Although RBD and OSA may occasionally share similar manifestations of DEB and reciprocal modulation, they are different sleep disorders with different effects on the brain. RBD is initiated at the brain stem and spreads to the limb muscles in a top-down manner, whereas in OSA, upper airway obstruction occurs first,followed by apneic episodes affecting the brain in a bottom-up manner. It is essential to distinguish pseudo-RBD associated with OSA from RBD concomitant with OSA, because these 2 conditions have different clinical implications for neuro degeneration as well as different treatment options. Video PSG is mandatory to establish accurate diagnosis, and CPAP treatment is necessary to confirm the diagnosis in patients with clinical uncertainty. Furthermore, CPAP is the first treatment option for patients diagnosed with concomitant RBD and OSA. Further studies are needed to establish the role of OSA as a trigger of neurodegeneration and to determine whether RBD is a friend or foe of OSA.
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