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Melatonin Effects in REM Sleep Behavior Disorder Associated with Obstructive Sleep Apnea Syndrome: A Case Series

Carolin Schaefer1, Dieter Kunz1, Frederik Bes2

  • 1Institute of Physiology, Charité-Universitätsmedizin Berlin (CBF), in St. Hedwig-Krankenhaus, Grosse Hamburger Str. 5-7, 10115 Berlin. Germany.

Current Alzheimer Research
|May 27, 2017
PubMed
Abstract

Insights

REM sleep behavior disorder (RBD) and Obstructive Sleep Apnea Syndrome (OSAS) often coexist. Treating both conditions may improve RBD symptoms and REM sleep, suggesting a dual therapeutic approach for better outcomes.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Neurodegenerative Diseases

Background:

  • REM sleep behavior disorder (RBD) is linked to neurodegenerative diseases.
  • Obstructive Sleep Apnea Syndrome (OSAS) can cause RBD-like symptoms due to arousal events.
  • Co-occurrence of RBD and OSAS is underreported, often mistaken for OSAS mimicking RBD.

Purpose of the Study:

  • To investigate the clinical presentation and management of patients with coexisting severe RBD and OSAS.
  • To explore the impact of treating both sleep disorders on RBD symptoms and polysomnographic findings.

Main Methods:

  • Case series of four patients with severe RBD and polysomnographically confirmed OSAS (AHI 10.1-53.2/h).
  • Clinical assessment of RBD symptoms and polysomnography (PSG) including REM sleep without atonia (RSWA) measurement.
  • Treatment administered was prolonged-release melatonin (2 mg) for RBD symptoms.

Main Results:

  • Melatonin treatment significantly improved RBD symptoms in all four patients.
  • High REM sleep without atonia (RSWA) values (5.1-20.4%) persisted despite melatonin, potentially due to untreated OSAS.
  • Polysomnography revealed severe OSAS in all cases.

Conclusions:

  • RBD and OSAS likely interact to destabilize REM sleep and contribute to symptom emergence.
  • A combined therapeutic strategy addressing both RBD and OSAS is recommended for optimal patient outcomes.
  • Early recognition and management of coexisting RBD and OSAS are crucial.
Keywords:
REM sleep without atoniaREM sleepREM sleep behavior disordermelatoninobstructive sleep apnea syndromepolysomnography

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