Sleep-Related Head Jerk Presenting With Dream Enactment Behavior: A Case Report

Abstract

Sleep-related head jerk (SRHJ) is conceived as a physiological motor phenomenon, which is mostly seen during rapid eye movement (REM) sleep. It should be distinguished from movements during REM sleep, mainly REM sleep behavior disorder (RBD). A 25-year-old male complained of daytime sleepiness with snoring and dream enactment behavior (DEB). Video polysomnography (PSG) excluded RBD and obstructive sleep apnea; frequent SRHJs during REM sleep with or without respiratory effort-related arousals, and SRHJs followed by one episode of DEB was observed. On PSG with continuous positive airway pressure titration, SRHJ with arousal events still remained but DEB symptom was resolved. REM without atonia unrelated to head jerks was not observed on all PSG data. Excessive SRHJs with arousal related to a sleep disturbance could indicate an SRHJ disorder, which might be a novel sleep-related movement disorder. In addition, clinicians should be careful in diagnosing young patients with RBD.