Comorbid Depression Is Associated with a Negative Treatment Response in Idiopathic REM Sleep Behavior Disorder
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Background and Purpose: The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD). Methods: We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0± 7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment. Results: Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029). Conclusions: We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.
Abstract
Background and Purpose: The first-line medications for the symptomatic treatment of rapid eye movement sleep behavior disorder (RBD) are clonazepam and melatonin taken at bedtime. We aimed to identify the association between depression and treatment response in patients with idiopathic RBD (iRBD). Methods: We reviewed the medical records of 123 consecutive patients (76 males; age, 66.0± 7.7 years; and symptom duration, 4.1±4.0 years) with iRBD who were treated with clonazepam and/or melatonin. Clonazepam and melatonin were initially administered at 0.25–0.50 and 2 mg/day, respectively, at bedtime, and the doses were subsequently titrated according to the response of individual patients. Treatment response was defined according to the presence or absence of any improvement in dream-enacting behaviors or unpleasant dreams after treatment. Results: Forty (32.5%) patients were treated with clonazepam, 56 (45.5%) with melatonin, and 27 (22.0%) with combination therapy. The doses of clonazepam and melatonin at followup were 0.5±0.3 and 2.3±0.7 mg, respectively. Ninety-six (78.0%) patients reported improvement in their RBD symptoms during a mean follow-up period of 17.7 months. After adjusting for potential confounders, depression was significantly associated with a negative treatment response (odds ratio=3.76, 95% confidence interval=1.15–12.32, p=0.029). Conclusions: We found that comorbid depression is significantly associated with a negative response to clonazepam and/or melatonin in patients with iRBD. Further research with larger numbers of patients is needed to verify our observations and to determine the clinical implications of comorbid depression in the pathophysiology of iRBD.
참고문헌 (39)
- Schenck CH, "Chronic behavioral disorders of human REM sleep : a new category of parasomnia", Sleep, 9, pp.293~308 (1986)
- Fernández-Arcos A, "The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation : a study in 203 consecutive patients", Sleep, 39, pp.121~132 (2016)
- Uguccioni G, "Fight or flight? Dream content during sleepwalking", sleep terrors vs. rapid eye movement sleep behavior disorder, 2013, pp.14, 391~398
- Dauvilliers Y, "REM sleep behaviour disorder", Nat Rev Dis Primers, 4, pp.19~ (2018)
- Berg D, "MDS research criteria for prodromal Parkinson’s disease", Mov Disord, 30, pp.1600~1611 (2015)
- Aurora RN, "Best practice guide for the treatment of REM sleep behavior disorder (RBD)", J Clin Sleep Med, 6, pp.85~95 (2010)
- Winkelman JW, "Serotonergic antidepressants are associated with REM sleep without atonia", Sleep, 27, pp.317~321 (2004)
- Postuma RB, "Identifying prodromal Parkinson’s disease : pre-motor disorders in Parkinson’s disease", Mov Disord, 27, pp.617~626 (2012)
- Fujishiro H, "Prodromal dementia with Lewy bodies", Geriatr Gerontol Int, 15, pp.817~826 (2015)
- Barber TR, "Prodromal parkinsonism and neurodegenerative risk stratification in REM sleep behavior disorder", Sleep, 40, pp.zsx071~ (2017)
- Postuma RB, "Antidepressants and REM sleep behavior disorder : isolated side effect or neurodegenerative signal?", Sleep, 36, pp.1579~1585 (2013)
- Schenck CH, "REM sleep behavior disorder : clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP", Sleep, 25, pp.120~138 (2002)
- Lapierre O, "Polysomnographic features of REM sleep behavior disorder : development of a scoring method", Neurology, 42, pp.1371~1374 (1992)
