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Nat Rev Dis Primers. 2018 Aug 30;4(1):19. doi: 10.1038/s41572-018-0016-5.

REM sleep behaviour disorder.

Author information

1
Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France. ydauvilliers@yahoo.fr.
2
INSERM, U1061, Montpellier, France, Université Montpellier, Montpellier, France. ydauvilliers@yahoo.fr.
3
Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA.
4
Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada.
5
Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
6
UMR 5292 CNRS/U1028 INSERM, Center of Research in Neuroscience of Lyon (CRNL), SLEEP Team, Université Claude Bernard Lyon I, Faculté de Médecine RTH Laennec, Lyon, France.
7
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
8
IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy.
9
Department of Psychiatry, Université de Montréal, Québec, Canada and Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada.
10
Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.

Abstract

Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia that is characterized by loss of muscle atonia during REM sleep (known as REM sleep without atonia, or RSWA) and abnormal behaviours occurring during REM sleep, often as dream enactments that can cause injury. RBD is categorized as either idiopathic RBD or symptomatic (also known as secondary) RBD; the latter is associated with antidepressant use or with neurological diseases, especially α-synucleinopathies (such as Parkinson disease, dementia with Lewy bodies and multiple system atrophy) but also narcolepsy type 1. A clinical history of dream enactment or complex motor behaviours together with the presence of muscle activity during REM sleep confirmed by video polysomnography are mandatory for a definite RBD diagnosis. Management involves clonazepam and/or melatonin and counselling and aims to suppress unpleasant dreams and behaviours and improve bedpartner quality of life. RSWA and RBD are now recognized as manifestations of an α-synucleinopathy; most older adults with idiopathic RBD will eventually develop an overt neurodegenerative syndrome. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α-synucleinopathy-related motor and cognitive decline.

PMID:
30166532
DOI:
10.1038/s41572-018-0016-5

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