REM Sleep Behaviour Disorder Is An Early Marker Of Neurodegenerative Diseases

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REM Sleep Behaviour Disorder Is An Early Marker Of Neurodegenerative

Diseases

http://www.medicalnewstoday.com/medicalnews.php?newsid=46209

The front page of the July 2006 issue of The Lancet Neurology, the

journal with the highest international impact, contains a work that

shows the relationship between disorders during REM sleep and future

neurodegenerative pathologies. This study has been conducted by a

Hospital Clinic group led by Dr. Iranzo. This study is a good

example of the fact that a correct diagnosis of sleep disorders by a

specialist group can achieve a high relevancy. This diagnosis is

possible in the Hospital Clinic thanks to the Multidisciplinary Unit

of Sleep Disorders, which is in operation since May 2003, and which

consists in 17 specialists from five areas, namely, neurology,

psychiatry, psychology, otorhinolaryngology, and pulmonology. This

organisation permits a multidisciplinary approach with high

resolution tests, department clinical protocols and sessions, with a

clear optimisation of resources. The most frequent pathologies

treated in this unit are sleep apnoea, snoring, REM sleep behaviour

disorders, narcolepsy, night epilepsy or hypersomnia. Only last year,

3,809 visits, 1,819 sleep tests and 40 surgical interventions were

made in the unit.

As well as clinical and teaching areas, this unit has high research

activity as shown by the study explained below. This work has been

led by Dr. Iranzo, member of the Unit of Neurology of Hospital

Clinic and of the Functional Studies of the Nervous System Group of

the Institut dInvestigacions Biomediques August Pi i Sunyer

(IDIBAPS). Not only The Lancet Neurology published the work, but also

it dedicates the front page to the article, and a reflection by

Canadian neurologists Dr. Postuma (Department of Neurology of

the Montreal General Hospital de Quebec) and Dr. Jacques Montplaisir

(Centre DEtude du Sommeil in the Hospital du Sacre-Coeur de

Montreal).

This article is based in a descriptive study conducted since 1991 in

which 44 patients from the Unit of Sleep Disorder of the Hospital

Clinic were assessed. Given the low incidence of this disorder, the

sample of patients studied by this Catalan group is the highest until

today. All these patients presented idiopathic REM sleep behaviour

disorder. These patients, usually over 60 years, suffer from

unpleasant dreams and express uneasiness by screaming, crying,

kicking, punching and even falling from their beds.

According to the results of this study, 20 of these patients (45%),

after being correctly diagnosed in the centre and followed up during

five years, developed a neurodegenerative disease. This incidence is

much higher than what is expected in the general population of the

same age and gender. Therefore, scientists drew the conclusion that

this disorder permits the early detection of neurodegenerative

diseases such as Parkinson's disease, Lewy body dementia, multiple

system atrophy or mild cognitive impairment. Furthermore, the fact

that the twenty patients who developed a neurodegenerative disease

were those who had suffered from REM sleep behaviour disorder for the

longest time, suggests that this incidence could be superior in the

future.

The importance of these results lie firstly in the future possibility

of administrating neuroprotective drugs to patients with the REM

sleep behaviour disorder who have still not developed a degenerative

disease. Furthermore, the monitoring of these patients will permit an

early administration of palliative drugs, which are already

available. Toward this end, the Ministry of Health has awarded this

group with a FIS award named " Prognostic markers of the development

of a neurodegenerative disease in patients affected with REM sleep

behaviour disorder " .