Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder.
OBJECTIVE
To describe the clinical and video-polysomnographic (VPSG) features of a group of subjects with severe obstructive sleep apnea/hypopnea (OSAH) mimicking the symptoms of REM sleep behavior disorder (RBD).


METHODS
Evaluation of clinical and VPSG data.


METHODS
University hospital sleep laboratory unit.


METHODS
Sixteen patients that were identified during routine first evaluation visits. Patients' PSG measures were compared with those of 20 healthy controls and 16 subjects with idiopathic RBD of similar age and sex distribution and apnea/hypopnea index lower than 10.


METHODS
NA.


RESULTS
Sixteen subjects were identified presenting with dream-enacting behaviors and unpleasant dreams suggesting the diagnosis of RBD, in addition to snoring and excessive daytime sleepiness. VPSG excluded RBD showing REM sleep with atonia and without increased phasic EMG activity, and was diagnostic of severe OSAH with a mean apnea-hypopnea index of 67.5 +/- 18.7 (range, 41-105) demonstrating that the reported abnormal sleep behaviors occurred only during apnea-induced arousals. Continuous positive airway pressure therapy eliminated the abnormal behaviors, unpleasant dreams, snoring and daytime hypersomnolence.


CONCLUSIONS
Our study shows that severe OSAH may mimick the symptoms of RBD and that VPSG is mandatory to establish the diagnosis of RBD, and identify or exclude other causes of dream-enacting behaviors.
Iranzo
Alex
A
Neurology Service, Hospital Clinic and Institut d'Investigacions Biomèndiques August Pi i Sunyer, Barcelona, Spain. airanzo@clinic.ub.es
Santamaría
Joan
J
D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004576:Electromyography; D006801:Humans; D008875:Middle Aged; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000453:epidemiology*; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy