The Latest Trends in Sleep Medicine

REM Sleep Behavior Disorder: Diagnosis, Epidemiology & Management

Author(s): John DuBose and Emmanuel During * .

Pp: 106-134 (29)

DOI: 10.2174/9789815051032122010010

* (Excluding Mailing and Handling)

Abstract

REM Sleep Behavior Disorder (RBD), often known as injurious dream enacting behaviors secondary to loss of atonia in REM sleep, was first described in 1986. While in the younger population, RBD can be associated with narcolepsy, posttraumatic stress disorder (PTSD) and antidepressant use, in middle-aged and older adults, RBD is almost always associated with a neurodegenerative disorder of synuclein––primarily Parkinson’s disease and dementia with Lewy bodies. For this reason, so-called isolated, or idiopathic RBD (iRBD), is in the great majority of cases a prodromal manifestation of neurodegeneration. Diagnosis of RBD requires video polysomnography to rule out common mimics. Specific diagnostic procedures and thresholds of electromyography (EMG) activity for the diagnosis of RBD have been developed and show high accuracy. Epidemiological studies have placed the overall prevalence of RBD around 2% across all age groups. Sleep-related injurious behaviors are common in RBD, especially in men, explaining the higher proportion of males diagnosed with RBD. In the management of RBD, safety is therefore paramount. Prognostic counselling is often warranted in iRBD, given the high rate of conversion to overt synucleinopathy. Offending agents, such as serotonergic medications, should be reduced or discontinued as possible as they exacerbate RBD behaviors. Pharmacological management involves primarily melatonin and/or clonazepam, while transdermal rivastigmine and, in select cases, sodium oxybate may be considered in treatment-resistant cases. 


Keywords: Antidepressants, Diagnosis, Dream-enacting behavior, Epidemiology, Lewy body dementia, Multiple system atrophy, Management, Narcolepsy, Parasomnia, Parkinson’s disease, Prognosis, Posttraumatic stress disorder, PTSD, Polysomnography, PSG, REM sleep behavior disorder, RBD, REM sleep without atonia, RSWA, Sleep-related injury, Synucleinopathy.

