Rapid Eye Movement (REM) Sleep Behavior Disorder and REM Sleep with Atonia in the Young

Abstract

ABSTRACT:Background:Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects.Methods:A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period.Results:Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects.Conclusion:We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.

A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls

“…RBD/RWA was identified among many ADHD patients included in our study. This novel finding has been discussed in detail in a previous publication [ 32 ].…”

“…In the control group, three (7.5%) participants each were diagnosed with RLS and PLMD and two (5%) participants were diagnosed with OSA. In addition, among 10 patients, whose polysomnography studies were later included for detailed REM sleep analysis as part of a larger study [ 32 ], 6 demonstrated excessive transient muscle activity and/or sustained muscle activity, suggestive of REM sleep without atonia (RWA), and 3 of these had abnormal behaviors corresponding to the RWA, suggestive of REM sleep behavior disorder.…”

Artificial Neural Networks Analysis of polysomnographic and clinical features in Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): from sleep alteration to “Brain Fog”

“…7 Unfortunately, we could not compare our RSWA rate to that of the general pediatric population, since, to the best of our knowledge, this rate is not available in the existing literature. 23 Moreover, the prevalence of PLMD in our Tic/Tourette's PANS patients was also significantly higher than that among pediatric patients with isolated Tourette's Disorder (6% described by Kostanecka-Endress et al). 25 This difference might represent a possible distinction-key between a "pure" Tourette's Disorder and a Tourette's Disorder diagnosed in the context of a PANS.…”

REM Sleep Behavior Disorder and Other REM Parasomnias

“…36 RBD in children and young adults is typically secondary to another disorder such as narcolepsy or a neurodevelopmental disorder such as autism. 37 Pediatric RBD can also be due to other symptomatic disorders such as epilepsy, attention deficit hyperactivity disorder, and tumors. 37 DRUG-INDUCED RBD.…”

“…37 Pediatric RBD can also be due to other symptomatic disorders such as epilepsy, attention deficit hyperactivity disorder, and tumors. 37 DRUG-INDUCED RBD. Some medications can induce or worsen RBD.…”