Humans ; Sleep, REM ; Memory ; Sleep ; REM Sleep Behavior Disorder

INTRODUCTION: It has been proposed that narcolepsy and REM sleep behavior disorder (RBD) have overlapped symptom profile and pathophysiology. This study was aimed at measuring and comparing changes in EEG frequency band of REM sleep in narcolepsy and RBD, applying EEG spectral analysis method. METHODS: Nine patients diagnosed as narcolepsy and the same number of RBD patients were studied. Spectral analysis of the REM sleep EEG was performed in each patient on 9 epochs selected evenly from the first, second, and third REM periods. Then, we compared frequency band percentages of REM sleep EEG in narcolepsy and RBD. RESULTS: Narcolepsy patients had significantly higher delta frequency ratio than RBD ones (p=0.00). In alpha and beta2 frequency bands, RBD patients showed higher percentage than narcolepsy ones. Slow wave sleep was more prevalent in narcolepsy patients. But, no difference of REM sleep percentage was found between the two groups (p=0.93). CONCLUSION: Higher delta frequency ratio in REM sleep of narcolepsy patients than RBD ones reflects that sleep-promoting mechanism is more dominant in narcolepsy than in RBD.
Electroencephalography ; Humans ; Narcolepsy ; REM Sleep Behavior Disorder ; Sleep, REM

OBJECTIVES: The dream recall and sleep of patients with rapid eye movement sleep behavior disorder (RBD) were not sufficiently studied. We hypothesized that RBD patients have frequent dream recall with poor sleep quality, and investigated the relationship between the dream recall frequency and sleep quality in RBD patients compared to controls. METHODS: We analyzed 81 drug naïve patients [RBD (+), 64.6±8.3 y, 57 males] and 81 age and gender matched patients with sleep disturbances without RBD [RBD (−), 63.7±7.3 y, 57 males]. All completed Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), Epworth sleepiness scale and Beck depression inventory. The 5-point rating scale was used to categorize dream recall frequency of most recent month (0=never, 4=very frequent). RESULTS: In RBD (+), dream recall frequency was much higher [frequent dreaming, 77.2% vs. 35.4%], and subjective sleep quality was much better [PSQI, 6.36±3.26 vs. 8.71±4.69]. Insomnia severity was much less in RBD (+) (ISI, 9.13±5.86) than RBD (−) (12.43±7.62). No significant differences were found in sleep parameters except lower N2 sleep % in RBD (+). The relationship between dream recall frequency and sleep was not significant in RBD (+), yet, a positive correlation was noted in RBD (−). CONCLUSIONS: RBD (+) had better sleep quality despite higher frequency of dream recall compared to RBD (−). Also dream recall was not related to their sleep quality in RBD (+), which suggests that RBD patients may have different sleep perception about their sleep and sleep quality.
Depression ; Dreams ; Humans ; REM Sleep Behavior Disorder ; Sleep Initiation and Maintenance Disorders ; Sleep, REM

OBJECTIVES: The aim of this study is to analyze dream-enacting behaviors (DEB) using video REM sleep behavior disorder severity scale (RBDSS) during night polysomnography (PSG) and compare them between in patients with idiopathic RBD (iRBD) and patients with symptomatic RBD (sRBD). METHODS: 21 consecutive patients with either iRBD or sRBD were recruited (15 female and 10 male, mean age 63.6+/-13.86 years). Video analysis of DEB in all the REM sleep during their night PSGs was retrospectively performed using RBDSS. According to the clinical history depicting behaviors were also categorized by RBDSS-C to compare with the video RBDSS. Comparison of difference of RBDSS in between patients with iRBD and in those with sRBD was done. The frequency of DEB during the night PSG was measured as RBD density. RESULTS: iRBD patients had higher RBD density than sRBD despite the same disease duration. iRBD patients also tended to have higher RBDSS than sRBD, compatible with higher prevalence of injury history. Night-night variability was observed in the patients comparing RBDSS and RBDSS-C. CONCLUSIONS: RBDSS is an easy tool to analyze severity of DEB in patients with RBD. Analysis of clinical feature of DEB may give a clue to differentiation of RBD patients as well as the alarm for the treatment of RBD to prevent potential injury.
Female ; Humans ; Male ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder* ; Retrospective Studies ; Sleep, REM*

