REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature

Abstract

REM sleep behaviour disorder (RBD) is an injurious clinical disorder of attempted dream-enactment ('oneirism') in humans which has a corresponding experimental animal model involving dorsolateral pontine tegmental lesions in cats. To date, our sleep disorders centre has collected data on 96 chronic RBD cases which can be compared with pooled data on 70 chronic RBD cases from other centres contained in 26 reports published in the world literature since 1985, when our initial cases were first reported. The data from our centre and from other centres demonstrate a male predominance in RBD (87.5% vs 63.5%); indicate a similar mean age of RBD onset (52.4 y vs 55.9 y); contain substantial numbers of diverse central nervous system disorders causally associated with RBD (47.9% vs 60.0%); and identify clonazepam treatment as being very effective in controlling both the (violent) dream and sleep behavioural disturbances of RBD. Our centre's data additionally reveal an 80% prevalence of elevated stage 3/4 (slow-wave) sleep% for age in RBD, and reveal a frequent presence of periodic and aperiodic limb movements during NREM sleep. Thus, RBD in humans is a complex syndrome in which there is generalized REM and NREM sleep motor dyscontrol, as was originally observed in the animal RBD model by Jouvet and Delorme in 1965.

Impaired GABA and Glycine Transmission Triggers Cardinal Features of Rapid Eye Movement Sleep Behavior Disorder in Mice

“…Patients not only arouse more from sleep, they can also experience more stage 1 NREM sleep (Schenck et al, 1987;Sforza et al, 1988). REM motor behaviors and NREM limb jerks may elicit sleep disruption; however, most arousals from sleep are not associated with preceding motor activity (Schenck et al, 1993). Current results show that most arousals from sleep (i.e., 90%) are not caused by NREM motor activity in transgenic mice, suggesting that other factors elicit sleep disruption in RBD.…”

“…Clonazepam is a benzodiazepine that is used to treat human RBD. It rapidly alleviates RBD motor symptoms in 90% of patients (Lapierre and Montplaisir, 1992;Schenck et al, 1993;Olson et al, 2000). To investigate the effects of clonazepam on the motor phenotype of transgenic mice, a subset of wild-type and transgenic mice received intraperitoneal injections of 0.3 mg/kg clonazepam (Roche) dissolved in 0.9% saline.…”

Perchance to dream? Primordial motor activity patterns in vertebrates from fish to mammals: their prenatal origin, postnatal persistence during sleep, and pathological reemergence during REM sleep behavior disorder

“…She was healthy, but had a notable childhood-onset sleep history that included sleeptalking, episodic screaming, and nightmares. During adolescence, a sibling observed recurrent episodes of bilateral arm waving during sleep associated with sleeptalking and shouting, which always occurred several hours after sleep onset and never within the fi rst hour of sleep, which is highly suggestive of a REM and lasting up to 48 years in some cases [85] . This prodrome in the same patient [86] .…”

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation

“…The sleep disturbance can precede the motor or cognitive symptoms of the disease by over ten years; therefore all patients suffering from RBD should be kept under regular review by a neurologist, who should be vigilant for any decline in cognition or motor function 13 . Approximately 90% of those who suffer from RBD are male 14 , leading to various hypotheses that sexual hormones may play a role, either in the failure of muscle atonia during sleep, or in a propensity to violent dreams 15 . However, one controlled study did not find any difference in the serum level of sex hormones between men with RBD and controls…”