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{{ClinPsy}}
 
{{ClinPsy}}
   
===Introduction===
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{{Infobox disease |
'''Rapid eye movement [[sleep]] behaviour disorder''', or '''RBD''', was first described by Schenck et al. in 1986 (Schenck et al. 1986). It is a parasomnia involving dissociation of the characteristic stages of sleep. The major and arguably only abnormal feature of RBD is loss of muscle atonia (paralysis) during otherwise intact REM sleep (the stage of sleep in which most vivid dreaming occurs). This loss of motor inhibition leads to a wide spectrum of behavioural release during sleep. This extends from simple limb twitches to more complex integrated movements where sufferers appear to be unconsciously acting out their dreams. These behaviours are often violent in nature and commonly result in injury to either the patient or their bed partner. Injuries range from bruises and cuts to fractures, subdural haematoma and other serious injuries. In contrast, all other aspects of sleep appear similar to normal.
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Name = Rapid eye movement behavior disorder |
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Image = |
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Caption = |
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DiseasesDB = |
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ICD10 = |
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ICD9 = |
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ICDO = |
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OMIM = |
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MedlinePlus = |
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eMedicineSubj = |
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eMedicineTopic = |
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MeshID = D020447 |
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'''Rapid eye movement sleep behavior disorder''' ('''RBD''') is a [[sleep disorder]] (more specifically a [[parasomnia]]) that involves abnormal behavior during the [[sleep phase]] with [[Rapid eye movement sleep|rapid eye movement]] (REM sleep). It was first described in 1986.
   
===Epidemiology===
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The major and arguably only abnormal feature of RBD is loss of muscle [[atonia]] ([[paralysis]]) during otherwise intact REM sleep. This is the stage of sleep in which most vivid [[dream]]ing occurs. The loss of motor inhibition leads to a wide spectrum of behavioral release during sleep. This extends from simple limb twitches to more complex integrated movement, in which sufferers appear to be [[Unconsciousness|unconsciously]] acting out their dreams. These behaviors can be violent in nature and in some cases will result in injury to either the patient or their bed partner.
The most comprehensive assessment so far has estimated RBD prevalence to be around 0.5% in individuals aged 15-100 (Ohayon et al. 1997). However this is probably an overestimation. It is far more common in males: most studies report that only around a tenth of sufferers are female. This may be due to a referral bias, as violent activity carried out by men is more likely to result in harm and injury and is more likely to be reported than injury to male bed partners by women, or it may reflect a true difference in prevalence as a result of genetic or androgenic factors. The mean age of onset is estimated to be around 60 years of age.
 
   
===Associated Conditions===
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==Symptoms==
Various conditions are very similar to RBD in that sufferers exhibit excessive sleep movement and potentially violent behaviour. Such disorders include sleepwalking and sleep terrors, which are associated with other stages of sleep, nocturnal seizures and obstructive sleep apnea which can induce arousals from REM sleep associated with complex behaviours. Because of the similarities between the conditions, polysomnography plays an important role in confirming RBD diagnosis.
+
RBD is characterized by the dreamer acting out his or her dreams. Usually negative ones which involve kicking, screaming, punching, grabbing, and even jumping out of bed. When awakened, one can usually recall the dream they were having which will match the actions they were performing, but they will not be aware that they were moving.
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Episodes occur more towards the morning hours because that is when REM sleep is more frequent. People with RBD experience episodes at least once a week, sometimes more and each episode can result in injuries to oneself or one's bed partner.<ref name="Mayo Clinic">
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{{cite web
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|url=http://www.mayoclinic.org/rem-sleep-behavior-disorder/
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|title=REM Sleep Behavior Disorder
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|publisher=[[Mayo Clinic]]
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|accessdate=2010-01-02
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}}
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</ref>
   
