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Nightmare disorder and REM sleep behavior disorder in inflammatory arthritis: Possibility beyond neurodegeneration.

Luca Baldelli, Olga Addimanda, Marco Burattini, Giacomo Chiaro, Veronica Brusi, Elettra Pignotti, Riccardo Meliconi, Federica Provini

Brain and Behavior March 2019 DOI: 10.1002/brb3.1230 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Observational cross-sectional study Peer reviewed
Sample size 103
Population Patients with a confirmed diagnosis of inflammatory arthritis
Measures Pittsburgh Sleep Quality Index, Berlin questionnaire, Beck Depression Inventory II, State-Trait Anxiety Inventory
Topics Dreaming
Keywords Inflammatory arthritis Neurodegeneration Nightmares Prevalence Rbd Sleep
Key findings RBD prevalence in inflammatory arthritis patients did not differ from the general population, while nightmare disorder was about twice as prevalent (31 of 103 patients). The authors propose nightmare disorder may be a new factor in the relation between sleep and inflammation, and state that whether RBD can be considered a red flag for internal danger remains an open question.

Abstract

To investigate the prevalence of REM sleep behavior disorder (RBD) in patients with inflammatory arthritis (IA) to ascertain if RBD could be an internal red flag signaling a fluctuating state of inflammation based on the theory of "protoconsciousness". One hundred and three patients with a confirmed diagnosis of IA were consecutively recruited. The patients underwent general (IA activity, functional status, laboratory tests) and neurological evaluations. A neurologist investigated RBD and REM sleep parasomnias in a semi-structured interview. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while the risk of obstructive sleep apnea syndrome (OSAS) was evaluated with the Berlin questionnaire. Beck Depression Inventory II and State-Trait Anxiety Inventory investigated depression and anxiety. Patients had a mean age of 53.7 ± 14.6 years, 65% were women; 57.3% were in a clinically active phase of IA. Two women fulfilled ICSD-3 criteria for RBD appearing 11 years after and 20 years before IA onset respectively. 31 patients scored positive for nightmare disorder (ND), 8 for recurrent isolated sleep paralysis. 65 (63.1%) patients reported poor sleep quality and 25 (24.3%) resulted at high risk for OSAS. 32 (31.0%) patients scored positively for depression or anxiety. The prevalence of RBD in patients with IA did not differ from that in the general population, whereas ND presented a 2-fold increased prevalence. Whether RBD can be considered a red flag signaling an internal danger remains an open question, while ND may be a new player in this intriguing relation.

Comparable studies

Other cross-sectional and survey studies on dreaming, most cited first.

Study Year Design Participants
Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Undergraduate students at a large, public university in the southeastern United States 2011 Observational cross-sectional survey n = 583
Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Middle-aged Hong Kong Chinese adults from the community, mean age 40.9 years (SD 5.5,... 2010 Cross-sectional survey with subsequent clinical evaluation (two-phase design) n = 8,558
Factors of home dream recall: a structural equation model Adults (general population sample) 2003 Cross-sectional survey with structural equation modeling n = 444
The Phenomenology of Lucid Dreaming: An Online Survey Respondents to an online survey about lucid dreams 2014 Online survey n = 684
Frequency of Lucid Dreaming in a Representative German Sample Representative sample of German adults 2011 Cross-sectional survey n = 919

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