Howl: Nightmare or REM Sleep Behavior Disorder?
Neurology. Clinical practice February 1, 2023 Maria Jose Abenza-Abildúa, Vanesa Lores-Gutiérrez, Guadalupe Gutiérrez-Cueto et al.
A 41-year-old man with vivid, unpleasant dreams linked to work stress underwent polysomnography, which revealed loss of muscle atony during REM sleep and a prolonged howl, leading to a diagnosis of REM sleep behavior disorder (RSBD). Prolonged howling is a very rare and atypical symptom in RSBD, so polysomnography is essential to confirm the diagnosis and rule out other parasomnias. The case highlights the importance of objective sleep testing in atypical presentations. Nightmare disorder and RSBD are distinct parasomnias with different prevalence rates and clinical features.