Factors associated with disruptive behavioral symptoms in idiopathic rapid eye movement sleep behavior disorder

Abstract

Background and Objective Little is known about the factors associated with disruptive behaviors in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). Thus, we report the demographic and clinical characteristics of iRBD patients with disruptive behaviors. Methods Patients diagnosed as having iRBD through video-polysomnography were included in the present study. The REM sleep behavior disorder questionnaire-Hong Kong (RBDQ-HK) was used to divide participants into two groups according to the presence or absence of disruptive behaviors. Neuropsychological tests as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI) were also conducted. Results Of 188 iRBD patients, 160 patients showed more disruptive behaviors and were of a younger age (66.8 ± 7.4 vs. 70.5 ± 6.0, p = 0.012), of a higher proportion of men (69.4% vs. 39.3%, p = 0.004), and showed lower Apnea-Hypopnea Indexes (AHI) (9.2 ± 0.9 vs. 17.8 ± 2.2, p < 0.001) than those without disruptive behavioral symptoms. No statistically significant differences in PSQI, ESS, BDI, or neuropsychological testing were found. In multiple logistic regression analysis, age ≥ 70 [odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.15-0.87, p = 0.023], male sex (OR = 2.80, 95% CI = 1.14-6.91, p = 0.025), and score of item 4 (violent or aggressive dreams) of RBDQ-HK (OR = 1.57, 95% CI = 1.17-2.12, p = 0.003) all showed a significant association with disruptive behaviors. Conclusions Age < 70, male sex, lower AHI, and frequent violent or aggressive dreams are associated with an increased risk of disruptive behavioral symptoms in iRBD. Therapeutic plans including clonazepam medication should be individualized considering patients' demographic and clinical features.