{ "schemaVersion": 2, "eyebrow": "Sleep Medicine", "title": "REM Sleep Behavior Disorder", "summary": "Confirm REM sleep behavior disorder with attended video polysomnography demonstrating REM sleep without atonia, exclude mimics and medication effects, immediately mitigate injury risk, and distinguish isolated disease from secondary RBD because isolated RBD confers substantial long-term synucleinopathy risk.", "seoDescription": "Physician guide to REM sleep behavior disorder: video-polysomnographic diagnosis, mimics, injury prevention, treatment options, and synucleinopathy surveillance.", "clinicalQuestion": "How should clinicians confirm, treat, and longitudinally manage suspected REM sleep behavior disorder in adults?", "specialty": "Sleep Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "REM sleep behavior disorder", "RBD", "dream enactment", "REM sleep without atonia", "video polysomnography", "isolated RBD", "synucleinopathy" ], "keyTakeaways": [ "Do not diagnose RBD from history or a questionnaire alone; diagnosis requires recurrent sleep-related vocalization or complex behavior plus REM sleep without atonia on attended in-laboratory video polysomnography. [13][15][22]", "Treat injury exposure immediately while diagnostic testing proceeds: recurrent dream enactment can cause injury to the patient or bed partner, including life-threatening injury. [6][12]", "Before labeling RBD isolated, identify obstructive sleep apnea, nocturnal seizures, NREM parasomnias, medication or substance effects, and psychiatric or dissociative mimics. [13][15][17]", "For isolated or secondary RBD, the AASM suggests clonazepam or immediate-release melatonin; pramipexole is an additional suggested option for isolated RBD. [11]", "Counsel patients with polysomnography-confirmed isolated RBD that it is a high-risk prodromal synucleinopathy state: one prospective cohort reported cumulative phenoconversion of 16.3% at 3 years, 27.6% at 5 years, and 57.2% at 10 years. [4]" ], "sections": [ { "id": "first-visit-triage", "eyebrow": "Immediate action", "heading": "Protect against sleep-related injury before diagnostic confirmation", "intro": "The first management decision is whether dream enactment creates an imminent injury hazard.", "paragraphs": [ "At the initial visit, document event frequency, violent or high-amplitude behaviors, falls from bed, injuries, weapons or dangerous furniture near the bed, and bed-partner exposure. Recurrent RBD behaviors may injure the patient or bed partner and have been associated with life-threatening injury; institute environmental protection at the same visit rather than waiting for polysomnography. [6][12][16]", "Take a collateral history from the bed partner when available. History alone has only moderate interobserver reliability for sleep-related injuries and can miss RBD; obtain a detailed description of vocalization, punching, kicking, running, dream recall, timing within the sleep period, and whether events occur in association with gasping or witnessed apneas. [14][15]" ], "bullets": [ "Remove weapons and potentially hazardous bedside objects; create a protected sleep environment for the patient and bed partner. [6][12]", "Expedite sleep-medicine evaluation and attended video polysomnography when behaviors have caused injury, threaten a bed partner, or are recurrent and disruptive. [14][15]", "Do not assume apparently typical dream enactment is RBD when events are temporally linked to respiratory arousals, stereotyped motor spells, or NREM confusional behaviors. [15][17]" ], "subsections": [], "table": { "caption": "Initial triage decisions in suspected RBD. [6][12][15][17]", "columns": [ "Clinical finding", "Interpretation", "Next action" ], "rows": [ [ "Prior injury, near-injury, bed fall, or bed-partner threat", "Immediate safety risk from nocturnal motor behavior. [6][12]", "Implement bedroom safety measures immediately and expedite attended video polysomnography. [6][12][15]" ], [ "Gasping, snoring, witnessed apnea, or behavior after respiratory arousal", "Obstructive sleep apnea can produce pseudo-RBD behavior. [15][17]", "Use polysomnography to assess sleep-disordered breathing and determine whether behaviors are respiratory-event related. [15]" ], [ "Stereotyped recurrent spells or concern for epilepsy", "Nocturnal seizures remain a diagnostic mimic. [15][17]", "Obtain attended video polysomnography with EEG recording and interpret events in relation to sleep stage and epileptiform activity. [15][22]" ] ] } }, { "id": "confirm-the-diagnosis", "eyebrow": "Diagnostic standard", "heading": "Use attended video polysomnography to establish RBD", "intro": "The diagnostic endpoint is REM sleep without atonia linked to a compatible clinical syndrome.", "paragraphs": [ "Order an attended in-laboratory video polysomnogram, not a home sleep test, when RBD is suspected. The required physiologic finding is REM