Objective: Explore differences in dream quality between REM Sleep Behavior Disorder (RBD) and Trauma Associated Sleep Disorder (TASD).

Background: Idiopathic RBD is known to progress to a synucleinopathy in 70-90% of patients and can serve as an early indicator of incipient neurodegeneration. TASD is a sleep disorder which occurs in individuals with a history of trauma and presents with clinical (dream enactment behavior) and polysomnographic (REM sleep without atonia) features identical to those in RBD. There is no validated criterion that distinguishes the two disorders, which can impact the utility of midlife-onset RBD as an early diagnostic marker for synucleinopathies.

Method: Four participants with TASD and 7 with RBD completed clinical surveys (regarding nightmares, RBD, sleep, and mood), dream interviews, and physical exam. Participants also recorded dream journals for one week. Dream content was assessed by the Trauma Related Nightmare Scale (participant self-report), and the Orlinski and Dream Threat Scales (researcher-scored [CD]).

Results: The RBD group was older (69.0 vs 55.8), with older age at sleep symptom onset (59.57 vs 29), with a higher percentage of males (86% vs 50%), and lower rates of mood disorder history (43% vs 75%) and treatment with antidepressants (29% vs 75%), than the TASD group. The RBD group reported: 1) less subjective autonomic hyperarousal following dreams, including: accelerated heart rate (29% vs 75%), shortness of breath (0% vs 75%) and sweating (0% vs 25%); 2) less aggression (journals [14% vs 33%] and interviews [43% vs 100%]); 3) less dream association with themes of powerlessness (.85 vs 3.67) and safety (1.14 vs 3.33); 4) more presence of threat (20% vs 14%).

Conclusion: Dream qualitative characteristics may help distinguish RBD and TASD, including subjective autonomic hyperarousal and themes of powerlessness and safety in dreams. These findings will be confirmed in a larger sample of individuals with RBD and TASD, including those with biomarker-confirmed synucleinopathy and/or dopaminergic deficit. The relationship between trauma history, dream content, and synucleinopathy risk must be understood to improve screening, early identification, and potential initiation of disease-modifying therapies for this category of neurodegenerative disease.

References: Postuma RB, Iranzo A, Hu M, et al. Risk and predictors of dementia and parkinsonism in idiopathic REM sleep behaviour disorder: a multicentre study. Brain 2019;142(3):744-759. DOI: 10.1093/brain/awz030.
Mysliwiec V, O’Reilly B, Polchinski J, Kwon HP, Germain A, Roth BJ. Trauma associated sleep disorder: a proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares, and REM without atonia in trauma survivors. J Clin Sleep Med 2014;10(10):1143-8. DOI: 10.5664/jcsm.4120.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/what-moves-in-the-night-differences-in-dream-quality-between-rem-sleep-behavior-disorder-and-trauma-associated-sleep-disorder/