0663 Rates and Predictors of Rapid Eye Movement Sleep Behavior Disorder Symptoms in Post-9/11 Veterans

Abstract Introduction Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), both prevalent conditions in post-9/11 Veterans, have been linked to rapid eye movement sleep behavior disorder (RBD). We administered a validated screening instrument for RBD to post-9/11 Veterans enrolled in the Houston branch of the Translational Research Center for TBI and Stress Disorders (TRACTS) to investigate rates of RBD symptoms and clinical predictors of positive screens in this cohort. Methods In this cross-sectional analysis, the English translation of the Rapid Eye Movement Behavior Disorder Questionnaire - Hong Kong (RBDQ-HK) was administered with the standardized TRACTS battery. A systematic chart review was performed to assess for known sleep disorders. Fisher’s exact and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively. Multivariable logistic regression was conducted, including as covariates the most significant clinical variables from univariable analyses. A p-value < 0.05 was considered statistically significant. Results Of the 119 subjects with available RBDQ-HK screens, 71 (59.66%) scored above the recommended total cut-off of ≥21 for psychiatric RBD. When positive screens were defined as a cut-off of ≥8 on Factor 2 of the RBDQ-HK, 65 of 119 (54.62%) subjects screened positive. Univariable analyses indicated that global sleep quality, number of TBI exposures, and current PTSD severity were most consistently associated with positive screens. Multivariable logistic regression analysis using a total cut-off score of ≥21 showed that PTSD severity (OR 1.06, 95% C.I. 1.02-1.10, p=0.003) and number of lifetime TBIs (OR 1.63, 95% CI 1.16-2.41, p=0.01) were independent predictors of positive screens, whereas global sleep quality was no longer significant (OR 1.10, CI 0.97-1.26, p=0.149). Multivariable logistic regression analyses were repeated using a cut-off score of ≥8 on Factor 2 and showed similar results. Conclusion Given the high positive screening rates for RBD in our cohort, future efforts are needed to validate RBD screening instruments; enhance interdisciplinary sleep assessments; and investigate pathophysiological relationships between PTSD, TBI, and parasomnias. Support (if any) Center for Alzheimer's and Neurodegenerative Diseases, Baylor College of Medicine; RR&D Veterans Administration (B9268-X)