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Introduction Most older adults with isolated REM sleep behavior disorder (iRBD) are men, yet in younger adults there is greater parity between the sexes. Whether the clinical characteristics between women and men with iRBD may differ remains unclear. We aimed to analyze presenting clinical and demographic characteristics of iRBD in men and women. Methods We identified 130 women and 130 men with PSG confirmed iRBD who were matched for time of polysomnographic diagnosis, abstracted their clinical histories, and comparatively analyzed clinical characteristics between the sexes. Results RBD symptom onset average age (50.4 ± 20.0 vs. 55.4 ±16.9 years, p=0.03) and age at diagnosis (56.4 ±16.7 vs. 62.5 ± 13.3 years, p< 0.01) were younger in women than in men. Injury frequency was similar between groups. Antidepressant use prior to diagnosis (80.8% vs 53.0%, p< 0.01), psychiatric comorbidity (79.8% vs. 50.8%, p< 0.01) and chronic pain syndrome (39.2% vs. 17.4%, p< 0.01) diagnoses were more frequent in women than men. Insomnia (31.5% vs. 18.2%, p= 0.01), hypersomnoence (50.8% vs 37.9%, p=0.04) and overlap parasomnia disorder (13.8% vs 9.8%, p=0.06) were more frequent in women than men, while sleep apnea (43.1% vs. 70.5%, p < 0.01.) and vascular co-morbidity (62.3% vs 83.3%, p< 0.01) occurred more frequently in men than women. Autoimmunity was similar between sexes. Conclusion Women were younger when diagnosed, and had more frequent psychiatric diagnoses and antidepressant use, with different comorbid sleep disturbances and comorbidities than men with iRBD. Key sex differences in iRBD could imply different etiologies and aid accurate and timely diagnosis. Support (if any)

Recent evidence for a strong bidirectional relationship between sleep and neurocognitive disorders has emerged. A key function of sleep in brain health is drainage of metabolites and toxins such as beta-amyloid that accumulate with continued wakefulness, making insufficient sleep, and sleep disorders possible contributors toward development of neurodegeneration. Sleep disturbances are frequent in patients with dementia and neurocognitive disorders, including poor sleep efficiency and architecture, sleep disordered breathing, sleep-related limb movements, and parasomnias. This chapter highlights current DSM-5 classifications for the major and mild neurocognitive disorders, including Alzheimer’s and Lewy body diseases and the related prodromal states of amnestic and nonamnestic mild cognitive impairment; less common neurodegenerative dementias are also reviewed. Diagnostic and therapeutic approaches to key sleep comorbidities in patients with neurocognitive disorders including insomnia, hypersomnia, sleep-disordered breathing, nocturnal movements, and parasomnias are also discussed.

Introduction Accurate, early diagnosis of isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is crucial given its injury potential and neurological prognosis. We aimed to analyze visual and automated REM sleep without atonia (RSWA) diagnostic thresholds in a current cohort of iRBD patients using submentalis (SM) and individual four limb electromyography (EMG) recordings, including bilateral flexor digitorum superificialis (FDS) and anterior tibialis (AT) during polysomnography. Methods We analyzed RSWA in 20 iRBD patients and 20 age-sex-AHI matched controls who underwent polysomnography between 2017-2021 for phasic burst durations, phasic, tonic, and "any" muscle activity, and automated REM atonia index (RAI). Group RSWA metrics were analyzed with non-parametric comparisons, logistic regression, and receiver operating characteristic (ROC) curves to determine optimal diagnostic cutoff thresholds for iRBD. Correlation explored associative relationships between RSWA metrics, and principal components analysis (PCA) defined determinants of RSWA metric variance. Results All mean RSWA metrics were higher in iRBD patients than controls (p Conclusion This study provides evidence for quantitative RSWA diagnostic thresholds applicable in current iRBD populations, and confirms the key importance of FDS to assure accurate iRBD diagnosis. Interestingly, these RSWA diagnostic thresholds are lower than previously determined thresholds, suggesting secular trends toward earlier iRBD detection and heterogeneous disease duration relative to polysomnography acquisition, underscoring the necessity of future large scale prospective, multicenter polysomnographic analyses to determine definitive iRBD diagnostic RSWA thresholds. Support (If Any)