It is now apparent that RBD appears in association with a variety of different conditions. Narcolepsy has been reported as a related disorder. This is unsurprising, as both RBD and narcolepsy involve dissociation of sleep states probably arising from a disruption of sleep control mechanisms. RBD has also been reported following cerebrovascular accident and neurinoma (tumour), indicating that damage to a brainstem area may precipitate RBD. RBD is usually chronic, however may be acute and sudden in onset if associated with drug treatment or withdrawal (particularly with alcohol withdrawal) 60% of RBD is idiopathic. This includes RBD that is found in association with conditions such as Parkinson’s disease and dementia with Lewy bodies, where it is often seen to precede the onset of neurodegenerative disease.
+
==Causes==
  +
Rapid eye movement behavior disorder occurs when there is a loss of normal voluntary muscle atonia during REM sleep resulting in motor behavior in response to dream content. It can be caused by adverse reactions to certain drugs or else during drug withdrawal; however it is most often associated with the elderly and in those with [[neurodegenerative disorders]] such as [[Parkinson disease]], and other neurodegenerative diseases<ref>{{Cite journal | last1 = Gugger | first1 = JJ. | last2 = Wagner | first2 = ML. | title = Rapid eye movement sleep behavior disorder. | journal = Ann Pharmacother | volume = 41 | issue = 11 | pages = 1833-41 | month = Nov | year = 2007 | doi = 10.1345/aph.1H587 | PMID = 17925503 }}</ref> for example [[multiple system atrophy]] and [[lewy Body Dementia]].
   
===Treatment===
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==Treatment==
RBD is a treatable condition. The standard therapy is the anti-convulsant drug clonazepam, and this is generally received very well. How this drug works to restore REM atonia is unclear, however it is thought to suppress muscle activity, rather than directly restoring atonia.
+
RBD is treatable. Various medications are prescribed for RBD based on varying symptoms. Low doses of [[clonazepam]] is most effective with a 90% success rate, how this drug works to restore REM atonia is unclear, however it is thought to suppress muscle activity, rather than directly restoring atonia. [[Melatonin]] is also effective and can also be prescribed as a more natural alternative. For those with Parkinson's and RBD, Levodopa is a popular choice.
  +
In addition to medication it is also wise to secure the sleeper's environment in preparation for episodes. Remove potentially dangerous objects from the bedroom and either place a cushion around the bed or move the mattress to the floor for added protect against injuries.<ref name="Mayo Clinic"/><ref>{{Cite journal | last1 = Ferini-Strambi | first1 = L. | last2 = Zucconi | first2 = M. | title = REM sleep behavior disorder. | journal = Clin Neurophysiol | volume = 111 Suppl 2 | pages = S136-40 | month = Sep | year = 2000 | PMID = 10996567 }}</ref><ref>{{Cite journal | last1 = Boeve | first1 = BF. | last2 = Silber | first2 = MH. | last3 = Ferman | first3 = TJ. | title = REM sleep behavior disorder in Parkinson's disease and dementia with Lewy bodies. | journal = J Geriatr Psychiatry Neurol | volume = 17 | issue = 3 | pages = 146-57 | month = Sep | year = 2004 | doi = 10.1177/0891988704267465 | PMID = 15312278 }}</ref> [[Pramipexole]] is another drug which can be an effective treatment option.<ref>{{Cite journal | last1 = Paparrigopoulos | first1 = TJ. | title = REM sleep behaviour disorder: clinical profiles and pathophysiology. | journal = Int Rev Psychiatry | volume = 17 | issue = 4 | pages = 293-300 | month = Aug | year = 2005 | doi = 10.1080/09540260500104540 | PMID = 16194802 }}</ref>
   
