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Siclari F. Consciousness in non-REM-parasomnia episodes. J Sleep Res 2024:e14275. [PMID: 38952031 DOI: 10.1111/jsr.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
Sleepwalking and related parasomnias are thought to result from incomplete awakenings out of non-rapid eye movement (non-REM) sleep. Non-REM parasomnia behaviours have been described as unconscious and automatic, or related to vivid, dream-like conscious experiences. Similarly, some observations have suggested that patients are unresponsive during episodes, while others that they can interact with their surroundings. To better grasp and characterise the full spectrum of consciousness and environmental (dis)connection associated with behavioural episodes, 35 adult patients with non-REM sleep parasomnias were interviewed in-depth about their experiences. The level of consciousness during parasomnia episodes was reported to be variable both within and between individuals, ranging from minimal or absent consciousness and largely automatic behaviours (frequently/always present in 36% of patients) to preserved conscious experiences characterised by delusional thinking to varying degrees of specificity (65%), often about impending danger, variably formed, uni- or multisensory hallucinations (53%), impaired insight (77%), negative emotions (75%), and variable, but often pronounced, amnesia (30%). Patients described their experiences as a dream scene during which they felt awake ("awake dreaming"). The surroundings were either realistically perceived, misinterpreted (in the form of perceptual illusions or misidentifications of people), or entirely hallucinated as a function of the prevailing delusion. These observations suggest that the level of consciousness, amnesia and sensory disconnection during non-REM parasomnia episodes is variable and graded. In their full-fledged expression, non-REM parasomnia experiences feature several core features of dreams. They therefore represent a valuable model for the study of consciousness, sleep-related sensory disconnection and dreaming.
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Affiliation(s)
- Francesca Siclari
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
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2
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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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Cataldi J, Stephan AM, Haba-Rubio J, Siclari F. Shared EEG correlates between non-REM parasomnia experiences and dreams. Nat Commun 2024; 15:3906. [PMID: 38724511 PMCID: PMC11082195 DOI: 10.1038/s41467-024-48337-7] [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: 01/25/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Sleepwalking and related parasomnias result from incomplete awakenings out of non-rapid eye movement sleep. Behavioral episodes can occur without consciousness or recollection, or in relation to dream-like experiences. To understand what accounts for these differences in consciousness and recall, here we recorded parasomnia episodes with high-density electroencephalography (EEG) and interviewed participants immediately afterward about their experiences. Compared to reports of no experience (19%), reports of conscious experience (56%) were preceded by high-amplitude EEG slow waves in anterior cortical regions and activation of posterior cortical regions, similar to previously described EEG correlates of dreaming. Recall of the content of the experience (56%), compared to no recall (25%), was associated with higher EEG activation in the right medial temporal region before movement onset. Our work suggests that the EEG correlates of parasomnia experiences are similar to those reported for dreams and may thus reflect core physiological processes involved in sleep consciousness.
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Affiliation(s)
- Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - José Haba-Rubio
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland.
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
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4
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Huijben IAM, van Sloun RJG, Hoondert B, Dujardin S, Pijpers A, Overeem S, van Gilst MM. Temporal dynamics of awakenings from slow-wave sleep in non-rapid eye movement parasomnia. J Sleep Res 2024; 33:e14096. [PMID: 38069589 DOI: 10.1111/jsr.14096] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/29/2023] [Accepted: 10/29/2023] [Indexed: 05/15/2024]
Abstract
Non-rapid eye movement parasomnia disorders, also called disorders of arousal, are characterized by abnormal nocturnal behaviours, such as confusional arousals or sleep walking. Their pathophysiology is not yet fully understood, and objective diagnostic criteria are lacking. It is known, however, that behavioural episodes occur mostly in the beginning of the night, after an increase in slow-wave activity during slow-wave sleep. A better understanding of the prospect of such episodes may lead to new insights in the underlying mechanisms and eventually facilitate objective diagnosis. We investigated temporal dynamics of transitions from slow-wave sleep of 52 patients and 79 controls. Within the patient group, behavioural and non-behavioural N3 awakenings were distinguished. Patients showed a higher probability to wake up after an N3 bout ended than controls, and this probability increased with N3 bout duration. Bouts longer than 15 min resulted in an awakening in 73% and 34% of the time in patients and controls, respectively. Behavioural episodes reduced over sleep cycles due to a reduction in N3 sleep and a reducing ratio between behavioural and non-behavioural awakenings. In the first two cycles, N3 bouts prior to non-behavioural awakenings were significantly shorter than N3 bouts advancing behavioural awakenings in patients, and N3 awakenings in controls. Our findings provide insights in the timing and prospect of both behavioural and non-behavioural awakenings from N3, which may result in prediction and potentially prevention of behavioural episodes. This work, moreover, leads to a more complete characterization of a prototypical hypnogram of parasomnias, which could facilitate diagnosis.
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Affiliation(s)
- Iris A M Huijben
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Onera Health, Eindhoven, The Netherlands
| | - Ruud J G van Sloun
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | | | - Sebastiaan Overeem
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
| | - Merel M van Gilst
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands
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5
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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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6
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Cordani R, Lopez R, Barateau L, Chenini S, Nobili L, Dauvilliers Y. Somnambulism. Sleep Med Clin 2024; 19:43-54. [PMID: 38368068 DOI: 10.1016/j.jsmc.2023.10.001] [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
Somnambulism, also called sleepwalking, classified as a non-rapid eye movement sleep parasomnia, encompasses a range of abnormal paroxysmal behaviors, leading to sleepwalking in dissociated sleep in an altered state of consciousness with impaired judgment and configuring a kind of hierarchical continuum with confusional arousal and night terror. Despite being generally regarded as a benign condition, its potential severity entails social, personal, and even forensic consequences. This comprehensive review provides an overview on the current state of knowledge, elucidating the phenomenon of somnambulism and encompassing its clinical manifestations and diagnostic approaches.
