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Waters F, Ling I, Azimi S, Blom JD. Sleep-Related Hallucinations. Sleep Med Clin 2024; 19:143-157. [PMID: 38368061 DOI: 10.1016/j.jsmc.2023.10.008] [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] [Indexed: 02/19/2024]
Abstract
The diagnostic category of sleep-related hallucinations (SRH) replaces the previous category of Terrifying Hypnagogic Hallucinations in the 2001 edition of International Classification of Sleep Disorders-R. Hypnagogic and hypnopompic hallucinations (HHH) that occur in the absence of other symptoms or disorder and, within the limits of normal sleep, are most likely non-pathological. By contrast, complex nocturnal visual hallucinations (CNVH) may reflect a dimension of psychopathology reflecting different combinations of etiologic influences. The identification and conceptualization of CNVH is relatively new, and more research is needed to clarify whether CNVH share common mechanisms with HHH.
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Affiliation(s)
- Flavie Waters
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Brockway Road, John XXIII Avenue, Mount Claremont, Perth, Western Australia 6009, Australia; School of Psychological Science, The University of Western Australia, Crawley, Western Australia, Australia.
| | - Ivan Ling
- West Australian Sleep Disorders Research Institute, Perth, Australia; Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, 5th Floor, G-block, Nedlands, Western Australia 6009, Australia
| | - Somayyeh Azimi
- Clinical Research Centre, Graylands Hospital, North Metropolitan Health Service Mental Health, Brockway Road, John XXIII Avenue, Mount Claremont, Perth, Western Australia 6009, Australia; School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, Kiwistraat 43, The Hague 2552 DH, the Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
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2
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Avidan AY. The Clinical Spectrum of the Parasomnias. Sleep Med Clin 2024; 19:1-19. [PMID: 38368057 DOI: 10.1016/j.jsmc.2023.12.003] [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] [Indexed: 02/19/2024]
Abstract
Parasomnias are defined as abnormal movements or behaviors that occur in sleep or during arousals from sleep. Parasomnias vary in frequency from episodic events that arise from incomplete sleep state transition. The framework by which parasomnias are categorized and diagnosed is based on the International Classification of Sleep Disorders-Third Edition, Text Revision (ICSD-3-TR), published by the American Academy of Sleep Medicine. The recent Third Edition, Text Revision (ICSD-3-TR) of the ICSD provides an expert consensus of the diagnostic requirements for sleep disorders, including parasomnias, based on an extensive review of the current literature.
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Affiliation(s)
- Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, UCLA, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA 90095-1769, USA.
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Darby RR, Considine C, Weinstock R, Darby WC. Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law. Nat Rev Neurol 2024; 20:183-193. [PMID: 38228905 DOI: 10.1038/s41582-023-00920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of 'forensic neurology', a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency.
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Affiliation(s)
- R Ryan Darby
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Ciaran Considine
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Weinstock
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Darby
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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YAZICI S, ÖNCÜ ÇETİNKAYA B. Sleep Disorders during Adolescence. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1105463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sleep disorders during adolescence period increase each year and adversely affect the physical and mental health of adolescents. After-school social activities and various work outside the school may cause delays in bedtime. In addition, there can be shifts in the circadian rhythm due to a number of biological changes seen in the transition to adolescence, which can result in a wide range of sleep problems, such as not being able to fall asleep at night, difficulty waking up in the morning, daytime sleepiness, sleep deprivation and deterioration in sleep quality. It is important to know the causes of sleep disorders, possible effects on physical health and mental health, and protective and risk-forming factors seen in adolescent period; to intervene in these disorders and to develop preventive measures. Preventive measures, such as increasing awareness about sleep disorders in adolescents, informing families and adolescents about the issue, and organizing school start-up times for this age group, may contribute significantly to solving this important issue, which has increased year-to-year.
