Information sourced from Epocrates:
The Man Who Dove Out of Bed
Ankita Saxena1, Charlene E. Gamaldo1, Amanda Chow2, Rachel Marie E. Salas1
1 Johns Hopkins School of Medicine
2 Johns Hopkins University (JH Pre-Doc Program)
A 61-year-old man suffers a clavicular fracture after “diving out of bed” when dreaming of jumping after a friend falling from a bridge. EMG recordings on polysomnography demonstrate REM sleep without atonia. What does he have?
• Substance abuse
• REM sleep behavior disorder
• Night terrors
Correct answer: REM sleep behavior disorder (RBD). RBD is associated with alpha-synucleinopathies (e.g., Parkinson disease).1 The prevalence of sleep-related injuries in RBD ranges from 33% to 96%.1 “Diving from bed” may result in facial hematoma, head laceration, subdural hemorrhage2, or clavicular fracture. Management of RBD includes strategies to maintain a safe sleep environment and counseling on risks of severe injury.
(A) Photograph of the thorax shows multiple bruises across the chest, lower sternum, and right arm. (B) X-ray of the right shoulder shows a clavicular fracture with inferior displacement of the distal fragment (red arrow).
Polysomnography documents patient in REM sleep, with sudden loss of atonia and abrupt arousal at time 4:38:48 AM (red arrow).
Patient consent obtained.
1. McCarter S, St. Louis E, Boswell C, et al. Factors associated with injury in REM sleep behavior disorder. Sleep Med 2014;15:1332-8. [Free full-text Sleep Med article PDF in PubMed® Central | PubMed® abstract]
2. Schenck C, Lee S, Bornemann M, et al. Potentially lethal behaviors associated with rapid eye movement sleep behavior disorder: review of the literature and forensic implications. J Forensic Sci 2009;54:1475-84. [PubMed® abstract]
Author contributions and disclosures
1. Ankita Saxena, BA: Ankita Saxena has drafted and revised the content of the manuscript and reports no disclosures.
2. Charlene E. Gamaldo, MD: Dr. Gamaldo has revised the content of the manuscript and reports receiving UpToDate royalties.
3. Amanda Chow: has drafted and revised the content of the manuscript and reports no disclosures.
4. Rachel Marie E. Salas, MD: Dr. Salas has revised the content of the manuscript and reports receiving UpToDate royalties.
The above message comes from Epocrates, who is solely responsible for its content.
You have received this email because you requested follow-up information to an Epocrates DocAlert® message. For more information about Epocrates, please click here.
For questions, feedback, or suggestions regarding Epocrates DocAlert® messages, please contact the Medical Information Team at firstname.lastname@example.org.