Until recently, the diagnosis of RBD was based on clinical manifestations, namely the presence of limb or body movements associated with dream mentation and at least one of the following: (1) harmful or potentially harmful sleep behaviors during sleep; (2) dreams that appear to be acted out; and (3) sleep behaviors that disrupt sleep continuity. Polysomnographic observations of patients were not necessary for diagnosis according to the International Classification of Sleep Disorders-1 (ICSD-1).
Eisensehr et al. and Gagnon et al. pointed out the limitations of these criteria because one half of the cases of RBD with PD would have been undetected based clinical interviews alone (Eisensehr et al., 2001; Gagnon et al., 2002). RBD-like features can occur with other sleep conditions such as obstructive sleep apnea syndrome (OSAS), sleepwalking, night terrors, and sleep-related seizures (see below 4). In the second version of the ICSD (ICSD-2), PSG findings were required to establish the diagnosis. The first essential criterion is the presence of REM sleep without atonia. The second criterion is the presence of either sleep-related injurious or disruptive behaviors revealed by history or abnormal REM sleep behaviors documented during PSG recording. Time-synchronized video recording is essential for helping to establish the diagnosis of RBD during PSG. The last two criteria are exclusion criteria, which are the absence of epileptiform activity during sleep and the presence of other sleep disorders or medical or neurological disorders that could better explain the sleep disturbance. The diagnostic criteria are listed in Table 2.
A. I'l es ci'.cc of REM sleep without a to ma EMG finding of excessif amounts of sustained or intermittent elevation of submental EMG tone or excessive phasic submental or (tipper or lower) limb EMG twi telling.
B. At least one of the following is present:
i. Sleep related injurious, potentially injurious, or disruptive behaviors :'v history ii. Abnormal REM sleep behaviors documented during polysomnography monitoring
C. Absence of I v > epileptiform activity during REM sleep -unless RBD call be clearly distinguished from any concurrent REM sleep related seizure disorder,
D. The sleep disturbance is not better explained by another sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder.
Table 2. Diagnostic criteria for REM sleep behavior disorder in ICSD-2
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