The Tasmania-London protocol to detect isolated rapid eye movement sleep behavior disorder using home-based...

Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is an early manifestation of alpha-synuclein-related neurodegenerative diseases (NDD). There is an average delay in iRBD diagnosis of 9 years from the onset of symptoms, showing that we need easier methods of detection to improve access to specialist care and potential disease-modifying clinical trials. We designed a 3-step approach to detect iRBD in a community of older adults (≥50 years) in Tasmania, Australia, using home-based video-polysomnography (vPSG).

The Tasmania-London (TASLON) protocol for iRBD detection comprised 3 key steps: participants completed an online iRBD screening question; those who screened positive were invited to undertake the TASLON iRBD Screening Interview by telephone; a sample then completed a home-based vPSG based on iRBD screening risk level.

A total of 2891 participants (mean [SD] age 64 [7.7] years; 74% female) without any known NDD were recruited from throughout Tasmania. 267 (9%; age 63 [7.7] years; 55% female) were identified as having "probable" RBD through positive online screening; 87 (33%) agreed to complete the clinical screening interview; 47 (55%) underwent home-based vPSG; and 21 (45%; age 68 [7] years; 52% female) were found to have iRBD.

The TASLON protocol is a feasible method of improving timely access to iRBD diagnoses in the community. It streamlines the path to vPSG by identifying those at highest risk of iRBD, thus improving access to diagnostic testing and clinical trial opportunities for those who otherwise may not have been identified. Statement of Significance The TASLON protocol offers a novel, community-based approach to early detection of isolated REM sleep behavior disorder (iRBD), a precursor to alpha-synuclein-related neurodegenerative diseases (NDD). By streamlining the path to home-based video-polysomnography (vPSG), bypassing the need for hospital/laboratory-based vPSG, this method addresses a critical delay in iRBD diagnosis, especially for populations with limited access to specialist sleep centers. This study highlights the feasibility and preliminary results of the TASLON protocol in detecting new cases of iRBD in the community. This holds potential to reduce inequity of access to early interventions and may improve patient outcomes in NDD through enhanced access to specialist care and clinical trials. Future work should focus on extending this approach and exploring its applicability in broader populations to aid access to earlier diagnosis.