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316595280 and j.to_ip >=316595280 )) and ((j.from_date <= 1740676433 and j.to_date >= 1740676433 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16751) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316595280 and j.to_ip >=316595280 )) and ((j.from_date <= 1740676433 and j.to_date >= 1740676433 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16751) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 316595280 and j.to_ip >=316595280 )) and ((j.from_date <= 1740676433 and j.to_date >= 1740676433 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16751)
      690μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3326 and `b`.`banner_from_date` <= 1740676433 and `b`.`banner_to_date` >= 1740676433 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.09msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3326
      • 3: 1740676433
      • 4: 1740676433
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='96885375113ddc1b1bd5055e1d75641a'
      240μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    21Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        cWqryKj9OoT6OI0IDRY3HxJutJaC74m8wGdu3bX4
        uc_cart_id
        96885375113ddc1b1bd5055e1d75641a
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16751" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/16751
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:16 [ "x-https" => array:1 [ 0 => "1" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] "priority" => array:1 [ 0 => "u=0, i" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Thu, 27 Feb 2025 17:13:53 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkpVSVRZclozazczcXZ3RnpLWExCNXc9PSIsInZhbHVlIjoibGFvZUQxWUx3TTNVVFRTT2ozUktFQ0U3Qm9FZG5zTC9jNDJMTFJuOFVuSVlkcnZ6dndyZnozTDExaXltMEZ2Si9RSlZpdFZVWHFRcEJCQlhRc1ZIdXd0d0N5VDRjMFFubnVydEhvVXpoWFpWSWJpL3RlS0h2c204eXRndVM0VEciLCJtYWMiOiJkMjVmOGEwMWI5MzdjNDZlZDZmZjlkYzhhZDNmMmJmODYyOGYxMzExYzU4NjkzYWQ4MjQ3NTkwMWMzYzRlZGU1IiwidGFnIjoiIn0%3D; expires=Sun, 02 Mar 2025 05:13:53 GMT; Max-Age=215999; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6IkpVSVRZclozazczcXZ3RnpLWExCNXc9PSIsInZhbHVlIjoibGFvZUQxWUx3TTNVVFRTT2ozUktFQ0U3Qm9FZG5zTC9jNDJMTFJuOFVuSVlkcnZ6dndyZnozTDExaXltMEZ2Si9RSlZpd" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkZ2azV4YVFuYktKMFhqbVFEcGlRZlE9PSIsInZhbHVlIjoiZjZmQ1Y1ZmZkWmtPU2xMSVFZb3BWZnNqYXhzMHlEcTN6UGdMcTBkc2NsbGk3eEg3ZzZkcmozY3orbDUwU21UYWo1MjZIK2NWRy83eDFvU0VRUXBpKzFncURnbUczVjlGVVFmN1VpT2Fpb2VURU9LMVhZU1NlM0xpTTY0a0N2MHciLCJtYWMiOiI5OTk4ZmFkMDg0ZWVmNTU1MjhlN2IxMTkwZGRlMjU2NjcwZDRiYzBkMWRhYWJiM2M1OGM2NjIyMmI0MDZmYTQxIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IkZ2azV4YVFuYktKMFhqbVFEcGlRZlE9PSIsInZhbHVlIjoiZjZmQ1Y1ZmZkWmtPU2xMSVFZb3BWZnNqYXhzMHlEcTN6UGdMcTBkc2NsbGk3eEg3ZzZkcmozY3o" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6IkpVSVRZclozazczcXZ3RnpLWExCNXc9PSIsInZhbHVlIjoibGFvZUQxWUx3TTNVVFRTT2ozUktFQ0U3Qm9FZG5zTC9jNDJMTFJuOFVuSVlkcnZ6dndyZnozTDExaXltMEZ2Si9RSlZpdFZVWHFRcEJCQlhRc1ZIdXd0d0N5VDRjMFFubnVydEhvVXpoWFpWSWJpL3RlS0h2c204eXRndVM0VEciLCJtYWMiOiJkMjVmOGEwMWI5MzdjNDZlZDZmZjlkYzhhZDNmMmJmODYyOGYxMzExYzU4NjkzYWQ4MjQ3NTkwMWMzYzRlZGU1IiwidGFnIjoiIn0%3D; expires=Sun, 02-Mar-2025 05:13:53 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6IkpVSVRZclozazczcXZ3RnpLWExCNXc9PSIsInZhbHVlIjoibGFvZUQxWUx3TTNVVFRTT2ozUktFQ0U3Qm9FZG5zTC9jNDJMTFJuOFVuSVlkcnZ6dndyZnozTDExaXltMEZ2Si9RSlZpd" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkZ2azV4YVFuYktKMFhqbVFEcGlRZlE9PSIsInZhbHVlIjoiZjZmQ1Y1ZmZkWmtPU2xMSVFZb3BWZnNqYXhzMHlEcTN6UGdMcTBkc2NsbGk3eEg3ZzZkcmozY3orbDUwU21UYWo1MjZIK2NWRy83eDFvU0VRUXBpKzFncURnbUczVjlGVVFmN1VpT2Fpb2VURU9LMVhZU1NlM0xpTTY0a0N2MHciLCJtYWMiOiI5OTk4ZmFkMDg0ZWVmNTU1MjhlN2IxMTkwZGRlMjU2NjcwZDRiYzBkMWRhYWJiM2M1OGM2NjIyMmI0MDZmYTQxIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IkZ2azV4YVFuYktKMFhqbVFEcGlRZlE9PSIsInZhbHVlIjoiZjZmQ1Y1ZmZkWmtPU2xMSVFZb3BWZnNqYXhzMHlEcTN6UGdMcTBkc2NsbGk3eEg3ZzZkcmozY3o" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "cWqryKj9OoT6OI0IDRY3HxJutJaC74m8wGdu3bX4" "uc_cart_id" => "96885375113ddc1b1bd5055e1d75641a" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16751" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-27 17:13:54GET/chapter/167511121923