Low Specificity of Rapid Eye Movement Sleep Behavior Disorder Questionnaires: Need for Better Screening Methods.
RBD
polysomnography
prodromal PD
sleep
α-synucleinopathy
Journal
Movement disorders : official journal of the Movement Disorder Society
ISSN: 1531-8257
Titre abrégé: Mov Disord
Pays: United States
ID NLM: 8610688
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
revised:
28
02
2023
received:
04
01
2023
accepted:
28
03
2023
medline:
23
10
2023
pubmed:
6
5
2023
entrez:
5
5
2023
Statut:
ppublish
Résumé
Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited. The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG. In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis. Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires. RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Sections du résumé
BACKGROUND
Correct diagnosis of rapid eye movement sleep behavior disorder (RBD) is critical due to its link to α-synucleinopathies and risk of injuries and requires video-polysomnography (V-PSG). Usefulness of screening questionnaires outside the context of validation studies is limited.
OBJECTIVE
The aim was to assess the performance of three validated RBD screening questionnaires compared with gold-standard V-PSG.
METHODS
In this bicentric prospective study, 400 consecutive subjects referred to a sleep center for the first time filled three RBD questionnaires (RBD Screening Questionnaire, RBD Single Question, and Innsbruck RBD Inventory) in random order before sleep experts' interview. Subjects positive for at least one questionnaire were invited to undergo V-PSG. Data from patients negative for all questionnaires undergoing V-PSG for other reasons were also evaluated. Questionnaire performances were compared to gold-standard V-PSG RBD diagnosis.
RESULTS
Three hundred ninety-nine patients (median age: 51 [interquartile range: 37-64] years, 54.9% men) participated. Two hundred thirty-eight (59.6%) were positive for at least one questionnaire, and RBD was diagnosed using V-PSG in 30 patients (7.5%). Questionnaire specificity was 48.1% to 67.4%, sensitivity 80% to 92%, accuracy 51% to 68.3%, negative predictive value 94.2% to 98%, and positive predictive value 14.1% to 20.7%, with no relevant differences in performances among the evaluated questionnaires.
CONCLUSIONS
RBD questionnaires have low specificity and low positive predictive value and should not be used as a standalone tool for the diagnosis of RBD. Further development of RBD screening methods is needed, particularly for upcoming neuroprotective trials. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1000-1007Informations de copyright
© 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Références
American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: AASM; 2015.
Cesari M, Heidbreder A, St Louis EK, et al. Video-polysomnography procedures for diagnosis of rapid eye movement sleep behavior disorder (RBD) and the identification of its prodromal stages: Guidelines from the International RBD Study Group. Sleep 2022;43(3):1-20. https://doi.org/10.1093/sleep/zsab257
Högl B, Stefani A, Videnovic A. Idiopathic REM sleep behaviour disorder and neurodegeneration-an update. Nat Rev Neurol 2018;14(1):40-55. https://doi.org/10.1038/nrneurol.2017.157
Dauvilliers Y, Schenck CH, Postuma RB, et al. REM sleep behaviour disorder. Nat Rev Dis Primers 2018;4(1):19. https://doi.org/10.1038/s41572-018-0016-5
Postuma RB, Gagnon JF, Vendette M, Charland K, Montplaisir J. REM sleep behaviour disorder in Parkinson's disease is associated with specific motor features. J Neurol Neurosurg Psychiatry 2008;79(10):1117-1121. https://doi.org/10.1136/jnnp.2008.149195
Pagano G, De Micco R, Yousaf T, Wilson H, Chandra A, Politis M. REM behavior disorder predicts motor progression and cognitive decline in Parkinson disease. Neurology 2018;91(10):e894-e905. https://doi.org/10.1212/WNL.0000000000006134
Mao J, Huang X, Yu J, et al. Association between REM sleep behavior disorder and cognitive dysfunctions in Parkinson's disease: a systematic review and meta-analysis of observational studies. Front Neurol 2020;11:577874. https://doi.org/10.3389/fneur.2020.577874
Ashraf-Ganjouei A, Moradi K, Aarabi M, et al. The association between REM sleep behavior disorder and autonomic dysfunction in Parkinson's disease. J Parkinsons Dis 2021;11(2):747-755. https://doi.org/10.3233/JPD-202134
Postuma RB, Montplaisir J, Lanfranchi P, et al. Cardiac autonomic denervation in Parkinson's disease is linked to REM sleep behavior disorder. Mov Disord 2011;26(8):1529-1533. https://doi.org/10.1002/mds.23677
