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Blanchette-Carrière C, Montplaisir J, Boucetta S, Desautels A, Zadra A. Differential effects of sleep deprivation on sleepwalking: Role of demographic and clinical profiles. Sleep Med 2024; 121:144-150. [PMID: 38972128 DOI: 10.1016/j.sleep.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/29/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Although sleepwalking is one of the most prevalent and potentially injurious of the NREM parasomnias, it is still diagnosed primarily based on the patient's clinical history. Early pilot work suggested that sleep deprivation protocols could help obtain a polysomnographically-based (PSG) diagnosis of sleepwalking, but larger studies remain lacking. METHODS We compared baseline PSG recordings with those obtained after 25hrs of sleep deprivation in a cohort of 124 consecutively assessed adult sleepwalkers. RESULTS When compared to baseline recordings, post-sleep deprivation PSG assessments resulted in nearly twice as many somnambulistic episodes being recorded in the laboratory and significantly increased the proportion of patients (from 48 % to 63 %) experiencing at least one lab-based episode. Moreover, while 17 % of patients experienced a sleepwalking event exclusively during recovery sleep, only 2 % of patients did so solely at baseline. Sleep deprivation had similar facilitating effects on patents' somnambulistic events regardless of age of onset and positive versus negative family history for sleepwalking. Younger age and higher home episode frequency both predicted a positive response to sleep deprivation. A separate group of 17 patients with comorbid sleep disorders showed a similar increase in their proportion experiencing at least one episode during recovery sleep. CONCLUSION The results from this large series of sleepwalkers provide strong support for the use of sleep deprivation in facilitating the occurrence of somnambulistic events in the sleep laboratory.
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Affiliation(s)
- C Blanchette-Carrière
- Department of Psychology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada.
| | - J Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada; Department of Psychiatry, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - S Boucetta
- Neurotherapy Montreal, 1140 Beaumont Av., Montréal, Québec, H3P 3E5, Canada.
| | - A Desautels
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada; Department of Neurosciences, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - A Zadra
- Department of Psychology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada.
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Lopez R, Dauvilliers Y. Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications. Sleep Med Rev 2024; 73:101888. [PMID: 38150767 DOI: 10.1016/j.smrv.2023.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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3
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Lopez R, Barateau L, Chenini S, Rassu AL, Dauvilliers Y. Home nocturnal infrared video to record non-rapid eye movement sleep parasomnias. J Sleep Res 2023; 32:e13732. [PMID: 36122661 DOI: 10.1111/jsr.13732] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
To assess the feasibility, the acceptability and the usefulness of home nocturnal infrared video in recording the frequency and the complexity of non-rapid eye movement sleep parasomnias in adults, and in monitoring the treatment response. Twenty adult patients (10 males, median age 27.5 years) with a diagnosis of non-rapid eye movement parasomnia were consecutively enrolled. They had a face-to-face interview, completed self-reported questionnaires to assess clinical characteristics and performed a video-polysomnography in the Sleep Unit. Patients were then monitored at home during at least five consecutive nights using infrared-triggered cameras. They completed a sleep diary and questionnaires to evaluate the number of parasomniac episodes at home and the acceptability of the home nocturnal infrared video recording. Behavioural analyses were performed on home nocturnal infrared video and video-polysomnography recordings. Eight patients treated by clonazepam underwent a second home nocturnal infrared video recording during five consecutive days. All patients had at least one parasomniac episode during the home nocturnal infrared video monitoring, compared with 75% during the video-polysomnography. A minimum of three consecutive nights with home nocturnal infrared video was required to record at least one parasomniac episode. Most patients underestimated the frequency of episodes on the sleep diary compared with home nocturnal infrared video. Episodes recorded at home were often more complex than those recorded during the video-polysomnography. The user-perceived acceptability of the home nocturnal infrared video assessment was excellent. The frequency and the complexity of the parasomniac episodes decreased with clonazepam. Home nocturnal infrared video has good feasibility and acceptability, and may improve the evaluation of the phenotype and severity of the non-rapid eye movement parasomnias and of the treatment response in an ecological setting.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Lucie Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Sofiène Chenini
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Anna Laura Rassu
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
