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What is REM sleep behavior disorder (RBD)?
REM sleep behavior disorder (RBD) is characterized by repeated episodes of sleep-related vocalization and/or complex motor behaviors, such as chewing, punching, singing, whistling, running, kicking, dancing, arm flaring, etc.
These behaviors are either documented by PSG to occur during REM sleep or are presumed to occur during REM sleep based on clinical history of dream enactment.
Polysomnography (PSG) recording demonstrates REM sleep without atonia.
The disturbance is not better explained by another sleep disorder, psychiatric disorder, medication, or substance use.
What sleep disorders are associated with REM sleep behavior disorder ?
RBD can be strongly linked with narcolepsy type 1.
The behavior associated with RBD may be precipitated or worsened by the pharmacologic therapy of the cataplexy. Per the ICSD-3, RBD associated with narcolepsy is now considered to be a distinct phenotype of RBD.
The presence of RBD in the pediatric population may be an initial manifestation of narcolepsy type 1.
RBD can be also associated with
- periodic limb movement disorder,
- neurologic disorders such as ischemic or hemorrhagic cerebrovascular disease
- multiple sclerosis
- Lewy body dementia
- Parkinson’s disease
- multisystem atrophy
- Guillain–Barré syndrome
- mitochondrial disorders
- Tourette syndrome
- autism
- normal pressure hydrocephalus
- Medication use as well as medication withdrawal has been reported to be associated with RBD.
How is REM sleep behavior disorder treated?
Patients with RBD are at risk for sleep-related injury.
Therefore, efforts in modifying the sleep environment to ensure patient safety are strongly recommended.
This includes placing a mattress on the floor, padding corners of furniture, window protection, and removing potentially dangerous objects, such as guns or sharp objects, from the bedroom.
When self-injury is present secondary to RBD, clonazepam is suggested for the treatment of RBD in adults but should be used with caution in patients with dementia, gait disorders, or concomitant OSA.
Melatonin is suggested for the treatment of RBD because it has few side effects.
Pramipexole, l -DOPA, zopiclone, benzodiazepines other than clonazepam, Yi-Gan San, desipramine, clozapine, carbamazepine, and sodium oxybate may also be considered to treat RBD; however, the clinical evidence available is limited.
Sources
Sheldon S: Parasomnias in childhood. Pediatr Clin N Am 51:69-88, 2004.
