Rapid eye movement sleep behavior disorder: a narrative review from a technological perspective

Abstract

Study objectives Isolated REM sleep behaviour disorder (iRBD) is a parasomnia characterized by dream enactment. It represents a prodromal state of alpha-synucleinopathies, like Parkinson’s disease. In recent years, biomarkers of increased risk of phenoconversion from iRBD to overt alpha-synucleinopathies have been identified. Currently, diagnosis and monitoring rely on subjective reports and polysomnography performed in the sleep lab, which is limited in availability and cost intensive. Wearable technologies and computerized algorithms may provide comfortable and cost-efficient means to not only improve the identification of iRBD patients but also to monitor risk factors of phenoconversion. In this work, we review studies using these technologies to identify iRBD or monitor phenoconversion biomarkers. Methods A review of articles published until 31st May 2022 using the Medline database was performed. We included only papers in which subjects with RBD were part of the study population. The selected papers were divided into four sessions: actigraphy, gait analysis systems, computerized algorithms, and novel technologies. Results 25 articles were included in the review. Actigraphy, wearable accelerometers, pressure mats, smartphones, tablets, and algorithms based on polysomnography signals were used to identify RBD and monitor the phenoconversion. Rest-activity patterns, core body temperature, gait, and sleep parameters were able to identify the different stages of the disease. Conclusions These tools may complement current diagnostic systems in the future, providing objective ambulatory data obtained comfortably and inexpensively. Consequently, screening for iRBD and follow-up will be more accessible for the concerned patient cohort.

A Paradigm Shift in the Management of Patients with Parkinson’s Disease

“…The incorporation of continuous blood pressure measurements into these systems could provide valuable insights into autonomic dysfunction, aiding in the effective management of orthostatic hypotension [74,75]. Advancements in sleep and cognitive disorder technologies are also rapidly progressing [76][77][78], making their integration into future smart systems for comprehensive detection of PD symptoms a feasible possibility.…”

Rapid eye movement sleep behavior disorder and its relation to Parkinson's disease: The potential of graph measures as brain biomarkers to identify the underlying physiopathology of the disorder

“…A biomarker is a measurable characteristic indicating normal or pathogenic biological processes or pharmacological responses to therapeutic drugs (Miglis et al, 2021). Biomarkers used for diagnosis of and fMRI), and genetic biomarker (GBA variants, SNCA, TMEM175) (Bramich et al, 2022;Gnarra et al, 2023;Zhang et al, 2023).…”

“…Promising findings have been observed regarding the use of novel technologies for investigating motor functions in patients with iRBD such as leg movement during REM, postural and rest tremor, voice and speech features, and pupillary responses (Barber et al, 2023;Gnarra et al, 2023). However, their use as a potential biomarker of PD risk needs to be further tested (Gnarra et al, 2023).…”

“…Parkinson's disease (PD), Lewy bodies (DLB), and multiple system atrophy during a 12-year follow-up (Gnarra et al, 2023). Thus, it is logical to expect malfunctions in structures other than the nuclei of the brainstem, including the striatum, substantia nigra, the limbic system, and the cerebral cortex during the development of this disorder (Campabadal et al, 2021).…”

“…Furthermore, screening a large number of people is not feasible (de Natale et al, 2022;Gnarra et al, 2023). Less complex instruments like the RBD screening questionnaire (RBDSQ) have been developed.…”