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Bruni O, DelRosso LM, Melegari MG, Ferri R. The Parasomnias. Psychiatr Clin North Am 2024; 47:135-146. [PMID: 38302202 DOI: 10.1016/j.psc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy.
| | - Lourdes M DelRosso
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Aellen FM, Van der Meer J, Dietmann A, Schmidt M, Bassetti CLA, Tzovara A. Disentangling the complex landscape of sleep-wake disorders with data-driven phenotyping: A study of the Bernese center. Eur J Neurol 2024; 31:e16026. [PMID: 37531449 PMCID: PMC11235675 DOI: 10.1111/ene.16026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND PURPOSE The diagnosis of sleep-wake disorders (SWDs) is challenging because of the existence of only few accurate biomarkers and the frequent coexistence of multiple SWDs and/or other comorbidities. The aim of this study was to assess in a large cohort of well-characterized SWD patients the potential of a data-driven approach for the identification of SWDs. METHODS We included 6958 patients from the Bernese Sleep Registry and 300 variables/biomarkers including questionnaires, results of polysomnography/vigilance tests, and final clinical diagnoses. A pipeline, based on machine learning, was created to extract and cluster the clinical data. Our analysis was performed on three cohorts: patients with central disorders of hypersomnolence (CDHs), a full cohort of patients with SWDs, and a clean cohort without coexisting SWDs. RESULTS A first analysis focused on the cohort of patients with CDHs and revealed four patient clusters: two clusters for narcolepsy type 1 (NT1) but not for narcolepsy type 2 or idiopathic hypersomnia. In the full cohort of SWDs, nine clusters were found: four contained patients with obstructive and central sleep apnea syndrome, one with NT1, and four with intermixed SWDs. In the cohort of patients without coexisting SWDs, an additional cluster of patients with chronic insomnia disorder was identified. CONCLUSIONS This study confirms the existence of clear clusters of NT1 in CDHs, but mainly intermixed groups in the full spectrum of SWDs, with the exception of sleep apnea syndromes and NT1. New biomarkers are needed for better phenotyping and diagnosis of SWDs.
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Affiliation(s)
- Florence M. Aellen
- Institute of Computer ScienceUniversity of BernBernSwitzerland
- Center for Experimental Neurology, Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Julia Van der Meer
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Anelia Dietmann
- Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Markus Schmidt
- Center for Experimental Neurology, Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Claudio L. A. Bassetti
- Center for Experimental Neurology, Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
| | - Athina Tzovara
- Institute of Computer ScienceUniversity of BernBernSwitzerland
- Center for Experimental Neurology, Department of NeurologyInselspital, Bern University Hospital and University of BernBernSwitzerland
- Sleep Wake Epilepsy Center–NeuroTec, Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
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Blaszczyk B, Wieczorek T, Michalek-Zrabkowska M, Wieckiewicz M, Mazur G, Martynowicz H. Polysomnography findings in sleep-related eating disorder: a systematic review and case report. Front Psychiatry 2023; 14:1139670. [PMID: 37234216 PMCID: PMC10206059 DOI: 10.3389/fpsyt.2023.1139670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
Background Sleep-related eating disorder (SRED) consists of recurrent episodes of uncontrolled, involuntary eating and drinking 1-3 h after falling asleep with partial or full unconsciousness. This condition is diagnosed based on interviews with the patients affected and the diagnostic criteria of the International Classification of Sleep Disorders. However, polysomnography (PSG) is not necessary to confirm this disease. This systematic review aims to evaluate the findings of PSG in SRED patients. Methods For this systematic review, PubMed, Embase, and Scopus databases were searched in February 2023, which resulted in 219 records. After removing duplicates, the articles that included the presentation of PSG results of SRED patients in English were selected. In addition, only original studies were considered. The risk of bias by using case reports and descriptive studies was assessed using the Joanna Briggs Institute critical appraisal tools and the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Furthermore, a case report of a 66-year-old woman with SRED was included. Results A total of 15 papers were selected for further analysis, of which 7 were descriptive studies, 6 were case reports, and 2 were observational studies. The risk of bias in the majority of the studies was moderate or high. Unexpectedly, if the eating episode occurred during PSG, in most cases it was not observed during deep sleep (the N3 sleep stage). Moreover, studies did not report significant deviations in the sleep parameters measured using PSG. Among SRED patients, the prevalence of sleepwalking was much higher than the general population. Our case report presented a potentially life-threatening episode of holding an apple in the mouth that might result in choking, which was captured using PSG. Conclusion Polysomnography is not necessary for the diagnosis of SRED. However, it could facilitate the diagnosis and differentiation of SRED from other eating disorders. PSG also has limitations in capturing eating episodes and in addition, its cost effectiveness should be considered during the diagnostic process. More studies into the pathophysiology of SRED are needed because classifying SRED as non-rapid eye movement parasomnias can be inappropriate as it does not always occur during deep sleep.
