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REM Sleep Behaviour Disorder — SCE Neurology MCQ

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ModerateSleep DisordersREM Sleep Behaviour DisorderSCE Neurology

A 55-year-old man presents with episodic violent limb movements during sleep, shouting, and punching his wife. He has no daytime symptoms. His wife reports that these episodes occur during the second half of the night. Video polysomnography shows REM sleep without atonia. What is the diagnosis?

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Correct answer: D — REM sleep behaviour disorder

REM sleep behaviour disorder (RBD) is characterised by loss of normal REM atonia leading to dream-enactment behaviour. It occurs predominantly in the latter half of the night when REM sleep is most abundant. Video PSG showing REM without atonia is diagnostic. RBD is an important prodromal marker for alpha-synucleinopathies (PD, DLB, MSA). A: OSA causes apnoeas, not dream-enactment. B: Night terrors occur in NREM sleep, typically in the first third of the night. D: PLMD causes periodic leg movements. E: Nocturnal frontal lobe epilepsy would show EEG abnormalities.

Reference: AASM ICSD-3; NICE NG71 Parkinson's Disease (2017)