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Jung-Ick Byun,1 Tae-Won Yang,2– 4 Jun-Sang Sunwoo,5 Won Chul Shin,1,6 Oh-Young Kwon,2,4,7,* Ki-Young Jung8,* 1Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea; 2Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; 3Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea; 4Institute of Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; 5Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea; 6Department of Medicine, AgeTech-service Convergence Major, Kyung Hee University, Seoul, Republic of Korea; 7Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea; 8Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Oh-Young Kwon, Department of Neurology, Gyeongsang National University College of Medicine, 15, Jinjudae-ro 816beon-gil, Jinju, 52727, Republic of Korea, Tel +82-55-750-8288, Email oykwon@gnu.ac.kr Ki-Young Jung, Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea, Tel +82-2-920-6649, Email jungky@snu.ac.krPurpose: Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by REM sleep without atonia (RWA) and is regarded as the prodromal stage of α-synucleinopathies, such as Parkinson’s disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). RWA is also associated with neurodegeneration driven by α-synucleinopathy. However, the level of RWA across the α-synucleinopathy spectrum remains elusive. We aimed to rate the percentage of RWA across the α-synucleinopathy spectrum, encompassing prodromal and overt phenotypes.Methods: A systematic search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases. We included cohort, cross-sectional, and case–control studies comparing the RWA percentage during REM sleep evaluated by tonic chin activity (RWA%-T) or by phasic chin activity (RWA%-P) across the α-synucleinopathy spectrum. Bayesian network meta-analysis was used to combine both direct and indirect evidence regarding the group differences in the RWA%-T and RWA%-P. The surface under the cumulative ranking curve was used to estimate the ranked probability.Results: Fifteen articles met the inclusion criteria. The investigations included 204 iRBD, 295 PD with RBD (PDwtRBD), 187 PD without RBD (PDwoRBD), 42 MSAwtRBD, 9 DLBwtRBD patients, and 246 controls. MSAwtRBD ranked first in RWA%-T, whereas iRBD ranked first in RWA%-P. RWA% in PDwoRBD patients was comparable to that in the controls and was lower than that in PDwtRBD patients.Conclusion: Overt phenotypes such as MSAwtRBD and PDwtRBD ranked high in RWA%-T, whereas iRBD, a prodromal type, ranked highest in RWA%-P. Taken together, our data suggest that the percentage of neurodegeneration in RBD patients may be associated with RWA%-T rather than RWA%-P.Prospero Registration Number: CRD42021276445.Keywords: REM sleep behavior disorder, α-synucleinopathy, REM sleep without atonia, network meta-analysis

Yujin Choi,1,* Byunwoo Son,2,* Woo-Chul Shin,3,4 Seong-uk Nam,5 Jaehong Lee,6 Jinwoong Lim,3,7 Sungha Kim,1 Changsop Yang,1 Hyeonhoon Lee8– 10 1KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; 2Combined Dispensary, 7th Corps, Republic of Korea Army, Icheon, Republic of Korea; 3Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea; 4Medical Company, 1st Airborne Special Forces Brigade, Republic of Korea Army, Seoul, Republic of Korea; 5 28th Division, Republic of Korea Army, Yangju-si, Republic of Korea; 6Medical Corps, The Capital Defense Command, Seoul, Republic of Korea; 7Department of Acupuncture and Moxibustion, Wonkwang University Gwangju Korean Medicine Hospital, Gwangju, Republic of Korea; 8Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 9Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; 10 9th Division, Republic of Korea Army, Goyang, Republic of Korea*These authors contributed equally to this workCorrespondence: Changsop Yang, KM Science Research Division, Korea Institute of Oriental Medicine, 1672, Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea, Tel +82-42-869-2705, Fax +82-42-868-9395, Email yangunja@kiom.re.kr Hyeonhoon Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, Tel +82-2-2072-0505, Fax +82-2-747-5639, Email hhoon@snu.ac.krPurpose: Sleep quality among military service members is important for enhancing their capabilities and preventing psychiatric problems. We aimed to explore the association of dietary behaviors with poor sleep quality and increased risk of obstructive sleep apnea (OSA) in military men on active duty.Patients and Methods: A large-scale multi-site cross-sectional survey was conducted in five units of the Republic of Korea’s army. Poor sleep quality and increased risk of OSA were defined using the Pittsburgh sleep quality index (PSQI) and Berlin Questionnaire, respectively. Information on dietary behaviors, including the frequency of skipping breakfast, eating snacks, consuming a night meal, and overeating, were collected.Results: From August 2021 to September 2021, 4389 male respondents, mean age (20.8 ± 1.3 years), completed the survey; 2579 (58.8%) were assessed as having poor sleep quality, and 614 (14.0%) increased risk of OSA. After adjusting for lifestyle and occupational covariates, skipping breakfast 1– 2 times weekly was associated with an increased likelihood of experiencing poor sleep quality, compared with not skipping breakfast (odds ratio: 1.23 [95% CI 1.02– 1.47]). Eating night meals 5– 6 times weekly was also associated with poor sleep quality (odds ratio: 5.54 [95% CI 2.49– 14.18]). In addition, skipping breakfast daily (odds ratio: 2.28 [95% CI 1.27– 4.03]) and eating night meals daily (odds ratio: 2.30 [95% CI 1.21– 4.22]) were related to an increased risk of OSA.Conclusion: Dietary behaviors appear to be related to poor sleep quality and a high risk of OSA. To improve sleep quality, dietary factors could be considered when promoting health programs for military personnel in further research.Keywords: sleep, dietary behavior, insomnia, obstructive sleep apnea, military