Beyond RBD: covert REM sleep abnormalities in Parkinson's disease

REM sleep behavior disorder (RBD), involving REM sleep without atonia (RSWA), is a prodromal marker of Parkinson's disease (PD). We investigated whether RBD may represent the "tip of the iceberg" of pathology driving wider REM sleep disruptions. In this study, 25 early-stage, drug-naïve PD patients and 23 age-matched healthy controls underwent overnight polysomnography with high-density EEG (256 channels) to assess how sleep patterns relate to generalized motor learning (GML). PD patients showed no significant differences in overall sleep architecture but exhibited elevated RSWA levels, with 9 individuals (36% of the PD group) meeting criteria for excessive RSWA (PD^+RSWA). Spectral analysis revealed increased occipital-parietal theta activity during REM sleep in PD^+RSWA patients, which correlated with disease progression. In both healthy participants and PD patients, sleep benefited consolidation of overnight GML. However, only in PD patients, and particularly in PD^+RSWA, REM sleep duration was negatively correlated with behavioral benefits in the GML task. These findings suggest that subtle REM sleep abnormalities extend beyond clinically defined RBD and may contribute to impaired sleep-dependent memory consolidation in early PD. REM sleep disruptions could serve as an early neurophysiological marker of disease progression and a potential target for therapeutic intervention.