The treatment efficacy of pharmacotherapies for rapid eye movement sleep behavior disorder with polysomnography evaluation: A systematic review and meta-analysis

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

“…consequent reduction of dream activity, could be the reason for the clinical improvement observed in these patients in our study as well as others in the literature 27 and documented by the CGI-I; while the dramatic increase in SWS could explain why patients treated with MLT reported an improvement in sleep quality not only compared to controls but also compared to iRBD treated with other CLO or CLO + MLT.…”

“…RSWA seemed to improve significantly with the use of ramelteon (MLT agonist); dopamine agonists demonstrated, as expected, improvements of PLMS, but not of other PSG parameters. 27 Therefore, there is no doubt about the importance of carrying out further investigations on this topic, 29 aimed however at understanding how these drugs can act on the pathophysiology of iRBD.…”

“…anism not yet well understood. Although there is a need to better know the rationale for the use of these drugs, the studies conducted in the literature on their effect on the PSG parameters of iRBD are very few, sometimes on small series 27 one with rotigotine (among these, the study with the largest series enrolled 39 patients). 27 CLO increased the percentage of N2 sleep, while MLT was associated with significant improvements in sleep efficiency and reduction in both phasic and tonic muscle activity;…”

“…On the other hand, a meta‐analysis evaluated the effects of the different treatments administered to RBD patients on PSG parameters, including a total of only 13 studies, of which two with CLO, four with MLT, three with Ramelteon, three with pramipexole and one with rotigotine (among these, the study with the largest series enrolled 39 patients) 27 . CLO increased the percentage of N2 sleep, while MLT was associated with significant improvements in sleep efficiency and reduction in both phasic and tonic muscle activity; RSWA seemed to improve significantly with the use of ramelteon (MLT agonist); dopamine agonists demonstrated, as expected, improvements of PLMS, but not of other PSG parameters 27 …”

“…on the effect of CLO on PSG parameters in patients with iRBD, 27,44 which have shown a significant decrease in the instability of the N1 and N2 sleep stages, especially in long-term treatment, 45 but have not shown drug-induced variations on RSWA, 19,22,46 also suggesting that the therapeutic effect of CLO is likely to act on supratentorial rather than subtentorial networks, reducing the negative effects of brainstem dysfunction on supratentorial regions, without affecting the pathogenetic core of the disease. 46 Current evidence indicates that CLO might decrease phasic muscle activations without restoring muscle atonia, suggesting its action on glutamatergic neurons of the motor cortex or their relays in pontine and medullary reticular formation and spinal cord, 33 which always seem to be implicated in the pathogenesis of a network disorder 11,33 and in agreement with previous assumptions on the effect of CLO on supratentorial networks.…”