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Hiding in plain sight

REM sleep behavior disorder (RBD) is a parasomnia characterized by loss of normal REM sleep muscle atonia that is usually accompanied by dream enactment.1 The prevalence of this disorder is unknown, but has been estimated at 0.4%–0.5% among adults. RBD is notable both for its potential for disruption of the sleep milieu by complex and aggressive behaviors with resulting injury, and for its identity as a “preclinical” sign of synuclein-mediated neurodegenerative disease such as Parkinson disease (PD) and dementia with Lewy bodies (DLB). The association with neurodegenerative disease is complex, and some investigators argue that RBD marks a subtype of PD. Until now, the genesis of RBD is most often …