Frequency of Orthostatic Hypotension in Isolated REM Sleep Behavior Disorder: The North American Prodromal Synucleinopathy Cohort

Jonathan E. Elliott, Mohini D. Bryant-Ekstrand, Allison T. Keil, Brittany R. Ligman, Miranda M. Lim, Jennifer Zitser, Emmanuel H. During, Jean Francois Gagnon, Erik K. St Louis, Julie A. Fields, Daniel E. Huddleston, Donald L. Bliwise, Alon Y. Avidan, Carlos H. Schenck, Jennifer McLeland, Susan R. Criswell, Albert A. Davis, Aleksandar Videnovic, Joyce K. Lee-Iannotti, Ronald PostumaBradley F. Boeve, Yo El S. Ju, Mitchell G. Miglis, Parichita Choudhury, Leah K. Forsberg, Michael J. Howell, David R. Shprecher, Sommer Amudson-Huffmaster, Anam Arik, Nellie Brushaber, Jae Woo Chung, Joshua De Kam, Adrian Ekelmans, Ellen Fischbach, Marissa Keane, Ruth Kraft, Colum MacKinnon, Daeva Miner-Rose, Samantha Murphy, Cosette Olivo, Amelie Pelletier, Katherine L.M. Powers, Adreanne M. Rivera, Sarahmay Sanchez, Matthew Stauder, Rebekah Summers, Leah Taylor, Luke Tiegan, Paul Timm, Kelsey A. Tucker, Peter Tran, Douglas Galasko, Emmanuel Mignot

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background and ObjectivesAlthough orthostatic hypotension (OH) can be an early feature of autonomic dysfunction in isolated REM sleep behavior disorder (iRBD), no large-scale studies have examined the frequency of OH in iRBD. In this study, we prospectively evaluated the frequency of OH in a large multicenter iRBD cohort.MethodsParticipants 18 years or older with video polysomnogram-confirmed iRBD were enrolled through the North American Prodromal Synucleinopathy consortium. All participants underwent 3-minute orthostatic stand testing to assess the frequency of OH, and a Δ heart rate/Δ systolic blood pressure (ΔHR/ΔSBP) ratio <0.5 was used to define reduced HR augmentation, suggestive of neurogenic OH. All participants completed a battery of assessments, including the Scales for Outcomes in Parkinson Disease-Autonomic Dysfunction (SCOPA-AUT) and others assessing cognitive, motor, psychiatric, and sensory domains.ResultsOf 340 iRBD participants (65 ± 10 years, 82% male), 93 (27%) met criteria for OH (ΔHR/ΔSBP 0.37 ± 0.28; range 0.0-1.57), and of these, 72 (77%) met criteria for OH with reduced HR augmentation (ΔHR/ΔSBP 0.28 ± 0.21; range 0.0-0.5). Supine hypertension (sHTN) was present in 72% of those with OH. Compared with iRBD participants without OH, those with OH were older, reported older age of RBD symptom onset, and had worse olfaction. There was no difference in autonomic symptom scores as measured by SCOPA-AUT.DiscussionOH and sHTN are common in iRBD. However, as patients may have reduced autonomic symptom awareness, orthostatic stand testing should be considered in clinical evaluations. Longitudinal studies are needed to clarify the relationship between OH and phenoconversion risk in iRBD.Trial Registration InformationClinicalTrials.gov: NCT03623672; North American Prodromal Synucleinopathy Consortium.

Original languageEnglish
Pages (from-to)E2545-E2559
JournalNeurology
Volume101
Issue number24
DOIs
StatePublished - Dec 12 2023

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