1226 Shift Workers Acting Out? A Case of Shift Work Sleep Disorder Causing REM Behavior Disorder

Abstract Introduction Rapid eye movement behavior disorder (RBD) is the manifestation of dream enactment with the failure of muscle atonia during rapid eye movement (REM) sleep. Shift work sleep disorder presents as sleep disruption and/or excessive sleepiness due to an atypical work schedule. Here we show a unique case of RBD provoked by a longstanding history of shift work sleep disorder. Report of case(s) 67-year-old male with shift work sleep disorder, hypertension, and depression who presented for evaluation of RBD. Patient recently retired as a night shift worker and was taking melatonin and citalopram for more than 20 years. For the past several months, the patient has been having episodes of acting out his dreams, such as punching his wife if he was dreaming about punching someone in his sleep. Patient’s polysomnography showed REM sleep without atonia (RWA) in the chin and limb leads with 30% of the 30-s epochs having chin EMG activity with bilateral flexor digitorum superficialis (FDA) phasic EMG activity. Patient’s melatonin dose was increased and he was also started on benzodiazepine with control of his symptoms. Conclusion The common risk factors of RBD include Parkinson’s Disease, occupational toxin exposure, antidepressants, psychological stress (PTSD), or compromised health conditions (such as smoking or cardiovascular diseases). The patient has a chronic use of citalopram but antidepressant-induced RBD usually presents in the fourth/fifth decade of life. A review of literature indicates no cases of shift work disorder causing RBD. However, disruptions in the circadian rhythm put shift workers at an increased risk for conditions such as cardiovascular disease, metabolic syndrome, and psychological disorders, all exposures for RBD. Patient developed shift work sleep disorder causing sleep-onset and sleep-maintenance insomnia with a disturbance in the circadian rhythm, ultimately leading to an increased risk for developing RBD. Treatment for RBD includes melatonin as the first-line treatment with addition of low-dose clonazepam or cholinergic agents. With the increasing prevalence of shift work, it is imperative to understand the risks of shift work and identify sleep disorders that may arise, such as RBD, through more research. Support (if any)