Analysis Of The Characteristics Of Rapid Eye Movement Sleep In Patients With Parkinson's Disease

Part1 Clinical correlation of rapid eye movement density in Parkinson’s disease and REM sleep behavior disorderObjective:Recently,studies have found that rapid eye movement(REM)sleep behavior disorder(RBD)is closely related to neurodegenerative diseases.The risk of RBD conversion to Parkinson’s disease(PD)and other synucleinopathies is extremely high,and the prevalence of RBD in PD is more than half.At present,most studies pay more attention to the EMG and EEG during the impaired REM sleep.Information on REM density is lacking.Therefore,the current study sought to characterize REM density in patients with i RBD patients and PD with or without RBD patients and PD+RBD patients,and to explore the associations between REM density and clinical manifestations.Methods We retrospectively recruited the subjects who underwent polysomnography in department of the Nanjing Brain Hospital from December 2015 to March 2018,including 105 PD patients(40 PD-RBD patients,51 PD+RBD patients and 14 subjects who did not meet the inclusion criterias),42 i RBD patients and 40 sex and age-matched healthy controls(HC).Demographic data,clinical features and sleep parameters of all subjects were collected.REM density was defined as the number of ocular movements per minute during the REM sleep.REM density of all subjects were automatically calculated by the monitoring system after identifying the REM sleep based on the standard criteria.SPSS 23.0 program was used for statistical analyses.Kruskal-Wallis H test and LSD test were used to compare the differences of REM density between four groups.Partial correlation coeffcients were calculated to present the correlation between REM density,sleep parameters and clinical manifestations in each group.The relationship between REM density and the occurrence of PD or RBD was analyzed by binary logistic regression.Results(1)REM density was higher in i RBD patients [6.9(3.0)],PD-RBD patients [6.1(3.4)] and PD+RBD patients [6.8(2.5)] than in HC [5.4(2.4)].The difference was most significant between HC and PD+RBD patients.(2)REM density in i RBD patients was positively correlated with UPDRSⅢ(r=0.467,p=0.025)、 total sleep time(r=0.447,p=0.004),sleep efficiency(r=-0.314,p=0.048)and NREM2stage(r=0.346,p=0.029),and negatively correlated with sleep latency.In PD-RBD patients,REM density was positively correlated with PLMS(r=0.419,p=0.009)and PDSS(r=0.432,p=0.007),and negatively correlated with disease duration(r=-0.434,p=0.006),LEDD(r=-0.322,p=0.049),UPDRS Ⅱ(r=-0.374,p=0.021),HAMD(r=-0.416,p=0.009).In PD+RBD patients,REM density was positively correlated with REM latency(r=0.347,p=0.015),PDQ39(r=0.312,p=0.029).(3)REM density(OR=1.211,95%CI:1.052,1.395)was an independent risk factor for PD,and arouse index(OR=-0.933,95%CI: 0.895,0.973),sleep efficiency(OR=0.950,95%CI:0.927,0.975)may be a protective factor for PD.REM density(OR=1.157,95%CI:1.014,1.321)was an independent risk factor for RBD,while NREM3(OR=0.989,95%CI: 0.981,0.996)and arouse index(OR=0.038,95%CI: 0.930,0.998)may be a protective factor for RBD.Conclusions Whether it is an i RBD patient or a PD patient with or without RBD,the REM sleep of them is impaired.and appears as increased rapid eye movements.However,in PD patients without RBD,higher REM density may be related to milder clinical manifestations;in PD patients with RBD,it may be opposite.Sleep efficiency and NREM3 stage are protective factors for PD and RBD,respectively,and improving sleep may help delay the disease progression of PD and RBD.REM density may be used as a risk factor for the development of PD and RBD.And it may be a promising early biological marker in PD.Part2 Increased rapid eye movement density in Chinese patients of Parkinson’s diseaseObjective Impaired rapid eye movement(REM)sleep is common among patients with Parkinson’s disease(PD).However,information on rapid eye movement density among PD patients is currently lacking.The current study sought to characterize REM density in different severity PD patients and to examine the associations between REM density,sleep parameters and clinical manifestations.Methods We retrospectively recruited 142 subjects in department of the Nanjing Brain Hospital from December 2015 to March 2018,including 54 early stage PD patients(H-Y 1-2.5),37 middle-late stage PD patients(H-Y 3-5),37 sex and age-matched healthy controls(HC)and 14 subjects who did not meet the inclusion criterias.Demographic data,clinical features and sleep parameters of all subjects were collected.REM density was defined as the number of ocular movements per minute during the REM sleep.After the REM sleep was identified according to the standard criteria.Monitoring system automatically genenrated REM density of all subjects.SPSS 23.0 program was used for statistical analyses.Kruskal-Wallis H test and LSD test were used to compare the differences of REM density between three groups.Partial correlation coeffcients were calculated to present the relationship between REM density,sleep parameters and Clinical manifestations.Results(1)The prevalence of RBD in all PD patients was 56%(51/91).Though the prevalence of RBD in early stage PD patients(52%,28/54)was lower than that in middle-late stage PD patients(62%,23/37),but the difference was not statistically significant.(2)REM density was higher in early stage PD patients [6.3(3.0)] and middle-late stage PD patients [7.3(2.4)] than in HC [5.5(2.9)].(3)In early stage PD patients,REM density was relevant with the disease duration(r=-0.310,p=0.025)、UPDRSⅡ(r=-0.340,p=0.014)and PLMS(r=0.275,p=0.048).In middle-late stage PD patients,REM density was negatively correlated with UPDRSⅢ(r=-0.337,p=0.048).Conclusions REM density was increased in PD patients and correlated with UPDRS score and disease duration in PD patients.REM density may be a promising early biological marker in PD.