REM-Schlafverhaltensstörung

ZUSAMMENFASSUNG

Die Rapid-Eye-Movement (REM)-Schlafverhaltensstörung (RBD) ist eine Parasomnie, bei der es zu einem unwillkürlichen Ausleben von Trauminhalten während des REM-Schlafes kommt. Die physiologische Muskelatonie während des REM-Schlafes ist aufgehoben. Die Mehrheit (> 90 %) der Patienten mit einer isolierten RBD (iRBD) entwickeln im weiteren Verlauf eine alpha-Synukleinopathie (M. Parkinson, Demenz mit Lewy-Körperchen, Multisystematrophie). Liegt eine RBD vor, führt die Degeneration von Schaltkreisen des Nucleus subcoeruleus, die inhibierend auf die medulläre Formatio reticularis und in die spinalen Vorderhörner einwirken, dazu, dass Bewegungen während des REM-Schlafs möglich werden. Um die Diagnose einer RBD stellen zu können, ist der Nachweis einer fehlenden Muskeltonusabsenkung während des REM-Schlafes (REM-sleep without atonia, RWA) notwendig, was nur mit Hilfe einer Videopolysomnografie möglich ist. Grundvoraussetzung für die Beurteilung von Verhaltensauffälligkeiten und Vokalisationen ist die zeitsynchrone Aufzeichnung von Video und Ton. Kurative oder krankheitsmodulierende Therapien existieren nicht. Groß angelegte Behandlungsstudien, die einen Effekt in der symptomatischen Behandlung nachweisen, liegen ebenfalls nicht vor, sodass Therapieempfehlungen meist auf Expertenmeinungen und Daten retrospektiver Fallserien basieren. Dabei zeigten sich Melatonin 3–12 mg und Clonazepam 0,25–2 mg als wirksam. Da die RBD ein Frühstadium einer neurodegenerativen Erkrankung darstellt, bietet sie sich in der Zukunft als Ausgangspunkt für neuroprotektive Studien an.

ABSTRACT

Rapid eye movement (REM) behaviour disorder is a parasomnia characterized by dream enactment during REM-sleep, caused by a loss of physiological muscle atonia during REM sleep. Over 90 % of the patients with isolated RBD (iRBD) develop an overt alpha-synucleinopathy (Parkinson’s disease, dementia with Lewy bodies, multisystem atrophy) over time. Degeneration of neuronal circuits in the coeruleus nucleus, physiologically inhibiting neurons in the medullarly reticular formation and ventral horn spinal interneurons, explain the occurrence of movements during REM sleep. Videopolysomnography is mandatory for the diagnosis of RBD by demonstrating REM sleep without atonia (RWA). In order to evaluate behaviours and vocalisations, time synchronized video and audio recordings are necessary. A curative or disease modifying treatment is not available so far. Symptomatic treatment recommendations are mostly based on expert opinion and retrospective case series, with melatonin 3–12 mg and clonazepam 0,25–2 mg showing efficacy. Since RBD represents an early phase of neurodegeneration, it can represent an ideal starting point for future neuroprotective trials.

Schlüsselwörter

REM-Schlaf ohne Atonie - isolierte REM-Schlafverhaltensstörung - Videopolysomnografie

Key words

REM sleep without atonia - isolated REM-sleep behaviour disorder - videopolysomnography

Publication History

Article published online:
09 July 2021

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