Sex differences in clinical and prognostic trajectories in patients with idiopathic REM sleep behavior disorder: Insights from the FARPRESTO cohort

IntroductionThere are conflicting findings regarding the influence of sex on idiopathic REM sleep behavior disorder (iRBD) in terms of prevalence and associated clinical characteristics. This study, conducted as part of the Italian multicenter longitudinal FARPRESTO project, aims to explore sex-related differences in the age of onset, iRBD diagnosis, and phenoconversion, as well as in cognitive and non-motor features and the occurrence of RBD-related injuries among male and female patients with iRBD.MethodsThe FARPRESTO study included 536 iRBD patients recruited from 13 Italian centers. This analysis assessed the age at iRBD diagnosis, diagnostic delay, motor and non-motor symptoms, global cognitive performance, conversion rates to neurodegenerative disorders, and the prevalence of RBD-related injuries at the time of iRBD diagnosis, stratified by sex.ResultsFemale patients were older at iRBD diagnosis compared to males (males: 67.8 years, IQR 62.5-72.6; females: 69.8 years, IQR 65.1-74.8; p = 0.003). Compared to male patients, female patients exhibited a higher prevalence of orthostatic hypotension (27.9% vs. 16.2%; p = 0.019), depression (43.9% vs. 26.6%; p = 0.010), and hallucinations (43.9% vs. 26.6%; p = 0.010) at iRBD diagnosis. Additionally, self-directed injuries were significantly more frequent in females compared to males at the first visit (71% vs. 53.2%; p = 0.034). No significant differences were observed in the phenoconversion rate between sexes.ConclusionAlthough research on sex-related differences in iRBD remains limited, this study highlights the importance of understanding sex-specific characteristics. As diagnostic and therapeutic approaches evolve, incorporating these differences will be essential for tailoring clinical strategies and improving patient outcomes.

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Journal
Journal of Parkinson s Disease
Published
2025-11-04
DOI
https://doi.org/10.1177/1877718x251385422
Primary Topic
Parkinson's Disease Mechanisms and Treatments
Type
article
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article

Sex differences in clinical and prognostic trajectories in patients with idiopathic REM sleep behavior disorder: Insights from the FARPRESTO cohort

Francesca Casoni, Monica Puligheddu, Alessandra Castelnuovo, Marcello Mario Mascia et al.
Journal of Parkinson s Disease
Parkinson's Disease Mechanisms and Treatments
article

Sex differences in clinical and prognostic trajectories in patients with idiopathic REM sleep behavior disorder: Insights from the FARPRESTO cohort

Francesca Casoni, Monica Puligheddu, Alessandra Castelnuovo, Marcello Mario Mascia, Giuseppe Lanza, Flavia Cirillo, Raffaele Ferri, Felice Di Laudo, Valter Rustioni, Biancamaria Guarnieri, Luisa Sambati, Federico Meloni, Valerio Brunetti, Pietro Mattioli, Domeniko Hoxhaj, Sara Marelli, Francesca Ingravallo, Enrica Bonanni, Michela Figorilli, Michele Terzaghi, Elena Capriglia, Michelangelo Maestri, Gaia Pellitteri, Giacomo Della Marca, Elena Antelmi, Federica Provini, Luigi Ferini‐Strambi, Dario Arnaldi, Mariana Fernandes, Elisa Casaglia, Beatrice Orso, Gianluca Rossato, Luca Baldelli, Francesco Biscarini, Claudio Liguori, Martina Mulas, Mattia Losa, Gaetano Malomo, Giuseppe Plazzi
article en

Abstract

IntroductionThere are conflicting findings regarding the influence of sex on idiopathic REM sleep behavior disorder (iRBD) in terms of prevalence and associated clinical characteristics. This study, conducted as part of the Italian multicenter longitudinal FARPRESTO project, aims to explore sex-related differences in the age of onset, iRBD diagnosis, and phenoconversion, as well as in cognitive and non-motor features and the occurrence of RBD-related injuries among male and female patients with iRBD.MethodsThe FARPRESTO study included 536 iRBD patients recruited from 13 Italian centers. This analysis assessed the age at iRBD diagnosis, diagnostic delay, motor and non-motor symptoms, global cognitive performance, conversion rates to neurodegenerative disorders, and the prevalence of RBD-related injuries at the time of iRBD diagnosis, stratified by sex.ResultsFemale patients were older at iRBD diagnosis compared to males (males: 67.8 years, IQR 62.5-72.6; females: 69.8 years, IQR 65.1-74.8; p = 0.003). Compared to male patients, female patients exhibited a higher prevalence of orthostatic hypotension (27.9% vs. 16.2%; p = 0.019), depression (43.9% vs. 26.6%; p = 0.010), and hallucinations (43.9% vs. 26.6%; p = 0.010) at iRBD diagnosis. Additionally, self-directed injuries were significantly more frequent in females compared to males at the first visit (71% vs. 53.2%; p = 0.034). No significant differences were observed in the phenoconversion rate between sexes.ConclusionAlthough research on sex-related differences in iRBD remains limited, this study highlights the importance of understanding sex-specific characteristics. As diagnostic and therapeutic approaches evolve, incorporating these differences will be essential for tailoring clinical strategies and improving patient outcomes.

Journal of Parkinson s DiseaseVol. 16(1)
Università Cattolica del Sacro Cuore (IT), University of Pisa (IT), University of Rome Tor Vergata (IT), University of Verona (IT), University of Modena and Reggio Emilia (IT), University of Udine (IT), Vita-Salute San Raffaele University (IT), University of Cagliari (IT), University of Pavia (IT), Fondazione Roma (IT), Agostino Gemelli University Polyclinic (IT), University of Catania (IT), Oasi Maria SS (IT), Ospedale Sacro Cuore Don Calabria (IT), Istituto delle Scienze Neurologiche di Bologna (IT), Azienda Ospedaliero-Universitaria Cagliari (IT), The San Raffaele Telethon Institute for Gene Therapy (IT), Ospedale Policlinico San Martino (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Genoa (IT), University of Bologna (IT)
Openalex Percentile: Top 54%
Parkinson's Disease Mechanisms and Treatments
DOIOpen Access PDFOpenAlex
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