PTSD Among Men, People of Color Linked to REM Sleep Behavior Disorder Risk

Donald Bliwise, PhD

Rapid eye movement (REM) sleep behavior disorder (RBD) risk is closely associated with post-traumatic stress disorder (PTSD), according to a new study that also showed a greater likelihood of dream enactment among persons with PTSD.

In new data presented at the Associated Professional Sleep Societies (SLEEP) 2022 Annual Meeting this week, a team of US investigators observed gender- and race-specific correlations between PTSD and disturbed sleep habits among veterans receiving care. The trial, supported by the Wounded Warrior Project, could provide further insight into the comprehensive psychiatric and neurocognitive needs of persons suffering from trauma.

Donald Bliwise, PhD, a professor in the department of neurology at Emory University School of Medicine,and colleagues sought to examine the impact of demographics including race, gender and education on the link between primary PTSD diagnoses and probable RBD. Their population included “relatively younger, diverse, help-seeking, psychiatric outpatient” participants, in order to expand clinical understanding of the link between trauma and sleep from standard research.

“PTSD has been associated with polysomnography-derived measurements of REM without atonia suggestive of RBD,” investigators wrote. “Those findings have been reported in men in their mid-50’s.”

Bliwise and colleagues assessed 1658 patients who were veterans enrolled in a non-Veteran’s Affairs (VA) based treatment program; all patients received diagnostic interviews and psychometrics. Approximately half (48%) met the analysis criteria for having PTSD. Among them, mean age was 40.0 years old, more than two-thirds (n = 549) were men, and nearly half (n = 381) were non-White patients. Other prominent diagnoses among eligible patients included major depression and various anxiety disorders.

The team assessed dream enactment with the University of Michigan RBD Questionnaire (UMRBDQ), a 7-item either self- or bedpartner-administered that grades dream enactment behavior between 0.0 and 1.0 and provides a mean score for each patient.

Mean UMRBDQ scores among included patients was 0.52. The likelihood of RBD was defined by the 90th percentile of UMRBDQ scores, based on previously published psychometrics. Multiple logistic regression was used to define predictors of high versus low UMRBDQ scores. Predictors included diagnosis, self-reported gender, race, and education.

Patients with PTSD were 77% more likely to report a positive UMRBDQ score (odds ratio [OR], 1.77; 95% CI, 1.40 – 2.23) than those without. Significantly greater predictors of the association included patients being male (OR, 1.93; 95% CI, 1.45 – 2.58) and non-White (OR, 1.81; 95% CI, 1.03 – 1.65). College education was associated with a decreased likelihood of a positive UMRBDQ score among patients with PTSD (OR, 0.86; 95% CI, 0.68 – 1.09)

In a recent interview with HCPLive, Gina Poe, PhD, the Eleanor Leslie Chair for Innovative Brain Research at UCLA, explained the burden of poor sleep among patients with PTSD: it had been previously observed in research that patients with trauma suffer from over-activation of the locus coeruleus prior to the brain’s progression to the REM stage of sleep—similar to patients with anxiety-related insomnia. While people are supposed to have “entirely silent” locus coerulueus prior to REM sleep, patients with PTSD can fall asleep with rapid activity.

“What we think is that REM sleep becomes maladaptive, and instead of us helping us to break apart the emotionality from the facts of what we’ve learned, it in fact melds them together in an abnormal fashion so that whenever we’re remembering that traumatic event, instead of just having the knowledge of the memory…we still feel horrible,” Poe said. “People with PTSD are afraid to go to sleep for a good reason.”

Indeed, investigators concluded an observed correlation between PTSD in veterans and RBD risk.

“These results confirmed that PTSD may be associated with higher likelihood of reported dream enactment and that these results were not dependent on self-reported gender, race or education,” they wrote.

The study, “DSM-V Diagnosed Post-Traumatic Stress Disorder (PTSD) is Associated With Reported Dream Enactment Independently From Gender, Race or Education in a Psychiatric Outpatient Population,” was presented at SLEEP 2022.