REM sleep without atonia in middle-aged and older psychiatric patients and Lewy body disease: a case series
Corresponding Author
Hiroshige Fujishiro
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence to: H. Fujishiro, MD, PhD, E-mail: [email protected]Search for more papers by this authorMasato Okuda
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKunihiro Iwamoto
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorSeiko Miyata
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorHironao Otake
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorAkiko Noda
Department of Biomedical Science, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
Search for more papers by this authorShuji Iritani
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNorio Ozaki
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorCorresponding Author
Hiroshige Fujishiro
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence to: H. Fujishiro, MD, PhD, E-mail: [email protected]Search for more papers by this authorMasato Okuda
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorKunihiro Iwamoto
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorSeiko Miyata
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorHironao Otake
Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorAkiko Noda
Department of Biomedical Science, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
Search for more papers by this authorShuji Iritani
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorNorio Ozaki
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorAbstract
Objective
Rapid eye movement (REM) sleep behavior disorder (RBD) is commonly associated with Lewy body disease, narcolepsy, or depression. In contrast, the relationship between REM sleep without atonia (RWA), which is a hallmark of RBD on polysomnography, and clinical characteristics remains unclear. The purpose of this study is to investigate the clinical features of psychiatric patients exhibiting RWA and its relevance to Lewy body disease.
Methods
Of 55 consecutive patients who underwent polysomnography at the psychiatric ward, 25 patients with sleep apnea syndrome were excluded, and 12 patients exhibiting RWA were identified. The clinical profiles were compared between the groups with and without RWA.
Results
The mean age and the frequency of neurocognitive disorders were significantly higher in 12 patients with RWA than in 18 without. Only five of the 12 patients exhibiting RWA had episodes of dream-enactment behavior, and fulfilled the clinical criteria for RBD. Two young patients were diagnosed with narcolepsy, while the other middle-aged and older patients fulfilled the clinical criteria for Parkinson's disease (n = 1), dementia with Lewy bodies (n = 4), idiopathic RBD (n = 2), and major depressive disorder (MDD) (n = 3). The patients with MDD exhibited constipation and/or olfactory dysfunction. Moreover, neuroimaging examinations in the patients with MDD revealed isolated occipital hypoperfusion in three patients and mild dopamine transporter deficit in one patient.
Conclusions
Rapid eye movement sleep without atonia itself may be associated with specific clinical profiles, even when dream-enactment behavior is absent. Continued follow-up of the patients with MDD exhibiting RWA is warranted to determine if they represent the prodromal Parkinson's disease/dementia with Lewy bodies. Copyright © 2016 John Wiley & Sons, Ltd.
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