A data-driven system to identify REM sleep behavior disorder and to predict its progression from the prodromal stage in Parkinson's disease

Matteo Cesari*, Julie A.E. Christensen, Maria Lucia Muntean, Brit Mollenhauer, Friederike Sixel-Döring, Helge B.D. Sorensen, Claudia Trenkwalder, Poul Jennum

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

30 Citationer (Scopus)

Abstract

Objectives: To investigate electroencephalographic (EEG), electrooculographic (EOG) and micro-sleep abnormalities associated with rapid eye movement (REM) sleep behavior disorder (RBD) and REM behavioral events (RBEs) in Parkinson's disease (PD). Methods: We developed an automated system using only EEG and EOG signals. First, automatic macro- (30-s epochs) and micro-sleep (5-s mini-epochs) staging was performed. Features describing micro-sleep structure, EEG spectral content, EEG coherence, EEG complexity, and EOG energy were derived. All features were input to an ensemble of random forests, giving as outputs the probabilities of having RBD or not (P (RBD) and P (nonRBD), respectively). A patient was classified as having RBD if P (RBD)≥P (nonRBD). The system was applied to 107 de novo PD patients: 54 had normal REM sleep (PDnonRBD), 26 had RBD (PD + RBD), and 27 had at least two RBEs without meeting electromyographic RBD cut-off (PD + RBE). Sleep diagnoses were made with video-polysomnography (v-PSG). Results: Considering PDnonRBD and PD + RBD patients only, the system identified RBD with accuracy, sensitivity, and specificity over 80%. Among the features, micro-sleep instability had the highest importance for RBD identification. Considering PD + RBE patients, the ones who developed definite RBD after two years had significantly higher values of P (RBD) at baseline compared to the ones who did not. The former were distinguished from the latter with sensitivity and specificity over 75%. Conclusions: Our method identifies RBD in PD patients using only EEG and EOG signals. Micro-sleep instability could be a biomarker for RBD and for proximity of conversion from RBEs, as prodromal RBD, to definite RBD in PD patients.

OriginalsprogEngelsk
TidsskriftSleep Medicine
Vol/bind77
Sider (fra-til)238-248
Antal sider11
ISSN1389-9457
DOI
StatusUdgivet - jan. 2021

Bibliografisk note

Funding Information:
BM reports grants and personal fees from Michael J. Fox Foundation for Parkinson's Research , personal fees from Roche , personal fees from Biogen , personal fees from UCB personal fees from Sun Pharma Advanced research Company , grants from Deutsche Forschungsgemeinschaft , grants from Parkinson Fonds Deuschland , grants from Deutsche Parkinson Vereinigung , outside the submitted work.

Funding Information:
BM reports grants and personal fees from Michael J. Fox Foundation for Parkinson's Research, personal fees from Roche, personal fees from Biogen, personal fees from UCB personal fees from Sun Pharma Advanced research Company, grants from Deutsche Forschungsgemeinschaft, grants from Parkinson Fonds Deuschland, grants from Deutsche Parkinson Vereinigung, outside the submitted work.FSD reports personal fees from Abbott, other from Boston Scientific, personal fees from Desitin, personal fees from Grunenthal, personal fees and other from Licher MT, personal fees from STADA Pharm, personal fees from UCB, outside the submitted work.

Funding Information:
CT reports grants from Britannia, Roche, M.J. Fox (European grant: program Horizon 2020), UCB, Gruenenthal, Otsuka, outside submitted work.

Publisher Copyright:
© 2020 Elsevier B.V.

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