Sex Differences at Presentation in Isolated Rapid Eye Movement Sleep Behavior Disorder
Christina Alexandres1, Stuart McCarter1, Grace Tabatabai2, John Feemster3, Thomas Gossard1, Paul Timm1, David Sandness4, Diego Carvalho1, Jack Jagielski1, Emma Strainis1, Laurene Leclair-Visonneau5, Mithri Junna1, Maja Tippmann-Peikert1, Bradley Boeve1, Melissa Lipford1, Layne Moore6, Erik St. Louis1, Michael Silber1
1Mayo Clinic, 2Pediatric Neurology Washington University School of Medicine, 3John Hopkins University, 4University of Rochester Medical Center, 5Universite de Nantes, 6Mayo Clinic Health System
Objective:
To compare clinical and demographic characteristics of iRBD at diagnosis in men and women.
Background:
Isolated REM sleep behavior disorder (iRBD) is male-predominant in older adults, yet has approximately equal frequency between women and men in younger adults. Data concerning clinical and demographic characteristics in women with iRBD remain limited.
Design/Methods:
We identified 130 women with PSG confirmed iRBD and matched them with 132 PSG-confirmed iRBD men who underwent PSG within 1 month of their female counterparts. Chart review was performed to extract relevant clinical and demographic information. Group comparisons were made with t-tests and chi square analyses.
Results:
Age at RBD symptom onset (50.4 ± 20.0 vs. 55.4 ±16.9 years, p=0.03) and diagnosis (56.4 ±16.7 vs. 62.5 ± 13.3 years, p<0.01) was younger in women than in men. RBD-related injury frequency was similar between groups. Antidepressant use prior to RBD diagnosis (80.8% vs 53.0%, p<0.01), psychiatric comorbidities (79.8% vs. 50.8%, p<0.01) and chronic pain syndromes (39.2% vs. 17.4%, p<0.01) were more frequent in women than men. Women also had more frequent comorbid insomnia (31.5% vs. 18.2%, p= 0.01), hypersomnia (50.8% vs 37.9%, p=0.04) and trended toward more frequent overlap parasomnia disorder (13.8% vs 9.8%, p=0.06) while obstructive sleep apnea (43.1% vs. 70.5%, p < 0.01.) and vascular disease (62.3% vs 83.3%, p<0.01) were more common in men. There were no differences in systemic autoimmune disease between sexes.
Conclusions:
Women with iRBD are younger at symptom onset and diagnosis, more likely to have psychiatric comorbidities and antidepressant use, and differ in profiles of comorbid sleep disturbances and medical comorbidities than men with iRBD. Awareness of key differences between the sexes in iRBD provides insight into possible etiologic factors and will enable clinicians to accurately diagnose iRBD and provide individualized recommendations.