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Carrarini C, Calisi D, De Rosa MA, Di Iorio A, D'Ardes D, Pellegrino R, Gazzina S, Pilotto A, Arighi A, Carandini T, Cagnin A, Mozzetta S, Gallucci M, Bonifati DM, Costa C, D'Antonio F, Bruno G, Cipollone F, Babiloni C, Padovani A, Onofrj M, Bonanni L. QEEG abnormalities in cognitively unimpaired patients with delirium. J Neurol Neurosurg Psychiatry 2023; 94:251-254. [PMID: 36261290 PMCID: PMC9985751 DOI: 10.1136/jnnp-2022-330010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 02/16/2023]
Affiliation(s)
- Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Matteo Alessandro De Rosa
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Angelo Di Iorio
- Department of Innovative Technologies in Medicine & Dentistry, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, off-Campus Semmelweis, University of Lugano, Lugano, Switzerland
| | - Stefano Gazzina
- Neurophysiology Unit, Azienda Ospedaliera Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Arighi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziana Carandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annachiara Cagnin
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Stefano Mozzetta
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | - Maurizio Gallucci
- Cognitive Impairment Center, Marca Trevigiana Local Unit of Health and Social Services 2, Treviso, Italy
| | - Domenico Marco Bonifati
- Unit of Neurology, Department of Neuro-cardio-vascular, Ospedale Santa Maria di Ca Foncello, Treviso, Italy
| | - Cinzia Costa
- Section of Neurology, S. Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizia D'Antonio
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Roma, Italy
| | - Giuseppe Bruno
- Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University of Rome, Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology, University of Rome La Sapienza, Rome, Italy.,San Raffaele Cassino Hospital, Cassino, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, Gabriele d'Annunzio University of Chieti and Pescara, Chieti, Italy
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Limbekar N, Pham J, Budhiraja R, Javaheri S, Epstein LJ, Batool-Anwar S, Pavlova M. NREM Parasomnias: Retrospective Analysis of Treatment Approaches and Comorbidities. Clocks Sleep 2022; 4:374-380. [PMID: 35997385 PMCID: PMC9397000 DOI: 10.3390/clockssleep4030031] [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: 12/30/2021] [Revised: 01/21/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Brief Summary Non-rapid eye movement (NREM) parasomnias are relatively common among children and can often persist into adulthood, where they can pose as a clinical challenge:, the behaviors can result in injury or have negative impacts on functioning and quality of life, thus necessitating treatment, but the choice of treatment is complicated by the lack of evidence—based guidelines, as well as potential side effects. The aim of this retrospective analysis is to examine the most frequently used treatment strategies and pharmaceuticals for NREM parasomnias and evaluate perceived outcomes based on the patient’s subjective reports of the frequency and severity of symptoms. Abstract The aim of this retrospective analysis is to determine the most frequently prescribed medications for the treatment of NREM parasomnias and evaluate reported outcomes. We performed a retrospective chart review of all patients with NREM parasomnia diagnosed within Brigham and Women’s Hospital (BWH) clinics examining the date of diagnosis, date of starting therapy, comorbidities, type of medication prescribed, and the reported change in symptoms or side effects at follow-up visits. From 2012 to 2019, 110 patients (59 females, 51 male) at BWH clinics received a diagnosis of NREM parasomnia, including sleepwalking and night terrors. The mean age was 44. Comorbidities included obstructive sleep apnea (OSA) (46%), periodic limb movement syndrome (PLMS) (13%), insomnia (19%), Restless leg syndrome (RLS) (9%), epilepsy (4%), and REM behavior disorder (RBD) (9%). Initial treatment strategies include behavioral and safety counseling only (34%), pharmacological treatment (29%), treatment of any comorbidity (28%), and combined treatment of any of the above (9%). Improvement was reported with: treatment of OSA (n = 23 52% reported improvement), melatonin (n = 8, improvement reported by 88%.,benzodiazepine (n = 7, improvement reported by 57%). Treating comorbid conditions is a frequent treatment strategy, often associated with symptom improvement. The pharmacologic treatment most commonly included melatonin and benzodiazepines. Comprehensive management should include behavioral and safety recommendations, assessment of comorbid conditions, and individually tailored pharmaceutical treatment.
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Baldelli L, Provini F. Fragmentary Hypnic Myoclonus and Other Isolated Motor Phenomena of Sleep. Sleep Med Clin 2021; 16:349-361. [PMID: 33985659 DOI: 10.1016/j.jsmc.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Excessive fragmentary hypnic myoclonus, hypnic jerks, hypnagogic foot tremor, alternating leg muscle activation, and sleep-related cramps are less known sleep-related motor disorders (SRMDs). These manifestations are frequently missed or misinterpreted polygraphic findings that can be frequently confused with the more frequent SRMDs. These symptoms can present as isolated motor symptoms but can be also the cause of otherwise cryptogenic insomnias and somnolence. Expanding the knowledge on these isolated symptoms and defining their polygraphic and clinical features are essential for their identification. However, clear cut-offs to discern between the isolated phenomenon and the disorder are still to be found.
