Isolated REM sleep behavior disorder is associated with altered 24-h rest-activity measures
Joseph R Winer1, Renske Lok2, Adrian Ekelmans2
1Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.
Frontiers in Sleep
|October 27, 2025
Summary
Patients with isolated REM sleep behavior disorder (iRBD) show disrupted 24-hour activity patterns, with less daytime movement and more nighttime activity compared to healthy individuals. These findings suggest early signs of Lewy body disease.
Area of Science:
- Neurology
- Sleep Medicine
- Movement Disorders
Background:
- Isolated REM sleep behavior disorder (iRBD) is a prodromal symptom of Lewy body diseases, including Parkinson's disease and dementia with Lewy bodies.
- Over 80% of iRBD patients progress to these neurodegenerative conditions.
- Disruption of rest-activity patterns is a known predictor of Parkinson's disease but is not well-characterized in iRBD.
Purpose of the Study:
- To investigate whether accelerometer-based measures of 24-hour activity reveal greater fragmentation and variability in iRBD patients compared to healthy controls.
- To characterize rest-activity patterns in iRBD using advanced analytical techniques.
Main Methods:
- 38 iRBD patients and 119 matched healthy controls underwent 24-hour activity monitoring using wrist-worn accelerometers for approximately 25 days.
- Raw accelerometer data were processed to calculate nonparametric and cosinor measures of activity.
- Functional principal component analyses (fPCA) were employed to detect differences in 24-hour activity patterns.
Main Results:
- iRBD patients exhibited significantly lower overall activity levels, including reduced activity during their most active 10 hours.
- Individuals with iRBD showed significantly increased movement during nighttime hours (L5).
- fPCA revealed that decreased daytime activity and increased nighttime activity are key differences observed in iRBD patients.
Conclusions:
- Multiple metrics of rest-activity rhythms confirm that 24-hour activity measures are altered in iRBD.
- These rest-activity disruptions may reflect degeneration in sleep-wake regulating circuits.
- Altered activity patterns in iRBD represent an early symptom of Lewy body disease.
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