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Chopra A, Patel RS, Baliga N, Narahari A, Das P. Sleepwalking and sleep-related eating associated with atypical antipsychotic medications: Case series and systematic review of literature. Gen Hosp Psychiatry 2020; 65:74-81. [PMID: 32535329 DOI: 10.1016/j.genhosppsych.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sleep walking (SW) is a parasomnia behavior characterized by repetitious occurrence of ambulation during a partial arousal from non-rapid eye movement (NREM) sleep. Sleep-related eating (SRE) is one of the complex sleep behaviors that may accompany SW. Emerging evidence suggests that NREM parasomnias can be associated with atypical antipsychotic medication use. METHODS We present a case series (n = 5) and a systematic review of the literature of cases of SW, with or without SRE (n = 23), associated with atypical antipsychotic use. RESULTS Twenty-eight cases of SW, with and without SRE, with a mean age of 44.8 years (S.D. = 15.04) and a male predominance (75%; n = 21) were identified. Quetiapine was the most commonly implicated medication with SW and SRE (n = 14). Remission from SW/SRE was noted in all cases with measures including antipsychotic dosage reduction, discontinuation of medication, switching to an alternate medication, and use of continuous positive airway pressure (CPAP) for comorbid obstructive sleep apnea (OSA) treatment. CONCLUSIONS Sleep walking (SW), with or without sleep related eating (SRE), can be a rare but reversible side effect associated with use of atypical antipsychotics. More research is warranted to elucidate the mechanisms underlying SW and SRE associated with atypical antipsychotic use.
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Affiliation(s)
- Amit Chopra
- Psychiatry and Behavioral Health Institute, Department of Sleep Medicine, Allegheny Health Network, Pittsburgh, PA, United States.
| | - Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, Norman, OK, United States
| | - Nisha Baliga
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.
| | - Anoop Narahari
- Psychiatry and Behavioral Health Institute, Allegheny Health Network, Pittsburgh, PA, United States.
| | - Piyush Das
- Department of Sleep Medicine, CentraCare, MN, United States.
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52
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Secrist ME, John SG, Harper SL, Conners Edge NA, Sigel BA, Sievers C, Kramer T. Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:249-256. [PMID: 32549936 PMCID: PMC7289908 DOI: 10.1007/s40653-019-00268-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although nightmares are frequently endorsed symptoms in children who have experienced trauma, limited research has been conducted on how nightmares vary with different forms of trauma exposure. Our goal was to assess the relationship between nightmares, trauma exposure, and symptoms of Posttraumatic Stress Disorder (PTSD) in youth. A total of 4440 trauma exposed treatment-seeking youth (ages 7 to 18) were administered the UCLA PTSD Reaction Index. Different trauma types, total traumas experienced, and PTSD symptoms were analyzed with correlations and a logistic regression in relation to nightmare frequency. Overall, 33.1% of participants reported experiencing clinically-significant nightmares. 79.1% of the sample experienced more than one trauma type, with an average of 3.06 trauma types endorsed. A binary logistic regression demonstrated the odds of reporting clinically-significant nightmares increased by 1.3 times for every additional type of trauma experienced. Lastly, nightmares were positively correlated with all PTSD criterion. The current study provides prevalence rates of trauma exposure and nightmares in a large, statewide sample of treatment-seeking youth. Each new trauma type experienced resulted in a greater likelihood of endorsing clinically-significant nightmares. This study provides useful information related to assessing and addressing nightmares in youth who have experienced trauma.
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Affiliation(s)
- Marie E. Secrist
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Present Address: San Diego Center for Children, San Diego, CA USA
| | - Sufna G. John
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Shannon L. Harper
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Present Address: Albany Medical Center, Albany, NY USA
| | - Nicola A. Conners Edge
- Department of Family and Preventative Medicine, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Benjamin A. Sigel
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Chad Sievers
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Teresa Kramer
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR USA
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53
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Munro NA. Alcohol and Parasomnias: The Statistical Evaluation of the Parasomnia Defense in Sexual Assault, Where Alcohol is Involved. J Forensic Sci 2020; 65:1235-1241. [PMID: 32259289 DOI: 10.1111/1556-4029.14322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 12/28/2022]
Abstract
Sleep sex may be a defense for alleged sexual assault. The International Classification of Sleep Disorders (ICSD3) states: "Disorders of arousal should not be diagnosed in the presence of alcohol intoxication… The former [alcohol blackouts] are exponentially more prevalent." A panel member of ICSD3, quoting ICSD3 asserts: "alcohol intoxication should rule out a sleep-walking defense". This implies extremely strong support for a prosecution hypothesis (Hp ) over a defense hypothesis (Hd ). I use Bayesian methodology to evaluate the evidential probity of alcohol intoxication. The likelihood ratio, LR, measures the amplification of prior odds of guilt, LR = Posterior odds of guilt after considering alcohol intoxication /Prior odds of guilt before considering alcohol intoxication . By Bayes' theorem, LR = p ( alcohol intoxication, given H p ) / p ( alcohol intoxication, given H d ) . I use data from cross-sectional studies of sexual assault and prevalence of alcohol use, in college students, with data from longitudinal studies, and data from the epidemiology of parasomnias to evaluate LR (alcohol). LR ~1.5 or 5, depending whether alcohol does, or does not, increase the risk of parasomnias. The proposition of extremely strong support for Hp implies a LR ~1,000,000, so the proposition in ICSD3 is not supported by formal analysis. The statistical reasoning in ICSD3 is unclear. There appears to be inversion of the Bayesian conditional (confusing intoxication given assault, and assault given intoxication) and failure to evaluate alcohol intoxication in Hd . Similar statistical errors in R. v Sally Clark are discussed. The American Academy of Sleep Medicine should review the statistical methodology in ICSD3.
