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Research paper
Sleep and REM sleep behaviour disorder in Parkinson’s disease with impulse control disorder
  1. Maria Livia Fantini1,2,3,
  2. Michela Figorilli2,4,
  3. Isabelle Arnulf5,
  4. Maurizio Zibetti6,
  5. Bruno Pereira7,
  6. Patricia Beudin1,
  7. Monica Puligheddu4,
  8. Florence Cormier-Dequaire8,
  9. Lucette Lacomblez8,
  10. Eve Benchetrit8,
  11. Jean Christophe Corvol8,
  12. Alessandro Cicolin9,
  13. Leonardo Lopiano6,
  14. Ana Marques2,3,
  15. Franck Durif2,3
  1. 1 Sleep and EEG Unit, Centre Hospitalier Universitaire, Clermont-Ferrand, France
  2. 2 EA7820 UFR Medecine, Universite Clermont Auvergne, Clermont-Ferrand, France
  3. 3 Department of Neurology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
  4. 4 Neurophysiology Unit, Sleep Center, University of Cagliari, Monserrato, Italy
  5. 5 Sleep Disorders Unit, AP-HP, Pitié-Salpêtrière Hospital and Pierre and Marie Curie University, Paris, France
  6. 6 Department of Neuroscience, University of Turin, Turin, Italy
  7. 7 Biostatistics DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
  8. 8 Department of Neurology, Hôpital Pitié-Salpêtrière, Sorbonne Universités, Paris, France
  9. 9 Department of Neuroscience, Sleep Disorders Center, University of Turin, Turin, Italy
  1. Correspondence to Dr Maria Livia Fantini, EEGand Sleep Unit, Neurology Department, CHU Clermont Ferrand, Clermont-Ferrand, France; mfantini{at}


Introduction Because the association between rapid eye movement sleep behaviour disorder (RBD) and impulse control disorders (ICDs) in Parkinson’s disease (PD) has been debated, we assessed the sleep characteristics and the frequency of RBD using video-polysomnography (v-PSG) in patients with PD with versus without ICDs.

Methods Eighty non-demented patients with PD consecutively identified during routine evaluation at three movement disorders centres were enrolled in a case–control study. Forty patients (22 men; mean age: 62.6±9.7 years, Hoehn & Yahr: 2.1±0.6) with one or more current ICDs were age-matched and sex-matched with 40 patients with no history of ICDs (22 men, mean age: 64.9±7.8 years, Hoehn & Yahr: 2.2±0.6). They underwent a detailed sleep interview followed by a full-night in-lab v-PSG. Sleep was scored blindly to ICDs condition and RBD diagnosis included a clinical complaint of enacted dreams and/or documented behaviour during rapid eye movement (REM) sleep, with the presence of quantified REM sleep without atonia (RSWA).

Results Patients with ICDs had a higher arousal index and higher RSWA than those without ICDs (51.9%±28.2%vs 32.2±27.1%, p=0.004). In addition, RBD was more frequent in the ICD group (85%vs53%, p=0.0001). RBD was still associated with ICDs in a multivariate regression analysis including age of onset, PD duration and severity, treatment duration, levodopa-equivalent and dopamine agonist-equivalent daily doses and antidepressant use (OR: 4.9 (95% CI 1.3 to 18.5), p=0.02).

Conclusions This large, controlled series of patients with PD with ICDs assessed by v-PSG confirms the association between ICDs and RBD. Increased surveillance of symptoms of ICDs should be recommended in patients with PD with RBD.

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  • Contributors MLF conceptualised the study, interpreted the data and drafted the manuscript. MF analysed and interpreted the data and revised the manuscript for intellectual content; IA interpreted the data and revised the manuscript for intellectual content; MZ participated in the design of the study and revised the manuscript for intellectual content; PB designed the study, analysed the data and revised the manuscript for intellectual content; BP and MP participated in collecting data and revised the manuscript for intellectual content. JCC, AC and LL revised the manuscript for intellectual content; FCD, LL and EB participated in collecting and analysing the data; AM and FD conceptualised the study, interpreted the data and revised the manuscript for intellectual content.

  • Funding MLF received honoraria from Lundbeck, IA had consultancy and congress fees financed by UCB Pharma. JCC declares stock ownership of B&A Therapeutics, received honoraria from Zambon, Pfizer, Abbvie, and Amarantus, and research grants from Ipsen, Michael J Fox Foundation, Sanofi, and travel grants from Abbvie, Lundbeck; LL and MZ received honoraria from Compumedics, Abbvie and Lundbeck; FD received honoraria from Aguettant/Orkin, Novartis, Medtronic, Allergan and Abbvie. MF, AM and BP have nothing to disclose.

  • Competing interests None declared.

  • Ethics approval Comité Protection des Personnes (CPP) Sud Est 6.

  • Provenance and peer review Not commissioned; externally peer reviewed.