Diagnostic Criteria for REM Sleep Behavior Disorder (RBD)

Core Diagnostic Requirements

The American Academy of Sleep Medicine recommends that the diagnosis of RBD requires both polysomnographic evidence of REM sleep without atonia AND either a clinical history of dream enactment behaviors or documented abnormal REM behaviors on video polysomnography 1, 2, 3, 4
The International Classification of Sleep Disorders (ICSD-2) defines polysomnographic evidence as either sustained (tonic) muscle activity or excessive phasic muscle activity, with specific criteria for each 5
Clinical or observed behavioral evidence, such as sleep-related injurious or potentially injurious disruptive behaviors, is required for diagnosis 1, 2, 3, 4

The American Academy of Sleep Medicine recommends excluding other sleep disorders, such as obstructive sleep apnea, non-REM parasomnias, periodic limb movements of sleep, and nocturnal seizures, as well as medical or neurological disorders, mental disorders, and medication use or substance use disorder 1, 2, 3, 4, 6, 7

The American Academy of Sleep Medicine recommends that definitive diagnosis of RBD absolutely requires overnight video polysomnography to document REM sleep without atonia and/or capture actual dream enactment behaviors 7
Obstructive sleep apnea can mimic RBD, and polysomnography is necessary to distinguish between the two 1, 2, 3, 4, 6
Medication-induced RBD must be evaluated, including medications such as antidepressants, β-blockers, and withdrawal states 1, 2, 3, 4, 7, 8

The American Academy of Sleep Medicine recommends evaluating for associated conditions, such as neurodegenerative diseases, including α-synucleinopathies, multiple system atrophy, dementia with Lewy bodies, and Parkinson's disease 4, 7
Secondary causes, such as spinocerebellar ataxia, limbic encephalitis, brain tumors, multiple sclerosis, stroke, and narcolepsy type 1, must also be considered 1, 2, 3, 4