The Clinical Phenotype of Idiopathic Rapid Eye Movement Sleep Behavior Disorder at Presentation: A Study in 203 Consecutive Patients

Abstract

A commentary on this article appears in this issue on page 7.

Prognostic Counseling for Patients With Idiopathic/Isolated REM Sleep Behavior Disorder: Should We Tell Them What's Coming? Yes

“…Previous research suggests that sleep clinic populations are unsurprisingly enriched for the discovery of iRBD, with approximately 5% of sleep clinic cohorts having an iRBD diagnosis . In another recent study, 11% of patients had another presenting primary sleep complaint and RBD diagnosis was elicited only upon specific questioning, whereas 44% of patients in this cohort were unaware of their dream enactment behaviors . These data are consistent with our clinical experience in sleep medicine clinics where RBD is commonly discovered in the history taking process, by screening questionnaires, or even as a secondary and incidental finding during PSG indicated for another primary sleep concern.…”

“…Prognostic counseling in iRBD is further complicated by how the patient presents and is given the diagnosis. In between 50% to 60% of patients, dream enactment is not the patient's primary clinical complaint or concern in the sleep clinic, given that they may instead first present for concerns related to obstructive sleep apnea, restless legs syndrome, hypersomnia symptoms, or chronic insomnia . Previous research suggests that sleep clinic populations are unsurprisingly enriched for the discovery of iRBD, with approximately 5% of sleep clinic cohorts having an iRBD diagnosis .…”

REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions

“…47 A recent large idiopathic RBD case series from Barcelona has also similarly suggested that up to 44% of idiopathic RBD cases may be unaware of their sleep behaviors, suggesting that the diagnosis may be detected secondarily when patients present with other sleep problems. 13 In this case, prompt diagnosis and treatment with melatonin helped prevent injury and enabled surveillance and early detection and treatment of symptomatic parkinsonism that may improve function and quality of life, and hopefully one day, serial follow-up may enable application of neuroprotective therapy.…”

“…1 The prevalence of RBD has been estimated to be in the range of 0.5% to 2%, 2–4 yet larger population-based studies of probable dream enactment symptoms suggest that RBD is likely considerably more frequent and present in between 5% and 13% of older community-dwelling adults aged 60 to 99 years. 5–8 Rapid eye movement sleep behavior disorder appears to be more common in men than women in older adults, 9–13 yet below the age of 50 years it is equally frequent in women and men. 14–17 Rapid eye movement sleep behavior disorder is 5-fold more likely to develop in patients receiving antidepressants and 10-fold more likely to develop in those with a psychiatric diagnosis.…”

Prognostic Counseling for Patients With Idiopathic/Isolated Rapid Eye Movement Sleep Behavior Disorder: Should We Tell Them What's Coming? No

“…Depending on age, comorbidities, and life expectancy, an individual diagnosed with iRBD may never during his or her lifetime experience clinically relevant manifestation of parkinsonism and/or dementia. Furthermore, it is still unclear whether or not prognostic data derived from iRBD cohorts presenting to specialized sleep centers because of violent dream enactment may be generalized to those in whom RBD or isolated REM sleep without atonia (RSWA) is an incidental finding during the diagnostic workup for other sleep disorders …”