The REM sleep behavior disorder screening questionnaire—A new diagnostic instrument
Corresponding Author
Karin Stiasny-Kolster MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Department of Neurology, Center of Nervous Diseases, Rudolf-Bultmann-Strasse 8D-35033 Marburg, GermanySearch for more papers by this authorGeert Mayer MD
Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
Search for more papers by this authorSylvia Schäfer MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorJens Carsten Möller MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorMonika Heinzel-Gutenbrunner PhD
Department of Child and Adolescent Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
Search for more papers by this authorWolfgang H. Oertel MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorCorresponding Author
Karin Stiasny-Kolster MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Department of Neurology, Center of Nervous Diseases, Rudolf-Bultmann-Strasse 8D-35033 Marburg, GermanySearch for more papers by this authorGeert Mayer MD
Department of Neurology, Hephata-Klinik, Schwalmstadt-Treysa, Germany
Search for more papers by this authorSylvia Schäfer MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorJens Carsten Möller MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorMonika Heinzel-Gutenbrunner PhD
Department of Child and Adolescent Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
Search for more papers by this authorWolfgang H. Oertel MD
Department of Neurology, Center of Nervous Diseases, Philipps-University, Marburg, Germany
Search for more papers by this authorAbstract
Many patients with assumed idiopathic REM sleep behavior disorder (RBD) may actually represent an early clinical manifestation of an evolving neurodegenerative disorder, such as the α-synucleinopathies, Parkinson's disease or multiple system atrophy. Early detection of these patients is clinically relevant for long-term prospective as well as future neuroprotective studies. For this purpose, we validated a 10-item patient self-rating questionnaire (maximum total score 13 points) covering the clinical features of RBD. The RBD screening questionnaire (RBDSQ) was applied to 54 patients with polysomnographically confirmed RBD (29 men; mean age 53.7 ± 15.8 years), 160 control subjects (81 men; mean age 50.8 ± 15.5 years) in whom RBD was excluded by history and polysomnography (PSG, control group 1) and 133 unselected healthy subjects (58 men; mean age 46.9 ± 12.3 years; no PSG, control group 2). In most subjects (n = 153) of control group 1, other sleep-wake disturbances were present. The mean RBDSQ score in the RBD group was 9.5 ± 2.8 points compared with 4.6 ± 3.0 points in control group 1 (P < 0.0001). Considering an RBDSQ score of five points as a positive test result, we found a sensitivity of 0.96 and a specificity of 0.56. The RBDSQ poorly discriminated patients with the most challenging differential diagnoses such as sleepwalking or epilepsy. In control group 2, the mean RBDSQ score (2.02 ± 1.78) was significantly lower than in the RBD group (P < 0.0005), revealing a specificity of 0.92. Due to its high sensitivity, the RBDSQ appears to be particularly useful as a screening tool. © 2007 Movement Disorder Society
REFERENCES
- 1 Atlas Task Force of the American Sleep Disorders Association (ASDA). The International Classification of Sleep Disorders—Diagnostic and Coding Manual. Minnesota: Rochester; 2005.
- 2 Unger M, Eggert KM, Höffken H, et al. Rapid eye movement sleep behaviour disorder—A predictor for a subgroup of alpha-synucleinopathies? CNS Drugs (in press).
- 3 Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in Sleep. Sleep 2002; 25: 120–138.
- 4 Lapierre O, Montplaisir J. Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 1992; 42: 1371–1374.
- 5 Eisensehr I, Linke R, Tatsch K, et al. Increased muscle activity during rapid eye movement sleep correlates with decrease of striatal presynaptic dopamine transporters. IPT and IBZM SPECT imaging in subclinical and clinically manifest idiopathic REM sleep behavior disorder, Parkinson's disease, and controls. Sleep 2003; 26: 507–512.
- 6 Consens FB, Chervin RD, Koeppe RA, et al. Validation of a polysomnographic score for REM sleep behavior disorder. Sleep 2005; 28: 993–997.
- 7
Mayer G,
Leonhardt E,
Kesper K,
Penzel T,
Ploch T.
Phasic and tonic muscle activity during REM sleep in RBD.
Sleep Medicine
2007;
8:
S54.
10.1016/S1389-9457(07)70209-5 Google Scholar
- 8 Chiu HF, Wing YK, Lam LC, et al. Sleep-related injury in the elderly—An epidemiological study in Hong Kong. Sleep 2000; 23: 513–517.
- 9 Ohayon MM, Caulet M, Priest RG. Violent behavior during sleep. J Clin Psychiat 1997; 58: 369–376.
- 10 Mayer G, Kesper K, Peter H, Ploch T, Leinweber T, Peter JH. Comorbidity in narcoleptic patients. Dtsch Med Wochenschr 2002; 127: 1942–1946.
