TY - JOUR
T1 - Normative and isolated rapid eye movement sleep without atonia in adults without REM sleep behavior disorder
AU - Feemster, John C.
AU - Jung, Youngsin
AU - Timm, Paul C.
AU - Westerland, Sarah M.
AU - Gossard, Thomas R.
AU - Teigen, Luke N.
AU - Buchal, Lauren A.
AU - Cattaneo, Elena F.D.
AU - Imlach, Charlotte A.
AU - McCarter, Stuart J.
AU - Smith, Kevin L.
AU - Boeve, Bradley F.
AU - Silber, Michael H.
AU - Louis, Erik K.St
N1 - Funding Information:
This project was supported by Mayo Clinic Alzheimer’s Disease Research Center Grant Award from the National Institute on Aging (P50 AG016574) and the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number 1 UL1 RR024150-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Conflict of interest statement. E.K.S.L. is the Principal Investigator. Messrs. Feemster, Timm, Gossard, Teigen, Smith, Mesdames. Westerland, Cattaneo, Imlach, and Drs. Jung, McCarter, and Silber have nothing to disclose. B.F.B. reports grants from the National Institute on Aging, grants from the National Institute on Stroke and Neurological Disorders, grants from the Mangurian Foundation, grants from the Little Family Foundation, outside the submitted work. He serves as an investigator in clinical trials sponsored by Axovant and GE Healthcare and as a scientific advisor for the Tau Consortium. E.K.S. reports grants from the National Institute on Aging, the National Center for Advancing Clinical and Translational Science in relation to the submitted work and grants from the Michael J. Fox Foundation and Sunovion, Inc., outside the submitted work. He has served as a consultant for Axovant, Inc., but has received no personal fees.
Publisher Copyright:
© Sleep Research Society 2019.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Study Objectives: Values for normative REM sleep without atonia (RSWA) remain unclear. Older age and male sex are associated with greater RSWA, and isolated elevated RSWA has been reported. We aimed to describe normative RSWA and characterize isolated RSWA frequency in adults without REM sleep behavior disorder (RBD). Methods: We visually quantified phasic, "any," and tonic RSWA in the submentalis (SM) and anterior tibialis (AT) muscles, and the automated Ferri REM Atonia Index during polysomnography in adults without RBD aged 21-88. We calculated RSWA percentiles across age and sex deciles and compared RSWA in older (≥ 65) versus younger (<65) men and women. Isolated RSWA (exceeding diagnostic RBD cutoffs, or >95th percentile) frequency was also determined. Results: Overall, 95th percentile RSWA percentages were SM phasic, any, tonic = 8.6%, 9.1%, 0.99%; AT phasic and "any" = 17.0%; combined SM/AT phasic, "any" = 22.3%, 25.5%; and RAI = 0.85. Most phasic RSWA burst durations were ≤1.0 s (85th percentiles: SM = 1.07, AT = 0.86 seconds). Older men had significantly higher AT RSWA than older women and younger patients (all p < 0.04). Twenty-nine (25%, 18 men) had RSWA exceeding the cohort 95th percentile, while 17 (14%, 12 men) fulfilled diagnostic cutoffs for phasic or automated RBD RSWA thresholds. Conclusions: RSWA levels are highest in older men, mirroring the demographic characteristics of RBD, suggesting that older men frequently have altered REM sleep atonia control. These data establish normative adult RSWA values and thresholds for determination of isolated RSWA elevation, potentially aiding RBD diagnosis and discussions concerning incidental RSWA in clinical sleep medicine practice.
AB - Study Objectives: Values for normative REM sleep without atonia (RSWA) remain unclear. Older age and male sex are associated with greater RSWA, and isolated elevated RSWA has been reported. We aimed to describe normative RSWA and characterize isolated RSWA frequency in adults without REM sleep behavior disorder (RBD). Methods: We visually quantified phasic, "any," and tonic RSWA in the submentalis (SM) and anterior tibialis (AT) muscles, and the automated Ferri REM Atonia Index during polysomnography in adults without RBD aged 21-88. We calculated RSWA percentiles across age and sex deciles and compared RSWA in older (≥ 65) versus younger (<65) men and women. Isolated RSWA (exceeding diagnostic RBD cutoffs, or >95th percentile) frequency was also determined. Results: Overall, 95th percentile RSWA percentages were SM phasic, any, tonic = 8.6%, 9.1%, 0.99%; AT phasic and "any" = 17.0%; combined SM/AT phasic, "any" = 22.3%, 25.5%; and RAI = 0.85. Most phasic RSWA burst durations were ≤1.0 s (85th percentiles: SM = 1.07, AT = 0.86 seconds). Older men had significantly higher AT RSWA than older women and younger patients (all p < 0.04). Twenty-nine (25%, 18 men) had RSWA exceeding the cohort 95th percentile, while 17 (14%, 12 men) fulfilled diagnostic cutoffs for phasic or automated RBD RSWA thresholds. Conclusions: RSWA levels are highest in older men, mirroring the demographic characteristics of RBD, suggesting that older men frequently have altered REM sleep atonia control. These data establish normative adult RSWA values and thresholds for determination of isolated RSWA elevation, potentially aiding RBD diagnosis and discussions concerning incidental RSWA in clinical sleep medicine practice.
KW - Isolated REM sleep without atonia
KW - Normative values
KW - Polysomnogram
KW - REM sleep behavior disorder
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U2 - 10.1093/sleep/zsz124
DO - 10.1093/sleep/zsz124
M3 - Article
C2 - 31587043
AN - SCOPUS:85073079986
SN - 0161-8105
VL - 42
JO - Sleep
JF - Sleep
IS - 10
M1 - zsz124
ER -