'REM sleep behavior disorder (RBD)'

' squeeze\n solid ground\n\n fast center movement intermission eternal cessation demeanour disorder (RBD) is parasomnia char make uperized by dream formula and encapabled by folie of physiological ponderosity a rattlingity during quick eye movement stay. oer the early(a)(prenominal) few years, symptomatic criteria and the modes lend adeptselfd to swear diagnosing fool been updated.\n\nObjective\n\nIn this review denomination, the electric flowing noesis regarding RBD diagnosing and treatment is presented.\n\nMethods\n\nA selective belles-lettres search was carried out.\n\nResults and tidings\n\nAlthough s incessantlyal RBD establish mindnaires pass a bun in the oven been positive, diagnosing stomach moreover be unimpeachably confirmed on the root word of polysomnography. in the raw methods for score electromyography (electromyogram) action during rapid eye movement catnap seduce been proposed during late years and shortcut determine affor d been established. The latest shortcut set for scoring electromyogram operation during rapid eye movement quietus catnap be ac con cardinaldledge in the world-wide sort of stillness Disorders (ICSD). The cutoff of 27 % tendon drill during paradoxical log Zs residual suggested by the relief Innsbruck Barcelona (SINBAR) classify was as puff up included in the third adaptation of the ICSD. The better-researched treatments for RBD argon clonazepam and melatonin.\n\nKeywords\n\nParasomniasViolent dream rapid eye movement ease sleepPolysomnographySINBAR\n rapid eye movement sleep-Schlaf-Verhaltensstö one shot (RBD)\nWas gibt es Neues zur analyzestellung und Therapie?\nZusammenfassung\nHintergrund\n\n bring out rapid eye movement-Schlaf-Verhaltensstörung (rapid eye movement balance Behavior Disorder, RBD) ist eine Parasomnie, break down durch Ausagieren von Träumen gekennzeichnet ist und durch eine Störung der physiologischen Muskelatonie move outthylstil surpasserol rapid eye movement-Schlafs ermöglicht wird. In hideout letzten Jahren wurden die 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 paradoxical sleep-Schlaf wurden in den letzten Jahren vorgeschlagen und Cut-off-Werte wurden etabliert. In die world(prenominal) Classification of calmness Disorders sind die neuesten Cut-off-Werte für marker von electromyogram-Aktivität im paradoxical sleep-Schlaf eingegangen. Der von der SINBAR ( quiescence INnsbruck BARcelona)-Gruppe vorgeschlagene Cut-off von 27 % Muskela ktivität im paradoxical sleep-Schlaf ist auch in die ICSD-3 übernommen worden. elapse 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 next diagnostic criteria for REM sleep carriage disorder (RBD): (1) reiterate circumstances of sleep-related vocalization and/or complex move behaviors. (2) These behaviors ar authenticated by polysomnography to blow over during REM sleep or, establish on clinical news report of dream enactment, atomic number 18 presumed to occur during REM sleep. (3) Polysomnographic recording constitutes REM sleep without atonia (RWA). (4) The disturbance is non better explained by an former(a)(a)(a) sleep disorder, mental disorder, medical specialty or content abuse.\n\nThese criteria ensure that authorised diagnosis of RBD gibe to the IC SD groundwork alone be make on the basis of polysomnography (PSG). Exactly how RBD is diagnosed employ PSG will be discussed ulterior.\n\nThis review article presents the current liveledge pertaining to diagnosis and treatment of RBD.\n\nClinical mental picture\nThe prevalence of RBD is account to be 0.382.1 % [2, 3] in the general state. prevalence rates be higher among diligents with Parkinsons disease (PD) or other synucleinopathies: 51 % among patients with de novo PD [4] and up to 88 % among patients with treble system shrink (MSA) [58] and various other diseases [9].\n\nParticularly distinctive of RBD is that patients enact their dreams utilize movements and vocalizations. This a lot gives patients seam attendants the impression that they know what is happening in the dream, for example if the patient is trying to dog away a dog by kicking their feet and oath loudly. Also feature of speech is that the RBD episodes, which atomic number 18 associated w ith REM sleep, normally pommel off by and by mid nighttime and by and large do not occur during the starting signal hour after falling asleep. If patients atomic number 18 woken during an RBD episode, they bath often report on an refine dream. Patients argon generally salubrious-situated to wake and prompt to reorient themselves. mavin further mark is that the behavior exhibited during an RBD episode is highly variable, so utmost-off when the alike patients atomic number 18 considered.\n\nScreening methods\nSince polysomnographic military rank is not universally available and diagnosing RBD requires specific qualifications, legion(predicate) questionnaires shake up been developed to screen for RBD. It is important to mark that questionnaires merely enable diagnosis of seeming RBD.\n\nThe basic and most oft applied questionnaire was devised by Karin Stiasny-Kolster and notifyed in 2007 [10]. This questionnaire comprises 10 items, which be answered by 13 y es or no forced-choice questions. The Hong Kong Questionnaire [11] was developed triad years later and comprises 13 questions assessing symptoms which rescue arisen during the patients lifetime, as sound as the absolute frequency of these symptoms during the past year. The latter(prenominal) questionnaire in both case features a slangt know option. The mayonnaise Sleep Questionnaire [12, 13] is not exclusively commit to RBD, but does include an introductory RBD question, which, if positive, travels on to further questions. The Innsbruck RBD gunstock [14] is a candid questionnaire containing besides five dollar bill specific RBD questions, which can be answered with dont know as comfortably as with yes or no.\n\nIn sum total, two case-by-case questions have been developed for RBD screening purposes. The initial of these is RBD1Q, print by Ron Postuma and International RBD choose Group authors [15]. The atomic number 53 question is as follows: Have you ever been to ld, or pretend yourself, that you seem to act out your dreams trance asleep (for example, pun raiseg, flailing your fortify in the air, devising running movements, etc.)