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Prevalence and impact of rapid eye movement sleep behavior disorder in multiple system atrophy: a systematic review

Hui Wang1, Ting Zhang1, Wenhui Fan1

  • 1Department of Neurology, Sichuan Taikang Hospital, Chengdu, China.

Frontiers in Neurology
|October 28, 2024
PubMed
Abstract

Insights

Multiple system atrophy (MSA) is frequently linked to rapid eye movement sleep behavior disorder (RBD), affecting 79.9% of patients. Those with RBD are younger, have earlier onset, and more severe MSA symptoms.

Area of Science:

  • Neurology
  • Sleep Medicine
  • Neurodegenerative Diseases

Background:

  • Multiple system atrophy (MSA) is a neurodegenerative disorder often co-occurring with rapid eye movement sleep behavior disorder (RBD).
  • Previous research on RBD prevalence and its impact on MSA patients has shown inconsistent findings.
  • A significant knowledge gap exists regarding the impact of RBD on MSA progression, with only one prior meta-analysis on RBD prevalence in MSA.

Purpose of the Study:

  • To systematically review and meta-analyze the prevalence of RBD in MSA patients.
  • To investigate the clinical impact of RBD on MSA, including age of onset, disease severity, and demographic factors.
  • To provide a comprehensive overview of the association between MSA and RBD.

Main Methods:

  • A systematic review and meta-analysis of studies on MSA and RBD.
  • Searches were conducted across PubMed, Web of Science, Embase, and Cochrane databases.
  • Prevalence, odds ratios (OR), and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I-squared statistic.

Main Results:

  • The pooled prevalence of polysomnography-confirmed RBD in MSA was 79.9% (95% CI, 68.8-89.3%) among 598 subjects.
  • MSA patients with RBD were younger at examination (WMD -3.26 years) and had an earlier age of onset (WMD -3.27 years).
  • RBD was more prevalent in male MSA patients (OR 2.11) and associated with higher UMSARS scores (UMSARS I and IV).

Conclusions:

  • The prevalence of polysomnography-confirmed RBD in MSA is high at 79.9%.
  • MSA patients with RBD tend to be younger, have an earlier disease onset, and experience more severe symptoms.
  • Regional differences in prevalence (lower in Asia) may indicate underestimation, warranting further investigation.
Keywords:
REM sleep behavior disordermotor symptomsmultiple system atrophynonmotor symptomsprevalence

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