Sleep and Biological Rhythms

, Volume 17, Issue 1, pp 113–122 | Cite as

REM sleep behavior disorder in patients with Parkinson’s disease: clinical and polysomnographic characteristics

  • Manoel Alves Sobreira-NetoEmail author
  • Márcio Alexandre Pena-Pereira
  • Emmanuelle Silva Tavares Sobreira
  • Marcos Hortes Nisihara Chagas
  • Carlos Maurício Oliveira de Almeida
  • Regina Maria França Fernandes
  • Vitor Tumas
  • Alan Luiz Eckeli
Original Article


The objectives of this study were to describe the characteristics of RBD in a group of PD patients and verify the accuracy of the clinical interview in this group, determine the causes of failure of the interview, as well as to verify the clinical and polysomnographic differences between the groups of PD patients with and without RBD. So, a cross-sectional study was conducted in 88 consecutive PD patients from the outpatient clinic, during a period of 21 months. Participants underwent a clinical interview, assessment based on standardized scales (Epworth Sleepiness Scale, Parkinson’s disease Questionnaire, Pittsburgh Sleep Quality Index), and video polysomnography. Out of the 88 participants, 55 underwent vPSG which confirmed a diagnosis of RBD. The clinical interview had a high sensitivity (87.5%) but a low specificity (42.1%) for RBD diagnosis and thus the clinical interview alone may miss those without episodes of dream-enacting behavior. We note in this group a higher proportion of men (54.5%) and an average age of 60.4 years ± 10.6. In 54% of patients, RBD preceded motor symptoms of PD. In addition, patients with PD and RBD had lower Apnea–Hypopnea Index in REM sleep and a higher equivalent dose of levodopa than PD patients without RBD. RBD is a prevalent condition in patients with PD, requiring polysomnography for diagnostic confirmation, and is associated with certain particularities in PD.


Parkinson disease Sleep REM sleep REM sleep behavior disorder 



We are grateful to the patients with PD whose collaboration was essential to the success of this study.