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Affiliation(s)
- Neil A Munro
- East Grinstead Sleep Centre, Queen Victoria Hospital NHS Foundation Trust, Holtye Rd, East Grinstead, RH19 3DZ, U.K.,Neurology Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, U.K.,East Kent University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent, CT1 3NG, U.K
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54
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Romiszewski S, May FEK, Homan EJ, Norris B, Miller MA, Zeman A. Medical student education in sleep and its disorders is still meagre 20 years on: A cross‐sectional survey of UK undergraduate medical education. J Sleep Res 2020; 29:e12980. [DOI: 10.1111/jsr.12980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Ben Norris
- Royal Devon and Exeter NHS Foundation Trust Exeter UK
| | | | - Adam Zeman
- University of Exeter Medical School Exeter UK
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55
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Mysliwiec V, Brock MS. Time to recognize trauma associated sleep disorder as a distinct parasomnia. Sleep 2020; 43:5799152. [DOI: 10.1093/sleep/zsaa019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vincent Mysliwiec
- Division of Behavioral Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Matthew S Brock
- Department of Sleep Medicine, San Antonio Military Health System, JBSA-Lackland, TX
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56
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Leung AKC, Leung AAM, Wong AHC, Hon KL. Sleep Terrors: An Updated Review. Curr Pediatr Rev 2020; 16:176-182. [PMID: 31612833 PMCID: PMC8193803 DOI: 10.2174/1573396315666191014152136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. METHODS A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. CONCLUSION Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong,Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
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57
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Barghouthi T, Lemley R, Figurelle M, Bushnell C. Epidemiology of neurologic disease in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:119-141. [PMID: 32736746 DOI: 10.1016/b978-0-444-64239-4.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many neurologic diseases in women are influenced by the physiologic and hormonal changes of pregnancy, and pregnancy itself poses challenges in both treatment and evaluation of these conditions. Some diseases, such as epilepsy and multiple sclerosis, have a high enough prevalence in the young female population to support robust epidemiologic data while many other neurologic diseases, such as specific myopathies and muscular dystrophies, have a low prevalence, with data limited to case reports and small case series. This chapter features epidemiologic information regarding a breadth of neurologic conditions, including stroke, epilepsy, demyelinating disease, peripheral neuropathies, migraine, sleep-disordered breathing, and meningioma, in women in the preconception, pregnancy, and postpartum stages.
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Affiliation(s)
- Tamara Barghouthi
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Regan Lemley
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Morgan Figurelle
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cheryl Bushnell
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
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58
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Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
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Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
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59
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BaHammam AS, Almeneessier AS. Dreams and Nightmares in Patients With Obstructive Sleep Apnea: A Review. Front Neurol 2019; 10:1127. [PMID: 31695676 PMCID: PMC6817494 DOI: 10.3389/fneur.2019.01127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/09/2019] [Indexed: 01/02/2023] Open
Abstract
Obstructive sleep apnea (OSA) can present with or provoke various psychological symptoms. In this article, we critically review studies that have examined dreams, dream recall, and dream content in patients with OSA. Obstructive events induce recurrent sleep fragmentation and intermittent desaturations in patients with OSA, which may trigger different parasomnias, including nightmares. Contradictory results have been reported concerning dreams in patients with OSA; while some investigators have reported less dreams in OSA patients, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile content. Although there are reports of respiratory-related dream content in patients with OSA, most studies that have assessed the dream content of patients with OSA revealed that respiratory-related dream content was unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Furthermore, an improvement in nightmare frequency with continuous positive airway pressure (CPAP) treatment has been shown. An inverse relationship between the severity of OSA reflected by the apnea-hypopnea index and dream recall has been demonstrated in several studies. Future studies should differentiate between patients with non-stage specific OSA and patients with rapid eye movement (REM) predominant OSA.
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Affiliation(s)
- Ahmed S BaHammam
- Department of Medicine, The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia.,Prince Naif Health Research Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- Department of Medicine, The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
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60
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Interobserver reliability of ICSD-3 diagnostic criteria for disorders of arousal in adults. Sleep Breath 2019; 23:1309-1314. [DOI: 10.1007/s11325-019-01937-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/28/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
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61
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Cornejo-Sanchez DM, Carrizosa-Moog J, Cabrera-Hemer D, Solarte-Mila R, Gomez-Castillo C, Thomas R, Leal SM, Cornejo-Ochoa W, Pineda-Trujillo N. Sleepwalking and Sleep Paralysis: Prevalence in Colombian Families With Genetic Generalized Epilepsy. J Child Neurol 2019; 34:491-498. [PMID: 31012364 DOI: 10.1177/0883073819842422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sleep deprivation commonly increases seizure frequency in patients with genetic generalized epilepsy, though it is unknown whether there is an increased prevalence of sleepwalking or sleep paralysis in genetic generalized epilepsy patients. Establishing this could provide insights into the bio-mechanisms or genetic architecture of both disorders. The aim of this study was to determine the prevalence of sleepwalking and sleep paralysis in a cohort of patients with genetic generalized epilepsy and their relatives in extended families. METHODS A structured interview based on International League Against Epilepsy (ILAE) and International Classification of Sleep Disorders (ICSD-3) criteria was applied to 67 index cases and their relatives to determine genetic generalized epilepsy subtypes and assess the occurrence of sleepwalking or sleep paralysis. Bivariate analysis was performed using chi-square and Fisher exact tests. RESULTS The prevalence of sleepwalking and sleep paralysis was 15.3% (95% confidence interval 12.1-18.9) and 11.7% (95% confidence interval 8.7-15.3), respectively. Unusually, no sleepwalkers were found among individuals displaying epilepsy with generalized tonic-clonic seizures. Approximately a quarter of the patients had either parasomnia or genetic generalized epilepsy. Over half the genetic generalized epilepsy families had at least 1 individual with sleepwalking, and more than 40% of the families had one individual with sleep paralysis. CONCLUSION The prevalence of sleepwalking or sleep paralysis is reported for individuals with genetic generalized epilepsy and their relatives. The co-existence of either parasomnia in the genetic generalized epilepsy patients and the co-aggregation within their families let suggest that shared heritability and pathophysiological mechanisms exist between these disorders. We hypothesize that sleepwalking/sleep paralysis and genetic generalized epilepsy could be variable expression of genes in shared pathways.
