Advertisement

REM Sleep Behavior Disorder

  • Michael J. HowellEmail author
  • Carlos H. Schenck
Chapter

Abstract

REM sleep behavior disorder (RBD), a condition of dream enactment, often predates Parkinson’s disease (PD) and is the result of early neurodegenerative processes in the brainstem. Normally, REM sleep is characterized by vivid mentation combined with skeletal muscle paralysis. This REM atonia is diminished or absent in RBD, which enables patients to act out their dreams with violent, injurious nocturnal behaviors. Consistent with an impending neurodegenerative disorder, patients with RBD demonstrate subtle motor, autonomic, and cognitive changes frequently seen in synucleinopathies. These disorders include PD as well as multiple system atrophy (MSA) and dementia with Lewy bodies (DLB). In PD, RBD is linked with the akinetic–rigid predominant subtype, gait freezing, and predicts aggressive cognitive impairment. Clinical management is focused upon decreasing the potential for sleep-related injuries (SRIs), treating comorbid sleep disorders, and eliminating exacerbating agents. High-dose melatonin, low-dose clonazepam, and combined melatonin–clonazepam appear to be effective therapies.

Keywords

Obstructive Sleep Apnea Deep Brain Stimulation Multiple System Atrophy Dementia With Lewy Body Sodium Oxybate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Parkinson J. An essay on the shaking palsy. London: Sherwood, Neely, and Jones; 1817.Google Scholar
  2. 2.
    Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science. 1953;118(3062):273–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Jouvet D, Vimont P, Delorme F. Study of selective deprivation of the paradoxal phase of sleep in the cat. J Physiol Paris. 1964;56:381.PubMedGoogle Scholar
  4. 4.
    Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81 % of older males initially diagnosed with idiopathic REM sleep behavior disorder (RBD): 16year update on a previously reported series. Sleep Med. 2013;14:744–8.CrossRefPubMedGoogle Scholar
  5. 5.
    American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.Google Scholar
  6. 6.
    Boeve BF. REM sleep behavior disorder: updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci. 2010;1184:15–54.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Nielsen T, Svob C, Kuiken D. Dream-enacting behaviors in a normal population. Sleep. 2009;32(12):1629–36.PubMedCentralPubMedGoogle Scholar
  8. 8.
    Boeve BF, Silber MH, Parisi JE, Dickson DW, Ferman TJ, Benarroch EE, et al. Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology. 2003;61(1):40–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Nihei Y, Takahashi K, Koto A, Mihara B, Morita Y, Isozumi K, et al. REM sleep behavior disorder in Japanese patients with Parkinson’s disease: a multicenter study using the REM sleep behavior disorder screening questionnaire. J Neurol. 2012;259(8):1606–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Poryazova R, Oberholzer M, Baumann CR, Bassetti CL. REM sleep behavior disorder in Parkinson’s disease: a questionnaire-based survey. J Clin Sleep Med. 2013;9(1):55–9.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Plazzi G, Corsini R, Provini F, Pierangeli G, Martinelli P, Montagna P, et al. REM sleep behavior disorders in multiple system atrophy. Neurology. 1997;48(4):1094–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Postuma RB, Montplaisir JY, Pelletier A, Dauvilliers Y, Oertel W, Iranzo A, et al. Environmental risk factors for REM sleep behavior disorder: a multicenter case-control study. Neurology. 2012;79(5):428–34.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Womens Health (Larchmt). 2009;18(12):1955–63.CrossRefGoogle Scholar
  14. 14.
    Bjornara KA, Dietrichs E, Toft M. REM sleep behavior disorder in Parkinson’s disease–is there a gender difference? Parkinsonism Relat Disord. 2013;19(1):120–2.CrossRefPubMedGoogle Scholar
  15. 15.
    Postuma RB, Lang AE, Massicotte-Marquez J, Montplaisir J. Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder. Neurology. 2006;66(6):845–51.CrossRefPubMedGoogle Scholar
  16. 16.
    Postuma RB, Gagnon JF, Vendette M, Desjardins C, Montplaisir JY. Olfaction and color vision identify impending neurodegeneration in rapid eye movement sleep behavior disorder. Ann Neurol. 2011;69(5):811–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Boot BP, Boeve BF, Roberts RO, Ferman TJ, Geda YE, Pankratz VS, et al. Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: a population-based study. Ann Neurol. 2012;71(1):49–56.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Ferman TJ, Boeve BF, Smith GE, Lin SC, Silber MH, Pedraza O, et al. Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology. 2011;77(9):875–82.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Fantini ML, Postuma RB, Montplaisir J, Ferini-Strambi L. Olfactory deficit in idiopathic rapid eye movements sleep behavior disorder. Brain Res Bull. 2006;70(4–6):386–90.CrossRefPubMedGoogle Scholar
