Factors associated with injury in REM sleep behavior disorder

Stuart J McCarter; Erik K St Louis; Christopher L Boswell; Lucas G Dueffert; Nancy Slocumb; Bradley F Boeve; Michael H Silber; Eric J Olson; Timothy I Morgenthaler; Maja Tippmann-Peikert

doi:10.1016/j.sleep.2014.06.002

Factors associated with injury in REM sleep behavior disorder

Sleep Med. 2014 Nov;15(11):1332-8. doi: 10.1016/j.sleep.2014.06.002. Epub 2014 Jun 23.

Affiliations

¹ Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
² Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address: stlouis.erik@mayo.edu.
³ Department of Family Medicine, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
⁴ Mayo Center for Sleep Medicine, Department of Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
⁵ Mayo Center for Sleep Medicine, Departments of Medicine and Pulmonary & Critical Care Medicine, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
⁶ Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.

Abstract

Objective: As factors associated with injury in rapid eye movement (REM) sleep behavior disorder (RBD) remain largely unknown, we aimed to identify such factors.

Methods: We surveyed consecutive idiopathic (iRBD) or symptomatic RBD patients seen between 2008 and 2010 regarding RBD-related injuries. Associations between injuries and clinical variables were determined with odds ratios (OR) and multiple logistic regression analyses. The primary outcome variables were injury and injury severity.

Results: Fifty-three patients (40%) responded. Median age was 69 years, and 35 (73.5%) were men. Twenty-eight (55%) had iRBD. Twenty-nine (55%) reported injury, with 37.8% to self and 16.7% to the bed partner. 11.3% had marked injuries requiring medical intervention or hospitalization, including two (4%) subdural hematomas. iRBD diagnosis (OR = 6.8, p = 0.016) and dream recall (OR = 7.5, p = 0.03) were associated with injury; and iRBD diagnosis was independently associated with injury and injury severity adjusting for age, gender, DEB frequency, and duration. Falls (p = 0.03) were also associated with injury severity. DEB frequency was not associated with injury, injury severity, or falls.

Conclusions: Injuries appear to be a frequent complication of RBD, although the relatively low response rate in our survey could have biased results. iRBD patients are more likely to suffer injury--and more severe injuries--than symptomatic RBD patients. In addition, recall of dreams was also associated with injury, and dream enactment behavior (DEB)-related falls were associated with more severe injuries. One in nine patients suffered injury requiring medical intervention. The frequency of DEB did not predict RBD-related injuries, highlighting the importance of timely initiation of treatment for RBD in patients having even rare DEB episodes. Future prospective studies will be necessary to define predictors of injury in RBD.

Keywords: Falls; Injury; Parkinson's disease; REM sleep behavior disorder; Subdural hematoma; Synucleinopathy.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Dreams
Female
Hematoma, Subdural / etiology
Humans
Male
REM Sleep Behavior Disorder / complications*
Risk Factors
Wounds and Injuries / etiology*

Factors associated with injury in REM sleep behavior disorder

Authors

Affiliations

Abstract

Publication types

MeSH terms

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