title: Antidepressants Increase REM Sleep Muscle Tone in Patients with and without REM Sleep Behavior Disorder.
abstract: OBJECTIVE
  REM sleep behavior disorder (RBD) is associated with antidepressant treatment, especially in younger patients; but quantitative REM sleep without atonia (RSWA) analyses of psychiatric RBD patients remain limited. We analyzed RSWA in adults receiving antidepressants, with and without RBD.
  
  
  METHODS
  We comparatively analyzed visual, manual, and automated RSWA between RBD and control groups. RSWA metrics were compared between groups, and regression was used to explore associations with clinical variables.
  
  
  METHODS
  Tertiary-care sleep center.
  
  
  METHODS
  Participants included traditional RBD without antidepressant treatment (n = 30, 15 Parkinson disease [PD-RBD] and 15 idiopathic); psychiatric RBD receiving antidepressants (n = 30); and adults without RBD, including antidepressant-treated psychiatric (n = 30), untreated psychiatric (n = 15), and OSA (n = 60) controls.
  
  
  METHODS
  N/A.
  
  
  RESULTS
  RSWA was highest in traditional and psychiatric RBD, intermediate in treated psychiatric controls, and lowest in untreated psychiatric and OSA controls (P < 0.01). RSWA distribution and type also differed between antidepressant-treated patients having higher values in anterior tibialis, and PD-RBD with higher submentalis and tonic RSWA. Psychiatric RBD had significantly younger age at onset than traditional RBD patients (P < 0.01).
  
  
  CONCLUSIONS
  Antidepressant treatment was associated with elevated REM sleep without atonia (RSWA) even without REM sleep behavior disorder (RBD), suggesting that antidepressants, not depression, promote RSWA. Differences in RSWA distribution and type were also seen, with higher anterior tibialis RSWA in antidepressant-treated patients and higher tonic RSWA in Parkinson disease-RBD patients, which could aid distinction between RBD subtypes. These findings suggest that antidepressants may mediate different RSWA mechanisms or, alternatively, that RSWA type and distribution evolve during progressive neurodegeneration. Further prospective RSWA analyses are necessary to clarify the relationships between antidepressant treatment, psychiatric disease, and RBD.
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: McCarter
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: Erik K
authors.initials: EK
authors.lastname: St Louis
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: David J
authors.initials: DJ
authors.lastname: Sandness
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.|Cornell College, Mount Vernon, Iowa.
authors.forename: Katlyn
authors.initials: K
authors.lastname: Arndt
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.|St. Olaf College, Northfield, MN.
authors.forename: Maia
authors.initials: M
authors.lastname: Erickson
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.|St. Olaf College, Northfield, MN.
authors.forename: Grace
authors.initials: G
authors.lastname: Tabatabai
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Boeve
authors.affiliation: Mayo Center for Sleep Medicine, Departments of Medicine and Neurology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Silber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000494:pharmacology*; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000139:chemically induced; D009129:Muscle Tonus / Q000187:drug effects*; D018482:Muscle, Skeletal / Q000187:drug effects; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology; D020187:REM Sleep Behavior Disorder / Q000139:chemically induced / Q000150:complications / Q000503:physiopathology*; D012895:Sleep, REM / Q000187:drug effects*
chemical_list: D000928:Antidepressive Agents
keywords: REM sleep behavior disorder; REM sleep without atonia; antidepressants; automated analysis; depression; parasomnia; quantitative analysis; synucleinopathy; tonic muscle activity; transient/phasic muscle activity