Estudio del tiempo de aparición de enfermedades neurodegenerativas en pacientes diagnosticados de trastorno de conducta de sueño REM mediante polisomnografía

Resumo

Introduction: RBD is a type of parasomnia characterized by the dream enactment during rapid eye movement (REM) sleep due to a lack of physiologic muscle atonia and increased muscle twitching. The onset of RBD precedes the development of neurodegeneration by several years. Its prevalence is largely unknown. RBD is diagnosed by a clinical history and polysomnographic rapid eye movement sleep atonia loss. Objetives: To establish the rate of conversion of RBD into neurodegenerative diseases using an analysis of survival. To determine the risk for developing neurodegenerative according to the gender and age. To determine the kind of neurodegenerative diseases. To determine the mortality in patients with RBD. To determine the clinical markers of prodromal synucleinopathy in BD: presynaptic lesion of the dopaminergic pathway, anosmia, and visual alteration. To determine the influence of certain drugs in patients who develop acute RBD. To study polysomnography as an objective diagnostic test for REM sleep behavior disorder. To study the influence of Sleep Apnea-Hypopnea Syndrome (SAHS) on the development of idiopatic RBD. Material and methods: A descriptive, observational and longitudinal survival study. All patients who present clinical symptoms of RBD, are studied by PSG. Depending on the result, all the patients with a positive PSG of RBD will be followed during many years until the development of a neurodegenerative disease at the Hospital Central de la Defensa. Focusing on clinical, prodromal markers result (Dat-SCAN, anosmia and chromatic visual impairment), gender and age, the overall sample will be divided into different neurodegenerative processes (Parkinson Disease, Lewy Body Dementia, Cognitive Impairment, tremor, etc.) until the date of death. Results: PSG is the only test for diagnosing rem behavior sleep disorders with 90,67% of sensitivity and 20% of specificity. We obtained a phenoconversion rate for neurodegenerative diseases of 48.1% (66 patients). Of these, 71.8% developed Parkinson's disease, 15.4% tremor, 7.7% cognitive impairment and 5.1% Lewy Body Dementia. We identified 79 patients with RBD. We concluded that of the 66 patients diagnosed with RBD, half of them developed a neurodegenerative disease in 9 years. In cases of RBD due to drugs (all of them were selective serotonin euptake inhibitors (venlafaxine, fluoxetine, sertraline and mirtazapine in our study), did not present symptoms of the RBD, but they did present episodes of REM without atony analyzed with polysomnography. The presence of rem without atony during REM sleep remitted in 100% of the cases with the withdrawal of this medication. The study of survival from the diagnosis of RBD to the development of a neurodegenerative disease, differentiated by sex, it was found that half of the male patients will develop the disease at 14 years, while female patients will develop at 9 years. Meanwhile, differentiated by age, we obtained that the average of patients older than 70 years, will develop the neurodegenerative disease at 6 years, while those younger or equal to 70 years, will develop it at 12 years. The average age of patients who develop a neurodegenerative disease secondary to an idiopatic RBD was 74 years, while those who did not develop it have an average of 66 years. Visual dysfunction, especially chromatic disturbances, is considered as a biomarker of neurodegenerative disease in the context of REM Sleep Behavior Disorder. We found statistically significant differences with it (p <0.007 and a 95% confidence interval for the difference). The study of survival according to registered deaths, we obtained that the mean of the events occurred at 12.7 years: o The mean of the events in the male sex differentiated by sex, occurred at 12 years, while in the female sex, the average of deaths was 13.5 years after the diagnosis of RBD. No statistically significant difference was observed o The mean of the events differentiated by age, 11.8 years for subjects over 70 years of age and 13.9 years for those patients under or equal to 70 years. No statistically significant difference was observed. There was no evidence of a relationship between the mortality of patients who developed a neurodegenerative disease, 12.2 years, and those who did not develop it, 12.8 years.