Clinical correlates of sleep profiles in dementia with Lewy bodies: a latent class approach.

BACKGROUND

Rapid eye movement behavioral disorder (RBD) is a well-studied feature of dementia with Lewy bodies (DLB). However, patients with DLB report a significantly wider range of sleep symptoms than those of RBD. Our objective was to characterize profiles of sleep disturbances in DLB.

METHODS

Retrospective cross-sectional study including patients with DLB fulfilling McKeith et al. diagnostic criteria in 3 centers at AP-HP GHU Nord, Paris, France. Nine sleep symptoms were evaluated. Latent class analysis was performed on sleep symptoms to identify underlying patterns. Classes were compared on demographic and clinical characteristics.

RESULTS

Among 359 patients (age 74.6 ± 7.5 years; 49% female, disease evolution: 4.6 ± 4.1 years), 95% had sleep disturbances. The most frequent symptoms included excessive daytime sleepiness (70.8%), probable RBD (67.7%), and insomnia/sleep fragmentation (60.9%). A motor disease onset was associated with RBD and nightmares, and a psychiatric onset with insomnia/sleep fragmentation. Latent class analysis identified three sleep profiles: a "Global sleep impairment" profile (n = 106) with the highest sleep-symptom burden, advanced cognitive impairment, and frequent hallucinations and fluctuations; a "RBD - Nightmares" profile (n = 149) associated with dysautonomia, clinical breathing disturbances and better-preserved cognition; and a "Paucisymptomatic" profile (n = 104) with the lowest sleep-symptom burden but advanced cognitive impairment.

CONCLUSION

We identified three distinct sleep profiles, which were associated with distinct patterns of core clinical features. These profiles may reflect specific underlying pathophysiological mechanisms. Better characterization of sleep symptoms may help guide therapeutic strategies and improve quality of life.