REM sleep microstructure alterations in REM sleep behavior disorder: beyond muscle tone
Résumé
Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by dream enactment behaviors and loss of physiological atonia during REM sleep. It is considered a prodromal stage of alpha-synucleinopathies and may result from dysfunction of brainstem structures regulating muscle tone in REM sleep. Whether other REM sleep features are simultaneously affected remains unclear. Here, we investigated alterations in REM sleep microstructure, including phasic REM sleep, sawtooth waves (STW) and non-REM/REM sleep transitions, in iRBD and RBD associated with Parkinson′s disease (PD+RBD). We retrospectively included 20 patients with iRBD (85% male, 66.5[63-68]years), 20 patients with PD+RBD (75% male, 62.5[57.5-65]years) and 20 controls (75% male, 67[61-70]years). REM sleep without atonia (RSWA), bursts of REMs and STW bursts were manually scored. Phasic REM sleep proportion (derived from REMs), STW density/duration/frequency and the duration of NREM/REM transitions were compared between groups with a general linear mixed-effects model. Phasic REM sleep proportion was higher in the iRBD group (26.5[21-33]%) than in control (16.4[12.5-22.3]%, p-corrected=0.005) and PD+RBD (17.6[13.9-21.7]%, p-corrected=0.005) ones. Non-REM/REM transitions showed a duration gradient, increasing from controls (119.0[58.5-186.1]sec) to iRBD (212.1[68.5-391.4]sec, p-corrected=0.0038) and PD+RBD (375.8[217.6-514.6]sec, p-corrected<0.001) patients. STW density and duration were reduced in the PD+RBD group only (1.33[1.1-1.54]/min; 2.13[1.70-2.69]sec) vs controls (1.74[1.52-2.05]/min, p-corrected=0.005; 2.98[2.18-4.11], p-corrected<0.001), whereas altered STW spectral content was observed in both patient′s groups with a power shift toward higher frequencies (both p<0.001 vs controls). These results reinforce the hypothesis that REM sleep dysregulation in RBD extends to REM-specific electrophysiological features beyond loss of muscle atonia and dream enactments.
Mots clés
Rapid eye movement sleep Rapid eye movement sleep behavior disorder Parkinson's disease Polysomnography Sawtooth waves Phasic REM sleep Sleep stage transition Spectral analysis
Rapid eye movement sleep
Rapid eye movement sleep behavior disorder
Parkinson's disease
Polysomnography
Sawtooth waves
Phasic REM sleep
Sleep stage transition
Spectral analysis
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