Current Neurology and Neuroscience Reports

, Volume 7, Issue 2, pp 167–172 | Cite as

Pathophysiologic mechanisms in REM sleep behavior disorder

  • Mark W. Mahowald
  • Carlos H. Schenck
  • Michel A. Cramer Bornemann
Article
First Online:

Abstract

REM sleep behavior disorder (RBD) is a fascinating experiment in nature predicted by animal studies in 1964. A defining feature of REM sleep is active paralysis of all somatic musculature (sparing the diaphragm to permit respiration). RBD is characterized by the absence of REM atonia, permitting the appearance of dream-enacting behaviors. These oneiric behaviors may be violent or injurious. RBD typically affects men over the age of 50 years. Longitudinal follow-up has shown that the majority of individuals with RBD will eventually develop additional signs and symptoms of a number of neurodegenerative disorders, most notably one of the synucleinopathies (Parkinson’s disease, dementia with Lewy body disease, multiple system atrophy, or pure autonomic failure), often after a prolonged interval lasting more than 10 years. RBD is also a common manifestation of narcolepsy. RBD may be induced by medications, especially the tricyclic antidepressants and serotonin-specific reuptake inhibitors. In most cases, clonazepam is a highly effective treatment.

Keywords

Obstructive Sleep Apnea Multiple System Atrophy Narcolepsy Progressive Supranuclear Palsy Single Photon Emission Compute Tomography Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Jouvet M, Delorme F: Locus coeruleus et sommeil paradoxal. Comptes Rendus Des Seances de la Societe de Biologie et de ses Filiales 1965, 159:895–899.Google Scholar
  2. 2.
    Sanford LD, Cheng CS, Silvestri AJ, et al.: Sleep and behavior in rats with pontine lesions producing REM without atonia. Sleep Res Online 2001, 4:1–5.Google Scholar
  3. 3.
    Schenck CH, Mahowald MW: REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in sleep. Sleep 2002, 25:120–130.PubMedGoogle Scholar
  4. 4.
    Fantini ML, Corona A, Clerici S, Ferini-Strambi L: Increased aggressive dream content without increased daytime aggressiveness in REM sleep behavior disorder. Neurology 2005, 65:1010–1015.PubMedCrossRefGoogle Scholar
  5. 5.
    Schenck CH, Mahowald MW: REM sleep parasonmnias. Neurol Clin 2005, 23:1107–1126.PubMedCrossRefGoogle Scholar
  6. 6.
    Gagnon JF, Postuma RB, Mazza S, et al.: Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 2006, 5:424–432.PubMedCrossRefGoogle Scholar
  7. 7.
    Iranzo A, Molinuevo JL, Santamaria J, et al.: Rapid-eye-movement sleep behavior disorder as an early marker for neurodegenerative disorder: a descriptive study. Lancet Neurol 2006, 5:572–577.PubMedCrossRefGoogle Scholar
  8. 8.
    Weyer A, Minnerop M, Abele M, Klockgether T: REM sleep behavioral disorder in pure autonomic failure (PAF). Neurology 2006, 66:608–609.PubMedCrossRefGoogle Scholar
  9. 9.
    Schenck CH, Bundlie SR, Mahowald MW: REM behavior disorder (RBD): delayed emergence of parkinsonism and/or dementia in 65% of older men initially diagnosed with idiopathic RBD, and analysis of the minimum and maximum tonic and/or phasic electromyographic abnormalities found during REM sleep. Sleep 2003, 26(Abstract Suppl):A316.Google Scholar
  10. 10.
