Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_41_библиотеки_им_акад_М_И_Перельмана

Male sex is another very strong risk factor, though the mechanism for this is unknown [3]. Some case series report a male-female prevalence of 9:1, though this is likely inated due to both the fact that women generally express less injurious dream enactment behaviors, which makes them less likely to seek medical attention, and that older women often outlive their spouses and therefore do not have a bed partner to report their symptoms [21]. Other risk factors include the presence of comorbid psychiatric conditions and antidepressant use, especially in cases where RBD has a relatively rapid onset [22–24]. Antidepressants of nearly all categories have been observed to acutely precipitate or exacerbate RBD episodes, including SSRIs, SNRIs, tricyclic acids (TCAs), monoamine oxidase inhibitors (MAOIs), and mirtazapine, though notably this has not been seen with bupropion [3, 23, 25, 26]. Further medications which have been implicated include beta-blockers and selegi­line, and anticholinesterase inhibitors [3]. PTSD has an association with RBD, though it is more commonly associated with a different REM parasomnia, night­mare disorder, as discussed in section “Nightmare Disorder”. There is also a clear association with narcolepsy, primarily narcolepsy type 1 [27]. Up to 50% of patients with narcolepsy type 1 may demonstrate RBD, though the mechanism for this is distinct from other causes of RBD, as discussed below. Unfortunately, treatments aimed at reducing cataplexy in narcolepsy patients, such as TCAs or SNRIs, may exacerbate RBD symptoms. While patients commonly report dreams with aggres­sive content, in waking life there is no clear association with aggressive personality traits; therefore, no particular personality traits are thought to impart risk [28–30]. Traumatic brain injury is a risk factor for all types of parasomnia (both NREM and REM), with one study estimating new onset of RBD in 8% of TBI patients [31]. Family history is also a risk factor, with one study showing that among patients with conrmed idiopathic RBD, 14% had a close family member with a history of dream enactment [32]. Tobacco smokers are also more likely to develop RBD, both among those with Parkinson disease and among the general population [33, 34].