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  • A seventh study sought to determine

    2018-11-13

    A seventh study sought to determine the pathologic substrates in patients with RBD with or without a coexisting neurologic disorder [34]. Clinical and neuropathologic findings were analyzed on all autopsied RBD cases from collaborating sites in North America and Europe. 172 RBD cases were identified (83% male). The primary clinical diagnoses among those with a coexisting neurologic disorder were DLB (n=97), PD with or without mild cognitive impairment or dementia (n=32), MSA (n=19), Alzheimer׳s disease (AD) (n=9) and other various disorders (n=3). The neuropathologic diagnoses were Lewy body disease (LBD) (n=77), combined LBD and AD (n=59), MSA (n=19), AD (n=6), progressive supranulear palsy (PSP) (n=2), and other disorders (n=9). The key finding was that among the neurodegenerative disorders associated with RBD (n=170), 160 (94%) were synucleinopathies. Furthermore, the RBD–synucleinopathy association was particularly high when RBD preceded the onset of other neurodegenerative syndrome features. Finally, Brazilian investigators have broken new ground with RBD research in at least three directions: (i) Wilson׳s disease (hepatolenticular degeneration) presenting with RBD as the initial symptom [35], which comprises the first published description of RBD in Wilson׳s disease in the literature, and adds further evidence to the parallelism of PD and Wilson׳s disease in UNC 0642 Supplier and brainstem topography. (ii) Cannabidiol (CBD) therapy in RBD associated with PD [36]. CBD is the main non-psychotropic component of the Cannabis sativa plant. Four patients with RBD-PD treated with CBD had prompt and substantial reduction in the frequency of RBD-related events, without side effects. (iii) A new category of Parasomnia Overlap Disorder (i.e. RBD combined with a NREM parasomnia [37]) was identified, consisting of Sleep Related Eating Disorder combined with RBD-PD [38].
    Conclusion The current, rapidly-evolving knowledge on the NREM sleep parasomnias, nocturnal seizures and RBD reflects the beneficial interplay of the fields of neuroscience and clinical (sleep) medicine, which will continue to deepen as additional neuroscientific tools become available. Parasomnias are clearly embedded within the core of sleep medicine and sleep science. One striking example consists of the many parasomnias that can be associated with sleep-disordered breathing and its therapy [39]. Other major examples consist of the strong association of sleep related eating disorder with RLS [40,41], and with narcolepsy [42]. Consequently, sleep clinicians and clinical investigators are encouraged to increase their interest and knowledge on the parasomnias, and in so doing they can hopefully make useful and important contributions to the field, while enhancing patient care.
    Introduction Worldwide populations, especially those living in industrialized countries, experience sleep curtailment, which is rapidly becoming a hallmark of modern society associated with significant social, financial, and human cost [23]. Chronic sleep restriction is often related to the changes due to modern life, such as work-related demands, social and domestic responsibilities, and current lifestyles [5]. In addition, sleep disorders are becoming more and more common, resulting in a clinically significant impact on public health [15]. Ten percent of the American population is reported to suffer from chronic sleep disorders with health and safety consequences [32]. Similarly, over 3 decades, an increase in sleep complaints such as snoring, insomnia, and bruxism has been observed in the population of São Paulo, the largest city in Brazil [35]. Snoring is the most prevalent complaint, with increase of 20% in the last 2 decades [35]. National and epidemiological studies provide scientific knowledge about sleep for the population as well as the development of public health policies. In 2008, a national survey with a sample of 2110 subjects from 150 different cities estimated the prevalence of sleep disorders in the Brazilian population, indicating that 63% reported at least 1 sleep related complaint [6]. Brazil in particular has experienced continuous changes in lifestyle and environment recently, as the Brazilian economy develops and the middle class increases within an underlying context of social inequality, limited access to specialized support services, scarce financial resources, and a lack of structural adaptations [9].