Sleep-related violence, injury, and REM sleep behavior disorder in Parkinson's disease

Objective: To determine the occurrence of REM sleep behavior disorder (RE and sleep-related injury (SRI) in an outpatient PD practice. Background: RED is a frequent cause of SRI in older individuals. Although RED is seen in PD, the association of SRI and RED in PD has not been previously assessed. Design/Methods: Consecutive patients with PD and their caregivers were interviewed using a structured questionnaire assessing the presence of RED and SRI. Patients fulfilling the International Classification of Sleep Disorders (ICSD) criteria for RED were compared with non-RED patients. In a separate analysis, patients with a prior SRI were compared to those without. Results: Of the 61 patient/caregiver pairs, 15% (7 men and 2 women) met the clinical criteria for RED. There were more episodes of SRI in the RED group, with 33% causing injury to themselves or to their caregivers compared with 6% of the non-RED group (chi(2) = 13, p = 0.005). In the second analysis, 15% tall men) patient/caregiver pairs reported SRI. Of these, 66% of the patients had behaviors resembling those seen in RED, and 33% had recalled dream content. There isa significant association between SRI and RED for dream-enacting sleep behaviors (Fisher's exact test, p = 0.0001). Conclusion; PD patients with SRI frequently have behavioral features of RED. If RED underlies most SRI, treatment with appropriate pharmacologic agents, such as clonazepam, may prevent future occurrences of SRI.