Trauma-Associated Sleep Disorder: A Posttraumatic Stress/REM Sleep Behavior Disorder Mash-Up?

J Clin Sleep Med. 2019 Feb 15;15(2):345-349. doi: 10.5664/jcsm.7642.

Abstract

Abstract: Trauma-associated sleep disorder (TASD) is a parasomnia sharing characteristics of post-traumatic stress disorder (PTSD) and REM sleep behavior disorder (RBD) including dream-enactment behavior (DEB). Here we report REM sleep without atonia (RSWA) and other neurological features in a patient with complex vocal and motor DEB following traumatic combat military exposure. Post-discharge, his wife observed frequent yelling and jerking during sleep with dream mentation reminiscent of traumatic military experiences. He was initially diagnosed with PTSD. Polysomnography demonstrated RSWA and severe obstructive sleep apnea treated with nasal continuous positive airway pressure (CPAP). Dream-enactment behavior severity and frequency was reduced, but still persisted despite nasal CPAP and sequential fluoxetine, escitalopram, prazosin, and melatonin trials. Our case demonstrated overlapping clinical features of PTSD and RBD with polysomnography features of RSWA supportive of idiopathic RBD but no "soft signs" suggesting underlying synucleinopathy. Longitudinal follow-up of larger case series must clarify whether TASD consistently manifests REM sleep atonia loss and determine the phenoconversion risk for synucleinopathy neurodegeneration.

Commentary: A commentary on this article appears in this issue on page 181.

Keywords: REM sleep behavior disorder; polysomnography; posttraumatic stress disorder; trauma associated sleep disorder.

Publication types

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

MeSH terms

  • Combat Disorders / diagnosis
  • Combat Disorders / psychology
  • Comorbidity
  • Continuous Positive Airway Pressure
  • Diagnosis, Differential
  • Dreams
  • Humans
  • Male
  • Middle Aged
  • Neurologic Examination
  • Polysomnography
  • REM Sleep Behavior Disorder / diagnosis*
  • REM Sleep Behavior Disorder / psychology
  • REM Sleep Behavior Disorder / therapy
  • Stress Disorders, Post-Traumatic / diagnosis*
  • Stress Disorders, Post-Traumatic / psychology
  • Stress Disorders, Post-Traumatic / therapy