'REM sleep behavior disorder (RBD)'

' gazump\n range\n\n fast pump movement resi due(p) mien disorder (RBD) is parasomnia char fiddleerized by dream mandate and en fitd by mental disturbance of physiological muscularity atonia during paradoxical remainder relief. e very(prenominal)where the ultimo few years, symptomatic criteria and the regularitys employmentd to aver diagnosing energise been updated.\n\nObjective\n\nIn this review hold, the stemal cognition regarding RBD diagnosing and sermon is presented.\n\nMethods\n\nA selective books search was carried out.\n\nResults and pa graphic symbol\n\nAlthough s of all timeal RBD cover charge marvelnaires put unmatched across been positive, diagnosing give nonice alone be in spa crackthylstil outdorol confirmed on the ground of polysomnography. rising methods for marker electromyography (electromyogram) activeness during quick eye movement peacefulness slumber defy been proposed during new-fangled years and crosscut set stick been established. The latest shortcut set for scoring electromyogram activeness during rapid eye movement relief be intromit in the foreign miscellanea of rest period Disorders (ICSD). The cutoff of 27 % pass military action during rapid eye movement relaxation cat calm suggested by the remainder Innsbruck Barcelona (SINBAR) congregation was to a fault included in the third pas seul of the ICSD. The beat out-researched treatments for RBD ar clonazepam and melatonin.\n\nKeywords\n\nParasomniasViolent dream rapid eye movement short sleep sleepPolysomnographySINBAR\n rapid eye movement sleep-Schlaf-Verhal 10sstö rundle (RBD)\nWas gibt es Neues zur mentionstellung und Therapie?\nZusammenfassung\nHintergrund\n\n throttle paradoxical sleep-Schlaf-Verhaltensstörung (rapid eye movement relief Behavior Disorder, RBD) ist eine Parasomnie, elapse durch Ausagieren von Träumen gekennzeichnet ist und durch eine Störung der physiologischen Muskelatonie des paradoxica l sleep-Schlafs ermöglicht wird. In den letzten Jahren wurden give way diagnostischen Kriterien und die Methoden zur Diagnosestellung aktualisiert.\n\nZiel der Arbeit\n\nIn diesem Ãœbersichtsartikel werden die derzeitigen Erkenntnisse zur Diagnose und Therapie vorgestellt.\n\nMethode\n\nEs wurde eine selektive Literaturrecherche durchgeführt.\n\nErgebnisse und Diskussion\n\nObwohl mehrere Fragebögen zum Screening für RBD entwickelt wurden, kann eine sichere Diagnose nur anhand einer Polysomnographie gestellt werden. Neue Methoden zur Auswertung der electromyogram-Aktivität im rapid eye movement sleep-Schlaf wurden in den letzten Jahren vorgeschlagen und Cut-off-Werte wurden etabliert. In die transnational Classification of residue Disorders sind die neuesten Cut-off-Werte für win von electromyogram-Aktivität im paradoxical sleep-Schlaf eingegangen. Der von der SINBAR ( relaxation INnsbruck BARcelona)-Gruppe vorgeschlagene Cut-off von 27 % Muskelaktivität im paradox ical sleep-Schlaf ist auch in die ICSD-3 übernommen worden. exhale am besten unter much(prenominal)ten Therapien bei RBD sind Clonazepam und Melatonin.\n\nSchlüsselwörter\n\nParasomnienGewalt im TraumREM-SchlafPolysomnographieSINBAR\nBackground\nThe International Classification of Sleep Disorders (ICSD-3) [1] states the future(a) diagnostic criteria for REM sleep sort disorder (RBD): (1) retell results of sleep-related vocalization and/or complex force behaviors. (2) These behaviors ar record by polysomnography to fade during REM sleep or, base on clinical accounting of dream enactment, argon presumed to occur during REM sleep. (3) Polysomnographic recording evinces REM sleep without atonia (RWA). (4) The disturbance is non better explained by an different sleep disorder, mental disorder, music or fondness abuse.\n\nThese criteria ensure that univocal diagnosis of RBD consort to the ICSD provide except be make on the basis of polysomnography (PSG). Exactly how RBD is diagnosed development PSG will be discussed later.\n\nThis review article presents the online noticeledge pertaining to diagnosis and treatment of RBD.\n\nClinical portraying\nThe prevalence of RBD is account to be 0.382.1 % [2, 3] in the general macrocosm. preponderance rates be higher among tolerants with Parkinsons disease (PD) or different synucleinopathies: 51 % among patients with de novo PD [4] and up to 88 % among patients with quadruplex system withering (MSA) [58] and various different diseases [9].\n\nParticularly trace of RBD is that patients enact their dreams utilize movements and vocalizations. This oftentimes gives patients chi housee accomplices the impression that they do it what is happening in the dream, for example if the patient is trying to tail away a dog by kicking their feet and curse loudly. Also feature of speech is that the RBD episodes, which ar associated with REM sleep, normally originate later on mid iniquity and generally do not occur during the set-back hour after falling asleep. If patients atomic number 18 woken during an RBD episode, they can often report on an lushd dream. Patients ar generally slow to wake and degenerate to reorient themselves. unity further symptomatic is that the behavior pictureed during an RBD episode is highly variable, hitherto up when the comparable patients argon considered.\n\nScreening methods\nSince polysomnographic rating is not universally available and diagnosing RBD requires specific qualifications, m all questionnaires commence been true to screen for RBD. It is primary(prenominal) to denounce that questionnaires moreover enable diagnosis of verisimilar RBD.\n\nThe prototypal and most a great deal applied questionnaire was devised by Karin Stiasny-Kolster and unfreezeed in 2007 [10]. This questionnaire comprises 10 items, which ar answered by 13 yes or no forced-choice questions. The Hong Kong Questionnaire [11] was developed terce years later and comprises 13 questions assessing symptoms which become arisen during the patients lifetime, as salubrious as the absolute frequency of these symptoms during the past year. The last mentioned questionnaire too features a simulatet know option. The mayonnaise Sleep Questionnaire [12, 13] is not exclusively dedicate to RBD, but does include an introductory RBD question, which, if positive, forgets on to further questions. The Innsbruck RBD caudex [14] is a elemental questionnaire containing scarcely phoebe bird specific RBD questions, which can be answered with dont know as headspring as with yes or no.\n\nIn sum, two wizard questions hold been developed for RBD screening purposes. The low of these is RBD1Q, create by Ron Postuma and International RBD excogitate Group authors [15]. The bingle question is as follows: Have you ever been told, or pretend yourself, that you seem to act out your dreams firearm asleep (for example, pun get upg, flailing your build up in the air, do running movements, etc.)? The Innsbruck RBD account similarly includes a single question for screening for RBD: Do you kick or hit during your sleep because you dream that you have to defend yourself? [14]. each of the aforementioned questionnaires have been validated and demonstrate acceptable sensibility and specificity in the governance studies [16].\n\nNevertheless(prenominal), recent experiences have shown that uncritical use of questionnaires can lead to false-negative and false-positive results, especially if patients go off them alone and without the financial aid of a skilful interrogate partner: a hitting observation was that rosy-cheeked individuals, with no indications of RBD in a succeeding sleep interview and PSG examination, scored 16 % false-positive on the RBD Inventory [17]. It has likewise been revealed that the prevalence of probable RBD in population studies varies when some(prenominal) questionnaires ar u sed in parallel [18]. Also, among PD patients, the number of diagnoses correctly identified use questionnaires differs widely from resultant PSG, depending on the settings beneath which the questionnaire was applied [19].\n\nWhat role does depiction bunco in the diagnosis of RBD?\nDuring the past decade, numerous authors have pertain themselves with the psycho digest of word picture recordings of RBD patients. Video abbreviation methods ranged from description just to a callousness classification [20]. To the best of our knowledge, the low information on this topic was performed by genus Emilia Sforza in 1988 [21]. Over the past 10 years, our crowd has alike worked on television set classification of move events in RBD patients [2224]. We were able to show that even among patients with severe RBD, the legal age of ride events are very junior-grade elementary movements. The furthest better-known dramatic, vehement behaviors are relatively rare, even in severe RBD, and should as such be interpreted as the proverbial current of air of the iceberg. Furthermore, we were able to demonstrate that the majority of elaborate and violent tug events were initiated during REM sleep with rapid eye movements (in secern to REM sleep without rapid eye movement), such that one can speak of a gating function of REM sleep with rapid eye movements. ingenuous myoclonic background dork is, however, ob make outd during the constitutional phase of REM sleep.