BACKGROUND: Isolated REM sleep without atonia (RSWA) as a main polysomnograhic feature of REM sleep behaviour disorder (RBD) is thought to be a prodromal or subclinical state of the disease. RSWA/RBD occurence in psychiatric population is much more frequent than in general population but its associated factors are still not known. METHODS: We invited 88 psychiatry in-patients to undervent video-polysomnography. The visual scoring was focused on RSWA in submentales and flexores digitales superficiales muscles. This parametr was subsequently correlated mainly with age/gender, their medication and mental status. RESULTS: The RWSA was mostly still in normal range despite the fact, that selected psychiatry patients (≤ 50 years) were taking several classes of psychoactive medication. 3,6% had convincingly RBD, although 35.7% reported rare lifetime occurence of dream-enacting behaviour and 62.8% sporadic nightmares. We found correlation between RSWA and SNRI medication class (p = 0.015), specifically venlafaxine (p = 0.029) as well as quetiapine (p = 0.030). Another significant associated factors were current anxiety (p < 0.001) and depressive symptoms (p = 0.05), but we found no relation between RSWA and given diagnosis. CONLUCIONS: Isolated RSWA in younger psychiatry patients might be a result of multiple factors, including medication and current mental status but these factors are in most cases not sufficient to manifest RBD.

3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Sleep Medicine National Institute of Mental Health Topolová 748 250 67 Klecany Czech Republic

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Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, et al. AASM scoring manual updates for 2017 (version 2.4) J Clin Sleep Med. 2017;13(5):665–666. doi: 10.5664/jcsm.6576. PubMed DOI PMC

Postuma RB, Iranzo A, Hu M, Hogl B, Boeve BF, Manni R, et al. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain. 2019;142(3):744–759. doi: 10.1093/brain/awz030. PubMed DOI PMC

Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, et al. REM sleep behaviour disorder. Nat Rev Dis Primers. 2018;4(1):19. doi: 10.1038/s41572-018-0016-5. PubMed DOI

Lam SP, Fong SY, Ho CK, Yu MW, Wing YK. Parasomnia among psychiatric outpatients: a clinical, epidemiologic, cross-sectional study. J Clin Psychiatry. 2008;69(9):1374–1382. doi: 10.4088/JCP.v69n0904. PubMed DOI

Teman PT, Tippmann-Peikert M, Silber MH, Slocumb NL, Auger RR. Idiopathic rapid-eye-movement sleep disorder: associations with antidepressants, psychiatric diagnoses, and other factors, in relation to age of onset. Sleep Med. 2009;10(1):60–65. doi: 10.1016/j.sleep.2007.11.019. PubMed DOI

Lam SP, Zhang J, Tsoh J, Li SX, Ho CK, Mok V, et al. REM sleep behavior disorder in psychiatric populations. J Clin Psychiatry. 2010;71(8):1101–1103. doi: 10.4088/JCP.l05877gry. PubMed DOI

Wing YK, Lam SP, Tsoh JM, Mok VC. Rapid eye movement sleep behaviour disorder and psychiatry: a case-control study. Hong Kong Med J. 2015;21(Suppl 6):34–38. PubMed

Winkelman JW, James L. Serotonergic antidepressants are associated with REM sleep without atonia. Sleep. 2004;27(2):317–321. doi: 10.1093/sleep/27.2.317. PubMed DOI

Lam SP, Li SX, Mok V, Wing YK. Young-onset REM sleep behavior disorder: beyond the antidepressant effect. Sleep Med. 2012;13(2):211. doi: 10.1016/j.sleep.2011.04.018. PubMed DOI

Lam SP, Zhang J, Wing YK. REM sleep behavior disorder: from epidemiology to heterogeneity. Sleep. 2013;36(8):1117–1119. doi: 10.5665/sleep.2860. PubMed DOI PMC

Ju YE, Larson-Prior L, Duntley S. Changing demographics in REM sleep behavior disorder: possible effect of autoimmunity and antidepressants. Sleep Med. 2011;12(3):278–283. doi: 10.1016/j.sleep.2010.07.022. PubMed DOI

Zhang B, Hao Y, Jia F, Tang Y, Li X, Liu W, et al. Sertraline and rapid eye movement sleep without atonia: an 8-week, open-label study of depressed patients. Prog Neuro-Psychopharmacol Biol Psychiatry. 2013;47:85–92. doi: 10.1016/j.pnpbp.2013.08.010. PubMed DOI

McCarter SJ, St Louis EK, Sandness DJ, Arndt K, Erickson M, Tabatabai G, et al. Antidepressants increase REM sleep muscle tone in patients with and without REM sleep behavior disorder. Sleep. 2015;38(6):907–917. PubMed PMC

