Isolated rapid eye movement sleep behavior disorder and cyclic alternating pattern: is sleep microstructure a predictive parameter of neurodegeneration?

To evaluate the role of sleep cyclic alternating pattern (CAP) in patients with isolated REM sleep behavior disorder (IRBD) and ascertain whether CAP metrics might represent a marker of phenoconversion to a defined neurodegenerative condition. Sixty-seven IRBD patients were included and classified i...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) N.Y.), 2019-10, Vol.42 (10), p.1
Main Authors: Melpignano, Andrea, Parrino, Liborio, Santamaria, Joan, Gaig, Carles, Trippi, Irene, Serradell, Monica, Mutti, Carlotta, Riccò, Matteo, Iranzo, Alex
Format: Article
Language:English
Subjects:
Adult
Aged
Behavior disorders
Comparative analysis
Eye movements
Female
Humans
Male
Mental illness
Middle Aged
Nervous system diseases
Neurodegeneration
Neurodegenerative Diseases - diagnosis
Neurodegenerative Diseases - epidemiology
Neurodegenerative Diseases - physiopathology
Polysomnography - methods
Predictive Value of Tests
REM Sleep Behavior Disorder - diagnosis
REM Sleep Behavior Disorder - epidemiology
REM Sleep Behavior Disorder - physiopathology
Sleep
Sleep, REM - physiology
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Summary:To evaluate the role of sleep cyclic alternating pattern (CAP) in patients with isolated REM sleep behavior disorder (IRBD) and ascertain whether CAP metrics might represent a marker of phenoconversion to a defined neurodegenerative condition. Sixty-seven IRBD patients were included and classified into patients who phenoconverted to a neurodegenerative disease (RBD converters: converter REM sleep behavior disorder [cRBD]; n = 34) and remained disease-free (RBD non-converters: non-converter REM sleep behavior disorder [ncRBD]; n = 33) having a similar follow-up duration. Fourteen age- and gender-balanced healthy controls were included for comparisons. Compared to controls, CAP rate and CAP index were significantly decreased in IRBD mainly due to a decrease of A1 phase subtypes (A1 index) despite an increase in duration of both CAP A and B phases. The cRBD group had significantly lower values of CAP rate and CAP index when compared with the ncRBD group and controls. A1 index was significantly reduced in both ncRBD and cRBD groups compared to controls. When compared to the ncRBD group, A3 index was significantly decreased in the cRBD group. The Kaplan-Meier curve applied to cRBD estimated that a value of CAP rate below 32.9% was related to an average risk of conversion of 9.2 years after baseline polysomnography. IRBD is not exclusively a rapid eye movement (REM) sleep parasomnia, as non-rapid eye movement (non-REM) sleep microstructure can also be affected by CAP changes. Further studies are necessary to confirm that a reduction of specific CAP metrics is a marker of neurodegeneration in IRBD.
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/zsz142