Sleep-related violence, injury, and REM sleep behavior disorder in PD

To the Editor: Although Comella et al.1 make a welcome contribution to increasing awareness of various sleep disorders, a word of caution should be added. Polysomnography may not be required to make a diagnosis of REM sleep behavior disorder (RBD), but clonazepam should not be prescribed without having ruled out other conditions that may be clinically difficult to distinguish from RBD. A mildly demented patient could exhibit confusional arousals with violent behavior, sleepwalking may lead to injuries, and patients with obstructive sleep apnea have been described in association with sleep-related injuries (SRIs). Clonazepam could worsen these conditions and pose a significant risk to the patients. Some form of objective monitoring should be employed in patients with a history of SRIs to confirm a diagnosis of RBD before clonazepam is administered and to rule out conditions that may …