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

John C. Feemster, Kevin L. Smith, Stuart J. McCarter, Erik K St Louis

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)345-349
Number of pages5
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Volume15
Issue number2
DOIs
StatePublished - Feb 15 2019

Fingerprint

REM Sleep Behavior Disorder
REM Sleep
Post-Traumatic Stress Disorders
Continuous Positive Airway Pressure
Polysomnography
Wounds and Injuries
Parasomnias
Citalopram
Prazosin
Fluoxetine
Obstructive Sleep Apnea
Melatonin
Spouses
Sleep
Sleep Wake Disorders

Keywords

  • polysomnography
  • posttraumatic stress disorder
  • REM sleep behavior disorder
  • trauma associated sleep disorder

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

Cite this

Trauma-Associated Sleep Disorder : A Posttraumatic Stress/REM Sleep Behavior Disorder Mash-Up? / Feemster, John C.; Smith, Kevin L.; McCarter, Stuart J.; St Louis, Erik K.

In: Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Vol. 15, No. 2, 15.02.2019, p. 345-349.

Research output: Contribution to journalArticle

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