Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline

Howell, Michael J.; Avidan, Alon Y.; Foldvary‐Schaefer, Nancy; Malkani, Roneil G.; During, Emmanuel; Roland, Joshua; McCarter, Stuart J.; Zak, Rochelle S.; Carandang, Gerard; Kazmi, Uzma; Ramar, Kannan

doi:10.5664/jcsm.10424

Cited by 39 publications

(28 citation statements)

References 21 publications

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“…Safety considerations in RBD include lowering the bedframe to prevent falls, moving sharp-cornered furniture away from the bed, and removing weapons or other dangerous objects from the bedroom environment. 17…”

Section: Ethical Considerations In Prognostic Counseling In Clinical ...mentioning

confidence: 99%

Ethical Aspects of Prodromal Synucleinopathy Prognostic Counseling

et al. 2023

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Alpha-synucleinopathies can be identified in their prodromal phase, raising several ethical issues. In this review, we first provide definitions of prodromal α-synucleinopathies and discuss the importance of distinguishing between prodromes and risk factors. Next, we discuss the implications of a diagnosis of prodromal α-synucleinopathy and considerations regarding prognostic counseling in both clinical and research settings. We review available data on patient preferences regarding disclosure as well as providers' perspectives. We examine the pros and cons of disclosing a diagnosis of prodromal α-synucleinopathy, taking into consideration the differences between clinical and research settings. Asking about willingness to know in clinical and research settings and the shared decision-making process applied to prognostic counseling is discussed. Concerning research settings, ethical aspects regarding clinical trials are addressed. Availability of direct-to-consumer technologies will likely lead to novel contexts requiring prognostic counseling, and future neuroprotective or neuromodulating treatments may require further considerations on the timing, role, and importance of prognostic counseling. Recommendations on how to address ethical gaps should be a priority for patients, medical professional societies, and research workgroups. Ethical issues must be considered as an integral part of the overall clinical and research approach to prodromal synucleinopathies.

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Section: Ethical Considerations In Prognostic Counseling In Clinical ...mentioning

confidence: 99%

Ethical Aspects of Prodromal Synucleinopathy Prognostic Counseling

et al. 2023

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“…Management of RBD includes patient education, suppressing dream enactment events and implementing safety precautions to reduce the risk of injury, treating nightmares, and, in the case of isolated RBD, counseling on the risk of neurodegeneration. 54 Violent dreams associated with RBD can cause distress and concern for the patient and family. Education about the lack of correlation between dream enactment behaviors and the patient's personality and the typical characteristics of RBD can provide insight and reassurance for the patient and family.…”

Section: Managementmentioning

confidence: 99%

“…Safety precautions should always be reviewed to lower injury risk to the patient and their bed partner. 54 Each of these environmental adjustments may lower the risk of injury to the patient: pad or remove nearby furniture; remove nearby sharp objects, weapons, or other potentially injurious objects; add a bedrail; or lower the mattress. Bed partners often sleep in another bed by the time of clinical presentation; for those in the same bed, sleeping apart or the addition of a barrier may be recommended.…”

Section: Key Pointsmentioning

confidence: 99%

“…Several medications have been studied, with the most data available on clonazepam and melatonin. 54 The choice of medication will also depend on the subtype of RBD and the patient's comorbidities (eg, dementia, sleep apnea). Several limitations influence the selection of optimal medication therapy or the benefits of monotherapy versus combination therapy.…”

Section: Key Pointsmentioning

confidence: 99%

Section: Rapid Eye Movement Sleep Behavior Disordermentioning

confidence: 99%

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REM Sleep Behavior Disorder and Other REM Parasomnias

Malkani

2023

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.

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Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts’ Perspective

Ingravallo,

D'Alterio,

Rossetti

et al. 2024

Movement Disord Clin Pract

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BackgroundIsolated rapid‐eye‐movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated.ObjectivesThe aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure.MethodsIn this qualitative study, semi‐structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach.ResultsWe interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video‐polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient‐tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient‐physician relationship, while they had contrasting views regarding patients’ previous knowledge.ConclusionsSleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients’ and families’ preferences.

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Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline

Cited by 39 publications

References 21 publications

Ethical Aspects of Prodromal Synucleinopathy Prognostic Counseling

Ethical Aspects of Prodromal Synucleinopathy Prognostic Counseling

REM Sleep Behavior Disorder and Other REM Parasomnias

Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts’ Perspective

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