Management of REM Sleep Behavior Disorder: A Clinical Practice Guideline from the American Academy of Sleep Medicine
Introduction:
This guideline establishes clinical practice recommendations for the treatment of rapid eye movement (REM) sleep behavior disorder in adults.
Methods:
The American Academy of Sleep Medicine (AASM) commissioned a task force of sleep medicine experts to develop recommendations and assign strengths based on a systematic review of the literature and evaluation of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group provided a summary of the relevant literature and the certainty of the evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations supporting the recommendations. The AASM Board of Directors approved the final recommendations.
Good Practice Statement:
The following best practice statement is based on expert consensus, and its implementation is necessary for the appropriate and effective management of patients with REM sleep behavior disorder (RBD):
It is vitally important to help patients maintain a safe sleeping environment to prevent potentially harmful nighttime behaviors.
|
recommendations
The following recommendations, with medications listed in alphabetical order, are a guide for physicians in choosing a specific treatment for RBD in adults. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (i.e., "We recommend...") is one that physicians should follow in most circumstances. A "conditional" recommendation (i.e., "We suggest...") is one that requires the physician to use clinical knowledge and experience, and seriously consider the patient’s values and preferences to determine the best course of action.
Adult patients with isolated RBD
1. *The AASM suggests that doctors use clonazepam (rather than no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL)
2. *The AASM suggests that doctors use immediate-release melatonin (rather than no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL)
3. *The AASM suggests that doctors use pramipexole (rather than no treatment) for the treatment of isolated RBD in adults. (CONDITIONAL)
4. The AASM suggests that clinicians use transdermal rivastigmine (rather than no treatment) for the treatment of isolated RBD in adults with mild cognitive impairment (MCI). (CONDITIONAL)
Adult patients with secondary RBD due to medical condition
5. *The AASM suggests that doctors use clonazepam (rather than no treatment) for the treatment of secondary RBD due to a medical condition in adults. (CONDITIONAL)
6. *The AASM suggests that doctors use immediate-release melatonin (rather than no treatment) for the treatment of secondary RBD due to a medical condition in adults. (CONDITIONAL)
7. The AASM suggests that doctors use transdermal rivastigmine (rather than no treatment) for the treatment of secondary RBD due to a medical condition (Parkinson’s disease) in adults. (CONDITIONAL)
8. *The AASM suggests that doctors not use deep brain stimulation (instead of no treatment) for the treatment of secondary RBD due to a medical condition in adults. (CONDITIONAL)
Adult patients with drug-induced RBD
9. *The AASM suggests that physicians use drug discontinuation (vs. drug continuation) for the treatment of drug-induced RBD in adults. (CONDITIONAL)
*Recommendations include comments listed below that provide additional context to guide clinicians with implementation.
REM sleep behavior disorder results in potentially violent and harmful behaviors.
Comments
A new clinical practice guideline developed by the American Academy of Sleep Medicine provides recommendations for the management of REM sleep behavior disorder in adults.
The guideline, available online in the Journal of Clinical Sleep Medicine , updates the previous AASM guideline published in 2010. Several clinical trials conducted in the last decade have contributed new evidence to the published literature, providing additional support for the recommendations.
" REM sleep behavior disorder is common, affecting more than 80 million people worldwide," said senior author Dr. Michael Howell, chair of the AASM task force and professor and division head. of sleep medicine in the department of neurology at the University of Minnesota. in Minneapolis. “This clinical practice guideline provides clinicians with information on how best to prevent sleep-related injuries and how to provide patients with a risk assessment for neurological disease. "The task force assembled by the AASM diligently reviewed thousands of clinical studies to provide updated guidance for clinicians managing REM sleep behavior disorder."
REM sleep behavior disorder is classified as a parasomnia , a group of sleep disorders that involve undesirable physical events or experiences that occur while falling asleep, falling asleep, or waking up. REM sleep is characterized by rapid eye movements and dream activity, and typically involves skeletal paralysis. This paralysis, or muscle atonia, is lost in REM sleep behavior disorder, causing people to act out potentially harmful behaviors in their dreams. These dreams tend to be unpleasant, action-packed, or violent, and the dreamer is confronted, attacked, or chased by unknown people or animals.
The symptoms of REM sleep behavior disorder are often ignored for years, usually until an injury occurs to the dreamer or the bed. REM sleep behavior disorder often occurs due to an underlying neurological disorder , such as dementia with Lewy bodies, Parkinson’s disease, multiple system atrophy, narcolepsy, or stroke .
The guideline provides recommendations for specific medications, such as clonazepam and immediate-release melatonin, that clinicians should consider when treating REM sleep behavior disorder in adults. All recommendations are conditional, requiring the physician to use clinical knowledge and experience, and to carefully consider the patient’s values and preferences to determine the best course of action. Treatment options also depend on whether the case of REM sleep behavior disorder is isolated, secondary to another medical condition, or drug-induced.
The guideline also emphasizes the need for patients to maintain a safe sleeping environment to prevent injuries while sleeping.
The guideline suggests removing objects next to the bed that could easily injure someone while they sleep. Sharp furniture should be removed or its edges padded; A soft rug or mat should be placed next to the bed in case of sudden falls. To reduce the risk of injury, people with severe REM sleep behavior disorder should be advised to sleep separately from their partners until they receive treatment.
To develop the guideline, the AASM commissioned a task force of sleep medicine physicians with expertise in REM sleep behavior disorder. They developed clinical practice recommendations based on a systematic review of the literature and an evaluation of the evidence according to the GRADE process, taking into account the quality of the evidence, the benefits and harms, the values and preferences of the patients. patients and resource use.
The guideline was endorsed by the International RBD Study Group, Project Sleep, and Wake Up Narcolepsy, and was endorsed by the American Academy of Neurology and the American Geriatrics Society.
Access the full text of the guide in English
