Rapid Eye Movement Sleep Behavior Disorder: What Is Known and What Should Be Studied
Bibliographic record
Abstract
Rapid eye movement sleep behavior disorder (RBD), characterized by vivid striking dreams and dream-enacting behaviors, can be classified as both young and old.RBD is young in that it was conceptualized as a distinct clinical disorder by Schenck et al. [1] in 1986, and it is old because it mainly affects older people.In Korea, an RBD case, confirmed by polysomnography, was reported in 1994.REM sleep without atonia (RWA) on the polysomnography is requisite for RBD diagnosis.Currently, qualitative analysis of RWA is used as RWA quantification is burdensome and time-consuming.Notably, patients complaining of vigorous dreams and violent behaviors are occasionally diagnosed with obstructive sleep apnea or show no definite RWA, which may negate diagnosis based on clinical history or RBD questionnaires.Regarding pathophysiology, dopaminergic degeneration was investigated because of its close relationship with alpha-synucleinopathies.Studies using dopamine transporter (DAT) positron emission tomography (PET) or single photon emission computed tomography (SPECT) showed that dopamine (DA) dysfunction might be implicated in RBD.However, several findings suggest that other pathogenic processes can be involved; 1) in managing RBD symptoms, effectiveness of clonazepam with no influence on DA and little effect of dopaminergic drugs, 2) appearance of RBD in narcoleptic patients, 3) young RBD patients without progression to alpha-synucleinopathies, and 4) RBD symptoms induced by antidepressants.Clonazepam is widely prescribed for the control of RBD symptoms, even if there are few randomized controlled trials on its use and it has not been demonstrated that it is superior to other benzodiazepines.Clonazepam is effective in 80% to 90% of cases with adjuvant therapy such as carbamazepine and zolpidem.Melatonin, having more tolerable side effects but less efficacy than clonazepam [2], is also used singly or in combination with clonazepam.Managing vigorous and violent behaviors is required to prevent injuries to patients themselves and their bed partners, but RBD treatment cannot modify the progression to alpha-synucleinopathies.Compared to other sleep disorders, much attention is being paid to the clinical course of RBD rather than its treatment.Studies from Spain and Canada have reported the risk of developing neurodegenerative disorders to be about 30% at 5 years and up to 80% at 10 years from the time of RBD diagnosis.Lower phenoconversion rates in Japan, China, and Korea (35.5% at 10 years and 56.5% at 14 years) might suggest racial or geographical differences in conversion [3].Biomarkers of risk factors for phenoconversion include [4-6]; older age, disease duration, motor dysfunction, mild cognitive impairment, electromyographic tonic activity, and decreased putamen DAT density.These markers can be used to classify and select patients for clinical trials of neuroprotective agents.It will take 2-3 years to complete clinical trial of therapies whose effects are demonstrated in RBD animal models [7].Probiot-
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.002 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".