Video-polysomnography (v-PSG) is essential for diagnosing rapid eye movement (REM) sleep behavior disorder (RBD). Although there are current American Academy of Sleep Medicine standards to diagnose RBD, several aspects need to be addressed to achieve harmonization across sleep centers. Prodromal RBD is a stage in which symptoms and signs of evolving RBD are present, but do not yet meet established diagnostic criteria for RBD. However, the boundary between prodromal and definite RBD is still unclear. As a common effort of the Neurophysiology Working Group of the International RBD Study Group, this manuscript addresses the need for comprehensive and unambiguous v-PSG recommendations to diagnose RBD and identify prodromal RBD. These include: (1) standardized v-PSG technical settings; (2) specific considerations for REM sleep scoring; (3) harmonized methods for scoring REM sleep without atonia; (4) consistent methods to analyze video and audio recorded during v-PSGs and to classify movements and vocalizations; (5) clear v-PSG guidelines to diagnose RBD and identify prodromal RBD. Each section follows a common template: The current recommendations and methods are presented, their limitations are outlined, and new recommendations are described. Finally, future directions are presented. These v-PSG recommendations are intended for both practicing clinicians and researchers. Classification and quantification of motor events, RBD episodes, and vocalizations are however intended for research purposes only. These v-PSG guidelines will allow collection of homogeneous data, providing objective v-PSG measures and making future harmonized multicentric studies and clinical trials possible.

Clinic for Sleep and Chronomedicine St Hedwig Krankenhaus Berlin Germany

Danish Center for Sleep Medicine Department of Clinical Neurophysiology Rigshospitalet Glostrup Denmark

Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy

Department of Health Technology Technical University of Denmark Lyngby Denmark

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University General University Hospital Prague Czech Republic

Department of Neurology Brigham and Women's Hospital; Division of Sleep Medicine Harvard Medical School Boston MA USA

Department of Neurology Hephata Klinik Schwalmstadt Germany

Department of Neurology Massachusetts General Hospital Harvard Medical School Boston MA USA

Department of Neurology Medical University of Innsbruck Innsbruck Austria

Department of Neurology Philipps University Marburg Germany

Department of Neurosurgery Seoul National University Hospital Seoul South Korea

Department of Research Mayo Clinic Health System Southwest Wisconsin La Crosse WI USA

IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy

Mayo Center for Sleep Medicine Departments of Neurology and Medicine Division of Pulmonary and Critical Care Medicine Mayo Clinic College of Medicine and Science Rochester MN USA

Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias Department of Rare disorders Oslo University Hospital Oslo Norway

NPsy Sydo Clermont Ferrand University Hospital Neurology Department Université Clermont Auvergne Clermont Ferrand France

Paracelsus Elena Klinik Kassel Germany

Sleep Center Department of Neurology Emory University School of Medicine Atlanta GA USA

Sleep Disorders Center Neurology Service Hospital Clínic Barcelona Universitat de Barcelona IDIBAPS Barcelona Spain

Sleep. 2023 Jan 11;46(1):zsac261. doi: 10.1093/sleep/zsac261. PubMed

Sleep. 2023 Jan 11;46(1):zsac276. doi: 10.1093/sleep/zsac276. PubMed

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