Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy.
Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
Sleep Med. 2022 Apr;92:19-23. doi: 10.1016/j.sleep.2022.02.022. Epub 2022 Mar 5.
Although aggressive dream content is considered a distinctive feature of REM Sleep Behavior Disorder (RBD) and patients often report violent dreams during medical interviews, nonviolent behaviors (eating, drinking, urinating) and pleasant actions (e.g laughing, singing, dancing) or simply elemental, jerky limb movements are frequently observed during video-polysomnography. As a first-line pharmacological treatment, clonazepam has been shown to reduce motor symptoms during REM sleep, but its effect on dream content remains unclear. Here, we aimed to prospectively assess the dream content of individuals with drug-naïve isolated RBD (iRBD) and iRBD patients treated with clonazepam.
Thirteen (12 Male, 1 Female; age 65.38 ± 10.95) iRBD patients treated with clonazepam (iRBD-T), eleven (9 M, 2 F; age 68.90 ± 6.8) drug-naïve patients (iRBD-NT) and twelve (8 M, 1 F; age 63.33 ± 12.88) healthy control subjects of comparable age kept a dream diary over a 3-week period. Dream content analysis was conducted according to the Hall and Van de Castle method (HVdC). The Threat Simulation Scale (TSS) was employed to assess the frequency of threatening contents.
A total of 214 dream reports were collected. No significant differences were found in the frequency of threatening dream contents between the iRBD subsamples and healthy control subjects (p = 0.732). The HVdC analysis detected higher levels of Friendliness in iRBD patients compared to the control group (p = 0.036). Increased levels of Aggressiveness were only observed when differentiating dreams in which dream enactment behaviors (DEB) were present compared to dreams without DEBs, both in the iRBD-T group (p = 0.007) and the iRBD-NT group (p = 0.012).
Our study shows no difference in the frequency of violent or threatening dreams in drug-naïve iRBD patients, clonazepam-treated iRBD patients and healthy control individuals. Aggressiveness is more frequent when DEBs are reported, suggesting motor disinhibition could require sufficiently dramatic and emotionally intense dreams, independent of clonazepam treatment.
尽管剧烈的梦境内容被认为是 REM 睡眠行为障碍（RBD）的一个显著特征，并且患者在接受医学访谈时经常报告暴力梦境，但在视频多导睡眠图检查中，经常观察到非暴力行为（如进食、饮水、排尿）和愉快的动作（如大笑、唱歌、跳舞）或仅仅是元素性的、急促的肢体运动。氯硝西泮作为一线药物治疗，已被证明可减少 REM 睡眠中的运动症状，但对梦境内容的影响尚不清楚。在这里，我们旨在前瞻性评估未经药物治疗的孤立性 RBD（iRBD）个体和接受氯硝西泮治疗的 iRBD 患者的梦境内容。
13 名（12 名男性，1 名女性；年龄 65.38 ± 10.95）接受氯硝西泮治疗的 iRBD 患者（iRBD-T）、11 名（9 名男性，2 名女性；年龄 68.90 ± 6.8）未经药物治疗的患者（iRBD-NT）和 12 名（8 名男性，1 名女性；年龄 63.33 ± 12.88）年龄相当的健康对照者在 3 周的时间内记录了梦境日记。根据霍尔和范德卡斯尔方法（HVdC）进行梦境内容分析。采用威胁模拟量表（TSS）评估威胁内容的频率。
共收集了 214 份梦境报告。iRBD 亚组与健康对照组之间威胁性梦境内容的频率无显著差异（p = 0.732）。与对照组相比，iRBD 患者的 HVdC 分析显示出更高水平的友好度（p = 0.036）。仅在区分存在梦境行为（DEB）的梦境与不存在 DEB 的梦境时，iRBD-T 组（p = 0.007）和 iRBD-NT 组（p = 0.012）中观察到攻击性水平升高。
我们的研究表明，未经药物治疗的 iRBD 患者、接受氯硝西泮治疗的 iRBD 患者和健康对照个体之间，暴力或威胁性梦境的频率无差异。当报告 DEB 时，攻击性更为频繁，这表明运动抑制可能需要足够剧烈和情绪强烈的梦境，而与氯硝西泮治疗无关。
