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REM sleep behaviour disorder

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.

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Fig. 1: Conversion of RBD to synucleinopathy.
Fig. 2: Neuronal network generating REM sleep and inducing REM sleep without atonia and RBD.
Fig. 3: PSG recording of REM sleep.
Fig. 4: Schematic framework of the natural history effects of neuroprotective therapies in iRBD.

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Acknowledgements

The authors thank R. Lopez for assisting with the reference management.

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Nature Reviews Disease Primers thanks C. Bassetti, Y. Wing and the other anonymous referee(s) for their contribution to the peer review of this work.

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Contributions

Introduction (Y.D. and C.H.S.); Epidemiology (B.B. and R.B.P.); Mechanisms/pathophysiology (A.I. and P.-H.L.); Diagnosis, screening and prevention (G.P., J.M. and Y.D.); Management (B.B. and A.I.); Quality of life (C.H.S. and G.P.); Outlook (R.B.P. and Y.D.); Overview of Primer (Y.D.).

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Correspondence to Yves Dauvilliers.

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Competing interests

Y.D. has consulted for UCB Pharma, Jazz, Theranexus, Flamel, Idorsia, Takeda, Harmony Biosciences and Bioprojet. C.H.S. is a Consultant for Axovant Sciences, Inc. R.B.P. reports grants and personal fees from Fonds de la Recherche en Sante, the Canadian Institute of Health Research, Parkinson Canada, the Garfield Weston Foundation, the Michael J. Fox Foundation and the Webster Foundation and personal fees from Biotie, Roche/Prothena, Takeda, Teva Neurosciences, AbbVie, Novartis, Janssen, Jazz Pharmaceuticals, Biogen, Boehringer Ingelheim, Theranexus and GE HealthCare outside the submitted work. G.P. participated in advisory boards for Jazz Pharmaceuticals, UCB Pharma and Bioprojet. J.M. received an honorarium to participate in advisory boards for Merck, Novartis and Takeda pharmaceuticals. B.B. has served as an investigator for clinical trials sponsored by GE Healthcare and Axovant, receives royalties from the publication of a book entitled Behavioral Neurology Of Dementia (Cambridge Medicine, 2009, 2017) and serves on the Scientific Advisory Board of the Tau Consortium. B.B. also receives research support from the NIH (U01 AG045390, U54 NS092089, P50 AG016574, UO1 AG006786 and RO1 AG041797), the Mayo Clinic Dorothy and Harry T. Mangurian Jr. Lewy Body Dementia Program and the Little Family Foundation. All other authors declare no competing interests.

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Dauvilliers, Y., Schenck, C.H., Postuma, R.B. et al. REM sleep behaviour disorder. Nat Rev Dis Primers 4, 19 (2018). https://doi.org/10.1038/s41572-018-0016-5

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