Rapid eye movement behavior disorder (RBD) is a parasomnia involving dream enactment behavior associated with loss of atonia during rapid eye movement (REM) sleep. These symptoms may bring serious harm to the individual themselves and their sleeping partners. RBD has been associated with antidepressant use as well as narcolepsy. The strongest correlation exists between RBD and comorbid neurodegenerative alpha-synucleinopathies (i.e., Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy). Symptoms of RBD may precede neurodegenerative disorders by decades; therefore, a careful history is significant in assessing these patients.
The diagnosis requires confirmation by an in-laboratory sleep study (polysomnography) with video recording, which helps assert abnormal behaviors during REM sleep and excludes other sleep disorders. Counseling and management of RBD focus on injury prevention and the treatment of underlying precipitating disorders in addition to pharmacological treatment of severe cases using oral medications such as melatonin or clonazepam. This topic will review the etiology, epidemiology, pathogenesis, clinical features, evaluation, management, and prognosis of RBD in adults.
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