Zaburzenie zachowania we śnie rem

Zaburzenie zachowania we śnie rem
Epidemiologia

Zaburzenie zachowania we śnie REM (RBD) to parasomnia charakteryzująca się utratą atonii mięśniowej podczas fazy REM, co prowadzi do odgrywania marzeń sennych i gwałtownych ruchów. Epidemiologia RBD wskazuje na częstość występowania w populacji ogólnej na poziomie 0,5-1,5%, z wyższą częstością u osób starszych, sięgającą nawet 8,9% w grupie wiekowej 70-89 lat. RBD dotyka głównie mężczyzn (stosunek 9:1 u osób starszych), choć u osób poniżej 50. roku życia częstość jest podobna u obu płci. Diagnostyka opiera się na badaniu polisomnograficznym (PSG) z oceną wideo, które jest niezbędne do potwierdzenia utraty atonii REM i obecności objawów klinicznych. Wtórne przyczyny RBD obejmują parkinsonizm, narkolepsję (częstość do 36%) oraz stosowanie leków przeciwdepresyjnych (do 6%).

Epidemiologia zaburzenia zachowania we śnie REM

Częstotliwość występowania w populacji ogólnej
Występowanie w różnych grupach wiekowych
Różnice płciowe w występowaniu RBD
Związek z chorobami neurodegeneracyjnymi
RBD jako marker ryzyka
Wtórne przyczyny RBD

Nadzór i monitorowanie RBD

Diagnoza i badania przesiewowe
Badania kliniczne i rejestry
Nadzór nad progresją choroby
Badania nad etiologią i epidemiologią
Kolejne rozdziały

Epidemiologia zaburzenia zachowania we śnie REM

Zaburzenie zachowania we śnie REM (RBD – REM sleep behavior disorder) to parasomnia charakteryzująca się odgrywaniem marzeń sennych podczas snu REM z powodu utraty atonii mięśniowej, co prowadzi do żywych, czasami gwałtownych zachowań ruchowych podczas snu. Epidemiologia tego schorzenia stanowi istotny przedmiot badań, szczególnie ze względu na jego powiązanie z chorobami neurodegeneracyjnymi.¹²

Częstotliwość występowania w populacji ogólnej

Szacowana częstość występowania zaburzenia zachowania we śnie REM w populacji ogólnej wynosi około 0,5-1,5%. Dane te opierają się na badaniach populacyjnych z potwierdzeniem polisomnograficznym przeprowadzonych w Hiszpanii, Szwajcarii, Japonii, Włoszech i Korei.¹ Według DSM-5-TR, częstość występowania RBD wynosi około 0,38-0,5% w populacji ogólnej.² Warto jednak zauważyć, że dwa pierwsze populacyjne badania częstości występowania, przeprowadzone w Wielkiej Brytanii i Hongkongu ponad dekadę temu, wykazały zbieżne wyniki wskazujące, że częstość występowania RBD jest stosunkowo niska i wynosi od 0,38% do 0,5% u osób starszych.³

Nowsze badania populacyjne wykazały wyższą częstość występowania RBD. Kang i współpracownicy w trzecim populacyjnym badaniu epidemiologicznym RBD podają wyższą częstość występowania RBD wynoszącą 2%. Ta różnica może być częściowo wyjaśniona kwestiami metodologicznymi (tzn. retrospektywną diagnozą RBD na podstawie stwierdzenia utraty atonii REM w PSG), ale może być również związana z próbkowaniem mniej ciężkich przypadków RBD w społeczności.⁴ Niektóre badania epidemiologiczne umieszczają ogólną częstość występowania RBD na poziomie około 2% we wszystkich grupach wiekowych.⁵

Występowanie w różnych grupach wiekowych

Zaburzenie zachowania we śnie REM dotyka przede wszystkim osoby starsze. Ryzyko wzrasta po szóstej dekadzie życia, chociaż choroba może wystąpić w każdym wieku, w tym w dzieciństwie.¹ Średni wiek wystąpienia to 61 lat.² Częstość występowania wzrasta wraz z wiekiem, osiągając około 2% u osób starszych.³⁴

W badaniach populacyjnych osób w wieku 70-89 lat odnotowano wyższe poziomy występowania (8,9%), co sugeruje, że RBD może być częstsze w starzejącej się populacji niż wcześniej sądzono.⁵ Szacunki z 2017 roku wskazują, że częstość występowania RBD wynosi 0,52% ogółem, ale wzrasta do 5-13% u osób w wieku 60-99 lat.⁶ Badanie przeprowadzone na populacji osób starszych wskazuje, że RBD potwierdzone w badaniu PSG występuje z częstością 2%, podczas gdy RWSA (REM sleep without atonia – sen REM bez atonii) bez klinicznych objawów występuje z częstością 5%.⁷

Różnice płciowe w występowaniu RBD

RBD występuje przeważnie u mężczyzn. W badaniu Olsona i współpracowników obejmującym 93 pacjentów z RBD, tylko 12 pacjentów (13%) stanowiły kobiety.¹ U osób starszych mężczyźni dziewięciokrotnie częściej niż kobiety cierpią na RBD, co odzwierciedla stosunek mężczyzn do kobiet wynoszący 9:1.²³

Zaburzenie zachowania we śnie REM jest ogólnie częstsze u mężczyzn, ale równie częste wśród mężczyzn i kobiet poniżej 50. roku życia.¹ Mimo raportowanej dominacji mężczyzn (82-88%), RBD jest powszechne również u kobiet. Pojawiają się dowody, że RBD jest bardziej rozpowszechnione u kobiet niż obecnie się uznaje.² Szwajcarskie badanie wykazało równy stosunek mężczyzn do kobiet z RBD w badaniu PSG opartym na społeczności u osób w średnim i starszym wieku.³

