Greatest rapid eye movement sleep atonia loss in men and older age

To determine quantitative REM sleep muscle tone in men and women without REM sleep behavior disorder, we quantitatively analyzed REM sleep phasic and tonic muscle activity, phasic muscle burst duration, and automated REM atonia index in submentalis and anterior tibialis muscles in 25 men and 25 women without REM sleep behavior disorder. Men showed significantly higher anterior tibialis phasic muscle activity. Higher phasic muscle activity was independently associated with male sex and older age in multivariate analysis. Men and the elderly may be biologically predisposed to altered REM sleep muscle atonia control, and/or some may have occult neurodegenerative disease, possibly underlying the predominance of older men with REM sleep behavior disorder.