Dados do Trabalho

Título

Pseudo-REM behavior disorder in a patient with obstructive sleep apnea, Parkinsonism and REM without atonia: predictor or overlap of two syndromes?

Introdução

Complex motor-behavioral events were found to occur upon arousals from obstructive apnea/hypopnea in patients with OSA, which is named OSA pseudo-RBD and characteristically preserves REM atonia. REM sleep behavior disorder (RBD) presents as a motor-behavioral, dream enactment episode during REM sleep also as a consequence of REM without atonia (RWA). RBD usually is associated with neurodegenerative diseases. In this case report, the same patient presents symptoms of OSA pseudo-RBD, RBD and Parkinson's Disease (PD).

Objetivo

To report a clinical case involving OSA, RBD, pseudo-RBD, PD and to analyze the possible relationships between these syndromes.

Métodos

Clinical follow-up and video polysomnography (vPSG) monitoring were performed.

Resultados

Male, 52 years old, with excessive daytime sleepiness, fatigue, nocturnal awakenings, with snoring and apnea witnessed for 22 years. In 2019, he had a polysomnography with an AHI of 23.7 events/hour (minimum saturation of 80%). He started tremors in right arm, difficulty walking, resting tremor, and being woken up by tremors when sleeping. He was diagnosed with Parkinson's Disease and started Prolopa 100 mg/ 25mg every 8 hours. In 2020, he begins to have restless sleep, with aggressive events, aggressive vocalization, enactment of dreams (vivid and violent content), with difficulty to be aroused and confused when awakened at any time during the night. In 2022, Autoset CPAP therapy was prescribed, with improved sleep, reduced fatigue and behavioral events during sleep, and also reduced tremors. He came to our sleep clinic in 2022 for follow-up, a v-PSG with CPAP was performed and showed AHI 12.4 events/ hour (04 Obstructive Apnea, 37 Central Apnea, 41 Central Hypopnea), tremor after awakenings, and REM without atonia. After 2 months, the patient again presented behavioral symptoms during sleep, and the CPAP prescription was optimized to a fixed pressure of 8.5 cmH2O, with improvement of symptoms.

Conclusões

It is noted, in this clinical case, that the patient had a clinical presentation of motor behaviors during sleep in the presence of OSA, suggestive of OSA pseudo-RBD, and showed improvement with the start of CPAP therapy for OSA treatment. But he also has a RWA and PD, which is suggestive of RBD. The findings described allow us to conclude the coexistence of OSA pseudo-RBD and RBD, however more studies are necessary to understand the role of OSA pseudo-RBD as a predictor factor for RBD.

Palavras -chave

REM behavior disorder, Obstructive Sleep Apnea, Parkinsonism.