Alcohol Use, Psychological Distress Linked to Possible REM-sleep-behavior Disorder

January 2, 2019

By Will Boggs MD 

NEW YORK—Alcohol use and psychological distress are newly identified risk factors for possible REM-sleep-behavior disorder (pRBD), according to findings from the Canadian Longitudinal Study on Aging (CLSA).

RBD is the strongest known prodromal symptom of neurodegenerative synucleinopathy. Most patients (around 80%) with confirmed RBD will develop Parkinson disease (PD), dementia with Lewy bodies (DLB), or multiple system atrophy. Risk factors for RBD remain poorly defined.

"The vast majority of people who have RBD don't present to sleep physicians (or any physician)," Dr. Ronald B. Postuma from McGill University, in Montreal, Canada, told Reuters Health by email. "Physicians should be alert to this - if somebody describes a clear case of dream enactment, they might be in the early stages of Parkinson's disease."

Dr. Postuma's team used CLSA data from more than 30,000 participants between 2012 and 2015 to assess sociodemographic, socioeconomic and clinical correlates of pRBD.

After the removal of potential false RBD mimics, 3.2% of the overall group was considered as having pRBD, the researchers report in Neurology, online December 26.

Age and ethnicity did not differ significantly between participants with pRBD and controls, but those with pRBD were twice as likely to be male, had lower education and were more likely to be smokers, compared with controls. These risk factors had been reported in earlier studies.

Newly identified risk factors for pRBD included higher levels of alcohol consumption, antidepressant use, higher levels of psychological distress, physician-diagnosed anxiety and depressive disorder, and screening positive for posttraumatic stress disorder (PTSD).

Participants with pRBD rated themselves lower on life satisfaction and social standing on average and were more likely to report retirement due to health issues, compared with controls.

"One of the most striking things about risk factors for REM-sleep-behavior disorder is that they only partially resemble those of PD," Dr. Postuma said. "If all patients will get PD or a related disorder, shouldn't their risk factors be the same? For example, smoking, which has been consistently associated with a lower risk of PD in the general population, has the opposite relationship in RBD (people with RBD smoke more)."

"This suggests to me that PD is not one thing, and that subtypes of disease can have different relationships with risk factors," he said.

Unfortunately, Dr. Postuma said, even if RBD is diagnosed, there is little that can be done to prevent the development of one of the associated neurodegenerative diseases.


Neurology 2018.

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