{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:44:20Z","timestamp":1768517060920,"version":"3.49.0"},"posted":{"date-parts":[[2024,9,24]]},"group-title":"Physiology","reference-count":70,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T00:00:00Z","timestamp":1727136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.biorxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,9,24]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>Individuals with comorbid REM sleep behavior disorder (RBD) and neurotrauma (defined by traumatic brain injury and post-traumatic stress disorder) have an earlier age of RBD symptom onset, increased RBD-related symptom severity and more neurological features indicative of prodromal synucleinopathy compared to RBD only. An early sign of neurodegenerative condition is autonomic dysfunction, which we sought to evaluate by examining heart rate variability during sleep. Participants with overnight polysomnography were recruited from the VA Portland Health Care System. Veterans without neurotrauma or RBD (controls; n=19), with RBD only (RBD, n=14), and with RBD and neurotrauma (RBD+NT, n=19) were evaluated. Eligible 5-minute NREM and REM epochs without apneas\/hypopneas, microarousals, and ectopic beats were analyzed for frequency and time domain (e.g. low frequency power, LF; high frequency power, HF; root mean square of successive RR intervals, RMSSD; % of RR intervals that vary \u226550 ms, pNN50) heart rate variability outcomes. Heart rate did not significantly differ between groups in any sleep stage. Time domain and frequency domain variables (e.g., LF power, HF power, RMSSD, and pNN50) were significantly reduced in the RBD and RBD+NT groups compared to controls and RBD only during NREM sleep. There were no group differences detected during REM sleep. These data suggest significant reductions in heart rate variability during NREM sleep in RBD+NT participants, suggesting greater autonomic dysfunction compared to controls or RBD alone. Heart rate variability during sleep may be an early, promising biomarker, yielding mechanistic insight for diagnosis and prognosis of early neurodegeneration in this vulnerable population.<\/jats:p>\n                <jats:sec>\n                  <jats:title>STATEMENT OF SIGNIFICANCE<\/jats:title>\n                  <jats:p>Comorbid REM sleep behavior disorder (RBD) and neurotrauma (NT, traumatic brain injury + post-traumatic stress disorder; RBD+NT) is associated with increased neurodegenerative symptom burden and worsened health. Sleep and autonomic function are integrally and bidirectionally related to neurodegenerative processes. In the current study, we sought to determine if early signs of autonomic dysfunction, measured via heart rate variability (HRV), were present during sleep in comorbid RBD+NT compared to RBD only and controls. Our data show reduced time and frequency domain HRV during NREM sleep in RBD+NT Veterans compared to RBD only and controls. These data contribute evidence that participants with RBD and comorbid NT demonstrate significantly worse autonomic dysfunction compared to age\/sex matched participants with RBD alone.<\/jats:p>\n                <\/jats:sec>","DOI":"10.1101\/2024.09.20.614142","type":"posted-content","created":{"date-parts":[[2024,9,24]],"date-time":"2024-09-24T15:30:13Z","timestamp":1727191813000},"source":"Crossref","is-referenced-by-count":0,"title":["Heart rate variability impairment during sleep in Veterans with REM sleep behavior disorder, traumatic brain injury, and posttraumatic stress disorder: An early potential window into autonomic dysfunction?"],"prefix":"10.64898","author":[{"given":"Hannah A.","family":"Cunningham","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Dovek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasha","family":"Recoder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohini D.","family":"Bryant-Ekstrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany R.","family":"Ligman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Piantino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda M.","family":"Lim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan E.","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"issue":"14","key":"2024092713051524000_2024.09.20.614142v1.1","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1002\/mds.26055","article-title":"Five-year follow-up of substantia nigra echogenicity in idiopathic REM sleep behavior disorder","volume":"29","year":"2014","journal-title":"Mov Disord"},{"issue":"8","key":"2024092713051524000_2024.09.20.614142v1.2","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.sleep.2013.02.016","article-title":"Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy--a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group","volume":"14","year":"2013","journal-title":"Sleep Med"},{"key":"2024092713051524000_2024.09.20.614142v1.3","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awz030"},{"key":"2024092713051524000_2024.09.20.614142v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2018.09.008"},{"issue":"1","key":"2024092713051524000_2024.09.20.614142v1.5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1177\/0004867420976853","article-title":"Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis","volume":"56","year":"2022","journal-title":"Aust N Z J Psychiatry"},{"issue":"7","key":"2024092713051524000_2024.09.20.614142v1.6","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.parkreldis.2015.04.024","article-title":"Impaired heart rate variability in patients with dementia with Lewy bodies: Efficacy of electrocardiogram as a supporting diagnostic marker","volume":"21","year":"2015","journal-title":"Parkinsonism Relat Disord"},{"key":"2024092713051524000_2024.09.20.614142v1.7","doi-asserted-by":"crossref","unstructured":"Heimrich, K.G. , et al., Heart Rate Variability Analyses in Parkinson\u2019s Disease: A Systematic Review and Meta-Analysis. 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