OBJECTIVE: Rapid eye movement sleep behavior disorder (RBD) is associated with α-synucleinopathies, such as Parkinson's disease (PD). We aimed to assess the differences in the clinical characteristics of PD with and without RBD. METHODS: Forty-two patients previously diagnosed with PD were evaluated for clinical history, motor and cognitive functioning using the Unified Parkinson's Disease Rating Scale (UPDRS) and Mini-Mental State Examination (MMSE), autonomic symptoms, sleep characteristics using the Pittsburg Sleep Quality Index (PSQI), and the presence of RBD using the Korean version of the RBD screening questionnaire (RBDSQ). The prevalence of RBD and the patients' demographic features were evaluated. The patients were classified into two groups, PD with RBD and PD without RBD, based on the RBDSQ scores. The motor and cognitive functions, as well as other clinical features of the two groups were compared. RESULTS: A total of 42 PD patients were enrolled. Eighteen patients were classified as PD with RBD. Compared to PD without RBD, PD with RBD showed higher scores of rigidity in the UPDRS subscale. Regarding sleep problems, PD with RBD revealed higher sleep disturbance, lower sleep efficiency, and lower overall sleep quality in the PSQI. There was no difference in cognitive dysfunction between the two groups according to the Korean version of the MMSE. CONCLUSIONS: PD with RBD was associated with poorer sleep and motor symptoms. Therefore, RBD symptoms in PD are possibly poor prognostic markers.
Cognition ; Humans ; Mass Screening ; Parkinson Disease ; Prevalence ; REM Sleep Behavior Disorder* ; Sleep, REM*

Rapid eye movement sleep behavior disorder (RBD) is a sleep disorder characterized by loss of muscle atonia during REM sleep associated with dream enactment, which usually start at the age of older than 50. RBD in elders are known to be developing symptoms of neurodegenerative disorders in the course of disease. However, the pathophysiology and prognosis of "early-onset" idiopathic RBD is unclear. Several existing standard value about REM sleep without atonia (RSWA) of RBD patients was established with "late-onset" RBD for those diagnosed at age 50 and greater, RSWA metrics in "early-onset" RBD patients diagnosed prior to age 50 years have not been previously described. Therefore, we report here two patients who were diagnosed as "early-onset" idiopathic RBD, and performed quantitative RSWA scoring. We suggested that "early-onset" idiopathic RBD has different etiologies the various characteristics of RSWA than adults with RBD.
Adult ; Dreams ; Humans ; Neurodegenerative Diseases ; Polysomnography* ; Prognosis ; REM Sleep Behavior Disorder* ; Sleep, REM ; Young Adult*

OBJECTIVES: REM sleep behavior disorder (RBD) has received little attention in epidemiologic studies. This study aimed to determine the prevalence of probable REM sleep behavior disorder (pRBD) in the elderly population and its clinical features. METHODS: A random sample of 1,588 was selected from a roster of 14,050 elderly population living in Osan city. The subjects were asked to fill out the REM sleep behavior disorder screening questionnaire (RBDSQ). Subjects whose score were 5 or higher on RBDSQ underwent a diagnostic phase of person-to-person assessment by experts in RBD. RESULTS: Among 1,588 subjects, 886 elderly subjects participated in the screening phase and 123 subjects were assessed in the diagnostic phase. Eleven subjects were diagnosed as having pRBD, so prevalence was 1.5% (95% CI=0.70-2.30%). The frequency of depression and cognitive decline was significantly increased in patients with pRBD compared to subjects without pRBD, and there was no difference in sleep disturbances between two groups. CONCLUSIONS: Probable REM sleep behavior disorder is not rare in the elderly but frequently under-recognized. More attention should be paid to evaluation and treatment of RBD.
Aged ; Depression ; Epidemiologic Studies ; Humans ; Mass Screening ; Prevalence ; Surveys and Questionnaires ; REM Sleep Behavior Disorder ; Sleep, REM

