Impact of REM Sleep Behavior and Sleep Talking on Mortality in Parkinson's Disease

Eemil Partinen; Ari Ylikoski; Mariusz Sieminski; Markku Partinen

doi:10.7759/cureus.52565

Impact of REM Sleep Behavior and Sleep Talking on Mortality in Parkinson's Disease

Cureus. 2024 Jan 19;16(1):e52565. doi: 10.7759/cureus.52565. eCollection 2024 Jan.

Authors

Eemil Partinen^{1

2}, Ari Ylikoski³, Mariusz Sieminski⁴, Markku Partinen^{5

6}

Affiliations

¹ Department of Neurology, University of Helsinki, Helsinki, FIN.
² Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, FIN.
³ Department of Neurology, Social Insurance Institution of Finland (KELA), Helsinki, FIN.
⁴ Department of Emergency Medicine, University of Gdansk, Gdansk, POL.
⁵ Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, FIN.
⁶ Department of Clinical Neurosciences, University of Helsinki, Helsinki, FIN.

Abstract

Background REM sleep behavior disorder (RBD) is a prodromal marker for Parkinson's disease (PD) and other alpha-synucleinopathies. Sleep talking (ST) is an isolated symptom and is frequent in PD and RBD. Here, we investigate the associations of ST and RBD with the mortality of PD patients. Patients and methods A total of 1,500 PD patients were randomly selected from the registry of the Finnish Parkinson's Association. Of the 855 that participated at baseline, 645 gave permission for follow-up studies. We gathered a completely filled sleep questionnaire and mortality information from 384 subjects. The Nelson-Aalen test and Cox hazard ratios (HR) were used for mortality analyses. Results The mean follow-up time was 4.3 years (0.3-7.0). PD patients with RBD or frequent ST had more non-motor symptoms. Depression, hallucinations, constipation, and excessive daytime sleepiness were more prevalent among subjects with RBD. Subjects with RBD and frequent ST (talking in their sleep ≥ once per week) had increased mortality (HR: 1.90, 95% CI: 1.18-3.06). RBD without frequent ST was not associated with mortality (HR: 0.77, 95% CI: 0.4-1.5). Frequent ST was associated with increased mortality when adjusted for age, PD duration, depression, gender, RBD, BMI, and hallucinations (HR: 2.22, 95% CI: 1.10-4.51). Additionally, age, duration of PD, arterial hypertension, and lower BMI were associated with increased mortality. Male gender, dopaminergic medication, depression, and hallucinations were not significantly associated with mortality. Conclusions RBD with frequent ST and ST alone appear to be risk factors for mortality in PD. Frequent ST may be a sign representing wider neurodegeneration. RBD subjects and frequent sleep talkers demonstrated more non-motor symptoms compared to PD without RBD or ST. Our findings have clinical implications. It remains to be seen if frequent ST indicates a poorer prognosis. Prospective studies are needed to find whether frequent ST is also a risk factor for developing PD.

Keywords: mortality; parasomnias; parkinson’s disease; rbd; rem sleep behaviour disorder; sleep disorders; sleep talking.

Grants and funding

A grant from the Finnish Parkinson Foundation.