Związek z chorobami neurodegeneracyjnymi

Istnieje silny związek między RBD a wieloma zaburzeniami neurodegeneracyjnymi. RBD może być zwiastunem poważniejszych stanów związanych z neuropatiami alfa-synukleiny, takich jak parkinsonizm, zanik wieloukładowy lub otępienie z ciałami Lewy’ego, gdzie częstość występowania może sięgać 76-81% osób dotkniętych chorobą.¹

Choroba neurodegeneracyjna	Częstość występowania RBD
Choroba Parkinsona	30-60%
Otępienie z ciałami Lewy’ego	50-80%
Zanik wieloukładowy	80-95%

¹²

W serii przypadków, około połowa pacjentów z RBD przekształciła się w zaburzenie neurologiczne w ciągu 12 lat.¹ Prospektywne wieloośrodkowe badanie obejmujące 24 ośrodki udokumentowało roczny wskaźnik fenokonwersji na poziomie 6,3%, z 73,5% wskaźnikiem fenokonwersji po 12 latach obserwacji. Większość osób rozwinęła chorobę Parkinsona (56,5%), następnie otępienie z ciałami Lewy’ego (43,5%) i zanik wieloukładowy (4,5%).¹

Ryzyko rozwoju zdefiniowanego zespołu neurodegeneracyjnego od czasu diagnozy idiopatycznego RBD (IRBD) wynosiło 33,1% po pięciu latach, 75,7% po dziesięciu latach i 90,9% po 14 latach.² Około 97% osób z izolowanym (idiopatycznym) RBD będzie miało chorobę Parkinsona, otępienie z ciałami Lewy’ego lub zanik wieloukładowy w ciągu 14 lat od diagnozy.³

RBD jako marker ryzyka

Idiopatyczne RBD (IRBD) stanowi istotny marker ryzyka rozwoju chorób neurodegeneracyjnych. Osoby z IRBD mają znacznie wyższe ryzyko zdiagnozowania neurodegeneracyjnych zaburzeń parkinsonowskich lub otępienia w rzeczywistych warunkach klinicznych.¹ Wykrycie IRBD stwarza ważną możliwość dla klinicystów do wczesnej interwencji w schorzeniu, poprzez terapie lub modyfikację ryzyka, aby dostosować jego trajektorię lub nawet zapobiec rozwojowi chorób neurodegeneracyjnych w przyszłości.²

Badania nad IRBD mają ważne implikacje w praktyce klinicznej, w badaniu wczesnych wydarzeń patologicznych występujących w synukleinopatiach oraz dla projektowania interwencji z potencjalnymi środkami modyfikującymi przebieg choroby.¹ Badanie pacjentów z IRBD oferuje unikalną możliwość uzyskania informacji o etiologii, patogenezie i progresji prodromalnego stadium synukleinopatii.²

Wtórne przyczyny RBD

Przyczyny wtórnego RBD, szczególnie u młodszych osób, obejmują parkinsonizm, narkolepsję lub stosowanie leków przeciwdepresyjnych.¹ Częstość występowania RBD w narkolepsji była zgłaszana na poziomie nawet 36%.²³ RBD występuje u 60% przypadków narkolepsji z innym fenotypem, charakteryzującym się brakiem dominacji mężczyzn, która jest obserwowana w idiopatycznym RBD.¹

Leki przeciwdepresyjne mogą wywoływać objawy typu RBD w nawet 6% przypadków.¹²³ Inne wtórne przyczyny RBD mogą obejmować zmiany naczyniowe, guzy, choroby demielinizacyjne, zaburzenia autoimmunologiczne lub zapalne.¹

Nadzór i monitorowanie RBD

Diagnoza i badania przesiewowe

W przypadku RBD kluczowe znaczenie ma wczesna identyfikacja i diagnoza. Badanie polisomnograficzne (PSG) z oceną wideo jest obowiązkowe dla identyfikacji RBD.¹ Ze względu na stosunkowo niską częstość występowania RBD, metody badań przesiewowych i rekrutacji do badań klinicznych RBD muszą być starannie zaplanowane. Skuteczne metody przesiewowe o doskonałej dokładności będą kluczowym krokiem w badaniach modyfikujących przebieg choroby ukierunkowanych na populację z RBD.²

Bardzo ograniczone dane populacyjne dotyczące RBD są częściowo wynikiem rygorystycznych kryteriów diagnostycznych wymagających dokumentacji polisomnograficznej oraz potrzeby stosunkowo dużej wielkości próby w celu zapewnienia ważnych szacunków częstości występowania zaburzenia o stosunkowo niskiej częstości występowania.¹

Badania kliniczne i rejestry

Badania kliniczne w RBD zyskują na znaczeniu. Populacja RBD jest idealną populacją badawczą do testowania leczenia modyfikującego przebieg choroby dla synukleinopatii, ponieważ RBD reprezentuje wczesne prodromalne stadium synukleinopatii, gdy neuropatologia może być bardziej podatna na leczenie.¹

Zalecany projekt badania klinicznego modyfikującego przebieg choroby w RBD to prospektywne, randomizowane, równoległe, podwójnie zaślepione, kontrolowane placebo badanie. Ważną kwestią do rozważenia jest to, jak odróżnić potencjalny efekt objawowy (na mierzoną wartość, taką jak funkcja motoryczna) od efektu modyfikującego przebieg choroby, jeśli środek ma jakikolwiek efekt objawowy.²

Istnieje co najmniej 53 badań klinicznych dotyczących RBD, w tym 4 aktywne, 14 zakończonych i 17 rekrutujących.³ Jeśli to możliwe, pacjenci powinni być kierowani do rejestrów pacjentów z RBD i zasobów, gdzie mogą uzyskać aktualne informacje o wszelkich pojawiających się badaniach klinicznych.⁴