sleep without atonia (RSWA): increased tonic chin electromyographic activity and/or excessive phasic chin or limb electromyographic activity during REM sleep. EEG, respiratory channels, limb EMG, and synchronized video permit event staging and evaluation for sleep-disordered breathing, seizures, periodic limb movements, and alternative parasomnias. [13][15][22]", "Apply ICSD-3 criteria: recurrent sleep-related vocalization and/or complex motor behavior; behaviors documented during REM sleep or clinically presumed to occur in REM sleep; polysomnographic RSWA; and no better explanation from another sleep disorder, mental disorder, medication, or substance use. RSWA alone is not RBD because it can be an incidental finding, including in patients receiving antidepressants. [13][17]", "If no overt dream-enactment event occurs during the study, RSWA can still establish the required polysomnographic component in a patient with a convincing clinical history. Conversely, do not diagnose RBD from video behavior without RSWA or when movements are better explained by respiratory events or periodic limb movements. [14][15]" ], "bullets": [ "Request chin and limb EMG assessment during REM sleep; standard chin and anterior tibialis channels may be supplemented with flexor digitorum brevis and biceps brachii when upper-extremity behaviors predominate. [22]", "Interpret isolated RSWA separately from clinical RBD; it has prognostic relevance but does not fulfill RBD criteria without repeated compatible behaviors. [13][16][17]", "Use screening instruments only to identify patients for formal evaluation; current diagnostic criteria still require polysomnographic demonstration of RSWA. [21][24]" ], "subsections": [ { "heading": "Polysomnographic interpretation", "paragraphs": [ "AASM scoring standards cited for RSWA include excessive phasic activity in at least five 3-second mini-epochs within a 30-second REM epoch, or excessive tonic chin EMG activity lasting more than 15 seconds. These scoring findings support RSWA but must be interpreted with the clinical history and exclusion of competing explanations. [17]" ], "bullets": [] } ], "table": { "caption": "Findings that separate RBD from common dream-enactment mimics. [13][15][17][22]", "columns": [ "Condition", "Key discriminator", "Diagnostic consequence" ], "rows": [ [ "RBD", "Compatible recurrent vocalization or complex motor behavior with RSWA on video polysomnography. [13][22]", "Classify as isolated or secondary only after exclusion of medication, substance, sleep, psychiatric, and neurologic alternatives. [13]" ], [ "Obstructive sleep apnea with pseudo-RBD", "Atypical arousals from REM sleep associated with sleep-disordered breathing; RSWA may occur in this context. [15][17]", "Identify and address sleep-disordered breathing before attributing behavior to isolated RBD. [15]" ], [ "NREM parasomnia", "Sleepwalking and sleep terrors are recognized mimics rather than evidence of REM parasomnia. [17]", "Use sleep-stage correlation on video polysomnography; absence of required RSWA argues against RBD. [13][17]" ], [ "Nocturnal seizure", "Epilepsy may mimic dream enactment behavior. [15][17]", "Assess EEG and video correlation during attended polysomnography; do not diagnose RBD until epileptiform activity is excluded. [15][22]" ], [ "Medication-associated RSWA or RBD-like behavior", "Antidepressant therapy can be associated with RSWA; diagnostic criteria require that medication or substance use not better explain the disturbance. [13][17]", "Perform medication and substance review before assigning isolated RBD. [13]" ] ] } }, { "id": "determine-etiologic-context", "eyebrow": "Etiologic branch", "heading": "Separate isolated RBD from secondary and medication-associated disease", "intro": "Etiologic classification changes counseling, treatment context, and neurologic follow-up.", "paragraphs": [ "After PSG confirmation, review medication and substance exposure and assess for comorbid sleep and neurologic disorders. RBD is interlinked with narcolepsy-cataplexy, neurologic disease, antidepressants, beta blockers, and other medical pharmacotherapies; ICSD-3 criteria require that another sleep disorder, mental disorder, medication, or substance use not better explain the presentation. [12][13]", "In patients with established Parkinson disease, dementia with Lewy bodies, or multiple system atrophy, treat RBD as secondary to a medical condition and coordinate symptom management with the neurologic care plan. In patients without overt parkinsonism or dementia after exclusion of an alternative explanation, designate the condition isolated RBD and initiate longitudinal surveillance for synucleinopathy. [3][4][11][19]", "Assess for emerging motor and cognitive disease at baseline and follow-up rather than relying on a single normal neurologic examination. In longitudinal iRBD cohorts, motor measures and Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III changes accelerated approximately 4 years before phenoconversion, supporting repeated clinical assessment when subtle gait, bradykinetic, cognitive, or perceptual symptoms emerge. [20]" ], "bullets": [ "Medication review should specifically include antidepressants and beta blockers, which are reported in association with RBD or RSWA. [12][13][17]", "Screen for parkinsonism, cognitive decline, visual or minor hallucinations, and gait change during follow-up; these features may signal progression toward a synucleinopathy phenotype. [3][10][20]", "Refer or co-manage with neurology when parkinsonism, cognitive impairment, hallucinations, autonomic complaints, or progressive gait dysfunction is present. Phenoconversion outcomes include Parkinson disease, dementia with Lewy bodies, and less commonly multiple system atrophy. [3][4][10]" ], "subsections": [], "table": { "caption": "Etiologic classification after RBD confirmation. [3][4][11][12][13][19]", "columns": [ "Clinical context", "Classification", "Management implication" ], "rows": [ [ "No overt neurodegenerative disorder and no alternative medication, substance, psychiatric, or sleep explanation", "Isolated RBD. [13][19]", "Provide synucleinopathy-risk counseling and longitudinal neurologic surveillance while treating behavior-related injury risk. [4][19]" ], [ "Parkinson disease or another medical condition associated with RBD", "Secondary RBD due to medical condition. [11]", "Treat RBD symptoms and coordinate management with the underlying neurologic disorder. [11]" ], [ "Antidepressant or other relevant drug exposure plausibly explains symptoms or RSWA", "Medication-associated disturbance rather than isolated RBD unless evaluation supports an independent diagnosis. [12][13][17]", "Reassess medication necessity and diagnostic classification; do not assign isolated RBD until alternative explanation is addressed. [13]" ], [ "Untreated sleep-disordered breathing with REM-associated behaviors", "Potential pseudo-RBD. [15][17]", "Evaluate and treat the breathing disorder, then reassess residual behaviors and RSWA. [15]" ] ] } }, { "id": "symptomatic-treatment", "eyebrow": "Treatment", "heading": "Select symptom therapy after safety intervention and diagnostic classification", "intro": "Drug treatment reduces disruptive dream enactment but does not replace environmental risk reduction.", "paragraphs": [ "For adults with isolated RBD, the AASM suggests clonazepam, immediate-release melatonin, or pramipexole versus no treatment. The guideline recommendations are conditional; choose among agents according to patient-specific adverse-effect vulnerability, comorbidity, concomitant medications, and the severity and frequency of injurious nocturnal behavior. [11]", "For secondary RBD due to a medical condition, the AASM suggests clonazepam or immediate-release melatonin; transdermal rivastigmine is also suggested for secondary RBD due to Parkinson disease. For isolated RBD with mild cognitive impairment, transdermal rivastigmine is a suggested option. [11]", "Do not use deep brain stimulation as RBD treatment; the AASM guideline suggests against it. Sodium oxybate has been studied in a small randomized phase 2 trial in treatment-resistant iRBD and Parkinson disease-associated RBD, but adverse events leading to withdrawal included anxiety and dizziness, and serious events included myoclonic episodes, sleep terror, and suicidal ideation; it should not displace guideline-supported first-line options. [7][11]" ], "bullets": [ "Use immediate-release rather than prolonged-release melatonin when following the AASM RBD recommendation. [11]", "Reassess episode frequency, injury or near-injury, bed-partner impact, adverse effects, and adherence to bedroom safety measures after starting or changing therapy. [6][11][12]", "Treat coexisting obstructive sleep apnea as part of the RBD management plan because sleep-disordered breathing can mimic or complicate nocturnal behaviors. [12][15][17]" ], "subsections": [ { "heading": "What the guideline supports", "paragraphs": [ "The AASM guideline provides treatment recommendations but the retrieved guideline excerpt does not specify drug doses. Prescribe and titrate clonazepam, immediate-release melatonin, pramipexole, or transdermal rivastigmine using current product labeling, comorbidity review, and individualized follow-up. [11]" ], "bullets": [] } ], "table": { "caption": "AASM-suggested pharmacologic options by RBD context. [11]", "columns": [ "RBD context", "Suggested options", "Selection note" ], "rows": [ [ "Isolated RBD", "Clonazepam; immediate-release melatonin; pramipexole. [11]", "Match selection to adverse-effect risk, concurrent drugs, comorbidities, and injury burden; maintain environmental protection. [6][11]" ], [ "Isolated RBD with mild cognitive impairment", "Transdermal rivastigmine. [11]", "Use