Correlates of REM sleep without atonia in dream enactment behavior associated with Parkinson’s disease, medication use and obstructive sleep apnea

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Poster presented at the Sleep 2022 Conference in Charlotte, NC.


METHODS: We did a retrospective review of medical records and polysomnographic (PSG) data of patients with dream enactment behavior (DEB) from 2015 to 2020. REM sleep without atonia (RSWA) was scored according to the AASM rules, and %RSWA was calculated.

RESULTS: Thirty-six patients with DEB were analyzed. Recursive partitioning algorithm was used to determine the %RSWA that correlated with the presence or absence of Parkinson’s disease (PD). RSWA >=20% was present in 11 patients, and had the highest correlation with PD (9/11). RSWA of 2.1% to 19.9% was present in 10 patients, and had modest correlation with PD (3/10). RSWA= 18% yielded the maximum combined sensitivity of 75% and specificity of 91.7% for concurrent diagnosis of PD. Due to a small sample size, we could not determine the minimum amount of total REM sleep that gives power to RSWA >=20% (RSWA20) in predicting the presence of PD. The PD group (7) had a mean RSWA of 33.3%. The SSRI/SNRI group (4) had a mean RSWA of 26%. Patients who had PD and were on SSRI/SNRI (5) had a mean RSWA of 21%. The sleep apnea group (8) had a mean RSWA of 8.9%. Patients with DEB, but without PD, sleep apnea, and not on SSRI/SNRI (7) had a mean RSWA of 5.4%. A generalized linear regression analysis on the entire cohort revealed that patients on SSRI/SNRI (14) have 2.767 times higher %RSWA than those not on the medication (95% CI 1.393-5.497, p = .004).

CONCLUSION: Among patients with dream enactment behavior, a diagnosis of PD and SSRI/SNRI use had the highest %RSWA on PSG, 33.3% and 26% respectively. Patients on SSRI/SNRI had 3 times higher %RSWA than those not on the medication.



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