Nadzór nad progresją choroby

Zalecany jest regularny nadzór pod kątem objawów jawnej synukleinopatii, w tym parkinsonizmu, pogorszenia funkcji poznawczych i dysfunkcji autonomicznej, aby mogły być one niezwłocznie leczone.¹ Coroczny nadzór ze szczegółową oceną neurologiczną jest niezbędny dla wczesnego wykrywania i ostatecznego leczenia zaburzeń neurodegeneracyjnych.²

Osoby z RBD powinny również mieć regularne kontrole pod kątem choroby Parkinsona.³ Ruchy związane z RBD mogą z czasem stawać się coraz bardziej gwałtowne. Leczenie tego schorzenia jest ważne, ponieważ może zapobiec urazom w nocy.⁴

Badania nad etiologią i epidemiologią

Badania nad RBD szybko postępują, obecnie znajdują się na skrzyżowaniu medycyny snu, neurologii, psychiatrii i neuronauki. Obecne badania koncentrują się na zrozumieniu progresji neurodegeneracyjnej, włączaniu pacjentów do badań neuroprotekcyjnych oraz epidemiologii RBD, a także jej powiązań z takimi schorzeniami jak uraz mózgu, PTSD i depresja.¹

Istnieje wiele nierozwiązanych pytań dotyczących epidemiologii RBD, w tym częstość występowania prodromalnego/subklinicznego RBD, czynniki ryzyka RBD, dane normatywne RSWA, kliniczne znaczenie bezobjawowego RSWA, zmieniająca się demografia i heterogenność RBD oraz prognoza spektrum RBD w populacji ogólnej.²

Mimo że tłumaczona częstość występowania 0,5% jest prawdopodobnie niedoszacowaniem pochodzącym z badań u osób w wieku 15-100 lat, nowsze populacyjne badania u osób w wieku 70-89 lat wykazały wyższe poziomy częstości występowania (8,9%), co sugeruje, że RBD może być częstsze w starzejącej się populacji niż wcześniej sądzono.³

Formalna identyfikacja i nazwanie zaburzenia zachowania we śnie REM (RBD) nastąpiło między 1985 a 1987 rokiem, po jego historycznym rozwoju od 1966 do 1985 roku.⁴ Od tego czasu badania nad tą jednostką chorobową znacznie się rozwinęły, a zainteresowanie badaczy nad RBD stale rośnie ze względu na jego silne powiązanie z chorobami neurodegeneracyjnymi i potencjał do wczesnej interwencji.

