TY - JOUR

T1 - Arousal characteristics in patients with Parkinson's disease and isolated rapid eye movement sleep behavior disorder

AU - Brink-Kjær, Andreas

AU - Cesari, Matteo

AU - Sixel-Döring, Friederike

AU - Mollenhauer, Brit

AU - Trenkwalder, Claudia

AU - Mignot, Emmanuel

AU - Sorensen, Helge B.D.

AU - Jennum, Poul

N1 - Publisher Copyright: © Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

PY - 2021

Y1 - 2021

N2 - STUDY OBJECTIVES: Patients diagnosed with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and Parkinson's disease (PD) have altered sleep stability reflecting neurodegeneration in brainstem structures. We hypothesize that neurodegeneration alters the expression of cortical arousals in sleep. METHODS: We analyzed polysomnography data recorded from 88 healthy controls (HC), 22 iRBD patients, 82 de novo PD patients without RBD, and 32 with RBD (PD + RBD). These patients were also investigated at a 2-year follow-up. Arousals were analyzed using a previously validated automatic system, which used a central electroencephalography lead, electrooculography, and chin electromyography. Multiple linear regression models were fitted to compare group differences at baseline and change to follow-up for arousal index (ArI), shifts in electroencephalographic signals associated with arousals, and arousal chin muscle tone. The regression models were adjusted for known covariates affecting the nature of arousal. RESULTS: In comparison to HC, patients with iRBD and PD + RBD showed increased ArI during REM sleep and their arousals showed a significantly lower shift in α-band power at arousals and a higher muscle tone during arousals. In comparison to HC, the PD patients were characterized by a decreased ArI in non-REM (NREM) sleep at baseline. ArI during NREM sleep decreased further at the 2-year follow-up, although not significantly. CONCLUSIONS: Patients with PD and iRBD present with abnormal arousal characteristics as scored by an automated method. These abnormalities are likely to be caused by neurodegeneration of the reticular activation system due to alpha-synuclein aggregation.

AB - STUDY OBJECTIVES: Patients diagnosed with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and Parkinson's disease (PD) have altered sleep stability reflecting neurodegeneration in brainstem structures. We hypothesize that neurodegeneration alters the expression of cortical arousals in sleep. METHODS: We analyzed polysomnography data recorded from 88 healthy controls (HC), 22 iRBD patients, 82 de novo PD patients without RBD, and 32 with RBD (PD + RBD). These patients were also investigated at a 2-year follow-up. Arousals were analyzed using a previously validated automatic system, which used a central electroencephalography lead, electrooculography, and chin electromyography. Multiple linear regression models were fitted to compare group differences at baseline and change to follow-up for arousal index (ArI), shifts in electroencephalographic signals associated with arousals, and arousal chin muscle tone. The regression models were adjusted for known covariates affecting the nature of arousal. RESULTS: In comparison to HC, patients with iRBD and PD + RBD showed increased ArI during REM sleep and their arousals showed a significantly lower shift in α-band power at arousals and a higher muscle tone during arousals. In comparison to HC, the PD patients were characterized by a decreased ArI in non-REM (NREM) sleep at baseline. ArI during NREM sleep decreased further at the 2-year follow-up, although not significantly. CONCLUSIONS: Patients with PD and iRBD present with abnormal arousal characteristics as scored by an automated method. These abnormalities are likely to be caused by neurodegeneration of the reticular activation system due to alpha-synuclein aggregation.

KW - arousal

KW - Multimodal Arousal Detector

KW - Parkinson’s disease

KW - polysomnography

KW - rapid eye movement sleep behavior disorder

KW - reticular activating system

U2 - 10.1093/sleep/zsab167

DO - 10.1093/sleep/zsab167

M3 - Journal article

C2 - 34214165

AN - SCOPUS:85127729282

VL - 44

JO - Sleep (Online)

JF - Sleep (Online)

SN - 0161-8105

IS - 12

M1 - zsab167

ER -