Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?
Identifieur interne : 000684 ( Pmc/Curation ); précédent : 000683; suivant : 000685Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?
Auteurs : Ronald B. Postuma [Canada] ; Jean-Francois Gagnon [Canada] ; Maria Tuineaig [Canada] ; Josie-Anne Bertrand [Canada] ; Veronique Latreille [Canada] ; Catherine Desjardins [Canada] ; Jacques Y. Montplaisir [Canada]Source :
- Sleep [ 0161-8105 ] ; 2013.
Abstract
Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration.
Prospective cohort study.
Tertiary sleep disorders center.
100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls.
Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74).
Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with “purely-idiopathic” RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.
Postuma RB; Gagnon JF; Tuineaig M; Bertrand JA; Latreille V; Desjardins C; Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal?
Url:
DOI: 10.5665/sleep.3102
PubMed: 24179289
PubMed Central: 3792373
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<front><div type="abstract" xml:lang="en"><sec><title>Objectives:</title>
<p>Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration.</p>
</sec>
<sec><title>Design:</title>
<p>Prospective cohort study.</p>
</sec>
<sec><title>Setting:</title>
<p>Tertiary sleep disorders center.</p>
</sec>
<sec><title>Participants:</title>
<p>100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls.</p>
</sec>
<sec><title>Measurements/Results:</title>
<p>Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74).</p>
</sec>
<sec><title>Conclusions:</title>
<p>Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with “purely-idiopathic” RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.</p>
</sec>
<sec><title>Citation:</title>
<p>Postuma RB; Gagnon JF; Tuineaig M; Bertrand JA; Latreille V; Desjardins C; Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? <italic>SLEEP</italic>
2013;36(11):1579-1585.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Sleep</journal-id>
<journal-id journal-id-type="iso-abbrev">Sleep</journal-id>
<journal-id journal-id-type="publisher-id">Sleep</journal-id>
<journal-title-group><journal-title>Sleep</journal-title>
</journal-title-group>
<issn pub-type="ppub">0161-8105</issn>
<issn pub-type="epub">1550-9109</issn>
<publisher><publisher-name>Associated Professional Sleep Societies, LLC</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24179289</article-id>
<article-id pub-id-type="pmc">3792373</article-id>
<article-id pub-id-type="doi">10.5665/sleep.3102</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Antidepressants and REM Sleep Behavior Disorder</subject>
</subj-group>
</article-categories>
<title-group><article-title>Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal?</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Postuma</surname>
<given-names>Ronald B.</given-names>
</name>
<degrees>MD, MSc</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gagnon</surname>
<given-names>Jean-Francois</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tuineaig</surname>
<given-names>Maria</given-names>
</name>
<degrees>BSc</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bertrand</surname>
<given-names>Josie-Anne</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Latreille</surname>
<given-names>Veronique</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Desjardins</surname>
<given-names>Catherine</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Montplaisir</surname>
<given-names>Jacques Y.</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
<aff id="aff1"><label>1</label>
Department of Neurology, McGill University, Montreal General Hospital, Montreal, Québec, Canada</aff>
<aff id="aff2"><label>2</label>
Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada</aff>
<aff id="aff3"><label>3</label>
Department of Psychology, Université du Québec à Montréal, Montreal, Québec, Canada</aff>
<aff id="aff4"><label>4</label>
Department of Psychology, Université de Montréal, Montreal, Québec, Canada</aff>
<aff id="aff5"><label>5</label>
Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada</aff>
</contrib-group>
<author-notes><corresp id="cor1">Address correspondence to: Jacques Montplaisir, MD, PhD, <addr-line>CRCPC Centre d'Études Avancées en Médecine du Sommeil, Hôpital du Sacré-Cœur de Montréal, 5400 Boul. Gouin Ouest, Montréal, Québec, Canada, H4J 1C5</addr-line>
<phone>(514) 338-2693</phone>
<fax>(514) 338-2531</fax>
<email>JY.Montplaisir@UMontreal.CA</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>1</day>
<month>11</month>
<year>2013</year>
</pub-date>
<volume>36</volume>
<issue>11</issue>
<fpage>1579</fpage>
<lpage>1585</lpage>
<history><date date-type="received"><month>2</month>
<year>2013</year>
</date>
<date date-type="rev-recd"><month>4</month>
<year>2013</year>
</date>
<date date-type="accepted"><month>5</month>
<year>2013</year>
</date>
</history>
<permissions><copyright-statement>© 2013 Associated Professional Sleep Societies, LLC.</copyright-statement>
<copyright-year>2013</copyright-year>
</permissions>
<abstract><sec><title>Objectives:</title>
<p>Antidepressants, among the most commonly prescribed medications, trigger symptoms of REM sleep behavior disorder (RBD) in up to 6% of users. Idiopathic RBD is a very strong prodromal marker of Parkinson disease and other synuclein-mediated neurodegenerative syndromes. It is therefore critically important to understand whether antidepressant-associated RBD is an independent pharmacologic syndrome or a sign of possible prodromal neurodegeneration.</p>
</sec>
<sec><title>Design:</title>
<p>Prospective cohort study.</p>
</sec>
<sec><title>Setting:</title>
<p>Tertiary sleep disorders center.</p>
</sec>
<sec><title>Participants:</title>
<p>100 patients with idiopathic RBD, all with diagnosis confirmed on polysomnography, stratified to baseline antidepressant use, with 45 matched controls.</p>
</sec>
<sec><title>Measurements/Results:</title>
<p>Of 100 patients, 27 were taking antidepressants. Compared to matched controls, RBD patients taking antidepressants demonstrated significant abnormalities of 12/14 neurodegenerative markers tested, including olfaction (P = 0.007), color vision (P = 0.004), Unified Parkinson Disease Rating Scale II and III (P < 0.001 and 0.007), timed up-and-go (P = 0.003), alternate tap test (P = 0.002), Purdue Pegboard (P = 0.007), systolic blood pressure drop (P = 0.029), erectile dysfunction (P = 0.002), constipation (P = 0.003), depression indices (P < 0.001), and prevalence of mild cognitive impairment (13% vs. 60%, P < 0.001). All these abnormalities were indistinguishable in severity from RBD patients not taking antidepressants. However, on prospective follow-up, RBD patients taking antidepressants had a lower risk of developing neurodegenerative disease than those without antidepressant use (5-year risk = 22% vs. 59%, RR = 0.22, 95%CI = 0.06, 0.74).</p>
</sec>
<sec><title>Conclusions:</title>
<p>Although patients with antidepressant-associated RBD have a lower risk of neurodegeneration than patients with “purely-idiopathic” RBD, markers of prodromal neurodegeneration are still clearly present. Development of RBD with antidepressants can be an early signal of an underlying neurodegenerative disease.</p>
</sec>
<sec><title>Citation:</title>
<p>Postuma RB; Gagnon JF; Tuineaig M; Bertrand JA; Latreille V; Desjardins C; Montplaisir JY. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? <italic>SLEEP</italic>
2013;36(11):1579-1585.</p>
</sec>
</abstract>
<kwd-group><kwd>REM sleep behavior disorder</kwd>
<kwd>antidepressants</kwd>
<kwd>Parkinson disease</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>
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