    Lai YY, Siegel JM: Physiological and anatomical link between Parkinson-like disease and REM sleep behavior disorder. Mol Neurobiol 2003, 27:137–151.PubMedCrossRefGoogle Scholar
  11. 11.
    Staisny-Kolster K, Doerr Y, Moller JC, et al.: Combination of ‘idiopathic’ REM sleep behaviour disorder and olfactory dysfunction as possible indicator for alpha-synucleinopathy demonstrated by dopamine transporter FP-CIT-SPECT. Brain 2005, 128:126–137.CrossRefGoogle Scholar
  12. 12.
    Postuma RB, Lang AE, Massicotte-Marquez J, Montplaisir J: Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder. Neurology 2006, 66:845–851.PubMedCrossRefGoogle Scholar
  13. 13.
    Kumru H, Santamaria J, Tolosa E, et al.: Rapid eye movement sleep behavior disorder in Parkinsonism with PARKIN mutations. Ann Neurol 2004, 56:599–603.PubMedCrossRefGoogle Scholar
  14. 14.
    Arnulf I, Merino-Andreu M, Bloch F, et al.: REM sleep behavior disorder and REM without atonia in patients with progressive supranuclear palsy. Sleep 2005, 28:349–354.PubMedGoogle Scholar
  15. 15.
    Iranzo A, Santamaria J, Rye DB, et al.: Characteristics of idiopathic REM sleep behavior disorder and that associated with MSA and PD. Neurology 2005, 65:247–252.PubMedCrossRefGoogle Scholar
  16. 16.
    Goldstein M: Brain research and violent behavior. Arch Neurology 1974, 30:1–34.Google Scholar
  17. 17.
    Moyer KE: Kinds of aggression and their physiological basis. Commun Behav Biol 1968, 2(part A):65–87.Google Scholar
  18. 18.
    Ramirez JM: Hormones and aggression in childhood and adolescence. Aggression Violent Behavi 2003, 8:621–644.CrossRefGoogle Scholar
  19. 19.
    Tatman JE, Sind JM: REM behavior disorder manifests differently in women and men. Sleep Res 1996, 25:380.Google Scholar
  20. 20.
    Ozekmekci S, Apaydin H, Kilic E: Clinical features of 35 patients with Parkinson’s disease displaying REM sleep behavior disorder. Clin Neurol Neurosurg 2005, 107:306–309.PubMedCrossRefGoogle Scholar
  21. 21.
    Nightingale S, Orgill JC, Ebrahim IO, et al.: The association between narcolepsy and REM behavior disorder (RBD). Sleep Med 2005, 6:253–258.PubMedCrossRefGoogle Scholar
  22. 22.
    Schenck CH, Mahowald MW: Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992, 32:3–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Montagna P, Lugaresi E: Agrypnia excitata: a generalized overactivity syndrome and a useful concept in the neurophysiology of sleep. Clin Neurophysiol 2002, 113:552–560.PubMedCrossRefGoogle Scholar
  24. 24.
    Josephs KA, Silber MH, Fealey RD, et al.: Neurophysiologic studies in Morvan syndrome. J Clin Neurophysiol 2004, 21:440–445.PubMedCrossRefGoogle Scholar
  25. 25.
    Mahowald MW: Does “idiopathic” REM sleep behavior disorder exist [editorial]? Sleep 2006, 29:874–875.PubMedGoogle Scholar
  26. 26.
    Ferini-Strambi L, DeGioia MR, Castronovo VE, et al.: Neuropsychological assessment in idiopathic REM sleep behavior disorder (RBD). Does the idiopathic form of RBD really exist? Neurology 2004, 62:41–45.PubMedGoogle Scholar
  27. 27.
    Fantini ML, Ferini-Strambi L, Montplaisir J: Idiopathic REM sleep behavior disorder. Toward a better nosologic definition. Neurology 2005, 64:780–786.PubMedGoogle Scholar
  28. 28.
    Lai YY, Siegel JM: Muscle tone suppression and stepping produced by stimulation of midbrain and rostral pontine reticular formation. J Neurosci 1990, 10:2727–2734.PubMedGoogle Scholar
