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Abstract(s)
Introdução: A perturbação de comportamento do sono com movimento rápido dos olhos
(REM) é uma parassónia que ocorre durante esta fase do sono e que acontece,
geralmente, em associação a sonhos vividos. Caracteriza-se pela ausência de atonia
muscular durante o sono REM que resulta em atividade motora simples ou complexa
(nomeadamente comportamentos motores violentos como esbracejar e pontapear).
Existem 2 formas desta perturbação: a primária ou idiopática, e a secundária. A forma
idiopática parece preceder doenças neurodegenerativas pelo que poderá funcionar como
indicador precoce do desenvolvimento deste tipo de doenças e tornar mais fácil o
diagnóstico, antecipando o início do tratamento de forma a retardar a evolução dos
sintomas e a melhorar o prognóstico.
Com esta revisão tentamos perceber se a perturbação comportamental do sono REM
pode ser utilizada como indicador precoce do desenvolvimento de alguns processos
neurodegenerativos, nomeadamente associados à Doença de Parkinson, Demência dos
Corpos de Lewy e Atrofia Multissistémica e tentar definir o intervalo de tempo entre o
aparecimento das alterações comportamentais e o diagnóstico da doença
neurodegenerativa. Por fim, tentaremos também perceber o papel da Polissonografia
(PSG) no diagnóstico e quais os achados eletroencefalográficos e eletromiográficos mais
relevantes do doente com perturbação de comportamento do sono REM que possam
indicar a evolução para estas doenças, bem como perceber de que forma o diagnóstico
precoce pode influenciar o prognóstico deste tipo de doenças.
Métodos: Foi feita uma revisão da literatura dos últimos 20 anos recorrendo às bases de
dados Pubmed e Scopus. Foram incluídos estudos publicados até Dezembro de 2022, em
português, inglês e espanhol e selecionados numa primeira abordagem por título e
resumo. Em seguida foi feita uma seleção dos estudos a incluir segundo os critérios de
inclusão e exclusão.
Resultados: Dos 8 estudos analisados resultou uma taxa de conversão para doença
neurodegenerativa que variou entre 23,2% (que correspondeu a um follow-up médio de
3 anos) e 80% (para um follow-up médio de 14.2 anos). Adicionalmente, em dois dos
estudos foram calculadas taxas de conversão progressivas de 10,6% em 2 anos, 17,9% em
3 anos, 31,3 a 33,1% em 5 anos, 51,4% em 8 anos, 75,7% em 10 anos e 90,9% a 14 anos.
Relativamente ao diagnóstico, a progressão para Doença de Parkinson ocorreu entre 38 e 61% dos indivíduos, no caso da Demência dos Corpos de Lewy houve uma taxa de
conversão entre 14 e 45% e na Atrofia Multissistémica a taxa de conversão foi entre 2 e
12%. O intervalo entre o início da perturbação comportamental do sono REM e o
diagnóstico da doença neurodegenerativa situa-se entre os 12,2 e 19,5 anos.
Relativamente aos achados na polissonografia, apenas se verificou uma diminuição na
percentagem de sono em fase N3 e um aumento da percentagem de sono REM sem
atonia no grupo com distúrbio comportamental do sono REM em relação ao grupo
controlo. Adicionalmente, parece haver uma associação entre o aumento da atividade
eletromiográfica tónica e progressão para Doença de Parkinson e aumento da atividade
fásica e desenvolvimento de Demência dos Corpos de Lewy.
Conclusões: Apesar de não ser ainda possível estabelecer uma relação direta entre RDB
e as doenças neurodegenerativas estudadas, estudos anteriores parecem apontar nesse
sentido. Esta revisão da literatura revela que parece haver uma taxa de conversão por
ano entre 5.38 e 7.73% e uma percentagem maior de pacientes a desenvolver DP, em
detrimento de demência. Sugere-se que a RBD pode ser considerada um sinal precoce
do risco de desenvolver doença neurodegenerativa e ainda considerar a polissonografia
como um meio complementar de diagnóstico importante no diagnóstico precoce de RBD,
que pode levar à adoção de medidas preventivas numa fase pré-clínica da doença
neurodegenerativa. De futuro, serão necessários mais estudos prospectivos com maior
número de doentes de forma a confirmar esta possibilidade e uma melhor caracterização
dos registos poligráficos para identificar possíveis alterações.
