Abstract
ObjectivesTo investigate the prevalence of REM sleep behavior disorder (RBD) in patients with inflammatory arthritis (IA) to ascertain if RBD could be an internal red flag signaling a fluctuating state of inflammation based on the theory of “protoconsciousness”.Materials & MethodsOne hundred and three patients with a confirmed diagnosis of IA were consecutively recruited. The patients underwent general (IA activity, functional status, laboratory tests) and neurological evaluations. A neurologist investigated RBD and REM sleep parasomnias in a semi‐structured interview. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while the risk of obstructive sleep apnea syndrome (OSAS) was evaluated with the Berlin questionnaire. Beck Depression Inventory II and State‐Trait Anxiety Inventory investigated depression and anxiety.ResultsPatients had a mean age of 53.7 ± 14.6 years, 65% were women; 57.3% were in a clinically active phase of IA. Two women fulfilled ICSD‐3 criteria for RBD appearing 11 years after and 20 years before IA onset respectively. 31 patients scored positive for nightmare disorder (ND), 8 for recurrent isolated sleep paralysis. 65 (63.1%) patients reported poor sleep quality and 25 (24.3%) resulted at high risk for OSAS. 32 (31.0%) patients scored positively for depression or anxiety.ConclusionsThe prevalence of RBD in patients with IA did not differ from that in the general population, whereas ND presented a 2‐fold increased prevalence. Whether RBD can be considered a red flag signaling an internal danger remains an open question, while ND may be a new player in this intriguing relation.
Highlights
Two women fulfilled ICSD‐3 criteria for REM sleep behavior disorder (RBD) appear‐ ing 11 years after and 20 years before inflammatory arthritis (IA) onset respectively. 31 patients scored posi‐ tive for nightmare disorder (ND), 8 for recurrent isolated sleep paralysis. 65 (63.1%) patients reported poor sleep quality and 25 (24.3%) resulted at high risk for obstructive sleep apnea syndrome (OSAS). 32 (31.0%) patients scored positively for depression or anxiety
Whether RBD can be considered a red flag signaling an internal danger remains an open ques‐ tion, while ND may be a new player in this intriguing relation
We further speculated that disruption of physiological REM sleep regulation in RBD could represent the harbinger of a prominent neurodegenerative disease (Schenck et al, 2013), but could be a red flag signaling an internal danger such as the au‐ toimmune inflammatory activation found in IA
Summary
REM sleep behavior disorder (RBD) is a REM sleep parasomnia char‐ acterized by loss of physiological muscle atonia during REM sleep and dream enacting behavior (AASM, 2014). Through the creation of a virtual representation of reality based on experience on the “outside world” (dreams), REM sleep could anticipate events and percep‐ tions yet to occur and prepare the individual to adopt the most appropriate behaviors during wakefulness, especially in situations of danger (Hobson, 2009; Horowski, Benes, & Fuxe, 2004). In line with this hypothesis, a REM sleep disorder such as RBD could represent an internal red flag signaling a condition with a negative impact exposing us to constant or prominent danger. Exclusion criteria were a history of alcohol or drug abuse/dependence, chronic use of anti‐ depressants at the time of the visit and documented neurological diseases (e.g., stroke, neurodegenerative diseases, epilepsy, demye‐ linating diseases, etc.)
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