Rapid Eye Movement Behavior Disorder
A. Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors which may be sufficient to result in injury to the individual or bedpartner.
B. These behaviors arise during REM sleep and therefore usually occur greater that 90 minutes after sleep onset, are more frequent during the later portions of the sleep period, and rarely occur during daytime naps.
C. Upon awakening, the individual is completely awake, alert, and not confused or disoriented.
D. The observed vocalizations or motor behavior often correlate with simultaneously occurring dream mentation leading to the report of “acting out of dreams”.
E. The behaviors cause clinically significant distress or impairment in social or other important areas of functioning – particularly pertaining to distress to bedpartner or injury to self or bedpartner.
F. At least one of the following is present: 1) Sleep related injurious, potentially injurious, or disruptive behaviors arising from sleep and 2) Abnormal REM sleep behaviors documented by polysomnographic recording
G. REM sleep without atonia on polysomnographic recording
H. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. Rapid Eye Movement Behavior Disorder is a very well characterized independent parasomnia of great interest to psychiatry due to a) its high correlation with neurodegenerative disorders of interest to psychiatry (Parkinson’s disease and dementia with Lewy body disease) and b) the fact that it can be caused by or exacerbated by medications frequently prescribed by psychiatrists (SSRIs and SNRIs).
Validators:
1. Concurrent - biological, polysomnographic REM sleep findings, functional neuroimaging studies.
2. Predictive - early marker of neurodegenerative disorders.
Relationship to International Classification of Sleep Disorders 2nd Edition
RBD Disorder is virtually identical to RBD in the ICSD 2. Rapid movement behavior disorder 327.42
References:
1. Iranzo A, Santamaria J, Tolosa E. The clinical and pathophysiological relevance of REM sleep behavior disorder in neurodegenerative diseases. Sleep Medicine Reviews 2009;13(6):385-401.
2. Boeve BF, Silber MH, Saper CB, Ferman JT, Dickson DW, Parisi JE, et al. Pathophysiology of REM sleep behavior disorder and relevance to neurodegenerative disease. Brain 2007;130:2770-88.
3. Schenck CH,Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in Sleep. Sleep 2002; 25:120-30.
This new disorder is not listed in DSM-IV and was previously subsumed under Parasomnia Not Otherwise Specified.