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Affiliation(s)
- Ramona Cordani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Regis Lopez
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Sofiene Chenini
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France.
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7
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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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8
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Lopez R, Micoulaud-Franchi JA, Peter-Derex L, Dauvilliers Y. Nocturnal agitation: From sleep state dissociation to sleep-related dissociative state. Rev Neurol (Paris) 2023; 179:675-686. [PMID: 37625976 DOI: 10.1016/j.neurol.2023.07.003] [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] [Received: 07/20/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
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Affiliation(s)
- R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, PAM Team, Inserm U1028, CNRS UMR 5292, Lyon, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
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Sodré ME, Wießner I, Irfan M, Schenck CH, Mota-Rolim SA. Awake or Sleeping? Maybe Both… A Review of Sleep-Related Dissociative States. J Clin Med 2023; 12:3876. [PMID: 37373570 DOI: 10.3390/jcm12123876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/29/2023] Open
Abstract
Recent studies have begun to understand sleep not only as a whole-brain process but also as a complex local phenomenon controlled by specific neurotransmitters that act in different neural networks, which is called "local sleep". Moreover, the basic states of human consciousness-wakefulness, sleep onset (N1), light sleep (N2), deep sleep (N3), and rapid eye movement (REM) sleep-can concurrently appear, which may result in different sleep-related dissociative states. In this article, we classify these sleep-related dissociative states into physiological, pathological, and altered states of consciousness. Physiological states are daydreaming, lucid dreaming, and false awakenings. Pathological states include sleep paralysis, sleepwalking, and REM sleep behavior disorder. Altered states are hypnosis, anesthesia, and psychedelics. We review the neurophysiology and phenomenology of these sleep-related dissociative states of consciousness and update them with recent studies. We conclude that these sleep-related dissociative states have a significant basic and clinical impact since their study contributes to the understanding of consciousness and the proper treatment of neuropsychiatric diseases.
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Affiliation(s)
| | - Isabel Wießner
- Brain Institute, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Muna Irfan
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Carlos H Schenck
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sergio A Mota-Rolim
- Brain Institute, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
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10
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Baron M, Devor M. From molecule to oblivion: dedicated brain circuitry underlies anesthetic loss of consciousness permitting pain-free surgery. Front Mol Neurosci 2023; 16:1197304. [PMID: 37305550 PMCID: PMC10248014 DOI: 10.3389/fnmol.2023.1197304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
The canonical view of how general anesthetics induce loss-of-consciousness (LOC) permitting pain-free surgery posits that anesthetic molecules, distributed throughout the CNS, suppress neural activity globally to levels at which the cerebral cortex can no longer sustain conscious experience. We support an alternative view that LOC, in the context of GABAergic anesthesia at least, results from anesthetic exposure of a small number of neurons in a focal brainstem nucleus, the mesopontine tegmental anesthesia area (MPTA). The various sub-components of anesthesia, in turn, are effected in distant locations, driven by dedicated axonal pathways. This proposal is based on the observations that microinjection of infinitesimal amounts of GABAergic agents into the MPTA, and only there, rapidly induces LOC, and that lesioning the MPTA renders animals relatively insensitive to these agents delivered systemically. Recently, using chemogenetics, we identified a subpopulation of MPTA "effector-neurons" which, when excited (not inhibited), induce anesthesia. These neurons contribute to well-defined ascending and descending axonal pathways each of which accesses a target region associated with a key anesthetic endpoint: atonia, anti-nociception, amnesia and LOC (by electroencephalographic criteria). Interestingly, the effector-neurons do not themselves express GABAA-receptors. Rather, the target receptors reside on a separate sub-population of presumed inhibitory interneurons. These are thought to excite the effectors by disinhibition, thus triggering anesthetic LOC.
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Affiliation(s)
- Mark Baron
- Department of Cell and Developmental Biology, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marshall Devor
- Department of Cell and Developmental Biology, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
- Center for Research on Pain, The Hebrew University of Jerusalem, Jerusalem, Israel
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11
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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: 0] [Impact Index Per Article: 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: 2] [Impact Index Per Article: 2.0] [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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13
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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: 0] [Impact Index Per Article: 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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14
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Ukraintseva YV, Soloveva AK. [The phenomenon of awakening from sleep and underlying neurophysiological and autonomic mechanisms]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:21-27. [PMID: 37275994 DOI: 10.17116/jnevro202312305221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Current research has shown that sleep is not a global process evenly covering the entire brain. The heterogeneity of wakefulness levels in different parts of the brain and differences in their activation thresholds are especially pronounced during the transitions between sleep and wakefulness. During awakening, subcortical brain structures activate first, followed by sensory and motor cortical regions, whereas the associative cortex wakes up much later. Awakening, unlike falling asleep, is not a smooth process. It begins with a short-term sharp activation of the autonomic nervous system and some wake-promoting brain regions. The amplitude of this activity burst is out of proportion to obvious physiological needs and exceeds that observed in later periods of quiet wakefulness. The review discusses the similarities and differences between awakening from sleep and hibernation in hibernating rodents. Data on some clinical consequences of impaired awakening mechanisms are also provided.
