J Clin Neurol.  2012 Mar;8(1):51-57. 10.3988/jcn.2012.8.1.51.

Sleep-Related Falling Out of Bed in Parkinson's Disease

Affiliations
  • 1Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA. dwallace@med.miami.edu
  • 2Division of Pulmonary Critical Care and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
  • 3Neurology Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul School of Medicine, Porto Alegre, RS, Brazil.

Abstract

BACKGROUND
AND PURPOSE: Sleep-related falling out of bed (SFOB), with its potential for significant injury, has not been a strong focus of investigation in Parkinson's disease (PD) to date. We describe the demographic and clinical characteristics of PD patients with and without SFOB.
METHODS
We performed a retrospective analysis of 50 consecutive PD patients, who completed an REM sleep behavior disorder screening questionnaire (RBDSQ), questionnaires to assess for RBD clinical mimickers and questions about SFOB and resulting injuries. Determination of high risk for RBD was based on an RBDSQ score of 5 or greater.
RESULTS
Thirteen patients reported history of SFOB (26%). Visual hallucinations, sleep-related injury, quetiapine and amantadine use were more common in those patients reporting SFOB. Twenty-two patients (44%) fulfilled criteria for high risk for RBD, 12 of which (55%) reported SFOB. Five patients reported injuries related to SFOB. SFOB patients had higher RBDSQ scores than non-SFOB patients (8.2+/-3.0 vs. 3.3+/-2.0, p<0.01). For every one unit increase in RBDSQ score, the likelihood of SFOB increased two-fold (OR 2.4, 95% CI 1.3-4.2, p<0.003).
CONCLUSIONS
SFOB may be a clinical marker of RBD in PD and should prompt confirmatory polysomnography and pharmacologic treatment to avoid imminent injury. Larger prospective studies are needed to identify risk factors for initial and recurrent SFOB in PD.

Keyword

Parkinson's disease; REM sleep behavior disorder; sleep disturbance; falls; sleep-related injury
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