Impaired Dynamic Cerebral Autoregulation Across the REM Sleep Behavior Disorder Spectrum: Evidence From Isolated REM Sleep Without Atonia to Parkinson's Disease With RBD.

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ObjectivesRapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by REM sleep without atonia (RSWA) and dream-enactment behaviors and is recognized as a prodromal manifestation of α-synucleinopathies. Isolated RSWA (iRSWA) has been proposed as a potential early stage within the RBD spectrum, although its clinical and physiological significance remains incompletely understood. This study aimed to investigate alterations in sleep architecture, phasic muscle activity, and dynamic cerebral autoregulation (dCA) across the spectrum from iRSWA to isolated RBD (iRBD) and Parkinson's disease with RBD (PD + RBD).MethodsWe conducted a case-control study involving patients with iRSWA, iRBD, and PD + RBD, as well as age- and sex-matched healthy controls, based on video-polysomnography and magnetic resonance imaging. Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction (SCOPA-AUT) were used to evaluate the autonomic function. Transcranial Doppler and finger plethysmography were used to assess dCA by analyzing the phase difference using transfer function analysis.ResultsA total of 25 patients with iRSWA, 30 with iRBD, 28 with PD + RBD, and 30 healthy controls were included. REM sleep percentage was significantly lower in the iRBD and PD + RBD groups than in controls. Phasic RSWA, but not tonic RSWA, differed significantly among the three patient groups (p ConclusionsThese findings suggest that dCA is impaired in patients with iRSWA, iRBD, and PD + RBD. Reduced phase difference was associated with lower REM sleep amount and greater phasic RSWA, suggesting disrupted coupling among REM sleep regulation, autonomic function, and cerebrovascular control. dCA dysfunction may represent an early pathophysiological feature in RBD-related neurodegeneration.Trial registrationClinicalTrials.gov Identifier: NCT02752139.

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