rapid eye movement sleep behavioral disorder (RBD)

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]

Introduction

Dream-enacting behavior during REM sleep.

Etiology

neurologic disorders (Parkinson's disease)^[1]
- parkinson plus syndrome^[5]
  - multiple system atrophy, Shy-Drager syndrome^[5]
- Lewy body dementia
SSRI, SNRI^[1]

Epidemiology

occurs primarily in patients > 50 years of age
men 2-5 fold more often affected than women

Clinical manifestations

may be acute, episodic or chronic
patients get up during REM sleep & engage in dream-like behavior, often violent, that may result in self injury
behaviors
- talking or laughing
- arm swinging
- punching, kicking
- yelling, cursing
- jumping out of bed
may occur several times nightly
episodes occur at approximately 90 minute intervals coinciding with REM sleep
patients are usually easily awakened
NO prolonged confusion upon awakening
often dim or no recollection of events

Diagnostic procedures

polysomnography
- increased muscle activity during sleep
- loss of sleep-associated muscle atonia

Radiology

FDG-PET imaging may distinguish patients at increased risk for Parkinson's disease^[12]

Complications

may be associated with narcolepsy
may precede synucleinopathy by 50 years^[3]
- Parkinson's disease, Lewy body dementia, multiple system atrophy or other synucleinopathy (risk is 45% within 6 years)^[13]
increased risk of cognitive impairment in patients with Parkinson's disease^[14]
risk factors for neurogenerative disease
- abnormal olfaction (RR 2.6)
- motor symptoms (RR 2.6)
- subtle motor signs (RR 2.0)
- abnormal quantitative motor testing (RR 3.5)
- constipation (RR 1.6)
- increased REM tone (RR 1.6)
- abnormal DAT scan (RR 3.2)^[10]
- older age^[13]
- use of nitrates^[13]
- low caffeine use^[13]

disease interaction(s) of rapid eye movement sleep behavioral disorder with synucleinopathy

Differential diagnosis

nocturnal seizures
nocturnal panic disorder
nocturnal dissociative disorder
sleep walking
sleep terrors
nocturnal confusional state, resulting from
nocturnal myoclonus (no association with Parkinson's disease)

Management

environmental safety
- padding of sharp edges
- removng objects near the bed
clonazepam 0.5-1.0 mg QHS
- effective in 90% of patients^[3]
- may increase risk of confusion & falls in the elderly^[1]
- may exacerbate obstructive sleep apnea^[1]
levodopa/carbidopa &/or dopamine agonists may be helpful^[3]
melatonin 3-12 mg QHS
- may be helpful^[3]
- initial treatment of choice in the elderly (GRS9 & GRS11)^[1]
carbamazepine is second line agent 6 avoid SSRI& SNRI (sertraline, venlafaxine ...)
- induces or increases motor activity during sleep & exacerbate REM sleep behavior disorder^[1]

More general terms

parasomnia

Additional terms

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
↑ Nightingale S, Orgill JC, Ebrahim IO, de Lacy SF, Agrawal S, Williams AJ. The association between narcolepsy and REM behavior disorder (RBD). Sleep Med. 2005 May;6(3):253-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15854856
↑ ^3.0 ^3.1 ^3.2 ^3.3 ^3.4 Olson EJ et al, Rapid eye movement sleep behoviour disorder: demographic, clinical and laboratory findings in 93 cases Brain 2000, 123(pt 2):331 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10648440
Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001 Jul;16(4):622-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11481685
Boeve BF et al, Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003, 4:281 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14592300
Gagnon JF et al, Update on the pharmacology of REM sleep disorder. Neurology 2006, 67:742 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16966533
Mahowald MW, Schenck CH. REM sleep behaviour disorder: a marker of synucleinopathy. Lancet Neurol. 2013 May;12(5):417-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23578776
Postuma RB Prodromal Parkinson's disease--using REM sleep behavior disorder as a window. Parkinsonism Relat Disord. 2014 Jan;20 Suppl 1:S1-4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24262156
↑ Claassen DO et al REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology. 2010 Aug 10;75(6):488-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20668263
↑ ^5.0 ^5.1 ^5.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2017
↑ Alessi, C. In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
↑ Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Womens Health (Larchmt). 2009 Dec;18(12):1955-63 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20044857
↑ Chen MC, Yu H, Huang ZL, Lu J. Rapid eye movement sleep behavior disorder. Curr Opin Neurobiol. 2013 Oct;23(5):793-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23518139
↑ Aurora RN, Zak RS, Maganti RK et al Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010 Feb 15;6(1):85-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20191945 Free PMC Article
↑ ^10.0 ^10.1 Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci. 2014 May;37(5):279-88. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24673896
↑ Monaco K. Predictive Factors ID'd for Neurodegeneration in Idiopathic RBD. Opens the door to intervening with neuroprotective therapy. MedPage Today. April 24, 2018 https://www.medpagetoday.com/meetingcoverage/aan/72511
Postuma R, et al Predictors of neurodegeneration in idiopathic REM sleep behavior disorder: A multicenter cohort study. American Academy of Neurology (AAN) 2018; Abstract CCI.002.
↑ ^12.0 ^12.1 Shin JH, Lee JY, Kim YK et al. Parkinson disease-related brain metabolic patterns and neurodegeneration in isolated REM sleep behavior disorder. Neurology 2021 May 19; [e-pub]. https://n.neurology.org/content/early/2021/05/19/WNL.0000000000012228
↑ ^13.0 ^13.1 ^13.2 ^13.3 ^13.4 Zhang H, Iranzo A, Hogl B et al. Risk factors for phenoconversion in rapid eye movement sleep behavior disorder. Ann Neurol 2022 Mar; 91:404; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34981563 https://onlinelibrary.wiley.com/doi/10.1002/ana.26298
↑ ^14.0 ^14.1 Jozwiak N, Postuma RB, Montplaisir J et al REM sleep behavior disorder and cognitive impairment in Parkinson's disease. Sleep. 2017 Aug 1;40(8):zsx101. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28645156 PMCID: PMC5806543 Free PMC article

