REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

Abstract

Rapid eye movement sleep behavior disorder (RBD) is diagnosed by a clinical history of dream enactment accompanied by polysomnographic rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia). Rapid eye movement sleep behavior disorder is strongly associated with neurodegenerative disease, especially synucleinopathies such as Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. A history of RBD may begin several years to decades before onset of any clear daytime symptoms of motor, cognitive, or autonomic impairments, suggesting that RBD is the presenting manifestation of a neurodegenerative process. Evidence that RBD is a synlucleinopathy includes the frequent presence of subtle prodromal neurodegenerative abnormalities including hyposmia, constipation, and orthostatic hypotension, as well as abnormalities on various neuroimaging, neurophysiological, and autonomic tests. Up to 90.9% of patients with idiopathic RBD ultimately develop a defined neurodegenerative disease over longitudinal follow-up, although the prognosis for younger patients and antidepressant-associated RBD is less clear. Patients with RBD should be treated with either melatonin 3 to 12 mg or clonazepam 0.5 to 2.0 mg to reduce injury potential. Prospective outcome and treatment studies of RBD are necessary to enable accurate prognosis and better evidence for symptomatic therapy and future neuroprotective strategies.

Morphological MRI investigations of the hypothalamus in 232 individuals with Parkinson's disease

“…[22][23][24] Second, a number of hypothalamic-dependent functions, such as sleep and circadian rhythmicity, are severely affected by disease progression. 3,25,26 This hypothalamic involvement could be secondary to dopaminergic 7,27,28 or serotonergic 29 and related to involvement of the autonomic nervous system. 30 In the current study, despite these repeatedly observed features of hypothalamic involvement by others, we were unable to observe gross atrophy of the hypothalamus.…”

Compromised Dynamic Cerebral Autoregulation in Patients With Idiopathic Rapid Eye Movement Behavior Disorder: A Case-Control Study Using Transcranial Doppler

“…Idiopathic rapid eye movement (REM) sleep behavior disorder (IRBD) is a parasomnia characterized by loss of normal skeletal muscle atonia and dream-enacting behaviors during REM sleep, which affect 0.5% to 2% of the general populations and 5% to 13% of adults older than 60 years (1). RBD is not only frequent in patients with neurodegenerative diseases, but also considered to be a prodromal sign, especially of those with alphasynuclein deposition such as Parkinson's disease (PD) and Lewy body dementia (LBD).…”

STOP-Bang Questionnaire in Patients with Rapid Eye Movement Sleep Behavior Disorder

“…1 The estimated prevalence of RBD is in the range of 0.5% to 2%. 2 Loss of REM sleep atonia is diagnostic for RBD, although probable RBD may be diagnosed on clinical grounds. Obstructive sleep apnea (OSA) is also prevalent in adults and caused by repetitive complete or partial obstruction of the upper airway during sleep.…”