AI Insight
The DREAMER study is a multicenter prospective observational protocol designed to characterize isolated REM sleep without atonia (RSWA) in adults who do not yet show clinical REM sleep behavior disorder (RBD). Using standardized video-polysomnography across four Italian sleep centers and a validated REM Atonia Index threshold below 0.85, the study aims to recruit more than 500 participants aged 40 or older over 18 months, with an expected subgroup of approximately 85 individuals presenting isolated RSWA. The core scientific question is whether isolated RSWA represents a benign incidental finding or an early prodromal marker for future RBD and alpha-synuclein-related neurodegeneration.
Why it matters
RBD is one of the strongest known predictors of Parkinson's disease and related disorders, and identifying individuals at risk before clinical symptoms emerge could open critical windows for neuroprotective intervention. A well-characterized, trial-ready cohort of people with isolated RSWA would support future biomarker research and early-stage clinical trials targeting neurodegeneration prevention.
⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Isolated rapid eye movement sleep behavior disorder is a strong clinical marker of future alpha-synucleinopathy, but earlier stages of this risk pathway remain insufficiently characterized. Rapid eye movement sleep without atonia is the polysomnographic substrate of this disorder and may also be detected in individuals without clinical dream-enactment behavior. Whether isolated rapid eye movement sleep without atonia is a benign finding or an early risk state for future rapid eye movement sleep behavior disorder and neurodegeneration remains unknown. DREAMER is a multicenter, prospective, observational cohort protocol designed to identify adults without clinical rapid eye movement sleep behavior disorder who show isolated rapid eye movement sleep without atonia during full-night laboratory video-polysomnography. Four Italian sleep centers will use harmonized eligibility criteria, standardized clinical and sleep assessment, quantitative REM Atonia Index scoring, secure web-based data capture, and planned longitudinal follow-up. Adults aged 40 years or older undergoing video-polysomnography will be screened. Participants with prior rapid eye movement sleep behavior disorder or technically inadequate REM sleep/chin electromyographic data will be excluded. Isolated rapid eye movement sleep without atonia will be defined in participants without clinical rapid eye movement sleep behavior disorder using a REM Atonia Index threshold of <0.85. The target recruitment is more than 500 participants over 18 months, with an expected enriched subgroup of approximately 85 individuals with isolated rapid eye movement sleep without atonia. Ancillary neurophysiological assessments and blood sampling for future biomarker studies will be obtained when feasible. DREAMER is intended to create a harmonized, trial-ready cohort for evaluating isolated rapid eye movement sleep without atonia as a potential early risk marker for incident rapid eye movement sleep behavior disorder and subsequent neurodegenerative outcomes. The study is registered at ClinicalTrials.gov as DREAMER, ClinicalTrials.gov Identifier NCT06140511.