REM Sleep Without Atonia and Gait Impairment in People with Mild-to-Moderate Parkinson’s Disease

Article type: Research Article

Authors: Amundsen-Huffmaster, Sommer L.^{a; *} | Petrucci, Matthew N.^a | Linn-Evans, Maria E.^a | Chung, Jae Woo^a | Howell, Michael J.^a | Videnovic, Aleksandar^b | Tuite, Paul J.^a | Cooper, Scott E.^a | MacKinnon, Colum D.^a

Affiliations: [a] University of Minnesota, Department of Neurology, Minneapolis, MN, USA | [b] Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Correspondence: [*] Correspondence to: Sommer L. Amundsen Huffmaster, PhD, 717 Delaware St SE, Room 516E, Minneapolis, MN 55414, USA. Tel.: +1 612 301 1297; E-mail: slamunds@umn.edu.

Abstract: Background:Subtle gait deficits can be seen in people with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD), a prodromal stage of Parkinson’s disease (PD) and related alpha-synucleinopathies. It is unknown if the presence and level of REM sleep without atonia (RSWA, the electromyographic hallmark of RBD) is related to the severity of gait disturbances in people with PD. Objective:We hypothesized that gait disturbances in people with mild-to-moderate PD would be greater in participants with RSWA compared to those without RSWA and matched controls, and that gait impairment would correlate with measures of RSWA. Methods:Spatiotemporal characteristics of gait were obtained from 41 people with PD and 21 age-matched controls. Overnight sleep studies were used to quantify muscle activity during REM sleep and group participants with PD into those with RSWA (PD-RSWA+, n = 22) and normal REM sleep muscle tone (PD-RSWA-, n = 19). Gait characteristics were compared between groups and correlated to RSWA. Results:The PD-RSWA+ group demonstrated significantly reduced gait speed and step lengths and increased stance and double support times compared to controls, and decreased speed and cadence and increased stride velocity variability compared to PD-RSWA- group. Larger RSWA scores were correlated with worse gait impairment in the PD group. Conclusion:The presence and level of muscle tone during REM sleep is associated with the severity of gait disturbances in PD. Pathophysiological processes contributing to disordered gait may occur earlier and/or progress more rapidly in people with PD and RBD.

Keywords: Parkinson’s disease, REM sleep without atonia, gait

DOI: 10.3233/JPD-202098

Journal: Journal of Parkinson's Disease, vol. 11, no. 2, pp. 767-778, 2021