Sleep-Related Falling Out of Bed a Marker of Disturbed REM Sleep in Parkinson's Disease

Megan Brooks

June 29, 2010

June 29, 2010 (Buenos Aires, Argentina) — In patients with Parkinson's disease, sleep-related falling out of bed could be a clinical marker of REM sleep behavior disorder (RBD), according to research presented here at the Movement Disorder Society 14th International Congress of Parkinson's Disease and Movement Disorders.

Sleep-related falling out of bed in patients with Parkinson's "should prompt rapid confirmatory polysomnography and pharmacologic treatment to avoid imminent injury," Carlos Singer, MD, from the University of Miami Movement Disorder Clinic, in Florida, and colleagues conclude in their report.

In people with RBD, the muscle paralysis that normally accompanies REM sleep is incomplete or absent, leading the sleepers to physically and sometimes violently act out their dreams, causing injury to themselves or their bed partners. The exact cause of RBD is unknown, although it often occurs in association with various neurodegenerative diseases such as Parkinson's disease.

Sleep-Related Falls

For this report, Dr. Singer and colleagues conducted a retrospective analysis of 50 consecutive patients with Parkinson's disease and a mean Hoehn-Yahr stage of 2.1 (bilateral symptoms; no impairment of balance). All patients completed an initial clinical assessment and the validated RBD Screening Questionnaire (RBDSQ), which was modified to spot sleep-related falling out of bed and resulting injuries. The cohort included 34 men and 16 women.

Thirteen of the patients (26%) reported a history of sleep-related falling out of bed, and 17 (34%) met International Classification on Sleep Disorders-Revised Diagnostic and Coding Manual criteria for RBD. According to the investigators, 10 of these patients (58.8%) reported sleep-related falling out of bed, and 5 suffered related injuries.

"As expected," the study team notes, patients with RBD had significantly higher mean scores on the RBDSQ than those without RBD (8.0 vs 2.8; P < .001). The same was true for patients with sleep-related falling out of bed: they had a mean score of 8.2 on the RBDSQ, whereas patients without sleep-related falls had a mean score of 3.3 (P < .01).

Of note, according to the team, patients with RBD and sleep-related falls had the highest RBDSQ scores (9.3) — significantly higher than patients with RBD but no sleep-related falls (6.3; P = .014).

"A Common and Important Problem"

Commenting on the study findings for Medscape Neurology, Matthew B. Stern, MD, director of the Parkinson's Disease and Movement Disorders Center at Pennsylvania Hospital in Philadelphia and a member of the Movement Disorders Society, said: "RBD is a common and important problem in Parkinson's disease."

The disorder, he added, "is not particularly hard to diagnose when you ask the appropriate questions, but certainly any kind of warning sign like the one identified in this study is a really good indication that the patient ought to get treated." Dr. Stern was not involved in the study.

Dr. Singer and Dr. Stern have disclosed no relevant financial relationships.

Movement Disorder Society 14th International Congress of Parkinson's Disease and Movement Disorders: Abstract 757. Presented June 16, 2010.

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