Requested DocAlert: Picture Quiz Poll: The Man Who Dove Out of Bed

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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?

• Sleepwalking
• Seizures
• 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.
Figure 1
(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).
Figure 2
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.

References

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.

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