REM Sleep Behaviour Disorder

Overview

Journal Nat Rev Dis Primers

Specialty General Medicine

Date 2018 Sep 1

PMID 30166532

Citations 165

Authors

Yves Dauvilliers

Carlos H Schenck

Ronald B Postuma

Alex Iranzo

Pierre-Herve Luppi

Giuseppe Plazzi

Jacques Montplaisir

Bradley Boeve

Affiliations

Soon will be listed here.

Abstract

Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia that is characterized by loss of muscle atonia during REM sleep (known as REM sleep without atonia, or RSWA) and abnormal behaviours occurring during REM sleep, often as dream enactments that can cause injury. RBD is categorized as either idiopathic RBD or symptomatic (also known as secondary) RBD; the latter is associated with antidepressant use or with neurological diseases, especially α-synucleinopathies (such as Parkinson disease, dementia with Lewy bodies and multiple system atrophy) but also narcolepsy type 1. A clinical history of dream enactment or complex motor behaviours together with the presence of muscle activity during REM sleep confirmed by video polysomnography are mandatory for a definite RBD diagnosis. Management involves clonazepam and/or melatonin and counselling and aims to suppress unpleasant dreams and behaviours and improve bedpartner quality of life. RSWA and RBD are now recognized as manifestations of an α-synucleinopathy; most older adults with idiopathic RBD will eventually develop an overt neurodegenerative syndrome. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α-synucleinopathy-related motor and cognitive decline.

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References

Sateia M . International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014; 146(5):1387-1394. DOI: 10.1378/chest.14-0970. View

Frauscher B, Iranzo A, Gaig C, Gschliesser V, Guaita M, Raffelseder V . Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012; 35(6):835-47. PMC: 3353058. DOI: 10.5665/sleep.1886. View

Frauscher B, Gschliesser V, Brandauer E, Ulmer H, Peralta C, Muller J . Video analysis of motor events in REM sleep behavior disorder. Mov Disord. 2007; 22(10):1464-1470. DOI: 10.1002/mds.21561. View

Frauscher B, Ehrmann L, Hogl B . Defining muscle activities for assessment of rapid eye movement sleep behavior disorder: from a qualitative to a quantitative diagnostic level. Sleep Med. 2012; 14(8):729-33. DOI: 10.1016/j.sleep.2012.09.028. View

Boeve B . REM sleep behavior disorder: Updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci. 2010; 1184:15-54. PMC: 2902006. DOI: 10.1111/j.1749-6632.2009.05115.x. View

Olson E, Boeve B, Silber M . Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain. 2000; 123 ( Pt 2):331-9. DOI: 10.1093/brain/123.2.331. View

Iranzo A, Santamaria J, Tolosa E . Idiopathic rapid eye movement sleep behaviour disorder: diagnosis, management, and the need for neuroprotective interventions. Lancet Neurol. 2016; 15(4):405-19. DOI: 10.1016/S1474-4422(16)00057-0. View

Fernandez-Arcos A, Iranzo A, Serradell M, Gaig C, Santamaria J . The Clinical Phenotype of Idiopathic Rapid Eye Movement Sleep Behavior Disorder at Presentation: A Study in 203 Consecutive Patients. Sleep. 2016; 39(1):121-32. PMC: 4678361. DOI: 10.5665/sleep.5332. View

Schenck C, Mahowald M . REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002; 25(2):120-38. DOI: 10.1093/sleep/25.2.120. View

10.

Castelnovo A, Lopez R, Proserpio P, Nobili L, Dauvilliers Y . NREM sleep parasomnias as disorders of sleep-state dissociation. Nat Rev Neurol. 2018; 14(8):470-481. DOI: 10.1038/s41582-018-0030-y. View

11.

Postuma R, Gagnon J, Vendette M, Fantini M, Massicotte-Marquez J, Montplaisir J . Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder. Neurology. 2008; 72(15):1296-300. PMC: 2828948. DOI: 10.1212/01.wnl.0000340980.19702.6e. View

12.

Claassen D, Josephs K, Ahlskog J, Silber M, Tippmann-Peikert M, Boeve B . REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology. 2010; 75(6):494-9. PMC: 2918473. DOI: 10.1212/WNL.0b013e3181ec7fac. View

13.

Boot B, Boeve B, Roberts R, Ferman T, Geda Y, Pankratz V . Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: a population-based study. Ann Neurol. 2012; 71(1):49-56. PMC: 3270692. DOI: 10.1002/ana.22655. View

14.

Wong J, Li J, Pavlova M, Chen S, Wu A, Wu S . Risk factors for probable REM sleep behavior disorder: A community-based study. Neurology. 2016; 86(14):1306-1312. PMC: 4826335. DOI: 10.1212/WNL.0000000000002414. View

15.

Ma J, Qiao Y, Gao X, Liang L, Liu X, Li D . A community-based study of risk factors for probable rapid eye movement sleep behavior disorder. Sleep Med. 2017; 30:71-76. DOI: 10.1016/j.sleep.2016.06.027. View

16.

Ma C, Pavlova M, Liu Y, Liu Y, Huangfu C, Wu S . Probable REM sleep behavior disorder and risk of stroke: A prospective study. Neurology. 2017; 88(19):1849-1855. PMC: 5419983. DOI: 10.1212/WNL.0000000000003902. View

17.

Mahlknecht P, Seppi K, Frauscher B, Kiechl S, Willeit J, Stockner H . Probable RBD and association with neurodegenerative disease markers: A population-based study. Mov Disord. 2015; 30(10):1417-21. DOI: 10.1002/mds.26350. View

18.

Kang S, Yoon I, Lee S, Han J, Kim T, Kim K . REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics. Sleep. 2013; 36(8):1147-52. PMC: 3700711. DOI: 10.5665/sleep.2874. View

19.

Pujol M, Pujol J, Alonso T, Fuentes A, Pallerola M, Freixenet J . Idiopathic REM sleep behavior disorder in the elderly Spanish community: a primary care center study with a two-stage design using video-polysomnography. Sleep Med. 2017; 40:116-121. DOI: 10.1016/j.sleep.2017.07.021. View

20.

Mayer . Motor dyscontrol in sleep of narcoleptic patients (a lifelong development?). J Sleep Res. 1993; 2(3):143-148. DOI: 10.1111/j.1365-2869.1993.tb00078.x. View