0643 The Associated Factors Of Optimal Treatment Responses In Rapid Eye Movement Sleep Behavior Disorder. (12th April 2019)

• Record Type: Journal Article
• Authors: Lee, Hyuk Joo; Choi, Hayun; Yoon, In-Young
• Is Part Of: Sleep. Volume 42(2019)Supplement 1
• Page Start: A257
• Page End: A257
• Publication Date: 2019-04-12
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz067.641
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Rapid eye movement sleep behavior disorder (RBD) is characterized by unpleasant dreams and dream-enacting behaviors that can result in sleep-related injuries. For treatment of RBD, clonazepam has been widely used. The aims of this study were (1) to evaluate the treatment outcome with clonazepam and (2) to explore associated factors related to optimal treatment responses. Methods: We performed a retrospective medical chart review of 175 RBD patients attending the sleep clinic in Seoul National University Bundang Hospital. The optimal treatment response was defined as the absence of unpleasant dreams or behavioral disruptions including falling out of bed, sleep-related injuries or potentially injurious behaviors during the recent 1-year period of follow up. All the subjects underwent full-night video-polysomnography and completed self-reported questionnaires regarding demographic information, insomnia and depressive symptoms. Results: Among the 170 patients with initial symptoms of behavioral disruptions, 130 experienced optimal treatment responses representing a response rate of 76.5%. Compared to non-responders, responders showed later age of diagnosis and lower final dose of clonazepam (all p < 0.05). Regarding unpleasant dreams, among 175 patients with initial symptoms, 85 achieved optimal treatment responses with a response rate of 48.6%. Responders demonstrated later age of diagnosis, less severe symptoms of insomnia and higher prevalence of obstructive sleep apnea (OSA) (all p < 0.05). After multiple logistic regression analysis, age of diagnosis ≥ 75 (OR=22.63, 95% CI=2.90-176.70), female gender (OR=3.51, 95% CI=1.23-10.06) and presence of synucleinopathies at the last visit (OR=4.50, 95% CI=1.05-19.31) were related to the successful elimination of disruptive behaviors. In terms of unpleasant dreams, the presence of OSA at the baseline assessment (OR=2.80, 95% CI=1.20-6.52) was associated to the optimal treatment responses. Conclusion: Clonazepam is effective in alleviating disruptive behaviors and unpleasant dreams in RBD patients. Optimal response of disruptive behaviors in RBD patients with late age of diagnosis, female gender and the presence of synucleinopathies could be associated with sedative and myorelaxation effects of clonazepam. Support (If Any)