Lee K, Baron K, Soca R, Attarian H. The prevalence and characteristics of REM sleep without atonia (RSWA) in patients taking antidepressants. J Clin Sleep Med. 2016;12(3):351–355. doi: 10.5664/jcsm.5582. PubMed DOI PMC

Beck AT, Steer RA, Ball R, Ranieri W. Comparison of beck depression inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67(3):588–597. doi: 10.1207/s15327752jpa6703_13. PubMed DOI

Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–897. doi: 10.1037/0022-006X.56.6.893. PubMed DOI

Berry RB, Gamaldo CE, Harding SM, Brooks R, Lloyd RM, Vaughn BV, et al. AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med. 2015;11(11):1253–1254. doi: 10.5664/jcsm.5176. PubMed DOI PMC

Schenck CH, Mahowald MW. Rapid eye movement sleep parasomnias. Neurol Clin. 2005;23(4):1107–1126. doi: 10.1016/j.ncl.2005.06.002. PubMed DOI

Frauscher B, Iranzo A, Gaig C, Gschliesser V, Guaita M, Raffelseder V, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep. 2012;35(6):835–847. doi: 10.5665/sleep.1886. PubMed DOI PMC

Montplaisir J, Gagnon JF, Fantini ML, Postuma RB, Dauvilliers Y, Desautels A, et al. Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Mov Disord. 2010;25(13):2044–2051. doi: 10.1002/mds.23257. PubMed DOI

Gagnon JF, Postuma RB, Montplaisir J. Update on the pharmacology of REM sleep behavior disorder. Neurology. 2006;67(5):742–747. doi: 10.1212/01.wnl.0000233926.47469.73. PubMed DOI

Zhang J, Lam SP, Ho CK, Li AM, Tsoh J, Mok V, et al. Diagnosis of REM sleep behavior disorder by video-polysomnographic study: is one night enough? Sleep. 2008;31(8):1179–1185. PubMed PMC

Consens FB, Chervin RD, Koeppe RA, Little R, Liu S, Junck L, et al. Validation of a polysomnographic score for REM sleep behavior disorder. Sleep. 2005;28(8):993–997. doi: 10.1093/sleep/28.8.993. PubMed DOI

Frauscher B, Ehrmann L, Hogl B. Defining muscle activities for assessment of rapid eye movement sleep behavior disorder: from a qualitative to a quantitative diagnostic level. Sleep Med. 2013;14(8):729–733. doi: 10.1016/j.sleep.2012.09.028. PubMed DOI

Zhou J, Zhang J, Li Y, Du L, Li Z, Lei F, et al. Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. Sleep Med. 2015;16(3):414–418. doi: 10.1016/j.sleep.2014.10.020. PubMed DOI

Haba-Rubio J, Frauscher B, Marques-Vidal P, Toriel J, Tobback N, Andries D, et al. Prevalence and determinants of REM sleep behavior disorder in the general population. Sleep. 2017. PubMed

Bonakis A, Howard RS, Ebrahim IO, Merritt S, Williams A. REM sleep behaviour disorder (RBD) and its associations in young patients. Sleep Med. 2009;10(6):641–645. doi: 10.1016/j.sleep.2008.07.008. PubMed DOI

Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Women's Health (Larchmt) 2009;18(12):1955–1963. doi: 10.1089/jwh.2008.1348. PubMed DOI

Wing YK, Lam SP, Li SX, Yu MW, Fong SY, Tsoh JM, et al. REM sleep behaviour disorder in Hong Kong Chinese: clinical outcome and gender comparison. J Neurol Neurosurg Psychiatry. 2008;79(12):1415–1416. doi: 10.1136/jnnp.2008.155374. PubMed DOI

Liu Y, Zhang J, Lam SP, Zhou J, Yu MWM, Li SX, et al. A case-control-family study of idiopathic rapid eye movement sleep behavior disorder. Ann Neurol. 2019;85(4):582–592. doi: 10.1002/ana.25435. PubMed DOI

Yao C, Fereshtehnejad SM, Keezer MR, Wolfson C, Pelletier A, Postuma RB. Risk factors for possible REM sleep behavior disorder: a CLSA population-based cohort study. Neurology. 2018. PubMed PMC

Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep. 1992;15(3):226–235. doi: 10.1093/sleep/15.3.226. PubMed DOI

Onofrj M, Luciano AL, Thomas A, Iacono D, D'Andreamatteo G. Mirtazapine induces REM sleep behavior disorder (RBD) in parkinsonism. Neurology. 2003;60(1):113–115. doi: 10.1212/01.WNL.0000042084.03066.C0. PubMed DOI