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Affiliation(s)
- Bartlomiej Blaszczyk
- Student Research Club No K133, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Wieczorek
- Department and Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Michalek-Zrabkowska
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Mieszko Wieckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Helena Martynowicz
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:jcm12010372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Paulekiene G, Pajarskiene M, Pajediene E, Radziunas A. Sleep Dysfunction and Grey Matter Volume. Curr Neurol Neurosci Rep 2022; 22:275-283. [PMID: 35364772 DOI: 10.1007/s11910-022-01190-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW With the voxel-based morphometry (VBM), structural imaging studies turned into new directions aiming to explore neurological disorders differently. This approach helps identify possible pathophysiological correlations between neuroanatomical grey matter (GM) structures in patients with sleep dysfunction. This article reviews recent findings on GM structure in various sleep disorders and possible causes of disturbed sleep and discusses the future perspectives. RECENT FINDINGS At present, research on the effect of GM volume changes in specific brain areas on the pathogenesis of sleep disturbances is incomplete. It remains unknown if the GM thickness reduction in patients with REM sleep behaviour disorder, obstructive sleep apnea, restless legs syndrome, and insomnia is due to complex disease presentation or direct response to disturbed sleep. Additionally, many VBM studies have yielded inconsistent results showing either reduction or increase in GM. The spatiotemporal complexity of whole-brain networks and state transitions during sleep and the role of GM changes increase new debates. Having multimodal data from large sample studies can help model sleep network dynamics in different disorders and provide novel data for possible therapeutic interventions.
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Affiliation(s)
- Gintare Paulekiene
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas , Lithuania
| | - Milda Pajarskiene
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas , Lithuania
| | - Evelina Pajediene
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas , Lithuania.
| | - Andrius Radziunas
- Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences , Kaunas, Lithuania
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Maytum J, Garcia J, Leighty D, Belew J. Utility of the Frontal Lobe Epilepsy Parasomnia Scale in Evaluation of Children With Nocturnal Events. J Neurosci Nurs 2021; 53:34-38. [PMID: 33298683 DOI: 10.1097/jnn.0000000000000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Sleep-related hypermotor epilepsy (SHE) and nocturnal non-rapid eye movement parasomnias are difficult to differentiate. Neurologists and sleep medicine clinicians largely rely on clinical history when evaluating nocturnal spells. When the diagnosis is in question, referral for video electroencephalogram monitoring is the standard. However, there are no guidelines as to when this evaluation is needed. The Frontal Lobe Epilepsy Parasomnia (FLEP) scale was developed to assist clinicians in differentiating the two among adults. The aim of this study was to provide a preliminary evaluation of the FLEP for use with children. METHODS: This was a retrospective pilot instrument validation study with a convenience sample of 17 children seen in neurology or sleep medicine clinics. To determine concurrent validity, FLEP scores were compared with clinical diagnoses by neurology providers confirmed by electroencephalography. RESULTS: With a cutoff score of 2, the modified FLEP distinguished between children with and without SHE. The FLEP tool had a specificity of 0.58, implying that 7 of the 12 children without SHE would have been accurately recommended to follow up for parasomnia management rather than more urgent evaluation of potential frontal lobe epilepsy. CONCLUSIONS: With some minor adaptations for children, the FLEP satisfactorily distinguished between SHE and non-SHE patients.
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Abstract
Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy.
| | | | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Irfan M, Schenck CH, Howell MJ. NonREM Disorders of Arousal and Related Parasomnias: an Updated Review. Neurotherapeutics 2021; 18:124-139. [PMID: 33527254 PMCID: PMC8116392 DOI: 10.1007/s13311-021-01011-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/14/2022] Open
Abstract
Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related parasomnias in this article. Sleepwalking (SW), sleep terrors (ST), confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications, in particular the widely prescribed benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation. Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED. Paroxetine has been reported to provide benefit in some cases of ST. Topiramate, pramipexole, and sertraline can be effective in SRED. Pharmacotherapy for other parasomnias continues to be less certain, necessitating further investigation. NREM parasomnias may resolve spontaneously but require a review of priming and predisposing factors.
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Affiliation(s)
- Muna Irfan
- Department of Neurology, Minneapolis Veterans Affairs Medical Center/ Pulmonary allergy, Critical Care and Sleep, University of Minnesota, Minneapolis, MN USA
| | - Carlos H. Schenck
- Department of Psychiatry, Hennepin Health Care, University of Minnesota, Minneapolis, MN USA
| | - Michael J Howell
- Department of Neurology, Sleep Disorders Center, University of Minnesota Medical Center, Minneapolis, MN USA
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Grigg-Damberger M, Foldvary-Schaefer N. Eyes wide open minds shut best identify disorders of arousal in adult sleepwalkers. J Clin Sleep Med 2020; 16:7-8. [PMID: 31957655 PMCID: PMC7053004 DOI: 10.5664/jcsm.8154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022]
Abstract
Grigg-Damberger M, Foldvary-Schaefer N. Eyes wide open minds shut best identify disorders of arousal in adult sleepwalkers. J Clin Sleep Med. 2020;16(1):7–8.
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Affiliation(s)
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Neurological Institute, Cleveland Clinic Lerner College of Medicine, Sleep Disorders and Epilepsy Centers, Cleveland, Ohio
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