Meta-analysis of clinical differences between Parkinson's disease patients with and without REM sleep behavior disorder

Abstract

Objective To compare the clinical differences between Parkinson's disease (PD) patients with and without rapid eye movement sleep behavior disorder (RBD). Methods PubMed, EMBASE, Cochrane Library, Chinese Biology Medicine (CBM) and China National Knowledge Infrastructure (CNKI) databases were used to search for studies on RBD in PD patients. Meticulous data were extracted and Meta-analysis was performed. All analyses were conducted with the software of Revman Manager 5.2.4. Results Five clinical studies involving total 650 PD patients were included. The Meta-analysis showed that PD patients with RBD had an older mean age (WMD = 2.870, 95%CI:1.490-4.260; P = 0.000), a higher Hoehn-Yahr stage (WMD = 0.300, 95% CI: 0.160-0.450; P = 0.000), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor scores during the "on" state (WMD = 2.370, 95%CI: 0.260-4.490; P = 0.030), and larger levodopa dose (WMD = 90.550, 95% CI: 31.040-150.060; P = 0.003) in comparison with PD patients without RBD. In addition, PD patients with RBD were more likely to develop motor fluctuation (OR = 1.520, 95% CI: 1.080-2.140; P = 0.020) and orthostatic hypotension (OR = 11.390, 95% CI: 4.790-27.090; P = 0.000) as compared to PD patients without RBD. However, gender (OR = 1.850, 95%CI: 0.810-4.230; P = 0.150), disease duration (WMD = 0.130, 95% CI: ⁃ 1.230-1.500; P = 0.850) and Mini-Mental State Examination (MMSE) scores (WMD = ⁃ 0.220, 95%CI: ⁃ 0.600-0.160; P = 0.260) did not differ between PD patients with and without RBD. Conclusion PD patients with RBD were more likely to be associated with older age, more severe motor disability, higher levodopa usage, higher incidence of motor fluctuation and orthostatic hypotension, indicating thatPD with RBD might be at an advanced stage and had more widespread and severe neurodegeneration.