Introduction REM sleep behavior disorder (RBD) is a parasomnia characterized by complex motor activity during REM sleep, usually associated with dream mentation. Patients have elaborate nocturnal motor behaviors, such as screaming, punching, grasping, that are potentially harmful for themselves or their bed partner. In RBD patients polysomnographic (PSG) recording reveals intermittent or complete loss of REM sleep muscle atonia and excessive phasic electromyographic (EMG) activity during REM sleep. RBD affects mainly men after the age of 50 years although the prevalence remains largely unknown. A study performed among 1034 individuals aged 70 years and more in the Hong Kong area found self-injury during sleep in 8 patients, 4 of whom received a PSG diagnosis of RBD yielding an estimated prevalence of 0.04%. RBD may be idiopathic or associated with neurodegenerative diseases, most often the alpha-synucleinopathies, such as Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Moreover, a number of neurological conditions with the involvement of the brainstem may result in RBD. If no neurological signs or central nervous system (CNS) lesions are found, RBD is defined as “idiopathic.” This form accounts for up to 60% of the observed cases in the largest published series of RBD patients.
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