BACKGROUND: Sleep-related disturbances and sleep disorders are common in Parkinson's disease (PD) and have a great impact on daily life of PD patients. This study was done to find the sleep characteristics and sleep disturbing factors in PD patients according to disease severity through clinical interview and polysomnographic (PSG) study. METHODS: Fifty patients with PD (22 males, age 60.6 +/- 6.4, Hoehn and Yahr (HY) stage 2.7 +/- 1.0) were recruited and thoroughly interviewed about their sleep. PSG was performed on the patients taking routine antiparkinsonian medications. Patients were grouped into mild and moderate/severe group according to HY stage, and the results were compared between each group. RESULTS: Ninety-four percent of total patients had one or more sleep-related disturbances based on the interview or PSG. On interview, the moderate/severe group complained more insomnia and REM sleep behavior disorder (RBD) than mild group. In PSG findings, the moderate/severe group showed lower sleep efficiency, longer sleep latency, REM sleep latency, waking time after sleep onset, and higher prevalence of RBD. CONCLUSIONS: In this study, most patients with PD had sleep disturbances. Clinical interview and PSG findings revealed deterioration of sleep quality along the disease severity. Our results suggest that sleep disturbances in PD patients are prevalent and warrant clinical attention, especially to the patients with advanced disease.
Humans ; Male ; Parkinson Disease* ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sleep, REM

OBJECTIVE: The purpose of this paper is to study the possible differences in clinical and polysomnographic findings, depending on the presence or absence of subjective complaints of abnormal sleep behavior, in patients with RWA on polysomnography. METHOD: We reviewed patient records and polysomnographic data of patients referred to the Sleep Laboratory at Seoul National University Hospital from June 1996 through October 2002. We defined the manifest RBD group (n=32) as patients having both complaints of abnormal sleep behavior and RWA on polysomnography. The latent RBD group (n=20) consisted of patients who exhibited RWA on polysomnography but did not complain of abnormal sleep behavior. The clinical characteristics and polysomnographic findings between the two groups were compared and analyzed. RESULTS: Fifty-two subjects had RWA, as detected by polysomnography (42 males and 10 females, mean age of 55.1+/-19.1 years). Subjects in the manifest RBD group were significantly older than those in the latent RBD group (61.59+/-13.5 vs. 44.70+/-2.76 years, independent t-test, p<0.01). More subjects in the manifest RBD group exhibited abnormal REM behavior on polysomnography than did subjects in the latent RBD group (81.3 vs. 50.0%, Fisher's exact test, p<0.05). No significant differences between the groups were found in the prevalence of brain disorders and primary sleep disorders, gender proportion, and sleep architecture. CONCLUSION: No difference in sleep architecture was found between the manifest and the latent RBD groups. Only age and the presence of abnormal sleep behavior on polysomnography differentiated the two groups. We suggest that RWA on polysomnography without complaints of abnormal sleep behavior may be early manifestation of manifest RBD. Attention to RWA on polysomnography is necessary to help prevent full-blown RBD from developing.
Brain Diseases ; Female ; Humans ; Male ; Mental Disorders* ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder ; Seoul ; Sleep Wake Disorders ; Sleep, REM*

BACKGROUND: Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients. METHODS: Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances. RESULTS: Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score. CONCLUSION Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.
Humans ; Parkinson Disease/complications* ; Polysomnography ; REM Sleep Behavior Disorder ; Sleep ; Sleep Wake Disorders/etiology*