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Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, Castelnovo A. Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults. Diagnostics (Basel) 2023; 13:diagnostics13071261. [PMID: 37046480 PMCID: PMC10093221 DOI: 10.3390/diagnostics13071261] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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Gauld C, Lopez R, Philip P, Taillard J, Morin CM, Geoffroy PA, Micoulaud-Franchi JA. A Systematic Review of Sleep–Wake Disorder Diagnostic Criteria Reliability Studies. Biomedicines 2022; 10:biomedicines10071616. [PMID: 35884924 PMCID: PMC9313077 DOI: 10.3390/biomedicines10071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
The aim of this article is to provide a systematic review of reliability studies of the sleep–wake disorder diagnostic criteria of the international classifications used in sleep medicine. Electronic databases (ubMed (1946–2021) and Web of Science (—2021)) were searched up to December 2021 for studies computing the Cohen’s kappa coefficient of diagnostic criteria for the main sleep–wake disorder categories described in the principal classifications. Cohen’s kappa coefficients were extracted for each main sleep–wake disorder category, for each classification subtype, and for the different types of methods used to test the degree of agreement about a diagnosis. The database search identified 383 studies. Fifteen studies were analyzed in this systematic review. Insomnia disorder (10/15) and parasomnia disorder (7/15) diagnostic criteria were the most studied. The reliability of all sleep–wake disorders presented a Cohen’s kappa with substantial agreement (Cohen’s kappa mean = 0.66). The two main reliability methods identified were “test–retest reliability” (11/15), principally used for International Classification of Sleep Disorders (ICSD), and “joint interrater reliability” (4/15), principally used for Diagnostic and Statistical Manual of Mental Disorders (DSM) subtype diagnostic criteria, in particularl, the DSM-5. The implications in terms of the design of the methods used to test the degree of agreement about a diagnosis in sleep medicine are discussed.
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Affiliation(s)
- Christophe Gauld
- Department of Child Psychiatry, Hospices Civils de Lyon, 69000 Lyon, France;
- UMR CNRS 8590 IHPST, Sorbonne University, 75007 Paris, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, 34000 Montpellier, France;
- Inserm, Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, 34000 Montpellier, France
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33 076 Bordeaux, France;
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
| | - Jacques Taillard
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
| | - Charles M. Morin
- École de Psychologie, Université Laval, 2325 Rue des Bibliothèques, Québec City, QC G1V 0A6, Canada;
- Centre D’étude des Troubles du Sommeil, Université Laval, 2325 Rue des Bibliothèques, Québec City, QC G1V 0A6, Canada
| | - Pierre Alexis Geoffroy
- Département de Psychiatrie et d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat—Claude Bernard, 75018 Paris, France;
- GHU Paris—Psychiatry & Neurosciences, 1 Rue Cabanis, 75014 Paris, France
- NeuroDiderot, Inserm, Université de Paris, FHU I2-D2, 75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33 076 Bordeaux, France;
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
- Correspondence: ; Tel.: +33-(0)5-57-82-01-82
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Kalantari N, McDuff P, Pilon M, Desautels A, Montplaisir JY, Zadra A. Self-reported developmental changes in the frequency and characteristics of somnambulistic and sleep terror episodes in chronic sleepwalkers. Sleep Med 2021; 89:147-155. [PMID: 34990921 DOI: 10.1016/j.sleep.2021.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Far from being benign, somnambulistic episodes can be frequent and/or severe and potentially injurious. Episodes may also be accompanied by sleep mentation with variable degrees of retrograde amnesia. The present study investigated how somnambulistic episodes unfold from childhood through adulthood, a topic that remains understudied. METHODS Adult sleepwalkers with a diagnosis of primary somnambulism and a childhood onset of the disorder (n = 113) were assessed for changes in frequency of their episodes, recall of episode-related sleep mentation and aggressive episodes during childhood, adolescence and adulthood. In addition, sleepwalkers (n = 52) with childhood-onset of sleep terrors were assessed for developmental changes in sleep terror frequency. RESULTS Results indicate that the frequency of somnambulistic episodes remains unchanged during childhood and adolescence before increasing during adulthood. An opposite trend was observed for sleep terrors. The frequency of aggressive somnambulistic episodes and of sleep mentation associated with somnambulism increased from childhood to adolescence and into adulthood. By contrast, the recall of sleep mentation associated with sleep terrors did not change over time. Additionally, a higher frequency of aggressive somnambulistic episodes predicted a higher frequency of sleep mentation associated with somnambulism. These patterns were similar across men and women. CONCLUSION Our study demonstrates that in chronic sleepwalkers, sleep mentation associated with somnambulistic episodes increases with age while episodes worsen in frequency and severity from childhood to adulthood. These findings add to the limited literature in the field and provide valuable insights into how key clinical characteristics of somnambulism evolve across the lifespan.
