Abstract
REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Both clinicians and patients are therefore forced to deal with uncertain outcomes. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. We aim to raise awareness and develop a framework for best practice for RBD patient management.
Highlights
Specialty section: This article was submitted to Movement Disorders, a section of the journal Frontiers in Neurology
We summarize Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field
From a public health perspective, RBD highlights the importance of sleep for good health and the need for greater awareness of sleep disorders and their detrimental effects
Summary
Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a non-familial sleep disorder, characterized by the loss of the inherent muscle atonia observed during normal REM sleep. Disruption to this process results in abnormal motor behaviors during REM sleep (Figure 1) It is not definitively known whether RBD is caused by an imbalance originating in the glutamatergic SubC/PC or downstream in the GABA/Glycinergic VMM, though evidence from animal studies suggest the latter is more likely [14]. Several studies have attempted to assess the prevalence in the general population using screening questionnaires, finding the rate of probable RBD to be 0.4–5% [35,36,37] These investigations are not without their limitations—several conditions have similar symptomology to RBD, including the increasingly common condition obstructive sleep apnoea [38], and the aforementioned prevalence rates are likely to include individuals without RBD.
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