Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy.
Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy.
Sleep Med Rev. 2021 Dec;60:101515. doi: 10.1016/j.smrv.2021.101515. Epub 2021 Jun 10.
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia with dream-enactment behaviors occurring during REM sleep and associated with the lack of the physiological REM sleep muscle atonia. It can be isolated and secondary to other neurological or medical conditions. Isolated RBD heralds in most cases a neurodegenerative condition due to an underlying synucleinopathy and consequently its recognition is crucial for prognostic implications. REM sleep without atonia on polysomnography is a mandatory diagnostic criterion. Different conditions may mimic RBD, the most frequent being obstructive sleep apnea during sleep, non-REM parasomnia, and sleep-related hypermotor epilepsy. These diseases might also be comorbid with RBD, challenging the evaluation of disease severity, the treatment choices and the response to treatment evaluation. Video-PSG is the gold standard for a correct diagnosis and will distinguish between different or comorbid sleep disorders. Careful history taking together with actigraphy may give important clues for the differential diagnosis. The extreme boundaries of RBD might also be seen in more severe and complex conditions like status dissociatus or in the sleep disorders' scenario of anti IgLON5 disease, but in the latter both clinical and neurophysiological features will differ. A step-by-step approach is suggested to guide the differential diagnosis.
快速眼动（REM）睡眠行为障碍（RBD）是一种伴有梦境行为的睡眠障碍，发生在 REM 睡眠期间，与 REM 睡眠肌肉弛缓缺失有关。它可以是孤立的，也可以继发于其他神经或医学状况。孤立性 RBD 在大多数情况下预示着一种神经退行性疾病，由于潜在的突触核蛋白病，因此其识别对于预后意义至关重要。多导睡眠图上的 REM 睡眠无弛缓是强制性的诊断标准。不同的情况可能模仿 RBD，最常见的是睡眠时的阻塞性睡眠呼吸暂停、非 REM 睡眠障碍和与睡眠相关的运动性癫痫。这些疾病也可能与 RBD 同时存在，这使得疾病严重程度的评估、治疗选择和治疗反应评估变得具有挑战性。视频-PSG 是正确诊断的金标准，可区分不同或并存的睡眠障碍。仔细的病史采集加上活动记录仪可能会为鉴别诊断提供重要线索。RBD 的极端边界也可能出现在更严重和复杂的情况下，如分离状态或抗 IgLON5 病的睡眠障碍中，但在后一种情况下，临床和神经生理学特征将有所不同。建议采用逐步方法来指导鉴别诊断。
