Abstract
Purpose
The purpose of this study is to determine the diagnostic cutoff for the proportion of rapid eye movement (REM) sleep with tonic and phasic activities of the submentalis muscle activity that can be used to diagnose REM sleep behavior disorder (RBD).
Methods
Seventeen patients clinically diagnosed as idiopathic RBD and 15 age- and gender-matched controls were studied. Surface electromyography was recorded from the submentalis muscle, and two sleep technologists manually identified epochs with tonic and phasic activities during REM sleep. Receiver operating characteristic (ROC) curves were constructed to find the optimal cutoff values for diagnosing RBD using the proportion of REM sleep with tonic and phasic activities of the submentalis muscle. Cohen’s kappa coefficient was calculated to evaluate interrater reliability.
Results
The cutoff value with the optimal sensitivity and specificity was 6.5 % for the proportion of REM sleep with tonic activity (sensitivity, 94.1 %; specificity, 93.3 %; area under the ROC curve, 0.976) and 9.5 % for the proportion of REM sleep with phasic activity (sensitivity, 94.1 %; specificity, 93.3 %; area under the ROC curve, 0.992). The cutoff value required to achieve a specificity of 100 % was 8.9 % for tonic activity and 11.1 % for phasic activity. Cohen’s kappa coefficient between two scorers was 0.96 (95 % confidence interval, 0.95−0.97) and 0.95 (95 % confidence interval, 0.94−0.95) for tonic and phasic activities, respectively (both p < 0.001).
Conclusions
Identifying periods of tonic and phasic activities of the submentalis muscle during REM sleep is useful to discriminate patients with idiopathic RBD from controls.
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References
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW (1986) Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 9:293–308
Schenck CH, Bundlie SR, Mahowald MW (1996) Delayed emergence of a parkinsonian disorder in 38 % of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 46:388–393
Postuma RB, Gagnon JF, Vendette M, Fantini ML, Massicotte-Marquez J, Montplaisir J (2009) Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder. Neurology 72:1296–1300
Wallace D, Shafazand S, Carvalho D, Nahab F, Sengun C, Russell A, Moore H, Singer C (2012) Sleep-related falling out of bed in Parkinson’s disease. J Clin Neurol 8:51–57
Iranzo A, Santamaría J (2005) Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 28:203–206
American Academy of Sleep Medicine (2014) International Classification of Sleep Disorders. 3rd ed. Darien
Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV (2012) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, Ver. 2.0. Darien
Ferri R, Fantini ML, Schenck CH (2014) The role of REM sleep without atonia in the diagnosis of REM sleep behavior disorder: past errors and new challenges. Sleep Med 15:1007–1008
Fulda S, Plazzi G, Ferri R (2013) Scoring atonia during normal and pathologic REM sleep: visual and automatic quantification methods. Sleep Biol Rhythms 11(suppl 1):40–51
Lapierre O, Montplaisir J (1992) Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 42:1371–1374
Consens FB, Chervin RD, Koeppe RA, Little R, Liu S, Junck L, Angell K, Heumann M, Gilman S (2005) Validation of a polysomnographic score for REM sleep behavior disorder. Sleep 28:993–997
Montplaisir J, Gagnon J-F, Fantini ML, Postuma RB, Dauvilliers Y, Desautels A, Rompré S, Paquet J (2010) Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Mov Disord 25:2044–2051
Khalil A, Wright MA, Walker MC, Eriksson SH (2013) Loss of rapid eye movement sleep atonia in patients with REM sleep behavioral disorder, narcolepsy, and isolated loss of REM atonia. J Clin Sleep Med 9:1039–1048
Dauvilliers Y, Romprq S, Gagnon JF, Vendette M, Petit D, Montplaisir J (2007) REM sleep characteristics in narcolepsy and REM sleep behavior disorder. Sleep 30:844–849
