Neurophysiological Aspects of REM Sleep Behavior Disorder (RBD): A Narrative Review

Michela Figorilli, Giuseppe Lanza, Patrizia Congiu, Rosamaria Lecca, Elisa Casaglia, Maria P Mogavero, Monica Puligheddu, Raffaele Ferri, Michela Figorilli, Giuseppe Lanza, Patrizia Congiu, Rosamaria Lecca, Elisa Casaglia, Maria P Mogavero, Monica Puligheddu, Raffaele Ferri

Abstract

REM sleep without atonia (RSWA) is the polysomnographic (PSG) hallmark of rapid eye movement (REM) sleep behavior disorder (RBD), a feature essential for the diagnosis of this condition. Several additional neurophysiological aspects of this complex disorder have also recently been investigated in depth, which constitute the focus of this narrative review, together with RSWA. First, we describe the complex neural network underlying REM sleep and its muscle atonia, focusing on the disordered mechanisms leading to RSWA. RSWA is then described in terms of its polysomnographic features, and the methods (visual and automatic) currently available for its scoring and quantification are exposed and discussed. Subsequently, more recent and advanced neurophysiological features of RBD are described, such as electroencephalography during wakefulness and sleep, transcranial magnetic stimulation, and vestibular evoked myogenic potentials. The role of the assessment of neurophysiological features in the study of RBD is then carefully discussed, highlighting their usefulness and sensitivity in detecting neurodegeneration in the early or prodromal stages of RBD, as well as their relationship with other proposed biomarkers for the diagnosis, prognosis, and monitoring of this condition. Finally, a future research agenda is proposed to help clarify the many still unclear aspects of RBD.

Keywords: REM sleep behavior disorder; REM sleep without atonia; electroencephalography; neurophysiology; polysomnography; transcranial magnetic stimulation; vestibular evoked myogenic potentials.

Conflict of interest statement

The authors declare no conflict of interest and the absence of any personal circumstances or interest that may be perceived as inappropriately influencing the representation or interpretation of reported data. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Schematic representation of the REM sleep atonia circuitry. Ach = acetylcholine, LDT = laterodorsal tegmental nucleus, PPT = pedunculopontine nucleus, SLD = sublaterodorsal tegmental nucleus, SubC = subcoeruleus nucleus, and VMM = ventromedial medulla.

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