- 11 Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992; 32: 3–10.
- 12 Nightingale S, Orgill JC, Ebrahim IO, de Lacy SF, Agrawal S, Williams AJ. The association between narcolepsy and REM behavior disorder (RBD). Sleep Med 2005; 6: 253–256.
- 13 Peyron C, Faraco J, Rogers W, et al. A mutation in a case of early onset narcolepsy and a generalized absence of hypocretin peptides in human narcoleptic brains. Nat Med 2000; 6: 991–997.
- 14 Thannickal TC, Moore RY, Nienhuis R, et al. Reduced number of hypocretin neurons in human narcolepsy. Neuron 2000; 27: 469–474.
- 15 Boeve BF, Silber MH, Fermann TJ, Lucas JA, Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord 2001; 16: 622–630.
- 16 Rechtschaffen A, Kales A. A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. Los Angeles, CA: UCLA Brain Information Service/Brain Research Institute; 1968.
- 17 Atlas Task Force of the American Sleep Disorders Association. EEG arousals: scoring rules and examples. Sleep 1992; 15: 173–184.
- 18 Atlas Task Force of the American Sleep Disorders Association. Recording and scoring leg movements. Sleep 1993; 16: 748–759.
- 19 Scheffe H. A method of judging all contrasts in the analysis of variance. Biometrika 1953; 40: 87–104.
- 20 Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 2005; 28: 203–206.
- 21 Eisensehr I, Lindeiner HV, Jäger M, Noachtar S. REM sleep behavior disorder in sleep-disordered patients with versus without Parkinson's disease: is there a need for polysomnography? J Neurol Sci 2001; 186: 7–11.
- 22 Atlas Task Force of the American Sleep Disorders Association (ASDA) B. The international classification of sleep disorders—diagnostic and coding manual. Minnesota: Rochester; 1997.
- 23 Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 1996; 46: 388–393 (erratum, Neurology 1996;46:1787).
- 24 Schenck CH, Bundlie SR, Mahowald MW. REM behavior disorder (RBD): delayed emergence of parkinsonism and/or dementia in 65% of older men initially diagnosed with idiopathic RBD, and an analysis of the minimum and maximum tonic and/or phasic electromyographic abnormalities found during REM sleep. Sleep 2003; 26 (Suppl): 0794.M.
- 25 Iranzo A, Molinuevo JL, Santamaria J, et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006; 5: 572–577.
- 26 Fantini ML, Gagnon JF, Petit D, et al. Slowing of electroencephalogram in rapid eye movement sleep behavior disorder. Ann Neurol 2003; 53: 774–780.
- 27 Eisensehr I, Linke R, Noachtar S, Schwarz J, Gildehaus FJ, Tatsch K. Reduced striatal dopamine transporter in idiopathic rapid eye movement sleep behavior disorder. Brain 2000; 123: 1155–1160.
- 28 Albin RL, Koeppe RA, Chervin RD, et al. Decreased striatal dopaminergic innervation in REM sleep behavior disorder. Neurology 2000; 55: 1410–1412.
- 29 Stiasny-Kolster K, Dörr Y, Möller C, et al. Combination of ‘idiopathic’ REM sleep behavior disorder and olfactory dysfunction as possible indicator for a-synucleinopathy demonstrated by dopamine transporter FP-CIT-SPECT. Brain 2005; 128: 126–137.
- 30 Shirakawa S, Takeuchi N, Uchimura N, et al. Study of image findings in rapid eye movement sleep behavior disorder. Psychiatry Clin Neurosci 2002; 56: 291–292.
- 31 Ferini-Strambi L, Di Gioia MR, Castronovo V, Oldani A, Zucconi M, Cappa SF. Neuropsychological assessment in idiopathic REM sleep behavior disorder (RBD)—does the idiopathic form really exist? Neurology 2004; 62: 41–45.
- 32 Fantini ML, Ferini-Strambi L, Montplaisir J. Idiopathic REM sleep behavior disorder: toward a better nosologic definition. Neurology 2005; 64: 780–786.
- 33 Postuma RB, Lang AE, Massicotte-Marquez J, Montplaisir J. Potential early markers of Parkinson's disease in idiopathic REM sleep behaviour disorder. Neurology 2006; 66: 845–851.
- 34 Ferini-Strambi L, Oldani A, Zucconi M, Smirne S. Cardiac autonomic activity during wakefulness and sleep in REM sleep behavior disorder. Sleep 1996; 19: 367–369.
- 35 Fantini ML, Michaud M, Gosselin N, Lavigne G, Montplaisir J. Periodic leg movements in REM sleep behavior disorder and related autonomic and EEG activation. Neurology 2002; 59: 1889–1894.
