Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early-Stage Parkinson's Disease

Pauline Dodet; Marion Houot; Smaranda Leu-Semenescu; Rahul Gaurav; Graziella Mangone; Jean-Christophe Corvol; Stéphane Lehéricy; Marie Vidailhet; Emmanuel Roze; Isabelle Arnulf

doi:10.1002/mds.29813

Isolated REM Sleep without Atonia Is Not Equivalent to REM Sleep Behavior Disorder in Early-Stage Parkinson's Disease

Mov Disord. 2024 Apr 26. doi: 10.1002/mds.29813. Online ahead of print.

Authors

Pauline Dodet^{1

2}, Marion Houot^{3

4

5}, Smaranda Leu-Semenescu^{1

2}, Rahul Gaurav^{2

6}, Graziella Mangone⁵, Jean-Christophe Corvol^{2

3

5}, Stéphane Lehéricy^{2

6}, Marie Vidailhet^{2

3

5}, Emmanuel Roze^{2

3

5}, Isabelle Arnulf^{1

2}

Affiliations

¹ Service des Pathologies du Sommeil et Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance Publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France.
² Sorbonne University, Paris Brain Institute (ICM), Inserm, CNRS, Paris, France.
³ Center of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
⁴ Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
⁵ Assistance Publique Hôpitaux de Paris, Department of Neurology, Clinical Investigation Centre Neuroscience, Pitié-Salpêtrière Hospital, Paris, France.
⁶ Department of Neuroradiology, Assistance Publique Hôpitaux de Paris, Hôpital Pitié -Salpêtrière, Paris, France.

PMID: 38666582
DOI: 10.1002/mds.29813

Abstract

Background: In early-stage Parkinson's disease (PD), rapid eye movement (REM) sleep behavior disorder (RBD) predicts poor cognitive and motor outcome. However, the baseline significance and disease evolution associated with isolated REM sleep without atonia (iRWA, ie, enhanced muscle tone during 8.7% of REM sleep, but no violent behavior) are not well understood.

Objectives: The objective is to determine whether iRWA was a mild form of RBD and progressed similarly over time.

Methods: Participants with early PD (<4 years from medical diagnosis) were included from 2014 to 2021 in a longitudinal study. They underwent interviews and examinations in the motor, cognitive, autonomous, psychiatric, sensory, and sleep domains every year for 4 years along with a video polysomnography and magnetic resonance imaging examination of the locus coeruleus/subcoeruleus complex (LC/LsC) at baseline. The clinical characteristics were compared between groups with normal REM sleep, with iRWA and with RBD, at baseline and for 4 years.

Results: Among 159 PD participants, 25% had RBD, 25% had iRWA, and 50% had normal REM sleep. At baseline, the non-motor symptoms were less prevalent and the LC/LsC signal intensity was more intense in participants with iRWA than with RBD. Over 4 years, participants with normal REM sleep and with iRWA had a similar cognitive and motor trajectory, whereas participants with RBD had greater cognitive and motor decline.

Conclusions: We demonstrated that iRWA is frequent in early PD, but is not a milder form of RBD. Both groups have distinct baseline characteristics and clinical trajectories. They should be distinguished in clinical routine and research protocols. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: REM behavior disorder; REM sleep without atonia; early‐stage Parkinson's disease; progression.

Abstract

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