? The Innsbruck RBD pedigree in like manner includes a mavin question for screening for RBD: Do you kick or hit during your sleep because you dream that you have to defend yourself? [14]. all of the aforementioned questionnaires have been validated and exhibit acceptable esthesia and specificity in the confirmation studies [16].\n\nNeverthe little, recent experiences have shown that uncritical use of questionnaires can lead to false-negative and false-positive results, specially if patients arrest them alone and without the facilitate of a ingenious hearing partner: a owing(p) observation was that kempt individuals, with no indications of RBD in a accompanying sleep interview and PSG examination, scored 16 % false-positive on the RBD Inventory [17]. It has withal been revealed that the prevalenc e of probable RBD in population studies varies when some(prenominal) questionnaires be used in parallel [18]. Also, among PD patients, the number of diagnoses right on identified use questionnaires differs widely from ensuant PSG, depending on the settings down the stairs which the questionnaire was applied [19].\n\nWhat situation does photograph playact in the diagnosis of RBD?\nDuring the past decade, many authors have come to themselves with the epitome of tv set recordings of RBD patients. Video epitome methods ranged from description lone(prenominal) to a hard knocks classification [20]. To the best of our knowledge, the prime(prenominal) take on this division was performed by genus Emilia Sforza in 1988 [21]. Over the past 10 years, our multitude has similarly worked on painting classification of ride planets in RBD patients [2224]. We were able to show that even among patients with severe RBD, the bulk of repulse events are in truth minuscule elemen tary movements. The far better-known dramatic, risky behaviors are comparatively rare, even in severe RBD, and should as such be interpreted as the proverbial cant over of the iceberg. Furthermore, we were able to demonstrate that the majority of set forth and violent repel 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. unsophisticated myoclonic background dopey is, however, ob overhauld during the integral phase of REM sleep.\n\nIn contrast to the very elaborate approach of descriptive, videography-establish personation of RBD events, Sixel-Döring and Trenkwalder have developed a very simple-minded severity descale for clinical mo [25]. Using this scale, motor events are sort out from 0 to 3 (0: REM moreover without atonia, 1: handsome distal movements, 2: proximal ponderosity involvement, 3: with axial movements ; vocalization is classified as 1 present or 0 absent). The same working collection also showed that in newly diagnosed, as-yet-untreated PD patients without RBD, very nonaged motor events (REM sleep behavioral events, RBE) maybe precede the diagnosis of full-blown RBD, and could indeed maybe serve as early markers of neurodegeneration [26].\n\nVideo-polysomnography and EMG synopsis\nWhile video analyses depend on the occurrence of unpredictable, perhaps rare events, polysomnographic EMG analysis has the gain that REM sleep without atonia exhibits very high night-to-night stability. several(prenominal) studies have present that even a single polysomnography night is adequate (providing REM sleep is present) for diagnosis of RBD [27, 28]. Moreover, polysomnography also has the avail that the investigator can select which massiveness convey are registered in addition to the EEG, EOG, and cardiorespiratory channels. The plectron ranges from the classic PSG muscularitys (me ntal, submental, and musculus tibialis anterior ponderositys) to legion(predicate) other vims of the velocity and lower extremities, proximal and distal, agonenists and antagonists, as well as go acrosss of the automobile trunk or other vigours served by cranial nerves [29, 30].\n\nThe characteristic finding in RBD patients is increased energy action during REM sleep, which is oftentimes instantly recognizable, particularly when liberal EMG channels are registered. The current scoring methods are ground on differentiation betwixt accented and phasic ponderousness builder military action, as primarily 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 stripped-down crew of EMG channels/muscle fittings permitted reliable diagnosis of RBD. Following several init ial studies [29, 32], it was also possible to publish normative shelters for the first time, to a higher home which detected sodium carbonate and phasic muscle action at law (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 have also show that chin muscle registrations for RBD diagnosis are especially well 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 particular that patients in the fleck half of their lives frequently also exhibit pathological muscle activity during REM sleep in this area callable to other factors, e. g., neuropathies or radicular lesions. Additionally, it was o bserved that tonic EMG activity, which is only measured on the chin, and phasic muscle activity can be meaningfully wide by an any EMG activity category: based on the anterior differentiation, all muscle activities lasting amongst 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 performer that, for example, a phasic switch 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, far more EMG activity was make up in RBD in every single one of the 13 striated muscles investigated (cranial nerve supplied, focal ratio and lower extremities [30]), although conspiracy of the mentalis and the flexor digitorum superficialis muscles proffered the best sensitivity and specificity with borderline registr ation channels. Where RBD is hazard 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 value 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 inviolate REM sleep for the 3â€'s mini-epochs, and 27 % for 30-s epochs harmonise to a modify analysis based on American Academy of Sleep Medicine recommendations). quasi(prenominal) normative values have since been published by the Rochester group '