Skorvanek M, Feketeova E, Kurtis MM, Rusz J, Sonka K. Accuracy of rating scales and clinical measures for screening of rapid eye movement sleep behavior disorder and for predicting conversion to Parkinson's disease and other synucleinopathies. Front Neurol 2018;9(MAY). https://doi.org/10.3389/fneur.2018.00376
Stiasny-Kolster K, Mayer G, Schäfer S, Möller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM sleep behavior disorder screening questionnaire-a new diagnostic instrument. Mov Disord 2007;22(16):2386-2393. https://doi.org/10.1002/mds.21740
Postuma RB, Arnulf I, Högl B, et al. A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study. Mov Disord 2012;27(7):913-916. https://doi.org/10.1002/mds.25037
Frauscher B, Ehrmann L, Zamarian L, et al. Validation of the Innsbruck REM sleep behavior disorder inventory. Mov Disord 2012;27(13):1673-1678. https://doi.org/10.1002/mds.25223
Stiasny-Kolster K, Sixel-Döring F, Trenkwalder C, et al. Diagnostic value of the REM sleep behavior disorder screening questionnaire in Parkinson's disease. Sleep Med 2015;16(1):186-189. https://doi.org/10.1016/j.sleep.2014.08.014
Stefani A, Mahlknecht P, Seppi K, et al. Consistency of " probable RBD " diagnosis with the RBD screening questionnaire: a follow-up study. Mov Disord Clin Pract 2016;4(3):403-405. https://doi.org/10.1002/mdc3.12448
Halsband C, Zapf A, Sixel-Döring F, Trenkwalder C, Mollenhauer B. The REM sleep behavior disorder screening questionnaire is not valid in De novo Parkinson's disease. Mov Disord Clin Pract 2018;5(2):171-176. https://doi.org/10.1002/mdc3.12591
Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 2005;28(2):203-206.
Gaig C, Iranzo A, Pujol M, Perez H, Santamaria J, Montserrat PD. Periodic limb movements during sleep mimicking REM sleep behavior disorder: a new form of periodic limb movement disorder. Sleep 2017;40(3):zsw063.
Fernández-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep 2016;39(1):121-132. https://doi.org/10.5665/sleep.5332
Stefani A, Mahlknecht P, Seppi K, et al. Consistency of " Probable RBD " diagnosis with the RBD screening questionnaire: a follow-up study. https://doi.org/10.1002/mdc3.12448
Pujol M, Pujol J, Alonso T, et al. Idiopathic REM sleep behavior disorder in the elderly Spanish community: a primary care center study with a two-stage design using video-polysomnography. Sleep Med 2017;40:116-121. https://doi.org/10.1016/j.sleep.2017.07.021
Berry RB, Brooks R, Gamaldo CE, et al. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications: Version 2.6. Darian, IL: American Academy of Sleep Medicine; 2020.
Frauscher B, Iranzo A, Gaig C, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 2012;35(6):835-847. https://doi.org/10.5665/sleep.1886
Frauscher B, Gabelia D, Biermayr M, et al. Validation of an integrated software for the detection of rapid eye movement sleep behavior disorder. Sleep 2014;37(10):1663-1671. https://doi.org/10.5665/sleep.4076
Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated international restless legs syndrome study group (IRLSSG) consensus criteria-history, rationale, description, and significance. Sleep Med 2014;15(8):860-873. https://doi.org/10.1016/j.sleep.2014.03.025
Fernández-Arcos A, Morenas-Rodríguez E, Santamaria J, et al. Clinical and video-polysomnographic analysis of rapid eye movement sleep behavior disorder and other sleep disturbances in dementia with Lewy bodies. Sleep 2019;42(7):zsz086. https://doi.org/10.1093/sleep/zsz086
Baldelli L, Schade S, Jesús S, et al. Heterogeneity of prodromal Parkinson symptoms in siblings of Parkinson disease patients. npj Parkinson's Dis 2021;7(1). https://doi.org/10.1038/s41531-021-00219-1
Stefani A, Mozersky J, Kotagal V, et al. Ethical aspects of prodromal synucleinopathy prognostic counseling. Semin Neurol 2023;43(01):166-177. https://doi.org/10.1055/a-2019-0245
Yao CW, Saha-Chaudhuri P, Zolfaghari S, Pelletier A, Postuma RB. Phenoconversion from possible REM sleep behavior to parkinsonism in the population-based CLSA. Mov Disord 2021;36(6):1466-1467. https://doi.org/10.1002/mds.28571
Frauscher B, Gschliesser V, Brandauer E, et al. Video analysis of motor events in REM sleep behavior disorder. Mov Disord 2007;22(10):1464-1470. https://doi.org/10.1002/mds.21561
Frauscher B, Gschliesser V, Brandauer E, Ulmer H, Poewe W, Högl B. The relation between abnormal behaviors and REM sleep microstructure in patients with REM sleep behavior disorder. Sleep Med 2009;10(2):174-181. https://doi.org/10.1016/j.sleep.2008.01.003