EAN 2023 | The importance of polysomnography in diagnosing REM sleep behavior disorder
Ambra Stefani, MD, PhD, Medical University of Innsbruck, Innsbruck, Austria, discusses the significance of polysomnography in accurately diagnosing REM sleep behavior disorder (RBD). RBD is characterized by the manifestation of dream enactment behaviors during REM sleep, accompanied by increased muscular activity. Polysomnography plays a crucial role in providing a definitive diagnosis, as it helps exclude mimics and ensures a precise diagnosis of RBD. Dr Stefani emphasizes the ethical implications of this diagnosis and highlights the need for proper communication and support for patients. While screening questionnaires have been validated and can be helpful in identifying potential RBD cases, polysomnography remains essential for confirming the diagnosis. The potential utility of wearable and wearable devices as screening instruments has been shown, but their diagnostic capabilities are still being explored. This interview took place at the European Academy of Neurology (EAN) 2023 Congress in Budapest, Hungary.
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Transcript (edited for clarity)
This is a really important aspect as video polysomnography is fundamental for the diagnosis of REM sleep behavior disorder, because the definition is in the appearance of dream enactment behaviors during REM sleep and an increased muscular activity during REM sleep. So, this needs to be demonstrated through polysomnography and it’s really important to have an accurate diagnosis and not a probable or possible diagnosis based only on clinical history, because of the implication of isolated REM sleep behavior disorder, because we know that this is a prodromal alpha synucleinopathy...
This is a really important aspect as video polysomnography is fundamental for the diagnosis of REM sleep behavior disorder, because the definition is in the appearance of dream enactment behaviors during REM sleep and an increased muscular activity during REM sleep. So, this needs to be demonstrated through polysomnography and it’s really important to have an accurate diagnosis and not a probable or possible diagnosis based only on clinical history, because of the implication of isolated REM sleep behavior disorder, because we know that this is a prodromal alpha synucleinopathy. So, when we communicate the diagnosis with this patient, we want to be one-hundred percent sure that this is the true diagnosis, that we have excluded mimics, and we need also to communicate this diagnosis in the right way and give the patient the possibility to ask and answer us and get some support, because this have several ethical implications.
This is linked also to the previous aspect of ethical implications, there are screening questionnaires which have been validated, they can be useful to screen for REM sleep behavior disorder, but we still need to keep in mind that these are not instrumented to make a diagnosis. We always need the polysomnography to confirm the diagnosis and patients with REM sleep disorder in almost one hundred percent of the cases, they are not aware of having these behaviors because if they don’t injure themselves during sleep and then wake up because of injury, or because they fall out of bed then they do not remember the episodes or are not aware of having these behaviors. So just asking them is not sufficient in these cases and also questionnaires do not allow us to differentiate mimics. There are also other screening instruments, for example based on actigraphy or 3D analysis of videos, which can be done at home, but these are still needed to be further developed. It is important to confirm the diagnosis with polysomnography.
So, I just briefly mentioned the use of wearable device like actigraphy or a 3D camera, these are really promising instruments at the moment as a screening method. There are also other devices like headbands, which can measure sleep at home, and at the moment these are useful screening instruments. There have been already studies on that, and we will see if they can be developed further to become maybe diagnostic instrument, but probably we will still need the polysomnography to confirm the diagnosis.
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