as a guideline-suggested option in this specific population. [11]" ], [ "Secondary RBD due to medical condition", "Clonazepam; immediate-release melatonin. [11]", "Address the underlying medical condition and coexisting sleep disorders concurrently. [11][15]" ], [ "Secondary RBD due to Parkinson disease", "Transdermal rivastigmine. [11]", "Coordinate with Parkinson disease management and monitor cognitive and neuropsychiatric status. [11]" ] ] } }, { "id": "prognosis-and-follow-up", "eyebrow": "Longitudinal care", "heading": "Counsel confirmed isolated RBD as a prodromal synucleinopathy state", "intro": "Prognostic counseling should be explicit, individualized, and paired with planned clinical surveillance.", "paragraphs": [ "Explain that polysomnography-confirmed isolated RBD is a strong prodromal manifestation of alpha-synucleinopathies. In a prospective cohort of 141 patients, cumulative incidence of phenoconversion to Parkinson disease, dementia with Lewy bodies, or multiple system atrophy was 16.30% at 3 years, 27.57% at 5 years, and 57.20% at 10 years; other longitudinal literature reports that risk can reach approximately 80% over longer follow-up. [3][4][16]", "Frame the outcome spectrum accurately: Parkinson disease and dementia with Lewy bodies are the most common phenoconversion outcomes and occur with roughly equal risk in one summary, whereas multiple system atrophy is less common. In the 141-person prospective cohort, 36 patients converted: 21 to Parkinson disease, 11 to dementia with Lewy bodies, and 4 to multiple system atrophy. [3][4]", "At follow-up, specifically ask about new bradykinesia, rigidity, tremor, gait change, cognitive decline, hallucinations, and autonomic symptoms, and perform a focused neurologic examination. Escalate to neurology when these develop; no disease-modifying or neuroprotective therapy is established in the cited clinical materials, and observational cohorts are being developed to facilitate future trials. [19][20]" ], "bullets": [ "Avoid reassuring patients that injury-focused treatment changes neurodegenerative risk; symptomatic RBD therapy and bedroom safety address behavior-related harm, not proven prevention of phenoconversion. [6][11][19]", "Revisit prognostic counseling as neurologic symptoms evolve, because phenoconversion may follow either parkinsonism-first or dementia-first trajectories. [3]", "Consider discussion of research participation at centers studying prodromal synucleinopathy when patients seek risk stratification or trial access. [19]" ], "subsections": [], "table": { "caption": "Phenoconversion data for counseling patients with isolated RBD. [3][4][20]", "columns": [ "Time or feature", "Observed finding", "Clinical use" ], "rows": [ [ "3 years after baseline in one prospective iRBD cohort", "Cumulative phenoconversion incidence: 16.30%. [4]", "Communicate meaningful near-term risk while avoiding deterministic predictions." ], [ "5 years after baseline in the same cohort", "Cumulative phenoconversion incidence: 27.57%. [4]", "Plan continued neurologic surveillance even when initial examination is normal." ], [ "10 years after baseline in the same cohort", "Cumulative phenoconversion incidence: 57.20%. [4]", "Support long-horizon counseling regarding Parkinson disease, dementia with Lewy bodies, and multiple system atrophy." ], [ "Approximately 4 years before phenoconversion", "Motor and quantitative motor changes accelerated in a longitudinal iRBD cohort. [20]", "Investigate evolving gait or motor complaints rather than dismissing subtle change." ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Narcolepsy - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/428", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 2, "title": "Phenoconversion from Idiopathic REM Sleep Behavior Disorder | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/nejm-jw.NA54636", "authors": "clinician.nejm.org", "host": "clinician.nejm.org" }, { "number": 3, "title": "Association of wearable sensor-based gait analysis with phenoconversion trajectories in idiopathic REM sleep behavior disorder | npj Parkinson's Disease", "detail": "nature.com", "url": "https://nature.com/articles/s41531-026-01334-7", "authors": "nature.com", "host": "nature.com" }, { "number": 4, "title": "Factors associated with phenoconversion of idiopathic rapid eye movement sleep behavior disorder: a prospective study | npj Parkinson's Disease", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41531-024-00856-2", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 5, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1389945713001755", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 6, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1389945713001755", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Sodium oxybate in treatment-resistant rapid-eye-movement sleep behavior disorder | SLEEP | Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/sleep/article/46/8/zsad103/7117585", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 8, "title": "REM Sleep Parasomnias in Adults: REM Sleep Behavior Disorder, Isolated Sleep Paralysis, and Nightmare Disorders - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/B978143771703710043X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 9, "title": "Clinical and genetical study of a familial form of REM sleep behavior disorder - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0303846718303974", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 10, "title": "Minor hallucinations in isolated rapid eye movement sleep behavior disorder indicative of early phenoconversion: A preliminary study - Sumi - 2022 - Acta Neurologica Scandinavica - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13555", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com" }, { "number": 11, "title": "Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/36515157", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 12, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/8783206", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 13, "title": "Differential Impact on Isolated REM Sleep without Atonia by Varying Antidepressant Therapies - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8112624", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 14, "title": "Diagnosis of REM Sleep Behavior Disorder by Video-Polysomnographic Study: Is One Night Enough? 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Narcolepsy - Symptoms, diagnosis and treatment | BMJ Best Practice US", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-gb/428", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "### Definition\n\nNarcolepsy is a chronic sleep boundary disorder that affects the control of sleep and wakefulness with rapid eye movement sleep intrusion into the wake state. In its classic form, it is characterized by a tetrad of excessive daytime sleepiness, cataplexy (generalized muscle weakness ", "score": 0.6208291 }, { "number": 2, "title": "Phenoconversion from Idiopathic REM Sleep Behavior Disorder | NEJM Clinician", "detail": "clinician.nejm.org", "url": "https://clinician.nejm.org/nejm-jw.NA54636", "authors": "clinician.nejm.org", "host": "clinician.nejm.org", "snippet": "###### Topics\n\nRapid eye movement sleep behavior disorder (RBD) may occur years before onset of cognitive and motor symptoms in synucleinopathies such as Parkinson disease (PD), dementia with Lewy bodies (DLB), or multiple system atrophy (MSA). Researchers conducted this multicenter, prospective coh", "score": 0.8703443 }, { "number": 3, "title": "Association of wearable sensor-based gait analysis with phenoconversion trajectories in idiopathic REM sleep behavior disorder | npj Parkinson's Disease", "detail": "nature.com", "url": "https://nature.com/articles/s41531-026-01334-7", "authors": "nature.com", "host": "nature.com", "snippet": "Idiopathic REM sleep behavior disorder (iRBD) has been identified as one of the earliest and most specific prodromal manifestations of α-synucleinopathies. Longitudinal cohort studies have shown that individuals with iRBD have a cumulative risk of phenoconversion that increases over time, reaching u", "score": 0.88705814 }, { "number": 4, "title": "Factors associated with phenoconversion of idiopathic rapid eye movement sleep behavior disorder: a prospective study | npj Parkinson's Disease", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41531-024-00856-2", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal muscle atonia and dream enactment during REM sleep1.\"). Idiopathic or isolated RBD (iRBD) is currently recognized as a critical prodromal stage with a high risk of progressing to α-synucleinopathie", "score": 0.8729662 }, { "number": 5, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1389945713001755", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Rapid eye movement sleep behavior disorder (RBD) is a complex multidimensional parasomnia that frequently is interlinked with other sleep disorders and their therapies (e.g., narcolepsy-cataplexy), a wide range of neurologic disorders, and the pharmacotherapy of psychiatric and medical disorders (e.", "score": 0.8095324 }, { "number": 6, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1389945713001755", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Original Article Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group. We aimed to provide a consensus statement by th", "score": 0.7445268 }, { "number": 7, "title": "Sodium oxybate in treatment-resistant rapid-eye-movement sleep behavior disorder | SLEEP | Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/sleep/article/46/8/zsad103/7117585", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Treatment of REM Sleep Behavior Disorder (RBD) With