Is <scp>REM</scp> sleep behavior disorder changing? Secular changes versus referral patterns

Abstract Background Since 2014, there has been increasing public outreach effort regarding isolated/idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) in Montreal. Objective To assess if, over time, milder iRBD cases are presenting earlier. Methods Disease‐free survival was compared two recruitment epochs: 2004 to 2013 (“earlier”) versus 2014to 2022 (“later ” ) and by referral type (“self‐referral” vs. “conventional‐referral”) three large centers. Results In Montreal, among 209 subjects followed prospectively, shorter time phenoconversion observed the earlier epoch (5‐year = 42% 23% later); diagnosis before 2014 had a 1.8‐fold hazard. However, no difference 248 from Barcelona 166 Innsbruck. Analysis of Montreal data found that increased later driven an number self‐referrals, who phenoconverted at 1/3 rate physician‐referred subjects. Conclusions Increased patient awareness results presentation clinical attention, with longer phenoconversion.