![]() Moreover, we did not notice significant movements during REM sleep from the video of the evaluation night. ![]() However, the patient did not complain of any abnormal behaviors during nocturnal sleep except for more vivid dreams. During the 264 30-s epochs (132 min) of REM, we found that 29.5% of REM sleep had increased chin EMG activity with a 6.8% increase for tonic activity and a 22.7% for phasic activity (Fig. Tonic and phasic electromyography (EMG) activity were scored manually according to the criteria of the 2007 American Academy of Sleep Medicine (AASM) manual. The examination showed that she had a total sleep time (TST) of 7.2 h with apnea-hypopnea index (AHI) of 6.7 /h (AHI is a parameter used to classify the severity of sleep apnea, the cut-off point for mild, moderate and severe sleep apnea is 5 /h, 15 /h and 30 /h). For this reason, she sought help from our sleep medicine center and an overnight polysomnography (PSG) study was arranged. Although the somatic symptoms and related mood disorders improved, she also complained about frequent awakening during night and was unsatisfied with her sleep quality. She was diagnosed with somatoform disorder and treated with duloxetine, 60 mg per day, for 7 months. The current case appears to be the first observation of duloxetine-induced RBD.Ī 62-year old woman presented at the psychiatry clinic with dizziness, back pain, gastrointestinal discomfort and anxiety. They found that patients taking SNRIs had elevated RSWA, unfortunately, the association between duloxetine and RSWA was not reported in this work. analyzed RSWA in adults receiving antidepressants, with and without RBD. However, there is little information on the potential association between SNRI use and RBD or RSWA. In addition to TCAs and SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRI) such as venlafaxine and duloxetine are used clinically as antidepressants. Another large-scale study reported that 12.2% of patients taking antidepressants had REM sleep without atonia (RSWA) but only 0.48% of the patients had RBD. Among patients taking SSRIs, the prevalence of RBD-like disorder was 5%. In a group of 1235 outpatient psychiatric patients, the lifetime prevalence for RBD-like disorder was 5.8%. The prevalence of antidepressant-induced RBD varies across studies. It has been widely known that some antidepressants such as tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI) can induce RBD. Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by the loss of normal skeletal muscle atonia during REM sleep and the emergence of purposeful complex motor activity associated with vivid dreams.
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