REM sleep behavior disorder (RBD): Update on diagnosis and treatment

Birgit Högl, Ambra Stefani, Birgit Högl, Ambra Stefani

Abstract

Background: REM sleep behavior disorder (RBD) is parasomnia characterized by dream enactment and enabled by disruption of physiological muscle atonia during REM sleep. Over the past few years, diagnostic criteria and the methods used to confirm diagnosis have been updated.

Objective: In this review article, the current knowledge regarding RBD diagnosis and treatment is presented.

Methods: A selective literature search was carried out.

Results and discussion: Although several RBD screening questionnaires have been developed, diagnosis can only be definitely confirmed on the basis of polysomnography. New methods for scoring electromyography (EMG) activity during REM sleep have been proposed during recent years and cutoff values have been established. The latest cutoff values for scoring EMG activity during REM sleep are included in the International Classification of Sleep Disorders (ICSD). The cutoff of 27 % muscle activity during REM sleep suggested by the Sleep Innsbruck Barcelona (SINBAR) group was also included in the third edition of the ICSD. The best-researched treatments for RBD are clonazepam and melatonin.

Keywords: Parasomnias; Polysomnography; REM sleep; SINBAR; Violent dream.

Conflict of interest statement

Compliance with ethical guidelinesConflict of interestB. Högl received consulting fees from UCB, Axovant and Mundipharma; lecturing honoraria from UCB, Mundipharma, Otsuka, Respironics, Sanofi, Abbvie, and Lundbeck; and travel support from Habel and Vivisol. A. Stefani received travel support from Air Liquide, Habel Medizintechnik and UCB.The accompanying review manuscript does not include new studies on humans or animals.

Figures

Fig. 1
Fig. 1
30-s epoch of REM sleep, with REM sleep without atonia in the seven muscle channels between EEG and ECG
Fig. 2
Fig. 2
Phasic and tonic EMG activity in one epoch of REM sleep in RBD patients

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