Rapid Eye Movement Sleep Behavior Disorder

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Continuing Education Activity

Rapid eye movement behavior disorder (RBD) is a type of parasomnia that has a strong link to neurodegenerative diseases. It can also be very disturbing and lead to injury requiring medical attention. This activity describes the evaluation and management of RBD and highlights the role the healthcare team in improving care for patients with this condition.


  • Identify the etiology of rapid eye movement behavior disorder.
  • Outline the appropriate evaluation of rapid eye movement behavior disorder.
  • Review the treatment and management options available for rapid eye movement behavior disorder.
  • Describe the importance of interprofessional team strategies for improving care coordination and communication to advance management of rapid eye movement behavior disorder and improve outcomes.


Rapid eye movement behavior disorder (RBD) is a parasomnia involving dream reenactment 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.[1] Counseling and management of RBD focus on injury prevention and the treatment of underlying precipitating disorders.


Predisposing factors that increase RBD diathesis include elderly age, male sex, narcolepsy, antidepressant use, and neurological disorders. RBD is most suggestive in those with neurodegenerative synucleinopathies, including Lewy-body dementia, Parkinson's disease, olivopontocerebellar degeneration, multiple-system atrophy, and Shy-Drager syndrome.[1] The literature suggests that RBD precipitates in the event of aberrant connections between the brainstem control of muscle tonicity and the cortex.[2] Studies have also suggested associations with traumatic brain injury (TBI), post-traumatic stress syndrome (PTSD), congenital, and neurodevelopmental disorders.[3][4][5] 

The most likely antidepressants that will incite an RBD episode are serotonin reuptake inhibitors (fluoxetine), tricyclic antidepressants (mirtazapine, protriptyline, amitriptyline, nortriptyline, desipramine, imipramine), and monoamine oxidase inhibitors (phenelzine and selegiline).[6][7][8] Other acute transient forms of RBD involve toxic metabolic encephalopathy—most commonly involving ethanol use.[9]

RBD with concomitant narcolepsy may be considered a distinct phenotype of RBD. It is characterized by less violent or complex behavior during REM sleep, earlier age of onset, equal sex distribution, and hypocretin (orexin) deficiency (a lab diagnosis specific for narcolepsy type 1).[10]


Studies on RBD, although limited in quantity, suggest a prevalence of 0.5% in the general population.[11][12][13] The prevalence significantly increases in the elderly population, with RBD presenting between 5% to 13% in adults aged 60 to 99 years old.[14] Among the elderly population, approximately 60% of cases are idiopathic while 40% of cases are suggestive of an underlying neurologic disorder.[15] The onset of symptoms is typically seen during the sixth or seventh decade of life. There is a male predominance amongst the older population, but there is a more equal distribution between males and females under the age of 50 years.[13][16][17]

There is a strong link between RBD and psychiatric disorders. RBD is found to be 5-fold and 10-fold more likely to develop in patients receiving antidepressants and patients with psychiatric disorders, respectively.[18]


A prime feature of rapid eye movement behavior disorder is the intermittent loss of atonia during REM sleep that leads to motor behaviors associated with dreaming. Muscle atonia during normal REM sleep is controlled within the pontine tegmentum and medial medulla. Excitatory glutamatergic neurons within the dorsal pre-coeruleus nucleus activate the spinal cord inhibitory interneurons thereby initiating REM sleep atonia. Animal models and diagnostic imaging of case reports suggesting interruption or disinhibition of these areas of the brainstem is the pathophysiology of RBD.[2][19][20][21][22][23][24]

The neurodegenerative alpha-synucleinopathies consist of glial cytoplasmic inclusions, which are aggregates of insoluble alpha-synuclein protein.[2] However, it is unclear if the link between this neurodegenerative classification and RBD is a result of these accumulated aggregates or through another pathology.