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Materiały źródłowe

#1 REM Sleep Behavior Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534239/
The overall prevalence of spontaneous RBD is estimated to be about 1% in the general population and 2% in older individuals. […] It is more prevalent in elderly males than females with a male to female ratio of 9 to 1. […] There is a strong association of RBD with many neurodegenerative disorders. RBD can be a precursor to more serious conditions involving alpha-synuclein neuropathies such as parkinsonism, multiple system atrophy, or dementia with Lewy body where prevalence can be as high as 76% to 81% of affected individuals. […] In a case series, about half of the patients with RBD converted to a neurologic disorder within 12 years. […] Causes of secondary RBD, especially in younger individuals, include parkinsonism, narcolepsy, or the use of antidepressant medications. The prevalence of RBD in narcolepsy has been reported to be as high as 36%. […] Antidepressant medications can precipitate RBD-type symptoms in up to 6% of cases. […] Other secondary causes of RBD may include vascular lesions, tumors, demyelinating disease, autoimmune, or inflammatory disorders.
#1 Rapid eye movement sleep behavior disorder – UpToDate
https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print
Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. […] The prevalence of rapid eye movement (REM) sleep behavior disorder (RBD) is approximately 0.5 to 1.5 percent in the general population and approximately 2 percent in older adults. […] These estimates are based on community-based studies with polysomnography (PSG) confirmation conducted in Spain, Switzerland, Japan, Italy, and Korea. […] Although this translates to 40 to 100 million expected patients worldwide, the vast majority of cases go unrecognized.
#1 REM Sleep Behavior Disorder: Background, Etiology, Epidemiology
https://emedicine.medscape.com/article/1188651-overview
According to DSM-5-TR, the prevalence of REM sleep behavior disorder (RBD) is approximately 0.38%-0.5% in the general population. Prevalence in patients with psychiatric disorders is greater, possibly related to medications prescribed for psychiatric disorders. […] RBD occurs predominantly in males. In a report by Olson et al involving 93 patients with RBD, only 12 patients (13%) were female. […] Typically, RBD is a disease of elderly persons. The risk increases after the sixth decade, although the disease may occur at any age, including in childhood.
#1 Rapid eye movement sleep behavior disorder – Wikipedia
https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder
RBD prevalence as of 2017 is estimated to be 0.52% overall, and 5-13% of those aged 60 to 99. […] It is more common in males overall, but equally frequent among men and women below the age of 50. […] Almost half of those with Parkinson’s, at least 88% of those with multiple system atrophy, and about 80% of people with Lewy body dementia have RBD. […] RBD is a very strong predictor of progression to a synucleinopathy (for example, the Lewy body dementias). […] In the general population the incidence of RBD is around 0.5%, compared to the prevalence of RBD in PD patients, which has been reported to be between 38% and 60%. […] The diagnosis and symptom onset of RBD typically precedes the onset of motor or cognitive symptoms of PD by a number of years, typically ranging anywhere from 2 to 15 years prior.
#1 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management
https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/
Additionally, in regard to alpha-synucleinopathies, the main RBD risk factor involves age over 50 years old, and perhaps also male gender, although a Swiss study found an equal male-female RBD ratio in a community-based PSG study of middle-aged and older adults, as discussed. […] A strong association of RBD with diseases caused by the deposition of alpha-synuclein in neurons, such as Parkinson’s disease (PD), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB), is well-established. […] A prospective multicenter study involving 24 centers documented an annual phenoconversion rate of 6.3%, with a 73.5% phenoconversion rate after 12 years of follow-up. The majority of individuals developed PD (56.5%), followed by DLB (43.5%) and MSA (4.5%).
#1 Diagnostic Code Aids in Predicting Isolated REM Sleep Behavior Disorder in Outpatient Setting
https://www.neurologylive.com/view/diagnostic-code-proves-feasible-predicting-irbd-outpatient-setting
A recent study showed that patients with isolated REM sleep behavior disorder had a high risk of neurodegenerative parkinsonian disorders or dementia based on electronic health records. […] Overall, these findings support the feasibility of using statistical models that utilize EHR data to accurately predict iRBD in an outpatient setting. […] Patients with iRBD had a significantly higher risk of being diagnosed with neurodegenerative parkinsonian disorders or dementia in real-world settings. […] Additional findings showed that the iRBD group had a higher risk of neurodegenerative parkinsonian disorders or dementia (subdistribution HR, 10.4; 95% CI, 2.5-43.1) compared with the no iRBD group. […] Thus, healthcare data provided by EHR may offer the opportunity to identify large numbers of cases in iRBD among outpatients.
#1 Neurodegenerative Disorder Risk in Idiopathic REM Sleep Behavior Disorder: Study in 174 Patients | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089741
To estimate the risk for developing a defined neurodegenerative syndrome in a large cohort of idiopathic REM sleep behavior disorder (IRBD) patients with long follow-up. […] The risk of a defined neurodegenerative syndrome from the time of IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years. […] In a large IRBD cohort diagnosed in a tertiary referral sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA. […] Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents. […] Longitudinal studies conducted in sleep centers have shown that patients diagnosed with the idiopathic form of RBD (IRBD) may eventually be diagnosed with a neurological disorder such as Parkinson disease (PD) and dementia with Lewy bodies (DLB).
#1
https://link.springer.com/article/10.1007/s40675-016-0038-z
RBD is reported in 60 % of narcolepsy cases with a different phenotype, characterized by lack of the male preponderance that is seen in idiopathic RBD. […] Despite the reported male predominance (82-88 %), RBD is common in women. […] Because of this, there has been some emerging evidence that RBD is more prevalent in females than is currently recognized. […] Like Parkinson’s disease, many cases of RBD are familial. […] In addition, RBD is associated with various environmental, social, and behavioral factors. […] Yearly surveillance with detailed neurological evaluation is vital for early detection and eventual management of neurodegenerative disorder.
#1 REM sleep behaviour disorder: the importance of early identification in primary care | British Journal of General Practice
https://bjgp.org/content/73/726/40