[ref1-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016

[ref2-2] Nightingale S, Orgill JC, Ebrahim IO, de Lacy SF, Agrawal S, Williams AJ. The association between narcolepsy and REM behavior disorder (RBD). Sleep Med. 2005 May;6(3):253-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15854856

[ref3-3] 3.0 ^3.1 ^3.2 ^3.3 ^3.4 Olson EJ et al, Rapid eye movement sleep behoviour disorder: demographic, clinical and laboratory findings in 93 cases Brain 2000, 123(pt 2):331 PMID: https://www.ncbi.nlm.nih.gov/pubmed/10648440
Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord. 2001 Jul;16(4):622-30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11481685
Boeve BF et al, Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003, 4:281 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14592300
Gagnon JF et al, Update on the pharmacology of REM sleep disorder. Neurology 2006, 67:742 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16966533
Mahowald MW, Schenck CH. REM sleep behaviour disorder: a marker of synucleinopathy. Lancet Neurol. 2013 May;12(5):417-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23578776
Postuma RB Prodromal Parkinson's disease--using REM sleep behavior disorder as a window. Parkinsonism Relat Disord. 2014 Jan;20 Suppl 1:S1-4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24262156

[ref4-4] Claassen DO et al REM sleep behavior disorder preceding other aspects of synucleinopathies by up to half a century. Neurology. 2010 Aug 10;75(6):488-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20668263

[ref5-5] 5.0 ^5.1 ^5.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2017

[ref6-6] Alessi, C. In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002

[ref7-7] Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Womens Health (Larchmt). 2009 Dec;18(12):1955-63 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20044857

[ref8-8] Chen MC, Yu H, Huang ZL, Lu J. Rapid eye movement sleep behavior disorder. Curr Opin Neurobiol. 2013 Oct;23(5):793-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23518139

[ref9-9] Aurora RN, Zak RS, Maganti RK et al Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010 Feb 15;6(1):85-95. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20191945 Free PMC Article

[ref10-10] 10.0 ^10.1 Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci. 2014 May;37(5):279-88. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24673896

[ref11-11] Monaco K. Predictive Factors ID'd for Neurodegeneration in Idiopathic RBD. Opens the door to intervening with neuroprotective therapy. MedPage Today. April 24, 2018 https://www.medpagetoday.com/meetingcoverage/aan/72511
Postuma R, et al Predictors of neurodegeneration in idiopathic REM sleep behavior disorder: A multicenter cohort study. American Academy of Neurology (AAN) 2018; Abstract CCI.002.

[ref12-12] 12.0 ^12.1 Shin JH, Lee JY, Kim YK et al. Parkinson disease-related brain metabolic patterns and neurodegeneration in isolated REM sleep behavior disorder. Neurology 2021 May 19; [e-pub]. https://n.neurology.org/content/early/2021/05/19/WNL.0000000000012228

[ref13-13] 13.0 ^13.1 ^13.2 ^13.3 ^13.4 Zhang H, Iranzo A, Hogl B et al. Risk factors for phenoconversion in rapid eye movement sleep behavior disorder. Ann Neurol 2022 Mar; 91:404; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/34981563 https://onlinelibrary.wiley.com/doi/10.1002/ana.26298

[ref14-14] 14.0 ^14.1 Jozwiak N, Postuma RB, Montplaisir J et al REM sleep behavior disorder and cognitive impairment in Parkinson's disease. Sleep. 2017 Aug 1;40(8):zsx101. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28645156 PMCID: PMC5806543 Free PMC article

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rapid eye movement sleep behavioral disorder (RBD)

Contents

Introduction

Etiology

Epidemiology

Clinical manifestations

Diagnostic procedures

Radiology

Complications

Differential diagnosis

Management

More general terms

Additional terms

References

Navigation menu

rapid eye movement sleep behavioral disorder (RBD)

Introduction

Etiology

Epidemiology

Clinical manifestations

Diagnostic procedures

Radiology

Complications

Differential diagnosis

Management

More general terms

Additional terms

References

Navigation menu

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