Quantifying REM sleep atonia loss: ethnic variability and the diagnostic challenge of isolated REM sleep behavior disorder

Le résumé fourni par la source

Idiopathic or isolated REM sleep behavior disorder (iRBD) is characterized by dream-enacting behavior and loss of REM sleep atonia. Its global prevalence is estimated to be 0.5%–1% among older adults, with relatively uniform distribution across geographic regions [1]. It is widely recognized as a prodromal phase of synucleinopathies in middle-aged and older adults, with over 95% of patients eventually developing a manifest α-synucleinopathy [2]. Diagnosis relies on the identification of dream-enacting behavior and REM sleep without atonia (RWA) on polysomnography. While the American Academy of Sleep Medicine (AASM) scoring manual currently does not mandate quantification of RWA—relying instead on qualitative assessment—quantitative RWA evaluation is increasingly regarded as essential for research purpose and recommended, when feasible, for clinical purposes. RWA levels correlate with disease progression and higher baseline RWA predicts phenoconversion [3]. Moreover, RWA thresholds may help define prodromal RBD, underscoring the diagnostic and prognostic value of precise quantification [4, 5]. Despite the increasing use of quantitative metrics, most diagnostic RWA cutoffs have been derived from Western populations. Given the documented racial differences in sleep disorders [6–8], the generalizability of these thresholds to other populations remains uncertain.

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