Michael H. Silber

REM Sleep Behavior Disorder in Parkinson’s Disease, Dementia with Lewy Bodies, and Multiple System Atrophy

Rapid eye movement sleep behavior disorder (RBD) is characterized by loss of normal skeletal muscle atonia during rapid eye movement (REM) sleep with prominent motor activity and dreaming. The evolving literature and our clinical experience suggests RBD may not simply represent an interesting parasomnia, but rather reflect dysfunction in REM sleep control that has relevance for understanding certain neurodegenerative disorders. In this chapter, we first review the clinical and polysomnographic features of RBD, criteria for diagnosis of RBD, management of RBD, pathophysiologic underpinnings of RBD, and neuroimaging findings. We then view RBD in the context of certain neurodegenerative disorders. The window that RBD provides in understanding key features of REM sleep control as well as the clinical and pathophysiologic significance of REM sleep dyscontrol in neurodegenerative disorders become clear.