REM Sleep Behavior Disorder And Bright Light:Clinical Variations Insight For Parkinson's Disease

Part ?.Two polysomnographic features of REM sleep behavior disorder: Clinical variations insight for Parkinson's diseaseObject: Loss of REM sleep muscle atonia(RWA)and dream-enactment behavior(DEB)are two associated features of REM sleep behavior disorder(RBD),which is frequently associated with Parkinson's disease(PD).Few studies have examined both DEB and RWA simultaneously in patients with PD.This study aimed to evaluate relationships between RWA,DEB and clinical characteristics of PD.Methods: We reviewed 175 patients with PD and had complete clinical assessments,including the Unified Parkinson's Disease Rating Scale(UPDRS),Hoehn & Yahr(H&Y)stages,PD duration,Montreal Cognitive Assessment scale(MoCA),and Epworth sleepiness scale(ESS)and levodopa equivalent doses(LEDs).Finally,145 patients with PD were included and conducted overnight polysomnography.Tonic chin EMG density?30% or phasic ?15% were identified as increased RWA(IRWA).Motor behaviors and/or vocalizations in REM sleep with a purposeful component other than comfort moves were identified as DEB.According to the DEB and RWA,patients with PD were categorized into the following groups for analysis: clinical RBD(patients who had DEB positive and RWA was above the cut-off value,group PD + RBD),sub-DEB positive(patients who had DEB positive but RWA did not fulfill diagnostic criteria for RBD,group PD + s DEB),subclinical RBD(patients who had no DEB but RWA met diagnostic criteria for RBD,group PD + s RBD),and normal REM sleep(control group,group PD + c REM).Results: We found mean age across patients with PD was 64.7 ± 9.8 years;94 patients were male.After adjusting for age,RWA was observed to be associated with H&Y stage,UPDRS III scores,PD duration,LEDs,MoCA score,the percentage of non-rapid eye movement(NREM)stage 1(N1)and 2(N2)sleep,and the percentage of REM sleep.PD duration was associated with RWA,but not DEB.The PD patients with DEB,compared to without DEB group,were significantly older,exhibited more RWA,and had higher H&Y stage,UPDRS III scores,LED and worse cognitive function.The PD patients who exhibited clinical or subclinical RBD,compared to sub-DEB positive,had higher H&Y stage,UPDRS III score and LEDs,lower cognitive score,worse sleep structure than the PD with normal REM group.There was no statistically significant difference in PD duration among four different groups.Clinical characteristic and PSG parameters in the subclinical RBD group were more similar to the clinical RBD group than to the sub-DEB positive group.Conclusion: Both DEB and RWA were associated with severity of PD illness.PD duration was associated with RWA,but not DEB.Subclinical RBD might have different disease progression from sub-DEB positive.DEB symptoms may fluctuate or disappear whereas RWA may continue to develop as PD progresses.Differences in the course of DEB and RWA may reflect the difference in the degeneration process of neurodegenerative disorders.Part ?.The effect of bright light in patients with Parkinson's diseaseObject: Patients with Parkinson disease(PD)may experience circadian dysfunction,which might play important role in the progress of PD and contribute to many non-motor symptoms,such as sleep disturbances,depression and so on.Bright light(BL)has been introduced as a possible new treatment option to treat sleep disturbances and circadian dysfunction.However,it has not been systematically studied in the Chinese PD population.The objective of this study was firstly to investigate if BL has a beneficial effect on clinical symptoms in patients with PD.Methods: We invited 27 PD patients to receive 10,000 Lux BL once daily in 1-hour intervals for one week.Clinical assessments were repeated baseline(T0)and at the end of treatment(T1).After completing treatment,subjects entered a follow-up period of three weeks(T2).For this purpose,we evaluated the motor symptoms using the Unified Parkinson's Disease Rating Scale(UPDRS)and Hoehn and Yahr staging.Participants also completed some questionnaires to assess non-motor symptoms,including Mini-Mental State Examination,Montreal cognitive assessment(MoCA),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale,the Parkinson's Disease Questionnaire-39,Fatigue Severity Scale,Epworth Sleepiness Scale(ESS),Pittsburgh Sleep Quality Index(PSQI),Parkinson's disease sleep scale-2(PDSS-2),RBD screening questionnaire,RBD questionnaire-Hong Kong,Morningness-Eveningness questionnaire self-assessment version,Scales for outcomes in Parkinson's disease-Autonomic and the Non-motor symptom Questionnaire(NMSQ).Results: Finally,23 PD patients were included.We found mean age across patients with PD was 64.9 ± 11.6 years;14 patients were male.Through paired T-test,we found BL resulted in significant improvements in sleep quality,as assessed by the ESS,PSQI and PDSS-2.The score of sleepiness,sleep latency and sleep-specific disturbances had significant difference before and after intervention.BL was also associated with improvements in cognitive function as captured by global MoCA socre and delayed recall factor score.Motor symptoms and other non-motor symptoms,such as depression,anxiety,autonomic,had no significant difference between pre and post BL.BL seemed to an improved sleep-wake rhythm,that the percentage of neither type decreased and moderate morning type increased.However,it was no statistical significance.The effect of the intervention on the change wea mild.The measures at the T2 were really very close to T0 measures,except for HAMD and NMSQ score.Further analysis found BL was more effective for improving sleepiness in PD patients coexistent excessive daytime sleepiness.Conclusion: This research referred to preliminary clinical observation of BL in PD patients,and it had limited on short observation time and few samples.Therefore,the results we gained from this research were initial conclusion that BL appeared to have a positive,mild and transient effect on sleep and cognitive function in PD.We'll conduct randomized controlled trials in the future,and to determine optimal parameters of BL for PD.It will help to more objective and comprehensive understand the clinical effect of bright light on PD.