Emotion dysregulation in idiopathic rapid eye movement sleep behavior disorder

Study objectives: To characterize emotion regulation strategies in patients with idiopathic REM sleep behavior disorder (iRBD) and to explore whether these strategies are associated with clinical symptoms.

Methods: In this cross-sectional multicenter study, a total of 94 polysomnography-confirmed iRBD patients (mean age, 67.6 years; men, 56%) and 50 healthy controls (mean age, 65.4 years; men, 48%) completed the Cognitive Emotion Regulation Questionnaire (CERQ), the Korean version of the RBD questionnaire-Hong Kong (RBDQ-KR), the Buss-Durkee Hostility Inventory (BDHI), the second edition of the Beck Depression Inventory (BDI-II), and the Korean version of the Montreal Cognitive Assessment (MoCA-K).

Results: The iRBD group had lower CERQ adaptive scores than the control group, whereas the CERQ maladaptive scores were not significantly different between the groups. Among the CERQ adaptive subscales, the scores for positive refocusing, refocusing on planning, and positive reappraisal were significantly lower in the iRBD group than in the control group. Higher CERQ adaptive scores were correlated with lower scores on RBDQ-KR factor 1 (dream-related) and the BDI-II and higher MoCA-K scores but were not correlated with RBDQ-KR factor 2 (behavioral manifestation) or BDHI scores. Among the dream content-related items of RBDQ-KR factor 1, the CERQ adaptive score was associated only with frequent nightmares. No correlation was found between CERQ maladaptive scores and any variable except for a positive correlation with BDI-II scores.

Conclusions: Our results provide evidence of emotion regulation deficits in iRBD patients. Furthermore, these results were linked to dream-related factors, especially nightmares, along with depressive symptoms and cognitive impairment.