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Published on: September 22, 2020
REM sleep behavior disorder: motor manifestations and pathophysiology
1Sleep disorders unit, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Inserm U975, CRICM, Paris, France. isabelle.arnulf@psl.aphp.fr
Summary
Patients with REM sleep behavior disorder (RBD) enact violent dreams. This condition frequently signals future synucleinopathies like Parkinson's disease, making early detection crucial for intervention.
Area of Science:
- Neurology
- Sleep Medicine
- Neurodegenerative Diseases
Background:
- REM sleep behavior disorder (RBD) involves acting out dreams due to lack of muscle paralysis during REM sleep.
- RBD is strongly associated with synucleinopathies, affecting 60-100% of patients.
- Abnormal movements in RBD pose risks of injury and sleep disruption for patients and partners.
Purpose of the Study:
- To summarize the clinical presentation and diagnostic methods for RBD.
- To highlight the high prevalence of RBD in synucleinopathies.
- To discuss the prodromal nature of idiopathic RBD for neurodegenerative diseases.
Main Methods:
- Clinical interviews and video-polysomnography for diagnosis.
- Review of longitudinal studies on RBD progression.
- Assessment of associated nonmotor and imaging biomarkers.
Main Results:
- RBD movements are characterized by jerky, fast, and sometimes violent actions.
- Parkinsonism temporarily resolves during complex behaviors in some RBD patients.
- Idiopathic RBD predicts conversion to Parkinson's disease or dementia with Lewy bodies in 46% within 5 years.
Conclusions:
- RBD is a significant early indicator for synucleinopathies.
- Early identification of RBD and associated biomarkers can identify high-risk individuals.
- RBD patients are a key cohort for testing neuroprotective therapies.
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