Sleep medicine · 2026
Clinical, behavioral, and physiological characteristics of isolated rapid eye movement sleep behavior disorder patients with ambulatory dream enactment behaviors.
СтатьяНазвание и аннотация: Перевод в очереди
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Kim Su Min, Noh Tae-Gon, Byun Jung-Ick, Sunwoo Jun-Sang, Shin Jung-Won, Kim Tae-Joon, Jun Jin-Sun, Schenck Carlos H, Jung Ki-Young
Аннотация
STUDY OBJECTIVES: Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) involves dream enactment behaviors (DEBs) during REM sleep, accompanied by REM sleep without atonia (RWA). While most DEBs are bed-confined, a minority engage in ambulatory behaviors. This study investigated clinical, behavioral, and physiological characteristics of iRBD patients exhibiting ambulatory behaviors.
METHODS: We retrospectively reviewed electronic medical records of 361 patients with video-polysomnography (v-PSG)-confirmed iRBD (mean age: 66.9 years; 59.0% males). Patients reporting at least one DEB episode involving ambulation out of the bedroom were classified as RBD-walkers; those without any ambulatory episodes as non-walkers. Clinical assessments, dream contents, behaviors, and PSG metrics were compared between groups.
RESULTS: 31 patients (8.6%) were categorized as RBD-walkers, none with prior history of sleepwalking. RBD-walkers were more frequently female (64.5% vs. 38.0%, p = 0.006) and showed higher RBDQ-KR Factor 1 scores (15.7 vs. 12.6, p = 0.005). Combined clonazepam-melatonin use was more common among RBD-walkers (38.7% vs. 19.8%, adjusted residual = +2.443). Behaviorally, they frequently exhibited escape-related motor behaviors and object-interactive behaviors. PSG findings revealed preserved sleep architecture, along with elevated RWA and REM EMG amplitude (6.7 μV vs. 3.6 μV, p = 0.009) in RBD-walkers.
CONCLUSIONS: RBD-walkers represent a clinically and physiologically distinct iRBD subgroup, marked by complex ambulatory behaviors, increased treatment demands, and elevated RWA and REM EMG amplitude despite preserved sleep structure. These findings suggest that ambulatory DEB may arise from multifactorial mechanisms beyond simple REM-atonia loss, warranting further investigation for pathophysiology and clinical implications.
METHODS: We retrospectively reviewed electronic medical records of 361 patients with video-polysomnography (v-PSG)-confirmed iRBD (mean age: 66.9 years; 59.0% males). Patients reporting at least one DEB episode involving ambulation out of the bedroom were classified as RBD-walkers; those without any ambulatory episodes as non-walkers. Clinical assessments, dream contents, behaviors, and PSG metrics were compared between groups.
RESULTS: 31 patients (8.6%) were categorized as RBD-walkers, none with prior history of sleepwalking. RBD-walkers were more frequently female (64.5% vs. 38.0%, p = 0.006) and showed higher RBDQ-KR Factor 1 scores (15.7 vs. 12.6, p = 0.005). Combined clonazepam-melatonin use was more common among RBD-walkers (38.7% vs. 19.8%, adjusted residual = +2.443). Behaviorally, they frequently exhibited escape-related motor behaviors and object-interactive behaviors. PSG findings revealed preserved sleep architecture, along with elevated RWA and REM EMG amplitude (6.7 μV vs. 3.6 μV, p = 0.009) in RBD-walkers.
CONCLUSIONS: RBD-walkers represent a clinically and physiologically distinct iRBD subgroup, marked by complex ambulatory behaviors, increased treatment demands, and elevated RWA and REM EMG amplitude despite preserved sleep structure. These findings suggest that ambulatory DEB may arise from multifactorial mechanisms beyond simple REM-atonia loss, warranting further investigation for pathophysiology and clinical implications.