REM Sleep Behavior Disorder: Pathophysiology, Biomarkers, and Therapeutic Strategies

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by the loss of muscle atonia during rapid eye movement sleep, leading individuals to physically act out their dreams, often resulting in injuries. This condition is linked to SubCoeruleus nucleus dysfunction (homologous to the sublaterodorsal tegmental nucleus in rodents) and related neural circuits. Despite its profound impact on patient safety and quality of life, the role of environmental and lifestyle factors in RBD pathogenesis remains underexplored. To bridge this gap, we conducted a review of observational and interventional studies published between 2000 and 2025, using PubMed, Web of Science databases, and ScienceDirect. After systematic screening, 129 studies were selected, covering pathophysiological mechanisms, biomarkers, diagnostic approaches, and therapeutic interventions. Emerging evidence suggests that early detection through biomarkers and neuroimaging, combined with targeted therapeutic interventions, may help delay or prevent progression to more severe neurodegenerative diseases. This review underscores significant advances in identifying RBD biomarkers and targeted interventions, while highlighting the critical need for future research on modifiable environmental and lifestyle risk factors to guide preventive strategies.