===References===
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== Epidemiology ==
* {{cite journal | author=MM . Ohayon''et al'' | title=Violent behavior during sleep | journal=Jornal of Clinical Psychiatry | year=1997 | volume=58 | pages= 369–376}}
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The most comprehensive assessment so far has estimated RBD prevalence to be around 0.5% in individuals aged 15 to 100<ref>Ohayonet M.M. ''et al.'' (1997). Violent behavior during sleep. ''Journal of Clinical Psychiatry'' 58: 369–76.</ref>. It is far more common in males: most studies report that only around a tenth of sufferers are female. This may partially be due to a referral bias, as violent activity carried out by men is more likely to result in harm and injury and is more likely to be reported than injury to male bed partners by women, or it may reflect a true difference in prevalence as a result of [[Genetics|genetic]] or [[androgenic]] factors{{Fact|date=July 2008}}. The mean age of onset is estimated to be around 60 years<ref name=Olson>Olson EJ ''et al.'' (2000). Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. ''Brain'' 123: 331–39. PMID 10648440</ref>.
* {{cite journal | author=CH . Schenck''et al'' | title=Chronic behavioural disorders of human REM sleep: a new category of parasomnia | journal=Sleep | year=1986 | volume=9 | pages= 293–309}}
+
  +
Various conditions are very similar to RBD in that sufferers exhibit excessive sleep movement and potentially violent behavior. Such disorders include [[sleepwalking]] and [[night terrors|sleep terrors]], which are associated with other stages of sleep, nocturnal [[seizures]] and obstructive [[sleep apnea]] which can induce arousals from REM sleep associated with complex behaviors. Because of the similarities between the conditions, [[polysomnography]] plays an important role in confirming RBD diagnosis.
  +
  +
It is now apparent that RBD appears in association with a variety of different conditions. [[Narcolepsy]] has been reported as a related disorder. This is unsurprising, as both RBD and narcolepsy involve dissociation of sleep states probably arising from a disruption of sleep control mechanisms. RBD has also been reported following [[cerebrovascular accident]] and [[neurinoma]] (tumour), indicating that damage to the [[brain stem]] area may precipitate RBD. RBD is usually [[chronic (medicine)|chronic]], however may be [[acute (medical)|acute]] and sudden in onset if associated with [[medication|drug treatment]] or [[withdrawal]] (particularly with [[alcohol withdrawal]]) 60% of RBD is [[idiopathic]]. This includes RBD that is found in association with conditions such as [[Parkinsons|Parkinson’s disease]] and [[dementia]] with [[Lewy bodies]], where it is often seen to precede the onset of [[neurodegenerative disease]]. Monoamine oxidase inhibitors, tricyclic antidepressants, serotonergic synaptic reuptake inhibitors, and noradrenergic antagonists can induce or aggravate RBD symptoms and should be avoided in patients with RBD.
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==In non-humans==
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RBD has been diagnosed in non-[[human]]s, specifically, [[dog]]s.<ref>
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{{cite web
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|url=http://news.ufl.edu/2001/02/13/dog-sleep/
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|title=Dog with Rare Sleeping Disorder Sent Home After Unique Diagnosis at UF's Veterinary Medical Teaching Hospital
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|last=Carey
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|first=Sarah
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|publisher=[[University of Florida]]
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|date=2001-02-13
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|accessdate=2010-01-02
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}}
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</ref>
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==See also==
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*[[Parasomnias]]
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== References ==
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{{reflist}}
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==External links==
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* {{En icon}} [http://news.bbc.co.uk/2/hi/health/7795368.stm BBC article 25.12.2008: Canadian research on links between RBD and Parkinson's Disease]
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{{Mental and behavioral disorders}}
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[[Category:Parasomnias]]
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[[Category:Sleep disorders]]
 
{{enWP|Rapid eye movement behavior disorder}}
 
{{enWP|Rapid eye movement behavior disorder}}

Latest revision as of 23:57, January 3, 2010

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Rapid eye movement behavior disorder
Classification and external resources
MeSH D020447

Rapid eye movement sleep behavior disorder (RBD) is a sleep disorder (more specifically a parasomnia) that involves abnormal behavior during the sleep phase with rapid eye movement (REM sleep). It was first described in 1986.

The major and arguably only abnormal feature of RBD is loss of muscle atonia (paralysis) during otherwise intact REM sleep. This is the stage of sleep in which most vivid dreaming occurs. The loss of motor inhibition leads to a wide spectrum of behavioral release during sleep. This extends from simple limb twitches to more complex integrated movement, in which sufferers appear to be unconsciously acting out their dreams. These behaviors can be violent in nature and in some cases will result in injury to either the patient or their bed partner.

SymptomsEdit

RBD is characterized by the dreamer acting out his or her dreams. Usually negative ones which involve kicking, screaming, punching, grabbing, and even jumping out of bed. When awakened, one can usually recall the dream they were having which will match the actions they were performing, but they will not be aware that they were moving. Episodes occur more towards the morning hours because that is when REM sleep is more frequent. People with RBD experience episodes at least once a week, sometimes more and each episode can result in injuries to oneself or one's bed partner.[1]

CausesEdit

Rapid eye movement behavior disorder occurs when there is a loss of normal voluntary muscle atonia during REM sleep resulting in motor behavior in response to dream content. It can be caused by adverse reactions to certain drugs or else during drug withdrawal; however it is most often associated with the elderly and in those with neurodegenerative disorders such as Parkinson disease, and other neurodegenerative diseases[2] for example multiple system atrophy and lewy Body Dementia.

