Brief CommunicationDiagnostic value of the REM sleep behavior disorder screening questionnaire in Parkinson's disease
Introduction
Rapid eye movement (REM) sleep behavior disorder (RBD) is clinically characterized by the intermittent loss of physiological skeletal muscle atonia during REM sleep with the appearance of elaborate motor activity associated with dream mentation [1]. Apart from the characteristic clinical picture, polysomnography (PSG) demonstrating REM sleep without atonia is required for establishing a definite diagnosis of RBD [2]. The RBD screening questionnaire (RBDSQ) was developed and validated to meet the need for an easily applicable and short diagnostic screening tool [3]. It was shown to have a high sensitivity for RBD in both sleep-disorder patients and healthy controls [3]. Up to 46% of Parkinson's disease (PD) patients have RBD [4], [5], [6]. Since the usefulness of the RBDSQ in PD is still controversial [7], [8], [9], we aimed to validate the RBDSQ in 2 independent samples of PD patients using different settings when performing the investigations.
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Patient samples and procedures
All patients in this study were referred to video-PSG (vPSG) at the sleep laboratory of Innsbruck University or at the Paracelsus-Elena-Klinik Kassel because of reported sleep disturbances, and underwent single or multiple night v-PSG according to clinical considerations. The RBDSQ [3] was completed prior to vPSG.
All patients analyzed in this study consented to scientific evaluation of their clinical data. The Ethical Committee of the Landesärztekammer Hessen agreed to the project.
Patient
Clinical characteristics (Table 1)
Discussion
This study evaluated the diagnostic value of the RBDSQ in two samples of PD patients, and found substantial and surprising differences of sensitivity and specificity between both samples: whereas sensitivity and specificity were high in sample A, they were at best moderate in sample B.
Which factors might potentially account for this discrepancy? First, sample A consisted of PD patients who had a sleep interview including RBD assessment prior to the RBDSQ, which alerted the patients about RBD as
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2014.08.014.
Acknowledgment
We are grateful to Laura Ehrmann, MD, and Tina Falkenstetter, MD PhD, for attentive and dedicated assistance with the Innsbruck patients' questionnaires.
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Both authors contributed equally to this paper.