Dream-Enactment Behaviours During the COVID-19 Pandemic: An International COVID-19 Sleep Study

Authors

• Yaping Liu, The Chinese University of Hong Kong
• Eemil Partinen, Terveystalo Healthcare
• Ngan Yin Chan, The Chinese University of Hong Kong
• Yves Dauvilliers, University of Montpellier
• Yuichi Inoue, Tokyo Medical University
• Luigi De Gennaro, Sapienza University of Rome
• Giuseppe Plazzi, IRCCS Istituto delle Scienze Neurologiche di Bologna
• Courtney J. Bolstad, Mississippi State University
• Michael R. Nadorff, Mississippi State University
• Ilona Merikanto, University of Helsinki
• Bjørn Bjorvatn, University of Bergen
• Fang Han, Peking University People's Hospital
• Bin Zhang, Southern Medical University
• Ana Suely Cunha, Federal University of Rio Grande do Norte
• Sérgio Mota-Rolim, Federal University of Rio Grande do Norte
• Damien Léger, Université de Paris
• Kentaro Matsui, National Center of Neurology and Psychiatry
• Colin A. Espie, University of Oxford
• Frances Chung, University of Toronto
• Charles M. Morin, Université Laval
• Mariusz Sieminski, Medical University of Gdansk
• Thomas Penzel, Charite Universitätsmedizin Berlin
• Brigitte Holzinger, Medical University of Vienna
• Markku Partinen, Terveystalo Healthcare
• Yun Kwok Wing, The Chinese University of Hong Kong

ORCID

Liu: https://orcid.org/0000-0002-2015-8775; De Gennaro: https://orcid.org/0000-0003-3613-6631; Bolstad: https://orcid.org/0000-0003-2297-2778; Merikanto: https://orcid.org/0000-0002-1222-6678; Espie: https://orcid.org/0000-0002-1294-8734; Penzel: https://orcid.org/0000-0002-4304-0112; Wing: https://orcid.org/0000-0002-5745-5474

MSU Affiliation

College of Arts and Sciences; Department of Psychology

Creation Date

2026-06-30

Abstract

There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.

Publication Date

4-26-2022

Publication Title

Journal of Sleep Research

Publisher

Wiley

Rights

© 2022 European Sleep Research Society

Recommended Citation

Liu, Y., Partinen, E., Chan, N. Y., Dauvilliers, Y., Inoue, Y., De Gennaro, L., Plazzi, G., Bolstad, C. J., Nadorff, M. R., Merikanto, I., Bjorvatn, B., Han, F., Zhang, B., Cunha, A. S., Mota-Rolim, S., Léger, D., Matsui, K., Espie, C. A., Chung, F., Morin, C. M., Sieminski, M., Penzel, T., Holzinger, B., Partinen, M., & Wing, Y. K. (2023). Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study. Journal of Sleep Research, 32(1), e13613. https://doi.org/10.1111/jsr.13613