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Affiliation(s)
| | - Jaime Carrizosa-Moog
- 1 Grupo Mapeo Genético, Facultad de Medicina, Universidad de Antioquia, Medellin-Colombia
| | - Dagoberto Cabrera-Hemer
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Rodrigo Solarte-Mila
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Rhys Thomas
- 4 Institute of Neuroscience, Newcastle University, United Kingdom
| | - Suzanne M Leal
- 5 Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - William Cornejo-Ochoa
- 2 Grupo Pediaciencias, Facultad de Medicina, Universidad de Antioquia, Medellín, Antioquia, Colombia
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Abstract
Sleep problems are relatively common in patients with advanced disease, and are associated with significant morbidity in these groups of patients. The focus of this article is sleep problems in patients with advanced cancer, and specifically insomnia, 'vivid' dreams and nightmares. However, other sleep problems are also relatively common in this group of patients, including sleep-related breathing disorders and circadian rhythm sleep-wake disorders. Healthcare professionals should screen all patients with advanced diseases for sleep problems and, equally, initiate appropriate (evidence-based) interventions when they are discovered.
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63
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Dream recall frequency, nightmare frequency, attitude towards dreams, and other dream variables in patients with sleep-related breathing disorders. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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64
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Voinescu BI. Common Sleep, Psychiatric, and Somatic Problems According to Work Schedule: an Internet Survey in an Eastern European Country. Int J Behav Med 2019; 25:456-464. [PMID: 29557074 DOI: 10.1007/s12529-018-9719-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE A wide range of health problems was investigated, aiming to identify the presence and severity of a set of self-reported and common sleep, psychiatric, and somatic health problems among working professionals in four different shift schedules (morning, evening, rotating, and day) in several cities in Romania. METHODS A heterogeneous sample of 488 workers of different professions completed online a battery of tests, namely the Basic Nordic Sleep Questionnaire, the Parasomnia Questionnaire, the Epworth Sleepiness Scale, and the Patient Health Questionnaire, designed to identity symptoms of insomnia, sleepiness, snoring, parasomnia, as well as of depression, anxiety, eating, somatoform, and alcohol use disorders, respectively. The timing and the duration of the sleep, along with the presence of high blood pressure and type 2 diabetes mellitus were also inquired. The prevalence of the different health problems in relation to the type of shift schedule was evaluated with the Pearson Chi-square test. ANOVA was used to calculate the significance of the difference between the means, while associations with different health problems were estimated by binary logistic regression. RESULTS The most common mental health problems were depression (26%), insomnia (20%), alcohol misuse (18%), and anxiety (17%). No significant differences based on the type of shift in terms of health problems were found, except for high blood pressure and symptoms of panic disorder that were more frequently reported by the workers in early morning shifts. Together with the workers in rotating shifts, they also reported increased sleepiness, poorer sleep quality, and shorter sleep duration. In contrast, the workers in evening shifts reported less severe health problems and longer sleep duration. CONCLUSIONS Working in early morning shifts was found to be associated with poorer health outcomes, while working in rotating and early morning shifts with more severe sleep-related problems.
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Affiliation(s)
- Bogdan I Voinescu
- Department of Clinical Psychology and Psychotherapy, Laboratory for the Research of Sleep Disorders and Circadian Psychobiology, International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Str. Republicii 37, 400013, Cluj-Napoca, Romania. .,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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65
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Rodriguez CL, Foldvary-Schaefer N. Clinical neurophysiology of NREM parasomnias. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:397-410. [PMID: 31307616 DOI: 10.1016/b978-0-444-64142-7.00063-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The nonrapid eye movement (NREM) parasomnias range from age-related developmental phenomena in children to aggressive and injurious motor behaviors in all age groups. These parasomnias are commonly referred to as disorders of arousal and are an important cause of sleep-related injury. Genetic predisposition plays a role in the disorders of arousal, most evident in sleepwalking. Important concepts guiding our current understanding of the pathophysiology of the NREM parasomnias include sleep state instability (a propensity for arousal during NREM sleep), sleep inertia (incomplete awakening from NREM sleep), state dissociation (an ability to simultaneously straddle both NREM sleep and wakefulness), and activation of central pattern generators (permitting expression of subcortically determined motor behaviors without conscious higher cortical input). Management is multifaceted with an emphasis on education and nonpharmacologic measures. The purpose of this chapter is to review wake and NREM neurobiology and update our current understanding of NREM parasomnia pathophysiology, epidemiology, genetics, clinical features, precipitating factors, neurophysiologic evaluation, diagnosis, and clinical management.
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Affiliation(s)
- Carlos L Rodriguez
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States.
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States
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66
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Abstract
Parasomnias are a group of sleep disorders characterized by abnormal, unpleasant motor verbal or behavioral events that occur during sleep or wake to sleep transitions. Parasomnias can occur during non-rapid eye movement (NREM) and rapid eye movement (REM) stages of sleep and are more commonly seen in children than the adult population. Parasomnias can be distressful for the patient and their bed partners and most of the time, these complaints are brought up by their bed partners because of the possible disruption in their quality of sleep. As clinicians, it is crucial to understand the characteristics of various parasomnias and address them with detailed sleep history and essential diagnostic approach for proper evaluation. The review aims to highlight the epidemiology, pathophysiology and clinical features of various types of parasomnias along with the appropriate diagnostic and pharmacological approach.
