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REM Sleep Behavior Disorder in Children With Type 1 Narcolepsy Treated With Sodium Oxybate
Elena Antelmi1, Marco Filardi1, Fabio Pizza1
1From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy.
Objective:
To study the effect of stable treatment with sodium oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1).
Methods:
Nineteen children and adolescents with NT1 (9 female, mean age 12.5 ± 2.7 years, mean disease duration 3.4 ± 1.6 years) underwent neurologic investigations and video-polysomnography (v-PSG) at baseline and after 3 months of stable treatment with SO. v-PSG was independently analyzed by 2 sleep experts to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI).
Results:
Compared to baseline, RAI significantly improved (p < 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep-stage architecture.
Conclusions:
RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep.
Classification Of Evidence:
This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.
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