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Affiliation(s)
- Yu V Ukraintseva
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow, Russia
- Institute of Biomedical Problems of the Russian Academy of Science, Moscow, Russia
| | - A K Soloveva
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow, Russia
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15
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Proserpio P, Terzaghi M, Manni R, Nobili L. Drugs Used in Parasomnia. Sleep Med Clin 2022; 17:367-378. [PMID: 36150800 DOI: 10.1016/j.jsmc.2022.06.004] [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: 11/18/2022]
Abstract
Parasomnias, especially disorders of arousal during childhood, are often relatively benign and transitory and do not usually require a pharmacologic therapy. A relevant aspect in both nonrapid eye movement and rapid eye movement parasomnia treatment is to prevent sleep-related injuries by maintaining a safe environment. Physicians should always evaluate the possible presence of favoring and precipitating factors (sleep disorders and drugs). A pharmacologic treatment may be indicated in case of frequent, troublesome, or particularly dangerous events. The aim of this article is to review current available evidence on pharmacologic treatment of different forms of parasomnia.
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Affiliation(s)
- Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Lino Nobili
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa 5-16147, Italy
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16
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Cataldi J, Stephan AM, Marchi NA, Haba-Rubio J, Siclari F. Abnormal timing of slow wave synchronization processes in non-rapid eye movement sleep parasomnias. Sleep 2022; 45:6591470. [PMID: 35641120 DOI: 10.1093/sleep/zsac111] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/06/2022] [Indexed: 01/29/2023] Open
Abstract
STUDY OBJECTIVES Sleepwalking, confusional arousals, and sleep terrors are parasomnias occurring out of non-rapid eye movement (NREM) sleep. Several previous studies have described EEG changes associated with NREM parasomnia episodes, but it remains unclear whether these changes are specific to parasomnia episodes or whether they are part of the normal awakening process. Here we directly compared regional brain activity, measured with high-density (hd-) EEG, between parasomnia episodes and normal awakenings (without behavioral manifestations of parasomnia). METHODS Twenty adult patients with non-rapid eye movement parasomnias underwent a baseline hd-EEG recording (256 electrodes) followed by a recovery sleep recording after 25 h of total sleep deprivation, during which auditory stimuli were administered to provoke parasomnia episodes. RESULTS Both normal awakenings (n = 25) and parasomnia episodes (n = 96) were preceded by large, steep, and "K-complex-like" slow waves in frontal and central brain regions, and by a concomitant increase in high-frequency EEG (beta) activity. Compared to normal awakenings, parasomnia episodes occurred on a less activated EEG background and displayed higher slow wave activity (SWA) and lower beta activity in frontal and central brain regions after movement onset. CONCLUSIONS Our results suggest that non-rapid eye movement awakenings, irrespective of behavioral manifestations of parasomnia episodes, involve an arousal-related slow wave synchronization process that predominantly recruits frontal and central brain areas. In parasomnia episodes, this synchronization process comes into play abnormally during periods of high SWA and is associated with higher SWA after movement onset. Thus, an abnormal timing of arousal-related slow wave synchronization processes could underlie the occurrence of NREM parasomnias.
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Affiliation(s)
- Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Nicola A Marchi
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland.,Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
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17
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High-density EEG power topography and connectivity during confusional arousal. Cortex 2022; 155:62-74. [DOI: 10.1016/j.cortex.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/28/2022] [Accepted: 05/29/2022] [Indexed: 11/23/2022]
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18
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Gastrointestinal and Autonomic Symptoms—How to Improve the Diagnostic Process in Panayiotopoulos Syndrome? CHILDREN 2022; 9:children9060814. [PMID: 35740751 PMCID: PMC9222198 DOI: 10.3390/children9060814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
One of the most common epileptic disorders in the pediatric population is Panayiotopoulos syndrome. Clinical manifestations of this idiopathic illness include predominantly autonomic symptoms and dysfunction of the cardiorespiratory system. Another feature constitutes prolonged seizures that usually occur at sleep. It is crucial to differentiate the aforementioned disease from other forms of epilepsy, especially occipital and structural epilepsy and non-epileptic disorders. The diagnostic process is based on medical history, clinical examination, neuroimaging and electroencephalography—though results of the latter may be unspecific. Patients with Panayiotopoulos syndrome (PS) do not usually require treatment, as the course of the disease is, in most cases, mild, and the prognosis is good. The purpose of this review is to underline the role of central autonomic network dysfunction in the development of Panayiotopoulos syndrome, as well as the possibility of using functional imaging techniques, especially functional magnetic resonance imaging (fMRI), in the diagnostic process. These methods could be crucial for understanding the pathogenesis of PS. More data arerequired to create algorithms that will be able to predict the exposure to various complications of PS. It also concerns the importance of electroencephalography (EEG) as a tool to distinguish Panayiotopoulos syndrome from other childhood epileptic syndromes and non-epileptic disorders.
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19
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Iranzo A. Parasomnias and Sleep-Related Movement Disorders in Older Adults. Sleep Med Clin 2022; 17:295-305. [DOI: 10.1016/j.jsmc.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Poon SH, Tan WJ, Lee TS. Medicolegal aspects of non-rapid eye movement parasomnias. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:228-235. [PMID: 35506406 DOI: 10.47102/annals-acadmedsg.2021449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
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Affiliation(s)
- Shi Hui Poon
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
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21
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The disintegrated theory of consciousness: Sleep, waking, and meta-awareness. Behav Brain Sci 2022; 45:e64. [PMID: 35319408 DOI: 10.1017/s0140525x21001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of sleep and wakefulness can inform debates about the nature of consciousness. We argue that sleep and wakefulness fall along a multidimensional continuum and that inconsistencies and paradoxes with the accounts put forth by Merker et al. and Tononi can be understood in terms of a pervasive false dichotomy between these two states.
