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DOI: 10.1055/s-0045-1811804
REM Sleep Behavior Disorder in a Young Patient: Implications for Evolution and Treatment
Authors
Introduction: REM Sleep Behavior Disorder (RBD) is a parasomnia with loss of muscle atonia during REM sleep, leading to dream enactment behaviors like sleep-related vocalizations and complex motor activities. IIt affects 0.5 to 1.5% of the population. In adults under 40, RBD is linked to antidepressant use or narcolepsy. The symptoms of RBD typically begin in late adulthood, with the average age of diagnosis being between 60 and 70 years. RBD is an important predictor of neurodegenerative diseases, such as Parkinson's disease.
Objective: To report a case of RBD in a 40-year-old patient and discuss the challenges associated with the diagnosis and treatment of the condition.
Methods: This cross-sectional case report uses 2024 data from a patient's medical records, who was followed up in a private medical service.
Results: A 40-year-old male patient presented to the medical service complaining of “night terrors.” He reported experiencing abnormal movements during sleep for the past ten years, occurring 6 to 10 times per month. The patient had been using paroxetine continuously for many years and mirtazapine for the last six months to treat significant anxiety. A polysomnography demonstrated disturbed sleep with micro-awakenings, mild sleep apnea, and two episodes of RBD. A transcranial ultrasound revealed a 21 mm2 hyperechogenicity in the left substantia nigra. With the diagnosis of RBD secondary to the use of antidepressants, melatonin 10 mg was prescribed at night, and the antidepressants were replaced with trazodone 100 mg. Upon follow-up after two months, the patient reported a decrease in the intensity of motor behaviors during sleep. Regarding the diagnosis of RBD, its occurrence in young adults is frequently associated with the use of antidepressant medications, as in this case, or with narcolepsy. It is also known that RBD in young patients seems less associated with neurodegenerative diseases, with a similar incidence in both sexes.
Conclusion: In conclusion, although rare in young adults and challenging to diagnose, RBD should be considered, especially in the context of sleep-related motor behaviors associated with dreams. Early detection allows for guidance on the patient's physical protection and serves as a natural model for extrapyramidal diseases, promoting research into neuroprotective interventions. This patient's evolution has to be followed closely to better understand the brain ultrasound results.
No conflict of interest has been declared by the author(s).
Publication History
Article published online:
16 September 2025
© 2025. Brazilian Sleep Academy. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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