RBD is frequently associated with clinically-diagnosed Parkinson’s disease, dementia with Lewy bodies, and multiple system atrophy.
Dementia with Lewy bodies
Multiple system atrophy
Most patients with REM behavior disorder will eventually manifest neurodegenerative diseases like parkinsonism, dementia with Lewy body, or multisystem atrophy.
Clinical features during sleep include abnormal vocalizations, abnormal motor behavior, and altered dream mentation. This enactment may be violent and can lead to injury to themselves or others without any conscious awareness. A patient can recall the contents of the dream upon awakening.
International Classification of Sleep Disorders (ICSD-3):
Diagnosis of RBD requires all of the following
Repeated episodes of sleep-related vocalization and/or complex motor behaviors
Behaviors are documented by polysomnography to occur during REM sleep or, based on the clinical history of dream enactment, are presumed to occur during REM sleep
Presence of REM sleep without atonia (RSWA) on polysomnography
An absence of epileptiform activity during REM sleep, unless RBD can be clearly distinguished from any concurrent REM sleep-related seizure disorder
Sleep disturbance not better explained by another sleep disorder, medical or neurologic disorder, mental disorder, medication use, or substance use disorder
REM sleep without atonia (RSWA) (CHARACTERISTIC): Elevation of motor tone during REM sleep as measured by electromyography (EMG) activity in the chin and/or limb leads
Differentials include other sleep enactment behaviors. The differences of these disorders can usually be identified with detailed history taking, but a video-monitored polysomnographic study is often warranted.
Obstructive sleep apnea
Nocturnal panic attacks
Non-REM parasomnias: Night terrors, somnambulism, or confusional arousals
Primary goal of treatment is to provide patients with a safe sleeping environment for them and their bed partners. Healthcare professionals can achieve this through non-pharmacologic approaches and pharmacotherapy if needed.
Melatonin (first-line therapy): Augments REM atonia and improves RBD symptoms
Low-dose clonazepam (0.5-1 mg at bedtime): Suppress unpleasant dreams