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22
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Disorders of arousal and sleep-related hypermotor epilepsy - overview and challenges night is a battlefield of sleep and arousal promoting forces. Neurol Sci 2022; 43:927-937. [PMID: 34984571 DOI: 10.1007/s10072-021-05857-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Arousability and reactivity to sensory stimuli are essential features of sleep, discriminating it from coma and keeping the sleeper in contact with the environment. Arousals and oscillations during sleep serve the reversibility of sleep and carry an alarm function awakening the sleeper in danger. In this review, we will explore mechanisms and circuits involved in arousal intrusions within the sleep texture, focusing on the significance of these phenomena in two sleep-related conditions: NREM sleep parasomnias and sleep-related hypermotor epilepsy. Knowledges and gaps in the field are discussed.
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23
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Mainieri G, Loddo G, Castelnovo A, Balella G, Cilea R, Mondini S, Manconi M, Provini F. EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study. Nat Sci Sleep 2022; 14:1097-1111. [PMID: 35698590 PMCID: PMC9188335 DOI: 10.2147/nss.s360120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Disorders of arousal (DoA) are characterized by incomplete awakening from NREM sleep, with the admixture of both deep sleep and wake EEG activity. Previous observations suggested that changes in EEG activity could be detected in the seconds preceding DoA episodes. The aims of this work were to characterize the topography of EEG spectral changes prior to DoA episodes and to investigate whether or not behavioral complexity could be predicted by changes in EEG immediately preceding behavioral onsets. PATIENTS AND METHODS We collected 103 consecutive video-polysomnographic recordings of 53 DoA adult patients and classified all episodes as simple, rising and complex arousal movements. For each episode, a 5-second window preceding its motor onset ("pre-event") and a 60-second window from 2 to 3 minutes before the episodes ("baseline") were compared. Subsequently, a between-group comparison was performed for the pre-event of simpler versus the more complex episodes. RESULTS Spectral analysis over 325 DoA episodes showed an absolute significant increase prior to DoA episodes in all frequency bands excluding sigma, which displayed the opposite effect. In normalized maps, the increase was relatively higher over the central/anterior areas for both slow and fast frequency bands. No significant differences emerged from the comparison between simpler and more complex episodes. CONCLUSION Taken together, these results show that deep sleep and wake-like EEG rhythms coexist over overlapping areas before DoA episodes, suggesting an alteration of local sleep mechanisms. Episodes of different complexity are preceded by a similar EEG activation, implying that they possibly share a similar pathophysiology.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, Bologna, Italy
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Giulia Balella
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- Neurology Unit, "Morgagni-Pierantoni" Hospital, AUSL Romagna, Forlì, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
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24
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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: 7] [Impact Index Per Article: 2.3] [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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25
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van Mierlo P, Hermans L, Arnulf I, Pijpers A, Overeem S, van Gilst M. Validation of the Dutch translation of the Paris Arousal Disorders Severity Scale for NREM parasomnias in a one-year and one-month version. J Clin Sleep Med 2021; 18:1135-1143. [PMID: 34913868 DOI: 10.5664/jcsm.9830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES We created a Dutch version of the Paris Arousal Disorders Severity Scale, which assesses non-rapid eye movement (NREM) parasomnia symptoms over the past year (PADSS-year). This questionnaire was previously validated in patients with sleep walking and/or sleep terrors ('SW/ST'). We validated the questionnaire in SW/ST patients, and in a broader population, including patients with confusional arousals, co-morbidities, and medication-users ('other NREM parasomnias'). Furthermore, we introduced a version covering the past month (PADSS-month), with the potential purpose of evaluating symptom evolution and treatment response. METHODS We compared PADSS scores among 54 SW/ST patients, 34 age-matched controls, and 23 patients with other NREM parasomnias. We evaluated discriminative capacity, internal consistency and construct validity. Furthermore, we assessed the test-retest reliability and treatment response of PADSS-month. RESULTS Healthy controls scored significantly lower than both patient groups. We found an excellent diagnostic accuracy (AUC PADSS-year 0.990, PADSS-month 0.987) and an acceptable internal consistency. Exploratory factor analysis identified three components: 'behaviors outside the bed', 'behaviors in/around the bed', and 'violent behaviors', the former two factors reflecting the distinction between SW and ST. PADSS-month showed an acceptable test-retest reliability (0.75). Additionally, PADSS-month significantly decreased after pharmaceutical and/or behavioral treatment. This change was correlated with the clinical impression of the caregiver, implying that PADSS-month is sensitive to treatment effects. CONCLUSIONS The Dutch PADSS questionnaire can be used as a screening tool in a broad population of NREM parasomnia patients, not only SW/ST. Furthermore, we validated a PADSS-month version, to assess the evolution of symptoms and treatment effect.
