Dados do Trabalho

Título

Trauma-associated sleep disorder: a new parasomnia characterized by REM without atonia

Introdução

A 51-year-old male patient, with no prior history of illnesses, presented with significant executive dysfunction following a series of traumatic events in his professional environment, including witnessing fatal assaults. Subsequently, he began exhibiting symptoms indicative of a severe depressive episode and abnormal sleep-related behaviors. These behaviors were characterized by combative actions during sleep (frequently attacking his wife), vivid dreams, vocalizations during sleep, and diffuse sweating. Medical and laboratory investigations revealed no findings that could explain his condition. After evaluation by the Sleep Medicine Unit, the patient underwent video-polysomnography, which revealed REM sleep without atonia and violent behaviors during sleep (punching, kicking, shouting). He began pharmacological treatment, and his symptoms have since remitted under the use of 10 mg melatonin and 2 mg clonazepam.

Objetivo

To discuss different phenotypes of clinical presentations of REM sleep behavior disorder.

Métodos

A literature review was conducted by searching the PubMed and Lilacs databases for articles published in the last 20 years.

Resultados

The literature review indicates that Trauma-Associated Sleep Disorder (TASD) has been recognized as a nosological entity in publications since the early 2000s, with diagnostic criteria proposed in 2024. For a diagnosis to be established, a clear temporal relationship between the stressful episode (trauma) and the onset of sleep-related symptoms, such as atypical vocalizations, motor alterations during sleep (combative behaviors), and associated autonomic symptoms like tachycardia, tachypnea or diaphoresis, is essential. It is known that repeated traumas cause an increase in norepinephrine turnover, leading to its depletion in the locus coeruleus (LC), which exerts an inhibitory effect on the lateral dorsal tegmentum (LDT). It is hypothesized that LC dysfunction may underlie both disorders.

Conclusões

This case report highlights the importance of expanding the diagnostic reasoning when faced with behavioral alterations during sleep that occur at an early age, without association with other symptoms, and that have an intrinsic temporal relationship with stressors such as trauma. The description of Trauma-Associated Sleep Disorder is relatively recent, and knowledge of this entity may lead to a more targeted therapeutic approach.

Palavras -chave

RBD; PTSD; Trauma-Associated Sleep Disorder.