Histórico prévio de sintomas compatíveis com distúrbio comportamental do sono REM em população com Doença de Parkinson
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Data
2024-03-08
Autores
Viviane Akemi, Kakazu [UNIFESP]
Orientadores
Gabriel Natan, Pires [UNIFESP]
Tipo
Dissertação de mestrado
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Introdução: O Distúrbio Comportamental do Sono REM (DCREM) é uma parassonia marcada pela manutenção do tônus muscular durante o sono REM. As evidências colocaram o DCREM como um dos possíveis estágios prodrômicos da Doença de Parkinson (DP), mas os dados sobre a proporção de pessoas com DP que apresentaram sintomas de DCREM são limitados. Objetivo: Este estudo teve como objetivo investigar o histórico de sintomas compatíveis com DCREM em uma população com DP. Métodos: Foram convidados a participar os pacientes com DP em acompanhamento ambulatorial terciário, e seus acompanhantes (grupo controle). Todos responderam sobre sintomas de DCREM atuais e retrospectivos através do RBD Screening Questionnaire (RBDSQ), e tiveram o déficit cognitivo avaliado. Os pacientes com DP tiveram gravidade da doença computada pela escala visual de Hoen & Yahr e dados do prontuário foram coletados. Dados contínuos foram avaliados entre os grupos pelo teste t de Student e dados categóricos, pelo X2. Foi construída uma tabela de contingência entre DCREM e PD com dados de sensibilidade, especificidade, acurácia, valor preditivo positivo e negativo, razão de chances e risco relativo. Resultados: A amostra foi composta por 146 participantes: sendo 73 indivíduos com DP e 73 controles pareados por idade e sexo. A prevalência de sintomas compatíveis com DCREM foi de 65% para DP e 10,09% para controles. A pontuação do RBDSQ foi significativamente maior no grupo DP (6,03±0,35) em comparação ao grupo controle (2,38±0,23). A razão de chances para apresentar sintomas prévios compatíveis com DCREM foi de 12,09 a favor de casos positivos de DP. O diagnóstico de DP possui as seguintes propriedades diagnósticas em relação à apresentação de sintomas de DCREM: sensibilidade de 0,65, especificidade de 0,86, valor preditivo positivo de 0,82 e valor preditivo negativo de 0,71. Conclusão: A proporção de pacientes com DP apresentando sintomas de DCREM é alta, corroborando a neuroprogressão esperada da doença em um desenho caso-controle compreendendo casos de DP ambulatoriais. Os médicos clínicos devem incluir avaliações de sintomas compatíveis com DCREM durante a avaliação da DP e, se positivo, encaminhar para um especialista do sono.
Introduction: REM Sleep Behavioral Disorder (RBD) is a parasomnia marked by the maintenance of muscle tone during REM sleep. Evidence has placed RBD as one of the possible prodromal stages of Parkinson’s Disease (PD), but data on the proportion of people with PD who have had symptoms of RBD are limited. Objective: This study aimed to investigate the history of symptoms compatible with RBD in a population with PD. Methods: Patients with PD undergoing outpatient follow-up and their companions (control group) were invited to participate. Everyone responded about current and retrospective DCREM symptoms using the RBD Screening Questionnaire (RBDSQ), and had their cognitive deficit assessed. Patients with PD had disease severity computed by the Hoen & Yahr visual scale and medical record data were collected. Continuous data were evaluated between groups using the Student t test and categorical data using X2. A contingency table was constructed between DCREM and PD, with data on sensitivity, specificity, accuracy, positive and negative predictive value, odds ratio and relative risk. Results: The sample consisted of 146 participants: 73 individuals with PD and 73 controls matched by age and sex. The prevalence of symptoms compatible with RBD was 65% for PD and 10.09% for controls. The RBDSQ score was significantly higher in the PD group (6.03±0.35) in comparison to the control group (2.38±0.23). The odds ratio for presenting previous RBD-compatible symptoms was 12.09 in favor of positive PD cases. PD diagnosis has the following diagnostic properties in relation to presenting RBD symptoms: sensitivity of 0.65, specificity of 0.86, positive predictive value of 0.82 and negative predictive value of 0.71. Conclusion: The proportion of PD patients showing RBD symptoms is high, corroborating the expected neuroprogression of the disease on a case-control design comprising outpatient PD cases. Clinical practitioners should include evaluations of RBD-compatible symptoms during the PD assessment and, if positive, forward to a sleep specialist
Introduction: REM Sleep Behavioral Disorder (RBD) is a parasomnia marked by the maintenance of muscle tone during REM sleep. Evidence has placed RBD as one of the possible prodromal stages of Parkinson’s Disease (PD), but data on the proportion of people with PD who have had symptoms of RBD are limited. Objective: This study aimed to investigate the history of symptoms compatible with RBD in a population with PD. Methods: Patients with PD undergoing outpatient follow-up and their companions (control group) were invited to participate. Everyone responded about current and retrospective DCREM symptoms using the RBD Screening Questionnaire (RBDSQ), and had their cognitive deficit assessed. Patients with PD had disease severity computed by the Hoen & Yahr visual scale and medical record data were collected. Continuous data were evaluated between groups using the Student t test and categorical data using X2. A contingency table was constructed between DCREM and PD, with data on sensitivity, specificity, accuracy, positive and negative predictive value, odds ratio and relative risk. Results: The sample consisted of 146 participants: 73 individuals with PD and 73 controls matched by age and sex. The prevalence of symptoms compatible with RBD was 65% for PD and 10.09% for controls. The RBDSQ score was significantly higher in the PD group (6.03±0.35) in comparison to the control group (2.38±0.23). The odds ratio for presenting previous RBD-compatible symptoms was 12.09 in favor of positive PD cases. PD diagnosis has the following diagnostic properties in relation to presenting RBD symptoms: sensitivity of 0.65, specificity of 0.86, positive predictive value of 0.82 and negative predictive value of 0.71. Conclusion: The proportion of PD patients showing RBD symptoms is high, corroborating the expected neuroprogression of the disease on a case-control design comprising outpatient PD cases. Clinical practitioners should include evaluations of RBD-compatible symptoms during the PD assessment and, if positive, forward to a sleep specialist
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Citação
KAKAZU, Viviane Akemi. Histórico prévio de sintomas compatíveis com distúrbio comportamental do sono REM em população com Doença de Parkinson. 2024. 76 f. Dissertação (Mestrado em Psicobiologia) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024