Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson's disease.
OBJECTIVE
To determine the occurrence of REM sleep behavior disorder (RBD) and sleep-related injury (SRI) in an outpatient PD practice.


BACKGROUND
RBD is a frequent cause of SRI in older individuals. Although RBD is seen in PD, the association of SRI and RBD in PD has not been previously assessed.


METHODS
Consecutive patients with PD and their caregivers were interviewed using a structured questionnaire assessing the presence of RBD and SRI. Patients fulfilling the International Classification of Sleep Disorders (ICSD) criteria for RBD were compared with non-RBD patients. In a separate analysis, patients with a prior SRI were compared to those without.


RESULTS
Of the 61 patient/caregiver pairs, 15% (7 men and 2 women) met the clinical criteria for RBD. There were more episodes of SRI in the RBD group, with 33% causing injury to themselves or to their caregivers compared with 6% of the non-RBD group (chi(2) = 13, p = 0.005). In the second analysis, 15% (all men) patient/caregiver pairs reported SRI. Of these, 66% of the patients had behaviors resembling those seen in RBD, and 33% had recalled dream content. There is a significant association between SRI and RBD for dream-enacting sleep behaviors (Fisher's exact test, p = 0.0001).


CONCLUSIONS
PD patients with SRI frequently have behavioral features of RBD. If RBD underlies most SRI, treatment with appropriate pharmacologic agents, such as clonazepam, may prevent future occurrences of SRI.
Department of Neurological Sciences and the Sleep Disorders Center, Rush Medical College, Chicago, IL 60612, USA.
C L
CL
Comella
T M
TM
Nardine
N J
NJ
Diederich
G T
GT
Stebbins
D000368:Aged; D017028:Caregivers; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy; D012893:Sleep Wake Disorders / Q000150:complications*; D012895:Sleep, REM / Q000502:physiology*; D011795:Surveys and Questionnaires; D014754:Violence; D014947:Wounds and Injuries / Q000209:etiology*