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REM sleep behavior disorder, autonomic dysfunction and synuclein-related neurodegeneration: where do we stand?

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Abstract

Introduction

From newfound parasomnia to a marker of future synucleinopathy, since its first description in 1986, REM sleep behavior disorder (RBD) has been systematically tackled from virtually many viewpoints in basic, translational, and clinical studies. The time delay between RBD and synucleinopathy onset offers an exceptional window for observation and design of neuroprotective trials. In the last few years, research has focused on characterizing possible differences within RBD patients in order to draw potential profiles more or less susceptible to further neurodegeneration. Attention has been drawn towards autonomic dysfunction in RBD as one of such variables.

Overview

In this review, REM sleep physiology and relevant brain anatomy is briefly mentioned and integrated with neuroanatomical and physiological concepts regarding the central autonomic network. A detailed summary of works showing the presence of autonomic dysfunction in RBD is provided, and clinical and electrophysiological features of RBD in synucleinopathies are discussed. A short overview of RBD in other neurodegenerative diseases is also provided.

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Fig. 1

With permission from Luppi et al. [12]

Fig. 2

Inspired by Boeve et al. [16, 22] and integrated with Benarroch [44] with permissions, updated by the authors. Cited works: Flanagan et al., Neurology 2013; Provini et al., Mov Disord 2004; St Louis et al. Neurology 2014; Tribl et al., Arq Neuropsiq 2014; Reynolds et al., J Clin Sleep Med 2011; Mathis et al., JNNP 2007; Limousin et al., Sleep Med 2009; Jianhua et al., Intern Med 2013; Tippman et al., Neurology 2006; Flanagan et al., Neurology 2013; Felix et al., J Sleep Res 2016; Kimura et al., Neurology 2000; Xi et al., Sleep Med 2003

Fig. 3
Fig. 4

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Abbreviations

AD:

Alzheimer’s disease

CAN:

Central autonomic network

CBD:

Corticobasal degeneration

CNS:

Central nervous system

COMPASS:

Composite Autonomic Severity Score

DEB:

Dream enactment behavior

DLB:

Dementia with Lewy bodies

DMVN:

Dorsal motor vagal nucleus

EEG:

Electroencephalogram

EMG:

Electromyography

HF:

High frequency

HRV:

Heart rate variability

LF:

Low frequency

LPT:

Lateral pontine tegmentum

MSA:

Multiple system atrophy

MSA-C:

MSA-cerebellar

MSA-P:

MSA-parkinsonian

MSNA:

Muscle sympathetic nerve activity

NA:

Nucleus ambiguus

NREM:

Non-REM

PAF:

Pure autonomic failure

PBN:

Parabrachial nucleus

PD:

Parkinson’s disease

PLM:

Periodic limb movements

PPN:

Pedunculopontine nucleus

PSG:

Polysomnography

PSP:

Progressive supranuclear palsy

QSART:

Quantitative sudomotor axon reflex test

RBD:

REM sleep behavior disorder

REM:

Rapid eye movement

RSWA:

REM sleep without atonia

SCOPA-AUT:

Scale for Outcomes in PD-Autonomic

SDNN:

Standard deviation of normal RR intervals

SLD:

Sublaterodorsal nucleus

UMSARS:

Unified Multiple System Atrophy Rating Scale

VLF:

Very low frequency

vlPAG:

Ventrolateral part of the periaqueductal grey

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Authors and Affiliations

  1. Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Via Altura, 3, 40139, Bologna, Italy

    Giacomo Chiaro, Giovanna Calandra-Buonaura, Luisa Sambati, Giuseppe Loddo, Pietro Cortelli & Federica Provini

  2. IRCCS, Institute of Neurological Sciences of Bologna, Bologna, Italy

    Giovanna Calandra-Buonaura, Annagrazia Cecere, Francesco Mignani, Luisa Sambati, Pietro Cortelli & Federica Provini

  3. Neurocenter of Southern Switzerland, Lugano, Switzerland

    Giacomo Chiaro

Authors
  1. Giacomo Chiaro
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  2. Giovanna Calandra-Buonaura
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  3. Annagrazia Cecere
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  4. Francesco Mignani
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  5. Luisa Sambati
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  6. Giuseppe Loddo
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  7. Pietro Cortelli
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  8. Federica Provini
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Correspondence to Federica Provini.

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Chiaro, G., Calandra-Buonaura, G., Cecere, A. et al. REM sleep behavior disorder, autonomic dysfunction and synuclein-related neurodegeneration: where do we stand?. Clin Auton Res 28, 519–533 (2018). https://doi.org/10.1007/s10286-017-0460-4

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  • DOI: https://doi.org/10.1007/s10286-017-0460-4

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