Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study

How COVID-19 Affected Sleep Talking Episodes, Sleep and Dreams?

BACKGROUND

The COVID-19 pandemic increased symptoms of stress and anxiety and induced changes in sleep quality, dream activity, and parasomnia episodes. It has been shown that stressful factors and/or bad sleep habits can affect parasomnia behaviors. However, investigations on how COVID-19 has affected sleep, dreams, and episode frequency in parasomnias are rare. The current study focuses on the impact of the pandemic on a specific parasomnia characterized by speech production (sleep talking, ST).

METHODS

We selected 27 participants with frequent ST episodes (STs) during the pandemic and compared them with 27 participants with frequent STs from a previous study conducted during a pre-pandemic period. All participants performed home monitoring through sleep logs and recorded their nocturnal STs for one week.

RESULTS

We observed a higher frequency of STs in the pandemic group. Moreover, STs were related to the emotional intensity of dreams, independent of the pandemic condition. The pandemic was associated with lower bizarreness of dreams in the pandemic group. There were no differences in sleep variables between the two groups.

CONCLUSION

Overall, these results suggest a stressful effect of COVID-19 on the frequency of STs. Both the pandemic and the frequency of STs affect qualitative characteristics of dreams in this population.

Secondary RBD: Not just neurodegeneration

Rapid eye movement sleep behavior disorder is a parasomnia characterized by excessive muscle activity during rapid eye movement sleep (rapid eye movement sleep without atonia), along with dream enactment behavior. Isolated rapid eye movement sleep behavior disorder tends to occur in older males and is of concern due to the known link to Parkinson's disease and other synucleinopathies. When rapid eye movement sleep behavior disorder occurs in association with other neurological or general medical conditions, or resulting from the use of various substances, it is called secondary rapid eye movement sleep behavior disorder; the most common cause is neurodegenerative illness, specifically the synucleinopathies. Here, the focus will be on the subset of secondary rapid eye movement sleep behavior disorder in which there is no neurodegenerative disease.

Parasomnias During the COVID-19 Pandemic

COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.

Sleep disorders after COVID-19 in Czech population: Post-lockdown national online survey

Objective

This study aimed to determine the frequency, type, and correlates of a broad spectrum of sleep disorders in adults with COVID-19 up to 32 months after infection.

Methods

We conducted a national online survey (Jun 2021-Dec 2022), gathering information on COVID-19 diagnosis, acute disease course, and the subsequent development of sleep disorders from 1507 respondents (mean age 44.5 ± 13.1 years, 64.1% women).

Results

81.3% (1223) reported at least one sleep difficulty that either worsened or first appeared with COVID-19. Females reported a higher number of symptoms (2.03 ± 1.44 versus 1.72 ± 1.43 in men, p < 0.0001). Most common were insomnia symptoms (59.4%), followed by night sweats (38.4%), hypersomnolence (33.3%), vivid dreams or nightmares (26.4%), restless leg syndrome (RLS) (22.8%), and sleep-related breathing disorders (11.1%). All symptoms were associated with a more severe acute disease. A mild decreasing trend in the persistence of sleep symptoms with a longer latency since infection was observed, with 66.7% reporting at least half of their symptoms present at 3-5 months after acute infection, compared to 64.9% at 6-8 months, and 62.4% at 9-11 months (p = 0.0427). However, among those after 12 or more months, over half of the symptoms persisted in 69.5%. The frequency of vivid dreams and nightmares increased in association with COVID-19 in 32.9% (p < 0.001). 9.4% (141) reported new-onset or increased parasomnic manifestations after the infection.

Conclusions

Our research shows that sleep disturbances are a common and persistent manifestation of COVID-19 that affects a large proportion of the population and deserves careful monitoring.

The risk factors for probable REM sleep behavior disorder: A case-control study

OBJECTIVE

To investigate the risk factors for REM sleep behavior disorder (RBD) in a case-control study.

METHODS

Participants with probable RBD (pRBD) were defined using the RBD Questionnaire-Hong Kong (RBDQ-HK). Controls were collected by matching age and sex. Demographic information, lifestyle, comorbidity, prodromal symptoms of Parkinson's disease (PD), and blood biomarkers were assessed. The associations between these factors and pRBD were investigated by logistic regression. Partial correlation analysis was used to assess the association between the severity of RBD and depression.

RESULTS

A total of 278 pRBD participants (age = 58.31 ± 15.82 years) and 556 controls (age = 58.16 ± 15.84 years) were enrolled in this study. Patients with pRBD were more likely to be current alcohol drinkers (OR 1.50, 95% CI 1.0-2.32). Participants with pRBD had a higher Hamilton Depression Rating Scale (HAMD-17) score (OR 1.17, 95% CI 1.11-1.22) than controls and were more likely to report arthritis (OR 1.53, 95% CI 1.08-2.16), constipation (OR 1.93, 95% CI 1.31-2.86), hyposmia (OR 1.71, 95% CI 1.10-2.67), and depression (OR 3.15, 95% CI 2.17-4.58). Higher levels of total cholesterol (OR 1.15, 95% CI 0.99-1.33) and low-density lipoprotein (OR 1.21, 95% CI 0.99-1.47) had borderline associations with pRBD. Additionally, the severity of pRBD was positively related to depression (r = 0.31, P < 0.01).

