Frequency of Orthostatic Hypotension in Isolated REM Sleep Behavior Disorder.
Document Type
Article
Abstract
BACKGROUND AND OBJECTIVES: Although orthostatic hypotension (OH) can be an early feature of autonomic dysfunction in isolated REM sleep behavior disorder (iRBD), no large-scale studies have examined the frequency of OH in iRBD. In this study, we prospectively evaluated the frequency of OH in a large multicenter iRBD cohort.
METHODS: Participants 18 years or older with video polysomnogram-confirmed iRBD were enrolled through the North American Prodromal Synucleinopathy consortium. All participants underwent 3-minute orthostatic stand testing to assess the frequency of OH, and a Δ heart rate/Δ systolic blood pressure (ΔHR/ΔSBP) ratio
RESULTS: Of 340 iRBD participants (65 ± 10 years, 82% male), 93 (27%) met criteria for OH (ΔHR/ΔSBP 0.37 ± 0.28; range 0.0-1.57), and of these, 72 (77%) met criteria for OH with reduced HR augmentation (ΔHR/ΔSBP 0.28 ± 0.21; range 0.0-0.5). Supine hypertension (sHTN) was present in 72% of those with OH. Compared with iRBD participants without OH, those with OH were older, reported older age of RBD symptom onset, and had worse olfaction. There was no difference in autonomic symptom scores as measured by SCOPA-AUT.
DISCUSSION: OH and sHTN are common in iRBD. However, as patients may have reduced autonomic symptom awareness, orthostatic stand testing should be considered in clinical evaluations. Longitudinal studies are needed to clarify the relationship between OH and phenoconversion risk in iRBD.
TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov: NCT03623672; North American Prodromal Synucleinopathy Consortium.
Medical Subject Headings
Humans; Male; Female; REM Sleep Behavior Disorder; Hypotension, Orthostatic; Synucleinopathies; Parkinson Disease; Autonomic Nervous System Diseases
Publication Date
12-12-2023
Publication Title
Neurology
ISSN
1526-632X
Volume
101
Issue
24
First Page
2545
Last Page
2545
PubMed ID
37857496
Digital Object Identifier (DOI)
10.1212/WNL.0000000000207883
Recommended Citation
Elliott, Jonathan E; Bryant-Ekstrand, Mohini D; Keil, Allison T; Ligman, Brittany R; Lim, Miranda M; Zitser, Jennifer; During, Emmanuel H; Gagnon, Jean-Francois; St Louis, Erik K; Fields, Julie A; Huddleston, Daniel E; Bliwise, Donald L; Avidan, Alon Y; Schenck, Carlos H; McLeland, Jennifer; Criswell, Susan R; Davis, Albert A; Videnovic, Aleksandar; Lee-Iannotti, Joyce K; Postuma, Ronald; Boeve, Bradley F; Ju, Yo-El S; and Miglis, Mitchell G, "Frequency of Orthostatic Hypotension in Isolated REM Sleep Behavior Disorder." (2023). Neurology. 1939.
https://scholar.barrowneuro.org/neurology/1939