History and Physical

Rapid eye movement behavior disorder exhibits abnormal behaviors during REM sleep that may disrupt sleep and lead to injury. Sleep-related injuries are common and may include harm to sleeping partners. Symptoms are usually associated with the enactment of undesirable or violent dreams where the patient is being attacked, chased, or compromised. The patient often wakes up abruptly with prompt alertness and is able to recount the dream coherently. The observed sleep behavior corresponds to dream content, appropriately termed dream enactment behavior (DEB). An event would likely appear at least 90 minutes after sleep onset and more frequently during the latter half of sleep due to the typical pattern of REM sleep. 

The abnormal sleep-related behavior encompasses gesturing, talking, shouting, laughing, grabbing, punching, kicking, sitting up, flailing arms, or leaping from the bed. Some behavior may cause injuries that require immediate medical attention. It is uncommon to exhibit walking. The eyes are typically closed during an event. The patient would not typically interact with the environment but rather only behave in association with the dream. Increased periodic limb movement may occur that may disrupt the sleeping partner.[11]

Acute forms of RBD can be exhibited with intense REM sleep rebound due to withdrawal effects from REM suppressing drugs. These include alcohol, sedative-hypnotic medications, drug intoxication, or antidepressants.[13]


The diagnosis of rapid eye movement behavior disorder is comprised of two features: loss of normal atonia during REM sleep and dream enactment behavior. Evaluation involves in-lab video polysomnography (vPSG), but may also be diagnosed with suggestive clinical history when video polysomnography is unavailable or does not meet the polysomnography criteria for REM behavior disorder. Polysomnography involves the concurrent recording of many physiologic variables. In this case, the emphasis is on the evaluation of the video, electroencephalogram, electrooculogram, and electromyogram to assess the loss of REM atonia. The gold standard for tone evaluation includes manual scoring during REM sleep allowing for subjectivity. The most robust evidence-based data for identifying REM without atonia in the evaluation of RBD notes that any chin electromyography activity combined with increased limb electromyography activity in greater than 27% of REM sleep consistently differentiates REM behavior disorder from control.[25][26][27]

The International Classification of Sleep Disorders, 3 ed., states that diagnostic criteria for RBD must include the following:

  1. Repeated episodes of sleep-related behaviors such as vocalization and/or complex motor behaviors.
  2. Documenting behaviors by polysomnography during REM sleep or based on clinical history.
  3. Recordings of polysomnography that demonstrate REM sleep without atonia via submental or limb leads
  4. Behaviors that are not better explained by another sleep disorder, mental disorder, medication, substance use, or epilepsy.

Validated questionnaires have been established to screen patients for RBD. Two single-question questionnaires have been established; the Mayo Sleep Questionnaire, and the RBD1Q. The Mayo sleep question was tested in the general population and queried the bed partners (sensitivity 98% and specificity 74%); it asks “Have you ever seen the patient appear to ‘act out his or her dreams’ (punched or flailed arms in the air, shouted, or screamed) while sleeping?”[28] The RBD1Q was tested in a sleep center and queries the patient directly (sensitivity 98% and specificity 87%); it asks “Have you ever been told, or suspected yourself, that you seem to ‘act out your dreams’ while asleep (for example, punching, flailing your arms in the air, making running movements, etc.)?”[29] Other questionnaires included the 13-item RBDQ-HK (82% sensitivity and 87% specificity), 14-item RBDSQ (96% sensitivity and 56% specificity), and the 5-item Innsbruck Questionnaire (91% sensitivity, 86% specificity).[30][31][32]

Idiopathic RBD is uncommon. Therefore, in the general population, the positive predictive value of questionnaires with the highest specificity may be low, which suggests the continued importance of evaluation with polysomnography. However, polysomnography may be less important in patients with neurodegenerative synucleinopathy, where the prevalence of RBD can exceed 50%.[19]

Treatment / Management

The primary treatment goal of rapid eye movement behavior disorder is to reduce the risk of injury to the patient and bed partners. The change in routine sleep habits may prove challenging and difficult for the patient and their bed partners. Their risk for injury, however, needs to be emphasized. Patients and sleeping partners should be educated on the following:

