Nature and Science of Sleep (Sep 2022)

Emotional and Environmental Factors Aggravating Dream Enactment Behaviors in Patients with Isolated REM Sleep Behavior Disorder

  • Jun JS,
  • Sunwoo JS,
  • Byun JI,
  • Shin JW,
  • Kim TJ,
  • Schenck CH,
  • Jung KY

Journal volume & issue
Vol. Volume 14
pp. 1713 – 1720

Abstract

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Jin-Sun Jun1 *, Jun-Sang Sunwoo2 *, Jung-Ick Byun,3 Jung-Won Shin,4 Tae-Joon Kim,5 Carlos H Schenck,6 Ki-Young Jung7 1Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea; 2Department of Neurology, Kangbuk Samsung Hospital, Seoul, Republic of Korea; 3Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; 4Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea; 5Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea; 6Minnesota Regional Sleep Disorders Center, and Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA; 7Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea*These authors contributed equally to this workCorrespondence: Ki-Young Jung, Department of Neurology, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea, Tel +82-2-2072-4988, Fax +82-2-3672-7553, Email [email protected]: To identify emotional and environmental factors that aggravate dream enactment behaviors (DEBs) in isolated rapid eye movement (REM) sleep behavior disorder (iRBD).Methods: In this cross-sectional study, a total of 96 polysomnography-confirmed iRBD patients (mean age, 68.5 years; men, 68%) and their caregivers completed questionnaires regarding potential aggravating factors related to DEBs, including emotion/feelings (stress, anger, anxiety, depressive mood, fatigue, pain), food (alcohol, caffeine, overeating in the evening, fasting/hunger), activities and sleep patterns (strenuous exercise, sex before bed, conflict/fighting, sleep deprivation, oversleeping, sleeping away from home, watching TV before bed), weather/environmental factors (cloudy or rainy weather, heat, cold, noise) and medication (skipping medication, taking hypnotics).Results: The patients reported that stress (61%) was the most aggravating factor for DEBs, followed by anxiety (56%), anger (51%), fatigue (49%), and watching TV before bed (46%). Similarly, the caregivers reported that these factors were most relevant to the aggravation of DEBs in the patients, although some factors were ranked differently. In the subgroup analyses, aggravating factors for DEBs did not differ by RBD symptom severity. Interestingly, the proportion of patients experiencing DEB aggravation by stress, anxiety and depressive mood was significantly higher in women than in men. Furthermore, depressed patients reported that stress and cloudy or rainy weather made DEBs worse than nondepressed patients.Conclusion: Our results suggest that DEBs in iRBD patients may be mainly aggravated by emotional factors. These negative effects appeared to be more prominent in female and depressed patients.Keywords: REM sleep behavior disorder, dream enactment behavior, precipitating factors

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