Graduation Year
2023
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Public Health
Major Professor
Skai W. Schwartz, Ph.D.
Committee Member
Darren Scheer, Ph.D.
Committee Member
Maria Parr, M.D.
Committee Member
Jason L. Salemi, Ph.D.
Committee Member
Amy C. Alman, Ph.D.
Keywords
ADHD, MarketScan®, NREM, Parasomnia, REM sleep behavior disorder
Abstract
Parasomnias, such as sleepwalking and nightmare disorder, are abnormal behaviors and emotions emanating from sleep or wake to sleep transitions. Parasomnias can lead to significant adverse outcomes – sleepwalking can result in injuries and hospitalizations, frequent nightmares are associated with self-harm and suicidal thoughts, and rapid-eye movement (REM) sleep behavior disorder (RBD) is linked to neurodegeneration. Despite a history of fascination with abnormal sleep behaviors in the general and medical communities, epidemiologic understanding of parasomnias remains limited, in part due to their amnestic nature and presumption that they are benign childhood problems. This work used the MarketScan® Commercial Claims and Encounters Database, 2010-2012, to study three areas of parasomnia epidemiology in children and adults in the United States.
The first study (Chapter 2) is a descriptive analysis of the prevalence and incidence of non-rapid eye movement and REM parasomnias according to age, sex, and US regions. We found lower estimates compared to survey-based studies, although age and sex trends are consistent with current understanding. Significant findings include a higher prevalence/incidence of sleepwalking and sleep terror among male children and adolescents, higher estimates of nightmare disorder among older men, and higher estimates in the western US region.
The second study (Chapter 3) evaluated the association between parasomnias, specifically the disorders of arousal and nightmare disorder, with attention-deficit hyperactivity disorder (ADHD) and ADHD pharmacotherapy in patients less than 21 years of age. Despite the recognition of poor sleep in ADHD and common features with parasomnias, associations between ADHD and parasomnias have been scantly investigated. Through retrospective cohort analyses and propensity-score adjustment, we found that patients with ADHD are at increased risk of parasomnias, independent of comorbidities and pharmacologic treatment. ADHD patients initiated on non-stimulant medication were additionally found to have increased parasomnia risks compared to patients initiated on stimulant medications.
The third study (Chapter 4) used the case-control design to assess and identify novel diagnoses and pharmaceuticals associated with RBD in adults 18-65 years of age. Increased odds of RBD with psychiatric disorders, cardiovascular disease, alcohol use, and antidepressants, described from prior studies were substantiated. Novel associations with respiratory infections, asthma, cancer, gastrointestinal disorders, and evidence of age effect-modification were identified. Furthermore, antidiabetic medications were found associated with lower odds of RBD, which has important implications for drug-repurposing in prevention of neurodegeneration.
Collectively, these studies contribute to the dearth of epidemiologic studies of parasomnias and highlight ways in which administrative healthcare claims can be leveraged to investigate these intriguing sleep disorders.
Scholar Commons Citation
Nguyen, Anh Thy Ha, "A Healthcare Claims Investigation of Parasomnia Epidemiology, Associations with Attention Deficit/Hyperactivity Disorder, and REM Sleep Behavior Disorder Correlates" (2023). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/9988