GPs have a crucial role in identifying the symptoms of RBD (and other sleep disorders) and referring patients on to a neurologist or sleep specialist for further assessment. The International RBD Study Group state that an overnight sleep study (video polysomnography [vPSG]) in a sleep laboratory is mandatory for the identification of RBD. A neurologist may also assess cognitive and motor symptoms to determine any current evidence of a recognisable NDD. In the absence of an overt NDD, diagnosis of iRBD can lead to treatment (associated with improved quality of life), as well as opportunities for risk modification and clinical trial recruitment that hold potential to slow or even stop progression to NDD. […] While there remains uncertainty around iRBD and its association with different types of NDD, it is clear that iRBD is a prodrome of neurodegeneration. This means there is an opportunity for dementia risk reduction through managing potentially modifiable dementia risk factors. GPs therefore play a vital role in recognising potential iRBD and applying preventive medicine approaches with the aim of trying to alter iRBD trajectories. Furthermore, GPs will play a similarly vital role in timely referral to specialist settings when cognitive impairment and/or parkinsonism emerge.
#1 REM Sleep Behavior Disorder: From Epidemiology to Heterogeneity
https://pmc.ncbi.nlm.nih.gov/articles/PMC3700704/
The very limited population-based RBD data is in part the result of the stringent diagnostic criteria requiring polysomnographic (PSG) documentation, and the need for a relatively large sample size to ensure valid prevalence estimates of a disorder with relatively low prevalence rate. Although the modest sample size used in the report by Kang et al. might have limited the power of the study, it would be very costly to carry out video-polysomnography (vPSG) in a larger study population. A previous study by Ohayon et al. did not include PSG confirmation, and in the study by Chiu et al., only those who had positive response to a screening question of sleep-related injury underwent PSG. To lessen the resources required and thereby encourage research on RBD population-based epidemiology studies, a two-phase design with the use of valid screening tools followed by vPSG confirmation is recommended. Over the past few years, a few validated tools have been developed to assist in the screening, diagnosis, and monitoring of treatment response of RBD. They range from a simple screening questionnaire with a single question such as RBD1Q, to a composite questionnaire such as RBDQ-HK that could serve the purposes of both diagnosis and quantification of RBD severity. The availability of these valid questionnaires certainly helps in the implementation of large-scale RBD epidemiological studies.
#1 Clinical trials in REM sleep behavioural disorder: challenges and opportunities | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/91/7/740
The rapid eye movement sleep behavioural disorder (RBD) population is an ideal study population for testing disease-modifying treatments for synucleinopathies, since RBD represents an early prodromal stage of synucleinopathy when neuropathology may be more responsive to treatment. […] While clonazepam and melatonin are most commonly used as symptomatic treatments for RBD, clinical trials of symptomatic treatments are also needed to identify evidence-based treatments. […] A comprehensive framework for both disease-modifying and symptomatic treatment trials in RBD is described, including potential treatments in the pipeline, cost-effective participant recruitment and selection, study design, outcomes and dissemination of results. […] For disease-modifying treatment clinical trials, the recommended primary outcome is phenoconversion to an overt synucleinopathy, and stratification features should be used to select a study population at high risk of phenoconversion, to enable more rapid clinical trials.
#1 Clinical trials in REM sleep behavioural disorder: challenges and opportunities | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/91/7/740
For symptomatic treatment clinical trials, objective polysomnogram-based measurement of RBD-related movements and vocalisations should be the primary outcome measure, rather than subjective scales or diaries. […] Increasing awareness of RBD among the general public and medical community coupled with timely diagnosis of these diseases will facilitate progress in the development of therapeutics for RBD and associated neurodegenerative disorders. […] Regular surveillance for symptoms of an overt synucleinopathy, including parkinsonism, cognitive decline and autonomic dysfunction is recommended, so that they can be addressed promptly. […] However, there is an obvious need for clinical trials for disease-modifying treatments, and if feasible, patients should be referred to registries of patients with RBD and resources where they can obtain up-to-date information on any clinical trials that arise.
#1 REM Sleep Behavior Disorder (RBD): Personal Perspectives and Research Priorities — NAPS Consortium for REM Sleep Behavior Disorder
https://www.naps-rbd.org/blog-1/rbd-personal-perspectives-and-research-priorities-2
RBD research is progressing rapidly, now situated at the crossroads of sleep medicine, neurology, psychiatry, and neuroscience. […] Current studies focus on understanding neurodegenerative progression, patient enrollment in neuroprotective trials, and the epidemiology of RBD, as well as its links to conditions like traumatic brain injury, PTSD, and depression. […] The formal identification and naming of REM sleep behavior disorder (RBD) occurred between 1985 and 1987, following its historical development from 1966 to 1985.
#2 Rapid eye movement sleep behavior disorder – UpToDate
https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print
Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by dream-enactment behaviors that emerge during a loss of REM sleep atonia. […] The prevalence of rapid eye movement (REM) sleep behavior disorder (RBD) is approximately 0.5 to 1.5 percent in the general population and approximately 2 percent in older adults. […] These estimates are based on community-based studies with polysomnography (PSG) confirmation conducted in Spain, Switzerland, Japan, Italy, and Korea. […] Although this translates to 40 to 100 million expected patients worldwide, the vast majority of cases go unrecognized.
#2 REM Sleep Behavior Disorder: Background, Etiology, Epidemiology
https://emedicine.medscape.com/article/1188651-overview
According to DSM-5-TR, the prevalence of REM sleep behavior disorder (RBD) is approximately 0.38%-0.5% in the general population. Prevalence in patients with psychiatric disorders is greater, possibly related to medications prescribed for psychiatric disorders. […] RBD occurs predominantly in males. In a report by Olson et al involving 93 patients with RBD, only 12 patients (13%) were female. […] Typically, RBD is a disease of elderly persons. The risk increases after the sixth decade, although the disease may occur at any age, including in childhood.
#2 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd
REM sleep behavior disorder (RBD) most commonly affects people over the age of 50. The average age of onset is 61 years. It can also affect children and younger adults, but this is rare. […] Among people over age 50, men are nine times more likely than women to have RBD. […] RBD is strongly associated with certain neurodegenerative disorders. About 97% of people who have isolated (idiopathic) RBD will have Parkinsons disease, Lewy body dementia or multiple system atrophy within 14 years of diagnosis. […] Up to 36% of people with Type 1 narcolepsy have secondary (symptomatic) RBD. And about 6% of people who take antidepressants have drug-induced RBD. […] REM sleep behavior disorder (RBD) is relatively rare. It affects about 1% of the general U.S. population and affects 2% of people aged 50 or older.
#2 REM Sleep Behavior Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534239/
The overall prevalence of spontaneous RBD is estimated to be about 1% in the general population and 2% in older individuals. […] It is more prevalent in elderly males than females with a male to female ratio of 9 to 1. […] There is a strong association of RBD with many neurodegenerative disorders. RBD can be a precursor to more serious conditions involving alpha-synuclein neuropathies such as parkinsonism, multiple system atrophy, or dementia with Lewy body where prevalence can be as high as 76% to 81% of affected individuals. […] In a case series, about half of the patients with RBD converted to a neurologic disorder within 12 years. […] Causes of secondary RBD, especially in younger individuals, include parkinsonism, narcolepsy, or the use of antidepressant medications. The prevalence of RBD in narcolepsy has been reported to be as high as 36%. […] Antidepressant medications can precipitate RBD-type symptoms in up to 6% of cases. […] Other secondary causes of RBD may include vascular lesions, tumors, demyelinating disease, autoimmune, or inflammatory disorders.
#2
https://link.springer.com/article/10.1007/s40675-016-0038-z
RBD is reported in 60 % of narcolepsy cases with a different phenotype, characterized by lack of the male preponderance that is seen in idiopathic RBD. […] Despite the reported male predominance (82-88 %), RBD is common in women. […] Because of this, there has been some emerging evidence that RBD is more prevalent in females than is currently recognized. […] Like Parkinson’s disease, many cases of RBD are familial. […] In addition, RBD is associated with various environmental, social, and behavioral factors. […] Yearly surveillance with detailed neurological evaluation is vital for early detection and eventual management of neurodegenerative disorder.
#2
https://link.springer.com/article/10.1007/s40675-016-0038-z
Rapid eye movement (REM) stage of sleep in normal circumstances is composed of vivid dream mentation associated with physiological skeletal muscle paralysis and thus, quiescence of motor activity. […] REM sleep behavior disorder (RBD) is a parasomnia characterized by disinhibition of motor control facilitating dream enactment behaviors. […] The estimated prevalence of RBD in general population is 0.5 % but significantly higher in elderly and specific neurodegenerative conditions. […] An elderly general population study cites PSG-proven RBD at frequency of 2 % while RWSA in absence of clinical dream enactment of 5 %. […] In parkinsonian patients, the frequency of RBD is 30-54 %. […] The prevalence is higher in other synucleinopathies, such as 50-80 % in dementia of Lewy body and 80-95 % in multiple system atrophy.
#2 Neurodegenerative Disorder Risk in Idiopathic REM Sleep Behavior Disorder: Study in 174 Patients | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089741
To estimate the risk for developing a defined neurodegenerative syndrome in a large cohort of idiopathic REM sleep behavior disorder (IRBD) patients with long follow-up. […] The risk of a defined neurodegenerative syndrome from the time of IRBD diagnosis was 33.1% at five years, 75.7% at ten years, and 90.9% at 14 years. […] In a large IRBD cohort diagnosed in a tertiary referral sleep center, prolonged follow-up indicated that the majority of patients are eventually diagnosed with the synucleinopathies PD, DLB and less frequently MSA. […] Our findings in IRBD have important implications in clinical practice, in the investigation of the early pathological events occurring in the synucleinopathies, and for the design of interventions with potential disease-modifying agents. […] Longitudinal studies conducted in sleep centers have shown that patients diagnosed with the idiopathic form of RBD (IRBD) may eventually be diagnosed with a neurological disorder such as Parkinson disease (PD) and dementia with Lewy bodies (DLB).
#2 Diagnostic Code Aids in Predicting Isolated REM Sleep Behavior Disorder in Outpatient Setting
https://www.neurologylive.com/view/diagnostic-code-proves-feasible-predicting-irbd-outpatient-setting
Therefore, authors of the review recommended that neurologists and other clinicians diagnosing iRBD should conduct questionnaires to help them make a more „probable diagnosis” but this approach should not be used as the only diagnostic tool for iRBD. […] Thus, the detection of iRBD presents an important opportunity for clinicians to intervene early in the condition, through therapies or risk modification, to adjust its trajectory or even prevent the development of neurodegenerative diseases in the future.
#2 Neurodegenerative Disorder Risk in Idiopathic REM Sleep Behavior Disorder: Study in 174 Patients | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089741
Our findings indicate that there is a strong and specific association of IRBD with PD and DLB, and that this parasomnia can be considered in most cases a prodromal manifestation. […] The investigation of patients with IRBD offers a unique opportunity to obtain information of the aetiology, pathogenesis and progression of the prodromal stage of the synucleinopathies. […] Our study shows that a majority of IRBD patients with prolonged follow-up are diagnosed with the synucleinopathies PD, DLB and MSA.
#2 Clinical trials in REM sleep behavioural disorder: challenges and opportunities | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/91/7/740
Study participants for clinical trials in RBD should have RBD based on the criteria established by the International Classification of Sleep Disorders, the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition or the American Academy of Sleep Medicine Manual for the Scoring of Sleep and Associated Events. […] Given the relatively low prevalence of RBD, screening and recruitment methods for RBD clinical trials must be carefully planned. […] Effective screening methods with excellent accuracy will be a critical step in disease-modifying trials targeting the RBD population. […] The recommended design for a disease-modifying clinical trial in RBD is a prospective, randomised, parallel-group, double-blinded, placebo-controlled trial. […] An important issue to consider is how to distinguish a potential symptomatic effect (on the outcome measure, such as motor function) from a disease-modifying effect, if the agent has any symptomatic effect. […] Overall, the recommended design for a disease-modifying clinical trial in RBD is a prospective, randomised, parallel-group, double-blinded, placebo-controlled trial.
#2 REM Sleep Behavior Disorder: From Epidemiology to Heterogeneity
https://pmc.ncbi.nlm.nih.gov/articles/PMC3700704/