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Affiliation(s)
| | - Lieke Hermans
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Sorbonne University, and Paris Brain Institute (ICM), Paris, France
| | | | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Merel van Gilst
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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26
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Fournier S, Dauvilliers Y, Warby SC, Labrecque M, Zadra A, Boucetta S, El Gewely M, Kaddioui H, Lopez R, Montplaisir JY, Bareke E, Tétreault M, Desautels A. Does the adenosine deaminase (ADA) gene confer risk of sleepwalking? J Sleep Res 2021; 31:e13537. [PMID: 34913218 DOI: 10.1111/jsr.13537] [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] [Received: 07/28/2021] [Revised: 11/04/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
Abstract
Sleepwalking is a common non-rapid eye movement (NREM) parasomnia and a significant cause of sleep-related injuries. While evidence suggest that the occurrence of this condition is partly determined by genetic factors, its pattern of inheritance remains unclear, and few molecular studies have been conducted. One promising candidate is the adenosine deaminase (ADA) gene. Adenosine and the ADA enzyme play an important role in the homeostatic regulation of NREM sleep. In a single sleepwalking family, genome-wide analysis identified a locus on chromosome 20, where ADA lies. In this study, we examined if variants in the ADA gene were associated with sleepwalking. In total, 251 sleepwalking patients were clinically assessed, and DNA samples were compared to those from 94 unaffected controls. Next-generation sequencing of the whole ADA gene was performed. Bio-informatic analysis enabled the identification of variants and assessed variants enrichment in our cohort compared to controls. We detected 25 different coding and non-coding variants, of which 22 were found among sleepwalkers. None were enriched in the sleepwalking population. However, many missense variants were predicted as likely pathogenic by at least two in silico prediction algorithms. This study involves the largest sleepwalking cohort in which the role of a susceptibility gene was investigated. Our results did not reveal an association between ADA gene and sleepwalking, thus ruling out the possibility of ADA as a major genetic factor for this condition. Future work is needed to identify susceptibility genes.
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Affiliation(s)
- Simon Fournier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Neuroscience, Université de Montréal, Montréal, Canada
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, INSERM, Univ Montpellier, Montpellier, France
| | - Simon C Warby
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marjorie Labrecque
- Department of Bioinformatics, Université de Montréal, Montréal, Canada.,CHUM Research Center, Montréal, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Soufiane Boucetta
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada
| | - Maryam El Gewely
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Houda Kaddioui
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada
| | - Régis Lopez
- Sleep Unit, Department of Neurology, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, INSERM, Univ Montpellier, Montpellier, France
| | - Jacques Y Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | | | - Martine Tétreault
- Department of Neuroscience, Université de Montréal, Montréal, Canada.,CHUM Research Center, Montréal, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur (CIUSSS-NIM), Montréal, Canada.,Department of Neuroscience, Université de Montréal, Montréal, Canada
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Olanzapine-Related Somnambulism: A Systematic Review of Literature and a Case Report of Anorexia Nervosa. J Clin Psychopharmacol 2021; 41:658-666. [PMID: 34668875 DOI: 10.1097/jcp.0000000000001480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Somnambulism, or sleepwalking (SW), is one of the most common forms of arousal parasomnias. It is characterized by different complex motor behaviors leading to unwanted movements in bed or walking during sleep. It can be the consequence of psychological stress, abnormal breathing during sleep, high fever, or drug adverse effects. There is evidence of an association between antipsychotic treatment, including olanzapine, and SW. METHODS We present the case of a patient experiencing treatment-resistant anorexia nervosa whose somnambulism re-exacerbated after the addition of a low dose of olanzapine, following the CARE (CAse REport) Statement and Checklist. We also conducted a systematic review of the literature on olanzapine-induced somnambulism following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, PsychINFO, and the Cochrane Library databases were independently reviewed up to January 2021 for articles reporting olanzapine-related somnambulism cases, without language or time restriction. RESULTS We describe a case of somnambulism in a patient initially admitted to our hospital for anorexia nervosa and treated with a low dose of olanzapine. This is the first case of SW induced by olanzapine in eating disorders to be reported. Up-to-date olanzapine-related somnambulism was described in 8 patients experiencing psychiatric disorders (ie, schizophrenia and bipolar disorder). CONCLUSIONS To provide a reliable estimate of incidence and prevalence for olanzapine-related somnambulism, large-scale, pharmacovigilance studies are required, to allow for comparisons of overall clinical characteristics, outcomes, including time to recovery, between different treatment options. Clinician awareness should be enhanced, and attention should be given to such infrequent adverse effects associated with antipsychotics.
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Scavone G, Baril AA, Montplaisir J, Carrier J, Desautels A, Zadra A. Autonomic Modulation During Baseline and Recovery Sleep in Adult Sleepwalkers. Front Neurol 2021; 12:680596. [PMID: 34248823 PMCID: PMC8263899 DOI: 10.3389/fneur.2021.680596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Sleepwalking has been conceptualized as deregulation between slow-wave sleep and arousal, with its occurrence in predisposed patients increasing following sleep deprivation. Recent evidence showed autonomic changes before arousals and somnambulistic episodes, suggesting that autonomic dysfunctions may contribute to the pathophysiology of sleepwalking. We investigated cardiac autonomic modulation during slow-wave sleep in sleepwalkers and controls during normal and recovery sleep following sleep deprivation. Fourteen adult sleepwalkers (5M; 28.1 ± 5.8 years) and 14 sex- and age-matched normal controls were evaluated by video-polysomnography for one baseline night and during recovery sleep following 25 h of sleep deprivation. Autonomic modulation was investigated with heart rate variability during participants' slow-wave sleep in their first and second sleep cycles. 5-min electrocardiographic segments from slow-wave sleep were analyzed to investigate low-frequency (LF) and high-frequency (HF) components of heart rate spectral decomposition. Group (sleepwalkers, controls) X condition (baseline, recovery) ANOVAs were performed to compare LF and HF in absolute and normalized units (nLF and nHF), and LF/HF ratio. When compared to controls, sleepwalkers' recovery slow-wave sleep showed lower LF/HF ratio and higher nHF during the first sleep cycle. In fact, compared to baseline recordings, sleepwalkers, but not controls, showed a significant decrease in nLF and LF/HF ratio as well as increased nHF during recovery slow-wave sleep during the first cycle. Although non-significant, similar findings with medium effect sizes were observed for absolute values (LF, HF). Patterns of autonomic modulation during sleepwalkers' recovery slow-wave sleep suggest parasympathetic dominance as compared to baseline sleep values and to controls. This parasympathetic predominance may be a marker of abnormal neural mechanisms underlying, or interfere with, the arousal processes and contribute to the pathophysiology of sleepwalking.
