REM Sleep without Muscle Atonia (Stage 1‐REM) and Its Relation to Delirious Behavior during Sleep in Patients with Degenerative Diseases Involving the Brain Stem

Abstract

Nocturnal sleep was examined in 12 patients with degenerative diseases involving the brain stem and in 2 patients with late cerebellar cortical atrophy (LCCA). A peculiar sleep state, characterized by the concomitant appearance of a low‐voltage mixed frequency EEG, rapid eye movements (REMs) and tonic EMG in mental muscles, repeatedly appeared during nocturnal sleep in all of the 12 patients with degenerative diseases involving the brain stem and it was called stage 1‐REM after Tachibana et al.32 In 8 of the 12 patients, delirious or oneiric behavior appeared during, or soon after, the episodes of stage 1‐REM. Inner experiences reported by one of the subjects well corresponded to his behavior during the episode of stage 1‐REM. Stage 1‐REM was not observed during nocturnal sleep of the patients with LCCA. These results indicate that a degenerative lesion in the brain stem induced stage 1‐REM and delirious behavior during nocturnal sleep through abolishing muscle atonia of REM sleep and causing dissociation of the functional components characterizing REM sleep.

No Difference in Sleep and RBD between Different Types of Patients with Multiple System Atrophy: A Pilot Video-Polysomnographical Study

“…RBD and REM sleep without atonia (RWA) in MSA and PD patients may be related to lesions of brainstem nuclei and pontomedullary pathways, as suggested in previous studies [3, 12]. …”

Sleep changes and disorders in the elderly patient

“…Patients with Parkinson's disease not only have a predilection of RBD, but also have difficulties with other motor abnormalities, including the Parkinson's tremor and periodic limb movement of sleep. Patients with stroke, and specifically lacunar strokes in the tegmentum of the pons and periventricular white matter damage, may present with REM sleep without atonia, which is the substrate for RBD [58]. In addition, patients with Binswanger's disease with subcortical leukoencephalopathy are also at increased risk of developing RBD primarily secondary to white matter ischemia in the vicinity of the supratentorial system involved in modulating the REM induced atonia.…”

Sleep and Periodic Leg Movement Patterns in Drug-Free Patients with Parkinson's Disease and Multiple System Atrophy

“…18 RBD and REM sleep without atonia in humans and animals may be related to lesions of brainstem nuclei and pontomedullary pathways in both disorders, as suggested previously by other researchers. 60,61 However, the mechanisms underlying the co-occurrence of RBD and PLM in PD and MSA respectively, may be elucidated only by postmortem brain analyses.…”