CONCLUSIONS

We determined several risk factors for pRBD in this case-control study. Future studies are needed to understand the mechanism underlying the association between these factors and pRBD.

Neuropsychiatric Outcomes and Sleep Dysfunction in COVID-19 Patients: Risk Factors and Mechanisms

The ongoing global health crisis due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of life. While the majority of early research following the coronavirus disease caused by SARS-CoV-2 (COVID-19) has focused on the physiological effects of the virus, a substantial body of subsequent studies has shown that the psychological burden of the infection is also considerable. Patients, even without mental illness history, were at increased susceptibility to developing mental health and sleep disturbances during or after the COVID-19 infection. Viral neurotropism and inflammatory storm damaging the blood-brain barrier have been proposed as possible mechanisms for mental health manifestations, along with stressful psychological factors and indirect consequences such as thrombosis and hypoxia. The virus has been found to infect peripheral olfactory neurons and exploit axonal migration pathways, exhibiting metabolic changes in astrocytes that are detrimental to fueling neurons and building neurotransmitters. Patients with COVID-19 present dysregulated and overactive immune responses, resulting in impaired neuronal function and viability, adversely affecting sleep and emotion regulation. Additionally, several risk factors have been associated with the neuropsychiatric sequelae of the infection, such as female sex, age, preexisting neuropathologies, severity of initial disease and sociological status. This review aimed to provide an overview of mental health symptoms and sleep disturbances developed during COVID-19 and to analyze the underlying mechanisms and risk factors of psychological distress and sleep dysfunction.

Sleep Disorders in Patients with Neurologic Disease

OBJECTIVE

This article provides an overview of the growing body of evidence showing bidirectional relationships between sleep and various neurologic disorders.

LATEST DEVELOPMENTS

Mounting evidence demonstrates that disrupted sleep can negatively impact various neurologic disease processes, including stroke, multiple sclerosis, epilepsy, neuromuscular disorders including amyotrophic lateral sclerosis, and headache syndromes. Abnormal sleep can also be a precursor to Alzheimer disease and neurodegenerative disease states such as Parkinson disease and dementia with Lewy bodies. Interventions to improve sleep and treat obstructive sleep apnea may play a vital role in preventing neurologic disease development and progression.

ESSENTIAL POINTS

Sleep disorders are common among patients with neurologic disorders. To provide comprehensive care to patients with neurologic conditions, neurologists must ask patients about sleep issues that may warrant further diagnostic testing, treatment, and sleep medicine referral when indicated.

Biomarkers of Neurodegeneration in Post-Traumatic Stress Disorder: An Integrative Review

Post-Traumatic Stress Disorder (PTSD) is a chronic psychiatric disorder that occurs following exposure to traumatic events. Recent evidence suggests that PTSD may be a risk factor for the development of subsequent neurodegenerative disorders, including Alzheimer's dementia and Parkinson's disease. Identification of biomarkers known to be associated with neurodegeneration in patients with PTSD would shed light on the pathophysiological mechanisms linking these disorders and would also help in the development of preventive strategies for neurodegenerative disorders in PTSD. With this background, the PubMed and Scopus databases were searched for studies designed to identify biomarkers that could be associated with an increased risk of neurodegenerative disorders in patients with PTSD. Out of a total of 342 citations retrieved, 29 studies were identified for inclusion in the review. The results of these studies suggest that biomarkers such as cerebral cortical thinning, disrupted white matter integrity, specific genetic polymorphisms, immune-inflammatory alterations, vitamin D deficiency, metabolic syndrome, and objectively documented parasomnias are significantly associated with PTSD and may predict an increased risk of subsequent neurodegenerative disorders. The biological mechanisms underlying these changes, and the interactions between them, are also explored. Though requiring replication, these findings highlight a number of biological pathways that plausibly link PTSD with neurodegenerative disorders and suggest potentially valuable avenues for prevention and early intervention.

Sleep During the COVID-19 Pandemic

PURPOSE OF REVIEW

We reviewed current evidence on the impact of coronavirus disease 2019 (COVID-19) pandemic on sleep of different populations.

RECENT FINDINGS

Several studies demonstrated that sleep deprivation may cause immune system dysregulation, which deteriorates the course of COVID-19. The increased prevalence of sleep disorders among COVID-19 patients has been associated with more severe disease and worse clinical outcomes. Healthcare workers who were subjected to atypical workload and more nightshifts developed sleep disorders which associated with work-related errors and COVID-19 infection susceptibility. In general population, circadian misalignment and excessive stressors impaired sleep quality. Sleep dysfunction has been recorded due to the pandemic. It is essential to implement interventions in order to alleviate pandemic-related sleep disorders. Telemedicine, cognitive behavioral therapy, and sleep hygiene practices appear to be helpful. Psychotropic medication should be cautiously administered, while other pharmacological agents, such as melatonin, have shown promising results.