In summary, there are still many unanswered questions about RBD epidemiology, including the prevalence of prodromal/subclinical RBD, risk factors of RBD, normative data of RSWA, clinical significance of asymptomatic RSWA, changing demographics and heterogeneity of RBD, and prognosis of RBD spectrum in the general population. Given the availability of validated screening tools, increasing data on the quantification of RSWA, and the availability of international collaborative effort in RBD research, further developments in epidemiological research of RBD can be anticipated.
#3 REM Sleep Behavior Disorder: From Epidemiology to Heterogeneity
https://pmc.ncbi.nlm.nih.gov/articles/PMC3700704/
Epidemiology of REM Sleep Behavior Disorder (RBD) […] Compared to other sleep disorders such as obstructive sleep apnea syndrome and insomnia, the population-based epidemiological data on RBD are relatively sparse. The only two population-based prevalence studies, which were carried out in United Kingdom and Hong Kong more than a decade ago, had convergent findings that the prevalence of RBD is relatively low with a rate of 0.38% to 0.5% in elderly population. In this issue of SLEEP, Kang and colleagues present the third population-based epidemiologic study of RBD. They report a higher prevalence of RBD of 2%. This paper, together with the two previous population-based studies and other clinical epidemiological studies of RBD, document an interesting evolution and the gradual conceptual shift in RBD epidemiology over the past two decades.
#3 REM Sleep Behavior Disorder – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK534239/
The overall prevalence of spontaneous RBD is estimated to be about 1% in the general population and 2% in older individuals. […] It is more prevalent in elderly males than females with a male to female ratio of 9 to 1. […] There is a strong association of RBD with many neurodegenerative disorders. RBD can be a precursor to more serious conditions involving alpha-synuclein neuropathies such as parkinsonism, multiple system atrophy, or dementia with Lewy body where prevalence can be as high as 76% to 81% of affected individuals. […] In a case series, about half of the patients with RBD converted to a neurologic disorder within 12 years. […] Causes of secondary RBD, especially in younger individuals, include parkinsonism, narcolepsy, or the use of antidepressant medications. The prevalence of RBD in narcolepsy has been reported to be as high as 36%. […] Antidepressant medications can precipitate RBD-type symptoms in up to 6% of cases. […] Other secondary causes of RBD may include vascular lesions, tumors, demyelinating disease, autoimmune, or inflammatory disorders.
#3 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd
REM sleep behavior disorder (RBD) most commonly affects people over the age of 50. The average age of onset is 61 years. It can also affect children and younger adults, but this is rare. […] Among people over age 50, men are nine times more likely than women to have RBD. […] RBD is strongly associated with certain neurodegenerative disorders. About 97% of people who have isolated (idiopathic) RBD will have Parkinsons disease, Lewy body dementia or multiple system atrophy within 14 years of diagnosis. […] Up to 36% of people with Type 1 narcolepsy have secondary (symptomatic) RBD. And about 6% of people who take antidepressants have drug-induced RBD. […] REM sleep behavior disorder (RBD) is relatively rare. It affects about 1% of the general U.S. population and affects 2% of people aged 50 or older.
#3 SciELO Brasil – REM sleep behavior disorder: update on diagnosis and management REM sleep behavior disorder: update on diagnosis and management
https://www.scielo.br/j/anp/a/NyW6ysTnXjDj8kRrWFKmyLp/
Additionally, in regard to alpha-synucleinopathies, the main RBD risk factor involves age over 50 years old, and perhaps also male gender, although a Swiss study found an equal male-female RBD ratio in a community-based PSG study of middle-aged and older adults, as discussed. […] A strong association of RBD with diseases caused by the deposition of alpha-synuclein in neurons, such as Parkinson’s disease (PD), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB), is well-established. […] A prospective multicenter study involving 24 centers documented an annual phenoconversion rate of 6.3%, with a 73.5% phenoconversion rate after 12 years of follow-up. The majority of individuals developed PD (56.5%), followed by DLB (43.5%) and MSA (4.5%).
#3 REM sleep behavior disorder: Symptoms, causes, and treatment
https://www.medicalnewstoday.com/articles/247730
While it can occur at any age, men over the age of 50 years most commonly have Rapid eye movement (REM) sleep behavior disorder (RBD). […] About 38 percent of people with RBD might develop other neurological diseases such as Parkinsons disease, Lewy body dementia or multiple systems atrophy. Sometimes the RBD can occur 50 years prior to symptoms of other neurological diseases. […] Studies suggest that antidepressant medications trigger RBD in up to 6 percent of users. […] For an accurate diagnosis, doctors at a dedicated sleep center with experience in dealing with parasomnias should examine a person who has symptoms of RBD. […] Treatment for RBD is usually successful. Managing the condition often involves prescribed medication and by adapting sleep habits. […] The person with RBD should also have regular follow-up checks for Parkinsons disease.
#3 Top Published Expert Doctors for REM Sleep Behavior Disorder
https://www.findexpertmd.com/d/REM_Sleep_Behavior_Disorder?physician=physician
461 top medical experts on REM Sleep Behavior Disorder across 29 countries and 30 U.S. states, including 326 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] REM Sleep Behavior Disorder: A disorder characterized by episodes of vigorous and often violent motor activity during REM sleep (sleep, REM). The affected individual may inflict self injury or harm others, and is difficult to awaken from this condition. Episodes are usually followed by a vivid recollection of a dream that is consistent with the aggressive behavior. This condition primarily affects adult males. […] Clinical Trials: at least 53 including 4 Active, 14 Completed, 17 Recruiting.
#3 REM sleep behaviour disorder More than just a parasomnia
https://www.racgp.org.au/afp/2013/november/rem-sleep-behaviour-disorder
In REM sleep behaviour disorder (RBD), there is a loss of this muscle atonia where patients are able to act out their dreams, which can result in serious injury to the patient and their bed partner. […] The exact prevalence and incidence of RBD in the community are currently unknown. Although RBD has been most commonly reported in males over the age of 50 years, there is growing evidence it can occur frequently in women but exists in a more subtle form. […] The oft-quoted prevalence of 0.5% is probably an underestimation derived from studies in subjects aged 15-100 years old. […] Indeed, more recent population-based studies in subjects aged 70-89 years old have reported higher prevalence levels (8.9%), suggesting that it may be more frequent in the ageing population than previously thought. […] Younger-onset RBD (50 years) occurs more frequently in patients with narcolepsy and in those using antidepressant medications.
#4 REM Sleep Behavior Disorder: From Epidemiology to Heterogeneity
https://pmc.ncbi.nlm.nih.gov/articles/PMC3700704/