- Ferri R, "An observational clinical and video-polysomnographic study of the effects of clonazepam in REM sleep behavior disorder", Sleep Med, 14, pp.24~29 (2013)
- Kunz D, "A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder", J Sleep Res, 19, pp.591~596 (2010)
- Boeve BF, "Melatonin for treatment of REM sleep behavior disorder in neurologic disorders : results in 14 patients", Sleep Med, 4, pp.281~284 (2003)
- McCarter SJ, "Treatment outcomes in REM sleep behavior disorder", Sleep Med, 14, pp.237~242 (2013)
- You S, "The REM sleep behavior disorder screening questionnaire: validation study of the Korean version (RBDQ-KR)", J Clin Sleep Med, 13, pp.1429~1433 (2017)
- Bae JN, "Development of the Korean version of the geriatric depression scale and its short form among elderly psychiatric patients", J Psychosom Res, 57, pp.297~305 (2004)
- Smarr KL, "Measures of depression and depressive symptoms: Beck depression inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9)", Arthritis Care Res (Hoboken), 63(Suppl 11), pp.S454~S466 (2011)
- Berry RB, "The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications Version 2.2" (2015), American Academy of Sleep Medicine
- Li SX, "A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder", Sleep Med, 21, pp.114~120 (2016)
- Wing YK, "Prospective outcome of rapid eye movement sleep behaviour disorder : psychiatric disorders as a potential early marker of Parkinson’s disease", J Neurosurg Psychiatry, 83, pp.470~472 (2012)
- Bourgouin PA, "Gray matter substrates of depressive and anxiety symptoms in idiopathic REM sleep behavior disorder", Parkinsonism Relat Disord, 62, pp.163~170 (2019)
- Remy P, "Depression in Parkinson’s disease : loss of dopamine and noradrenaline innervation in the limbic system", Brain, 128, pp.1314~1322 (2005)
- Postuma RB, "Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder : a multicentre study", Brain, 142, pp.744~759 (2019)
- Palagini L, "REM sleep dysregulation in depression : state of the art", Sleep Med Rev, 17, pp.377~390 (2013)
- Pillai V, "A meta-analysis of electroencephalographic sleep in depression : evidence for genetic biomarkers", Biol Psychiatry, 70, pp.912~919 (2011)
- Argyropoulos SV, "Sleep disturbances in depression and the effects of antidepressants", Int Rev Psychiatry, 17, pp.237~245 (2005)
- Berger M, "The cholinergic rapid eye movement sleep induction test with RS-86. State or trait marker of depression?", Arch Gen Psychiatry, 46, pp.421~428 (1989)
- Nofzinger EA, "Increased activation of anterior paralimbic and executive cortex from waking to rapid eye movement sleep in depression", Arch Gen Psychiatry, 61, pp.695~702 (2004)
- Luppi PH, "The neuronal network responsible for paradoxical sleep and its dysfunctions causing narcolepsy and rapid eye movement(REM)behavior disorder", Sleep Med Rev, 15, pp.153~163 (2011)
- Sunwoo JS, "Abnormal activation of motor cortical network during phasic REM sleep in idiopathic REM sleep behavior disorder", Sleep, 42, pp.zsy227~ (2019)
- McCarter SJ, "Antidepressants increase REM sleep muscle tone in patients with and without REM sleep behavior disorder", Sleep, 38, pp.907~917 (2015)
- van der Helm E, "REM sleep depotentiates amygdala activity to previous emotional experiences", Curr Biol, 21, pp.2029~2032 (2011)
- Walker MP, "Overnight therapy? The role of sleep in emotional brain processing", Psychol Bull, 135, pp.731~748 (2009)
- Shin C, "Clonazepam for probable REM sleep behavior disorder in Parkinson’s disease : a randomized placebo-controlled trial", J Neurol Sci, 401, pp.81~86 (2019)
- McGrane IR, "Melatonin therapy for REM sleep behavior disorder : a critical review of evidence", Sleep Med, 16, pp.19~26 (2015)
- Ferri R, "Effects of long-term use of clonazepam on nonrapid eye movement sleep patterns in rapid eye movement sleep behavior disorder", Sleep Med, 14, pp.399~406 (2013)