Howl: Nightmare or REM Sleep Behavior Disorder?
Maria Jose Abenza-Abildúa, Vanesa Lores-Gutiérrez, Guadalupe Gutiérrez-Cueto, Eugenio Suárez-Gisbert, Carlos Pérez-López
Neurology. Clinical practice February 1, 2023 DOI: 10.1212/cpj.0000000000200093 (opens in new tab) via PubMed
Summary
AI-generated from the abstractA 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.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 41-year-old man referred for vivid and unpleasant dreams |
| Key finding | Polysomnography confirmed REM sleep behavior disorder in a patient with atypical symptom of prolonged howling, emphasizing the need for polysomnography to diagnose and rule out other parasomnias. |
Abstract
Nightmare disorder consists of the appearance of unpleasant and vivid, repeated dreams, with a situation of discomfort and anguish on awakening. Its prevalence is 3%-4% in adults. They do not associate muscle mobilization during this phase. REM sleep behavior disorder (RSBD) is a rare parasomnia (0.5% of people older than 60 years of age), characterized by the presence of unpleasant dreams, with violent content, and vigorous movements of limbs (kicks and punches), reflecting a loss of muscle atony typical of the REM phase of sleep. Language (screams and words) can also be emitted. The same clinical manifestations of RSBD can appear in other sleep disorders. The diagnosis requires the performance of a polysomnography. We present the case of a 41-year-old man referred for vivid and unpleasant dreams, beginning in the last year, related to work stress. The polysomnography showed the loss of atony in the REM phase and emission of a prolonged howl after which the patient continues in the REM phase. Prolonged howling is a very rare symptom in sleep disorders, and very atypical in RSBD, so polysomnography is essential to confirm the diagnosis and rule out other parasomnias.