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Affiliation(s)
- Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Harleen Kaur
- Neurology, Univeristy of Missouri, Columbia, USA
| | - Shivank Singh
- Internal Medicine, Maoming People's Hospital, Maoming, CHN
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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67
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Sleep talking: A viable access to mental processes during sleep. Sleep Med Rev 2018; 44:12-22. [PMID: 30594004 DOI: 10.1016/j.smrv.2018.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/05/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023]
Abstract
Sleep talking is one of the most common altered nocturnal behaviours in the whole population. It does not represent a pathological condition and consists in the unaware production of vocalisations during sleep. Although in the last few decades we have experienced a remarkable increase in knowledge about cognitive processes and behavioural manifestations during sleep, the literature regarding sleep talking remains dated and fragmentary. We first provide an overview of historical and recent findings regarding sleep talking, and we then discuss the phenomenon in the context of mental activity during sleep. It is shown that verbal utterances, reflecting the ongoing dream content, may represent the unique possibility to access the dreamlike mental experience directly. Furthermore, we discuss such phenomena within a cognitive theoretical framework, considering both the atypical activation of psycholinguistic circuits during sleep and the implications of verbal 'replay' of recent learning in memory consolidation. Despite current knowledge on such a common experience being far from complete, an in-depth analysis of sleep talking episodes could offer interesting opportunities to address fundamental questions on dreaming or information processing during sleep. Further systematic polysomnographic and neuroimaging investigations are expected to shed new light on the manifestation of the phenomenon and related aspects.
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68
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Abstract
Our understanding of non-rapid eye movement (NREM) parasomnias has improved considerably over the last two decades, with research that characterises and explores the causes of these disorders. However, our understanding is far from complete. The aim of this paper is to provide an updated review focusing on adult NREM parasomnias and highlighting new areas in NREM parasomnia research from the recent literature. We outline the prevalence, clinical characteristics, role of onset, pathophysiology, role of predisposing, priming and precipitating factors, diagnostic criteria, treatment options and medico-legal implications of adult NREM parasomnias.
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69
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Pöpel A. [Evidence-Based Treatment of Insomnia]. PRAXIS 2018; 107:1339-1343. [PMID: 30482125 DOI: 10.1024/1661-8157/a003160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Evidence-Based Treatment of Insomnia Abstract. This review article presents current evidence on the diagnosis and efficacy of treatment methods for non-organic insomnia. In diagnostics, it is particularly important to examine differential diagnoses individually and, if available, to treat them. Regarding the actual insomnia treatment, it should be emphasized that drug treatment provides proof of efficacy only in short-term treatments lasting less than four weeks. The most effective treatment for insomnia is disorder-specific cognitive-behavioral psychotherapy (CBT-I). CBT-I should therefore be accessible to every patient with insomnia.
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70
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Sleep spindle and psychopathology characteristics of frequent nightmare recallers. Sleep Med 2018; 50:113-131. [DOI: 10.1016/j.sleep.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/02/2017] [Indexed: 02/01/2023]
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71
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Abstract
Sleep disorders in children may lead to neurodevelopmental and neurocognitive deficits; it is important to diagnose and treat them properly. Apart from the existing challenges in diagnosis, another drawback is that few therapies are currently approved. In this article, a comprehensive summary of the most common pediatric sleep disorders, along with the various pharmacologic and nonpharmacologic approaches for their management, is presented. Special attention has been paid to the currently available treatment options for pediatric insomnia, obstructive sleep apnea, parasomnias, narcolepsy, and restless legs syndrome, and comparisons are made with the corresponding treatment options for sleep disorders in adults.
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72
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Lundetræ RS, Saxvig IW, Pallesen S, Aurlien H, Lehmann S, Bjorvatn B. Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study. Front Psychol 2018; 9:1140. [PMID: 30026716 PMCID: PMC6042013 DOI: 10.3389/fpsyg.2018.01140] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/14/2018] [Indexed: 12/05/2022] Open
Abstract
Objective: To assess the prevalence of parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity. Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption). Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR = 2.0, 95% CI = 1.12–3.55). The other parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age. Conclusions: We found no increase in parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the parasomnias were not associated with OSA severity.
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Affiliation(s)
- Ragnhild S Lundetræ
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingvild W Saxvig
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Harald Aurlien
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sverre Lehmann
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Creamer JL, Brock MS, Matsangas P, Motamedi V, Mysliwiec V. Nightmares in United States Military Personnel With Sleep Disturbances. J Clin Sleep Med 2018; 14:419-426. [PMID: 29510796 DOI: 10.5664/jcsm.6990] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. METHODS Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. RESULTS At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes). The comorbid disorders of depression (P ≤ .01, relative risk [RR] 3.55 [95% CI, 2.52-4.98]), anxiety (P ≤ .01, RR 2.57 [95% CI, 1.93-3.44]), posttraumatic stress disorder (P ≤ .01, RR 5.11 [95% CI, 3.43-7.62]), and insomnia (P ≤ .01, RR 1.59 [95% CI, 1.42-1.79]) were all associated with nightmares. CONCLUSIONS Clinically significant nightmares are highly prevalent in United States military personnel with sleep disturbances. Nightmares are associated with both subjective and objective sleep disturbances and are frequently comorbid with other sleep and mental health disorders. COMMENTARY A commentary on this article appears in this issue on page 303.
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Affiliation(s)
| | - Matthew S Brock
- San Antonio Military Medical Center, Department of Sleep Medicine, JBSA-Lackland, Texas
| | | | - Vida Motamedi
- National Institutes of Health, National Institutes of Nursing Research, Bethesda, Maryland
| | - Vincent Mysliwiec
- San Antonio Military Medical Center, Department of Sleep Medicine, JBSA-Lackland, Texas
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Abstract
PURPOSE OF REVIEW This article provides an overview of the clinical features, diagnosis, and treatment of insomnia, restless legs syndrome, periodic limb movements of sleep, parasomnias, narcolepsy, and sleep-related breathing disorders among children and adolescents. RECENT FINDINGS Pediatric presentations of sleep disorders differ from adult presentations, making diagnosis challenging. Specific clinical syndromes, such as cataplexy in children with narcolepsy type 1, can have an altogether different presentation compared to adult-onset symptoms, contributing to diagnostic delays and potential misdiagnoses. More broadly, research shows strong associations between sleep and daytime cognition, mood, and behavior among children with and without neurologic conditions and thus suggests a need to identify and treat sleep problems to optimize daytime functioning. SUMMARY Addressing sleep problems in children with neurologic conditions and neurodevelopmental disorders improves quality of life for patients and their families and, in many cases, reduces neurologic disease burden.
