Evaluation of a structured screening assessment to detect patients with isolated REM Sleep Behavior Disorder

Abstract

AbstractBackgroundIsolated rapid eye movement (REM) sleep behavior disorder (iRBD) cohorts have provided novel insights in the earliest neurodegenerative processes in α-synucleinopathies. Even though polysomnography remains the gold standard for diagnosis, an accurate questionnaire-based algorithm to identify eligible subjects could facilitate efficient recruitment in research.ObjectivesThis study aimed to optimize the identification of subjects with iRBD from the general population.MethodsBetween June 2020 and July 2021, we placed newspaper advertisements including the single-question screen for RBD (RBD1Q). Participants’ evaluations included a structured telephone screening consisting of the RBD screening questionnaire (RBDSQ) and additional sleep-related questionnaires. We examined anamnestic information predicting polysomnography-proven iRBD using logistic regressions and receiver operating characteristic curves.Results543 participants answered the advertisements and 185 subjects fulfilling in- and exclusion criteria were screened. Of these, 124 received polysomnography after expert selection and 78 (62.9%) were diagnosed with iRBD. Selected items of the RBDSQ, the Pittsburgh Sleep Quality Index, the STOP-Bang questionnaire, and age predicted iRBD with high accuracy in a multiple logistic regression model (area under the curve >80%). Comparing the algorithm to the sleep expert decision, 77 instead of 124 polysomnographies (62.1%) would have been carried out, while 63 (80.8%) of iRBD patients would have been identified. 32 of 46 (69.6%) unnecessary polysomnography examinations could have been avoided.ConclusionsOur proposed algorithm displayed high diagnostic accuracy for polysomnography-proven iRBD in a cost-effective manner and may be a convenient tool for application in research and clinical settings. External validation sets are warranted to prove its reliability.