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Affiliation(s)
- Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Ospedale Bellaria, Via Altura 3, Bologna 40139, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Ospedale Bellaria, Via Altura 3, Bologna 40139, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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Buenaver LF, Townsend D, Ong JC. Delivering Cognitive Behavioral Therapy for Insomnia in the Real World: Considerations and Controversies. Sleep Med Clin 2019; 14:275-281. [PMID: 31029193 DOI: 10.1016/j.jsmc.2019.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) has emerged as the first-line treatment for chronic insomnia but remains massively underused relative to the prevalence of insomnia disorder. This article focuses on 3 key issues in the delivery of CBT-I in the real world. First, where and how should CBT-I be delivered and who should deliver it? Second, who is an appropriate candidate for CBT-I? Third, how do you measure quality care with CBT-I? These issues give rise to targets for future research aimed at improving the implementation science of CBT-I in the real world.
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Affiliation(s)
- Luis F Buenaver
- Departments of Psychiatry and Behavioral Sciences, and Neurology, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 100, Baltimore, MD 21224, USA.
| | - Donald Townsend
- Arizona School of Professional Psychology at Argosy University, 3322 West Dunlap Avenue, Phoenix, AZ 85021, USA
| | - Jason C Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall Suite 1004, 710 North Lake Shore Drive, Chicago, IL 60611, USA
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Hernández-Torres S, Mancebo-Sosa V, Miranda-Ortiz J, Mancilla-Hernández V, Saldaña-Aceves R, Velasco-Flores R, Jiménez-Correa U. Sleep architecture in children with arousal disorders. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Hypnic jerks are an underestimated sleep motor phenomenon in patients with parkinsonism. A video-polysomnographic and neurophysiological study. Sleep Med 2016; 26:37-44. [DOI: 10.1016/j.sleep.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 11/20/2022]
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Lovati C, Giani L, D'Amico D, Mariani C. Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 2016; 17:239-250. [PMID: 27547918 DOI: 10.1080/14737175.2016.1226133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The amount of cerebral functions is particularly elevated. This intense activity requires a great expenditure of energy: the restoration of energy is the fundamental function of sleep whilst the slowdown in energy consumption may be considered the physiological effect of primary headaches. The continuous interaction of sleep and primary headaches is possible as they share many anatomical and functional cerebral systems. Areas covered: This review describes how sleep and headaches are reciprocally involved in preservation and restoration of brain energy. Data were obtained from the most relevant and recent works available in PubMed about this topic. Expert commentary: The energetic view of sleep, primary headaches and their relationship may have relevant clinical consequences: the investigation and the modification of the multiple aspects, primarily environmental, that may influence sleep and headache, become mandatory to facilitate the cerebral energy preservation by reducing its consumption and by ensuring its recovery.
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Affiliation(s)
| | - Luca Giani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
| | - Domenico D'Amico
- c Headache Center , C. Besta Neurological Institute and Foundation , Milan , Italy
| | - Claudio Mariani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
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Antelmi E, Ferri R, Iranzo A, Arnulf I, Dauvilliers Y, Bhatia KP, Liguori R, Schenck CH, Plazzi G. From state dissociation to status dissociatus. Sleep Med Rev 2016; 28:5-17. [DOI: 10.1016/j.smrv.2015.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/11/2015] [Accepted: 07/18/2015] [Indexed: 01/10/2023]
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13
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Lovati C, D’Amico D, Raimondi E, Mariani C, Bertora P. Sleep and headache: a bidirectional relationship. Expert Rev Neurother 2014; 10:105-17. [DOI: 10.1586/ern.09.135] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Roebuck A, Monasterio V, Gederi E, Osipov M, Behar J, Malhotra A, Penzel T, Clifford GD. A review of signals used in sleep analysis. Physiol Meas 2014; 35:R1-57. [PMID: 24346125 PMCID: PMC4024062 DOI: 10.1088/0967-3334/35/1/r1] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article presents a review of signals used for measuring physiology and activity during sleep and techniques for extracting information from these signals. We examine both clinical needs and biomedical signal processing approaches across a range of sensor types. Issues with recording and analysing the signals are discussed, together with their applicability to various clinical disorders. Both univariate and data fusion (exploiting the diverse characteristics of the primary recorded signals) approaches are discussed, together with a comparison of automated methods for analysing sleep.
