AASM Membership Sections Newsletter Issue #3
18
American Academy
of Sleep Medicine
6.
PSG with Parasomnia montage
7.
Brain imaging (CT or MRI) is mandatory if there
is suspicion of underlying neurodegenerative
disease or history of brain trauma
Physical exam is usually unremarkable in idio-
pathic RBD, but there may be findings in secondary
RBD. Some diagnostic/screening tools include the
Mayo clinic RBD questionnaire, the RBD question-
naire by Stiasny Kolster and the Hong Kong RBD
questionnaire.
Treatment
Clonazepam is highly effective in almost 90% of
patients with RBD. Melatonin is also effective and
can be used as monotherapy or in conjunction
with clonazepam. A dopaminergic agent can be
used in patients with RBD and Parkinson disease
(
Figure 4).
Non-pharmacologic measures should also be
taken to prevent sleep related injury (SRI) (Aurora,
2010).
Counseling should be provided to the patient
Figure 2.
30
second epoch of REM sleep demonstrating REM SleepWithout Atonia (RSWA), including both phasic and tonic
elevation of chin tone and phasic elevation of limb muscle tone. The high amplitude increase in muscle tone indicates a
movement.
Figure 3.
30
second epoch of REM sleep that shows tonic elevation of chin tone along with phasic elevation of limb muscle
tone.
Parasomnia Case of the Month continued