REM sleep muscle activity in idiopathic REM sleep behavior disorder predicts phenoconversion.

Autor:	McCarter SJ; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Sandness DJ; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., McCarter AR; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Feemster JC; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Teigen LN; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Timm PC; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Boeve BF; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., Silber MH; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN., St Louis EK; From the Mayo Center for Sleep Medicine, Departments of Neurology, and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN. stlouis.erik@mayo.edu.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2019 Sep 17; Vol. 93 (12), pp. e1171-e1179. Date of Electronic Publication: 2019 Aug 16.
DOI:	10.1212/WNL.0000000000008127
Abstrakt:	Objective: To determine whether REM sleep without atonia (RSWA) during polysomnography (PSG) predicts phenoconversion in patients with idiopathic REM sleep behavior disorder (iRBD), a prodromal feature of a neurodegenerative disease. Methods: We analyzed RSWA in 60 patients with iRBD, including manual phasic, tonic, and any muscle activity in the submentalis and anterior tibialis muscles and the automated REM atonia index in the submentals. We identified patients who developed parkinsonism or mild cognitive impairment (MCI) during at least 3 years of follow-up after PSG. Kaplan-Meier analysis was performed and receiver operator curves were calculated to determine RSWA cutoffs predicting faster phenoconversion. Results: Twenty-six (43%) patients developed parkinsonism (n = 17) or MCI (n = 9). Phenoconverters were older at iRBD diagnosis ( p = 0.02). Median time to phenoconversion was 3.9 ± 2.5 years. iRBD phenoconverters had significantly more RSWA at diagnosis. Phenoconversion risk from iRBD diagnosis was 20% and 35% at 3 and 5 years, respectively, with greater risk in patients with iRBD with >46.4% any combined RSWA, which increased further to 30% and 55% at 3 and 5 years for patients >65 years of age at diagnosis. Conclusions: Patients with iRBD with higher amounts of polysomnographic RSWA had a greater risk of developing Parkinson disease or MCI. Patients with older age and higher RSWA amounts had more rapid phenoconversion than younger patients with RBD. Our study suggests that RSWA is a potential biomarker for risk stratification of iRBD phenoconversion that could facilitate prognostication for patients with iRBD. Classification of Evidence: This study provides Class II evidence that for patients with iRBD, increased RSWA correlates with increased risk for developing parkinsonism or MCI. (© 2019 American Academy of Neurology.)
Databáze:	MEDLINE
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