Send to

Choose Destination
Acta Neurol Scand. 2019 Dec;140(6):399-404. doi: 10.1111/ane.13156. Epub 2019 Sep 8.

Rapid eye movement sleep without atonia constitutes increased risk for neurodegenerative disorders.

Author information

Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Neurology Sleep and Disorders Unit, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.



REM (rapid eye movement) sleep without atonia (RSWA) is a polysomnographic finding used in diagnosis of REM sleep behavior disorder (RBD). Clinical significance of idiopathic RSWA (iRSWA) unaccompanied by RBD is not known. We designed a prospective study to investigate whether iRSWA constitutes an increased risk for developing neurodegenerative disorders.


Between January 2010 and December 2014, a total of 4362 patients underwent a full-night video-polysomnography. Upon detailed clinical and polysomnographical examination, patients with iRSWA and idiopathic RBD (iRBD) were enrolled into this study and followed up at every six months for at least 4 years up to 9 years.


We had a total of 31 patients with iRBD and 67 patients with iRSWA. Mean age was higher in iRBD group than those in iRSWA group (P = .016). Restless legs syndrome/Willis-Ekbom disease was significantly more common in patients with iRBD than those in patient with iRSWA (P < .001). Eighteen patients with iRSWA (26.8%) developed iRBD after 2.6 + 2.2 years. Six patients with iRSWA (8.9%) developed neurodegenerative disorders following 2.4 + 1.5 years; four were diagnosed as Parkinson's disease (PD) and two developed probable Alzheimer-type dementia. In patients with iRBD, eight patients (25.8%) developed neurodegenerative disorders-all was Parkinson's disease-following 2.6 + 2.2 years. Development of neurodegenerative diseases was positively correlated with age (P < .001) and periodic leg movements in sleep in both groups (P < .010).


These results show that iRSWA may also be accepted as a risk factor in the development of PD or neurodegenerative diseases. Advanced age and periodic leg movements in sleep seem to be correlated with higher risk.


Parkinson's disease; REM sleep behavior disorder; REM sleep without atonia; neurodegenerative disorders; periodic leg movements in sleep


Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center