Parish JM. Violent dreaming and antidepressant drugs: or how paroxetine made me dream that I was fighting Saddam Hussein. J Clin Sleep Med. 2007;3(5):529–531. doi: 10.5664/jcsm.26919. PubMed DOI PMC

Takahashi T, Mitsuya H, Murata T, Murayama J, Wada Y. Opposite effects of SSRIs and tandospirone in the treatment of REM sleep behavior disorder. Sleep Med. 2008;9(3):317–319. doi: 10.1016/j.sleep.2007.05.003. PubMed DOI

Schenck CH, Hurwitz TD, Mahowald MW. REM sleep behavior disorder. Am J Psychiatry. 1988;145(5):652. PubMed

Ferri R, Arico D, Cosentino FII, Lanuzza B, Chiaro G, Manconi M. REM sleep without atonia with REM sleep-related motor events: broadening the spectrum of REM sleep behavior disorder. Sleep. 2018;41(12):zsy187. doi: 10.1093/sleep/zsy187. PubMed DOI

Tan L, Zhou J, Liang B, Li Y, Lei F, Du L, et al. A case of quetiapine-induced rapid eye movement sleep behavior disorder. Biol Psychiatry. 2016;79(5):e11–ee2. doi: 10.1016/j.biopsych.2014.08.002. PubMed DOI

Arnaldi D, Fama F, De Carli F, Morbelli S, Ferrara M, Picco A, et al. The role of the serotonergic system in REM sleep behavior disorder. Sleep. 2015;38(9):1505–1509. doi: 10.5665/sleep.5000. PubMed DOI PMC

Postuma RB, Gagnon JF, Tuineaig M, Bertrand JA, Latreille V, Desjardins C, et al. Antidepressants and REM sleep behavior disorder: isolated side effect or neurodegenerative signal? Sleep. 2013;36(11):1579–1585. doi: 10.5665/sleep.3102. PubMed DOI PMC

Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci. 2014;37(5):279–288. doi: 10.1016/j.tins.2014.02.009. PubMed DOI

Iranzo A, Santamaria J. Bisoprolol-induced rapid eye movement sleep behavior disorder. Am J Med. 1999;107(4):390–392. doi: 10.1016/S0002-9343(99)00245-4. PubMed DOI

Husain AM, Miller PP, Carwile ST. Rem sleep behavior disorder: potential relationship to post-traumatic stress disorder. J Clin Neurophysiol. 2001;18(2):148–157. doi: 10.1097/00004691-200103000-00005. PubMed DOI

Ross RJ, Ball WA, Dinges DF, Kribbs NB, Morrison AR, Silver SM, et al. Motor dysfunction during sleep in posttraumatic stress disorder. Sleep. 1994;17(8):723–732. doi: 10.1093/sleep/17.8.723. PubMed DOI

Ross RJ, Ball WA, Dinges DF, Kribbs NB, Morrison AR, Silver SM, et al. Rapid eye movement sleep disturbance in posttraumatic stress disorder. Biol Psychiatry. 1994;35(3):195–202. doi: 10.1016/0006-3223(94)91152-5. PubMed DOI

Hurwitz TD, Mahowald MW, Kuskowski M, Engdahl BE. Polysomnographic sleep is not clinically impaired in Vietnam combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1998;44(10):1066–1073. doi: 10.1016/S0006-3223(98)00089-4. PubMed DOI

Wing YK, Li SX, Mok V, Lam SP, Tsoh J, Chan A, et al. Prospective outcome of rapid eye movement sleep behaviour disorder: psychiatric disorders as a potential early marker of Parkinson's disease. J Neurol Neurosurg Psychiatry. 2012;83(4):470–472. doi: 10.1136/jnnp-2011-301232. PubMed DOI

Lam SP, Li SX, Chan JW, Mok V, Tsoh J, Chan A, et al. Does rapid eye movement sleep behavior disorder exist in psychiatric populations? A clinical and polysomnographic case-control study. Sleep Med. 2013;14(8):788–794. doi: 10.1016/j.sleep.2012.05.016. PubMed DOI

Wing YK, Lam SP, Mok VC, Zhang J, Tsoh JM, Leung EY. Early neurodegenerative biomarkers and clinical outcome in psychiatric patients with rapid eye movement sleep behaviour disorder: a prospective study. Hong Kong Med J. 2018;24(3):24–28. PubMed

Feemster JC, Jung Y, Timm PC, Westerland SM, Gossard TR, Teigen LN, et al. Normative and isolated rapid eye movement sleep without atonia in adults without REM sleep behavior disorder. Sleep. 2019;42(10):zsz124. doi: 10.1093/sleep/zsz124. PubMed DOI PMC