Idiopathic REM sleep behavior disorder in the elderly Spanish community: a primary care center study with a two-stage design using video-polysomnography

To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers. Participants were individuals aged 60 years or older who underwent routine visits in two prim...

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Bibliographic Details
Published in:Sleep medicine 2017-12, Vol.40, p.116-121
Main Authors: Pujol, Montserrat, Pujol, Jesús, Alonso, Tomás, Fuentes, Araceli, Pallerola, Mercè, Freixenet, Jovita, Barbé, Ferran, Salamero, Manel, Santamaría, Joan, Iranzo, Alex
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Epidemiology
Female
Humans
Idiopathic REM sleep behavior disorder
Male
Polysomnography
Primary Health Care
Questionnaires
REM Sleep Behavior Disorder - complications
REM Sleep Behavior Disorder - epidemiology
REM Sleep Behavior Disorder - physiopathology
Spain - epidemiology
Video-polysomnography
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Summary:To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers. Participants were individuals aged 60 years or older who underwent routine visits in two primary care centers. They underwent a two-stage study; a validated screening single question for IRBD diagnosis (RBD1Q) followed by, in those who endorsed positive answer, clinical assessment by a neurologist plus video-polysomnography (V-PSG). Of 539 individuals (56.4% women, mean age 72.86 ± 8.20 years), 28 (5.2%) endorsed positively the RBD1Q. Four of these 28 refused further assessments. Four of the 24 remaining subjects underwent clinical assessment but refused V-PSG. Of the 20 who underwent clinical assessment plus V-PSG, REM sleep was not recorded in four (20%, all four taking antidepressants). V-PSG ruled out RBD in 12 subjects who had obstructive sleep apnea (n = 9), periodic limb movement disorder in sleep (n = 2) and normal sleep (n = 1). IRBD was diagnosed in four individuals giving an estimated prevalence of 0.74% (95% CI = 0.29–1.89). They were three men and one woman between 74 and 82 years of age who never reported dream-enacting behaviors to their doctors because they thought they represented a normal phenomenon despite suffering sleep-related injuries. These patients had history of violent sleep behaviors with an interval between estimated RBD onset and V-PSG of 4.5 ± 4.2 years. IRBD is not uncommon in the elderly community and its demographic and clinical profile is similar to those diagnosed in sleep centers. •The estimated prevalence of IRBD in Spanish individuals aged 60 or older attending primary care centers is 0.74%.•Demographic and clinical features are similar to those seen in IRBD patients diagnosed in sleep centers.•The positive predictive value of the RBD1Q is low (25%) due to an important number of false positives with OSAS and PLMD.•In few individuals V-PSG is not able to diagnose or exclude RBD because REM sleep is not recorded.
ISSN:1389-9457
1878-5506
DOI:10.1016/j.sleep.2017.07.021