Antidepressant medications have differential effects on REM sleep without atonia quantified by chin and upper...

To determine associations between video polysomnography (vPSG)-quantified REM sleep without atonia (RSWA) and antidepressants (ADs) including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and tricyclic antidepressants (TCAs).

We analyzed 1474 vPSGs scored for possible REM sleep behavior disorder (RBD). RSWA scoring was based on submentalis and flexor digitorum superficialis (FDS) EMG using AASM criteria. Percent REM epochs meeting RSWA criteria (RSWA%) were compared by medication class in monotherapy or combination therapies using linear regression analysis, and adjusting for age, body mass index, gender, and race.

The sample included 1474 patients, 624 (42.3%) taking ADs and 850 (57.7%) non-users. Mean age was 53 ± 16.4 years, 53.1% male, and 73.1% White. Overall RSWA% was 11.9 ± 17.8. Compared to those medication-free, patients on SSRI or SNRI monotherapy had a 3.39% and 6.66% increase in RSWA%, respectively (p < 0.009 and p < 0.001); those on both SSRI and SNRI had a 10.44% increase (p = 0.089). In contrast, RSWA% did not increase in patients taking TCA monotherapy or the combination of SSRI + TCA or SNRI + TCA.

Use of SSRIs and SNRIs, but not TCAs, is associated with increased RSWA% in a population with suspected parasomnia. The highest RSWA% estimates among combination groups were observed with SSRI + SNRI, although combination subgroup findings should be interpreted cautiously given small sample sizes. This study is the largest to quantify RSWA% and identify the differential impact of AD class, and monotherapy versus combination therapy on RSWA%. These findings should be interpreted within the context of the clinical criteria used for RSWA scoring.