinson’s disease: a multicenter study using the REM sleep behavior disorder screening questionnaire. J Neurol 259:1606–1612CrossRefPubMedGoogle Scholar
- 35.Unger MM, Möller JC, Mankel K, Schmittinger K, Eggert KM, Stamelou M, Stiasny-Kolster K, Bohne K, Bodden M, Mayer G, Oertel WH, Tebbe JJ (2011) Patients with idiopathic rapid-eye-movement sleep behavior disorder show normal gastric motility assessed by the 13C-octanoate breath test. Mov Disord 26:2559–2563CrossRefPubMedGoogle Scholar
- 36.Unger MM, Möller JC, Mankel K, Eggert KM, Bohne K, Bodden M, Stiasny-Kolster K, Kann PH, Mayer G, Tebbe JJ, Oertel WH (2011) Postprandial ghrelin response is reduced in patients with Parkinson’s disease and idiopathic REM sleep behaviour disorder: a peripheral biomarker for early Parkinson’s disease? J Neurol 258:982–990CrossRefPubMedGoogle Scholar