REM Sleep Behavior Disorder (cont.)
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Exams and Tests
The neurologic examinationis often normal. However, symptoms and signs of Parkinson disease,such as hand tremor at rest, slowness in movement, and muscle stiffness (rigidity)that may suggestan underlying neurologic cause of REM sleep behavior disorder (RBD), should be considered.
Polysomnographic video recording is the single most important diagnostic test in persons with RBD. This test is usually conducted in a sleep study center. The person undergoing testing is required to sleep at the center while the following parameters are monitored:
These parameters are monitored as the person passes through the various sleep stages. Characteristic patterns from the electrodes are recorded while the personis awake and during sleep. Continuous video recording is done toobserve behaviors during sleep. It is important to rule out other causes of REM sleep disturbance including conditions such as obstructive sleep apnea (OSA). OSA can cause a person to have restless sleep but the sleep should not be violent. Another condition noted first on laboratory sleep study in REM without atonia (paralysis) which may be a mild form or precursor to RBD in some patients.
In persons with RBD, the polysomnogram shows an increase in the muscle tone associated with the EEG pattern of REM sleep,whereas in healthy persons, the EEG pattern of REM sleep is associatedwith an absence of muscle tone (atonia).
Additionally, the video recording shows body movements coinciding with the EEG pattern of REM sleep.
Imaging studies (for example, CT scan and MRI of the brain) are not routinely indicated in persons who have no neurologic cause of RBD, but they may be done if some abnormality is detected during neurologic examination. Imaging studies should also be considered in younger patients (younger than age 40) where there is no known precipitant cause such as alcohol or medication use (see Causes).
ABM Salah Uddin, MD
Erasmo A Passaro, MD
Francisco Talavera, PharmD, PhD
Stephen Berman, MD, PhD
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