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April 3, 1987, Vol 257, No. 13 >
ARTICLE | April 3, 1987

Rapid Eye Movement Sleep Behavior Disorder: Title and subTitle BreakA Treatable Parasomnia Affecting Older Adults FREE

Carlos H. Schenck, MD; Scott R. Bundlie, MD; Andrea L. Patterson, RPSGT; Mark W. Mahowald, MD
[+] Author Affiliations

Reprint requests to Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN 55415 (Dr Schenck).


JAMA. 1987;257(13):1786-1789. doi:10.1001/jama.1987.03390130104038
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References

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia defined by intermittent loss of electromyographic atonia during REM sleep with emergence of complex and vigorous behaviors. Punching, kicking, and leaping from bed during attempted dream enactment caused repeated injury in nine of our first ten adult patients. Mean age at onset was 62 years; nine of the patients were male. All patients underwent standard polysomnographic studies with videotaping of behaviors and extensive neurologic and psychiatric evaluations. The RBD was unrelated to psychopathologic conditions but in five cases was closely linked with major neuropathologic disorders: dementia (two), olivopontocerebellar degeneration, subarachnoid hemorrhage, and the Guillain-Barré syndrome. Other common polysomnographic abnormalities were high REM density, increased stage 3/4 (slow-wave) sleep, and both periodic and aperiodic limb twitching in non-REM sleep. Eight patients had dream changes involving motor overactivity and violent confrontations of dream characters. Clonazepam induced rapid and sustained improvement of dream and sleep behavior problems in seven patients, as did desipramine hydrochloride in one patient.

(JAMA 1987;257:1786-1789)

REFERENCES

1 +
Schenck CH, Bundlie SR, Ettinger MG, et al:  Chronic behavioral disorders of human REM sleep: A new category of parasomnia . Sleep 1986;; 9:293-308.
2 +
Rechtschaffen A, Kales AA: A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects . Bethesda, Md, National Institute of Neurological Diseases and Blindness, 1968;.
3 +
Taska L, Kupfer D:  A system for the quantification of phasic ocular activity during REM sleep . Sleep Watchers 1983;;6:15-17.
4 +
Reynolds CF III, Kupfer DJ, Taska LS, et al:  Sleep of healthy seniors: A revisit . Sleep 1985;; 8:20-29.
5 +
 Sleep Disorders Classification Committee, Roffwarg HP (chairman): Association of sleep disorders centers, diagnostic classification of sleep and arousal disorders . Sleep 1979;;2:1-137.
6 +
Broughton RJ:  Sleep disorders: Disorders of arousal? Science 1968;;159:1070-1078.
7 +
Schenck CH, Bundlie SR, Smith SA, et al:  REM behavior disorder in a 10-year-old girl and aperiodic REM and NREM sleep movements in an 8-year-old brother . Sleep Res 1986;;15:62.
8 +
Jouvet M, Delorme F:  Locus coeruleus et sommeil paradoxal . C R Soc Biol 1965;;159:895-899.
9 +
Jouvet M, Sastre J-P, Sakai K:  Toward an ethoethnology of dreaming , in Karacan I (ed): Psychophysiological Aspects of Sleep . Park Ridge, NJ,
10 +
Noyes Publishers, 1981;, pp 204-214.
11 +
Broughton R, Tolentino MA:  Fragmentary pathological myoclonus in NREM sleep . EEG Clin Neurophysiol 1984;;57:303-309.
12 +
Broughton R, Tolentino MA, Krelina M:  Excessive fragmentary myoclonus in NREM sleep: A report of 38 cases . EEG Clin Neurophysiol 1985;;61:123-133.
13 +
Jones BE:  Neuroanatomical and neurochemical substrates of mechanisms underlying paradoxical sleep , in McGinty DJ, Drucker-Colin R, Morrison A, et al (eds): Brain Mechanisms of Sleep . New York, Raven Press, 1985;, pp 139-156.
14 +
Sakai K, Sastre J-P, Danamori N, et al:  State-specific neurons in the ponto-medullary reticular formation with special reference to the postural atonia during paradoxical sleep in the cat , in Pompeiano O, Marsan CA (eds): Brain Mechanisms of Perceptual Awareness and Purposeful Behavior . New York, Raven Press, 1981;, pp 405-429.
15 +
Chase MH, Morales FR:  Subthreshold excitatory activity and motoneuron discharge during REM periods of active sleep . Science 1983;;221: 1195-1198.
16 +
Stern M, Roffwarg H, Duvoisin R:  The parkinsonian tremor in sleep . J Nerv Ment Dis 1968;; 147:202-210.
17 +
Schenck CH, Slater GE, Sherman RE, et al: Multiple sclerosis and sleep:  Survey report and polygraphic detection of REM and NREM motor abnormalities . Sleep Res 1986;;15:163.
18 +
Hendricks JC, Morrison AR, Mann GL:  Different behaviors during paradoxical sleep without atonia depend on pontine lesion site . Brain Res 1982;;239:81-105.
19 +
Hobson JA, McCarley RW:  The brain as a dream state generator: An activation-synthesis hypothesis of the dream process . Am J Psychiatry 1977;;134:1335-1348.
20 +
McCarley RW, Hobson JA:  The form of dreams and the biology of sleep , in Wolman BB (ed): The Handbook of Dreams . New York, Van Nostrand Reinhold Co, 1979;, pp 75-130.
21 +
Chadwick D, Hallett M, Harris R, et al:  Clinical, biochemical and physiological features distinguishing myoclonus responsive to 5-hydroxytryptophan, tryptophan with a monoamine oxidase inhibitor and clonazepam . Brain 1977;;100: 455-487.
22 +
Hishikawa Y, Sugita Y, Iijima S, et al:  Mechanisms producing 'stage 1-REM' and similar dissociations of REM sleep and their relation to delirium . Adv Neurol Sci 1981;;25:1129-1147.
23 +
Cowen PJ, Gearey DP, Schacter M, et al:  Desipramine in normal subjects . Arch Gen Psychiatry 1986;;43:61-67.
24 +
Steriade M, Hobson JA:  Neuronal activity during the sleep-waking cycle . Prog Neurobiol 1976;;6:155-376.

