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Non-motor symptoms are associated with REM sleep behavior disorder in Parkinson’s disease: a systematic review and meta-analysis

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Abstract

Objective

Parkinson’s disease (PD) is usually accompanied by rapid eye movement sleep behavior disorder (RBD). A systematic review has concluded that motor manifestations are associated with RBD in PD patients, but whether the same is true of non-motor symptoms is unclear.

Methods

A systematic review and meta-analysis was conducted by searching studies related to PD and RBD in PubMed, Web of Science, Embase, and Cochrane databases. Data were pooled where appropriate and used to calculate odds ratios (ORs), mean differences (MDs), or standardized mean differences (SMDs) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic.

Results

PD patients with RBD were more likely to be male (OR 1.26, 95% CI 1.14–1.40) and older (MD 1.70 years, 95% CI 1.24–2.16) than those of patients without RBD. Patients with RBD were at a higher risk of non-motor symptoms such as constipation (OR 1.94, 95% CI 1.57–2.38), hallucination (OR 2.62, 95% CI 2.01–3.41), depression (SMD 0.39, 95% CI 0.25–0.53), and cognitive impairment (SMD − 0.29, 95% CI − 0.42 to − 0.17) based on standardized questionnaire scores. Similarly, PD patients with RBD suffered more severe motor symptoms and required higher doses of levodopa therapy.

Conclusions

The available evidence suggests that PD patients with RBD suffer severer non-motor and motor symptoms than those without RBD. A potential explanation is that PD patients with RBD present more diffuse neurodegeneration.

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Funding

This work was funded by the Basic Conditions Platform Construction Project of Sichuan Science and Technology Department (2019JDPT0015) and Sichuan Province Applied Basic Research Program (17ZD011).

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Authors and Affiliations

  1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Dan Xie, Qiuyan Shen, Junying Zhou & Yanming Xu

  2. Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Junying Zhou

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DX wrote the main manuscript. YMX provided the study idea. DX and QYS conducted article literature search and data extraction. DX and JYZ contributed to analyze and interpret the data. YMX and JYZ made critical comments and revision for the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Junying Zhou or Yanming Xu.

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Xie, D., Shen, Q., Zhou, J. et al. Non-motor symptoms are associated with REM sleep behavior disorder in Parkinson’s disease: a systematic review and meta-analysis. Neurol Sci 42, 47–60 (2021). https://doi.org/10.1007/s10072-020-04769-9

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