Does rapid eye movement sleep behavior disorder exist in psychiatric populations? A clinical and polysomnographic case–control study

• Published in: Sleep medicine 2013-08, Vol.14 (8), p.788-794
• Main Authors: Lam, Siu-Ping, Li, Shirley Xin, Chan, Joey WY, Mok, Vincent, Tsoh, Joshua, Chan, Anne, Yu, Mandy Wai-Man, Lau, Christine YK, Zhang, Jihui, Lam, Venny, Ho, Crover KW, Wing, Yun-Kwok
• Format: Article
• Language: English
• Subjects: Aged; Antidepressants; Antidepressive Agents - therapeutic use; Anxiety Disorders - complications; Case-Control Studies; Case–control study; Depression; Depressive Disorder - complications; Depressive Disorder - drug therapy; Female; Humans; Male; Middle Aged; Neurology; Polysomnography; Prospective Studies; Psychiatric populations; REM sleep behavior disorder; REM Sleep Behavior Disorder - complications; REM Sleep Behavior Disorder - diagnosis; Sleep Medicine; Sleep, REM - physiology
• ISSN: 1389-9457; 1878-5506
• DOI: 10.1016/j.sleep.2012.05.016

Abstract Objectives Rapid eye movement (REM) sleep behavior disorder (RBD) has been increasingly reported in patients with psychiatric disorders (pRBD). Although a close association with the usage of psychotropics has been postulated, it remains elusive whether psychotropics are the only causative factor of RBD symptoms in psychiatric populations. Moreover, there is limited literature documenting and quantifying the clinical and polysomnographic features in this population. Methods A case–control study comparing the clinical and polysomnographic features of 31 pRBD patients with: (1) Age-, sex-, and psychiatric diagnoses-matched controls; and (2) Typical idiopathic RBD (tRBD) patients. Results Despite being prescribed with similar psychotropics, pRBD patients had more dream-enacting behaviors ( p < 0.01), sleep-related injuries ( p < 0.01), and nightmares ( p < 0.01) than the psychiatric controls. pRBD patients were younger with more females, but they had comparable sleep-related injuries to tRBD. Both tRBD and pRBD had more REM-related muscle activity than controls ( p < 0.01) and the effect remained significant after adjusting for age, gender, and use of antidepressants. Conclusions Our study suggests that pRBD had comparable clinical features and consequences to those of tRBD. The occurrence of RBD symptoms in these patients may be related to a constellation of factors, including individual predisposition, depressive illness, antidepressants, and other clinical factors. Given the association of RBD and neurodegeneration in tRBD, further prospective follow-up of these patients is warranted.