Biomaterial Database

Is REM Sleep Behavior Disorder Changing? Secular Changes Versus Referral Patterns. 2023

Stephen Joza, and Alex Iranzo, and Ambra Stefani, and Amelie Pelletier, and Monica Serradell, and Amaia Muñoz-Lopetegi, and Abubaker Ibrahim, and Evi Holzknecht, and Jacques Y Montplaisir, and Gerard Mayà, and Joan Santamaria, and Carles Gaig, and Melanie Bergmann, and Elisabeth Brandauer, and Birgit Högl, and Jean-François Gagnon, and Ronald B Postuma

Montreal Neurological Institute McGill University Montreal Quebec Canada.

Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. To assess if, over time, milder iRBD cases are presenting earlier. Disease-free survival was compared in two iRBD recruitment epochs: 2004 to 2013 ("earlier") versus 2014to 2022 ("later") and by referral type ("self-referral" vs. "conventional-referral") in three large centers. In Montreal, among 209 subjects followed prospectively, shorter time to phenoconversion was observed in the earlier epoch (5-year phenoconversion = 42% earlier vs. 23% later); diagnosis before 2014 had a 1.8-fold phenoconversion hazard. However, no difference was observed in 248 subjects from Barcelona and 166 from Innsbruck. Analysis of Montreal data found that increased survival in the later epoch was driven by an increasing number of self-referrals, who phenoconverted at 1/3 the rate of physician-referred subjects. Increased patient awareness of iRBD results in earlier presentation to clinical attention, with a longer time to phenoconversion.