REM Sleep without Atonia and Gait Impairment in People with Mild-to-Moderate Parkinson's Disease

Sommer L Amundsen-Huffmaster, Matthew N. Petrucci, Maria E. Linn-Evans, Jae Woo Chung, Michael J. Howell, Aleksandar Videnovic, Paul J Tuite, Scott E. Cooper, Colum D. MacKinnon

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Subtle gait deficits can be seen in people with idiopathic rapid eye movement (REM) sleep behavior disorder (RBD), a prodromal stage of Parkinson's disease (PD) and related alpha-synucleinopathies. It is unknown if the presence and level of REM sleep without atonia (RSWA, the electromyographic hallmark of RBD) is related to the severity of gait disturbances in people with PD. Objective: We hypothesized that gait disturbances in people with mild-to-moderate PD would be greater in participants with RSWA compared to those without RSWA and matched controls, and that gait impairment would correlate with measures of RSWA. Methods: Spatiotemporal characteristics of gait were obtained from 41 people with PD and 21 age-matched controls. Overnight sleep studies were used to quantify muscle activity during REM sleep and group participants with PD into those with RSWA (PD-RSWA+, n=22) and normal REM sleep muscle tone (PD-RSWA-, n=19). Gait characteristics were compared between groups and correlated to RSWA. Results: The PD-RSWA+ group demonstrated significantly reduced gait speed and step lengths and increased stance and double support times compared to controls, and decreased speed and cadence and increased stride velocity variability compared to PD-RSWA- group. Larger RSWA scores were correlated with worse gait impairment in the PD group. Conclusion: The presence and level of muscle tone during REM sleep is associated with the severity of gait disturbances in PD. Pathophysiological processes contributing to disordered gait may occur earlier and/or progress more rapidly in people with PD and RBD.

Original languageEnglish (US)
Pages (from-to)767-778
Number of pages12
JournalJournal of Parkinson's Disease
Issue number2
StatePublished - 2021

Bibliographical note

Funding Information:
We thank the volunteers for participation in this research, Devin O’Connell, BS, for assisting with data collection and analysis, Joshua De Kam, BA, CCRP for research coordination, and Chiahao Lu, PhD for statistical assistance. We are grateful for our additional referring movement disorders specialists including Dr. Martha Nance, MD, Dr. Daniel Kuyper, MD, and Dr. Sotirios Parashos, MD at Struthers Parkinson’s Center and Dr. Julia Johnson, MD at HealthPartners Parkinson’s Center. This work was supported by grants NIH RO1 NS070264 & NS088679 (CDM), NIH Clinical and Translational Science Award at the University of Minnesota (8UL1TR000114-02, Research support), and the National Center for Advancing Translational Sciences (NCATS) of the NIH (Grant Number UL1TR000114, Research support). Additional support for individuals came from: NIH R21 NS108022 (AV), NIH training grant T32GM008471 (MLE), NSF NRT Fellowship DGE-1734815 (MLE), the Wallin Neuroscience Foundation (JWC), the MnDRIVE Fellowship (SLAH, JWC, MNP), the Parkinson Study Group (MNP), the Parkinson’s Disease Foundation’s Advancing Parkinson’s Treatments Innovations Grant (MNP), and the Udall Center for Excellence in Parkinson’s Disease (NIH P50 NS09857) (SLAH, CDM).

Publisher Copyright:
© 2021 - IOS Press. All rights reserved.


  • Parkinson's disease
  • REM sleep without atonia
  • gait


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