Best practice guide for the treatment of REM sleep behavior disorder (RBD)

R. Nisha Aurora, Rochelle S. Zak, Rama K. Maganti, Sanford H. Auerbach, Kenneth R. Casey, Susmita Chowdhuri, Anoop Karippot, Kannan Ramar, David A. Kristo, Timothy I. Morgenthaler, Sharon L. Tracy

Research output: Contribution to journalReview article

257 Scopus citations

Abstract

Summary of Recommendations: Modifying the sleep environment is recommended for the treatment of patients with RBD who have sleep-related injury. Level A Clonazepam is suggested for the treatment of RBD but should be used with caution in patients with dementia, gait disorders, or concomitant OSA. Its use should be monitored carefully over time as RBD appears to be a precursor to neurodegenerative disorders with dementia in some patients. Level B Clonazepam is suggested to decrease the occurrence of sleeprelated injury caused by RBD in patients for whom pharmacologic therapy is deemed necessary. It should be used in caution in patients with dementia, gait disorders, or concomitant OSA, and its use should be monitored carefully over time. Level B Melatonin is suggested for the treatment of RBD with the advantage that there are few side effects. Level B Pramipexole may be considered to treat RBD, but efficacy studies have shown contradictory results. There is little evidence to support the use of paroxetine or L-DOPA to treat RBD, and some studies have suggested that these drugs may actually induce or exacerbate RBD. There are limited data regarding the efficacy of acetylcholinesterase inhibitors, but they may be considered to treat RBD in patients with a concomitant synucleinopathy. Level C The following medications may be considered for treatment of RBD, but evidence is very limited with only a few subjects having been studied for each medication: zopiclone, benzodiazepines other than clonazepam, Yi-Gan San, desipramine, clozapine, carbamazepine, and sodium oxybate. Level C.

Original languageEnglish (US)
Pages (from-to)85-95
Number of pages11
JournalJournal of Clinical Sleep Medicine
Volume6
Issue number1
StatePublished - Feb 15 2010

    Fingerprint

Keywords

  • Acetylcholinesterase inhibitor
  • Benzodiazepine
  • Carbamazepine
  • Clonazepam
  • Clozapine
  • Desipramine
  • L-DOPA
  • Melatonin
  • Paroxetine
  • Pramipexole
  • REM sleep behavior disorder
  • Sleep-related injury
  • Sodium oxybate
  • Synucleinopathy
  • Yi-Gan San
  • Zopiclone

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Aurora, R. N., Zak, R. S., Maganti, R. K., Auerbach, S. H., Casey, K. R., Chowdhuri, S., Karippot, A., Ramar, K., Kristo, D. A., Morgenthaler, T. I., & Tracy, S. L. (2010). Best practice guide for the treatment of REM sleep behavior disorder (RBD). Journal of Clinical Sleep Medicine, 6(1), 85-95.