Association between REM sleep behavior disorder and impulsive–compulsive behaviors in Parkinson’s disease: a systematic review and meta-analysis of observational studies

  • Hai-tao Lu
  • Qiu-yan Shen
  • Quan-zhen Zhao
  • Hong-yan Huang
  • Ping-ping Ning
  • Hui Wang
  • Dan Xie
  • Yan-ming XuEmail author
Original Communication



Both REM sleep behavior disorder (RBD) and impulsive–compulsive behaviors (ICBs) are well-recognized non-motor features in patients with Parkinson’s disease (PD). Studies have given contradictory results about the potential association between RBD and ICBs.


PubMed, Embase (via Ovid), and the Cochrane Central Registry of Controlled Trials (CENTRAL) databases were systematically searched till August 20, 2019 to identify studies that explored the possible correlation between RBD and ICBs in patients with PD. Two authors independently screened records, extracted data and evaluated quality of included studies. Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by employing a random or fixed-effects model. We performed subgroup and sensitivity analyses, and we assessed potential publication bias.


A total of 134 references were screened and 10 studies involving 2781 PD patients were included. Overall, RBD was associated with a more than twofold higher risk of developing ICBs (OR 2.12, 95% CI 1.43–3.14, I2 = 56.7%, P < 0.01). Similar results were obtained in sensitivity analyses and in meta-analyses of subgroups stratified based on multivariable adjustment and methods for diagnosing RBD and ICBs. No significant risk of publication bias was found.


RBD in PD is confirmed to be a risk factor for ICBs. Clinicians should be aware of this association to help them improve patient management.


REM sleep behavior disorder Impulsive–compulsive behaviors Impulse control disorders Parkinson’s disease Meta-analysis 



This work was funded by the Basic Conditions Platform Construction Project of Sichuan Science and Technology Department (2019JDPT0015) and the Major Clinical Disease Research Program from the Health and Family Planning Commission of Sichuan Province (17ZD011).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

This article does not contain any previously unpublished studies that would require informed consent.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurology, West China HospitalSichuan UniversityChengduPeople’s Republic of China

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