REM sleep behavior disorder following cerebrovascular stroke: a polysomnographic study in an egyptian sample

Abstract

Introduction REM sleep behavior disorder (RBD) is a parasomnia characterized by dream enacting behavior and vivid action-filled or unpleasant dreams, and presents a risk for self injury or harm to others. It is frequently seen in patients with neurodegenerative disorders, like Parkinsonism, demetia with Lewy bodies, and multiple system atrophy. The aim of the present study is to evaluate the presence of this parasomnia in patients with cerebrovascular strokes, applying the polysomnographic criteria of diagnosis. Materials and methods 30 patients with history of cerebrovascular stroke, within the 3 months prior to assessment, are selected from those attending the outpatient neurology clinic in Ain Shams University Specialized Hospital, Cairo, Egypt. Assessment should be, at least, two weeks after the onset of stroke, to avoid the acute period of hemodynamic instability. A control group of 30 age and sex matched healthy subjects has been considered. All subjects were assessed using REM sleep behavior disorder (RBD) screening questionnaire, as well as all-night polysomnography, in addition to the routine investigations, commonly done for stroke patients. Results 16.66% of the stroke patients fulfilled the PSG criteria of RBD, compared to none of the control group. According to the diagnostic criteria, the behavior could not be explained by any other associated sleep disorder or epilepsy. The male to female ratio was 4:1, and all the stokes associated with RBD were ischemic, mostly involving subcortical or brainstem structures. Conclusion REM sleep behavior disorder (RBD) is not uncommon, after ischemic cerebrovascular strokes, especially those involving brainstem or subcortical areas. Large scale studies are needed for proper estimation of the problem and evaluation of the associated risk factors. Acknowledgements The authors would like to acknowledge all residents of the Stroke Unit in Ain Shams University Specialized Hospital, as well as Dr. Adel Marie, the sleep specialist in the Institute of Psychiatry, Ain Shams University.