  29. 29.
    Schenkel E, Siegel JM: REM sleep without atonia after lesions of the medial medulla. Neurosci Lett 1989, 98:159–165.PubMedCrossRefGoogle Scholar
  30. 30.
    Mileykovskiy BY, Kiyashchenko LI, Kodama T, et al.: Activation of pontine medullary motor inhibitory regions reduces discharge in neurons located in the locus coeruleus and the anatomical equivalent of the midbrain locomotor region. J Neurosci 2000, 20:8551–8558.PubMedGoogle Scholar
  31. 31.
    Lai YY, Siegel JM: Brain stem-mediated locomotion and myoclonic jerks. I. Neural substrates. Brain Res 1997, 745:257–264.PubMedCrossRefGoogle Scholar
  32. 32.
    Lai YY, Siegel JM: Brainstem-mediated locomotion and myoclonic jerks. II. Pharmacological effects. Brain Res 1997, 745:265–270.PubMedCrossRefGoogle Scholar
  33. 33.
    Fort P, Rampon C, Gervasoni D, et al.: Anatomical demonstration of a medullary enkephalinergic pathway potentially implicated in the oro-facial muscle atonia of paradoxical sleep in the cat. Sleep Res Online 1998, 1:102–108.PubMedGoogle Scholar
  34. 34.
    Zagrodzka J, Hedberg CE, Mann GL, Morrison AR: Contrasting expressions of aggressive behavior released by lesions of the central nucleus of the amygdala during wakefulness and rapid eye movement sleep without atonia in cats. Behav Neurosci 1998, 112:589–602.PubMedCrossRefGoogle Scholar
  35. 35.
    Eisensehr I, Linke R, Noachtar S, et al.: Reduced striatal dopamine transporters in idiopathic rapid eye movement sleep behavior disorder. Comparison with Parkinson’s disease and controls. Brain 2000, 123:1155–1160.PubMedCrossRefGoogle Scholar
  36. 36.
    Eisensehr I, Linke R, Tatsch K, et al.: Increased muscle activity during rapid eye movement sleep correlates with decrease of striatal presynaptic dopamine transporters. IPT and IBZM SPECT imaging in subclinical and clinically manifest idiopathic REM sleep behavior disorder, Parkinson’s disease, and controls. Sleep 2003, 26:507–512.PubMedGoogle Scholar
  37. 37.
    Albin RL, Koeppe RA, Chervin RD, et al.: Decreased striatal dopaminergic innervation in REM sleep behavior disorder. Neurology 2000, 55:1410–1412.PubMedGoogle Scholar
  38. 38.
    Shirakawa S, Takeuchi N, Uchimura N, et al.: Study of image findings in rapid eye movement sleep behavioural disorder. Psychiatry Clin Neurosci 2002 56:291–292.PubMedCrossRefGoogle Scholar
  39. 39.
    Miyamoto M, Miyamoto T, Kubo J, et al.: Brainstem function in rapid eye movement sleep behavior disorder: the evaluation of brainstem function by proton MR spectroscopy (1H-MRS). Psychiatry Clin Neurosci 2000, 54:350–351.PubMedCrossRefGoogle Scholar
  40. 40.
    Gilman S, Koeppe RA, Chervin R, et al.: REM sleep behavior disorder is related to striatal monoaminergic deficit in MSA. Neurology 2003, 61:29–34.PubMedGoogle Scholar
  41. 41.
    Shirakawa SI, Takeuchi N, Uchimura N, et al.: Study of image findings in rapid eye movement sleep behavioral disorder. Psychiatry Clin Neurosci 2002, 56:291–292.PubMedCrossRefGoogle Scholar
  42. 42.
    Fantini ML, Gagnon JF, Petit D, et al.: Slowing of electroencephalogram in rapid eye movement sleep behavior disorder. Ann Neurol 2003, 53:774–780.PubMedCrossRefGoogle Scholar
  43. 43.
    Ohayon MM, Caulet M, Priest RG: Violent behavior during sleep. J Clin Psychiatry 1997, 58:369–376.PubMedGoogle Scholar
  44. 44.