  • Mitigating fall risk by lowering the bed closer to the floor
  • Safe-guarding any firearms, knives, and other weapons
  • Cushioning or padding the floor or sharp furniture surfaces.
  • Placing patients in restraining clothes or sleeping bags
  • Separating the sleeping partner from the patient to reduce the risk of injury

Primary pharmacological treatments of RBD include melatonin and clonazepam. Clonazepam is a very effective treatment for RBD and considered the first-line pharmacological therapy. Clonazepam is a long-acting benzodiazepine with a half-life of 30 to 40 hours and peak effect within 1 to 4 hours after ingestion. The recommended initial dose is 0.25 mg 30 minutes prior to bedtime, and a gradually increased dose to as high as 4 mg has been reported. As observed in studies, the low dose required for treatment offers a low concern for abuse and tolerance. Common side effects, however, have been observed, including residual morning sleepiness, increased fall risk, memory dysfunction, impotence, and unstable gait. Responders may note an initial period of symptomatic suppression with the reemergence of more complex behavior. Caution of use should be considered in those with dementia, fall risk, and obstructive sleep apnea due to the exacerbation of associated symptoms. Clonazepam can significantly reduce periodic limb movement syndrome but will not normalize REM sleep atonia.[33][34]

Melatonin is an alternative pharmacologic treatment. Melatonin is an endogenous hormone that is secreted from the pineal gland in association with circadian rhythm, and its secretion is influenced by light exposure. Although the mechanism of action is unclear, 3 to 12 mg of melatonin at bedtime is recommended and appears effective in reducing RBD symptoms.[35][36][34]

Other second-line therapies for RBD include pramipexole[37][38], paroxetine, L-DOPA, acetylcholinesterase inhibitors.[39]

Treating comorbid obstructive sleep apnea with continuous positive airway pressure may decrease the frequency and severity of RBD symptoms. Medication reconciliation is necessary to identify medications prone to inducing loss of REM atonia. Management should be discussed with ordering providers and the patient that may require discontinuation, reduction of dose, or earlier intake of medication.[33][34]

Differential Diagnosis

Dream enactment behavior (DEB) does not exclusively present in patients with RBD. Other manifestations that have been associated with DEB include:

  • Substance use and/or withdrawal
  • Benign childhood epilepsy
  • Complex partial seizures
  • Confusional arousals
  • Delirium
  • Epilepsia partialis continua
  • Epileptic encephalopathy
  • Juvenile myoclonic epilepsy
  • Malingering
  • Obstructive sleep apnea
  • Parasomnia overlap syndrome
  • Periodic limb movement disorder
  • Posttraumatic stress disorder
  • Psychogenic nonepileptic seizure
  • Sleep terror
  • Sleepwalking
  • Trauma-associated sleep disorder

Many conditions may mimic the appearance of rapid eye movement behavior disorder symptoms. Taking an appropriate history and conducting in-lab video polysomnography is necessary to distinguish the definitive diagnosis.

Primary causes of arousal disorders are often non-REM parasomnias, which include confusional arousals, sleepwalking, and sleep terrors. These disorders typically occur during childhood in the first half of the night during non-REM sleep without dream recall. These clinical findings, however, may be observed concomitantly with objective findings of REM without atonia and have been characterized as parasomnia overlap syndrome. Other associated parasomnias may include sleep-related eating disorder, sexsomnia, or rhythmic movement disorder.[40]

Trauma-associated sleep disorder has recently been characterized as a novel parasomnia. The patient demographics tend to be younger males with traumatic experiences as the temporal onset of disturbing nocturnal behaviors and nightmares. They may or may not have posttraumatic disorders. Objective findings include REM without atonia. Disruptive nocturnal behaviors captured in the lab are rare.[41]

