The treatment efficacy of pharmacotherapies for rapid eye movement sleep behavior disorder with polysomnography evaluation: A systematic review and meta-analysis
Zhiqiang Que,
Cuifeng Zheng,
Zhenhua Zhao,
Yanhong Weng,
Zhibao Zhu,
Yuqi Zeng,
Qinyong Ye,
Fabin Lin,
Guoen Cai
Affiliations
Zhiqiang Que
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China
Cuifeng Zheng
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China
Zhenhua Zhao
Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian, China
Yanhong Weng
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China
Zhibao Zhu
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China
Yuqi Zeng
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China
Qinyong Ye
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China; Corresponding author.
Fabin Lin
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China; Corresponding author.
Guoen Cai
Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou 350001, Fujian, China; Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou 350001, Fujian, China; Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, Fujian, China; Corresponding author.
Clonazepam and melatonin are commonly used as first-line medications for the treatment of rapid eye movement (REM) sleep behavior disorder (RBD), with other medications used in the clinic including pramipexole, ramelteon, and rotigotine. We performed a systematic review and meta-analysis of randomized and non-randomized controlled trials to assess the efficacy of these treatment options in RBD patients with polysomnography. We systematically retrieved results of randomized and non-randomized controlled trials using the PubMed, Embase, and Cochrane databases.Of the 454 studies identified, 13 were considered eligible for inclusion in the study. In comparison to baseline, clonazepam was found to significantly decrease the percentage of stage 2 sleep [4.00 (95% CI = 0.90 to 7.10)] in RBD patients. Melatonin was found to significantly improve patients’ sleep efficiency [2.51(95% CI = 0.75 to 4.28)], significantly reduce the time spent in bed (TIB) [−11.71(95% CI = −23.05 to −0.37)], phasic activity[−25.79(95% CI = −42.13 to −9.46)] and tonic activity[−10.44(95% CI = −12.24 to −8.64)]. RWA[−5.87 (95% CI = −8.25 to −3.50)] significantly improve with the use of ramelteon. Pramipexole was found to significantly increase the total sleep time (TST) [27.17 (95% CI = 0.06 to 54.29)], and significantly reduce the periodic limb movements of sleep (PLMS) index [−11.42(95% CI = −21.38 to −1.47)]. We also found that pramipexole had different effects on idiopathic RBD (iRBD) and secondary RBD (sRBD). These results will help to guide the clinical use of medication in patients with RBD.