Sodium Oxybate. We conducted a randomized, double-blind, placebo-controlled, parallel-group, single-center, phase 2 clinical trial to evaluate the efficacy, and tolerance of nightly SXB in adult patients with iRBD and PD-RBD. We tested the primary ", "score": 0.709684 }, { "number": 8, "title": "REM Sleep Parasomnias in Adults: REM Sleep Behavior Disorder, Isolated Sleep Paralysis, and Nightmare Disorders - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/B978143771703710043X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: REM Sleep Parasomnias in Adults: REM Sleep Behavior Disorder, Isolated Sleep Paralysis, and Nightmare Disorders - ScienceDirect\nThese findings carry important clinical and research implications in the convergent fields of sleep medicine, neurology, and neuroscience, and identify an optimal cl", "score": 0.6829338 }, { "number": 9, "title": "Clinical and genetical study of a familial form of REM sleep behavior disorder - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0303846718303974", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Elsevier logo\nClinical Neurology and Neurosurgery\n\n## Clinical Neurology and Neurosurgery\n\n## Published by: Elsevier\n\n### Published by\n\nElsevier\n\n# Clinical and genetical study of a familial form of REM sleep behavior disorder\n\n## Article preview\n\n## Highlights\n\n## Abstract\n\n### Objective\n\n### Patie", "score": 0.5911811 }, { "number": 10, "title": "Minor hallucinations in isolated rapid eye movement sleep behavior disorder indicative of early phenoconversion: A preliminary study - Sumi - 2022 - Acta Neurologica Scandinavica - Wiley Online Library", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13555", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "# Minor hallucinations in isolated rapid eye movement sleep behavior disorder indicative of early phenoconversion: A preliminary study. Minor hallucinations (MH) are psychotic symptoms that can occur anywhere between prodromal to early Parkinson's disease and after onset of motor problems. Isolated ", "score": 0.82288796 }, { "number": 11, "title": "Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/36515157", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "# Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. # Management of REM sleep behavior disorder: an American Academy of Sleep Medicine clinical practice guideline. **Introduction:** This guideline establishes clinical practice recommendatio", "score": 0.8245895 }, { "number": 12, "title": "Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy—a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/8783206", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Six inclusion criteria were identified for symptomatic therapy and neuroprotective trials: (1) diagnosis of RBD needs to satisfy the International Classification of Sleep Disorders, second edition, (ICSD-2) criteria; (2) minimum frequency of RBD episodes should preferably be ≥2 times weekly to allow", "score": 0.8080827 }, { "number": 13, "title": "Differential Impact on Isolated REM Sleep without Atonia by Varying Antidepressant Therapies - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8112624", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Rapid eye movement (REM)1 sleep without atonia (RSWA) is the neurophysiologic substrate of REM sleep-behavior disorder (RBD) and is characterized by increased phasic or tonic muscle activity in electromyography (EMG) channels during polysomnography (PSG). The International Classification of Sleep Di", "score": 0.8865877 }, { "number": 14, "title": "Diagnosis of REM Sleep Behavior Disorder by Video-Polysomnographic Study: Is One Night Enough? - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2542964", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "REM sleep without atonia (RSWA): The ICSD-2 criterion was defined as PSG abnormality of either excessive augmentation of chin EMG tone or excessive chin or limb EMG phasic twitching during REM sleep.1,26 This clinical impression was based (in our sleep center) on consensus meeting by experienced pol", "score": 0.84707206 }, { "number": 15, "title": "Rapid Eye Movement Sleep Behavior Disorder - StatPearls - NCBI", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK555928", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Polysomnography involves simultaneously recording many physiologic variables, including electroencephalography (EEG); therefore, home sleep tests can not be used. PSG is also helpful in excluding other sleep disorders such as sleep-disordered breathing, seizure, and other non-REM sleep disorders or ", "score": 0.8266142 }, { "number": 16, "title": "Long-Term Follow-up Investigation of Isolated Rapid Eye Movement Sleep Without Atonia Without Rapid Eye Movement Sleep Behavior Disorder: A Pilot Study - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4623125", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Sleep was scored according to American Academy of Sleep Medicine (AASM) criteria5 with the allowance to score REM sleep despite excessive chin EMG activity.7,8 REM sleep onset was determined by the occurrence of the first REM in the electrooculographic channel, and the end of REM sleep when either n", "score": 0.82048416 }, { "number": 17, "title": "REM Sleep Behavior Disorder and REM Sleep Without Atonia as an Early Manifestation of Degenerative Neurological Disease", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3656587", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "RSWA may also be found incidentally on polysomnographic recording without dream enactment behavior [2••]. Since normal individuals may also have short bursts of abnormal phasic or tonic muscle activity during REM sleep , the American Academy of Sleep Medicine (AASM) has established formal suggested ", "score": 0.78512776 }, { "number": 18, "title": "ClonazePAM | Drug Lookup | Pediatric Care Online - AAP Publications", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatriccare/drug-monograph/18/5434/ClonazePAM", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Comparative efficacy of prolonged-release melatonin versus clonazepam for isolated rapid eye movement sleep behavior disorder. Sleep Breath. 2023;27(1):309", "score": 0.62770075 }, { "number": 19, "title": "The North American Prodromal Synucleinopathy study: protocol for a multi-site, longitudinal, observational study of idiopathic/isolated rapid eye movement sleep behavior disorder - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/41725984", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: The North American Prodromal Synucleinopathy study: protocol for a multi-site, longitudinal, observational study of idiopathic/isolated rapid eye movement sleep behavior disorder - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. Federal governmen", "score": 0.9014448 }, { "number": 20, "title": "Evolution of Motor and Nonmotor Characteristics in an Idiopathic/Isolated REM Sleep Behavior Disorder Cohort | Neurology", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/WNL.0000000000214108", "authors": "www.neurology.org", "host": "www.neurology.org", "snippet": "Years before diagnosis of Parkinson disease (PD), dementia with Lewy bodies (DLB), or multiple system atrophy (MSA), mild prodromal manifestations can be detected. Longitudinal follow-up of people with prodromal synucleinopathy, particularly idiopathic/isolated REM sleep behavior disorder (iRBD), en", "score": 0.8810534 }, { "number": 21, "title": "The REM sleep behavior disorder screening questionnaire: Validation study of a Japanese version - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1389945709002317", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Elsevier logo\nSleep Medicine\n\n## Sleep Medicine\n\n## Published by: Elsevier\n\n### Published by\n\nElsevier\n\n# Brief Communication The REM sleep behavior disorder screening questionnaire: Validation study of a Japanese version\n\n## Article preview\n\n## Abstract\n\n### Background\n\n### Methods\n\n### Results\n\n##", "score": 0.20022945 }, { "number": 22, "title": "Rapid Eye Movement Behavior Disorder - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/rapid-eye-movement-behavior-disorder", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "•\nPolysomnographic recording demonstrates REM sleep without atonia a\n\n•\nThe disturbance is not better explained by another sleep disorder, mental health disorder, medication, or substance use\n\nThe gold standard for diagnosis of RBD is to perform an in-laboratory PSG. In addition to the standard moni", "score": 0.8571119 }, { "number": 23, "title": "Rapid Eye Movement Sleep Behavior Disorder - an overview | ScienceDirect Topics", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/neuroscience/rapid-eye-movement-sleep-behavior-disorder", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### 1 Introduction\n\nRapid eye movement (REM) sleep behavior disorder (RBD) is a REM parasomnia. According to the third International Classification of Sleep Disorders (ICSD-3), diagnosis of RBD is based on the presence of repeated episodes of vocalization or complex motor behaviors during REM sleep ", "score": 0.8335554 }, { "number": 24, "title": "Validation of the rapid eye movement sleep behavior disorder ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0967586815001745", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "The current diagnostic criteria for RBD requires polysomnography (PSG) to demonstrate REM sleep without atonia [6]. However, PSG is costly, labor intensive", "score": 0.8306082 } ], "publishedAt": "2026-09-15T17:37:06.437454+00:00", "updatedAt": "2026-09-15T17:37:06.437454+00:00", "readingMinutes": 6, "slug": "rem-sleep-behavior-disorder" }