0686 Systemic Evaluation of REM Without Atonia Associated with Psychotropic Medications

Abstract Introduction Selective serotonin reuptake inhibitors (SSRIs), Serotonin and norepinephrine reuptake inhibitors (SNRIs), and Tricyclic antidepressants (TCAs) alter REM sleep motor characteristics and have been associated with REM sleep behavior disorder (RBD). We leveraged a large cohort of polysomnograms (PSGs) to analyze the relationship of SSRI, SNRI, and TCA use on REM without atonia (RWA). Methods We analyzed 1075 PSGs from the Cleveland Clinic Starlit Registry with 10% total sleep time in REM sleep systematically scored for RWA using AASM 2.6 criteria. Percent of REM epochs meeting RWA criteria in PSGs without medication use were compared with the following medication groups: SSRI (N=303), SNRI (N=142), TCA (N=49), and combinations SSRI+SNRI (N=8), SSRI+TCA(N=11) and SNRI+TCA (N=7). We performed a linear regression analysis using the Ordinary Least Squares (OLS) method from the SciPy library (v1.11.1) to measure the association of RWA epochs by medication group adjusting for age, body mass index (BMI), and gender. Results Our sample included 48.2% females with a mean age of 52.7 (SD:16.7) and a mean BMI of 32.6 (8.6). The overall mean percentage of RWA epochs was 11.7 (SD:17.5), with a median, 25% and 75% of 4.1, 0.5, and 14.8, respectively. SSRI and SNRI use was associated with a 4.7% and 7.0% increase in RWA (p= 0.001), respectively, while a 13.6% increase was observed in the SSRI+SNRI group (p= 0.02). Although the TCA and TCA+SSRI groups were associated with only 1.8% and 5.4% increases, they were not significant (p=0.48 and 0.29). The TCA + SNRI group was associated with an increase of 18% (p= 0.001). Conclusion Use of SSRIs and SNRIs alone or in combination, and TCAs combined with SNRI increase the percentage of REM epochs meeting criteria for RWA. Although TCAs alone and combined with SNRIs were not associated with significant increases, this may be due to small sample sizes. These results suggest a potential synergistic effect on RWA criteria in patients using psychotropic medications that necessitates further study. This research has important implications for the diagnostic criteria for RWA and the diagnostic accuracy of RBD. Support (if any) We acknowledge the support of NIH grant R21HL170206.