Compliance with ethical standards

Ethical Committee Permission

This study was approved by the Ethics Committee of Clinical Hospital of Faculty of Medicine of Ribeirão Preto—University of São Paulo, under the protocol number 13410.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. American Academy of Sleep Medicine; 2005.Google Scholar
  2. 2.
    Iranzo A, Santamaria J, Tolosa E. The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. Sleep Med Rev. 2009;13(6):385–401CrossRefGoogle Scholar
  3. 3.
    Mahowald MW, Schenck CH. REM sleep parasomnias. In: Kryger M, Roth T, Dement W, editors. Principles and practice of sleep medicine. Philadelphia, PA: WB Saunders; 2005. p. 897–916.CrossRefGoogle Scholar
  4. 4.
    American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Westchester: American Academy of Sleep Medicine; 2013.Google Scholar
  5. 5.
    Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med. 2013;14(8):744–8.CrossRefGoogle Scholar
  6. 6.
    Iranzo A, Tolosa E, Gelpi E, Molinuevo JL, Valldeoriola F, Serradell M, et al. Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behavior disorder: an observational cohort study. Lancet Neurol. 2013;12(5):443–53.CrossRefGoogle Scholar
  7. 7.
    Rye DB. Contributions of the pedunculopontine region to normal and altered REM sleep. Sleep. 1997;20(9):757–88.CrossRefGoogle Scholar
  8. 8.
    Hendricks JC, Morrison AR, Mann GL. Different behaviors during paradoxical sleep without atonia depend on pontine lesion site. Brain Res. 1982;6(1):81–105. 239(.CrossRefGoogle Scholar
  9. 9.
    Greene RW, Gerber U, McCarley RW. Cholinergic activation of medial pontine reticular formation neurons in vitro. Brain Res. 1989;476(1):154–9.CrossRefGoogle Scholar
  10. 10.
    Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behavior disorder and relevance to neurodegenerative disease. Brain. 2007;130(Pt 11):2770–88.CrossRefGoogle Scholar
  11. 11.
    Braak H, Del Tredici K, Rub U, de Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging. 2003;24(2):197–211.CrossRefGoogle Scholar
  12. 12.
    Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K. Stages in the development of Parkinson’s disease-related pathology. Cell Tissue Res. 2004;318(1):121–34.CrossRefGoogle Scholar
  13. 13.
    Sixel-Doring F, Trautmann E, Mollenhauer B, Trenkwalder C. Associated factors for REM sleep behavior disorder in Parkinson disease. Neurology. 2011;77(11):1048–54.CrossRefGoogle Scholar
  14. 14.
    Nomura T, Inoue Y, Kagimura T, Uemura Y, Nakashima K. Utility of the REM sleep behavior disorder screening questionnaire (RBDSQ) in Parkinson’s disease patients. Sleep Med. 2011;12(7):711–3.CrossRefGoogle Scholar
  15. 15.
    Comella CL, Nardine TM, Diederich NJ, Stebbins GT. Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson’s disease. Neurology. 1998;51(2):526–9.CrossRefGoogle Scholar
  16. 16.
    Sobreira-Neto MA, Pena-Pereira MA, Sobreira EST, Chagas MHN, Fernandes RMF, Tumas V, et al. High frequency of sleep disorders in Parkinson’s disease and its relationship with quality of life. Eur Neurol. 2017;78(5–6):330–7.CrossRefGoogle Scholar
  17. 17.
    Nomura T, Inoue Y, Kagimura T, Nakashima K. Clinical significance of REM sleep behavior disorder in Parkinson’s disease. Sleep Med. 2013;14(2):131–5.CrossRefGoogle Scholar
  18. 18.
    Postuma RB, Gagnon JF, Vendette M, Charland K, Montplaisir J. Manifestations of Parkinson disease differ in association with REM sleep behavior disorder. Mov Disord. 2008;23(12):1665–72.CrossRefGoogle Scholar
  19. 19.
    Romenets SR, Gagnon JF, Latreille V, Panniset M, Chouinard S, Montplaisir J, et al. Rapid eye movement sleep behavior disorder and subtypes of Parkinson’s disease. Mov Disord. 2012;27(8):996–1003.CrossRefGoogle Scholar
  20. 20.
    Del-Ben C, Vilela J, Crippa J, Hallak J, Labate C, Zuardi A. Test-retest reliability of the structured clinical interview for DSM-IV—clinical version (SCID-CV) translated into portuguese. Revista Brasileira de Psiquiatria. 2001;23:156–9.CrossRefGoogle Scholar
  21. 21.
    Iber C, Ancoli-Israel S, Chesson AL, Quan SF. The AASM manual for scoring of sleep and associated events. 1st ed. Westchester: American Academy of Sleep Medicine; 2007.Google Scholar
  22. 22.
    Peregrim I, Gresova S, Pallayova M, Fulton BL, Stimmelova J, Bacova I, et al. Does obstructive sleep apnea worsen during REM sleep? Physiol Res (Academia Scientiarum Bohemoslovaca). 2013;62(5):569–75.Google Scholar
  23. 23.
