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Research paper
REM sleep behaviour disorder is associated with worse quality of life and other non-motor features in early Parkinson's disease
  1. Michal Rolinski1,
  2. Konrad Szewczyk-Krolikowski1,
  3. Paul R Tomlinson1,
  4. Kannan Nithi2,
  5. Kevin Talbot1,2,
  6. Yoav Ben-Shlomo3,
  7. Michele TM Hu1,2
  1. 1Nuffield Department of Clinical Neurosciences, Division of Neurology, University of Oxford, Oxford, UK
  2. 2Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK
  3. 3School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Michele Hu, Nuffield Department of Clinical Neurosciences, Level 3, West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DE, UK; michele.hu{at}ndcn.ox.ac.uk

Abstract

Background Concomitant REM sleep behaviour disorder (RBD) is commonly observed in patients with Parkinson's disease (PD). Although the brainstem structures responsible for the symptoms of RBD correspond to the premotor stages of PD, the association of RBD with motor and non-motor features in early PD remains unclear.

Methods The study evaluated 475 patients with PD within 3.5 years of diagnosis for the presence of probable RBD (pRBD) using the REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ). A neurologist and a trained research nurse carried out evaluation of each participant blinded to the results of the RBDSQ. Standardised rating scales for motor and non-motor features of PD, as well as health-related quality of life measures, were assessed. Multiple linear and logistic regression analyses were used to determine the relationship between pRBD and a variety of outcomes, controlling for confounding factors.

Results The overall frequency of pRBD was 47.2% (95% CI 42.7% to 51.9%). None of the patients had a previous diagnosis of RBD. Patients with PD and concomitant pRBD did not differ on motor phenotype and scored comparably on the objective motor scales, but reported problems with motor aspects of daily living more frequently. Adjusted for age, sex, disease duration and smoking history, pRBD was associated with greater sleepiness (p=0.001), depression (p=0.001) and cognitive impairment (p=0.006).

Conclusions pRBD is common and under-recognised in early PD. It is associated with increased severity and frequency of non-motor features, poorer subjective motor performance and a greater impact on health-related quality of life.

  • PARKINSON'S DISEASE
  • SLEEP DISORDERS
  • QUALITY OF LIFE

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