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A Two-Stage Questionnaire and Actigraphy Screening for iRBD in a Multicenter Retrospective Cohort
Caleb A Massimi1, Giorgio Ricciardiello Mejia1, Andre Metzger1
1Department of Neurology, Icahn School of Medicine, New York, New York, USA.
Annals of Clinical and Translational Neurology
|May 23, 2026
Summary
A new two-stage screening strategy using questionnaires and wrist actigraphy shows high accuracy in detecting REM sleep behavior disorder. This accessible method aids in identifying synucleinopathy prodromes early.
Area of Science:
- Neurology
- Sleep Medicine
- Biomedical Engineering
Background:
- Isolated rapid-eye-movement sleep behavior disorder (RBD) is an early sign of synucleinopathies.
- Current diagnostic methods like questionnaires have limited predictive value, and polysomnography is not widely accessible.
- Early detection of RBD is crucial for timely intervention in neurodegenerative disease progression.
Purpose of the Study:
- To assess a two-stage screening strategy for isolated RBD using a questionnaire and wrist actigraphy.
- To evaluate the diagnostic performance of this combined approach in a multicenter cohort.
- To establish a low-cost, scalable method for identifying prodromal synucleinopathy.
Main Methods:
- Recruited 396 participants (aged 40-80) across five cohorts, with RBD cases confirmed by video-polysomnography.
- Administered a four-item questionnaire and conducted ≥14 nights of home wrist actigraphy for 236 participants.
- Developed a wearable-based algorithm using four movement features (activity, immobility, twitching) and XGBoost for model training.
Main Results:
- The four-item questionnaire achieved an area under the curve (AUC) of 0.86 for RBD detection.
- Wrist actigraphy alone demonstrated 82% sensitivity and 84% specificity.
- The two-stage protocol achieved 73% sensitivity and 100% specificity when using the four-item questionnaire, indicating high diagnostic accuracy.
Conclusions:
- A two-stage screening protocol combining a questionnaire and wrist actigraphy is highly specific and sensitive for detecting isolated RBD.
- This strategy is cost-effective, scalable, and utilizes widely available wearable devices.
- Further validation in community-based populations is recommended to confirm its utility in broader settings.
