Rapid eye movement sleep behavior disorder
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Synopsis
The prevalence of RBD is about 1%-2% in the general population and about 50% in those with Parkinson disease. Although RBD affects men and women equally, men typically have more violent behaviors and more frequently recall dreams with aggressive content. Men are more often diagnosed than women due to this increased violent activity and greater likelihood of observant bed partners. RBD typically occurs in the fifth or sixth decade of life.
RBD is a strong predictor of alpha-synucleinopathies, such as Parkinson disease, and usually precedes the development of a neurodegenerative disease by about 10 years. At least 90% of patients with RBD will be diagnosed with a neurodegenerative disease by 15 years after RBD onset.
It is suggested that the etiology of RBD is neurodegeneration of glutamatergic neurons in the sublaterodorsal tegmental nucleus in the pons or their projection target, glycinergic neurons in the ventral medulla. Normally, these neurons project to spinal motor neurons and result in hyperpolarization during REM sleep, causing muscle atonia. Therefore, degeneration causes lack of atonia.
Codes
ICD10CM:G47.52 – REM sleep behavior disorder
SNOMEDCT:
415238003 – Rapid eye movement sleep behavior disorder
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Epilepsy
- Non-REM parasomnias
- Nightmare disorder
- Untreated obstructive sleep apnea
- Post-traumatic stress disorder
- Antidepressant medication use
- Narcolepsy type 1
- Acute inflammatory demyelinating polyneuropathy (AIDP)
- Spinocerebellar ataxia type 3
- Brain stem tumors (see, eg, brain stem glioma)
- Stroke
- Multiple sclerosis
- Paraneoplastic disorders
- Withdrawal from alcohol or sedatives (see, eg, benzodiazepine withdrawal, opioid withdrawal)
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/16/2019
Last Updated:05/12/2019
Last Updated:05/12/2019