Introduction: Rapid Eye Movement (REM) sleep behavior disorder is a parasomnia that occurs during this stage of sleep and is typically associated with vivid dreams. It is characterized by the absence of muscle atonia during REM sleep, resulting in simple or complex motor activity (including violent motor behaviors such as flailing and kicking). There are two forms of this disorder: primary or idiopathic, and secondary. The idiopathic form appears to precede neurodegenerative diseases and may serve as an early indicator of the development of such diseases, facilitating early diagnosis and initiation of treatment to delay symptom progression and improve prognosis. In this review, we aim to investigate whether REM sleep behavior disorder can be used as an early indicator of the development of certain neurodegenerative processes, specifically those associated with Parkinson's disease, Lewy Body Dementia and Multiple System Atrophy. We also seek to determine the time interval between the onset of behavioral changes and the diagnosis of the neurodegenerative disease. Additionally, we aim to understand the role of polysomnography (PSG) in the diagnosis and identify relevant electroencephalographic and electromyographic findings in patients with REM sleep behavior disorder that may indicate progression to these diseases. Furthermore, we aim to explore how early diagnosis may influence the prognosis of these conditions. Methods: A literature review spanning the last 20 years was conducted using the PubMed and Scopus databases. Studies published up until December 2022, in Portuguese, English, and Spanish, were included in the initial selection based on their titles and abstracts. Subsequently, studies were further selected according to inclusion and exclusion criteria. Results: Out of the 8 studies analyzed, the conversion rate to neurodegenerative disease ranged from 23.2% (corresponding to a mean follow-up of 3 years) to 80% (for a mean follow-up of 14.2 years). Additionally, two studies reported progressive conversion rates of 10.6% at 2 years, 17.9% at 3 years, 31.3% to 33.1% at 5 years, 51.4% at 8 years, 75.7% at 10 years, and 90.9% at 14 years. Regarding diagnosis, progression to Parkinson's disease occurred in 38% to 61% of individuals, while the conversion rate for Lewy body dementia ranged from 14% to 45%, and for Multiple System Atrophy was between 2% and 12%. The time interval between the onset of REM sleep behavior disorder and the diagnosis of neurodegenerative disease ranged from 12.2 to 19.5 years. In terms of polysomnographic findings, only a decrease in the percentage of N3 sleep and an increase in the percentage of REM sleep without atonia were observed in the REM sleep behavior disorder group compared to the control group. Additionally, there appears to be an association between increased tonic electromyographic activity and progression to Parkinson's disease, as well as increased phasic activity and the development of Lewy Body Dementia. Conclusions: Although it is not yet possible to establish a direct relationship between REM sleep behavior disorder (RBD) and the studied neurodegenerative diseases, previous studies seem to suggest such a connection. This literature review indicates an annual conversion rate between 5.38% and 7.73% and a higher percentage of patients developing Parkinson's disease compared to dementia. It is suggested that RBD may be considered an early signal of the risk of developing neurodegenerative disease, and polysomnography should be considered an important complementary diagnostic tool in the early diagnosis of RBD. This can lead to the adoption of preventive measures during the preclinical phase of neurodegenerative diseases. In the future, further prospective studies with a larger number of patients will be necessary to confirm this possibility and to provide a better characterization of polysomnographic records in order to identify possible diferences.
Introduction: Rapid Eye Movement (REM) sleep behavior disorder is a parasomnia that occurs during this stage of sleep and is typically associated with vivid dreams. It is characterized by the absence of muscle atonia during REM sleep, resulting in simple or complex motor activity (including violent motor behaviors such as flailing and kicking). There are two forms of this disorder: primary or idiopathic, and secondary. The idiopathic form appears to precede neurodegenerative diseases and may serve as an early indicator of the development of such diseases, facilitating early diagnosis and initiation of treatment to delay symptom progression and improve prognosis. In this review, we aim to investigate whether REM sleep behavior disorder can be used as an early indicator of the development of certain neurodegenerative processes, specifically those associated with Parkinson's disease, Lewy Body Dementia and Multiple System Atrophy. We also seek to determine the time interval between the onset of behavioral changes and the diagnosis of the neurodegenerative disease. Additionally, we aim to understand the role of polysomnography (PSG) in the diagnosis and identify relevant electroencephalographic and electromyographic findings in patients with REM sleep behavior disorder that may indicate progression to these diseases. Furthermore, we aim to explore how early diagnosis may influence the prognosis of these conditions. Methods: A literature review spanning the last 20 years was conducted using the PubMed and Scopus databases. Studies published up until December 2022, in Portuguese, English, and Spanish, were included in the initial selection based on their titles and abstracts. Subsequently, studies were further selected according to inclusion and exclusion criteria. Results: Out of the 8 studies analyzed, the conversion rate to neurodegenerative disease ranged from 23.2% (corresponding to a mean follow-up of 3 years) to 80% (for a mean follow-up of 14.2 years). Additionally, two studies reported progressive conversion rates of 10.6% at 2 years, 17.9% at 3 years, 31.3% to 33.1% at 5 years, 51.4% at 8 years, 75.7% at 10 years, and 90.9% at 14 years. Regarding diagnosis, progression to Parkinson's disease occurred in 38% to 61% of individuals, while the conversion rate for Lewy body dementia ranged from 14% to 45%, and for Multiple System Atrophy was between 2% and 12%. The time interval between the onset of REM sleep behavior disorder and the diagnosis of neurodegenerative disease ranged from 12.2 to 19.5 years. In terms of polysomnographic findings, only a decrease in the percentage of N3 sleep and an increase in the percentage of REM sleep without atonia were observed in the REM sleep behavior disorder group compared to the control group. Additionally, there appears to be an association between increased tonic electromyographic activity and progression to Parkinson's disease, as well as increased phasic activity and the development of Lewy Body Dementia. Conclusions: Although it is not yet possible to establish a direct relationship between REM sleep behavior disorder (RBD) and the studied neurodegenerative diseases, previous studies seem to suggest such a connection. This literature review indicates an annual conversion rate between 5.38% and 7.73% and a higher percentage of patients developing Parkinson's disease compared to dementia. It is suggested that RBD may be considered an early signal of the risk of developing neurodegenerative disease, and polysomnography should be considered an important complementary diagnostic tool in the early diagnosis of RBD. This can lead to the adoption of preventive measures during the preclinical phase of neurodegenerative diseases. In the future, further prospective studies with a larger number of patients will be necessary to confirm this possibility and to provide a better characterization of polysomnographic records in order to identify possible diferences.
Description
Keywords
Alterações Comportamentais do Sono Rem Atrofia Multissistémica Demência dos Corpos de Lewy Doença de Parkinson Doenças Neurodegenerativas Polissonografia Rem Sono