Actigraphy as a diagnostic aid for REM sleep behavior disorder in Parkinson's disease

• Published in: BMC neurology Vol. 14; no. 1; p. 76
• Main Authors: Louter, Maartje, Arends, Johan B A M, Bloem, Bastiaan R, Overeem, Sebastiaan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.04.2014; BioMed Central
• Subjects: Actigraphy - methods; Aged; Behavior disorders; Care and treatment; Complications and side effects; Diagnosis; Female; Humans; Insomnia; Male; Medical research; Medicine, Experimental; Middle Aged; Parkinson Disease - complications; Patient outcomes; Polysomnography; REM Sleep Behavior Disorder - diagnosis; REM Sleep Behavior Disorder - etiology; Risk factors; Sensitivity and Specificity; Sleep; Sleep disorders; Studies
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/1471-2377-14-76

Rapid eye movement (REM) sleep behavior disorder (RBD) is a common parasomnia in Parkinson's disease (PD) patients. The current International Classification of Sleep Disorders (ICSD-II) requires a clinical interview combined with video polysomnography (video-PSG) to diagnose. The latter is time consuming and expensive and not always feasible in clinical practice. Here we studied the use of actigraphy as a diagnostic tool for RBD in PD patients. We studied 45 consecutive PD patients (66.7% men) with and without complaints of RBD. All patients underwent one night of video-PSG and eight consecutive nights of actigraphy. Based on previous studies, the main outcome measure was the total number of bouts classified as "wake", compared between patients with (PD + RBD) and without RBD (PD- RBD). 23 (51.1%) patients had RBD according to the ICSD-II criteria. The total number of wake bouts was significantly higher in RBD patients (PD + RBD 73.2 ± 40.2 vs. PD-RBD 48.4 ± 23.3, p = .016). A cut off of 95 wake bouts per night resulted in a specificity of 95.5%, a sensitivity of 20.1% and a positive predictive value of 85.7%. Seven patients were suspected of RBD based on the interview alone, but not confirmed on PSG; six of whom scored below 95 wake bouts per night on actigraphy. PD patients with RBD showed a significantly higher number of bouts scored as "wake" using actigraphy, compared to patients without RBD. In clinical practice, actigraphy has a high specificity, but low sensitivity in the diagnosis of RBD. The combination of actigraphy and previously reported RBD questionnaires may be a promising method to diagnose RBD in patients with PD.