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REM Sleep Behavior DisorderFARPRESTONCT05262543

PREdictive Risk Factors of Conversion Into Idiopathic RBD. Italian Study

An observational study of REM Sleep Behavior Disorder, run by University of Cagliari at 2 sites in Italy.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

REM Sleep Behavior Disorder (RBD) is a REM sleep parasomnia first described in 1986 and characterized by the loss of physiological muscle atonia typical of REM sleep and by the presence of abnormal, sometimes violent, motor activity often related to dream content The observed motor behaviors are often associated to… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
REM Sleep Behavior Disorder
How many people
300 participants
Where
2 sitesItaly
Study dates
25 May 2020to 31 Jan 2035
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients, aged major of 18 years old, diagnosed with iRBD, that can provide informed consent referring to centers participating in the FARPRESTO study

Who may be able to join

  • Age: major of 18 years old
  • iRBD diagnosis, according to diagnostic criteria of the ICSD second and third edition

Who cannot join

  • Impossibility to provide or withdraw informed consent and inability to read, write and understand the purpose and modality of the study.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Monica Puligheddu, MD, PhD contact

070 5109 6016

centrosonnoca@unica.it

Italy2 sites, 2 recruiting
  • Centro Interdipartimentale di Medicina del Sonno, Università degli studi di Cagliari

    Cagliari, 09042

    Puligheddu, 070 5109 6016, centrosonnoca@unica.it

    Recruiting
  • IRCCS Auxologico Piancavallo

    Oggebbio, Verbania, 28824

    Riccardo Cremascoli, r.cremascoli@auxologico.it

    Riccardo Cremascoli

    Recruiting

Other trials in Italy

About this study

Official title: Redictive Risk Factors of Conversion Into Idiopathic RBD. Italian Study [FAttori di Rischio PREdittivi di Conversione Nell'RBD Idiopatico. STudio ItalianO

REM Sleep Behavior Disorder (RBD) is a REM sleep parasomnia first described in 1986 and characterized by the loss of physiological muscle atonia typical of REM sleep and by the presence of abnormal, sometimes violent, motor activity often related to dream content The observed motor behaviors are often associated to vivid dreams, characterized by an aggressive-defensive content, even if pleasant dreams have been described, resulting in non-violent behaviors. Diagnosis of RBD requires video-polysomnographic recording (vPSG) at a Sleep Center, essential to identify and quantify the complete or intermittent loss of physiological muscle atonia during REM sleep (REM sleep without atonia, RSWA) and record any related motor behaviors. The exact prevalence of RBD in the general population is not known and it seems underrated, but is estimated to be 0.3-1.15%. RBD is defined as idiopathic or isolated (iRBD) when it is not associated with other neurological diseases. The so-called symptomatic RBD, on the other hand, can occur in association with neurodegenerative diseases of the spectrum of alpha-synucleinopathies which include Parkinson's Disease (PD), Multiple System Atrophy (AMS), and Lewy Body Dementia (DLB). In recent years, several follow-up studies on large cohorts of iRBD patients have shown that the idiopathic form evolves towards a symptomatic form in most cases. More precisely, the risk of developing an alpha-synucleinopathies increases over time, with a conversion rate of up to 90% in some studies at 14 years. RBD represents an early marker of neurodegeneration, like a unique open window on the initial, pre-symptomatic phase of alpha-synucleinopathies, which could allow the use of neuroprotective therapies, as soon as they are available. Several longitudinal studies indicated older age, presence of hyposmia, abnormal color vision, minimal extrapyramidal motor signs, mild cognitive impairment, autonomic disturbances, and severity of loss of RSWA as risk factors for neurodegeneration. However, most studies investigated biomarkers separately, with retrospective study designs, in small cohorts or without a rigorous harmonization between centers in the case of multicenter studies.

To date, however, there is no reliable pool of biomarkers that predict the phenoconversion into α-synucleinopathy, the timing in which this can occur, and the phenotype of α-synucleinopathy. Furthermore, despite clinical and research evidence suggesting that iRBD is a heterogeneous disorder little attention was paid to different iRBD phenotypes and currently, there are no relevant data on the impact of iRBD on quality of life.

Read more

Actually, through neural network analysis approaches, it is possible to find out complex correlations between data from different sources (i.e., clinical examinations, questionnaires, biological data, imaging and neurophysiological techniques, etc.) and to identify subgroups of patients sharing the same substantial characteristics. Identifying different iRBD phenotypes through established as well as innovative biomarkers and standardized measures of wellbeing is crucial to better understanding alpha-synucleinopathies, developing targeted interventions, and reducing the disease burden.

