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

Abstract

Summary There has been increasing concern about the long‐term impact of coronavirus disease 2019 (COVID‐19) as evidenced by anecdotal case reports of acute‐onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream‐enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α‐synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID‐19 diagnosis and symptoms. We assessed dream‐enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single‐Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream‐enactment behaviours was 19.4% and 3.1% and were found to be 1.8‐ and 2.9‐times higher in COVID‐19‐positive cases, respectively. Both lifetime and weekly dream‐enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID‐19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post‐traumatic stress disorder features. Among COVID‐19‐positive cases, weekly dream‐enactment behaviours were positively associated with the severity of COVID‐19. Dream‐enactment behaviours are common among the general population during the COVID‐19 pandemic and further increase among patients with COVID‐19. Further studies are needed to investigate the potential neurodegenerative effect of COVID‐19.

Association between hypersomnolence and the COVID-19 pandemic: The International COVID-19 Sleep Study (ICOSS)

“…EDS is highly prevalent in synucleionopathies suggesting that similar neural networks regulate sleepiness, dream-enacting, and olfactory function. On the other hand, in our previous study we found an association between COVID-19 infection and dream enactment behavior that may suggest the involvement of mental factors rather than central effects of COVID-19 infection [ 32 ].…”

Biomarkers of neurodegeneration in post-traumatic stress disorder: an integrative review

“…A polysomnographic study comparing patients with PTSD to those with idiopathic RSBD and healthy controls found a higher rate of REM sleep with atonia, as measured by electromyography, in those with PTSD [55]. A larger study based on self-report data, including over 20,000 adults in the context of the COVID-19 pandemic, found a significant positive association between self-reported PTSD symptoms and dream enactment behavior, which is a symptom of RSBD [56]. Key: ++, positive evidence from more than one study; +, positive evidence from a single study; ±, conflicting results; ?, positive results only in sub-group analyses, or results of uncertain significance.…”

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

“…Restricted mobility and irregularity of the sleep-wake cycle hours, along with overall psychological distress and worry about the future, have affected the amount and quality of sleep in the general population. Physical exercise is well supported by the literature as a nonpharmacological treatment method for sleep disorders; however, COVID-19 patients, either bedridden or simply quarantined, lack the required exercise to maintain healthy sleep [82], and even incidents of dream-enactment behaviors and other parasomnias have been reported and have been attributed to physical restriction during quarantine that may potentially alter their physical activity pattern [83]. Furthermore, they are at risk of developing circadian rhythm problems due to changes in daytime routine, possible daytime naps, and insufficient exposure to natural light [82].…”