Kang and colleagues find a higher RBD prevalence than the existing literature. Although the result could be partially explained by the methodological issue (i.e., retrospective diagnosis of RBD as based on the finding of loss of REM atonia in PSG), it might also be related to the sampling of less severe RBD in the community. Previous epidemiologic studies mainly screened for the presence of RBD by the most conspicuous dream-enacting behavioral (DEB) symptom of RBD (sleep-related injury or violent behavior). However, as not all RBD cases will present with such an iceberg dramatic symptom, milder forms of RBD could have been missed. The report by Kang et al. suggests that RBD could have a higher prevalence than previously assumed. Since RBD is regarded as a precursor of neurodegeneration, the identification of mild forms of RBD could potentially provide a more valid estimate of the range of RBD severity, as well as information on risk factors for neurodegeneration, which in turn could provide neurotherapeutic opportunities.
#4 REM Sleep Behavior Disorder: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd
REM sleep behavior disorder (RBD) most commonly affects people over the age of 50. The average age of onset is 61 years. It can also affect children and younger adults, but this is rare. […] Among people over age 50, men are nine times more likely than women to have RBD. […] RBD is strongly associated with certain neurodegenerative disorders. About 97% of people who have isolated (idiopathic) RBD will have Parkinsons disease, Lewy body dementia or multiple system atrophy within 14 years of diagnosis. […] Up to 36% of people with Type 1 narcolepsy have secondary (symptomatic) RBD. And about 6% of people who take antidepressants have drug-induced RBD. […] REM sleep behavior disorder (RBD) is relatively rare. It affects about 1% of the general U.S. population and affects 2% of people aged 50 or older.
#4 Clinical trials in REM sleep behavioural disorder: challenges and opportunities | Journal of Neurology, Neurosurgery & Psychiatry
https://jnnp.bmj.com/content/91/7/740
For symptomatic treatment clinical trials, objective polysomnogram-based measurement of RBD-related movements and vocalisations should be the primary outcome measure, rather than subjective scales or diaries. […] Increasing awareness of RBD among the general public and medical community coupled with timely diagnosis of these diseases will facilitate progress in the development of therapeutics for RBD and associated neurodegenerative disorders. […] Regular surveillance for symptoms of an overt synucleinopathy, including parkinsonism, cognitive decline and autonomic dysfunction is recommended, so that they can be addressed promptly. […] However, there is an obvious need for clinical trials for disease-modifying treatments, and if feasible, patients should be referred to registries of patients with RBD and resources where they can obtain up-to-date information on any clinical trials that arise.
#4 REM sleep behavior disorder: Symptoms, causes, and treatment
https://www.medicalnewstoday.com/articles/247730
The movements involved in RBD may grow more violent over time. Treatment for this condition is important, as it can prevent injuries during the night-time. […] A dedicated sleep center should be able to diagnose the condition. Treatment includes medication and lifestyle adjustments to reduce the risk of injury during sleep hours.
#4 REM Sleep Behavior Disorder (RBD): Personal Perspectives and Research Priorities — NAPS Consortium for REM Sleep Behavior Disorder
https://www.naps-rbd.org/blog-1/rbd-personal-perspectives-and-research-priorities-2
RBD research is progressing rapidly, now situated at the crossroads of sleep medicine, neurology, psychiatry, and neuroscience. […] Current studies focus on understanding neurodegenerative progression, patient enrollment in neuroprotective trials, and the epidemiology of RBD, as well as its links to conditions like traumatic brain injury, PTSD, and depression. […] The formal identification and naming of REM sleep behavior disorder (RBD) occurred between 1985 and 1987, following its historical development from 1966 to 1985.
#5
https://eurekaselect.com/public/chapter/16751
REM Sleep Behavior Disorder (RBD), often known as injurious dream enacting behaviors secondary to loss of atonia in REM sleep, was first described in 1986. […] Epidemiological studies have placed the overall prevalence of RBD around 2% across all age groups. […] Sleep-related injurious behaviors are common in RBD, especially in men, explaining the higher proportion of males diagnosed with RBD.
#5 REM sleep behaviour disorder More than just a parasomnia
https://www.racgp.org.au/afp/2013/november/rem-sleep-behaviour-disorder
In REM sleep behaviour disorder (RBD), there is a loss of this muscle atonia where patients are able to act out their dreams, which can result in serious injury to the patient and their bed partner. […] The exact prevalence and incidence of RBD in the community are currently unknown. Although RBD has been most commonly reported in males over the age of 50 years, there is growing evidence it can occur frequently in women but exists in a more subtle form. […] The oft-quoted prevalence of 0.5% is probably an underestimation derived from studies in subjects aged 15-100 years old. […] Indeed, more recent population-based studies in subjects aged 70-89 years old have reported higher prevalence levels (8.9%), suggesting that it may be more frequent in the ageing population than previously thought. […] Younger-onset RBD (50 years) occurs more frequently in patients with narcolepsy and in those using antidepressant medications.
#6 Rapid eye movement sleep behavior disorder – Wikipedia
https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep_behavior_disorder
RBD prevalence as of 2017 is estimated to be 0.52% overall, and 5-13% of those aged 60 to 99. […] It is more common in males overall, but equally frequent among men and women below the age of 50. […] Almost half of those with Parkinson’s, at least 88% of those with multiple system atrophy, and about 80% of people with Lewy body dementia have RBD. […] RBD is a very strong predictor of progression to a synucleinopathy (for example, the Lewy body dementias). […] In the general population the incidence of RBD is around 0.5%, compared to the prevalence of RBD in PD patients, which has been reported to be between 38% and 60%. […] The diagnosis and symptom onset of RBD typically precedes the onset of motor or cognitive symptoms of PD by a number of years, typically ranging anywhere from 2 to 15 years prior.
#7
https://link.springer.com/article/10.1007/s40675-016-0038-z
Rapid eye movement (REM) stage of sleep in normal circumstances is composed of vivid dream mentation associated with physiological skeletal muscle paralysis and thus, quiescence of motor activity. […] REM sleep behavior disorder (RBD) is a parasomnia characterized by disinhibition of motor control facilitating dream enactment behaviors. […] The estimated prevalence of RBD in general population is 0.5 % but significantly higher in elderly and specific neurodegenerative conditions. […] An elderly general population study cites PSG-proven RBD at frequency of 2 % while RWSA in absence of clinical dream enactment of 5 %. […] In parkinsonian patients, the frequency of RBD is 30-54 %. […] The prevalence is higher in other synucleinopathies, such as 50-80 % in dementia of Lewy body and 80-95 % in multiple system atrophy.