title: Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China.
abstract: OBJECTIVE
  Rapid eye movement (REM) sleep behavior disorder (RBD) has been considered a male-predominant parasomnia, and there is little comparative data on potential differences between males and females. Therefore, the aim of our study was to examine and characterize gender difference in RBD.
  
  
  METHODS
  Ninety patients diagnosed with RBD were consecutively recruited from a sleep medicine clinic. All patients were assessed by a RBD questionnaire and overnight video polysomnography. Demographic, clinical data, presence of dreams and dream-enacting behaviors, sleep parameters and electromyographic (EMG) activity were compared for male and female patients with RBD.
  
  
  RESULTS
  Females were significantly younger than males, both in the mean age of RBD onset (45.3 ± 19.3 vs. 56.2 ± 14.1; p = 0.027) and the mean age at diagnosis (50.4 ± 18.2 vs. 61.1 ± 14.1; p = 0.022). Secondary RBD was 21% in males and 44% in females (p = 0.021). Antidepressant use was more common among females (22%) than males (2%; p = 0.003). There was no significant gender difference in dream content (eg, violent and frightening dreams) of RBD patients. However, females had less dream-enacting behaviors, especially in movement related dreams and falling out of bed. Interestingly, no significant difference was found in the quantification of EMG activity during REM sleep between male and female patients.
  
  
  CONCLUSIONS
  We found significant gender differences in demographics, associated comorbidities, and dream-related behaviors in patients with RBD. Female RBD patients reported significantly less behavior during dreams, but there was no significant gender difference in EMG activity during REM sleep.
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Junying
authors: J
authors: Zhou
authors: Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Jihui
authors: J
authors: Zhang
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Yun
authors: Y
authors: Li
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Lina
authors: L
authors: Du
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Zhe
authors: Z
authors: Li
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Fei
authors: F
authors: Lei
authors: Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Yun-Kwok
authors: YK
authors: Wing
authors: Sleep Medicine Center, Stanford University, CA, USA.
authors: Clete A
authors: CA
authors: Kushida
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China.
authors: Dong
authors: D
authors: Zhou
authors: Sleep Medicine Center, Mental Health Center, Department of Neurology, Translational Center, West China Hospital, Sichuan University, Chengdu, China. Electronic address: 2372564613@qq.com.
authors: Xiangdong
authors: X
authors: Tang
mesh_terms: D000328:Adult; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D002681:China; D015331:Cohort Studies; D004325:Dreams; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents
keywords: EMG activity; Gender; Neurodegenerative disease; Polysomnography; Questionnaire; REM sleep behavior disorder