Sex differences in rapid eye movement sleep behavior disorder: A systematic review and meta-analysis

Xiao Li; Qiang Zong; Liu Liu; Yaping Liu; Yanjiao Shen; Xiangdong Tang; Yun Kwok Wing; Shirley Xin Li; Junying Zhou

doi:10.1016/j.smrv.2023.101810

Sex differences in rapid eye movement sleep behavior disorder: A systematic review and meta-analysis

Sleep Med Rev. 2023 Oct:71:101810. doi: 10.1016/j.smrv.2023.101810. Epub 2023 Jun 26.

Authors

Xiao Li¹, Qiang Zong², Liu Liu³, Yaping Liu⁴, Yanjiao Shen⁵, Xiangdong Tang⁶, Yun Kwok Wing⁴, Shirley Xin Li⁷, Junying Zhou⁸

Affiliations

¹ Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
² Department of Trauma Surgery, Hannover Medical School, Germany.
³ Department of Anesthesiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁵ Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁶ Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁷ Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong. Electronic address: shirley.li@hku.hk.
⁸ Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: zhoujy2016@scu.edu.cn.

PMID: 37422999
DOI: 10.1016/j.smrv.2023.101810

Abstract

Although rapid eye movement (REM) sleep behavior disorder (RBD) has been widely considered as a male-predominant parasomnia, the existing evidence for the sex difference in the risk of RBD in the general population was conflicting. The present study conducted a systematic review to explore the sex differences in the prevalence, comorbidities, clinical characteristics, and phenoconversion of RBD. One hundred thirty-five eligible studies were identified for the systematic review, and 133 were finally included in the meta-analysis. Males in the general population showed a trend for a higher risk of probable/possible RBD (pRBD), especially among the male older adults (aged ≥60). In the clinical populations, males showed a significantly higher risk of confirmed RBD, but not of pRBD. Among idiopathic RBD (iRBD) patients, males had a significantly earlier age onset of RBD compared with females. Male patients with Parkinson's disease (PD) had a higher risk of comorbid RBD. There was no significant sex difference in the risk of developing neurodegenerative diseases in iRBD patients. Large scale and prospective studies utilizing stringent diagnostic criteria for RBD are recommended to further verify the sex differences in RBD and to investigate the mechanism underlying the sex difference.

Keywords: Neurodegenerative disease; Polysomnography; Questionnaire; REM sleep behavior disorder; Sex.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
Male
Parkinson Disease*
Polysomnography
Prospective Studies
REM Sleep Behavior Disorder* / diagnosis
REM Sleep Behavior Disorder* / epidemiology
Sex Characteristics