frequent nightmares were more likely to be female (p < .01) and have a diagnosed psychiatric disorder (p < .001). Frequent night- mares were associated with various self-reported sleep symptoms such as difficulty in maintaining sleep (p < .05), sleep paralysis (p < .05) and sleep related injuries to self (p < .05). Amongst different sleep disorders, sleep related bruxism was significantly associated with frequent nightmares (OR = 5.76, 95% C.I. 1.20–26.6). After excluding those diagnosed with a psychiatric disorder, subjects with frequent nightmares were found to score significantly higher on HADS-anxiety subscale (p < .001) and BDI (p < .01). Conclusion: Frequent nightmares are common in patients with sleep disorders other than REM parasomnias. The associations of fre- quent nightmare with psychopathology and self-perceived insomnia in sleep patients suggest a need of enhanced clinical attention to the nightmare complaint in the routine assessment of treatment seeking patients at sleep medical settings. http://dx.doi.org/10.1016/j.sleep.2013.11.430 Insomnia subtypes in sleep apnea: implications for screening and treatment E. Libman 1 , L. Creti 1 , C. Fichten 2 , D. Rizzo 3 , M. Baltzan 4 , S. Bailles 1 1 Jewish General Hospital, McGill University, Jewish General Hospital, Canada 2 Jewish General Hospital, McGill University, Dawson College, Jewish General Hospital, Canada 3 Jewish General Hospital, Universite de Montreal, Jewish General Hospital, Canada 4 OSR Medical, Mount Sinai Hospital, McGill University, Canada Introduction: Screening of obstructive sleep apnea in primary care settings is challenging for the family doctor, given the wide variety of patients’ symptom complaints. We developed the Sleep Symp- toms Checklist (SSC), which groups common complaints into four subscales: Insomnia, Daytime Distress, Sleep Disorder, and Psycho- logical Distress. In the present study, we investigated whether differ- ent SSC profiles exist for sleep apnea and chronic insomnia, in patients with and without an insomnia complaint. Materials and methods: Participants were 88 primary care patients with OSA; 57 individuals, without OSA, who sought cognitive- behaviour therapy for insomnia (CBT-I); and 14 healthy community controls without sleep apnea or sleep complaints. All completed the SSC and a sleep questionnaire. Sleep apnea participants were segre- gated into three groups according to their sleep questionnaire responses: no insomnia (OSA), n = 21; insomnia including a com- plaint and objective poor sleep (OSA-I), n = 30; and insomnia by objective criteria but no complaint (OSA-I-NC), n = 37. Results: There was no statistical difference in the severity of sleep apnea for the 3 OSA groups. All five groups were compared using ANOVA on the SSC subscale scores. The 3 OSA groups were charac- terized by worse Sleep Disorder scores than the CBT-I and Control groups. The two OSA groups with insomnia had worse Insomnia scores than the OSA and Control groups. The CBT-I participants had significantly worse Insomnia and Psychological Distress scores than the other clinical groups and their Sleep Disorder scores were similar to those of the Control group. Psychological Distress was worse for groups with insomnia (OSA-I- NC, OSA-I, CBT-I) compared to the OSA and Control groups. Conclusion: The present study demonstrates that the SSC can be used to identify distinct clinical ‘‘profiles’’ for sleep apnea patients with and without the complaint of insomnia and for chronic insom- nia patients with without sleep apnea. Of particular clinical impor- tance is the identification of two subgroups of sleep apnea patients – those who have diagnosable insomnia and those who meet objec- tive criteria for insomnia but are uncomplaining. The sleep problems of the non-complaining group of apnea patients with insomnia may not come to the attention of their treating sleep doctor and yet may interfere with CPAP therapy acceptance and adherence. These pro- files help identify sleep apnea patients who could benefit from addi- tional treatment for insomnia. Acknowledgement: This research was supported by the Canadian Institutes of Health Research. http://dx.doi.org/10.1016/j.sleep.2013.11.431 Restless legs syndrome in a patient with dysmetabolic iron overload syndrome and abnormal iron deposits in basal ganglia and susbtantia nigra L. Lillo 1 , A. Del Castillo 2 , M. Morán 3 , J. Guzmán De Villoria 4 , A. Guillem 1 , R. Peraita-Adrados 5 1 University Hospital Gregorio Marañón, Neurology Service, Spain 2 University Hospital Gregorio Marañón, Internal Medicine Service, Spain 3 Research Foundation, Spain 4 University Hospital Gregorio Marañón, Neuroradiology Department, Spain 5 University Hospital Gregorio Marañón, Sleep Unit-Clinical Neuro- physiology, Spain Introduction: Restless Legs Syndrome (RLS) is a sensorimotor dis- order involving primarily leg discomfort and motor restlessness. Iron deficiency anemia occurs in secondary cases and a decreased brain iron status in CSF and decreased regional iron particularly in the sub- stantia nigra has been postulated. Materials and methods: A 50 years old patient was referred for severe RLS and periodic leg movements (PLM) while sleeping. Past medical history showed completed bladder cancer remission, over- weight, high blood pressure and dyslipidemia. Results: Neurological examination and standard EEG were normal. The Epworth Sleepiness Scale score was 18. Polysomnography showed a disturbed and fragmented sleep with a reduction in total sleep time, low sleep efficiency, mild OSA with an apnea-hypopnea index of 14,4/h and periodic leg movements index 37,2/h. The serum ferritin was 390 lg/L, serum iron 175 lg/dl, transferrin 189 mg/dl, and transferrin saturation index 73%. The genetic study revealed hereterozygosity for the H63D mutation of HFE gen and another mutation in the 5UTR region of HFE gen, both not identified as path- ological. The cranial MRI initially normal, showed two years later to RLS diagnosis abnormal iron deposits in globus pallidus, dentate, red nuclei and substantia nigra. Liver MRI showed mild iron overload. The diagnosis was dysmetabolic iron overload syndrome. Conclusion: RLS with PLM was associated with high serum ferritin and iron levels, low transferrin and high saturation transferrin index suggesting an impaired mechanism of mobilization of stored iron. The abnormal iron deposits in basal ganglia and substantia nigra revealed a complex disorder of iron central metabolism. http://dx.doi.org/10.1016/j.sleep.2013.11.432 Abstracts / Sleep Medicine 14S (2013) e165–e238 e183