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Affiliation(s)
- Geneviève Scavone
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,The Framingham Heart Study, Boston University School of Medicine, Boston, MA, United States
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,Deparment of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,Department of Neurosciences, Université de Montréal, Montréal, QC, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur Montréal, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montréal, QC, Canada
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Ramm M, Urbanek A, Failing A, Young P, Scherfler C, Högl B, Heidbreder A. Increased behavioral inhibition trait and negative stress coping in non-rapid eye movement parasomnias. J Clin Sleep Med 2021; 16:1737-1744. [PMID: 32662417 DOI: 10.5664/jcsm.8688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Reduced gray matter volume in the posterior cingulate cortex (PCC) has recently been found in patients with non-rapid eye movement (NREM) parasomnia, providing a neuroanatomical substrate for the arousal state dissociation. It remains unclear whether PCC changes in NREM parasomnias might also play a role in cognitive or affective dysfunction in these patients. The aim of this exploratory study was to investigate neurobehavioral correlates of PCC abnormalities in patients with NREM parasomnia. METHODS The Reinforcement Sensitivity Theory of Personality Questionnaire and the Stress Coping Questionnaire were used to assess personality and stress coping in 15 patients with NREM parasomnia and 15 age- and sex-matched healthy controls. Patients' left PCC gray matter volume was quantified with voxel-based morphometry on 3 Tesla T1-weighted magnetic resonance imaging data. RESULTS In the Reinforcement Sensitivity Theory of Personality Questionnaire, increased trait reactivity of the behavioral inhibition system and goal-drive persistence contributed most to the discrimination of patients and controls. In the Stress Coping Questionnaire, patients showed an increased negative coping trait (ie, anxious rumination) related to an increase in adjusted left PCC volume. CONCLUSIONS The results suggest subclinical behavioral abnormalities in patients with NREM parasomnias. Such traits might trigger maladaptive emotion regulation processes related to a relative PCC volume increase. The findings encourage further longitudinal studies on this topic, which can provide insights into the causal relations underlying the PCC volume-behavior correlation. Such future studies will have a more direct implication for the clinical management of patients with NREM parasomnias.
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Affiliation(s)
- Markus Ramm
- Department of Neurology, Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Neurobiology and Genetics of Behavior, Department of Psychology and Psychotherapy, Centre for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany
| | - Alexandra Urbanek
- Department of Neurology, Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Annette Failing
- Radprax, Institute for Diagnostics and Research, Muenster, Germany
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach Reithofpark, Bad Feilnbach, Germany
| | | | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Camaioni M, Scarpelli S, Gorgoni M, Alfonsi V, De Gennaro L. EEG Patterns Prior to Motor Activations of Parasomnias: A Systematic Review. Nat Sci Sleep 2021; 13:713-728. [PMID: 34113199 PMCID: PMC8184251 DOI: 10.2147/nss.s306614] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Non-rapid eye movement (NREM) parasomnias are defined as abnormal nocturnal behaviors that typically arise from the NREM sleep stage 3 during the first sleep cycle. The polysomnographic studies showed an increase in sleep fragmentation and an atypical slow wave activity (SWA) in participants with NREM parasomnias compared to healthy controls. To date, the pathophysiology of NREM parasomnias is still poorly understood. The recent investigation of the EEG patterns immediately before parasomnia events could shed light on the motor activations' processes. This systematic review aims to summarize empirical evidence about these studies and provide an overview of the methodological issues. METHODS A systematic literature search was carried out in PubMed, Web of Science, and Scopus, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The documents obtained were evaluated using the Newcastle-Ottawa Scale (NOS). RESULTS Nine studies were included in the qualitative synthesis. The major evidence revealed an increased slow frequency EEG activity immediately before the motor activations in frontal and central areas and increased beta activity in the anterior cingulate cortices. DISCUSSION The investigation of EEG patterns before parasomniac episodes could provide new insight into the study of NREM parasomnia pathophysiology. The high- and low-frequency EEG increase before the episodes could represent a predictive electrophysiological pattern of the motor activations' onset. Overall, identifying specific sleep markers before parasomnias might also help differentiate between NREM parasomnias and other motor sleep disorders. Different methodological protocols should be integrated for overcoming the lack of consistent empirical findings. Thus, future studies should focus on the topographical examination of canonical EEG frequency bands to better understand spatial and time dynamics before the episodes and identify the networks underlying the onset of activations.