  20. 20.
    Ferini-Strambi L. Does idiopathic REM sleep behavior disorder (iRBD) really exist? What are the potential markers of neurodegeneration in iRBD? Sleep Med. 2011;12 Suppl 2:S43–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Frauscher B, Nomura T, Duerr S, Ehrmann L, Gschliesser V, Wenning GK, et al. Investigation of autonomic function in idiopathic REM sleep behavior disorder. J Neurol. 2012;259:1056–61.CrossRefPubMedGoogle Scholar
  22. 22.
    Miyamoto T, Miyamoto M, Suzuki K, Nishibayashi M, Iwanami M, Hirata K. 123I-MIBG cardiac scintigraphy provides clues to the underlying neurodegenerative disorder in idiopathic REM sleep behavior disorder. Sleep. 2008;31(5):717–23.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Postuma RB, Lang AE, Gagnon JF, Pelletier A, Montplaisir JY. How does parkinsonism start? Prodromal parkinsonism motor changes in idiopathic REM sleep behaviour disorder. Brain. 2012;135(Pt 6):1860–70.CrossRefPubMedGoogle Scholar
  24. 24.
    Romenets SR, Gagnon JF, Latreille V, Panniset M, Chouinard S, Montplaisir J, et al. Rapid eye movement sleep behavior disorder and subtypes of Parkinson’s disease. Mov Disord. 2012;27(8):996–1003.CrossRefPubMedGoogle Scholar
  25. 25.
    Dugger BN, Boeve BF, Murray ME, Parisi JE, Fujishiro H, Dickson DW, et al. Rapid eye movement sleep behavior disorder and subtypes in autopsy-confirmed dementia with Lewy bodies. Mov Disord. 2012;27(1):72–8.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Videnovic A, Marlin C, Alibiglou L, et al. Increased REM sleep without atonia in Parkinson’s disease patients with freezing of gait. Neurology. 2013;81:1030–5.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Nardone R, Bergmann J, Brigo F, Christova M, Kunz A, Seidl M, et al. Functional evaluation of central cholinergic circuits in patients with Parkinson’s disease and REM sleep behavior disorder: a TMS study. J Neural Transm. 2013;120(3):413–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Postuma RB, Bertrand JA, Montplaisir J, Desjardins C, Vendette M, Rios Romenets S, et al. Rapid eye movement sleep behavior disorder and risk of dementia in Parkinson’s disease: a prospective study. Mov Disord. 2012;27(6):720–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Scherfler C, Frauscher B, Schocke M, Iranzo A, Gschliesser V, Seppi K, et al. White and gray matter abnormalities in idiopathic rapid eye movement sleep behavior disorder: a diffusion-tensor imaging and voxel-based morphometry study. Ann Neurol. 2011;69(2):400–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Eisensehr I, Linke R, Tatsch K, Kharraz B, Gildehaus JF, Wetter CT, et al. Increased muscle activity during rapid eye movement sleep correlates with decrease of striatal presynaptic dopamine transporters. IPT and IBZM SPECT imaging in subclinical and clinically manifest idiopathic REM sleep behavior disorder, Parkinson’s disease, and controls. Sleep. 2003;26(5):507–12.PubMedGoogle Scholar
  31. 31.
    Iranzo A, Valldeoriola F, Lomena F, Molinuevo JL, Serradell M, Salamero M, et al. Serial dopamine transporter imaging of nigrostriatal function in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prospective study. Lancet Neurol. 2011;10(9):797–805.CrossRefPubMedGoogle Scholar
  32. 32.
    Miyamoto M, Miyamoto T, Iwanami M, Muramatsu S, Asari S, Nakano I, et al. Preclinical substantia nigra dysfunction in rapid eye movement sleep behaviour disorder. Sleep Med. 2012;13(1):102–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Kotagal V, Albin RL, Muller ML, Koeppe RA, Chervin RD, Frey KA, et al. Symptoms of rapid eye movement sleep behavior disorder are associated with cholinergic denervation in Parkinson disease. Ann Neurol. 2012;71(4):560–8.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Hanyu H, Inoue Y, Sakurai H, Kanetaka H, Nakamura M, Miyamoto T, et al. Regional cerebral blood flow changes in patients with idiopathic REM sleep behavior disorder. Eur J Neurol. 2011;18(5):784–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Vendette M, Gagnon JF, Soucy JP, Gosselin N, Postuma RB, Tuineag M, et al. Brain perfusion and markers of neurodegeneration in rapid eye movement sleep behavior disorder. Mov Disord. 2011;26(9):1717–24.CrossRefPubMedGoogle Scholar
  36. 36.
    Dang-Vu TT, Gagnon JF, Vendette M, Soucy JP, Postuma RB, Montplaisir J. Hippocampal perfusion predicts impending neurodegeneration in REM sleep behavior disorder. Neurology. 2012;79(24):2302–6.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Hoque R, Chesson Jr AL. Pharmacologically induced/exacerbated restless legs syndrome, periodic limb movements of sleep, and REM behavior disorder/REM sleep without atonia: literature review, qualitative scoring, and comparative analysis. J Clin Sleep Med. 2010;6(1):79–83.PubMedCentralPubMedGoogle Scholar
