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Sleep. 2017 Dec 5. doi: 10.1093/sleep/zsx197. [Epub ahead of print]

Prevalence and Determinants of REM Sleep Behavior Disorder in the General Population.

Author information

1
Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland.
2
Department of Medicine and Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.
3
Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
4
Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
5
Department of Neurology, Montreal General Hospital, Montréal, Quebec, Canada.
6
Pulmonary Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.

Abstract

Study Objectives:

REM sleep behavior disorder (RBD) is a parasomnia associated with neurodegenerative synucleinopathies. Its prevalence is largely unknown. This study determined the prevalence and characteristics of RBD in the general population using gold-standard polysomnography.

Methods:

Full polysomnographic data from 1997 subjects (age=59±11.1 years, 53.6% women) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Sleep-related complaints and habits were investigated using various sleep measures including the Munich Parasomnia Screening (MUPS) questionnaire, which includes two questions evaluating complex motor behaviors suggestive of RBD. Full polysomnography was performed at home. For subjects screening positive for RBD, muscle activity during REM sleep was quantified to diagnose RBD.

Results:

368 participants endorsed dream-enactment behavior on either of the two MUPS questions, and 21 fulfilled polysomnographic criteria for RBD, resulting in an estimated prevalence of 1.06% (95% CI=0.61-1.50), with no difference between men and women. Compared to RBD- participants, RBD+ took more frequently antidepressants and antipsychotics (23.8% vs. 5.4%, p=0.005; 14.3% vs. 1.5%, p=0.004, respectively), and were more frequently smokers/ex-smokers (85% vs. 56.6%, p=0.011). On polysomnography, RBD+ had more stage N2 sleep (52±11.5% vs. 46.3±10.2%, p=0.024) and less REM sleep (18±6.4% vs. 21.9±6.2%, p=0.007), lower AHI in REM sleep (3.8±5.2 vs. 8.9±13/h, p=0.035) and lower autonomic arousal index (31±14.9 vs. 42.6±19.5/h, p=0.002).

Conclusions:

In our middle-to-older age population-based sample, the prevalence of RBD was 1.06%, with no difference between men and women. RBD was associated with antidepressant and antipsychotic use and with minor differences in sleep structure.

KEYWORDS:

Polysomnography; REM sleep without atonia; parasomnia; sleep; synucleinopathies

PMID:
29216391
DOI:
10.1093/sleep/zsx197

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