A recent study identified key patient characteristics that can predict the risk of likely and confirmed rapid eye movement disorder (RBD) in patients with Parkinson’s disease (PD). This study was reported in Clinical Neurology and Neurosurgery.
The researchers in this study conducted a systematic review of studies that compared the characteristics of patients with PD with RBD versus those without RBD. They performed a meta-analysis on a total of 47 studies that met the inclusion criteria. These studies included a pooled cohort of 8019 patients with PD and likely RBD, confirmed RBD or non-RBD.
Compared to patients without RBD, patients with PD and probable RBD had a significantly longer duration of PD (weighted mean difference [WMD], 0.72; 95% CI 0.37-1.07; P <0.001), daily levodopa dose (WMD, 76.61; 95% CI, 45.80-107.42; P <0.001), Hoehn-Yahr stage (WMD, 0.14; 95% CI, 0 , 05 - 0.23; P = 0.003), Unified Parkinson's Disease Rating Scale-III (UPDRS-III; WMD 1.28; 95% CI 0.31-2.24; P = 0.009), UPDRS Motor Score (WMD , 3.29; 95% CI, 0.63-5.95; P =. 015), UPDRS activities of daily living (WMD 1.92; 95% CI 1.12-2.71; P <0.001) and Epworth Sleepiness Scale (ESS; WMD 1.57; 95% CI 0.99-2.15; P <0.001.)).
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Probable RBD was more common in men (odds ratio [OR], 1.21; 95% CI 1.03-1.40; P = 0.017) and in patients with dyskinesia (OR 2.79; 95% CI 1.49-5.21; P = 0.001) orthostatic hypotension (OR 3.27; 95% CI 1.38–7.74; P. = 0.007), constipation (OR 1.77; 95% CI 1.27-2.48; P = 0.001) or fluctuations (OR 2.07; 95% CI 1.35-3.18; P = 0.001).
Patient characteristics that were significantly associated with confirmed RBD included older age (WMD 2.16; 95% CI 1.28-3.04; p <0.001), longer duration of PD (WMD 0.97; 95% CI) % CI 0.42-1.51; P = .001), higher daily levodopa dose (WMD, 70.33; 95% CI, 21.23-119.43; P = 0.005)), higher level -Yahr stage (WMD, 0.23; 95% CI, 0.12-0.34; P <0.001), higher UPDRS motor score (WMD, 2.85; 95% CI, 0.26 - 5.44; P = 0.031), higher ESS (WMD, 1.18; 95% CI, 0.38-1.99; P = 0.004) and lower MMSE (WMD, -0.92; 95% CI, -1.43 to -0.41; P <0.001).
Study results showed that patients were at increased risk for confirmed RBD if they were men (OR 1.49; 95% CI 1.10-2.01; P = 0.009) or if they had dyskinesia (OR 2.01; 95% CI) % CI 1.35-3.00; P = 001), hallucinations (OR 3.19; 95% CI 2.24-4.55; P <0.001), insomnia (OR 5.75; 95% CI 2, 26-14.64; P <0.001), dementia (OR 2.50; 95% CI 1.10-5.68; P = 0.028), orthostatic hypotension (OR 4.87; 95% CI 1.66-14 , 28; P = 0.004), falls (OR 1.85; 95% CI 1.32.) -2.60; P <0.001) or fluctuations (OR 1.71; 95% CI, 1.18-2.47; P = 0.005).
One limitation of this meta-analysis was the inclusion of studies with various diagnostic criteria and instruments for assessing PD and RBD, which may have introduced possible confounding factors into the analysis.
Ultimately, the study’s investigators concluded that “more large-scale prospective cohort studies should be conducted to assess risk factors for RBD in PD patients without RBD”.
reference
Xie C, Zhu M, Hu Y. Risk stratification for REM sleep behavior disorders in patients with Parkinson’s disease: a PRISMA-compliant meta-analysis and systematic review. Clin Neurol neurosurgeon. 2021; 202: 106484. doi: 10.1016 / j.clineuro.2021.106484