- 36 Robbins TW, James M, Lange KW, Owen AM, Quinn NP, Marsden CD. Cognitive performance in multiple system atrophy. Brain 1992; 115: 271–291.
- 37 Wenning GK, Shephard B, Hawkes CH, Petruckevitch A, Lees A, Quinn NP. Olfactory function in atypical parkinsonian syndromes. Acta Neurol Scand 1995; 91: 247–250.
- 38 Abele M, Riet A, Hummel T, Klockgether T, Wullner U. Olfactory dysfunction in cerebellar ataxia and multiple system atrophy. J Neurol 2003; 250: 1453–1455.
- 39 Chaudhuri KR. Autonomic dysfunction in movement disorders. Curr Opin Neurol 2001; 14: 505–511.
- 40 Barber PA, Varma AR, Lloyd JJ, Haworth B, Snowden JS, Neary D. The electroencephalogram in dementia with Lewy bodies. Acta Neurol Scand 2000; 101: 53–56.
- 41 Briel RC, McKeith IG, Barker WA, et al. EEG findings in dementia with Lewy bodies and Alzheimer's disease. J Neurol Neurosurg Psychiatry 1999; 66: 401–403.
- 42 McKeith IG, Mintzer J, Aarsland D, et al. Dementia with Lewy bodies. Lancet Neurol 2004; 3: 19–28.
- 43 McShane RH, Nagy Z, Esiri MM, et al. Ansomia in dementia is associated with Lewy bodies rather than Alzheimer's pathology. J Neurol Neurosurg Psychiatry 2001; 70: 739–743.
- 44 Mosiman UP, Mather G, Wesnes KA, O'Brien JT, Burn DJ, McKeith IG. Visuospatial perception in Parkinson's disease dementia and dementia with Lewy bodies. Neurology 2004; 63: 2091–2096.
- 45 Thaisetthawatkul P, Boeve BF, Benaroch EE, et al. Autonomic dysfunction in dementia with Lewy bodies. Neurology 2004; 62: 1804–1809.
- 46 Neufeld MY, Inzelberg R, Korczyn AD. EEG in demented and non-demented parkinsonian patients. Acta Neurol Scand 1988; 78: 1–5.
- 47 Soikkeli R, Partanen J, Soininen H, Pääkkönen A, Riekkinen P. Slowing of EEG in Parkinson's disease. Electroencephalogr Clin Neurophysiol 1991; 79: 159–165.
- 48 Gagnon JF, Fantini ML, Bedard MA, et al. Association between waking EEG slowing and REM sleep behavior disorder in PD without dementia. Neurology 2004; 62: 401–406.
- 49 Imon Y, Matsuda H, Ogawa M, Kogure D, Sunohara N. SPECT image analysis using statistical parametric mapping in patients with Parkinson's disease. J Nucl Med 1999; 40: 1583–1589.
- 50 Firbank MJ, Molloy S, McKeith IG, Burn DJ, O'Brien JT. Longitudinal changes in 99m TcHMPAO cerebral perfusion SPECT in Parkinson's disease over one year. J Neurol Neurosurg Psychiatry 2005; 76: 1448–1451.
- 51 Emre M. Dementia associated with Parkinson's disease. Lancet Neurol 2003; 2: 229–237.
- 52 Sinforiani E, Zangaglia R, Manni R, et al. REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease. Mov Disord 2006; 21: 462–466.
- 53 Markopoulou K, Larsen KW, Wszolek EK, et al. Olfactory dysfunction in familial parkinsonism. Neurology 1997; 49: 1262–1267.
- 54 Müller A, Reichmann H, Livermore A, Hummel T. Olfactory function in idiopathic Parkinson's disease (IPD): results from cross-sectional studies in IPD patients and long-term follow-up of de novo IPD patients. J Neural Transm 2002; 109: 805–811.
- 55 Ponsen MM, Stoffers D, Booij J, van Eck-Smit BL, Wolters EC, Berendse HW. Idiopathic hyposmia as a preclinical sign of Parkinson's disease. Ann Neurol 2004; 56: 173–181.
- 56 Büttner T, Kuhn W, Muller T, Patzold T, Heidbrink K, Przuntek H. Distorted color discrimination in “de novo” parkinsonian patients. Neurology 1995; 45: 386–387.
- 57 Diederich NJ, Raman R, Leurgans S, Goetz CG. Progressive worsening of spatial and chromatic processing deficits in Parkinson's disease. Arch Neurol 2002; 59: 1249–1252.
- 58 Scaglione C, Vignatelli L, Plazzi G, et al. REM sleep behaviour disorder in Parkinson's disease: a questionnaire-based study. Neurol Sci 2005; 25: 316–321.