Bliwise DL, Rye DB (2008) Elevated PEM. (phasic electromyographic metric) rates identify rapid eye movement behavior disorder patients on nights without behavioral abnormalities. Sleep 31:853–857
Bliwise DL, Trotti LM, Greer SA, Juncos JJ, Rye DB (2010) Phasic muscle activity in sleep and clinical features of Parkinson disease. Ann Neurol 68:353–359
Frauscher B, Iranzo A, Hogl B, Casanova-Molla J, Salamero M, Gschliesser V, Tolosa E, Poewe W, Santamaria J, for SINBAR (Sleep Innsbruck Barcelona) Group (2008) Quantification of electromyographic activity during REM sleep in multiple muscles in REM sleep behavior disorder. Sleep 31:724–731
Burns JW, Consens FB, Little RJ, Angell KJ, Gilman S, Chervin RD (2007) EMG variance during polysomnography as an assessment for REM sleep behavior disorder. Sleep 30:1771–1778
Ferri R, Manconi M, Plazzi G, Bruni O, Vandi S, Montagna P, Ferini-Strambi L, Zucconi M (2008) A quantitative statistical analysis of the submentalis muscle EMG amplitude during sleep in normal controls and patients with REM sleep behavior disorder. J Sleep Res 17:89–100
Mayer G, Kesper K, Ploch T, Canisius S, Penzel T, Oertel W, Stiasny-Kolster K (2008) Quantification of tonic and phasic muscle activity in REM sleep behavior disorder. J Clin Neurophysiol 25:48–55
Frauscher B, Iranzo A, Gaig C, Gschliesser V, Guaita M, Raffelseder V, Ehrmann L, Sola N, Salamero M, Tolosa E, Poewe W, Santamaria J, Högl B, for the SINBAR (Sleep Innsbruck Barcelona) Group (2012) Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 35:835–847
Zhang J, Lam SP, Ho CK, Li AM, Tsoh J, Mok V, Wing YK (2008) Diagnosis of REM sleep behavior disorder by video-polysomnographic study: is one night enough? Sleep 31:1179–1185
Ferri R, Marelli S, Cosentino FI, Rundo F, Ferini-Strambi L, Zucconi M (2013) Night-to-night variability of automatic quantitative parameters of the chin EMG amplitude (Atonia Index) in REM sleep behavior disorder. J Clin Sleep Med 9:253–258
Iranzo A, Frauscher B, Santos H, Gschliesser V, Ratti L, Falkenstetter T, Stürner C, Salamero M, Tolosa E, Poewe W, Santamaria J, Högl B, for the SINBAR (Sleep Innsbruck Barcelona) Group (2011) Usefulness of the SINBAR electromyographic montage to detect the motor and vocal manifestations occurring in REM sleep behavior disorder. Sleep Med 12:284–288
Ferri R, Rundo F, Manconi M, Plazzi G, Bruni O, Oldani A, Ferini-Strambi L, Zucconi M (2010) Improved computation of the atonia index in normal controls and patients with REM sleep behavior disorder. Sleep Med 11:947–949
Ferri R, Bruni O, Fulda S, Zucconi M, Plazzi G (2012) A quantitative analysis of the submentalis muscle electromyographic amplitude during rapid eye movement sleep across the lifespan. J Sleep Res 21:257–263
Ferri R, Gagnon JF, Postuma RB, Rundo F, Montplaisir JY (2014) Comparison between an automatic and a visual scoring method of the chin muscle tone during rapid eye movement sleep. Sleep Med 15:661–665
Sasai-Sakuma T, Frauscher B, Mitterling T, Ehrmann L, Gabelia D, Brandauer E, Inoue Y, Poewe W, Högl B (2014) Quantitative assessment of isolated rapid eye movement (REM) sleep without atonia without clinical REM sleep behavior disorder: clinical and research implications. Sleep Med 15:1009–1015
Neikrug AB, Ancoli-Israel S (2012) Diagnostic tools for REM sleep behavior disorder. Sleep Med Rev 16:415–429
Ferri R, Franceschini C, Zucconi M, Vandi S, Poli F, Bruni O, Cipolli C, Montagna P, Plazzi G (2008) Searching for a marker of REM sleep behavior disorder: submentalis muscle EMG amplitude analysis during sleep in patients with narcolepsy/cataplexy. Sleep 31:1409–1417
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Lee, SA., Kim, C.S., Cho, C.U. et al. Quantitative EMG criteria for diagnosing idiopathic REM sleep behavior disorder. Sleep Breath 19, 685–691 (2015). https://doi.org/10.1007/s11325-014-1077-7
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DOI: https://doi.org/10.1007/s11325-014-1077-7