Objective: Aim of our study is to correlate the autonomic nervous system failure and circadian rhythm of arterial blood pressure in idiopathic REM behaviour disorders (iRBD) and Parkinson’s disease (PD).

Background: In prospective longitudinal study subjects with iRBD may convert in Parkinson’s disease (PD) or other synucleinopathies like Multiple System Atrophy (MSA) or Lewy-Body Dementia (LBD) with risk estimates that approximate 40–65% at 10 years. Many of the non-motor symptoms that occur in PD also occur in IRBD, moreover PD patients can also show the loss of circadian rhythm of arterial blood pressure and cardiac frequency. Recent imaging studies have provided evidence for cardiosympathetic denervation in iRBD and preliminary data suggest a major sensitivity of vagal maneuvers compared with simple tilt table test in the relief of autonomic dysfunction.

Methods: We enrolled 14 patients from Sleep Medicine Unit having Video-Polysonnographic diagnosis of iRBD. They were compared with 10 PD patients in early stage (PD “de novo” group) and 10 in late stage (PD “advanced” group) referred to Movement Disorders Unit. All these patients underwent neurological examination, tilt table test (Task Force Monitor device) (CNSsystems) with vagal tests, 24-hours ambulatory blood pressure monitoring, cerebral ecography using a phased array ultrasound system equipped with a 2.0-2.5 MHz transducer .

Results: 5 iRBD patients presented with TCS findings of SN hyperechogencity (iRBD/SN+ group); whilst the other 9 without hyperechogencity (iRBD/SN- group). 78.9 % of patients with iRBD and 77.8 % of PD- ADVANCED has at least one test autonomic compromised. OH was present in all groups except in PD “de novo” group. 65% of IRBD and 100% of PD -advanced show a loss of physiological drop in nocturnal blood pressure. The PD “de novo” group, as well as in iRBD/SN- group, does not show alterations in the circadian rhythm of blood pressure.

Conclusions: iRBD patients, especially those with SN hyperechogenicity, present comparable burden of autonomic dysfunction of advanced PD patients. Interestingly, PD “de novo” group didn’t show cardiovascular autonomic impairment in similar extent. If these preliminary findings will be confirmed, iRBD/ SN+ manifested a greater autonomic impairment than observed in early stage of PD. This could suggest an iRBD/SN+ conversion in a synucleinopathies dissimilar from PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/autonomic-failure-and-circadian-rhythm-of-arterial-blood-pressure-in-idiopathic-rem-behaviour-disorders-and-parkinsons-disease/