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Arnulf I, Uguccioni G, Gay F, Baldayrou E, Golmard JL, Gayraud F, Devevey A. What Does the Sleeping Brain Say? Syntax and Semantics of Sleep Talking in Healthy Subjects and in Parasomnia Patients. Sleep 2017; 40:4345704. [DOI: 10.1093/sleep/zsx159] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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77
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Davies AN, Patel SD, Gregory A, Lee B. Observational study of sleep disturbances in advanced cancer. BMJ Support Palliat Care 2017; 7:435-440. [DOI: 10.1136/bmjspcare-2017-001363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/07/2017] [Accepted: 07/19/2017] [Indexed: 11/04/2022]
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78
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Maski K, Owens JA. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Lancet Neurol 2017; 15:1170-81. [PMID: 27647645 DOI: 10.1016/s1474-4422(16)30204-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022]
Abstract
Sleep problems are frequently encountered as presenting complaints in child neurology clinical practice. They can affect the functioning and quality of life of children, particularly those with primary neurological and neurodevelopmental disorders, since coexisting sleep problems can add substantially to neurocognitive and behavioural comorbidities. Additionally, symptoms of some sleep disorders such as parasomnias and narcolepsy can be confused with those of other neurological disorders (eg, epilepsy), posing diagnostic challenges for paediatric neurologists. The understanding of the neurophysiology of sleep disorders such as insomnia, parasomnias, and narcolepsy is still evolving. There is a complex relation between the sleeping brain and its waking function. The interplay among genetic factors, alterations in neurotransmitters, electrophysiological changes, and environmental factors potentially contribute to the genesis of these sleep disorders.
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Affiliation(s)
- Kiran Maski
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Judith A Owens
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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79
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Dubessy AL, Leu-Semenescu S, Attali V, Maranci JB, Arnulf I. Sexsomnia: A Specialized Non-REM Parasomnia? Sleep 2016; 40:2666486. [DOI: 10.1093/sleep/zsw043] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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80
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Stallman HM, Kohler M. Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0164769. [PMID: 27832078 PMCID: PMC5104520 DOI: 10.1371/journal.pone.0164769] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023] Open
Abstract
Sleepwalking is thought to be a common arousal disorder; however, the epidemiology of this disorder has not yet been systematically examined. A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted for 'sleepwalking' OR 'somnambulism' in any field, to identify studies that reported the epidemiology of sleepwalking or sleepwalking disorders. Fifty-one studies assessed the prevalence rates of sleepwalking in a total sample of 100 490. The meta-analysis showed the estimated lifetime prevalence of sleepwalking was 6.9% (95% CI 4.6%-10.3%). The current prevalence rate of sleepwalking-within the last 12 months-was significantly higher in children 5.0% (95% CI 3.8%-6.5%) than adults 1.5% (95% CI 1.0%-2.3%). There was no evidence of developmental trends in sleepwalking across childhood. The significant risk of bias across all studies suggests these results should be used cautiously. Further epidemiological research that addresses methodological problems found in studies of sleepwalking to date is needed.
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Affiliation(s)
- Helen M. Stallman
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, 5001, Australia
- * E-mail:
| | - Mark Kohler
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, 5001, Australia
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82
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83
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Horváth A, Papp A, Szűcs A. Progress in elucidating the pathophysiological basis of nonrapid eye movement parasomnias: not yet informing therapeutic strategies. Nat Sci Sleep 2016; 8:73-9. [PMID: 27022307 PMCID: PMC4790540 DOI: 10.2147/nss.s71513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nonrapid eye movement (NREM) or arousal parasomnias are prevalent conditions in children and young adults, apparently provoked by any medical, physical, mental, or pharmacologic/toxic agent disturbing normal biorhythm and causing sleep fragmentation or abundant amount of slow wave sleep. The nadir and the ascending slope of the first sleep cycle of night sleep are the typical periods when NREM parasomnias, especially sleepwalking may occur on sleep-microstructural level; microarousals are the typical moments allowing NREM parasomnias. While sleep-disturbing factors have a clear precipitating effect, a genetic predisposition appears necessary in most cases. A candidate gene for sleepwalking has been identified on chromosome 20q12-q13.12 in one sleepwalking family. NREM parasomnias have a genetic and clinical link with nocturnal-frontal lobe epilepsies; possibly through an abnormality of the acetylcholine-related sleep-control system. The association of NREM parasomnias with the human leukocyte antigen system might be the sign of an autoimmune background to be further clarified. In the treatment of arousal parasomnias, the main tools are adequate sleep hygiene and the management of underlying conditions. Their pharmacotherapy has remained unresolved; the best options are clonazepam and some of the antidepressants, while a psychotherapy approach is also justified.
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Affiliation(s)
- András Horváth
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
| | - Anikó Papp
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
| | - Anna Szűcs
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
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Calabrò RS, Milardi D, Cacciola A, Marra A, Digangi G, Casella C, Manuli A, De Luca R, Silvestri R, Bramanti P. Moving into the wide clinical spectrum of consciousness disorders: Pearls, perils and pitfalls. MEDICINA-LITHUANIA 2016; 52:11-8. [PMID: 26987495 DOI: 10.1016/j.medici.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 11/21/2015] [Accepted: 01/06/2016] [Indexed: 12/30/2022]
Abstract
The last few years have been characterized by a growing interest of the medical and scientific world for the field of consciousness and its related disorders. Medically speaking, consciousness can be defined as the state of awareness of self and environment and the alertness to external stimulation, besides responsiveness to inner need. Transient loss of consciousness can be due to alterations in cerebral blood flow leading to fainting or syncope, migraine, metabolic dysfunctions, unexpected intracranial pressure increases, epileptic seizures, and sleep disorders. Chronic disorders of consciousness are a tragic success of high-technology treatment, in an attempt to maintain or reestablish brain function, which is to be considered as the main goal of therapeutics. Management of vegetative or a minimally conscious state individuals involves charily getting the right diagnosis with an evidence-based prognosis, also taking into account the medical, ethical, and legal key factors of the ideal treatment. This paper is aimed at exploring the wide spectrum of consciousness disorders and their clinical differential diagnosis, with particular regards to those with a negative impact on patient and their caregiver quality of life, including epilepsy, sleep disorders, and vegetative/minimally conscious state.
