Citation

Elliott JE, Opel RA, Pleshakov D, Rachakonda T, Chau AQ, Weymann KB, Lim MM. Sleep 2019; ePub(ePub): ePub.

Affiliation

Oregon Institute of Occupational Health Sciences; Oregon Health & Science University, Portland, OR, USA.

Copyright

(Copyright © 2019, American Academy of Sleep Medicine, Publisher Associated Professional Sleep Societies)

DOI

10.1093/sleep/zsz237

PMID

31587047

Abstract

STUDY OBJECTIVES: Describe the crude prevalence of rapid eye movement (REM) sleep behavior disorder (RBD) following traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) in Veterans, given potential relationships between TBI, PTSD, RBD, and neurodegeneration.

METHODS: Veterans (n=394; 94% male; 54.4±15.5 years of age) were prospectively/cross-sectionally recruited from the VA Portland Health Care System, and completed in-lab video-polysomnography and questionnaires. TBI and PTSD was assessed via diagnostic screening and medical record review. Subjects were categorized into 4-groups after assessment of REM sleep without atonia (RSWA) and self-reported dream enactment: 1) "Normal," neither RSWA nor dream enactment, 2) "Other Parasomnia," dream enactment without RSWA, 3) "RSWA," isolated-RSWA without dream enactment, and 4) "RBD," RSWA with dream enactment. Crude prevalence, prevalence odds ratio, and prevalence rate for parasomnias across subjects with TBI and/or PTSD was assessed.

RESULTS: Overall prevalence rates were 31%, 7% and 9% for Other Parasomnia, RSWA, and RBD, respectively. The prevalence rate of RBD increased to 15% in PTSD subjects [(age adjusted POR: 2.81 (1.17-4.66)] and to 21% in TBI+PTSD subjects [(age adjusted POR: 3.43 (1.20-9.35)]. No subjects met all diagnostic criteria for trauma-associated sleep disorder (TASD), and no overt dream enactment was captured on video.

CONCLUSIONS: The prevalence of RBD and related parasomnias is significantly higher in Veterans compared to the general population, and are associated with PTSD and TBI+PTSD. Considering the association between idiopathic-RBD and synucleinopathy, it remains unclear whether RBD (and potentially TASD) associated with PTSD or TBI+PTSD similarly increases risk for long-term neurologic sequelae.

Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2019. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Language: en

Keywords

PTSD; RBD; REM sleep without atonia; TBI; trauma-associated sleep disorder