Excessive Daytime Sleepiness Predicts Neurodegeneration in Idiopathic REM Sleep Behavior Disorder

Sleep. 2017 May 1;40(5). doi: 10.1093/sleep/zsx041.


Study objectives: To determine the association of excessive daytime sleepiness (EDS) with the conversion of neurodegenerative diseases in patients with idiopathic REM sleep behavior disorder (iRBD).

Methods: A total of 179 patients with iRBD (79.1% males, mean age = 66.3 ± 9.8 years) were consecutively recruited. Forty-five patients with Epworth Sleepiness Scale score ≥14 were defined as having EDS. Demographic, clinical, and polysomnographic data were compared between iRBD patients with and without EDS. The risk of developing neurodegenerative diseases was examined using Cox proportional hazards model.

Results: After a mean follow-up of 5.8 years (SD = 4.3 years), 50 (27.9%) patients developed neurodegenerative diseases. There was a significantly higher proportion of conversion in patients with EDS compared to those without EDS (42.2 % vs. 23.1%, p = .01). EDS significantly predicted an increased risk of developing neurodegenerative diseases (adjusted hazard ratios [HR] = 2.56, 95% confidence interval [CI] 1.37 to 4.77) after adjusting for age, sex, body mass index, current depression, obstructive sleep apnea, and periodic limb movements during sleep. Further analyses demonstrated that EDS predicted the conversion of Parkinson's disease (PD) (adjusted HR = 3.55, 95% CI 1.59 to 7.89) but not dementia (adjusted HR = 1.48, 95% CI 0.44 to 4.97).

Conclusions: EDS is associated with an increased risk of developing neurodegenerative diseases, especially PD, in patients with iRBD. Our findings suggest that EDS is a potential clinical biomarker of α-synucleinopathies in iRBD.

Keywords: Parkinson’s disease; REM sleep behavior disorder; dementia.; excessive daytime sleepiness; neurodegenerative disease.

MeSH terms

  • Age of Onset
  • Aged
  • Cohort Studies
  • Dementia / epidemiology
  • Dementia / physiopathology
  • Disorders of Excessive Somnolence / epidemiology*
  • Disorders of Excessive Somnolence / physiopathology
  • Female
  • Follow-Up Studies
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Neurodegenerative Diseases / epidemiology*
  • Neurodegenerative Diseases / physiopathology
  • Parkinson Disease / epidemiology
  • Parkinson Disease / physiopathology
  • Prognosis
  • Proportional Hazards Models
  • REM Sleep Behavior Disorder / epidemiology*
  • REM Sleep Behavior Disorder / physiopathology
  • Risk
  • Sleep Stages / physiology*
  • Synucleins / metabolism


  • Synucleins