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Affiliation(s)
| | - Demetrio Milardi
- IRCCS Neurolesi "Bonino Pulejo" Center, Messina, Italy; Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Alberto Cacciola
- IRCCS Neurolesi "Bonino Pulejo" Center, Messina, Italy; Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Angela Marra
- IRCCS Neurolesi "Bonino Pulejo" Center, Messina, Italy
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Schlafwandeln, Schlaftrunkenheit und Nachtschreck: die klassischen NREM‑Parasomnien und ihre Differenzialdiagnose im Erwachsenenalter. SOMNOLOGIE 2015. [DOI: 10.1007/s11818-015-0028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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86
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Bjorvatn B, Magerøy N, Moen BE, Pallesen S, Waage S. Parasomnias are more frequent in shift workers than in day workers. Chronobiol Int 2015; 32:1352-8. [DOI: 10.3109/07420528.2015.1091354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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87
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Terzaghi M, Manni R. Mapping the features of arousal parasonmnias in adults: on the way to better understand arousal parasomnias and ease differential diagnosis. Sleep Med 2015; 16:1439-1440. [DOI: 10.1016/j.sleep.2015.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
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Sandman N, Valli K, Kronholm E, Revonsuo A, Laatikainen T, Paunio T. Nightmares: risk factors among the Finnish general adult population. Sleep 2015; 38:507-14. [PMID: 25325474 DOI: 10.5665/sleep.4560] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/14/2014] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES To identify risk factors for experiencing nightmares among the Finnish general adult population. The study aimed to both test whether previously reported correlates of frequent nightmares could be reproduced in a large population sample and to explore previously unreported associations. DESIGN Two independent cross-sectional population surveys of the National FINRISK Study. SETTING Age- and sex-stratified random samples of the Finnish population in 2007 and 2012. PARTICIPANTS A total of 13,922 participants (6,515 men and 7,407 women) aged 25-74 y. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Nightmare frequency as well as several items related to socioeconomic status, sleep, mental well-being, life satisfaction, alcohol use, medication, and physical well-being were recorded with a questionnaire. In multinomial logistic regression analysis, a depression-related negative attitude toward the self (odds ratio [OR] 1.32 per 1-point increase), insomnia (OR 6.90), and exhaustion and fatigue (OR 6.86) were the strongest risk factors for experiencing frequent nightmares (P < 0.001 for all). Sex, age, a self-reported impaired ability to work, low life satisfaction, the use of antidepressants or hypnotics, and frequent heavy use of alcohol were also strongly associated with frequent nightmares (P < 0.001 for all). CONCLUSIONS Symptoms of depression and insomnia were the strongest predictors of frequent nightmares in this dataset. Additionally, a wide variety of factors related to psychological and physical well-being were associated with nightmare frequency with modest effect sizes. Hence, nightmare frequency appears to have a strong connection with sleep and mood problems, but is also associated with a variety of measures of psychological and physical well-being.
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Affiliation(s)
- Nils Sandman
- National Institute for Health and Welfare, Public Health Genomics Unit and Institute for Molecular Medicine FIMM, Helsinki, Finland.,University of Turku, Centre for Cognitive Neuroscience, Turku Brain and Mind Center, Department of Psychology, Turku, Finland
| | - Katja Valli
- University of Turku, Centre for Cognitive Neuroscience, Turku Brain and Mind Center Department of Psychology, Turku, Finland.,School of Bioscience, University of Skövde, Skövde, Sweden
| | - Erkki Kronholm
- National Institute for Health and Welfare, Department of Health, Unit of Chronic Disease Prevention, Turku, Finland
| | - Antti Revonsuo
- University of Turku, Centre for Cognitive Neuroscience, Turku Brain and Mind Center Department of Psychology, Turku, Finland.,School of Bioscience, University of Skövde, Skövde, Sweden
| | - Tiina Laatikainen
- National Institute for Health and Welfare, Department of Health, Unit of Chronic Disease Prevention, Turku, Finland.,University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland.,Hospital District of North Karelia, Joensuu, Finland
| | - Tiina Paunio
- National Institute for Health and Welfare, Public Health Genomics Unit and Institute for Molecular Medicine FIMM, Helsinki, Finland.,Helsinki University and University Hospital, Department of Psychiatry, Helsinki, Finland
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Januszko P, Niemcewicz S, Gajda T, Wołyńczyk-Gmaj D, Piotrowska AJ, Gmaj B, Piotrowski T, Szelenberger W. Sleepwalking episodes are preceded by arousal-related activation in the cingulate motor area: EEG current density imaging. Clin Neurophysiol 2015; 127:530-536. [PMID: 25708721 DOI: 10.1016/j.clinph.2015.01.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate local arousal fluctuations in adults who received ICSD-2 diagnosis of somnambulism. METHODS EEG neuroimaging (eLORETA) was utilized to compare current density distribution for 4s epochs immediately preceding sleepwalking episode (from -4.0 s to 0 s) to the distribution during earlier 4s epochs (from -8.0 s to -4.0 s) in 20 EEG segments from 15 patients. RESULTS Comparisons between eLORETA images revealed significant (t>4.52; p<0.05) brain activations before onset of sleepwalking, with greater current density within beta 3 frequency range (24-30 Hz) in Brodmann areas 33 and 24. CONCLUSIONS Sleepwalking motor events are associated with arousal-related activation of cingulate motor area. SIGNIFICANCE These results support the notion of blurred boundaries between wakefulness and NREM sleep in sleepwalking.
