Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study

Yaping Liu; Eemil Partinen; Ngan Yin Chan; Yves Dauvilliers; Yuichi Inoue; Luigi De Gennaro; Giuseppe Plazzi; Courtney J Bolstad; Michael R Nadorff; Ilona Merikanto; Bjørn Bjorvatn; Fang Han; Bin Zhang; Ana Suely Cunha; Sérgio Mota-Rolim; Damien Léger; Kentaro Matsui; Colin A Espie; Frances Chung; Charles M Morin; Mariusz Sieminski; Thomas Penzel; Brigitte Holzinger; Markku Partinen; Yun Kwok Wing

doi:10.1111/jsr.13613

Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study

J Sleep Res. 2023 Feb;32(1):e13613. doi: 10.1111/jsr.13613. Epub 2022 Apr 26.

Authors

Yaping Liu¹, Eemil Partinen², Ngan Yin Chan¹, Yves Dauvilliers³, Yuichi Inoue⁴, Luigi De Gennaro^{5

6}, Giuseppe Plazzi^{7

8}, Courtney J Bolstad⁹, Michael R Nadorff^{9

10}, Ilona Merikanto^{11

12}, Bjørn Bjorvatn¹³, Fang Han¹⁴, Bin Zhang¹⁵, Ana Suely Cunha¹⁶, Sérgio Mota-Rolim¹⁷, Damien Léger¹⁸, Kentaro Matsui¹⁹, Colin A Espie²⁰, Frances Chung²¹, Charles M Morin²², Mariusz Sieminski²³, Thomas Penzel²⁴, Brigitte Holzinger²⁵, Markku Partinen², Yun Kwok Wing¹

Affiliations

¹ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region (SAR), China.
² Helsinki Sleep Clinic, Terveystalo Healthcare and Department of Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
³ Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INM, INSERM, University of Montpellier, Montpellier, France.
⁴ Tokyo Medical University, Tokyo, Japan.
⁵ Department of Psychology, Sapienza, University of Rome, Rome, Italy.
⁶ IRCCS Fondazione Santa Lucia, Rome, Italy.
⁷ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
⁸ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy.
⁹ Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA.
¹⁰ Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
¹¹ SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
¹² Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
¹³ Department of Global Public Health and Primary Care, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, University of Bergen, Bergen, Norway.
¹⁴ The Sleep Center, Peking University People's Hospital, Beijing, China.
¹⁵ Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.
¹⁶ Department of Production Engineering, Federal University of Rio Grande do Norte, Natal, Brazil.
¹⁷ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal, Brazil.
¹⁸ APHP, VIFASOM, Hôtel Dieu, Centre du Sommeil et de la Vigilance, Université de Paris, Paris, France.
¹⁹ Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
²⁰ Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
²¹ Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.
²² Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec City, Quebec, Canada.
²³ Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
²⁴ Sleep Medicine Center, Charite Universitätsmedizin Berlin, Berlin, Germany.
²⁵ Institute for Dream and Consciousness Research, Medical University of Vienna, Vienna, Austria.

Abstract

There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.

Keywords: coronavirus disease 2019 (COVID-19); dream-enactment behaviour; neurodegeneration; prevalence; rapid eye movement sleep behaviour disorder (RBD).

MeSH terms

Adolescent
Adult
COVID-19 Testing
COVID-19* / epidemiology
Dreams
Female
Humans
Male
Pandemics
REM Sleep Behavior Disorder* / complications
REM Sleep Behavior Disorder* / diagnosis
REM Sleep Behavior Disorder* / epidemiology