    Chiu HF, Wing YK, Lam LC, et al.: Sleep-related injury in the elderly—an epidemiological study in Hong Kong. Sleep. 2000, 23:513–517.PubMedGoogle Scholar
  45. 45.
    Schenck CH, Boyd JL, Mahowald MW: A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997, 20:972–981.PubMedGoogle Scholar
  46. 46.
    Schenck CH, Mahowald MW: Long-term, nightly benzo-diazepine treatment of injurious parasomnias and other disorders of disrupted nocturnal sleep in 170 adults. Am J Med 1996, 100:333–337.PubMedCrossRefGoogle Scholar
  47. 47.
    Watanabe T, Sugita Y: REM sleep behavior disorder (RBD) and dissociated REM sleep. Nippon RTNSHO (Japanese Journal of Clinical Medicine) 1998, 56:433–438.Google Scholar
  48. 48.
    Lapierre O, Montplaisir J: Polysomnographic features of REM sleep behavior disorder: development of a scoring method. Neurology 1992, 42:1371–1374.PubMedGoogle Scholar
  49. 49.
    Boeve BF, Silber MH, Ferman JT: Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003, 4:281–284.PubMedCrossRefGoogle Scholar
  50. 50.
    Fantini ML, Gagno JF, Filipini D, Montplaisir J: The effects of pramipexole in REM sleep behavior disorder. Neurology 2003, 61:1418–1420.PubMedGoogle Scholar
  51. 51.
    Schmidt MH, Koshal VB, Schmidt HS: Use of pramipexole in REM sleep behavior disorder. Sleep Med 2006, 7:418–423.PubMedCrossRefGoogle Scholar
  52. 52.
    Schuld A, Kraus T, Haack M, et al.: Obstructive sleep apnea syndrome induced by clonazepam in a narcoleptic patient with REM-sleep-behavior disorder. J Sleep Res 1999, 8:321–322.PubMedCrossRefGoogle Scholar
  53. 53.
    Schenck CH, Bundlie SR, Mahowald MW: Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. [erratum appears in Neurology 1996 Jun, 46(6):1787]. Neurology 1996, 46:388–393.PubMedGoogle Scholar
  54. 54.
    Rye DB, Dempsay J, Dihenia B, et al.: REM-sleep dyscontrol in parkinson’s disease: case report of effects of elective pallidotomy. Sleep Res 1997, 26:591.Google Scholar
  55. 55.
    Iranzo A, Valldeoriola F, Santamaria J, et al.: Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002, 72:661–664.PubMedCrossRefGoogle Scholar
  56. 56.
    Arnulf I, Bejjani BP, Garma L, et al.: Improvement of sleep architecture in PD with subthalamic stimulation. Neurology 2000, 55:1732–1734.PubMedGoogle Scholar
  57. 57.
    Cicolin A, Lopiano L, Zibetti M, et al.: Effects of deep brain stimulation of he subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med 2004, 5:207–210.PubMedCrossRefGoogle Scholar
  58. 58.
    Dyken ME, Lin-Dyken DC, Seaba P, Yamada T: Violent sleep-related behavior leading to subdural hemorrhage. Arch Neurol 1995, 52:318–321.PubMedGoogle Scholar
  59. 59.
    Cramer Bornemann MA, Mahowald MW, Schenck CH: Parasomnias. Clinical features and forensic implications. Chest 2006, 130:605–610.CrossRefGoogle Scholar
  60. 60.
    Tachibana N, Oka Y: Longitudinal change in REM sleep components in a patient with multiple system atrophy associated with REM sleep behavior disorder: paradoxical improvement of nocturnal behaviors in a progressive neurodegenerative disease. Sleep Med 2004, 5:155–158.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  • Mark W. Mahowald
    • 1
  • Carlos H. Schenck
  • Michel A. Cramer Bornemann
  1. 1.Minnesota Regional Sleep Disorders CenterHennepin County Medical CenterMinneapolisUSA

Personalised recommendations