Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones

Objective REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. Methods In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). Results The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). Conclusion In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.

[1]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  A. Lang,et al.  Potential early markers of Parkinson disease in idiopathic REM sleep behavior disorder , 2006, Neurology.

[3]  C. Schenck,et al.  Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. , 2009, Journal of women's health.

[4]  V. Pankratz,et al.  P2-107: Anxiety and apathy are associated with probable REM sleep behavior disorder among cognitively normal elderly subjects: The Mayo Clinic study of aging , 2008, Alzheimer's & Dementia.

[5]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[6]  S. Tufik,et al.  Gender and age differences in polysomnography findings and sleep complaints of patients referred to a sleep laboratory. , 2008, Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas.

[7]  B. Boeve,et al.  Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy , 2001, Movement disorders : official journal of the Movement Disorder Society.

[8]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[9]  Dong Zhou,et al.  Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. , 2015, Sleep medicine.

[10]  M. Bertini,et al.  Alexithymia and Dream Recall Upon Spontaneous Morning Awakening , 2003, Psychosomatic medicine.

[11]  M. Mahowald,et al.  Violence in sleep. , 2010, Brain : a journal of neurology.

[12]  A. Chesson,et al.  The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology, and Techinical Specifications , 2007 .

[13]  D. Aarsland,et al.  A systematic review of prevalence studies of depression in Parkinson's disease , 2008, Movement disorders : official journal of the Movement Disorder Society.

[14]  G. Uguccioni,et al.  Fight or flight? Dream content during sleepwalking/sleep terrors vs. rapid eye movement sleep behavior disorder. , 2013, Sleep medicine.

[15]  F. Verhey,et al.  The validity of the Beck Depression Inventory as a screening and diagnostic instrument for depression in patients with Parkinson's disease , 2000, Movement disorders : official journal of the Movement Disorder Society.

[16]  E. Isometsä,et al.  The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population , 2006, Depression and anxiety.

[17]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[18]  A. Beekman,et al.  Review of community prevalence of depression in later life , 1999, British Journal of Psychiatry.

[19]  M. Raskind Diagnosis and treatment of depression comorbid with neurologic disorders. , 2008, The American journal of medicine.

[20]  W. Oertel,et al.  Comorbidity and medication in REM sleep behavior disorder , 2014, Neurology.

[21]  A. Rush,et al.  Dream recall and major depression: A preliminary report. , 1995 .

[22]  R. Chervin Epworth sleepiness scale? , 2003, Sleep medicine.

[23]  D. Aarsland,et al.  A systematic review of prevalence studies of dementia in Parkinson's disease , 2005, Movement disorders : official journal of the Movement Disorder Society.

[24]  M W Mahowald,et al.  Chronic behavioral disorders of human REM sleep: a new category of parasomnia. , 1986, Sleep.

[25]  Y. Wing,et al.  REM sleep behaviour disorder in Hong Kong Chinese: clinical outcome and gender comparison , 2008, Journal of Neurology, Neurosurgery, and Psychiatry.

[26]  T. Nielsen,et al.  Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder. , 2013, Sleep.

[27]  C. Kuehner Gender differences in unipolar depression: an update of epidemiological findings and possible explanations , 2003, Acta psychiatrica Scandinavica.

[28]  A. Chesson,et al.  The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications , 2007 .

[29]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .