Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam - PubMed (original) (raw)
. 2009 Jun 15;5(3):235-9.
Affiliations
- PMID: 19960644
- PMCID: PMC2699168
Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam
Kirstie N Anderson et al. J Clin Sleep Med. 2009.
Abstract
Study objectives: REM sleep behavior disorder (RBD) is characterized by loss of the normal muscle atonia during REM sleep associated with disruptive motor activity related to the acting out of dreams. There is frequently injury to the patient or bed partner, and treatment is usually required. Clonazepam has been the first-line therapy for many years, with 2 large case series reporting efficacy with few side effects in the majority of patients. However, long-acting hypnotics in the elderly or those with cognitive impairment can be associated with adverse events especially unacceptable daytime sedation, confusion, and exacerbation of existing sleep apnea.
Methods: We reviewed 39 patients with confirmed RBD who were treated within our regional sleep center, assessing both efficacy and side effects of drug therapies.
Results: Adverse effects were reported by 58% of the patients using clonazepam, with 50% either discontinuing the drug or reducing the dose. This prompted us review the side effects of clonazepam in detail and to look for alternative therapies. We report several novel and effective therapies, in particular zopiclone, in a series of patients under long-term follow-up for RBD.
Conclusions: There are alternatives to clonazepam therapy for RBD which can be as effective and may be better tolerated.
Figures
Figure 1a
Flowchart representing patient treatment pathways.
Figure 1b
Final therapy for patients with REM Sleep Behavior Disorder.
Similar articles
- Treatment outcomes in REM sleep behavior disorder.
McCarter SJ, Boswell CL, St Louis EK, Dueffert LG, Slocumb N, Boeve BF, Silber MH, Olson EJ, Tippmann-Peikert M. McCarter SJ, et al. Sleep Med. 2013 Mar;14(3):237-42. doi: 10.1016/j.sleep.2012.09.018. Epub 2013 Jan 23. Sleep Med. 2013. PMID: 23352028 Free PMC article. - A prospective, naturalistic follow-up study of treatment outcomes with clonazepam in rapid eye movement sleep behavior disorder.
Li SX, Lam SP, Zhang J, Yu MW, Chan JW, Liu Y, Lam VK, Ho CK, Zhou J, Wing YK. Li SX, et al. Sleep Med. 2016 May;21:114-20. doi: 10.1016/j.sleep.2015.12.020. Epub 2016 Feb 16. Sleep Med. 2016. PMID: 27448481 - Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients.
Boeve BF, Silber MH, Ferman TJ. Boeve BF, et al. Sleep Med. 2003 Jul;4(4):281-4. doi: 10.1016/s1389-9457(03)00072-8. Sleep Med. 2003. PMID: 14592300 - Rapid eye movement sleep behavior disorder.
Gugger JJ, Wagner ML. Gugger JJ, et al. Ann Pharmacother. 2007 Nov;41(11):1833-41. doi: 10.1345/aph.1H587. Epub 2007 Oct 9. Ann Pharmacother. 2007. PMID: 17925503 Review. - [REM sleep behavior disorder (RBD)].
Ylikoski A, Partinen M. Ylikoski A, et al. Duodecim. 2012;128(15):1602-6. Duodecim. 2012. PMID: 22970612 Review. Finnish.
Cited by
- Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease.
Taximaimaiti R, Luo X, Wang XP. Taximaimaiti R, et al. Curr Neuropharmacol. 2021;19(12):2233-2249. doi: 10.2174/1570159X19666210517115706. Curr Neuropharmacol. 2021. PMID: 33998990 Free PMC article. Review. - Therapeutic potential of melatonin and its analogs in Parkinson's disease: focus on sleep and neuroprotection.
Srinivasan V, Cardinali DP, Srinivasan US, Kaur C, Brown GM, Spence DW, Hardeland R, Pandi-Perumal SR. Srinivasan V, et al. Ther Adv Neurol Disord. 2011 Sep;4(5):297-317. doi: 10.1177/1756285611406166. Ther Adv Neurol Disord. 2011. PMID: 22010042 Free PMC article. - Treatment outcomes in REM sleep behavior disorder.
McCarter SJ, Boswell CL, St Louis EK, Dueffert LG, Slocumb N, Boeve BF, Silber MH, Olson EJ, Tippmann-Peikert M. McCarter SJ, et al. Sleep Med. 2013 Mar;14(3):237-42. doi: 10.1016/j.sleep.2012.09.018. Epub 2013 Jan 23. Sleep Med. 2013. PMID: 23352028 Free PMC article. - Multiple system atrophy: current and future approaches to management.
Flabeau O, Meissner WG, Tison F. Flabeau O, et al. Ther Adv Neurol Disord. 2010 Jul;3(4):249-63. doi: 10.1177/1756285610375328. Ther Adv Neurol Disord. 2010. PMID: 21179616 Free PMC article. - Causal associations between modifiable risk factors and isolated REM sleep behavior disorder: a mendelian randomization study.
Zhang RY, Li FJ, Zhang Q, Xin LH, Huang JY, Zhao J. Zhang RY, et al. Front Neurol. 2024 Feb 7;15:1321216. doi: 10.3389/fneur.2024.1321216. eCollection 2024. Front Neurol. 2024. PMID: 38385030 Free PMC article.
References
- American Academy of Sleep Medicine. Westchester, IL: American Academy of Sleep Medicine; 2005. International classification of sleep disorders: second edition: diagnostic and coding manual.
- Schenck C, Mahowald M. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep. 2002;25:120–38. - PubMed
- Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J. Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol. 2006;5:424–32. - PubMed
- Postuma RB, Lang AE, Massicote-Marquez J, Montplaisir J. Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder. Neurology. 2006;66:845–51. - PubMed
- Massicotte-Marquez J, Décary A, Gagnon JF, et al. Executive dysfunction and memory impairment in idiopathic REM sleep behavior disorder. Neurology. 2008;70:1250–7. - PubMed
MeSH terms
Substances
LinkOut - more resources
Full Text Sources