To this aim, clinical, biological, neurophysiological, neuropsychological and imaging biomarkers need to be prospectively collected, according to standardized and harmonized procedures. This would significantly increase our understanding of the physiopathological processes of alpha-synucleinopathy from the prodromal phase. Indeed, identifying phenotype clusters with both consolidated and innovative biomarkers may lay the groundwork for a reliable characterization of iRBD patients, likely providing the basis for an efficient stratification of patients longitudinally followed.

Several disease-modifying therapies are now in development, including but not limited to monoclonal antibodies against alpha-synucleinopathy. Prodromal synucleinopathy patients, such as those with iRBD, are the ideal target to test disease-modifying therapies because the neurodegeneration is still in an early stage and the likelihood to rescue both brain structures and function is higher. The last aim of the FarPResto study is to have a trial-ready cohort of iRBD patients, collected with standardized and harmonized procedures, to be enrolled in upcoming disease-modifying trials.

The FARPRESTO project is endorsed by the Italian Association of Sleep Medicine (AIMS) and by The RBD_Patients society (www.sonnomed.it)

Keywords
atonia, neurodegeneration
Medical subject headings
REM Sleep Behavior Disorder, Nerve Degeneration

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Identification of predictive risk factors of phenoconversion in patients with iRBD

    In order to increase our understanding on the physiopathological processes of alpha-synucleinopathy from the prodromal phase clinical, biological, neurophysiological, neuropsychological and imaging biomarkers need to be prospectively collected, according to standardized and harmonized procedures. Moreover, identifying phenotype clusters with both consolidated and innovative biomakers may lay the groundwork for a reliable characterization of iRBD patients, likely providing the basis for an efficient stratification of patients to be longitudinally followed.

    Measured: May 25, 2020 - January 31, 2035

Secondary outcomes (6)
  1. Description of the socio-demographic and clinical characteristics of patients diagnosed with iRBD

    Data on socio-demographic and clinical characteristics of patients diagnosed with iRBD will be collected and analyzed.

    Measured: May 25, 2020 - January 31, 2035

  2. Collection of longitudinal data about the development of alpha-synucleinopathies and estimation of the conversion rate at 3, 5, 7, and 10 years

    Information about the conversion rate at 3, 5, 7, and 10 years to neurodegenerative pathologies of the spectrum of alpha-synucleinopathies (Parkinson's Disease, Multiple System Atrophy and Lewy Body Dementia) will be collected and evaluated.

    Measured: May 25, 2020 - January 31, 2035

  3. Evaluation of the impact of iRBD on the quality of life and sleep

    The impact of iRBD on the quality of life and sleep will be assessed through the administration of validated questionnaires.

    Measured: May 25, 2020 - January 31, 2035

  4. Assessment of the correlation between phenoconversion, cognitive performance and loss of normal muscle atony during REM sleep

    The results of cognitive performance tests, video-polysomnographic recording and their connection with phenoconversion will be investigated

    Measured: May 25, 2020 - January 31, 2035

  5. Identification of RBD phenotypes through different biomarkers

    RBD phenotypes will be identified evaluating clinical, biological,neurophysiological, neuropsychological and imaging biomarkers.

    Measured: May 25, 2020 - January 31, 2035

  6. Validation of vPSG criteria for RBD diagnosis

    vPSG criteria for RBD diagnosis will be validated

    Measured: May 25, 2020 - January 31, 2035

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Mar 2022
  2. Study start25 May 2020
  3. Primary completion31 Mar 2025 (estimated)
  4. Study completion31 Jan 2035 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05262543
Sponsor's protocol ID
FarPresto01
Acronym
FARPRESTO
Status last verified
Mar 2024
First submitted
21 Feb 2022
Last updated
26 Mar 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Fantini ML, Corona A, Clerici S, Ferini-Strambi L. Aggressive dream content without daytime aggressiveness in REM sleep behavior disorder. Neurology. 2005 Oct 11;65(7):1010-5. doi: 10.1212/01.wnl.0000179346.39655.e0.

    PubMed 16217051
  • Oudiette D, De Cock VC, Lavault S, Leu S, Vidailhet M, Arnulf I. Nonviolent elaborate behaviors may also occur in REM sleep behavior disorder. Neurology. 2009 Feb 10;72(6):551-7. doi: 10.1212/01.wnl.0000341936.78678.3a.

    PubMed 19204265
  • Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002 Mar 15;25(2):120-38. doi: 10.1093/sleep/25.2.120. No abstract available.

    PubMed 11902423
  • Frauscher B, Iranzo A, Gaig C, Gschliesser V, Guaita M, Raffelseder V, Ehrmann L, Sola N, Salamero M, Tolosa E, Poewe W, Santamaria J, Hogl B; SINBAR (Sleep Innsbruck Barcelona) Group. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012 Jun 1;35(6):835-47. doi: 10.5665/sleep.1886.