It is important to differentiate RBD behaviors from nocturnal seizures, including juvenile myoclonic epilepsy, grand mal seizure, benign rolandic, Landau-Kleffner syndrome, and sleep-related hypermotor epilepsy (formerly known as nocturnal frontal lobe epilepsy). Patients with epilepsy may exhibit prodromal symptoms such as mood changes and auras, such as irregular blinking or loss of bladder/bowel control. Another differentiating behavior between RBD and seizures is the presentation of postictal states that may appear as confusion, headaches, nausea, temporary neurofocal deficits, sensory deficits, and/or suppressed alertness following the seizure.[42]


The clinical progression of rapid eye movement behavior disorder is dependent on the etiology. Idiopathic RBD and RBD associated with neurodegenerative disorders are often slowly progressive. Whereas, medication-induced RBD may occur acutely and improve upon discontinuing the medication. In RBD associated with neurodegenerative disorders, the prognosis is dependent on the underlying disorder.

Amongst those with confirmed diagnosed neurodegenerative alpha-synucleinopathies, it is estimated that the correlation with RBD is significantly high: 30 to 50% of Parkinson's disease, 75% of Lewy-body dementia, and 70% to 90% of multiple system atrophy.[43][44][45] Prognosis of RBD with Parkinson's disease has a higher risk for dementia, and RBD with Lewy-body dementia has a higher mortality risk.[22][46][47][48]


The primary complications concerning rapid eye movement behavior disorder are the risk of injury and the potential prodromal symptoms linking neurodegenerative alpha-synucleinopathies. The injuries sustained during an event may require immediate medical attention and/or involve sleeping partners causing legal implications. Management for RBD primarily involves injury risk mitigation through behavioral changes and/or pharmacologically. Early diagnosis and management of RBD provide a therapeutic window to treat the potential underlying neurodegenerative disorder. 

Deterrence and Patient Education

Patients with rapid eye movement behavior disorder and their sleeping partners are prone to injuries during their sleep that can result in serious harm. The sleeping partner could be a target of a violent dream reenactment behavior leading to the patient being arrested on charges of domestic assault. Therapeutic management should include injury risk mitigation discussions with both the patient and their sleeping partner.

It is ethically important to disclose potential risks for the development of neurodegenerative disease to patients diagnosed with RBD. An open discussion with family members offers an opportunity for improved understanding and avoiding misinformation about the disease process. It is recommended to counsel patients that Parkinson’s disease and other neurodegenerative disorders can be treatable. The prompt diagnosis of RBD may provide an early therapeutic window for neuroprotective therapies. Ongoing collaborative studies for symptomatic and neuroprotective therapy are being conducted by the International Rapid Eye Movement Sleep Behavior Disorder Study Group.[49]

Pearls and Other Issues

There is a high risk with rapid eye movement behavior disorder for the development of alpha-synucleinopathy pathology after 10 years from diagnosis.

There are currently no guidelines on counseling and management regarding potential phenoconversion of RBD to alpha-synucleinopathy. The approach may include a discussion with the patient to understand this risk. The patient should be recommended to seek consultation from their primary care provider, sleep specialist, and/or neurologist if associated symptoms were to manifest such as memory issues, constipation, gait abnormalities, orthostatic hypotension, or neurofocal deficits.

Prodromal alpha-synucleinopathy is possible in younger patients less than 50 years old, but nondegenerative disorders should be considered, including autoimmunity, narcolepsy, and REM-suppressing medication use.

There is a lack of controlled, randomized, double-blind studies for the treatment of RBD. However, injury prevention is critical in the management of RBD. Clonazepam is highly effective in treating RBD to reduce injury risks. 

Low risk for adverse reaction favors melatonin over clonazepam as initial pharmacological therapy for RBD.

Other etiology may resemble RBD symptoms and behaviors, necessitating evaluation with a formal vPSG to rule out malingering, psychogenic movement disorder, NREM parasomnias, sleep-related epilepsy syndrome, and obstructive sleep apnea. As physicians may be called upon for legal proceedings, this becomes more paramount when an illegal act was presented to occur during sleep.