  38. 38.
    Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain. 2007;130(Pt 11):2770–88.CrossRefPubMedGoogle Scholar
  39. 39.
    Dauvilliers Y, Jennum P, Plazzi G. REM sleep behavior disorder and REM sleep without atonia in narcolepsy. Sleep Med. 2013;14:775–81.CrossRefPubMedGoogle Scholar
  40. 40.
    Li SX, Wing YK, Lam SP, Zhang J, Yu MW, Ho CK, et al. Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK). Sleep Med. 2010;11(1):43–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Frauscher B, Ehrmann L, Zamarian L, Auer F, Mitterling T, Gabelia D, et al. Validation of the Innsbruck REM sleep behavior disorder inventory. Mov Disord. 2012;27(13):1673–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Postuma RB, Arnulf I, Hogl B, Iranzo A, Miyamoto T, Dauvilliers Y, et al. A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study. Mov Disord. 2012;27(7):913–6.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Neikrug AB, Ancoli-Israel S. Diagnostic tools for REM sleep behavior disorder. Sleep Med Rev. 2012;16:415–29.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Oudiette D, Leu-Semenescu S, Roze E, Vidailhet M, De Cock VC, Golmard JL, et al. A motor signature of REM sleep behavior disorder. Mov Disord. 2012;27(3):428–31.CrossRefPubMedGoogle Scholar
  45. 45.
    Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95.PubMedCentralPubMedGoogle Scholar
  46. 46.
    Gagnon JF, Postuma RB, Montplaisir J. Update on the pharmacology of REM sleep behavior disorder. Neurology. 2006;67(5):742–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Kunz D, Mahlberg R. A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder. J Sleep Res. 2010;19(4):591–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, et al. The movement disorder society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26 Suppl 3:S42–80.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain. 2000;123(Pt 2):331–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Gagnon JF, Petit D, Fantini ML, Rompre S, Gauthier S, Panisset M, et al. REM sleep behavior disorder and REM sleep without atonia in probable Alzheimer disease. Sleep. 2006;29(10):1321–5.PubMedGoogle Scholar
  51. 51.
    Gugger JJ, Wagner ML. Rapid eye movement sleep behavior disorder. Ann Pharmacother. 2007;41(11):1833–41.CrossRefPubMedGoogle Scholar
  52. 52.
    Anderson KN, Shneerson JM. Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam. J Clin Sleep Med. 2009;5(3):235–9.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Howell MJ, Arneson PA, Schenck CH. A novel therapy for REM sleep behavior disorder (RBD). J Clin Sleep Med. 2011;7(6):639–644A.PubMedCentralPubMedGoogle Scholar
  54. 54.
    McCarter SJ, Boswell CL, St Louis EK, Dueffert LG, Slocumb N, Boeve BF, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med. 2013;14(3):237–42.CrossRefPubMedCentralPubMedGoogle Scholar
  55. 55.
    Sasai T, Matsuura M, Inoue Y. Factors associated with the effect of pramipexole on symptoms of idiopathic REM sleep behavior disorder. Parkinsonism Relat Disord. 2013;19(2):153–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Di Giacopo R, Fasano A, Quaranta D, Della Marca G, Bove F, Bentivoglio AR. Rivastigmine as alternative treatment for refractory REM behavior disorder in Parkinson’s disease. Mov Disord. 2012;27(4):559–61.CrossRefPubMedGoogle Scholar
  57. 57.
    Arnulf I, Bejjani BP, Garma L, Bonnet AM, Houeto JL, Damier P, et al. Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology. 2000;55(11):1732–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Iranzo A, Valldeoriola F, Santamaria J, Tolosa E, Rumia J. Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry. 2002;72(5):661–4.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Cicolin A, Lopiano L, Zibetti M, Torre E, Tavella A, Guastamacchia G, et al. Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med. 2004;5(2):207–10.CrossRefPubMedGoogle Scholar
  60. 60.
    Verhave PS, Jongsma MJ, Van Den Berg RM, Vanwersch RA, Smit AB, Philippens IH. Neuroprotective effects of riluzole in early phase Parkinson’s disease on clinically relevant parameters in the marmoset MPTP model. Neuropharmacology. 2012;62(4):1700–7.CrossRefPubMedGoogle Scholar
  61. 61.
    Srinivasan V, Cardinali DP, Srinivasan US, Kaur C, Brown GM, Spence DW, et al. Therapeutic potential of melatonin and its analogs in Parkinson’s disease: focus on sleep and neuroprotection. Ther Adv Neurol Disord. 2011;4(5):297–317.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of MinnesotaMinneapolisUSA
  2. 2.Department of PsychiatryUniversity of MinnesotaMinneapolisUSA

Personalised recommendations