Abstract

Introduction: REM sleep behavior disorder (RBD) is a parasomnia due to an excessive muscle activity during REM sleep, expressed clinically as acting out of dreams, potentially injurious behaviors to patient or bedmate and high risk of subsequently developing alpha-synucleinopathy. RBD diagnosis is based on clinical history and confirmation of REM without atony (RWA) in polisomnography. SINBAR method quantifies pathological phasic and tonic EMG activity during REM sleep scoring records of mentalis and flexor digitorum superficialis (FDS) muscles. With this montages, validated normative values were established to define RWA in patients with idiopathic RBD and Parkinson's disease related RBD (RBD-PD). Cutoff of abnormal EMG activity were stablished comparing to healthy controls. However, in clinical practice other sleep disorders can increase electro- miographic activity in REM sleep due to secondary arousals, making it difficult to analyze records. In this study we compare PSG records using SINBAR montages in patients with RBD-PD patients with suspected OSA patients. Material and methods: We analize retrospectively PSG records of 12 PD patients with less than 5 years of evolution, in their usual pharmacological treatment, who complaint of suggestive symtoms of RBD. Their were compared with 18 patients who performed polysomnography to study a probable OSA. PSG records were reviewed by a neurologist with experience in sleep disorders. Their were performed in sleep laboratory, with usual sensors and scoring performed according to AASM recommendations. Quantification of tonic, phasic and "any" (either phasic or tonic) EMG ac- tivity in REM sleep was made in 3 sec-miniepochs (for phasic and “any” types) and 30 sec-epochs (for tonic activity). Artifacts due to movements, snoring or arousals were excluded. Finally a porcentage of epochs or miniepochs with positive muscle activity in REM sleep were obtained for each record. Results: No significant differences were observed in age (65.42 ± 11.30 versus 56.6 ±15.36) and in the male: female ratio among patients with RBD-PD and those with suspected OSA.