To evaluate the prevalence of REM sleep behavior disorder (RBD) and its possible prodromal conditions, isolated dream enactment behavior (DEB) and isolated REM without atonia (RWA), in a general population sample, and the factors associated with diagnosis and symptom frequency.

From a population-based prospective cohort in Korea, 1,075 participants (age 60.1 ± 7.0 years; range 50–80 years; men 53.7%) completed the RBD screening questionnaire (RBDSQ), a structured telephone interview for the presence and characteristics of repeated DEB, and home polysomnography (PSG). RWA was measured on submentalis EMG, including 30-second epoch-based tonic and phasic activity as well as 3-second mini-epoch–based phasic and any EMG activities. Based on the presence of repeated DEB and any EMG activity of ≥22.3%, we categorized the participants into no RBD, isolated RWA, isolated DEB, and RBD groups.

RBD was diagnosed in 20 participants, isolated RWA in 133 participants, and isolated DEB in 48 participants. Sex and DEB frequency-adjusted prevalence of RBD was 1.4% (95% CI 1.0%–1.8%), isolated RWA was 12.5% (95% CI 11.3%–13.6%), and isolated DEB was 3.4% (95% CI 2.7%–4.1%). Total RBDSQ score was higher in the RBD and isolated DEB groups than in the isolated RWA and no RBD group (median 5 [interquartile range (IQR) 4–6] for RBD, median 4 [IQR 3–6] for isolated DEB, median 2 [IQR 1–3] for isolated RWA, and median 2 [IQR 1–4] for no RBD groups, p < 0.001). RBDSQ score of ≥5 had good specificity but poor positive predictive value (PPV) for RBD (specificity 84.1% and PPV 7.7%) and its prodromal conditions (specificity 85.2% and PPV 29.1%). Among the RWA parameters, any EMG activity showed the best association with the RBD and its possible prodromes (area under the curve, 0.917). Three-second mini-epoch–based EMG activity and phasic EMG activity were correlated with the frequency of DEB (standardized Jonckheere-Terpstra statistic [std. J-T static] for trend = 0.488, p < 0.001, and std. J-T static = 3.265, p = 0.001, respectively).

This study provides prevalence estimates of RBD and its possible prodromal conditions based on a structured telephone interview and RWA measurement on PSG from the general population.

旨在评估一般人群样本中 REM 睡眠行为障碍 (RBD) 的患病率及其可能的前驱症状、孤立的梦境表现行为 (DEB) 和孤立的 REM 无弛缓症 (RWA)，以及与诊断和症状频率相关的因素。

来自韩国的一项基于人群的前瞻性队列，1,075 名参与者（年龄 60.1 ± 7.0 岁；范围 50-80 岁；男性 53.7%）完成了 RBD 筛查问卷 (RBDSQ)，这是一项针对重复 DEB 的存在和特征的结构化电话访谈和家庭多导睡眠图 (PSG)。RWA 是通过颏下肌电图测量的，包括基于 30 秒时期的强直和阶段性活动以及基于 3 秒迷你时期的阶段性和任何肌电图活动。根据重复 DEB 的存在和任何肌电图活动≥22.3%，我们将参与者分为无 RBD、孤立的 RWA、孤立的 DEB 和 RBD 组。

20 名参与者被诊断为 RBD，133 名参与者被诊断为 RWA，48 名参与者被诊断为 DEB。性别和 DEB 频率调整后的 RBD 患病率为 1.4%（95% CI 1.0%–1.8%），孤立 RWA 为 12.5%（95% CI 11.3%–13.6%），孤立 DEB 为 3.4%（95% CI 2.7） %–4.1%）。RBD 和孤立 DEB 组的 RBDSQ 总分高于孤立 RWA 和无 RBD 组（RBD 中位数为 5 [四分位距 (IQR) 4-6]，孤立 DEB 中位数为 4 [IQR 3-6]，中位数孤立的 RWA 为 2 [IQR 1-3]，无 RBD 组的中位数为 2 [IQR 1-4]，p < 0.001）。RBDSQ 评分≥5 具有良好的特异性，但对 RBD（特异性 84.1% 和 PPV 7.7%）及其前驱症状（特异性 85.2% 和 PPV 29.1%）的阳性预测值 (PPV) 较差。在 RWA 参数中，任何 EMG 活动都显示出与 RBD 及其可能的前驱症状的最佳关联（曲线下面积，0.917）。基于三秒小历元的 EMG 活动和阶段性 EMG 活动与 DEB 频率相关（标准化 Jonckheere-Terpstra 统计量 [标准 JT 静态]，趋势 = 0.488，p < 0.001，标准 JT 静态 = 3.265，p = 0.001，分别）。

本研究基于结构化电话访谈和对一般人群 PSG 的 RWA 测量，提供了 RBD 患病率及其可能的前驱症状估计。