Abstract Details

Title Association Between REM Sleep Without Atonia and Multiple Sclerosis Subtypes: A Polysomnographic Study

Topic Sleep

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 14-002

Objective

To investigate the association between REM sleep without atonia (RSWA) and multiple sclerosis (MS) and by progressive and non-progressive MS course.

Background

REM sleep behavior disorder (RBD) is the earliest prodromal feature of the α-synucleinopathies. RSWA is the polysomnographic (PSG) biomarker of RBD. While RBD is more common in MS than general population estimates, precise measurements of RSWA in MS are lacking. We analyzed the relationship between MS diagnosis, disease course, and other clinical and MRI features with RSWA.

Design/Methods

PSGs performed February 2023-August 2025 in patients with MS and matched controls (1:3) with at least 10 mins of REM sleep were scored for RSWA using chin and flexor-digitorum superficialis EMG including both tonic and phasic activity. RSWA was quantified using AASM v2.6 criteria. Epochs with respiratory events or arousals were excluded. MS patients were categorized as non-progressive or progressive. Wilcoxon rank-sum tests compared RSWA% between MS diagnosis adjusting for psychotropic use. Results are reported as median (IQR). Additional analyses assessed relationships between RSWA, motor performance, MRI volumetrics and lesion burden.

Results

A total of 209 patients were included: 52 with MS (36 non-progressive; 16 progressive) and 157 controls. Mean age was 52.8±16.9 years; 78% were female. Progressive MS was associated with significantly higher RSWA vs. non-progressive MS and controls (p=0.014). Progressive MS exhibited a 317.5% higher RSWA% vs. controls (95% CI: 36.58-1176; p=0.012) and 298.7% vs non-progressive MS (95% CI:16.20%-1268%; p=0.028). Within the non-progressive group, RSWA correlated positively with right-hand motor task time (Spearman r=0.40, p=0.022). No consistent associations were observed between RSWA and quantitative MRI markers.

Conclusions

Progressive MS is strongly associated with elevated RSWA. These findings suggest that RSWA and subsequentially RBD may reflect disease progression and neurodegenerative burden in MS with sparing in non-progressive MS, warranting further investigation into its clinical and prognostic significance.

Authors/Disclosures
Jad El Ahdab, MD PRESENTER	Dr. El Ahdab has nothing to disclose.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Tyler Bare, MD	Dr. Bare has nothing to disclose.
Sikawat Thanaviratananich, MD (Case Western Reserve University)	Dr. Thanaviratananich has nothing to disclose.
Kunio Nakamura, PhD (Cleveland Clinic)	Dr. Nakamura has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for INmune Bio. The institution of Dr. Nakamura has received research support from Biogen. The institution of Dr. Nakamura has received research support from PCORI. The institution of Dr. Nakamura has received research support from NIH. The institution of Dr. Nakamura has received research support from Genzyme. The institution of Dr. Nakamura has received research support from NIH. The institution of Dr. Nakamura has received research support from Genzyme. The institution of Dr. Nakamura has received research support from Novartis. The institution of Dr. Nakamura has received research support from DOD. Dr. Nakamura has received intellectual property interests from a discovery or technology relating to health care.
Matheus Lima Diniz Araujo, PhD	Dr. Lima Diniz Araujo has nothing to disclose.
Scott Husak	Scott Husak has nothing to disclose.
Julia O'Mahony (The Hospital for Sick Children)	Ms. O'Mahony has nothing to disclose.
James Bena, MS	Mr. Bena has nothing to disclose.
Delaney Ryan, MPH	Miss Ryan has nothing to disclose.
Nancy R. Foldvary-Schaefer, DO, FAAN (Cleveland Clinic)	Dr. Foldvary-Schaefer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jazz. The institution of Dr. Foldvary-Schaefer has received research support from Jazz. The institution of Dr. Foldvary-Schaefer has received research support from Suven. The institution of Dr. Foldvary-Schaefer has received research support from Takeda. Dr. Foldvary-Schaefer has received publishing royalties from a publication relating to health care. Dr. Foldvary-Schaefer has received publishing royalties from a publication relating to health care.

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