title: Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors.
abstract: OBJECTIVE
  To characterize the clinical, polysomnographic and treatment responses of patients with disruptive nocturnal behaviors (DNB) and nightmares following traumatic experiences.
  
  
  METHODS
  A case series of four young male, active duty U.S. Army Soldiers who presented with DNB and trauma related nightmares. Patients underwent a clinical evaluation in a sleep medicine clinic, attended overnight polysomnogram (PSG) and received treatment. We report pertinent clinical and PSG findings from our patients and review prior literature on sleep disturbances in trauma survivors.
  
  
  RESULTS
  DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient's traumatic experiences. All patients had REM without atonia during polysomnography; one patient had DNB and a nightmare captured during REM sleep. Prazosin improved DNB and nightmares in all patients.
  
  
  CONCLUSIONS
  We propose Trauma associated Sleep Disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings, and treatment responses of patients with DNB, nightmares, and REM without atonia after trauma.
authors.affiliation: Brian Allgood Army Community Hospital, South Korea.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mysliwiec
authors.affiliation: Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Reilly
authors.affiliation: Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA.
authors.forename: Jason
authors.initials: J
authors.lastname: Polchinski
authors.affiliation: Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA.
authors.forename: Herbert P
authors.initials: HP
authors.lastname: Kwon
authors.affiliation: University of Pittsburgh School of Medicine, Departments of Psychiatry & Psychology, Pittsburgh, PA.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.affiliation: Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Roth
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use; D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004325:Dreams / Q000187:drug effects* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008889:Military Personnel / Q000523:psychology; D009129:Muscle Tonus; D020447:Parasomnias / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D017286:Polysomnography / Q000379:methods; D011224:Prazosin / Q000627:therapeutic use; D012893:Sleep Wake Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D012895:Sleep, REM / Q000187:drug effects* / Q000502:physiology; D013009:Somnambulism / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D017741:Survivors / Q000523:psychology
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D011224:Prazosin
keywords: REM sleep behavior disorder; military; nightmares; posttraumatic stress disorder; veterans