Enhancing Healthcare Team Outcomes

The evaluation and management of newly diagnosed rapid eye movement behavior disorder require a multi-disciplinary effort involving a sleep specialist, neurologist, and primary care provider to maximize these patient’s wellbeing. Injury prevention is paramount and may require both pharmacological and non-pharmacological interventions. The looming prognosis of a neurodegenerative disorder in association with RBD will likely provoke anxiety and mood disruption and will require management on its own. Including family members is also a key element of support for these patients.

Unfortunately, there are no established means of predicting the development of neurodegenerative disease nor effective management to slow down the disease process. This makes the discussion with patients on the prognostic timeline and the decision of optimal treatment management truly difficult. Close follow-ups and multi-disciplinary communication are key.

Future research is needed to identify potential biomarkers and neuroprotective strategies to prevent further neurodegeneration in high-risk individuals.

Article Details

Article Author

Christopher Pham

Article Editor:

Jennifer Slowik


7/26/2021 1:08:18 PM



Barone DA,Henchcliffe C, Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2018 Aug;     [PubMed PMID: 29883833]


Boeve BF,Silber MH,Saper CB,Ferman TJ,Dickson DW,Parisi JE,Benarroch EE,Ahlskog JE,Smith GE,Caselli RC,Tippman-Peikert M,Olson EJ,Lin SC,Young T,Wszolek Z,Schenck CH,Mahowald MW,Castillo PR,Del Tredici K,Braak H, Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain : a journal of neurology. 2007 Nov;     [PubMed PMID: 17412731]


Verma A,Anand V,Verma NP, Sleep disorders in chronic traumatic brain injury. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2007 Jun 15;     [PubMed PMID: 17694723]


Elliott JE,Opel RA,Pleshakov D,Rachakonda T,Chau AQ,Weymann KB,Lim MM, Post-traumatic stress disorder increases odds of REM sleep behavior disorder and other parasomnias in Veterans with and without comorbid traumatic brain injury. Sleep. 2019 Oct 7;     [PubMed PMID: 31587047]


Lloyd R,Tippmann-Peikert M,Slocumb N,Kotagal S, Characteristics of REM sleep behavior disorder in childhood. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2012 Apr 15;     [PubMed PMID: 22505856]


Parish JM, Violent dreaming and antidepressant drugs: or how paroxetine made me dream that I was fighting Saddam Hussein. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2007 Aug 15     [PubMed PMID: 17803018]


McCarter SJ,St Louis EK,Sandness DJ,Arndt K,Erickson M,Tabatabai G,Boeve BF,Silber MH, Antidepressants Increase REM Sleep Muscle Tone in Patients with and without REM Sleep Behavior Disorder. Sleep. 2015 Jun 1     [PubMed PMID: 25325487]


Gagnon JF,Postuma RB,Montplaisir J, Update on the pharmacology of REM sleep behavior disorder. Neurology. 2006 Sep 12     [PubMed PMID: 16966533]


Ma C,Pavlova M,Li J,Liu Y,Sun Y,Huang Z,Wu S,Gao X, Alcohol consumption and probable rapid eye movement sleep behavior disorder. Annals of clinical and translational neurology. 2018 Oct     [PubMed PMID: 30349852]


Knudsen S,Gammeltoft S,Jennum PJ, Rapid eye movement sleep behaviour disorder in patients with narcolepsy is associated with hypocretin-1 deficiency. Brain : a journal of neurology. 2010 Feb;     [PubMed PMID: 20129934]


Frauscher B,Gschliesser V,Brandauer E,Marti I,Furtner MT,Ulmer H,Poewe W,Högl B, REM sleep behavior disorder in 703 sleep-disorder patients: the importance of eliciting a comprehensive sleep history. Sleep medicine. 2010 Feb;     [PubMed PMID: 20022299]


Ohayon MM,Schenck CH, Violent behavior during sleep: prevalence, comorbidity and consequences. Sleep medicine. 2010 Oct;     [PubMed PMID: 20817553]


Haba-Rubio J,Frauscher B,Marques-Vidal P,Toriel J,Tobback N,Andries D,Preisig M,Vollenweider P,Postuma R,Heinzer R, Prevalence and determinants of rapid eye movement sleep behavior disorder in the general population. Sleep. 2018 Feb 1;     [PubMed PMID: 29216391]


Kang SH,Yoon IY,Lee SD,Han JW,Kim TH,Kim KW, REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics. Sleep. 2013 Aug 1;     [PubMed PMID: 23904674]


Pujol M,Pujol J,Alonso T,Fuentes A,Pallerola M,Freixenet J,Barbé F,Salamero M,Santamaría J,Iranzo A, Idiopathic REM sleep behavior disorder in the elderly Spanish community: a primary care center study with a two-stage design using video-polysomnography. Sleep medicine. 2017 Dec;     [PubMed PMID: 29042180]


Bodkin CL,Schenck CH, Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. Journal of women's health (2002). 2009 Dec;     [PubMed PMID: 20044857]


Ju YE, Rapid eye movement sleep behavior disorder in adults younger than 50 years of age. Sleep medicine. 2013 Aug;     [PubMed PMID: 23347910]


Teman PT,Tippmann-Peikert M,Silber MH,Slocumb NL,Auger RR, Idiopathic rapid-eye-movement sleep disorder: associations with antidepressants, psychiatric diagnoses, and other factors, in relation to age of onset. Sleep medicine. 2009 Jan;     [PubMed PMID: 18226952]


Postuma RB,Iranzo A,Hu M,Högl B,Boeve BF,Manni R,Oertel WH,Arnulf I,Ferini-Strambi L,Puligheddu M,Antelmi E,Cochen De Cock V,Arnaldi D,Mollenhauer B,Videnovic A,Sonka K,Jung KY,Kunz D,Dauvilliers Y,Provini F,Lewis SJ,Buskova J,Pavlova M,Heidbreder A,Montplaisir JY,Santamaria J,Barber TR,Stefani A,St Louis EK,Terzaghi M,Janzen A,Leu-Semenescu S,Plazzi G,Nobili F,Sixel-Doering F,Dusek P,Bes F,Cortelli P,Ehgoetz Martens K,Gagnon JF,Gaig C,Zucconi M,Trenkwalder C,Gan-Or Z,Lo C,Rolinski M,Mahlknecht P,Holzknecht E,Boeve AR,Teigen LN,Toscano G,Mayer G,Morbelli S,Dawson B,Pelletier A, Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain : a journal of neurology. 2019 Mar 1;     [PubMed PMID: 30789229]


McCarter SJ,Tippmann-Peikert M,Sandness DJ,Flanagan EP,Kantarci K,Boeve BF,Silber MH,St Louis EK, Neuroimaging-evident lesional pathology associated with REM sleep behavior disorder. Sleep medicine. 2015 Dec;     [PubMed PMID: 26611948]


Sakai K,Sastre JP,Salvert D,Touret M,Tohyama M,Jouvet M, Tegmentoreticular projections with special reference to the muscular atonia during paradoxical sleep in the cat: an HRP study. Brain research. 1979 Nov 2;     [PubMed PMID: 227527]


Postuma RB,Gagnon JF,Bertrand JA,Génier Marchand D,Montplaisir JY, Parkinson risk in idiopathic REM sleep behavior disorder: preparing for neuroprotective trials. Neurology. 2015 Mar 17;     [PubMed PMID: 25681454]


Webster HH,Friedman L,Jones BE, Modification of paradoxical sleep following transections of the reticular formation at the pontomedullary junction. Sleep. 1986;     [PubMed PMID: 3961365]


