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The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder

PURPOSE: This study aimed to establish the diagnostic accuracy of a previously validated sleep staging system in patients with probable isolated REM sleep behavior disorder (iRBD), and to compare physicians’ diagnoses of iRBD based on REM sleep without atonia (RSWA) to non-REM hypertonia (NRH), a sl...

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Autores principales: Levendowski, Daniel J, Neylan, Thomas C, Lee-Iannotti, Joyce K, Timm, Paul C, Guevarra, Cyrus, Angel, Elise, Shprecher, David, Mazeika, Gandis, Walsh, Christine M, Boeve, Bradley F, St Louis, Erik K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10164388/
https://www.ncbi.nlm.nih.gov/pubmed/37162799
http://dx.doi.org/10.2147/NSS.S396853
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author Levendowski, Daniel J
Neylan, Thomas C
Lee-Iannotti, Joyce K
Timm, Paul C
Guevarra, Cyrus
Angel, Elise
Shprecher, David
Mazeika, Gandis
Walsh, Christine M
Boeve, Bradley F
St Louis, Erik K
author_facet Levendowski, Daniel J
Neylan, Thomas C
Lee-Iannotti, Joyce K
Timm, Paul C
Guevarra, Cyrus
Angel, Elise
Shprecher, David
Mazeika, Gandis
Walsh, Christine M
Boeve, Bradley F
St Louis, Erik K
author_sort Levendowski, Daniel J
collection PubMed
description PURPOSE: This study aimed to establish the diagnostic accuracy of a previously validated sleep staging system in patients with probable isolated REM sleep behavior disorder (iRBD), and to compare physicians’ diagnoses of iRBD based on REM sleep without atonia (RSWA) to non-REM hypertonia (NRH), a sleep measure independently associated with Parkinsonian spectrum disorders. PATIENTS AND METHODS: Twenty-six patients with a history of dream enactment behavior underwent a diagnostic PSG with simultaneous Sleep Profiler (SP) acquisition at two sites. PSG and SP records were sleep staged, and two sleep neurologists independently diagnosed iRBD based on the presence or absence of polysomnographic identified RSWA. Comparisons for PSG vs SP sleep staging and the qualitative presence or absence of PSG-based RSWA vs automated SP-detected NRH was performed using kappa coefficients (k), positive and negative percent agreements (PPA and NPA), and chi-square tests. RESULTS: The kappa scores from Sites-1 and −2 for PSG vs SP staging were different for Wake (k=0.82 vs 0.65), N2 (k=0.63 vs 0.72) and REM (k=0.83 vs.0.72). The by-site kappa values for stage N3 increased from 0.72 and 0.37 to 0.88 and 0.74 after PSG records were reedited. The kappa values for between-physician agreement in iRBD diagnoses were fair (k = 0.22). The agreement between each physician’s iRBD diagnoses and NRH were also fair (k=0.29 and 0.22). Abnormal NRH agreed with at least one physician’s iRBD diagnosis in 83% of the records. The PPA resulting from between-physician iRBD agreement was stronger and the NPA weaker than the values obtained from comparison of each physician’s iRBD diagnosis and abnormal NRH. CONCLUSION: The potential utility of RSWA and stage N3 as neurodegenerative disorder biomarkers was influenced by between-site variability in visual scoring. The degree to which NRH was associated with iRBD was similar to the between-physician agreement in their diagnosis of iRBD using RSWA.
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spelling pubmed-101643882023-05-08 The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder Levendowski, Daniel J Neylan, Thomas C Lee-Iannotti, Joyce K Timm, Paul C Guevarra, Cyrus Angel, Elise Shprecher, David Mazeika, Gandis Walsh, Christine M Boeve, Bradley F St Louis, Erik K Nat Sci Sleep Original Research PURPOSE: This study aimed to establish the diagnostic accuracy of a previously validated sleep staging system in patients with probable isolated REM sleep behavior disorder (iRBD), and to compare physicians’ diagnoses of iRBD based on REM sleep without atonia (RSWA) to non-REM hypertonia (NRH), a sleep measure independently associated with Parkinsonian spectrum disorders. PATIENTS AND METHODS: Twenty-six patients with a history of dream enactment behavior underwent a diagnostic PSG with simultaneous Sleep Profiler (SP) acquisition at two sites. PSG and SP records were sleep staged, and two sleep neurologists independently diagnosed iRBD based on the presence or absence of polysomnographic identified RSWA. Comparisons for PSG vs SP sleep staging and the qualitative presence or absence of PSG-based RSWA vs automated SP-detected NRH was performed using kappa coefficients (k), positive and negative percent agreements (PPA and NPA), and chi-square tests. RESULTS: The kappa scores from Sites-1 and −2 for PSG vs SP staging were different for Wake (k=0.82 vs 0.65), N2 (k=0.63 vs 0.72) and REM (k=0.83 vs.0.72). The by-site kappa values for stage N3 increased from 0.72 and 0.37 to 0.88 and 0.74 after PSG records were reedited. The kappa values for between-physician agreement in iRBD diagnoses were fair (k = 0.22). The agreement between each physician’s iRBD diagnoses and NRH were also fair (k=0.29 and 0.22). Abnormal NRH agreed with at least one physician’s iRBD diagnosis in 83% of the records. The PPA resulting from between-physician iRBD agreement was stronger and the NPA weaker than the values obtained from comparison of each physician’s iRBD diagnosis and abnormal NRH. CONCLUSION: The potential utility of RSWA and stage N3 as neurodegenerative disorder biomarkers was influenced by between-site variability in visual scoring. The degree to which NRH was associated with iRBD was similar to the between-physician agreement in their diagnosis of iRBD using RSWA. Dove 2023-05-03 /pmc/articles/PMC10164388/ /pubmed/37162799 http://dx.doi.org/10.2147/NSS.S396853 Text en © 2023 Levendowski et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Levendowski, Daniel J
Neylan, Thomas C
Lee-Iannotti, Joyce K
Timm, Paul C
Guevarra, Cyrus
Angel, Elise
Shprecher, David
Mazeika, Gandis
Walsh, Christine M
Boeve, Bradley F
St Louis, Erik K
The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title_full The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title_fullStr The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title_full_unstemmed The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title_short The Accuracy and Reliability of Sleep Staging and Sleep Biomarkers in Patients with Isolated Rapid Eye Movement Sleep Behavior Disorder
title_sort accuracy and reliability of sleep staging and sleep biomarkers in patients with isolated rapid eye movement sleep behavior disorder
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10164388/
https://www.ncbi.nlm.nih.gov/pubmed/37162799
http://dx.doi.org/10.2147/NSS.S396853
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