SLEEP 2026 | Diagnosing iRBD: challenges and opportunities

So the current framework for diagnosing iRBD is a video polysomnography, or also known as a sleep study. This is an expensive screening tool. It requires experts, it requires a specialized lab, and there’s inter-variability where different specialists or different technicians may diagnose differently. These limitations just all compound to make it more difficult to diagnose iRBD than would be preferred. There’s also some difficulties where detecting the symptoms himself is difficult because it requires a bed partner. The phenotype is weaker in women. And it also can be masked by other conditions like obstructive sleep apnea and PLMD. And all these things make it more difficult. And in a condition that has a prevalence of around 1.5% and an 80% conversion to worse neurodegenerative diseases, it’s important that we are constantly trying to address and improve how we screen for those conditions. So there are techniques that are being attempted. There are studies that have attempted at-home video polysomnography, which does address some of the issues of having a patient come into the clinic and having to sleep, which is a bit of a disruptive event. But there’s still some drawbacks with this as the setup is still difficult, which is being improved over time. There’s also questionnaires that are out there. These questionnaires, they have some efficacy, but they have a positive predictive value of around 10% alone, which just leads to many false positives, just because some patients may think that they are acting out their dreams, but it may just be something unrelated or it’s just not the true symptom that we’re looking for.

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