Parkinson’s Disease With Rapid Eye Movement Sleep Behavior Disorder:a Pilot Case Analysis And Literature Review

Objective:Rapid eye movement sleep behavior disorder (RBD) is one of the hottest research topics of Parkinson’s disease (PD) in recent years. The latest diagnostic criteria of RBD include clinical history and video-Polysomnography (v-PSG). But most researchers still use the minimum criteria for the diagnosis of RBD. To summarize the clinical features of PD patients with RBD and to identify whether RBD was associated with differences in clinical features and sleep parameters of PD patients, we analyzed the clinical information of patients in our hospital and the published literatures with polysomnography.Methods:This study included 16 hospital patients in Second Affiliated Hospital of Zhejiang University School of Medicine from June 2015 to March 2016. Clinical features and polysomnography information were collected. According to the criteria of the International Classification of Sleep Disorders third edition (ICSD-3), PD patients were divided into PD with RBD (PD+RBD) and without RBD (PD-RBD). Clinical features and PSG parameters were compared in PD+RBD and PD-RBD patients. Meanwhile, studies on RBD in PD patients with polysonmography from January 2005 to March 2016 were searched,clinical features were compared in PD+RBD and PD-RBD patients.Results:1. In case analysis, a total of 8/16 patients with PD (50%) were identified in PSG with RBD. Literature review shows 45～58% patients with PD were identified in PSG with RBD.2. In Case Analysis, PD+RBD patients had higher Hoehn&Yahr stages [3(2.5-3)vs 2(1.5-2), p=0.002]. There were no significant differences in PD duration,age and levodopa equivalent daily dose (LED) between PD+RBD and PD-RBD patients [PD duration:76.5 ±47.1vs40.7±37.1months,p=0.114;age:62.8±9.6 vs 59.9±14 year, p=0.646;LED:557.8 ±218.2 vs 481.2 ±127.3mg, p=0.4].3. In literature review,PD+RBD patients were older(WMD=2.646,95%CI:1.385-3.908, P=0.000), and had higher Hoehn&Yahr (H-Y) stages(WMD=0.344,95%CI: 0.151-0.536, P=0.000),higher UPDRS Ⅲscores(stage"on")(WMD=2.501,95%CI: 0.739-4.263, P=0.005),and needed more levodopa equivalent daily dose (LED)(WMD=134.447,95%CI:74.158-194.736mg, P=0.000).In addition, PD+RBD patients were more likely to develop orthostatic hypotension as compared to PD-RBD(OR=3.684,95%CI:2.125-6.387;P=0.000). However, gender and PD duration did not show significantly differences between PD+RBD and PD-RBD patients.4. In case analysis, PSG parameters did not differ significantly between PD+RBD and PD-RBD patients.Conclusion:In this study, according to the case analysis and literature review with polysomnography, there were some differences of clinical features between PD+RBD and PD-RBD patients. PD+RBD patients had more severe motor disability. Gender and PD duration did not show significantly differences between PD+RBD and PD-RBD patients.