Rapid eye movement sleep behavior disorder

Classification and Characteristics:
– RBD is a parasomnia.
– Idiopathic RBD is not associated with another neurological condition.
– Symptomatic RBD is a symptom of an underlying disorder.
– Involves complex behaviors during dreams like screaming, kicking, and punching.
– Dreamers may be unaware of their movements, leading to injuries.
– Can be associated with conditions like narcolepsy and Guillain–Barré syndrome.
– Symptoms may precede other neurodegenerative disorders.

Causes and Diagnosis:
– Results from a loss of muscle atonia during REM sleep.
– Can be due to drug reactions, aging, or neurodegenerative diseases.
– Diagnosis through clinical history, polysomnography, and validated questionnaires like RBDSQ.
– Bed partners’ observations and specific criteria from ICSD-3 aid in diagnosis.
– Risk factors include family history, head injury, and certain medications.
– RBD may be an early sign of synucleinopathy.

Differential Diagnosis and Treatment:
– Conditions like non-REM parasomnias and sleep apnea can resemble RBD.
– Polysomnography helps confirm RBD diagnosis.
– Melatonin and clonazepam are common treatments for RBD.
– Melatonin is preferred due to fewer side effects.
– Certain medications can worsen RBD and should be avoided.
– Environmental modifications can prevent injuries during episodes.

Prognosis and Epidemiology:
– Patients with RBD are at risk of sleep-related injuries.
– Most patients with idiopathic RBD may develop a neurodegenerative disorder.
– Early diagnosis and management are crucial for better outcomes.
– Regular follow-ups are essential for monitoring progression.
– RBD prevalence estimated at 0.5–2% overall and 5–13% in those aged 60 to 99.
– More common in males overall, with onset typically in the 50s or 60s.

History, Animal Diagnosis, and Additional Information:
– Michel Jouvet described brain lesions in cats leading to loss of atonia in REM sleep in the 1960s and 1970s.
– Carlos Schenck and Mark Mahowald first described RBD in 1986.
– RBD diagnosed in animals, specifically dogs.
– Almost half of Parkinson’s patients and a high percentage of other neurodegenerative disorder patients have RBD.
– RBD is a strong predictor of progression to synucleinopathies.