REM behavior disorder in adults

Abstract

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by loss of REM sleep atonia and clinical manifestations of dream reenactment. Patients typically present at the request of bed partners due to the often violent and dangerous nature of this nighttime disorder. RBD can present at any age, and is frequently associated with narcolepsy in the younger population. Older patients presenting with idiopathic RBD have a significant risk of developing neurodegenerative conditions. RBD is associated with other changes in the central nervous system (CNS) such as decreased olfaction, visuospatial issues, and mild slowing on electroencephalography (EEG). Treatment involves ensuring environmental safety, eliminating predisposing factors, and initiating medications such as clonazepam and melatonin. Given the relationship of RBD to neurodegenerative conditions, RBD represents a unique opportunity to understand the neuroanatomical basis for REM sleep-related mechanisms and may be a leading indicator for patients who may benefit from neuroprotective treatments for these neurodegenerative diseases.