Vol.:(0123456789) 1 3 Sleep and Biological Rhythms https://doi.org/10.1007/s41105-018-0189-z ORIGINAL ARTICLE REM sleep behavior disorder in patients with Parkinson’s disease: clinical and polysomnographic characteristics Manoel Alves Sobreira‑Neto 1,2  · 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 Received: 20 June 2018 / Accepted: 6 October 2018 © Japanese Society of Sleep Research 2018 Abstract 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 Question- naire, 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. Keywords Parkinson disease · Sleep · REM sleep · REM sleep behavior disorder Introduction REM sleep behavior disorder (RBD) is characterized by loss of skeletal muscle atonia during REM sleep associated with nightmares and dreams’ enactment [1–4]. There is an association of RBD with diseases that are generated by the deposition of alpha-synuclein in neurons, such as Parkin- son’s disease (PD), multiple system atrophy (MSA), and Lewy body dementia (LBD) [5, 6]. There is already evi- dence from experimental studies demonstrating that neurons located in the upper brainstem structures particularly the bulbar–pontine transition (sublaterodorsal nucleus-SLD and pre-coeruleus region) are active during REM sleep (called REM “on cells”) and important for the regulation of REM sleep and atonia [7, 8]. These neurons participate via a direct or indirect inhibitory descending pathway through the reticu- lar magnocellular tract and glycinergic neurons on the spi- nal motor neurons [9]. The neurodegenerative process that occurs in PD with abnormal deposition of this phospho- rylated alpha-synuclein leads to the formation of intraneu- ronal inclusion bodies, the so-called Lewy bodies, which may induce a dysfunction of this nucleus and its afferent or efferent pathways or both, resulting in loss of the normal inhibition of the motor neuron [10] and the clinical mani- festation of the RBD [11, 12]. A prevalence of presumptive RBD in 15–40% of PD patients was observed in studies using RBD screening scales and frequency of confirmed RBD in up to 62.5% in studies * Manoel Alves Sobreira-Neto manoelsobreira@yahoo.com.br 1 Department of Clinical Medicine, Faculty of Medicine of Federal, University of Ceará, Rua Prof. Costa Mendes, 1408-4o. Andar, Fortaleza CEP 60.430-140, Brazil 2 Faculty of Medicine, University of Fortaleza, Fortaleza, Brazil 3 Department of Neuroscience, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil 4 Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil