Innsbruck REM Sleep Behavior Disorder Inventory may distinguish abnormal nocturnal movements related to obstructive sleep apnea

Şenel, Gülçin Benbir; Ak, Ayşın Kısabay; Sarıtaş, Ayşegül Şeyma; Yılmaz, Hikmet; Metin, Kübra Mehel; Çokal, Burcu Gökçe; Ağan, Kadriye; Aksu, Murat; Akyıldız, Utku Oğan; Demir, Aylin Bican; Çevik, Betül; Ertürk, Ahmet Yusuf; Karadeniz, Derya; Öztura, İbrahim; Sünter, Gülin; Tekin, Selma; Tezer, İrsel; Berktaş, Deniz Tuncel; Totik, Nazlı; Aslan-Kara, Kezban

doi:10.1055/s-0045-1809543

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Original Article • Arq. Neuro-Psiquiatr. 83 (6) • 2025 • https://doi.org/10.1055/s-0045-1809543 linkcopy

Innsbruck REM Sleep Behavior Disorder Inventory may distinguish abnormal nocturnal movements related to obstructive sleep apnea

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by recurrent dream enactment behaviors like sleep-related vocalization and/or complex motor behaviors.

Objective To investigate the discriminative role of the validated Turkish version of the 9-Item Innsbruck REM Sleep Behavior Disorder Inventory (IRBD-9-Turkish) for idiopathic RBD (iRBD) in patients with obstructive sleep apnea (OSA).

Methods The current multicenter study was prospectively conducted in 13 accredited sleep centers in 10 different cities in Türkiye. Clinical data was obtained through a preformed questionnaire, and all participants were submitted to a full-night video-polysomnography (video-PSG) session in a sleep laboratory.

Results A total of 105 patients (mean age: 58.3 ± 11.6 years; 68.6% of male subjects) were prospectively and consecutively enrolled in the study; 51 patients (48.6%) presented iRBD, and 54 (51.4%), OSA, 19 (35.2%) of whom presented abnormal nocturnal behaviors (NBs) demonstrated by clinical and video-PSG findings associated with arousal reactions secondary to apneas and hypopneas. The cut-off value of the IRBD-9 was higher in patients with OSA-NBs than in those with OSA without NBs (p < 0.001), with a sensitivity of 0.765 and a specificity of 0.667, resulting in a correct diagnosis of NBs in 75% of patients with OSA. The receiver operating characteristic (ROC) curves for Factor I (items 1, 2, 3, 6, and 8) and Factor II (items 4, 5, 7, and 9) of the IRBD-9-Turkish showed that both factors were able to distinguish patients with iRBD from those with OSA, but only Factor I distinguishes patients with iRBD from those with OSA-NBs.

Conclusion The present study demonstrated a very high sensitivity and specificity of the IRBD-9-Turkish not only in patients with iRBD, but also in patients with OSA.

Keywords
REM Sleep Behavior Disorder; Sleep Apnea, Obstructive

		Patients with iRBD (n = 51)	Patients with OSA (n = 54)	pvalue
Sex: n (%)	Male (n = 131)	32 (62.7)	40 (74.1)	0.299
Sex: n (%)	Female (n = 107)	19 (37.3)	14 (25.9)	0.299
Mean age (years)		64.90 ± 7.69	51.96 ± 11.19	< 0.001
Mean IRBD-9-Turkish total score (symptom)		0.56 ± 0.20	0.17 ± 0.13	< 0.001
Mean RBDSQ-T total score		8.67 ± 1.87	2.69 ± 2.45	<0.001
Mean RBD duration (months)		50.18 ± 69.90	NA	–
Mean PLMSI		15.97 ± 20.36	10.35 ± 16.21	0.123
RSWA fulfilling the AASM criteria: n (%)	None	0 (0.0)	53 (98.1)	< 0.001
	Chin alone	0 (0.0)	0 (0.0)
	Extremity alone	2 (3.9)	1 (1.9)
	Chin and extremity	49 (96.1)	0 (0.0)
Mean duration of increased phasic/tonic activity in the chin EMG channel		156.26 ± 482.56	0.15 ± 0.31	< 0.001
Mean duration of increased phasic activity in the extremity EMG channels		61.58 ± 220.90	0.18 ± 0.51	< 0.001

Mean symptom score	Patients with iRBD (n = 51)	Patients with OSA (n = 54)	p-value
Factor I (questions 1,2,3,6,8 of the IRBD-9-Turkish)	0.78 ± 0.21	0.13 ± 0.17	< 0.001
Factor II (questions 4,5,7,9 of the IRBD-9-Turkish)	0.29 ± 0.28	0.23 ± 0.18	0.522

Diagnostic performance of the IRBD-9-Turkish inventory symptom section
In comparison to iRBD	Cut-off	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	LR (+)	LR (-)	AUC	pvalue
OSA	0.278	94.1	88.9	88.9	94.1	8.47	0.07	0.95	< 0.001
Diagnostic performance of the IRBD-9-Turkish inventory symptom section for factors I and II
Patients with iRBD and OSA	Cut-off	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	LR (+)	LR (-)	AUC	pvalue
Factor I	0.300	96.1	90.7	90.7	96.1	10.4	0.04	0.973	< 0.001
Factor II	0.375	29.4	88.9	71.4	57.1	2.65	0.79	0.533	0.557

		Patients with OSA-NBs (n = 19)	Patients with OSA (n = 39)	pvalue
Sex: n (%)	Male (n = 40)	11 (61.1)	29 (74.4)	0.326
Sex: n (%)	Female (n = 17)	7 (38.9)	10 (25.6)	0.326
Mean age (years)		50.5 ± 11.01	52.56 ± 10.92	0.264
Mean IRBD-9-Turkish total score (symptom)		0.35 ± 0.19	0.13 ± 0.08	< 0.001
Mean RBDSQ-T total score		4.39 ± 2.83	2.28 ± 2.32	0.001
Mean duration of increased phasic/tonic activity in chin EMG channel		0.06 ± 0.24	0.18 ± 0.34	< 0.001
Mean duration of increased phasic activity in extremity EMG channels		0.07 ± 0.31	0.22 ± 0.57	< 0.001

In comparison to RBD	Cut-off	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	LR (+)	LR (-)	AUC	p-value
OSA	0.28	94.1	100.0	100.0	92.9	–	0.06	0.99	< 0.001
OSA-NB	0.39	76.5	66.7	86.7	50.0	2.29	0.35	0.79	< 0.001

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[TFN1] Abbreviations: AASM, American Academy of Sleep Medicine; EMG, electromyography; iRBD, idiopathic rapid eye movement sleep behavior disorder; IRBD-9-Turkish, Turkish version of the 9-item Innsbruck Rapid Eye Movement Sleep Behavior Disorder Inventory; NA, not applicable; OSA, obstructive sleep apnea; PMLSI, Periodic Limb Movements in Sleep Index; RBDSQ-T, Turkish Version of the Rapid Eye Movement Sleep Behavior Disorder Questionnaire; RSWA, rapid eye movement sleep without atonia.