REM sleep behavior disorder

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Classification according to ICD-10
G47.8 Other sleep disorders
ICD-10 online (WHO version 2019)

The rapid eye movement sleep behavior disorder is a parasomnia in which during REM sleep vivid and often frightening dreams are translated into simple and complex movements. This can endanger yourself or others. The behavior of the patient during these events during sleep does not correspond to their character and behavior while awake.

Further names are, after the American psychiatrist and somnologist Carlos H. Schenck, who first described these disorders in 1986, also "Schenck syndrome" (incorrectly also "Schenk syndrome") and engl. "REM sleep behavior disorder" (also "Rapid eye movement sleep behavior disorder") and in technical literature the abbreviation RBD simplifies .

distribution

RBD occurs in varying degrees in around 5 people per 1000 inhabitants. Around 90% of those affected are male, and more than 80% are over 60 years old. When the symptoms first appear, the majority of those affected are 40 to 70 years old, only a few significantly younger people are affected.

Clinical manifestations

The disorder is tied to REM sleep and occurs mainly in the second half of the night. In REM sleep, there is atony of the skeletal muscles in healthy people, whereas in RBD this inhibition of motor skills does not occur.

Those affected have vivid dreams, most of which are about attacks, as a result of which they defend themselves or their loved ones or flee. In the absence of muscular atony, complex, targeted movements often occur, often accompanied by loud vocalizations.

In the dream the person concerned is hunted or attacked, only rarely does the aggression come from him. The attackers are insects, other animals and often humans, the patient sees himself in the defensive position.

In contrast to the Periodic Limb Movement Disorder (PLMD), the movements (punching , punching, kicking, kicking, getting up in bed, crawling around, rolling your body) are not periodic and much more violent. They are also significantly more complex and longer lasting than myoclonia . Typically, people will not get out of bed or will only move on, in contrast to sleepwalking , a sleep disorder associated with non-REM sleep. In RBD, the eyes are usually closed, while sleepwalking reports open eyes with aimless gaze. At night terrors it comes to cry and popping up out of bed, then but not too violent movements and another loud vocalizations, these events are also more likely in the first third of nocturnal sleep instead.

The sounds (screaming, screeching, cursing) often deviate from the otherwise described nature and manner of speaking of the person concerned, the volume is higher than when "speaking while sleeping" ( somniloquie ) or when "sleeping- related moaning" ( catathrenia ).

It happens again and again that the bed partner or someone who wants to wake the person concerned is mistakenly mistaken for the attacker occurring in the dream, from whom it is necessary to flee, against whom the person concerned is defending himself or whom he is supposed to protect his relatives must fight. The dream content is often well remembered for days, but there is amnesia about the real events.

The conversion of dream contents into real movements leads to arousals (wake-up reactions), which significantly reduces the quality of sleep and also disturbs the bed partner. In addition, there is a risk of injury to the person concerned and the bed partner, which in many cases becomes more specific.

When waking up, dream and wake-up action are mixed up. Reported on violations include hematomas (bruises), torn hair, bone fractures. The medical guidelines also give figures for the considerable danger to others and to oneself (64% danger to others, 32% danger to oneself, 7% fractures).

However, many other characteristics of REM sleep such as REM latency, the number of REM episodes and the sleep cycle with the sequence of non-REM sleep and REM sleep are unchanged. The frequency of occurrence of the symptoms varies greatly from several times in one night to about weekly occurrences.

There are several forms of REM sleep behavior disorder. In addition to the two chronic forms, idiopathic and symptomatic RBD, there is also an acute form.

Idiopathic REM sleep behavior disorder

A REM sleep behavior disorder is referred to as idiopathic if no previous causal disease can be found at the time it occurs. This form is found in around half of those affected.

However, 65% of those affected develop Parkinson’s syndrome or dementia in the further course . Therefore, this form is considered a prodromal stage (precursor stage ) of Parkinson's disease and Lewy body dementia (Lewy body dementia).

Decades can pass between the onset of RBD and these diseases. Idiopathic RBD is not a precursor to neurodegenerative diseases in all patients.

Symptomatic REM sleep behavior disorder

With this form, there is already a previous illness at the time of occurrence, which is to be regarded as the cause. These are often neurodegenerative diseases such as Parkinson's disease, multi-system atrophy , Lewy body dementia or PANS syndrome .

