A comparison of emotions in dreams and emotions triggering cataplexy in patients with narcolepsy Christian Sturzenegger, Claudio Bassetti, Matthias Gugger*, Christian W. Hess, Johannes Mathis Department of Neurology, Division of Pneumology*, University Hospital, 3010 Bern, Switzerland Introduction: Cataplexy is a cardinal symptom of narcolepsy characterized by sudden bilateral muscle weakness triggered by emotions. It is widely accepted that cataplexy is pathogenetically similar to the muscle atonia appearing in physiological rapid eye movement (REM) sleep. REM sleep is also the sleep stage, where dreams most often contain emotions. We analysed whether emotions provoking cataplexy in a given patient were over-represented in the dreams of the same patient. Such a result could indicate a causal relationship between emotional content and triggering of cataplexy. Patients and methods: We prospectively studied a consecutive series of 29 patients with narcolepsy (N, mean age=44±19) by questionnaire. The diagnosis of N was made according to international criteria. Narcoleptics without cataplexy were not included. A list of 12 emotions was presented and the patients were asked to indicate on a five point scale (never, rare, occasionally, frequent, always) how often each emotion appeared in his dreams and as trigger of cataplexy. The frequency of emotion is expressed as the percentage of patients reporting them to occur occasionally, frequent or always. Results: Emotions triggering cataplexy were indicated in the following order of frequency: joy, happiness (68%), anger (60%), anxiety (48%), surprise (46%), sorrow (41%), stress (38%), confusion (32%), interest (31%), guilt (24%), disgust (23%), disdain (22%) and shame (20%). Emotions reported from dreams: sorrow (77%), anxiety (73%), joy, happiness (64%), interest (60%), stress (57%), anger (55%), guilt (55%), confusion (52%), surprise (42%), disdain (33%), disgust (30%) and shame (30%). The similar order of frequency of emotions in dreams and triggering cataplexy may simply reflect the frequency of these emotions in general life. However, it is noteworthy that surprise ranked higher in cataplexy and interest in dreams. In 19 patients at least one emotion appeared in dreams and also triggered cataplexy ("concurrent emotion"). Five of these 19 patients reported between two and three "concurrent emotions" and five patients reported between four and 12 "concurrent emotions". Eight of 10 patients without any "concurrent emotion" did not remember any specific emotions in dreams. The 9th patient remembered only one dream emotion, and the 10th patient had rare emotions in both dreams and cataplexy. The frequency of "concurrent emotions" in a given patient appeared linearly related to the "sum of emotions" in sleep and cataplexy (r=0.8, F=68, p<0.001). "Concurrent emotions" were present only when the sum of emotions was five or greater. Conclusions: Although at least one single emotion was present in dreams and triggered cataplexy in 19 (65%) of 29 narcoleptics, this combination could be explained by the high number of emotions reported in both conditions. Therefore, the observed frequency of "concurrent emotions" does not imply compelling evidence for a causal relationship between emotions in dreams and triggering cataplexy. [14th Congress of the European Sleep Research Society, September 9-12, 1998, Madrid] 1998-99 by Christian Sturzenegger Update 03-01-99 contact webmaster@orangemind.ch