Abnormal REM Sleep Atonia Control in Patients With Chronic Post-Traumatic Stress Disorder
John Feemster1, Tyler Steele1, Kyle Palermo1, Yumeng Tao1, David Bauer1, Sonia Rivera1, Maxwell Walters-Smith1, Thomas Gossard1, Luke Teigen1, Paul Timm1, Stuart McCarter1, Erik St. Louis1
1Mayo Clinic Center for Sleep Medicine
We aimed to comparatively analyze REM sleep without atonia levels between patients with chronic Post-traumatic stress disorder (PTSD) with and without REM Sleep Behavior Disorder (RBD), idiopathic RBD (iRBD), and controls.
PTSD is characterized by persistent mental and emotional stress following physically or psychologically traumatic events. Vivid recall of events, including traumatic nightmares, and prominent sleep disturbances are frequent in PTSD. Previous studies suggest military combat associated PTSD and psychiatric illness may share clinical features, such as altered REM sleep without atonia (RSWA), with idiopathic REM sleep behavior disorder (iRBD). 
We selected 18 PTSD, 18 PTSD+RBD, 15 iRBD, and 51 healthy control patients matched for age and sex from the Mayo Clinic Center for Sleep Medicine’s polysomnography database for RSWA quantification. RSWA amounts in the submentalis (SM) and anterior tibialis (AT) were quantitatively analyzed in accordance with previously published methods. Non-parametric analyses were performed to compare RSWA, patient demographics, and PSG data.

Patients with PTSD had significantly higher RSWA than controls in all RSWA density measures (p < 0.016 for all). All measures of RSWA, excluding average SM duration, were significantly higher in PTSD+RBD patients compared with controls (p < 0.016 for all). PTSD+RBD patients had significantly higher SM Phasic, AT Any, SM+AT Any, and Tonic RSWA measures than PTSD patients (p <0.016 for all).


PTSD patients have significantly higher RSWA than controls, with PTSD+RBD patients having higher RSWA levels than PTSD patients. These data provide the first evidence for abnormal RSWA control in patients with chronic PTSD. This provides evidence for a unique biology in PTSD that could imply a future risk for neurodegenerative disease in PTSD similar to RBD patients. Further prospective studies will need to be performed on patients with PTSD to further understand this risk.