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Affiliation(s)
- Piotr Januszko
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland.
| | - Szymon Niemcewicz
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Tomasz Gajda
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Dorota Wołyńczyk-Gmaj
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Anna Justyna Piotrowska
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Bartłomiej Gmaj
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Tadeusz Piotrowski
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Waldemar Szelenberger
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
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Fois C, Wright MAS, Sechi G, Walker MC, Eriksson SH. The utility of polysomnography for the diagnosis of NREM parasomnias: an observational study over 4 years of clinical practice. J Neurol 2015; 262:385-93. [PMID: 25408370 PMCID: PMC4330461 DOI: 10.1007/s00415-014-7578-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/16/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
Abstract
Polysomnography (PSG) is considered the gold standard for diagnosis of non-rapid eye movement (NREM) parasomnias, however its diagnostic yield has been rarely reported. We aimed to assess the diagnostic value of polysomnography in different categories of patients with suspected NREM parasomnia and define variables that can affect the outcome. 124 adults referred for polysomnography for suspected NREM parasomnia were retrospectively identified and divided into clinical categories based on their history. Each polysomnography was analysed for features of NREM parasomnia or different sleep disorders and for presence of potential precipitants. The impact on the outcome of number of recording nights and concomitant consumption of benzodiazepines and antidepressants was assessed. Overall, PSG confirmed NREM parasomnias in 60.5 % patients and showed a different sleep disorder in another 16 %. Precipitants were found in 21 % of the 124 patients. However, PSG showed limited value when the NREM parasomnia was clinically uncomplicated, since it rarely revealed a different diagnosis or unsuspected precipitants (5 % respectively), but became essential for people with unusual features in the history where different or overlapping diagnoses (18 %) or unsuspected precipitants (24 %) were commonly identified. Taking benzodiazepines or antidepressants during the PSG reduced the diagnostic yield. PSG has a high diagnostic yield in patients with suspected NREM parasomnia, and can reveal a different diagnosis or precipitants in over 40 % of people with complicated or atypical presentation or those with a history of epilepsy. We suggest that PSG should be performed for one night in the first instance, with leg electrodes and respiratory measurements and after benzodiazepine and antidepressant withdrawal.
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Affiliation(s)
- Chiara Fois
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Mary-Anne S. Wright
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
| | - GianPietro Sechi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Matthew C. Walker
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
| | - Sofia H. Eriksson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
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Ylikoski A, Martikainen K, Partinen M. Parasomnias and isolated sleep symptoms in Parkinson's disease: A questionnaire study on 661 patients. J Neurol Sci 2014; 346:204-8. [DOI: 10.1016/j.jns.2014.08.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/30/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
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Abstract
The military population is particularly vulnerable to a multitude of sleep-related disorders owing to the type of work performed by active duty servicemembers (ADSMs). Inadequate sleep, due to insufficient quantity or quality, is increasingly recognized as a public health concern. Traditionally, ADSMs have been encouraged that they can adapt to insufficient sleep just as the body adapts to physical training, but there is a substantial body of scientific literature which argues that this is not possible. Additionally, the military work environment creates unique challenges with respect to treatment options for common sleep disorders like obstructive sleep apnea, restless legs syndrome, and parasomnias. This review highlights sleep disorders which are prevalent in the modern military force and discusses the impact of poor sleep on overall performance. Medical treatments and recommendations for unit leaders are also discussed.
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93
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Kilincaslan A, Yilmaz K, Oflaz SB, Aydin N. Epidemiological study of self-reported sleep problems in Turkish high school adolescents. Pediatr Int 2014; 56:594-600. [PMID: 24418006 DOI: 10.1111/ped.12287] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 12/04/2013] [Accepted: 12/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the frequency and correlates of a variety of sleep problems in adolescents. METHODS A representative school-based sample of 3485 8th-12th graders was selected according to the cluster sampling technique. A sleep questionnaire and the Strengths and Difficulties Questionnaire were completed by the students along with their parents. Logistic regression analysis was used to identify the independent variables of insomnia, parasomnia and excessive daytime sleepiness (EDS). RESULTS Initiation insomnia, maintenance insomnia, non-restorative sleep (NRS) and EDS were described by 12.4%, 10.7%, 9% and 9.7%, respectively. At least one parasomnia with a frequency above the median was reported by 23.4% (nightmare, 12.8%; sleep terror, 3.6%; sleepwalking, 2.5%; bruxism, 2.5%; and sleep talking, 10.9%). Insomnias and parasomnias were highly associated with each other. Female gender was related to maintenance insomnia, NRS and night terror. Emotional problems correlated with initiation insomnia, maintenance insomnia, NRS, EDS, nightmares and bruxism; hyperactivity/inattention with initiation insomnia, NRS and sleep talking. Conduct problems were associated with NRS, whereas poor school performance was associated with initiation insomnia. CONCLUSION Self-reported sleep problems were prevalent and highly associated with each other and behavioral and emotional difficulties in Turkish adolescents.
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Affiliation(s)
- Ayse Kilincaslan
- Department of Child and Adolescent Psychiatry, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Ferrara P, Ianniello F, Romani L, Fabrizio GC, Gatto A, Chiaretti A. Five years of experience in nocturnal enuresis and urinary incontinence in children: where we are and where we are going. Urol Int 2013; 92:223-9. [PMID: 24246887 DOI: 10.1159/000354388] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nocturnal enuresis (NE) is a very common pediatric disorder. The aim of this study was to evaluate the characteristics of patients with NE or urinary incontinence (UI) during a period of 5 years to increase the knowledge on these conditions and optimize their diagnosis and treatment. METHODS We enrolled 278 children with NE or UI referred to the pediatric nephrology ambulatory, 'A. Gemelli' University Hospital of Rome, from December 2006 to December 2011. RESULTS We observed that heredity, parasomnias, left-handedness, polythelia and constipation are correlated to NE and UI. CONCLUSIONS We wanted to clarify the definition of NE and UI and describe our experience on the main characteristics of these conditions by referring to the latest knowledge reported in the literature.