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Affiliation(s)
- A Roebuck
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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Abstract
The postictal state can be particularly confusing when occurring in association with sleep. Some seizures tend to occur predominantly or exclusively during sleep; as the patient may be unaware of the seizure itself, the postictal state may be the only observed manifestation. Seizures and postictal phenomena occurring during sleep can also lead to diagnostic confusion particularly with parasomnias. Confusion or apparent sleepwalking, for example, could be a postictal phenomenon or could be an independent parasomnia. Awareness of the various manifestations of sleep disorders, seizures, and postictal phenomena during sleep is critical to optimal diagnosis and treatment of patients with epilepsy.
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Affiliation(s)
- Carl W Bazil
- Columbia Comprehensive Epilepsy Center, New York, NY 10032, USA.
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Pérez-Díaz H, Iranzo A, Santamaría J. Zolpidem-induced sleep-related behavioural disorders. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70091-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lee CM, Herridge MS, Gabor JY, Tansey CM, Matte A, Hanly PJ. Chronic sleep disorders in survivors of the acute respiratory distress syndrome. Intensive Care Med 2008; 35:314-20. [PMID: 18802684 DOI: 10.1007/s00134-008-1277-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 07/19/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continues following discharge from hospital in several patients and becomes a chronic disorder in some. The aim of this study was to describe the etiology of chronic sleep complaints in survivors of ARDS. METHODS Seven ARDS survivors with no previous sleep complaints who reported difficulty sleeping 6 months or more following discharge from hospital were evaluated. Sleep quality was assessed subjectively with a sleep history and the Insomnia Severity Index and objectively with polysomnography. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. RESULTS A chronic sleep disorder was identified in each patient who reported difficulty sleeping. The primary sleep disorder was chronic conditioned insomnia (5 patients), parasomnia (1 patient) and obstructive sleep apnea (1 patient). In addition, 4 patients had periodic leg movements, which was of uncertain clinical significance. CONCLUSION Chronic sleep disorders, which originate during the acute illness, are present in some ARDS survivors several months after discharge from hospital. If unrecognized, lack of treatment may contribute to impaired quality of life and incomplete rehabilitation from their critical illness.
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Affiliation(s)
- Christie M Lee
- Department of Medicine, University of Toronto, Toronto, Canada
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Abstract
Somnambulism is an arousal disorder that is usually benign, self-limited and only infrequently requires treatment. Chronic sleepwalking in children has been shown to be associated with behavioral problems and poor emotional regulation. Most cases can be diagnosed with careful noting of case history and epilepsy is an important differential diagnosis. Management with pharmacological and behavioural measures is usually safe and effective. We present two cases of somnambulism that highlight the importance of the diagnosis and treatment of this condition.
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Affiliation(s)
- Rahul Bharadwaj
- Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
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25
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Pinder D, McDonald SE, Medcalf M, Bridger MW. Idiopathic laryngeal spasm: management and long-term outcome. Eur Arch Otorhinolaryngol 2006; 264:159-62. [PMID: 17033829 DOI: 10.1007/s00405-006-0165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Accepted: 08/03/2006] [Indexed: 11/29/2022]
Abstract
Idiopathic laryngeal spasm (ILS) is an uncommon disorder characterised by brief episodes of stridor, occurring at any time. Subsequent outpatient ENT examination is normal. These episodes cause considerable anxiety for both patient and physician. Little is known about the initiating event(s) in this condition or the long-term outcome. Using a combination of telephone and postal questionnaires with case note review, we have reviewed a cohort of 21 patients with this diagnosis managed by the senior author over the last 15 years. None of the 19 patients who responded were worse; 13 (68%) described improvement or complete resolution of symptoms. ILS is difficult to classify in the spectrum of vocal cord disorders, but appears distinct to those previously described. The condition responds well to a conservative management approach of reassurance and counselling.
