23
AASM Membership Sections Newsletter
■
Issue #6
Publication 5:
Publication:
Fantini ML, Macedo L, Zibetti M, Sarchioto M, Vidal
T, Pereira B, Marques A, Debilly B, Derost P, Ulla M, Vitello N, Cicolin
A, Lopiano L, Durif F. Increased risk of impulse control symptoms
in Parkinson’s disease with REM sleep behaviour disorder. J Neurol
Neurosurg Psychiatry. 2014 Jul 8. pii: jnnp-2014-307904. [Epub ahead
of print]
Review:
The goal of this study was to assess the relationship and
risk of impulse control disorders (ICD) and/or related symptoms
in Parkinson’s disease (PD) with and without probable REM sleep
behavior disorder (pRBD). 216 consecutive PD patients were
recruited out of 2 specialty clinics. pRBD was determined by the
RBD Screening Questionnaire. The Questionnaire for Impulsive-
Compulsive Behaviors in PD (QUIP) was used to assess ICDs
including compulsive gambling, buying, sexual behavior and eating,
as well as related behaviors including punding, hobbyism, walk-about
and dopamine dysregulation syndrome. Results demonstrated that
PD-pRBD patients had longer duration and more severe PD, had an
increased use of levodopa and a higher depression score compared
to the PD-without pRBD. Additionally, compared to PD-without
pRBD, those with PD-pRBD had a significantly higher QUIP score
and were significantly more likely to have one or more ICDs, as well
as symptoms of 2 or more concomitant ICDs or related behaviors.
PD-pRBD patients were almost 5 times more likely to develop
pathological gambling than PD-without pRBD patients. This is the
first study to demonstrate that the presence of RBD in PD is associated
with an increased likelihood to have symptoms and related behaviors
of ICDs, behaviors that could severely impact life functioning.
Case 6:
Publication:
McCarter SJ, St. Louis EK, Duwell EJ, Timm PC,
Sandness DJ, Boeve BF, Silber MH. Diagnostic thresholds for
quantitative REM sleep phasic burst duration, phasic and tonic muscle
activity, and REM atonia index in REM sleep behavior disorder with
and without co-morbid obstructive sleep apnea. Sleep 2014; 37 (10);
1649-1662, Oct 1; pii: sp-00817-13. [Epub ahead of print]
Review:
REM sleep behavior disorder (RBD) is difficult to
discern on polysomnography (PSG) among patients with coexistent
sleep disordered breathing; in particular, REM sleep predominant
obstructive sleep apnea (OSA). McCarter and colleagues addressed
the issue in this recently published study that examined EMG
activity during REM sleep in patients with Parkinson’s disease (PD)
and coexistent RBD, and matched controls with and without OSA.
By assessing RSWA phasic burst durations, phasic, “any” and tonic
muscle activity in 3-s mini-epochs, phasic activity in 30-s epochs and
automated REM atonia index, optimal diagnostic cutoff thresholds
for RBD were determined. These observations are important as RBD
predominantly occurs in the elderly population and frequently in
association with some degree of OSA. The findings therefore provide
guidance for clinicians in establishing the diagnosis of RBD in the
setting of sleep disordered breathing.
Publication 7:
Publication:
McCarter SJ, St. Louis EK, Boswell C, Boeve BF, Silber
MH, Olson EJ, Tippmann-Peikert M. Factors associated with injury
in REM sleep behavior disorder. Sleep Med 2014; Jun 23. pii: S1389-
9457(14)00246-9.
Review:
REM Sleep Behavior Disorder (RBD) is frequently
associated with injuries related to abnormal motor behaviors. The
aim of this study was to identify factors associated with these injuries.
Authors conducted a survey of 133 patients with RBD evaluated in
the Center for Sleep Medicine at the Mayo Clinic in Rochester, MN
between 2008 and 2010. The type and severity of reported injuries
were assessed. Among the 55 patients who responded to the survey,
55% reported injuries. While these injuries were usually self-directed
(38%), 17% of participants reported injuries to their bed partners.
Importantly, the frequency of dream enactment behavior did not
predict RBD injuries. Hospitalization and/or medical intervention
were required for 11% of reported injuries. A diagnosis of idiopathic
RBD, dream recall and falls were associated with the severity of
injuries. Although limited due to a relatively small study cohort, the
results emphasize the high frequency of RBD-related injuries and the
need for their timely diagnosis and treatment. Prospective studies are
needed to assess the predictors of injury in RBD.
Publication 8:
Publication:
Arnulf I, Zhang B, Uguccioni G, Flamand M, Noël
de Fontréaux A, Leu-Semenescu S, Brion A. A scale for assessing
the severity of arousal disorders. Sleep. 2014 Jan 1;37(1):127-36. doi:
10.5665/sleep.3322.
Review:
Screening tools for arousal disorders are lacking. In order
to address this gap, Arnulf and colleagues developed a new scale for
assessing arousals disorders – the Paris Arousal Disorders Severity
Scale (PADSS). This self-rated scale encompasses 17 parasomniac
behaviors, and assesses its frequency and consequences. The
population used throughout this scale validation study included
adolescents and adults with sleepwalking, sleep terrors, REM
sleep behavior disorder and healthy controls (n=171). The PADSS
demonstrated high sensitivity (84%), specificity (88%), internal
consistency and test-retest reliability (0.8). PSG recorded behaviors
emerging from N3 sleep correlated well with the total PADSS score,
as well as its subscores related to the type of parasomniac behavior
(PADSS-A) and its consequences (PADSS-C). This scale provides a
new tool for screening and characterization of patients with arousal
disorders and may be useful for the assessment of treatment effects in