Ebben MR,Shahbazi M,Lange DJ,Krieger AC, REM behavior disorder associated with familial amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases. 2012 Sep;     [PubMed PMID: 22670878]


Montplaisir J,Gagnon JF,Fantini ML,Postuma RB,Dauvilliers Y,Desautels A,Rompré S,Paquet J, Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Movement disorders : official journal of the Movement Disorder Society. 2010 Oct 15;     [PubMed PMID: 20818653]


Frauscher B,Iranzo A,Gaig C,Gschliesser V,Guaita M,Raffelseder V,Ehrmann L,Sola N,Salamero M,Tolosa E,Poewe W,Santamaria J,Högl B, Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012 Jun 1;     [PubMed PMID: 22654203]


Lapierre O,Montplaisir J, Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology. 1992 Jul;     [PubMed PMID: 1620348]


Boeve BF,Molano JR,Ferman TJ,Lin SC,Bieniek K,Tippmann-Peikert M,Boot B,St Louis EK,Knopman DS,Petersen RC,Silber MH, Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in a community-based sample. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2013 May 15;     [PubMed PMID: 23674939]


Postuma RB,Arnulf I,Hogl B,Iranzo A,Miyamoto T,Dauvilliers Y,Oertel W,Ju YE,Puligheddu M,Jennum P,Pelletier A,Wolfson C,Leu-Semenescu S,Frauscher B,Miyamoto M,Cochen De Cock V,Unger MM,Stiasny-Kolster K,Fantini ML,Montplaisir JY, A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study. Movement disorders : official journal of the Movement Disorder Society. 2012 Jun;     [PubMed PMID: 22729987]


Stiasny-Kolster K,Mayer G,Schäfer S,Möller JC,Heinzel-Gutenbrunner M,Oertel WH, The REM sleep behavior disorder screening questionnaire--a new diagnostic instrument. Movement disorders : official journal of the Movement Disorder Society. 2007 Dec;     [PubMed PMID: 17894337]


Li SX,Wing YK,Lam SP,Zhang J,Yu MW,Ho CK,Tsoh J,Mok V, Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK). Sleep medicine. 2010 Jan;     [PubMed PMID: 19945912]


Frauscher B,Ehrmann L,Zamarian L,Auer F,Mitterling T,Gabelia D,Brandauer E,Delazer M,Poewe W,Högl B, Validation of the Innsbruck REM sleep behavior disorder inventory. Movement disorders : official journal of the Movement Disorder Society. 2012 Nov;     [PubMed PMID: 23192924]


Ferri R,Zucconi M,Marelli S,Plazzi G,Schenck CH,Ferini-Strambi L, Effects of long-term use of clonazepam on nonrapid eye movement sleep patterns in rapid eye movement sleep behavior disorder. Sleep medicine. 2013 May;     [PubMed PMID: 23490738]


McCarter SJ,Boswell CL,St Louis EK,Dueffert LG,Slocumb N,Boeve BF,Silber MH,Olson EJ,Tippmann-Peikert M, Treatment outcomes in REM sleep behavior disorder. Sleep medicine. 2013 Mar;     [PubMed PMID: 23352028]


McGrane IR,Leung JG,St Louis EK,Boeve BF, Melatonin therapy for REM sleep behavior disorder: a critical review of evidence. Sleep medicine. 2015 Jan;     [PubMed PMID: 25454845]


Kunz D,Mahlberg R, A two-part, double-blind, placebo-controlled trial of exogenous melatonin in REM sleep behaviour disorder. Journal of sleep research. 2010 Dec;     [PubMed PMID: 20561180]


Schmidt MH,Koshal VB,Schmidt HS, Use of pramipexole in REM sleep behavior disorder: results from a case series. Sleep medicine. 2006 Aug;     [PubMed PMID: 16815751]