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Affiliation(s)
- Darren Pinder
- Department of Otolaryngology and Head and Neck Surgery, The Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK
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Abstract
Most violent behaviors arise from wakefulness. It is important to realize that violent behaviors that may have forensic science implications can arise from the sleep period. By virtue of the fact that these behaviors arise from sleep, they are executed without conscious awareness, and, therefore, without culpability. The most common underlying conditions arising from sleep are disorders of arousal (sleepwalking and sleep terrors), the rapid eye movement sleep behavior disorder, and nocturnal seizures. In addition, there are a number of psychiatric conditions (dissociative disorders, malingering, and Munchausen syndrome by proxy) that actually arise from periods of wakefulness occurring during the sleep period. The clinical and medico-legal evaluation of such cases is outlined, and should be performed by a multidisciplinary team of experienced sleep medicine practitioners.
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Affiliation(s)
- Mark W Mahowald
- Minnesota Regional Sleep Disorders Center, Hennepin County -Medical Center, 701 Park Avenue, Minneapolis, MN 55415, USA.
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Abstract
Behavioral sleep medicine (BSM) has recently emerged as a subspecialty area within the broader field of sleep medicine. Certain commonly used treatment approaches in BSM were first pioneered in the 1930s, and this article traces the developments within BSM to current practice. Important innovations include the expansion of BSM beyond the treatment of insomnia to include treatment of pediatric sleep disorders, circadian rhythm disorders, parasomnias, as well as desensitization procedures for patients undergoing treatment with nasal continuous positive airway pressure (CPAP).
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Affiliation(s)
- Edward J Stepanski
- Sleep Disorder Service and Research Center, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
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Abstract
Non-rapid eye movement parasomnias are unique physical or experiential phenomena that disrupt sleep. Non-rapid eye movement parasomnias are common in children, but they typically outgrow them. Sleep-stage shifts caused by sleep-disordered breathing and associated arousals may be precipitating events for episodes of parasomnia. Seizure disorders should always be considered in the differential diagnosis for the evaluation of parasomnias. Violent or injurious sleepwalking should be rapidly evaluated and treated.
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Affiliation(s)
- Mehran Farid
- Sleep Disorders Clinic, Stanford University, 401 Quarry Road, Suite 3301, Stanford, CA 94305, USA.
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Affiliation(s)
- Mark W Mahowald
- Minnesota Regional Sleep Disorders Center, 701 Park Avenue, Minneapolis, MN 55415, USA.
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Affiliation(s)
- Piotr W Olejniczak
- Department of Neurology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
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Abstract
OBJECTIVE To describe the association of amnestic nocturnal eating behavior with use of zolpidem for insomnia. BACKGROUND Sleep-related eating disorder is increasingly recognized in relationship to other diagnosable sleep disorders. Many of these disorders, like restless legs syndrome (RLS), give rise to complaints of insomnia. Zolpidem is the most commonly prescribed drug for insomnia complaints, and although it has sometimes been associated with side effects of transient amnesia and sleep walking, an association with sleep-related eating has not been previously emphasized. METHODS Consecutive case series of five patients who were using zolpidem and evaluated with nocturnal eating behaviors. RESULTS We evaluated five patients over 11 months with problematic amnestic nocturnal eating associated with zolpidem used for complaints of insomnia. All five patients had RLS, three had obstructive sleep apnea syndrome, two had sleep walking, and one had psychophysiologic insomnia. With discontinuation of zolpidem and effective treatment of their sleep disorders, nocturnal eating resolved. CONCLUSIONS Zolpidem, at least in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep-related eating behavior. This report demonstrates the importance of arriving at a specific diagnosis for insomnia complaints, and alerts the sleep practitioner to this unusual side effect of zolpidem.
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Shatkin JP, Feinfield K, Strober M. The misinterpretation of a non-REM sleep parasomnia as suicidal behavior in an adolescent. Sleep Breath 2002; 6:175-9. [PMID: 12524570 DOI: 10.1007/s11325-002-0175-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of misinterpretation of a non-REM sleep parasomnia as suicidal behavior in an early adolescent. A 12-year-old female with a history of sleepwalking but no prior psychiatric diagnosis awoke in the middle of the night with a deep laceration to her neck and complete amnesia for the event. During the initial 2-week pediatric hospitalization, it was believed that the wound was intentionally self-inflicted despite patient claims and evidence to the contrary. The patient was placed on a psychiatric hold and transferred to an appropriate facility. We review rule-out diagnoses and evidence supporting this case as an example of a violent non-REM parasomnia resulting in self-injurious behavior. Diagnostic and treatment implications are discussed.