    PubMed 22654203
  • Anang JB, Gagnon JF, Bertrand JA, Romenets SR, Latreille V, Panisset M, Montplaisir J, Postuma RB. Predictors of dementia in Parkinson disease: a prospective cohort study. Neurology. 2014 Sep 30;83(14):1253-60. doi: 10.1212/WNL.0000000000000842. Epub 2014 Aug 29.

    PubMed 25171928
  • Anang JB, Nomura T, Romenets SR, Nakashima K, Gagnon JF, Postuma RB. Dementia Predictors in Parkinson Disease: A Validation Study. J Parkinsons Dis. 2017;7(1):159-162. doi: 10.3233/JPD-160925.

    PubMed 27911340
  • Sinforiani E, Pacchetti C, Zangaglia R, Pasotti C, Manni R, Nappi G. REM behavior disorder, hallucinations and cognitive impairment in Parkinson's disease: a two-year follow up. Mov Disord. 2008 Jul 30;23(10):1441-5. doi: 10.1002/mds.22126.

    PubMed 18512749
  • Postuma RB, Gagnon JF, Vendette M, Charland K, Montplaisir J. Manifestations of Parkinson disease differ in association with REM sleep behavior disorder. Mov Disord. 2008 Sep 15;23(12):1665-72. doi: 10.1002/mds.22099.

    PubMed 18709686
  • Postuma RB, Gagnon JF, Bertrand JA, Genier Marchand D, Montplaisir JY. Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials. Neurology. 2015 Mar 17;84(11):1104-13. doi: 10.1212/WNL.0000000000001364. Epub 2015 Feb 13.

    PubMed 25681454
  • Fereshtehnejad SM, Romenets SR, Anang JB, Latreille V, Gagnon JF, Postuma RB. New Clinical Subtypes of Parkinson Disease and Their Longitudinal Progression: A Prospective Cohort Comparison With Other Phenotypes. JAMA Neurol. 2015 Aug;72(8):863-73. doi: 10.1001/jamaneurol.2015.0703.

    PubMed 26076039
  • Postuma RB, Adler CH, Dugger BN, Hentz JG, Shill HA, Driver-Dunckley E, Sabbagh MN, Jacobson SA, Belden CM, Sue LI, Serrano G, Beach TG. REM sleep behavior disorder and neuropathology in Parkinson's disease. Mov Disord. 2015 Sep;30(10):1413-7. doi: 10.1002/mds.26347. Epub 2015 Aug 12.

    PubMed 26265105
  • Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med. 2013 Aug;14(8):744-8. doi: 10.1016/j.sleep.2012.10.009. Epub 2013 Jan 22.

    PubMed 23347909
  • Iranzo A, Fernandez-Arcos A, Tolosa E, Serradell M, Molinuevo JL, Valldeoriola F, Gelpi E, Vilaseca I, Sanchez-Valle R, Llado A, Gaig C, Santamaria J. Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients. PLoS One. 2014 Feb 26;9(2):e89741. doi: 10.1371/journal.pone.0089741. eCollection 2014.

    PubMed 24587002
  • Postuma RB. Prodromal Parkinson's disease--using REM sleep behavior disorder as a window. Parkinsonism Relat Disord. 2014 Jan;20 Suppl 1:S1-4. doi: 10.1016/S1353-8020(13)00400-8.

    PubMed 24262156
  • Postuma RB, Iranzo A, Hogl B, Arnulf I, Ferini-Strambi L, Manni R, Miyamoto T, Oertel W, Dauvilliers Y, Ju YE, Puligheddu M, Sonka K, Pelletier A, Santamaria J, Frauscher B, Leu-Semenescu S, Zucconi M, Terzaghi M, Miyamoto M, Unger MM, Carlander B, Fantini ML, Montplaisir JY. Risk factors for neurodegeneration in idiopathic rapid eye movement sleep behavior disorder: a multicenter study. Ann Neurol. 2015 May;77(5):830-9. doi: 10.1002/ana.24385. Epub 2015 Mar 13.

    PubMed 25767079

Questions about this trial

What is this clinical trial studying?

An observational study of REM Sleep Behavior Disorder, run by University of Cagliari at 2 sites in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 26 Mar 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Monica Puligheddu, MD, PhD (070 5109 6016, centrosonnoca@unica.it), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Identification of predictive risk factors of phenoconversion in patients with iRBD (time frame: May 25, 2020 - January 31, 2035). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05262543, which also lists 20 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Mar 2024.

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