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Current Alzheimer Research


ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Research Article

Melatonin Effects in REM Sleep Behavior Disorder Associated with Obstructive Sleep Apnea Syndrome: A Case Series

Author(s): Carolin Schaefer*, Dieter Kunz* and Frederik Bes

Volume 14, Issue 10, 2017

Page: [1084 - 1089] Pages: 6

DOI: 10.2174/1567205014666170523094938

Price: $65


Objectives: REM sleep behavior disorder (RBD), with its main clinical symptoms of nightmares with dream-enacting behavior, is considered as a possible precursor of neurodegenerative disease. Obstructive Sleep Apnea Syndrome (OSAS) is known to be capable of provoking RBD-like symptoms by apneic event related arousals. The two sleep related pathologies must coincide in a relevant number of individuals because of overlapping prevalence in similar age groups. Until now RBD symptoms coexisting with OSAS are rarely described in scientific literature and in fact considered as OSAS mimicking RBD.

Methods: We report four cases with a severe clinical RBD syndrome which were polysomnographically also diagnosed with concomitant OSAS (AHI range: 10.1 -53.2/h).

Results: Treatment with 2 mg prolonged release melatonin led to a relevant clinical improvement of RBD symptoms in all patients, so far untreated for the sleep related breathing disorder. Measure of REM sleep without atonia (RSWA) in polysomnography showed values ranging from 5.1 to 20.4% determined with the Montplaisir method. Surprisingly, RSWA values in PSG with melatonin were high, probably because of the still untreated OSAS.

Conclusion: We presume that in patients with RBD and OSAS both pathologies contribute in varying degrees to the emergence of RBD symptoms by a destabilization of REM sleep. We suggest by consequence to consider a therapeutic strategy including the treatment of both disorders for an optimal therapeutic response.

Keywords: REM sleep behavior disorder, obstructive sleep apnea syndrome, REM sleep, melatonin, polysomnography, REM sleep without atonia.

Jouvet MDF. Locus coeruleus et le sommeil paradoxal. Comptes rendus des séances de la Société de biologie et de ses filiales 159: 895-9 (1965).
Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 9(2): 293-308. (1986).
Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 46(2): 388-93. (1996).
Van Den Heuvel CJ, Reid KJ, Dawson D. Effect of atenolol on nocturnal sleep and temperature in young men: reversal by pharmacological doses of melatonin. Physiol Behav 61(6): 795-802. (1997).
Schenck CH, Mahowald MW. Rapid eye movement sleep parasomnias. Neurol Clin 23(4): 1107-26. (2005).
Oertel WH, Depboylu C, Krenzer M, Vadasz D, Ries V, Sixel-Doring F, et al. REM sleep behavior disorder as a prodromal stage of alpha-synucleinopathies: symptoms, epidemiology, pathophysiology, diagnosis and therapy. Nervenarzt 85(1): 19-25. (2014).
Kunz D, Bes F. Melatonin as a therapy in REM sleep behavior disorder patients: an open-labeled pilot study on the possible influence of melatonin on REM-sleep regulation. Mov Disord 14(3): 507-11. (1999).
Sabater L, Gaig C, Gelpi E, Bataller L, Lewerenz J, Torres-Vega E, et al. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study. Lancet Neurol 13(6): 575-86.
Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 130(Pt 11): 2770-88. (2007).
McGrane IR, Leung JG, St Louis EK, Boeve BF. Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep Med 16(1): 19-26. (2015).
Mahowald MW. SC, editor. REM sleep behaviour disorder. Philadelphia: Saunders; (1994).
Kunz D, Bes F. Melatonin effects in a patient with severe REM sleep behavior disorder: case report and theoretical considerations. Neuropsychobiology 36(4): 211-4. (1997).
Boeve BF, Silber MH, Parisi JE, Dickson DW, Ferman TJ, Benarroch EE, et al. Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology 61(1): 40-5. (2003).
McCarter SJ, Boswell CL, St Louis EK, Dueffert LG, Slocumb N, Boeve BF, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med 14(3): 237-42. (2013).
Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 28(2): 203-6. (2005).
Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5(2): 136-43. (2008).
Marin JM, Gascon JM, Carrizo S, Gispert J. Prevalence of sleep apnoea syndrome in the Spanish adult population. Int J Epidemiol 26(2): 381-6. (1997).
Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T. Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165(20): 2408-13. (2005).
Boot BP, Boeve BF, Roberts RO, Ferman TJ, Geda YE, Pankratz VS, et al. Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: a population-based study. Ann Neurol 71(1): 49-56. (2012).
Zhou J, Zhang J, Li Y, Du L, Li Z, Lei F, et al. Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. Sleep Med 16(3): 414-8. (2015).
Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123(Pt 2): 331-9. (2000).
Wing YK, Lam SP, Li SX, Yu MW, Fong SY, Tsoh JM, et al. REM sleep behaviour disorder in Hong Kong Chinese: clinical outcome and gender comparison. J Neurol Neurosurg Psychiatry 79(12): 1415-6. (2008).
Montes MI, HR, Tavares S, Filho GL. REM behavior disorder associated with sleep disordered breathing. Sleep Sci 6(1): 32-5. (2013).
Consens FB, Chervin RD, Koeppe RA, Little R, Liu S, Junck L, et al. Validation of a polysomnographic score for REM sleep behavior disorder. Sleep 28(8): 993-7. (2005).
Lapierre O, Montplaisir J. Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 42(7): 1371-4. (1992).
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6): 540-5. (1991).
International classification of sleep disorders: diagnostic and coding manual. 3rd ed. Darien, Illinois: American Academy of Sleep Medicine; (2014).
NIMH. CGI - clinical global impression. In: Guy W, Bonato RR, editors. Manual for the EDCEU Assessment Battery. Chevy Chase, Bethesda, MD: National Institute of Mental Health; p. 12.1-6 (1970).
Rechtschaffen A KA, editor. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: Brain information center, Brain research institute; (1968).
Iber CA, IS, Chesson AL Jr. Quand SF editor. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL(2007).
Berry RB, BR, Gamaldo CE, Harding SM, Marcus CL, Vaughn BV. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.0 Darien, IL2012. Available from:
McCarter SJ, St Louis EK, Duwell EJ, Timm PC, Sandness DJ, Boeve BF, et al. Diagnostic thresholds for quantitative REM sleep phasic burst duration, phasic and tonic muscle activity, and REM atonia index in REM sleep behavior disorder with and without comorbid obstructive sleep apnea. Sleep 37(10): 1649-62. (2014).
Kunz D, Mahlberg R, Muller C, Tilmann A, Bes F. Melatonin in patients with reduced REM sleep duration: two randomized controlled trials. J Clin Endocrinol Metab 89(1): 128-34. (2004).
Dempsey JA, Veasey SC, Morgan BJ, O’Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 90(1): 47-112. (2010).

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