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. CLICK TO REVIEW
Keywords: IRBDSG, iRBD, RWA, iRWA, prodromal RBD, PSG.