{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T05:18:21Z","timestamp":1794115101995,"version":"4.8.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":330,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Isolated REM sleep without atonia (iRSWA) is increasingly detected on polysomnography (PSG), yet its clinical relevance remains unclear. We compared the demographic profile, sleep physiology, comorbidities, and longitudinal outcomes of people with iRSWA and isolated REM sleep behaviour disorder (iRBD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed PSG reports (2008\u20132022) from a tertiary sleep-medicine center, classifying people as iRSWA or iRBD based on self-reported dream-enactment behavior. Clinical data were extracted from charts, and PSG variables from sleep reports. Neurological and psychiatric diagnoses before the sleep examination were obtained from national registries. Comparisons used multivariable regression and Fine\u2013Gray competing-risk models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort comprised 302 participants (iRSWA\u2009=\u200998 and iRBD\u2009=\u2009204). Participants with iRSWA were more often female (38.8% vs 23%, p\u2009=\u2009.004), with a younger age distribution (35\u201349\u00a0years; 25.5% vs 13.7%, p\u2009=\u2009.015). They reported more daytime sleepiness\/fatigue (odds ratio [OR] 2.84, p\u2009&amp;lt;\u2009.001) despite comparable objective sleep architecture. Objective neurodegenerative signs appeared only in the iRBD group. Pre-index neurological disorders were more common in iRSWA (31.6% vs 19.1%, p\u2009=\u2009.042), while neurodegenerative conversion during follow-up occurred in 4.1 per cent of iRSWA and 8.8 per cent of iRBD. In multivariable analysis, sleepiness\/fatigue and pre-existing neurological disorder were associated with iRSWA; when spouse status was included in the model, spouse status became the strongest predictor, periodic limb movements in sleep of 15 or more reached significance, and the association with sex attenuated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>iRSWA differs from iRBD in profile and pre-index comorbidity patterns. Our findings support the view that iRSWA may reflect mechanisms other than a uniform prodromal stage of \u03b1-synucleinopathy.<\/jats:p>\n                    <jats:p>Statement of Significance REM sleep without atonia (RSWA) is increasingly recognized during polysomnographic evaluation of sleep disturbances, yet its clinical significance remains uncertain. In a direct comparison of sleep-clinic cohorts with isolated RSWA (iRSWA) and isolated REM sleep behaviour disorder (iRBD), we found that participants with iRSWA were younger, more often female, and reported greater self-reported sleepiness and fatigue despite similar sleep macroarchitecture. In multivariable modeling, significant predictors of iRSWA were female sex, pre-existing nondegenerative neurological disorders, and sleepiness\/fatigue. When spouse status was added, it became the strongest predictor, while PLMS equal to or greater than 15 reached significance and the association with sex attenuated, underscoring the risk of detection bias in DEB and the need to systematically document patients\u2019 living arrangements in future studies. No objective neurodegenerative signs were observed in the iRSWA group, and only 4 per cent converted to a neurodegenerative disorder within 7\u00a0years of follow-up. These findings question whether iRSWA should be regarded as an early stage of neurodegeneration and suggest that iRSWA alone may have limited predictive value. Prospective multicentre studies incorporating serial video-polysomnography and comprehensive neuropsychiatric follow-up are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleepadvances\/zpaf087","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:05:44Z","timestamp":1764248744000},"source":"Crossref","is-referenced-by-count":7,"title":["Isolated REM sleep without atonia and isolated REM sleep behaviour disorder: a study of clinical and prognostic differences"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9620-1450","authenticated-orcid":false,"given":"Cresta","family":"Asah","sequence":"first","affiliation":[{"name":"Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Copenhagen University Hospital \u2013 Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen , Copenhagen 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