Acute REM sleep behavior disorder

The acute form occurs with a temporary course, especially in the case of intoxication or withdrawal in connection with alcohol or antidepressants. It can also be triggered by monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), or norepinephrine antagonists.

Investigation methods

Diagnosis includes personal and external medical history , neurological examinations for neuropsychological deficits, Parkinson's symptoms and autonomic disorders, and polysomnography with videometry in a sleep laboratory .

As part of the external anamnesis, people from the patient's environment are interviewed as they can provide important additional information that the patient cannot perceive himself. When taking the anamnesis, special questionnaires are used to screen for RBD. The "REM Sleep Behavior Disorder Screening Questionnaire" (RBDSQ) is a questionnaire consisting of ten items on which the patient gives a self-assessment of the clinical aspects.

The neurological examination refers to diseases that occur with the symptomatic form of RBD.

Using EMG , polysomnography shows increased activity of the mentalis muscle ("chin muscle") in tonic and even more so in phasic REM sleep. Muscle activity occurs individually or in conjunction with movements of the extremities. This test also serves to rule out other sleep disorders such as Periodic Limb Movement Disorder (PLMD) and sleep-related breathing disorders.

The diagnostic criteria according to ICSD-2 speak of increased values ​​for the muscle tone, which is problematic for cases between the two extremes “atony” and “obviously complex movements of the extremities”, since “normal” values ​​are not known for the EMG. It is also not yet thoroughly researched which muscles in RBD have the highest values ​​in the EMG during REM sleep.

In cases where the chin EMG showed a lack of muscle atony during REM sleep, but no signs of RBD were reported or observed, about a quarter of those affected developed the corresponding symptoms later.

Around 75% of those affected also experience periodic leg movements during sleep (PLMS), and some have obstructive sleep apnea syndrome (OSAS) or narcolepsy .

treatment

The drug clonazepam (a benzodiazepine ) is recommended for treatment of chronic forms . Taken at bedtime will reduce muscle activity during REM sleep. In this context, even with long-term use, there is hardly any development of tolerance or loss of effectiveness. By melatonin , which is to restore also the muscle atonia during REM sleep, an improvement has been achieved in some patients.

history

This parasomnia associated with REM sleep was formally described in 1986. Diagnostic criteria have been included in the ICSD Classification System for Sleep Disorders since the 1990 edition.

literature

  • Richard T. Johnson: The Year in Neurology 2 . John Wiley & Sons, Hoboken, NJ 2010, ISBN 978-1-57331-780-1 , pp. 15-54 (American English).

Individual evidence

  1. ↑ a b c d e Bradley F. Boeve: REM Sleep Behavior Disorder: Updated Review of the Core Features, the RBD-Neurodegenerative Disease Association, Evolving Concepts, Controversies, and Future Directions . In: Annals of the New York Academy of Science . Vol. 1184, 2010, pp. 15–54 , doi : 10.1111 / j.1749-6632.2009.05115.x , PMC 2902006 (free full text) - (American English).
  2. ↑ Hans-Günter weeß: diagnosis of sleep disorders . In: behavior therapy . tape 15 , no. 4 , 2005, p. 220-233 , doi : 10.1159 / 000089490 . online ( Memento of the original from January 31, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (as PDF file, 306 kB), accessed on February 5, 2013  @1@ 2Template: Webachiv / IABot / www.pfalzklinikum.de
  3. ↑ a b c d e S3 guideline for non-restful sleep / sleep disorders of the German Society for Sleep Research and Sleep Medicine (DGSM). In: AWMF online (as of 2009)
  4. ^ A b Carlos H. Schenck, Mark W. Mahowald: REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP . In: Journal Sleep . Vol. 25, No. 2 , 2002, p. 120-138 , PMID 11902423 (English).
  5. ↑ Brit Mollenhauer, Hans Förstl, Günther Deuschl , Alexander Storch, Wolfgang Oertel, Claudia Trenkwalder: dementia with Lewy bodies and Parkinson's disease dementia . In: Deutsches Ärzteblatt . Volume 107, No. 39 , 2010, p. 684–691 , doi : 10.3238 / arztebl.2010.0684 ( aerzteblatt.de [PDF; 361 kB ]).
  6. ^ Carlos H. Schenck, Scott R. Bundlie, Milton G. Ettinger, Mark W. Mahowald: Chronic behavioral disorders of human REM sleep: a new category of parasomnia . In: Journal Sleep . tape 9 , no. 2 , 1986, p. 293-308 , PMID 3505730 (English).