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Affiliation(s)
- Jess P Shatkin
- UCLA Neuropsychiatric Institute and Hospital, Los Angeles, California, USA.
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Abstract
Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during sleep. These phenomena were initially thought to represent a unitary event, often attributed to psychiatric disease. Recent clinical and polygraphic analysis has revealed that they are, in fact, the result of a large number of very different conditions, most of which are diagnosable and treatable. In fact, most are not the manifestation of psychiatric disorders, and they are far more prevalent than previously suspected. Although there are many parasomnias (1,2), from a practical standpoint only the few that comprise the overwhelming majority will be discussed in this review. These include disorders of arousal, rapid-eye-movement sleep behavior disorder, nocturnal seizures, and restless legs syndrome. Most parasomnias are readily diagnosable and, more importantly, are treatable.
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Affiliation(s)
- M W Mahowald
- Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Department of Neurology, Minneapolis, USA
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Abstract
A recent, well-publicized case in which murder during sleepwalking was offered as a defense, underscores the fact that sleep medicine specialists are asked to render opinions or judgements regarding culpability in legal cases regarding violence claimed to have arisen from sleepwalking episodes. This review addresses this difficult issue from scientific, clinical and legal aspects, with emphasis upon the need for further research, calling for close collaboration between the legal and medical (both clinical and basic science) professions.
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Affiliation(s)
- Mark W. Mahowald
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry (CHS) and Neurology (MWM), Hennepin County Medical Center and the University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Sleepiness and sleep disorders are increasingly raising interesting and important medical-legal issues in three areas: violent or injurious behavior arising from the sleep period, accidents or errors in judgment caused by sleepiness behind the wheel or in the workplace, and disability determinations caused by sleepiness-induced work impairment. Sleep-related violence may be caused by many conditions, most of which are diagnosable and treatable. Legal issues raised by these behaviors are usually enigmatic. The nature of such behaviors may be extremely complex, and documenting that a given violent act was caused by such a behavior, after the fact, may be difficult. Guidelines for the medical-legal evaluation of such behaviors have been developed and are evolving. Culpability determination in sleepiness-related industrial or motor vehicle accidents is in the developmental stage, and varies by jurisdiction. Disability determination for workplace sleepiness caused by sleep disorders is in its infancy, and poses a challenge, given the erroneous but pervasive societal attitude that sleepiness is a manifestation of laziness, depression, sloth, work-avoidance behavior, or a defect of character.
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Affiliation(s)
- M W Mahowald
- Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Minneapolis, Minnesota 55415, USA.
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Abstract
Making a correct diagnosis in patients presenting with attack disorders is important. The clinical features of autosomal dominant nocturnal frontal lobe epilepsy and concussive seizures are reviewed. Recent work on the diagnosis and investigation of psychogenic non-epileptic attacks, drop attacks, falls, syncope and sleep disorders is discussed.
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Affiliation(s)
- R Roberts
- University of Dundee, Department of Medicine, Ninewells Hospital and Medical School, UK
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Abstract
The three states of mammalian being, W, REM sleep, and NREM sleep, are not mutually exclusive, and may occur simultaneously, oscillate rapidly, or appear in dissociated or incomplete form to produce primary sleep parasomnias. In addition, dysfunctions of a wide variety of organ systems may take adwide variety of organ systems may take advantage of the sleeping state to declare themselves, resulting in secondary sleep parasomnias. Contrary to popular opinion, the majority of the often bizarre and frightening experiences are not the manifestation of underlying psychological or psychiatric conditions. There is an interesting interaction between sleep-disordered breathing and parasominas. Formal study in an experienced sleep disorders center will usually reveal a diagnosable and treatable condition that explains the spells. Continued study of unusual sleep-related events undoubtedly will reveal more fascinating conditions, expanding our knowledge of sleep physiology, and strengthening the bonds between clinicians and basic-science sleep researchers.
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Affiliation(s)
- M W Mahowald
- Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Minneapolis, USA
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