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Affiliation(s)
- Milena Camaioni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
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Gouverneur A, Ferreira A, Morival C, Pageot C, Tournier M, Pariente A. A safety signal of somnambulism with the use of antipsychotics and lithium: A pharmacovigilance disproportionality analysis. Br J Clin Pharmacol 2021; 87:3971-3977. [PMID: 33713370 DOI: 10.1111/bcp.14818] [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] [Received: 06/11/2020] [Revised: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Antipsychotics and lithium are widely used in psychiatry, particularly in schizophrenia and bipolar disorders. Recently, some cases of somnambulism or sleep-related eating disorder (SRED) have been reported in patients treated with these drugs. This study investigated the risk of reporting somnambulism or SRED associated with the use of antipsychotics and lithium. METHODS The World Health Organization pharmacovigilance database (VigiBase), comprising >18 million adverse events, was queried. All somnambulism or SRED reports related to antipsychotics or lithium were identified. The association between antipsychotics or lithium and somnambulism or SRED was computed using the proportional reporting ratio (PRR) and information component. RESULTS Among the 5784 cases reporting somnambulism or SRED, 508 suspected at least 1 antipsychotic or lithium. Most patients were aged 18-64 years (62.0%), and 37.0% were men. In most cases (77.6%), antipsychotic or lithium were the only drug class involved, and 53.3% of cases suspected quetiapine. Somnambulism was reported in 88.6% of cases and SRED in 18.1%. A significant association was found for second-generation antipsychotics (PRR 3.44, 95% confidence interval 3.13) and lithium (PRR 2.03, [1.22; 3.37]), but not for first-generation antipsychotics (PRR 0.99, [0.68; 1.44]). CONCLUSIONS We found a significant signal of somnambulism or SRED related to second-generation antipsychotics and lithium. While case reports mentioned mostly quetiapine and olanzapine, almost all second-generation antipsychotics were associated with somnambulism or SRED.
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Affiliation(s)
- Amandine Gouverneur
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Bordeaux, F-33000, France.,CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Bordeaux, F-33000, France
| | - Amandine Ferreira
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Bordeaux, F-33000, France.,CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Bordeaux, F-33000, France
| | - Camille Morival
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Bordeaux, F-33000, France.,CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Bordeaux, F-33000, France
| | - Cécile Pageot
- CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Bordeaux, F-33000, France
| | - Marie Tournier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Bordeaux, F-33000, France.,Hospital Charles Perrens, Bordeaux, F-33000, France
| | - Antoine Pariente
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, Bordeaux, F-33000, France.,CHU de Bordeaux, Pôle de Santé Publique, Service de Pharmacologie Médicale, Bordeaux, F-33000, France
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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: 9] [Impact Index Per Article: 3.0] [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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Disorders of Arousal: A Chronobiological Perspective. Clocks Sleep 2021; 3:53-65. [PMID: 33494408 PMCID: PMC7838780 DOI: 10.3390/clockssleep3010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/13/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are characterized by motor and emotional behaviors emerging from incomplete arousals from NREM sleep and they are currently referred to as disorders of arousal (DoA). Three main clinical entities are recognized, namely confusional arousal, sleep terror and sleepwalking. DoA are largely present in pediatric populations, an age in which they are considered as transitory, unhabitual physiological events. The literature background in the last twenty years has extensively shown that DoA can persist in adulthood in predisposed individuals or even appear de novo in some cases. Even though some episodes may arise from stage 2 of sleep, most DoA occur during slow wave sleep (SWS), and particularly during the first two sleep cycles. The reasons for this timing are linked to the intrinsic structure of SWS and with the possible influence on this sleep phase of predisposing, priming and precipitating factors for DoA episodes. The objective of this paper is to review the intrinsic sleep-related features and chronobiological aspects affecting SWS, responsible for the occurrence of the majority of DoA episodes during the first part of the night.
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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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Mutti C, Bernabè G, Barozzi N, Ciliento R, Trippi I, Pedrazzi G, Azzi N, Parrino L. Commonalities and Differences in NREM Parasomnias and Sleep-Related Epilepsy: Is There a Continuum Between the Two Conditions? Front Neurol 2020; 11:600026. [PMID: 33362702 PMCID: PMC7759670 DOI: 10.3389/fneur.2020.600026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/19/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: Differential diagnosis between disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) often represents a clinical challenge. The two conditions may be indistinguishable from a semiological point of view and the scalp video-polysomnography is often uninformative. Both disorders are associated with variable hypermotor manifestations ranging from major events to fragments of a hierarchical continuum of increasing intensity, complexity, and duration. Given their semiological overlap we decided to explore the sleep texture of DoA and SHE seeking for similarities and differences. Methods: We analyzed sleep macrostructure and CAP (cyclic alternating pattern) parameters in a cohort of 35 adult DoA patients, 40 SHE patients and 24 healthy sleepers, all recorded and scored in the same sleep laboratory. Nocturnal behavioral manifestations included minor motor events, paroxysmal arousals and major attacks in SHE, and simple, rising, or complex arousal movements in DoA. Results: Compared to healthy controls, DoA and SHE showed similar amounts of sleep efficiency, light sleep, deep sleep, REM sleep, CAP subtypes. Both groups also showed slow wave sleep fragmentation and an increased representation of stage N3 in the second part of the night. The only discriminating elements between the two conditions regarded sleep length (more reduced in DoA) and sleep instability (more elevated in SHE). In DoA recordings, all motor episodes arose from NREM sleep: 37% during light NREM stages and 63% during stage N3 (simple arousal movements: 94%). In SHE recordings, 57% of major attacks occurred during stage N3. Conclusions: So far, emphasis has been placed on the differentiation of sleep-related epilepsy and NREM arousal disorders. However, the impressive analogies between DoA and SHE suggest the existence of an underestimated continuum across the conditions, linked by increased levels of sleep instability, higher amounts of slow wave sleep and NREM/REM sleep imbalance. Sleep texture is extremely similar in the two conditions, although CAP metrics disclose quantitative differences. In particular, SHE patients show a higher arousal instability compared to DoA subjects. Given their clinical and epidemiological overlap, a common genetic background is also hypothesized. In such a perspective, we suggest that the consolidated dichotomy DoA vs. SHE should be reappraised.
