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Prevalence of REM sleep behavior disorder in multiple system atrophy: a multicenter study and meta-analysis

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Abstract

Objective

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia frequently affecting patients with synucleinopathies, but its exact prevalence in multiple system atrophy (MSA) is unclear. Whether questionnaires alone are sufficient to diagnose RBD is also unknown.

Methods

We performed a cross-sectional study of patients with probable MSA from six academic centers in the US and Europe. RBD was ascertained clinically and with polysomnography; we also performed a meta-analysis according to PRISMA guidelines for studies published before September 2014 that reported the prevalence of RBD in MSA. A random-effects model was constructed using weighted prevalence proportions. Only articles in English were included. Studies were classified into those that ascertained the presence of RBD in MSA clinically and with polysomnography. Case reports or case series (≤5 patients) were not included.

Results

Forty-two patients completed questionnaires and underwent polysomnography. Of those, 32 (76.1 %) had clinically suspected RBD and 34 (81 %) had polysomnography-confirmed RBD. Two patients reported no symptoms of RBD but had polysomnography-confirmed RBD. The primary search strategy yielded 374 articles of which 12 met the inclusion criteria. The summary prevalence of clinically suspected RBD was 73 % (95 % CI, 62–84 %) in a combined sample of 324 MSA patients. The summary prevalence of polysomnography-confirmed RBD was 88 % (95 % CI, 79–94 %) in a combined sample of 217 MSA patients.

Interpretation

Polysomnography-confirmed RBD is present in up to 88 % of patients with MSA. RBD was present in some patients that reported no symptoms. More than half of MSA patients report symptoms of RBD before the onset of motor deficits.

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Acknowledgments

This study was funded by the National Institutes of Health (U54NS065736).

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Authors and Affiliations

  1. Dysautonomia Center, Department of Neurology, New York University School of Medicine, 530 First Avenue, Suite 9Q, New York, NY, 10016, USA

    Jose-Alberto Palma & Horacio Kaufmann

  2. Sleep Unit, Clinical Neurophysiology Section, University Clinic of Navarra, Pamplona, Spain

    Clara Fernandez-Cordon, Elena Urrestarazu & Jorge Iriarte

  3. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Elizabeth A. Coon & Phillip A. Low

  4. Department of Neurology, Stanford University, Palo Alto, CA, USA

    Mitchell G. Miglis & Safwan Jaradeh

  5. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Arijit K. Bhaumik & Praveen Dayalu

  6. Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

    Italo Biaggioni

Authors
  1. Jose-Alberto Palma
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  2. Clara Fernandez-Cordon
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  3. Elizabeth A. Coon
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  9. Elena Urrestarazu
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Corresponding author

Correspondence to Jose-Alberto Palma.

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Palma, JA., Fernandez-Cordon, C., Coon, E.A. et al. Prevalence of REM sleep behavior disorder in multiple system atrophy: a multicenter study and meta-analysis. Clin Auton Res 25, 69–75 (2015). https://doi.org/10.1007/s10286-015-0279-9

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  • DOI: https://doi.org/10.1007/s10286-015-0279-9

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