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Abstract Details

Neurogenic Orthostatic Hypotension is Common in Isolated REM Sleep Behavior Disorder
Sleep
P6 - Poster Session 6 (5:30 PM-6:30 PM)
11-001
Rapid eye movement (REM) sleep behavior disorder (RBD) is a prodromal synucleinopathy for most patients, and the majority of individuals with isolated RBD (iRBD) will phenoconvert to clinically manifest synucleinopathy within a decade. Autonomic dysfunction is common in iRBD, however the prevalence of neurogenic orthostatic hypotension (nOH) in iRBD is unknown. We aimed to prospectively evaluate the prevalence of nOH in a large multicenter cohort of participants with iRBD.
To characterize the prevalence of neurogenic orthostatic hypotension (nOH) in REM sleep behavior disorder (RBD) and associations with other prodromal features of the disease.
Participants >18 years of age with overnight polysomnogram-confirmed iRBD were enrolled from the North American Prodromal Synucleinopathy (NAPS) Consortium. Participants were excluded if they were on antihypertensives or other medications that might contribute to OH. All participants underwent 3-min orthostatic stand testing with blood pressure (BP) and heart rate (HR) measurements. The ΔHR/Δ systolic BP ratio was calculated for all participants. nOH was defined as OH with a ΔHR/ΔSBP ratio of <0.5. All participants also completed a battery of questionnaires including the Scales for Outcomes in Parkinson’s Disease – Autonomic Dysfunction (SCOPA-AUT), as well as detailed cognitive, motor, and sensory testing.
334 iRBD participants met eligibility criteria. OH was identified in 87 (26%) participants, of which 69 (21%) met criteria for nOH (ΔHR/ΔSBP 0.31±0.24) and 18 (5%) met criteria non-neurogenic OH (ΔHR/ΔSBP 0.70±0.27). There was no difference in participant age, age of RBD onset, or years of education across groups.  Pupillary and sexual dysfunction as measured by SCOPA-AUT subdomain scores, as well as olfaction, were all significantly worse in those with nOH and non-neurogenic OH compared to those without OH.
nOH is common in those with RBD. These data support the rationale to routinely include orthostatic stand testing in the evaluation of patients with iRBD.
Authors/Disclosures
Miranda M. Lim, MD, PhD (VA Portland Health Care System)
PRESENTER
Dr. Lim has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Applied Cognition. Dr. Lim has stock in Applied Cognition. The institution of Dr. Lim has received research support from NIH. The institution of Dr. Lim has received research support from VA. The institution of Dr. Lim has received research support from Department of Defense. The institution of Dr. Lim has received research support from National Science Foundation. Dr. Lim has received publishing royalties from a publication relating to health care.
Mitchell G. Miglis, MD, FAAN (Stanford University Medical Center) Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Infinite MD. Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint, LLC. Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 2nd MD. Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MED-IQ. Dr. Miglis has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Van Cott and Talamante. Dr. Miglis has received publishing royalties from a publication relating to health care.
Jennifer Zitser-Koren, MD (UCSF) Dr. Zitser-Koren has nothing to disclose.
Emmanuel H. During, MD (Stanford) Dr. During has nothing to disclose.
No disclosure on file
Daniel Huddleston, MD (Emory University) The institution of Dr. Huddleston has received research support from NIH-NINDS 1K23NS105944-01A1. The institution of Dr. Huddleston has received research support from Michael J. Fox Foundation (MJFF-010556). The institution of Dr. Huddleston has received research support from Lewy Body Dementia Association Research Center of Excellence (Emory). The institution of Dr. Huddleston has received research support from American Parkinson's Disease Association.
Michael J. Howell, MD, FAAN Dr. Howell has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for medlink. Dr. Howell has stock in Sleep Performance Institute. Dr. Howell has received publishing royalties from a publication relating to health care.
Erik K. St. Louis, MD (Mayo Clinic) Dr. St. Louis has received publishing royalties from a publication relating to health care. Dr. St. Louis has received publishing royalties from a publication relating to health care.
Jean-Francois Gagnon (Centre D'etude Du Sommeil) The institution of Jean-Francois Gagnon has received research support from Canadian Institute of Health Research. The institution of Jean-Francois Gagnon has received research support from Canada Research Chair. The institution of Jean-Francois Gagnon has received research support from National Institutes of Health.
Aleksandar Videnovic, MD, MSc, FAAN (MGH Neurological Clinical Research Institute) Dr. Videnovic has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion pharmaceuticals .
Alon Y. Avidan, MD, MPH, FAAN (David Geffen School of Medicine at UCLA) Dr. Avidan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Eisai. Dr. Avidan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Avadel. Dr. Avidan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Harmony. Dr. Avidan has received personal compensation in the range of $0-$499 for serving as a Consultant for Merck. Dr. Avidan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai. Dr. Avidan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Harmony. Dr. Avidan has received publishing royalties from a publication relating to health care.
Carlos H. Schenck, MD (Minnesota Regional Sleep Disorders Center) Dr. Schenck has received personal compensation for serving as an employee of Physicians' Educational Resource, LLC.. Dr. Schenck has received personal compensation for serving as an employee of Eisai Global Medical Affairs.
Ronald Postuma, MD (Montreal General Hospital) Dr. Postuma has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche, Biogen, Takeda, Theranexus, GE, Jazz, Curasen, Paladin, Inception Sciences, Phytopharmics, Vaxxinity, Merck. Dr. Postuma has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen/Partners. The institution of Dr. Postuma has received research support from CIHR, Weston Foundation, Webster Foundation, Roche, MJFF, Parkinson Canada, FRSQ, NIH.
Bradley F. Boeve, MD, FAAN (Mayo Clinic) Dr. Boeve has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Rainwater Charitable Foundation. The institution of Dr. Boeve has received research support from Alector. The institution of Dr. Boeve has received research support from EIP Pharma. The institution of Dr. Boeve has received research support from Transposon. The institution of Dr. Boeve has received research support from Cognition Therapeutics. Dr. Boeve has received publishing royalties from a publication relating to health care.
Yo-El Ju, MD The institution of Dr. Ju has received research support from National Institutes of Health.
Jonathan Elliott No disclosure on file