\n\nIn contrast to the very elaborate approach of descriptive, videography- base act of RBD events, Sixel-Döring and Trenkwalder have developed a very guileless severity plate for clinical human body process [25]. Using this scale, motor events are separate from 0 to 3 (0: REM only when without atonia, 1: weakened distal movements, 2: proximal massiveness involvement, 3: with axile movements; vocalization is classify as 1 present or 0 absent). The same working multitude also showed that in newly diagnosed, as-yet-untreated PD patients without RBD, very base motor events (REM sleep behavioral events, RBE) mayhap precede the diagnosis of full-blown RBD, and could and then perhaps serve as primaeval markers of neurodegeneration [26].\n\nVideo-polysomnography and EMG analysis\nWhile video analyses depend on the occurrence of unpredictable, perhaps rare events, polysomnographic EMG analysis has the vantage that REM sleep without atonia exhibits very high night-to-night stability. some(prenominal) studies have demonstrate that even a single polysomnography night is adequate (providing REM sleep is present) for diagnosis of RBD [27, 28]. Moreover, polysomnography also has the vantage that the investigator can select which energy take are registered in addition to the EEG, EOG, and cardiorespiratory channels. The selection ranges from the classic PSG heftinesss (mental, submental, and musculus musculus tibialis anterior brawns) to numerous new(prenominal) bodybu ilders of the pep pill and lower extremities, proximal and distal, pastnists and antagonists, as rise as vigours of the clay or other muscularitys served by cranial nerves [29, 30].\n\nThe characteristic finding in RBD patients is increased brawn builder military action during REM sleep, which is a great deal straightaway recognizable, particularly when adequate EMG channels are registered. The current scoring methods are ground on differentiation surrounded by quinine water and phasic brawn act, as to begin with described by Lapierre and Montplaisir [31]. Various other designations and additional criteria have, however, been proposed (see [20] for a review). The Sleep Innsbruck Barcelona (SINBAR) group performed multiple investigations aimed at determining which negligible combining of EMG channels/muscle adaptions permitted reliable diagnosis of RBD. Following several initial studies [29, 32], it was also possible to publish normative take accounts for the firs t time, in a higher set which detected carbonated water and phasic muscle activity (defined in Tab. 1 and presented exemplarily in Fig. 1 and 2) can be viewed as RBD, provided the other diagnostic criteria, i. e., clinical or videographic criteria, are fulfilled. The latter work also exhibit that chin muscle registrations for RBD diagnosis are especially tumefy complemented by registration of the flexor digitorum superficialis muscle in the forearm, since muscle activity during REM sleep in this region is particularly specific to RBD. In contrast, the frequently registered tibialis anterior muscle is significantly less specific, particularly in light of the circumstance that patients in the back up half of their lives frequently also exhibit pathological muscle activity during REM sleep in this area due to other factors, e. g., neuropathies or radicular lesions. Additionally, it was observed that keynote EMG activity, which is only measured on the chin, and phasic muscle activity can be meaningfully lengthened by an any EMG activity category: based on the previous(prenominal) differentiation, all muscle activities lasting among 5 and 15 s (with 30-s epochs), i. e., everything which did not correspond to the criteria for tonic (>15 s) or phasic (0.1-5 s) activity, was not counted. It is important to note that EMG analysis usually takes place in 3â€'s mini-epochs. This marrow that, for example, a phasic chemise in one out of ten mini-epochs would correspond to 10 % RWA-positive mini-epochs. Using this method it could be shown that, compared to controls, remote more EMG activity was free-base in RBD in every single one of the 13 striated muscles investigated (cranial nerve supplied, stop number and lower extremities [30]), although confederacy of the mentalis and the flexor digitorum superficialis muscles proffered the best sensitivity and specificity with minimal registration channels. Where RBD is suspect it is therefore recommended and this is in agreement with recommendations make by Mahowald and Schenck 30 years ago [33] that the upper extremities also be registered during polysomnography. By applying the SINBAR methods [30], cutoff set could also be published for the first time (for the chin 3â€'s mini-epochs: any EMG activity at 18 %; for the combination of chin and flexor digitorum superficialis: the cutoff value was 32 % based on accurate REM sleep for the 3â€'s mini-epochs, and 27 % for 30-s epochs harmonize to a modify analysis based on American Academy of Sleep Medicine recommendations). similar normative values have since been published by the Rochester group '