TreatmentEdit

RBD is treatable. Various medications are prescribed for RBD based on varying symptoms. Low doses of clonazepam is most effective with a 90% success rate, how this drug works to restore REM atonia is unclear, however it is thought to suppress muscle activity, rather than directly restoring atonia. Melatonin is also effective and can also be prescribed as a more natural alternative. For those with Parkinson's and RBD, Levodopa is a popular choice. In addition to medication it is also wise to secure the sleeper's environment in preparation for episodes. Remove potentially dangerous objects from the bedroom and either place a cushion around the bed or move the mattress to the floor for added protect against injuries.[1][3][4] Pramipexole is another drug which can be an effective treatment option.[5]

Epidemiology Edit

The most comprehensive assessment so far has estimated RBD prevalence to be around 0.5% in individuals aged 15 to 100[6]. It is far more common in males: most studies report that only around a tenth of sufferers are female. This may partially be due to a referral bias, as violent activity carried out by men is more likely to result in harm and injury and is more likely to be reported than injury to male bed partners by women, or it may reflect a true difference in prevalence as a result of genetic or androgenic factors[How to reference and link to summary or text]. The mean age of onset is estimated to be around 60 years[7].

Various conditions are very similar to RBD in that sufferers exhibit excessive sleep movement and potentially violent behavior. Such disorders include sleepwalking and sleep terrors, which are associated with other stages of sleep, nocturnal seizures and obstructive sleep apnea which can induce arousals from REM sleep associated with complex behaviors. Because of the similarities between the conditions, polysomnography plays an important role in confirming RBD diagnosis.

It is now apparent that RBD appears in association with a variety of different conditions. Narcolepsy has been reported as a related disorder. This is unsurprising, as both RBD and narcolepsy involve dissociation of sleep states probably arising from a disruption of sleep control mechanisms. RBD has also been reported following cerebrovascular accident and neurinoma (tumour), indicating that damage to the brain stem area may precipitate RBD. RBD is usually chronic, however may be acute and sudden in onset if associated with drug treatment or withdrawal (particularly with alcohol withdrawal) 60% of RBD is idiopathic. This includes RBD that is found in association with conditions such as Parkinson’s disease and dementia with Lewy bodies, where it is often seen to precede the onset of neurodegenerative disease. Monoamine oxidase inhibitors, tricyclic antidepressants, serotonergic synaptic reuptake inhibitors, and noradrenergic antagonists can induce or aggravate RBD symptoms and should be avoided in patients with RBD.

In non-humansEdit

RBD has been diagnosed in non-humans, specifically, dogs.[8]

See alsoEdit

References Edit

  1. 1.0 1.1 REM Sleep Behavior Disorder. Mayo Clinic. URL accessed on 2010-01-02.
  2. (Nov 2007). Rapid eye movement sleep behavior disorder.. Ann Pharmacother 41 (11): 1833-41.
  3. (Sep 2000). REM sleep behavior disorder.. Clin Neurophysiol 111 Suppl 2: S136-40.
  4. (Sep 2004). REM sleep behavior disorder in Parkinson's disease and dementia with Lewy bodies.. J Geriatr Psychiatry Neurol 17 (3): 146-57.
  5. (Aug 2005). REM sleep behaviour disorder: clinical profiles and pathophysiology.. Int Rev Psychiatry 17 (4): 293-300.
  6. Ohayonet M.M. et al. (1997). Violent behavior during sleep. Journal of Clinical Psychiatry 58: 369–76.
  7. Olson EJ et al. (2000). Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123: 331–39. PMID 10648440
  8. Carey, Sarah Dog with Rare Sleeping Disorder Sent Home After Unique Diagnosis at UF's Veterinary Medical Teaching Hospital. University of Florida. URL accessed on 2010-01-02.

External linksEdit

  • (English)
BBC article 25.12.2008: Canadian research on links between RBD and Parkinson's Disease

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