Abstract Details

Title Autonomic Reflex Testing Predicts Phenoconversion in Isolated REM Sleep Behavior Disorder

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-008

Objective To determine whether autonomic reflect testing can predict phenoconversion in individuals with isolated REM sleep behavior disorder (iRBD).

Background Autonomic dysfunction is common across alpha (α)-synucleinopathy subtypes,
including iRBD, a prodromal state of the α-synucleinopathies. However, the presence and distribution of autonomic dysfunction as a risk factor for phenoconversion in iRBD remains unclear.

Design/Methods We performed ART on 45 individuals with iRBD and followed them yearly for an average of 4.6 yrs., during which 6 individuals phenoconverted. We evaluated the ability of individual ART components (sympathetic cholinergic, cardiovagal, sympathetic adrenergic) to predict phenoconversion using predictive models, both alone and combined with measures of olfaction, cognition, motor function, and skin biopsy assessment of dermal α-synuclein. Six individuals had follow-up ART.

Results 87% of iRBD participants had an abnormal baseline ART, and 100% had an abnormal follow-up ART. A combination of cardiovagal function (abnormal heart rate variability with deep breathing) and MDS-UPDRS III score best predicted phenoconversion (AUC = 0.74).

Conclusions Autonomic dysfunction is common in iRBD. Cardiovagal dysfunction was most commonly affected and most predictive of phenoconversion, especially if combined with motor examination.

Authors/Disclosures
Mitchell G. Miglis, MD, FAAN (Stanford University Medical Center) PRESENTER	Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alight Health. Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint, LLC. Dr. Miglis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for 2nd MD. Dr. Miglis has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Jazz Pharmaceuticals. Dr. Miglis has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Van Cott and Talamante. The institution of Dr. Miglis has received research support from Dysautonomia International. The institution of Dr. Miglis has received research support from National Institute of Health. Dr. Miglis has received publishing royalties from a publication relating to health care.
Hash Brown Taha	Mr. Taha has nothing to disclose.
Jennifer Zitser-Koren, MD (UCSF)	Dr. Zitser-Koren has nothing to disclose.

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