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REM sleep behaviour disorder: not just a bad dream

Elie Matar1, Simon Jg Lewis2

  • 1Brain and Mind Centre, University of Sydney, Sydney, NSW simon.lewis@sydney.edu.au.

The Medical Journal of Australia
|September 14, 2017
PubMed

Insights

Rapid eye movement sleep behaviour disorder (RBD) involves acting out dreams due to lost muscle paralysis. Idiopathic RBD often precedes Parkinson

Area of Science:

  • Neurology
  • Sleep Medicine
  • Neurodegenerative Diseases

Background:

  • Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterized by the loss of normal atonia during REM sleep.
  • This leads to motor behaviors enacting dreams, often causing patient concern due to injuries or disturbing dream content.
  • Idiopathic RBD affects up to 2% of older adults and is frequently linked to neurodegenerative conditions.

Purpose of the Study:

  • To review the diagnosis and management of RBD.
  • To highlight the association between idiopathic RBD and future development of Parkinson disease or dementia with Lewy bodies.
  • To emphasize the prodromal nature of idiopathic RBD and the need for physician awareness of phenoconversion risks.

Main Methods:

  • Diagnosis involves screening questions and polysomnography to rule out mimics.
  • Treatment strategies include addressing underlying causes, environmental modifications, and pharmacotherapy (clonazepam or melatonin).

Main Results:

  • Idiopathic RBD is recognized as a prodromal phase for Parkinson disease and dementia with Lewy bodies.
  • Almost all idiopathic RBD patients are at high risk of developing these neurodegenerative conditions.

Conclusions:

  • Physicians must be aware of the phenoconversion risk in idiopathic RBD patients.
  • Educating patients on recognizing early symptoms of Parkinson disease or dementia with Lewy bodies is crucial.
  • Referral for further testing and enrollment in neuroprotective trials is recommended for idiopathic RBD patients.
Keywords:
DementiaMovement disorderNeurodegenerative diseaseParkinson diseaseSleep disorders

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