    Huang J, Zhang J, Lam SP, Li SX, Ho CK, Lam V, et al. Amelioration of obstructive sleep apnea in REM sleep behavior disorder: implications for the neuromuscular control of OSA. Sleep. 2011;34(7):909–15.CrossRefGoogle Scholar
  24. 24.
    Cochen De Cock V, Abouda M, Leu S, Oudiette D, Roze E, Vidailhet M, et al. Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Med. 2010;11(3):247–52.CrossRefGoogle Scholar
  25. 25.
    Yoritaka A, Ohizumi H, Tanaka S, Hattori N. Parkinson’s disease with and without REM sleep behaviour disorder: are there any clinical differences? Eur Neurol. 2009;61(3):164–70.CrossRefGoogle Scholar
  26. 26.
    Plomhause L, Dujardin K, Duhamel A, Delliaux M, Derambure P, Defebvre L, et al. Rapid eye movement sleep behavior disorder in treatment-naive Parkinson disease patients. Sleep Med. 2013;14(10):1035–7.CrossRefGoogle Scholar
  27. 27.
    Suzuki K, Miyamoto T, Miyamoto M, Watanabe Y, Suzuki S, Tatsumoto M, et al. Probable rapid eye movement sleep behavior disorder, nocturnal disturbances and quality of life in patients with Parkinson’s disease: a case–controlled study using the rapid eye movement sleep behavior disorder screening questionnaire. BMC Neurol. 2013;13:18.CrossRefGoogle Scholar
  28. 28.
    Rolinski M, Szewczyk-Krolikowski K, Tomlinson PR, Nithi K, Talbot K, Ben-Shlomo Y, et al. REM sleep behaviour disorder is associated with worse quality of life and other non-motor features in early Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2014;85(5):560–6.CrossRefGoogle Scholar
  29. 29.
    Benninger DH, Michel J, Waldvogel D, Candia V, Poryazova R, van Hedel HJ, et al. REM sleep behavior disorder is not linked to postural instability and gait dysfunction in Parkinson. Mov Disord. 2010;25(11):1597–604.CrossRefGoogle Scholar
  30. 30.
    Ferri R, Cosentino FI, Pizza F, Arico D, Plazzi G. The timing between REM sleep behavior disorder and Parkinson’s disease. Sleep Breath (Schlaf & Atmung). 2014;18(2):319–23.CrossRefGoogle Scholar
  31. 31.
    De Cock VC, Vidailhet M, Leu S, Texeira A, Apartis E, Elbaz A, et al. Restoration of normal motor control in Parkinson’s disease during REM sleep. Brain. 2007;130(Pt 2):450–6.CrossRefGoogle Scholar
  32. 32.
    Frauscher B, Gschliesser V, Brandauer E, Marti I, Furtner MT, Ulmer H, et al. REM sleep behavior disorder in 703 sleep-disorder patients: the importance of eliciting a comprehensive sleep history. Sleep Med. 2010;11(2):167–71.CrossRefGoogle Scholar
  33. 33.
    Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep. 2005;28(2):203–6.CrossRefGoogle Scholar
  34. 34.
    Mahale R, Yadav R, Pal PK. Rapid eye movement sleep behaviour disorder in young- and older-onset Parkinson disease: a questionnaire-based study. Sleep Med. 2014;15(6):642–6.CrossRefGoogle Scholar
  35. 35.
    Bugalho P, Paiva T. Dream features in the early stages of Parkinson’s disease. J Neural Transm. 2011;118(11):1613–9.CrossRefGoogle Scholar
  36. 36.
    Nausieda PA, Weiner WJ, Kaplan LR, Weber S, Klawans HL. Sleep disruption in the course of chronic levodopa therapy: an early feature of the levodopa psychosis. Clin Neuropharmacol. 1982;5(2):183–94.CrossRefGoogle Scholar
  37. 37.
    Fernandez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep. 2016;39(1):121–32.CrossRefGoogle Scholar
  38. 38.
    Oudiette D, De Cock VC, Lavault S, Leu S, Vidailhet M, Arnulf I. Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology. 2009;72(6):551–7.CrossRefGoogle Scholar
  39. 39.
    Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain. 2000;123(Pt 2):331–9.CrossRefGoogle Scholar
  40. 40.
    Dauvilliers Y, Boudousq V, Lopez R, Gabelle A, De Cock VC, Bayard S, et al. Increased perfusion in supplementary motor area during a REM sleep behaviour episode. Sleep Med. 2014;12(5):531–2.Google Scholar

Copyright information

© Japanese Society of Sleep Research 2018

Authors and Affiliations

  • Manoel Alves Sobreira-Neto
    • 1
    • 2
    Email author
  • Márcio Alexandre Pena-Pereira
    • 3
  • Emmanuelle Silva Tavares Sobreira
    • 3
  • Marcos Hortes Nisihara Chagas
    • 4
  • Carlos Maurício Oliveira de Almeida
    • 3
  • Regina Maria França Fernandes
    • 3
  • Vitor Tumas
    • 3
  • Alan Luiz Eckeli
    • 3
  1. 1.Department of Clinical Medicine, Faculty of Medicine of FederalUniversity of CearáFortalezaBrazil
  2. 2.Faculty of MedicineUniversity of FortalezaFortalezaBrazil
  3. 3.Department of Neuroscience, Faculty of Medicine of Ribeirão PretoUniversity of São PauloSão PauloBrazil
  4. 4.Department of GerontologyFederal University of São CarlosSão CarlosBrazil

Personalised recommendations