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Neurology. 2014 Mar 25;82(12):1076-9. doi: 10.1212/WNL.0000000000000247. Epub 2014 Feb 19.

Comorbidity and medication in REM sleep behavior disorder: a multicenter case-control study.

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From the Department of Neurology (B.F., D.G., T.M., B.H.), Innsbruck Medical University, Austria; Danish Center for Sleep Medicine (P.J.), University of Copenhagen, Denmark; Department of Neurology (Y.-E.S.J.), Washington University School of Medicine, St Louis, MO; Department of Neurology (R.B.P.), McGill University, Montreal General Hospital, Canada; Unité des Pathologies du Sommeil (I.A., S.L.-S.), Hôpital Pitié-Salpêtrière, APHP, and Inserm U975-CRICM-Pierre and Marie Curie University, Paris; Sleep Unit (V.C.D.C., Y.D.), Department of Neurology, Hôpital Gui de Chauliac, Montpellier, INSERM U1061, Montpellier, France; Sleep Disorders Center (M.L.F.), Department of Neurosciences, University of Turin, Italy; UFR Medecine (M.L.F.), EA 7280, University Clermont 1, France; Sleep Disorders Center (L.F.-S., M.Z.), Università Vita-Salute San Raffaele, Milan, Italy; Neurology Service (A.I., J.S.), Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Spain; Department of Neurology (M.M.), Dokkyo Medical University School of Medicine, Tochigi; Department of Neurology (T.M.), Dokkyo Medical University Koshigaya Hospital, Saitama, Japan; Centre d'Études Avancées en Médecine du Sommeil (J.Y.M.), Hôpital du Sacré-Coeur de Montréal, Canada; Philipps-Universität (W.O., M.U.), Marburg, Germany; Neuroepidemiology Research Unit (A.P., C.W.), Research Institute of the McGill University Health Centre, Montreal; Canada; Unit of Sleep Medicine (P.P., M.T., R.M.), National Institute of Neurology IRCCS, C. Mondino Foundation, Pavia; Sleep Center (M.P.), Department of Cardiovascular and Neurological Sciences, University of Cagliari, Italy; Department of Neurology (K.S.), First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Neurology (M.U.), Saarland University, Homburg/Saar; and Hephata Klinik (G.M.), Schwalmstadt-Treysa, Germany.



This controlled study investigated associations between comorbidity and medication in patients with polysomnographically confirmed idiopathic REM sleep behavior disorder (iRBD), using a large multicenter clinic-based cohort.


Data of a self-administered questionnaire on comorbidity and medication use of 318 patients with iRBD and 318 matched controls were analyzed. Comparisons between cases and controls were made using logistic regression analysis.


Patients with iRBD were more likely to report depression (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3-2.9) and concomitant antidepressant use (OR 2.2, 95% CI 1.4-3.6). Subanalysis of antidepressant agents revealed that the increased use of antidepressants in iRBD was due to selective serotoninergic reuptake inhibitors (OR 3.6, 95% CI 1.8-7.0) and not due to other antidepressant classes. Patients with iRBD reported more lifetime antidepressant use than comorbid depression (antidepressant use: OR 1.9, 95% CI 1.1-3.3; depression: OR 1.6, 95% CI 1.0-2.5). Patients with iRBD reported more ischemic heart disease (OR 1.9, 95% CI 1.1-3.1). This association did not change substantially when adjusting for cardiovascular risk factors (OR 2.3, 95% CI 1.3-3.9). The use of inhaled glucocorticoids was higher in patients with iRBD compared to controls (OR 5.3, 95% CI 1.8-15.8), likely reflecting the higher smoking rate in iRBD (smoking: OR 15.3, 95% CI 2.0-118.8; nonsmoking: OR 2.4, 95% CI 0.4-13.2) and consequent pulmonary disease.


This large study confirms the association between comorbid depression and antidepressant use in iRBD. In addition, there was an unexpected association of iRBD with ischemic heart disease that was not explained by cardiovascular risk factors.

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