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1 +
Schenck CH, Bundlie SR, Ettinger MG, et al:  Chronic behavioral disorders of human REM sleep: A new category of parasomnia . Sleep 1986;; 9:293-308.
2 +
Rechtschaffen A, Kales AA: A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects . Bethesda, Md, National Institute of Neurological Diseases and Blindness, 1968;.
3 +
Taska L, Kupfer D:  A system for the quantification of phasic ocular activity during REM sleep . Sleep Watchers 1983;;6:15-17.
4 +
Reynolds CF III, Kupfer DJ, Taska LS, et al:  Sleep of healthy seniors: A revisit . Sleep 1985;; 8:20-29.
5 +
 Sleep Disorders Classification Committee, Roffwarg HP (chairman): Association of sleep disorders centers, diagnostic classification of sleep and arousal disorders . Sleep 1979;;2:1-137.
6 +
Broughton RJ:  Sleep disorders: Disorders of arousal? Science 1968;;159:1070-1078.
7 +
Schenck CH, Bundlie SR, Smith SA, et al:  REM behavior disorder in a 10-year-old girl and aperiodic REM and NREM sleep movements in an 8-year-old brother . Sleep Res 1986;;15:62.
8 +
Jouvet M, Delorme F:  Locus coeruleus et sommeil paradoxal . C R Soc Biol 1965;;159:895-899.
9 +
Jouvet M, Sastre J-P, Sakai K:  Toward an ethoethnology of dreaming , in Karacan I (ed): Psychophysiological Aspects of Sleep . Park Ridge, NJ,
10 +
Noyes Publishers, 1981;, pp 204-214.
11 +
Broughton R, Tolentino MA:  Fragmentary pathological myoclonus in NREM sleep . EEG Clin Neurophysiol 1984;;57:303-309.
12 +
Broughton R, Tolentino MA, Krelina M:  Excessive fragmentary myoclonus in NREM sleep: A report of 38 cases . EEG Clin Neurophysiol 1985;;61:123-133.
13 +
Jones BE:  Neuroanatomical and neurochemical substrates of mechanisms underlying paradoxical sleep , in McGinty DJ, Drucker-Colin R, Morrison A, et al (eds): Brain Mechanisms of Sleep . New York, Raven Press, 1985;, pp 139-156.
14 +
Sakai K, Sastre J-P, Danamori N, et al:  State-specific neurons in the ponto-medullary reticular formation with special reference to the postural atonia during paradoxical sleep in the cat , in Pompeiano O, Marsan CA (eds): Brain Mechanisms of Perceptual Awareness and Purposeful Behavior . New York, Raven Press, 1981;, pp 405-429.
15 +
Chase MH, Morales FR:  Subthreshold excitatory activity and motoneuron discharge during REM periods of active sleep . Science 1983;;221: 1195-1198.
16 +
Stern M, Roffwarg H, Duvoisin R:  The parkinsonian tremor in sleep . J Nerv Ment Dis 1968;; 147:202-210.
17 +
Schenck CH, Slater GE, Sherman RE, et al: Multiple sclerosis and sleep:  Survey report and polygraphic detection of REM and NREM motor abnormalities . Sleep Res 1986;;15:163.
18 +
Hendricks JC, Morrison AR, Mann GL:  Different behaviors during paradoxical sleep without atonia depend on pontine lesion site . Brain Res 1982;;239:81-105.
19 +
Hobson JA, McCarley RW:  The brain as a dream state generator: An activation-synthesis hypothesis of the dream process . Am J Psychiatry 1977;;134:1335-1348.
20 +
McCarley RW, Hobson JA:  The form of dreams and the biology of sleep , in Wolman BB (ed): The Handbook of Dreams . New York, Van Nostrand Reinhold Co, 1979;, pp 75-130.
21 +
Chadwick D, Hallett M, Harris R, et al:  Clinical, biochemical and physiological features distinguishing myoclonus responsive to 5-hydroxytryptophan, tryptophan with a monoamine oxidase inhibitor and clonazepam . Brain 1977;;100: 455-487.
22 +
Hishikawa Y, Sugita Y, Iijima S, et al:  Mechanisms producing 'stage 1-REM' and similar dissociations of REM sleep and their relation to delirium . Adv Neurol Sci 1981;;25:1129-1147.
23 +
Cowen PJ, Gearey DP, Schacter M, et al:  Desipramine in normal subjects . Arch Gen Psychiatry 1986;;43:61-67.
24 +
Steriade M, Hobson JA:  Neuronal activity during the sleep-waking cycle . Prog Neurobiol 1976;;6:155-376.

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