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Affiliation(s)
- P Ferrara
- Institute of Pediatrics, 'A. Gemelli' University Hospital, Rome, Italy
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95
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Sandman N, Valli K, Kronholm E, Ollila HM, Revonsuo A, Laatikainen T, Paunio T. Nightmares: Prevalence among the Finnish General Adult Population and War Veterans during 1972-2007. Sleep 2013; 36:1041-1050. [PMID: 23814341 DOI: 10.5665/sleep.2806] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY OBJECTIVES To investigate the prevalence of nightmares among the Finnish general adult population during 1972-2007 and the association between nightmare prevalence and symptoms of insomnia, depression, and anxiety in World War II veterans. DESIGN Eight independent cross-sectional population surveys of the National FINRISK Study conducted in Finland in 1972, 1977, 1982, 1987, 1992, 1997, 2002, and 2007. SETTING Epidemiologic. PARTICIPANTS A total of 69,813 people (33,811 men and 36,002 women) age 25-74 years. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The investigation of nightmare prevalence and insomnia, depression, and anxiety symptoms was based on questionnaires completed by the participants. Among the whole sample, 3.5% of the men and 4.8% of the women reported frequent nightmares (P < 0.0001 for sex difference), but the prevalence was affected by the age of participants and the year of the survey. Nightmare prevalence increased with age, particularly among the men. The number of people reporting occasional nightmares increased roughly by 20% for both sexes from 1972 to 2007 (P < 0.0001). Participants with war experiences reported more frequent nightmares and symptoms of insomnia, depression, and anxiety than participants without such experiences (P < 0.0001). CONCLUSIONS Prevalence of nightmares was affected by the sex and age of the participants, and occasional nightmares have become more common in Finland. Exposure to war elevates nightmare prevalence as well as insomnia, depression, and anxiety symptoms even decades after the war; large numbers of war veterans can affect nightmare prevalence on population level. CITATION Sandman N; Valli K; Kronholm E; Ollila HM; Revonsuo A; Laatikainen T; Paunio T. Nightmares: prevalence among the Finnish general adult population and war veterans during 1972-2007. SLEEP 2013;36(7):1041-1050.
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Affiliation(s)
- Nils Sandman
- National Institute for Health and Welfare, Public Health Genomics Unit and Institute for Molecular Medicine FIMM, Helsinki, Finland ; University of Turku, Centre for Cognitive Neuroscience, Department of Psychology, Turku, Finland
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96
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Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is the second most common type of neurodegenerative dementia. It is frequently difficult to differentiate DLB from Alzheimer's disease (AD) and other types of dementia. This study examined the usefulness of monitoring sleep talking for the diagnosis of DLB. METHODS A total of 317 patients with dementia were selected from a consecutive series at the Dementia Clinic of Kumamoto University Hospital. Diagnostic categories consisted of probable DLB (n = 55), probable AD (n = 191), frontotemporal lobar degeneration (FTLD) (n = 16), vascular dementia (VaD) (n = 18), and other/unspecified dementia (n = 37). We evaluated sleep talking in all dementia patients and normal elderly subjects (n = 32) using an originally designed sleep talking questionnaire. RESULTS Sleep talking occurred most frequently in the DLB group (61.8%), followed by the VaD group (33.3%), other/unspecified dementia group (27.0%), AD group (18.8%), FTLD group (12.5%), and normal elderly subjects group (6.3%). The prevalence of sleep talking in the DLB group was significantly higher than in other groups, except in the VaD group. The sleep talking yielded high specificity (81.2%) and some sensitivity (61.8%) for the differential diagnosis of DLB from AD. Furthermore, loud sleep talking may improve the specificity (96.9%). For the differentiation of DLB from all other dementia types, the specificity of sleep talking and loud sleep talking was also high (79.4% and 95.8% respectively). CONCLUSIONS Assessing sleep talking, especially the volume of sleep talking, may be useful in the clinical discrimination of DLB from not only AD but also from all other types of dementia.
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Abstract
Although parasomnias should be considered benign conditions without a deleterious impact on sleep quality and quantity, especially in children, it is important to recognize and properly diagnose these phenomena. Moreover, parasomnias may be misdiagnosed as epileptic seizures, in particular seizures with a predominant complex motor behavior as seizures occurring in nocturnal frontal lobe epilepsy (NFLE), leading to unnecessary and expensive investigations and prolonged and unsuccessful treatment. In this article we describe the clinical and neurophysiologic features of the most common parasomnias, giving the most reliable elements of differential diagnosis between parasomnias and epileptic nocturnal seizures, namely the typical seizures occurring in NFLE. The diagnostic value of history-taking, video-polysomnography, home video recording, and diagnostic scales is discussed. Next we describe the intriguing aspect of the frequent coexistence, in the same family and even in the same patients, of epileptic and parasomniac attacks, giving a common neurophysiologic interpretation. Finally some brief indications to the treatment of parasomnias are suggested.
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Affiliation(s)
- Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche, Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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100
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Augedal AW, Hansen KS, Kronhaug CR, Harvey AG, Pallesen S. Randomized controlled trials of psychological and pharmacological treatments for nightmares: a meta-analysis. Sleep Med Rev 2012; 17:143-52. [PMID: 23046846 DOI: 10.1016/j.smrv.2012.06.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 12/17/2022]
Abstract
A meta-analysis of treatments for nightmares is reported. The studies were identified by database searches and by an inspection of relevant reference lists. The inclusion criteria were: nightmares as a target problem, studies published in English, use of a randomized controlled trials and reporting of nightmare-relevant outcomes. A total of 19 studies, published between 1978 and 2012 were identified, which included 1285 participants. Effect sizes were calculated as Cohen's d. A statistically significant improvement for all studies combined (d = 0.47, 95% CI = 0.33-0.60, fixed effects model; d = 0.49, 95% CI = 0.32-0.66, random effects model) and for psychological treatments alone (d = 0.48, 95% CI = 0.36-0.60, random) and for prazosin alone (d = 0.50, 95% CI = 0.03-0.96, random) was found. Individual therapy format yielded a higher effect size than a self-help format (p = 0.03). Minimal interventions (relaxation, recording) yielded lower overall effect size than studies offering more extensive interventions (p = 0.02). It is concluded that there are both psychological and pharmacological interventions which have documented effects for the treatment of nightmares.
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