Kumru H,Iranzo A,Carrasco E,Valldeoriola F,Marti MJ,Santamaria J,Tolosa E, Lack of effects of pramipexole on REM sleep behavior disorder in Parkinson disease. Sleep. 2008 Oct;     [PubMed PMID: 18853939]


Moraes Wdos S,Poyares DR,Guilleminault C,Ramos LR,Bertolucci PH,Tufik S, The effect of donepezil on sleep and REM sleep EEG in patients with Alzheimer disease: a double-blind placebo-controlled study. Sleep. 2006 Feb     [PubMed PMID: 16494088]


Soca R,Keenan JC,Schenck CH, Parasomnia Overlap Disorder with Sexual Behaviors during Sleep in a Patient with Obstructive Sleep Apnea. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2016 Aug 15     [PubMed PMID: 27166304]


Mysliwiec V,Brock MS,Creamer JL,O'Reilly BM,Germain A,Roth BJ, Trauma associated sleep disorder: A parasomnia induced by trauma. Sleep medicine reviews. 2018 Feb     [PubMed PMID: 28363448]


Al-Biltagi MA, Childhood epilepsy and sleep. World journal of clinical pediatrics. 2014 Aug 8;     [PubMed PMID: 25254184]


Boot BP,Boeve BF,Roberts RO,Ferman TJ,Geda YE,Pankratz VS,Ivnik RJ,Smith GE,McDade E,Christianson TJ,Knopman DS,Tangalos EG,Silber MH,Petersen RC, Probable rapid eye movement sleep behavior disorder increases risk for mild cognitive impairment and Parkinson disease: a population-based study. Annals of neurology. 2012 Jan;     [PubMed PMID: 22275251]


Mahlknecht P,Seppi K,Frauscher B,Kiechl S,Willeit J,Stockner H,Djamshidian A,Nocker M,Rastner V,Defrancesco M,Rungger G,Gasperi A,Poewe W,Högl B, Probable RBD and association with neurodegenerative disease markers: A population-based study. Movement disorders : official journal of the Movement Disorder Society. 2015 Sep;     [PubMed PMID: 26208108]


Galbiati A,Verga L,Giora E,Zucconi M,Ferini-Strambi L, The risk of neurodegeneration in REM sleep behavior disorder: A systematic review and meta-analysis of longitudinal studies. Sleep medicine reviews. 2019 Feb     [PubMed PMID: 30503716]


Kim Y,Kim YE,Park EO,Shin CW,Kim HJ,Jeon B, REM sleep behavior disorder portends poor prognosis in Parkinson's disease: A systematic review. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2018 Jan     [PubMed PMID: 29102236]


Zahirovic I,Torisson G,Wattmo C,Londos E, Survival among the older adults with clinical signs of Lewy body dementia in 40 Swedish nursing homes: a 6-year follow-up study. BMJ open. 2019 May 30     [PubMed PMID: 31152036]


Zhou J,Zhang J,Lam SP,Mok V,Chan A,Li SX,Liu Y,Tang X,Yung WH,Wing YK, Mortality and Its Risk Factors in Patients with Rapid Eye Movement Sleep Behavior Disorder. Sleep. 2016 Aug 1     [PubMed PMID: 27306273]


Schenck CH,Montplaisir JY,Frauscher B,Hogl B,Gagnon JF,Postuma R,Sonka K,Jennum P,Partinen M,Arnulf I,Cochen de Cock V,Dauvilliers Y,Luppi PH,Heidbreder A,Mayer G,Sixel-Döring F,Trenkwalder C,Unger M,Young P,Wing YK,Ferini-Strambi L,Ferri R,Plazzi G,Zucconi M,Inoue Y,Iranzo A,Santamaria J,Bassetti C,Möller JC,Boeve BF,Lai YY,Pavlova M,Saper C,Schmidt P,Siegel JM,Singer C,St Louis E,Videnovic A,Oertel W, Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy--a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group. Sleep medicine. 2013 Aug     [PubMed PMID: 23886593]