Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment

Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline for the management of rapid eye movement (REM) sleep behavior disorder in adults. Methods: The American Academy of Sleep Medicine commissioned a task force (TF) of 7 experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials and observational studies that addressed interventions for the management of REM sleep behavior disorder in adults. Statistical analyses were performed to determine the clinical significance of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. Results: The literature search resulted in 4,690 studies; 148 studies provided data suitable for statistical analyses; evidence for forty-five interventions is presented. The TF provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. worsening in sedation or cognitive impairment**; treatment-related worsening in gait stability**; treatment-related worsening in symptoms of or assessed