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Sleep Disorder as a Precursor to Parkinson

Meta-analysis examines often-violent sleep behavior

Publish date:: June 30, 2015

Rapid eye movement (REM) sleep behavior disorder (RBD) is often a precursor to parkinsonian disorder and other neurodegenerative disorders, according to a meta-analysis of peer-reviewed articles published between 1986 and 2014.

Key findings include:

• Clinical features that distinguish RBD from other parasomnias include the demonstration of REM sleep without atonia on polysomnography.

• RBD involves a-synuclein abnormalities in the brainstem.

• Dream enactment behaviors are often theatrical, with complexity, aggression, and violence, which can be harmful to patients and their bed partners.

• Treatment can prevent injury to patients and bed partners.

• Commonly cited treatments include low-dose clonazepam or high-dose melatonin at bedtime.

• In approximately 50% of cases, spontaneous RDB will convert to parkinsonian disorder within 10 years.

• 81% to 90% of patients with RBD develop a neurodegenerative disorder.

Citation: Howell MJ, Schenck CH. Rapid eye movement sleep behavior disorder and neurodegenerative disease. JAMA Neurol. 2015;72(6):707-712. doi:10.1001/jamaneurol.2014.4563.

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