1517 Severe REM Behavior Disorder in a Truck Driver Resolved with OSA Treatment

Daniel Rongo; Likhita Shaik; Janey Dudley; Abha Patel

doi:10.1093/sleep/zsaf090.1517

Introduction REM sleep behavior disorder (RBD) is characterized by dream enactment behaviors, which can be dangerous in occupational settings. Obstructive sleep apnea (OSA) has been associated with parasomnia presentations and can exacerbate sleep fragmentation and REM dysregulation. This case explores the interplay of RBD and OSA in a 50-year-old truck driver, emphasizing the life-altering outcomes of OSA treatment. Report of case A 54-year-old obese male (BMI: 39 kg/m²) with restless leg syndrome and OSA with a career as a long-distance truck driver presented with frequent episodes of acting out his dreams during sleep. His typical sleep routine involved bunking in the back of his truck at highway rest stops. Twice he woke up in his truck disoriented. He also found himself waking up eating, but he had no recollection of how he got the food. Polysomnography confirmed severe OSA with an apnea hypopnea index (AHI) of 84.9 events/hour. Symptoms met diagnostic criteria for RBD based on clinical history and PSG findings. Despite reluctance to start positive airway pressure (PAP) therapy, counseling directed towards the possibility of improving RBD-like behavior helped him gain the commitment for treatment. He was initiated on Auto-Bilevel PAP therapy at Max IPAP 20 Min EPAP 4 pressure settings resolved the patient’s apneas. At a 3-month follow-up, the patient reported complete resolution of dream enactment behaviors with excellent BiPAP compliance. Conclusion REM Sleep Behavior Disorder (RBD) involves the loss of normal muscle atonia during REM sleep, resulting in behaviors ranging from yelling and kicking to highly complex actions. While some cases are idiopathic, various conditions can disrupt REM sleep regulation and contribute to its development. This case highlights the need for comprehensive sleep evaluations in parasomnia presentations, especially in high-risk occupations, to identify and address underlying conditions like OSA and potentially reduce the need for adjunctive pharmacologic therapies. Despite his severity of RBD, addressing underlying OSA as a primary therapy is a worthwhile approach. In this case, PAP therapy alone led to complete resolution of the patient’s symptoms, highlighting its significance as a first-line treatment in certain clinical scenarios.

1517 Severe REM Behavior Disorder in a Truck Driver Resolved with OSA Treatment

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