Predictors of injury in REM sleep behavior disorder

Abstract

Introduction REM sleep behavior disorder (RBD) is widely recognized to involve potentially injurious dream enactment behaviors (DEB), but which clinical factors are associated with RBD-related injuries remain largely unknown. We aimed to identify injury predictors in RBD. Materials and methods We surveyed consecutive RBD patients seen at Mayo Clinic between 2008 and 2010 regarding RBD-related injuries and reviewed medical records to determine idiopathic (iRBD) or symptomatic RBD diagnosis. Associations between injuries prior to treatment and demographic, clinical, and medication variables were then determined with odd’s ratios and multiple logistic regression analyses. The primary outcome variables were injury and injury severity. Results Fifty-three patients (40%) responded. Median age was 69 years and 35 (75%) were men. Twenty-five (47%) had symptomatic RBD. Twenty-nine (55%) reported injury, including self (37.8%) and bed partner (16.7%) injury. iRBD diagnosis (OR = 6.8, p = 0.016) and dream recall (OR = 7.5, p = 0.03) were associated with injury, and iRBD diagnosis was independently associated with injury and injury severity, adjusting for age, gender, DEB frequency and duration. Falls during DEB ( p = 0.03) were also associated with more severe injury, while DEB frequency was not associated with injury, injury severity, or falls. Conclusion Injuries are a frequent complication of RBD. iRBD patients are more likely to suffer injury, and more severe injuries, than symptomatic RBD patients. In addition, recall of dreams was also associated with injury, and DEB-related falls were associated with more severe injuries. Frequency of DEB did not predict RBD-related injuries, highlighting the importance of timely initiation of treatment for RBD in patients having even rare DEB episodes. Acknowledgements The project described was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant No. 1 UL1 RR024150-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.