RBD is clearly a risk factor for PD but I don't think all patients pass through idiopathic RBD en-route to clinically probable PD. The role of 'loss of REM sleep atonia' or RSWA needs to be better understood...
J Clin Neurophysiol. 2014 Oct;31(5):409-15. doi: 10.1097/WNP.0000000000000065.
Kempfner J, Sorensen HB, Nikolic M, Jennum P.
SUMMARY:
Idiopathic rapid-eye-movement (REM) sleep behavior disorder (iRBD) is most likely the earliest sign of Parkinson's Disease (PD) and is characterized by REM sleep without atonia (RSWA) and consequently increased muscle activity. However, some muscle twitching in normal subjects occurs during REM sleep.
PURPOSE:
There are no generally accepted methods for evaluation of this activity and a normal range has not been established. Consequently, there is a need for objective criteria.
METHOD:
In this study we propose a full-automatic method for detection of RSWA. REM sleep identification was based on the electroencephalography and electrooculography channels, while the abnormal high muscle activity was detected from the electromyography channels, in this case the submentalis combined with left and right anterior tibialis. RSWA was identified by considering it an outlier problem, in which the number of outliers during REM sleep was used as a quantitative measure of muscle activity.
RESULTS:
The proposed method was able to automatically separate all iRBD test subjects from healthy elderly controls and subjects with periodic limb movement disorder.
CONCLUSION:
The proposed work is considered a potential automatic method for early detection of PD.
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