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A Preview of 'REM Sleep Behavior Disorder (RBD): Understanding the Clinician and Patient Perspectives' at SLEEP 2023

Op-Med is a collection of original articles contributed by Doximity members.

In advance of the 2023 SLEEP Conference, Doximity spoke with the presenters of REM Sleep Behavior Disorder (RBD): Understanding the Clinician and Patient Perspectives. This is what they wanted you to know before you go.

What are the highlights that attendees should take away from your presentation? 

This session will utilize a case-based approach to enhance participants’ competence in the objective evaluation, diagnosis, and management of patients presenting with dream enactment behaviors. Faculty will review scoring methods and criteria for REM sleep without atonia (RSWA, RWA), using polysomnographic examples and highlighting the importance of video inspection and documentation of RBD episodes. We will also highlight the updated practice guidelines for managing RBD, the utility of a shared decision approach, and ethical principles of respecting patients' wishes for/against full disclosure. Ongoing RBD clinical trials and upcoming neuroprotective trials will be discussed.

Key Points:

  • It is important for sleep specialists to effectively and accurately identify, screen, diagnose, and manage patients with REM sleep behavior disorder (RBD) due to the association of injuries and implications of possible neurodegenerative disease. 
  • There are several visual approaches for quantitative scoring and analysis of REM sleep without atonia (RSWA, RWA) on polysomnography, including the Montreal, SINBAR, Mayo, AASM, and others, as well as emerging automated signal analyses approaches that can be applied in clinical and research settings. 
  • Counseling patients with RBD with a shared decision making approach and disclosure considerations is critical. 
  • In order to better understand the natural history of isolated RBD and individualized risk for phenoconversion to neurodegenerative disease states, it is important for patients to be enrolled in research initiatives. 
  • Neuroprotective interventions are expected to be coming soon, and determining the optimal characteristics of isolated RBD participants who are at highest risk for near-term conversion to a defined neurodegenerative disease is an imperative for successful future clinical trials.

What is the central question that your presentation tries to answer?

Many sleep specialists may not feel confident evaluating and diagnosing patients with isolated RBD, a common — though still — underrecognized disease. Research studies and management approaches have evolved rapidly over the last five years, making it difficult for most practicing sleep specialists to stay on top of the data.

This workshop will enhance sleep medicine clinicians’ competency in appropriately assessing patients presenting with dream enactment behavior and managing and counseling patients with RBD. It will be presented in a practical, case-based format by experts in the field of RBD and neurodegeneration. Knowledge gained through this workshop will enhance participants' confidence in formally establishing a diagnosis of RBD selecting appropriate treatment options based on the RBD disease phenotype, and promoting a discussion of disclosure in a patient-centric fashion. By improving these clinical care attributes among clinicians, we hope that patients would be better served in recognizing the natural history of their condition. Patients and clinicians will be able to engage in a collaborative discussion of the potential value of symptomatic management and the potential value of enrolling in current clinical trials before phenoconversion progresses.

How do these findings and/or conclusions potentially impact clinical practice?

This session is designed to provide clinically relevant information for sleep medicine clinicians for evaluating patients with RBD. It will also provide applicable approaches to screen, diagnose, and manage RBD patients in the clinical setting. The goal is to increase awareness of RBD to inform patients better and reduce risk of injuries through the implementation of safety measures, and to hopefully increase opportunities for patient participation in ongoing RBD natural history cohort studies and future neuroprotective trials that could prevent the development of neurodegenerative disease states.

What else would you like attendees to know about your presentation?

We welcome all SLEEP/APSS 2023 attendees to this session, whether you are a medical student starting a career path in sleep medicine or a seasoned sleep specialist wanting to learn approaches for evaluating patients with parasomnias. This session will be a practical workshop to help people understand RBD and future directions. We look forward to hearing comments from the audience and field questions that hopefully stimulate productive discussion.

Dr. Lee-Iannotti has received grants from the following: NIH RECOVER, Michael J Fox PPMI, NIH Syn-One Study, OSPREY, ReST Study, SLEEP SMART trial. Dr. Avidan has received grants from the NIH and consulting fees from Harmony, EISAI, Merck, Idorsia, Avadel, and Takeda. Drs. Malkani, Schenck, Silber has no conflicts of interest to report.

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