Abstract
<title>Abstract</title> <p> Previous studies have reported that selective serotonin reuptake inhibitors (SSRIs) may induce or exacerbate rapid eye movement (REM) sleep without atonia (RSWA) and increase the risk of developing REM sleep behavior disorder (RBD). However, most of these studies were retrospective and cross-sectional in nature with small sample sizes, and they included data on a mixture of SSRIs. Because different SSRIs have different pharmacological profiles, the specific effects of individual SSRIs on RSWA should be studied. In an 8-week, open-label trial of sertraline in depressed patients (n = 31), patients were administered 50 mg of sertraline at 8 am on the 1st day; this dose was subsequently titrated up to a maximum of 200 mg/day. All patients underwent repeated video-polysomnography (vPSG) (at baseline and on days 1, 14, 28, and 56). Both tonic (submental) and phasic (submental and anterior tibialis) RSWA were visually assessed. Tonic RSWA increased from 3.2 ± 1.8% at baseline to 5.1 ± 2.3% on the 1st day on sertraline and to 10.4 ± 2.7% on the 14th day; this value then remained stable until the 56th day. A similar profile was observed for phasic RSWA as well as for the proportion of patients with abnormal phasic anterior tibialis RSWA. No RBD was observed. The increase in tonic muscle tone during REM sleep over time was correlated with reduced REM sleep latency ( <italic>r</italic> = 0.56, p = 0.004), PLMI ( <italic>r</italic> = 0.39, p = 0.047) and improvement in depression (HRSD score, <italic>r</italic> =-0.43, p = 0.03). The increases in phasic submental ( <italic>r</italic> =-0.51, p = 0.02) and anterior tibialis ( <italic>r</italic> = 0.41, p = 0.04) RSWA were correlated with decreased REM sleep latency and were not correlated with patient demographics or clinical characteristics. Sertraline induced or exacerbated RSWA but did not induce RBD. Compared with idiopathic RBD, sertraline-related RSWA had specific characteristics correlated with REM latency and no predominance of male gender or older age, suggesting that RSWA and idiopathic RBD might involve different mechanisms. </p>