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Affiliation(s)
- Narges Kalantari
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Pierre McDuff
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Mathieu Pilon
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Alex Desautels
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Jacques-Yves Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Antonio Zadra
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
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Gauld C, Lopez R, Geoffroy PA, Morin CM, Guichard K, Giroux É, Dauvilliers Y, Dumas G, Philip P, Micoulaud-Franchi JA. A systematic analysis of ICSD-3 diagnostic criteria and proposal for further structured iteration. Sleep Med Rev 2021; 58:101439. [DOI: 10.1016/j.smrv.2021.101439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
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Montini A, Loddo G, Baldelli L, Cilea R, Provini F. Sleep-Related Hypermotor Epilepsy vs Disorders of Arousal in Adults: A Step-Wise Approach to Diagnosis. Chest 2021; 160:319-329. [PMID: 33529771 DOI: 10.1016/j.chest.2021.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) are sleep-related events characterized by complex, often bizarre, and violent behaviors. DoA are involuntary motor manifestations of various complexities occurring during incomplete awakening from non-rapid eye movement sleep. SHE is a focal epilepsy characterized by stereotyped hyperkinetic or/and asymmetric tonic/dystonic seizures usually arising from non-rapid eye movement sleep. Even if many aspects regarding DoA and SHE have been clarified, the differential diagnosis remains challenging, because DoA and SHE share some semiologic features and genetic background. The clinical history, collected from the patient and his/her witness, represents the first and common milestone in the diagnosis. Validated questionnaires constitute suitable screening tools that could guide further analysis. The worldwide availability of homemade video recordings has increased the possibility of adding more objective information to the clinical history alone. The confirmed diagnosis relies on video-polysomnographic recording although it requires time, economic resources, and specific skills for the analysis. In this review we propose a simple diagnostic algorithm for the differential diagnosis between DoA and SHE in adults, based on the most updated knowledge, from the simpler tool to the most specific and tailored one.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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Loddo G, La Fauci G, Vignatelli L, Zenesini C, Cilea R, Mignani F, Cecere A, Mondini S, Baldelli L, Bisulli F, Licchetta L, Mostacci B, Guaraldi P, Giannini G, Tinuper P, Provini F. The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals, Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units. Sleep Med 2021; 80:279-285. [PMID: 33610075 DOI: 10.1016/j.sleep.2021.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arousal Disorders (DoA) include Confusional Arousals, Sleepwalking and Sleep Terrors. DoA diagnosis is mainly clinical but no validated questionnaires exist for DoA screening according to the criteria of the International Classification of Sleep Disorders, Third Edition. Recently our group proposed the Arousal Disorders Questionnaire (ADQ) as a new diagnostic tool for DoA diagnosis. The objective of this study was to evaluate the diagnostic accuracy of the ADQ in a sleep and epilepsy center. METHODS One interviewer blinded to clinical and video-polysomnographic (VPSG) data administered the ADQ to 150 patients consecutively admitted to our Sleep and Epilepsy Centers for a follow-up visit. The final diagnosis, according to VPSG recordings of at least one major episode, classified patients either with DoA (DoA group) or with other sleep-related motor behaviors confounding for DoA (nDoA group). RESULTS 47 patients (31%) composed the DoA group; 56 patients with REM sleep behavior disorder, 39 with sleep-hypermotor epilepsy, six with night eating syndrome, and two with drug-induced DoA composed the nDoA group. The ADQ had a sensitivity of 72% (95% CI: 60-82) and a specificity of 96% (95% CI: 89-98) for DoA diagnosis; excluding the items regarding consciousness and episode recall, sensitivity was 83% (95% CI: 71-90) and specificity 93% (95% CI: 86-97). CONCLUSIONS The ADQ showed good accuracy in screening patients with DoA in a sleep and epilepsy center setting. Diagnostic criteria related to cognition and episode recall reduced ADQ sensitivity, therefore a better definition of these criteria is required, especially in adults.
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Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giusy La Fauci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Mignani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Annagrazia Cecere
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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