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Affiliation(s)
- Carlotta Mutti
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Giorgia Bernabè
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Noemi Barozzi
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Rosario Ciliento
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Irene Trippi
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Giuseppe Pedrazzi
- Unit of Neuroscience & Interdepartmental Center of Robust Statistics, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nicoletta Azzi
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
| | - Liborio Parrino
- Department of Medicine and Surgery, Sleep Disorders Center, University of Parma, Parma, Italy
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NREM parasomnia as a dream enacting behavior. Sleep Med 2020; 75:103-105. [DOI: 10.1016/j.sleep.2020.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/23/2022]
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Lopez R, Laganière C, Chenini S, Rassu AL, Evangelista E, Barateau L, Jaussent I, Dauvilliers Y. Video-Polysomnographic Assessment for the Diagnosis of Disorders of Arousal in Children. Neurology 2020; 96:e121-e130. [PMID: 33087493 DOI: 10.1212/wnl.0000000000011091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To highlight the slow-wave sleep (SWS) fragmentation and validate the video-polysomnographic (vPSG) criteria and cutoffs for the diagnosis of disorders of arousal (DOA) in children, as already reported in adults. METHODS One hundred children (66 boys, 11.0 ± 3.3 years) with frequent episodes of DOA and 50 nonparasomniac children (32 boys, 10.9 ± 3.9 years) underwent vPSG recording to quantify SWS characteristics (number of N3 sleep interruptions, fragmentation index, slow/mixed and fast arousal ratios, and indexes per hour) and associated behaviors. We compared SWS characteristics in the 2 groups and defined the optimal cutoff values for the diagnosis of DOA using receiver operating characteristic curves. RESULTS Patients with DOA had higher amounts of N3 and REM sleep, number of N3 interruptions, SWS fragmentation, and slow/mixed arousal indexes than controls. The highest area under the curve (AUC) values were obtained for SWS fragmentation and slow/mixed arousal indexes with satisfactory classification performances (AUC 0.80, 95% confidence interval [CI] 0.73-0.87; AUC 0.82, 95% CI 0.75-0.89). SWS fragmentation index cutoff value of 4.1/h reached a sensitivity of 65.0% and a specificity of 84.0%. Slow/mixed arousal index cutoff of 3.8/h reached a sensitivity of 69.0% and a specificity of 82.0%. At least one parasomniac episode was recorded in 63.0% of patients and none of the controls. Combining behavioral component by vPSG increased sensitivity of both biomarkers to 83% and 89%, respectively. CONCLUSIONS We confirmed that SWS fragmentation and slow/mixed arousal indexes are 2 relevant biomarkers for the diagnosis of DOA in children, with different cutoffs obtained than those validated in adults. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that SWS fragmentation and slow/mixed arousal indexes on vPSG accurately identify children with DOA.
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Affiliation(s)
- Régis Lopez
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada.
| | - Christine Laganière
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Sofiène Chenini
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Anna Laura Rassu
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Elisa Evangelista
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Lucie Barateau
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Isabelle Jaussent
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada
| | - Yves Dauvilliers
- From Service de Neurologie (R.L., S.C., A.L.R., E.E., L.B., Y.D.), Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac Montpellier; PSNREC (R.L., E.E., L.B., I.J., Y.D.), Univ Montpellier, INSERM, France; Department of Educational and Counselling Psychology (C.L.), McGill University; Douglas Mental Health University Institute (C.L.); and Hôpital en Santé Mentale Rivière-des-Prairies (C.L.), CIUSSS-du-Nord-de-l'île-de-Montréal, Montréal, Canada.
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Dreams and nightmares in healthy adults and in patients with sleep and neurological disorders. Lancet Neurol 2020; 19:849-859. [PMID: 32949545 DOI: 10.1016/s1474-4422(20)30275-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/24/2019] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Dreams are experiences that occur during sleep, while we are disconnected from the environment. Thanks to recent progress in neuroimaging techniques, it is now becoming possible to relate dream features to specific patterns of brain activity. Some conditions occurring in patients with neurological disorders, such as lucid dreams and parasomnias, not only have diagnostic value, but also offer a window into the dream process. They show that dreaming is reflected in physiological signals, behaviours, and brain activity patterns, and that the body can enact dream content. Yet, the dream body can also be distinct from the real body; in their dreams, patients with congenital paraplegia can walk, those with sleep apnoea rarely suffocate, and phantom limb pain can disappear. These conditions provide valuable models for future studies investigating the mechanisms that underlie oneiric experiences.
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Castelnovo A, Turner K, Rossi A, Galbiati A, Gagliardi A, Proserpio P, Nobili L, Terzaghi M, Manni R, Ferini Strambi L, Manconi M, Miano S, Zambrelli E, Paola Canevini M. Behavioural and emotional profiles of children and adolescents with disorders of arousal. J Sleep Res 2020; 30:e13188. [PMID: 32909647 DOI: 10.1111/jsr.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022]
Abstract
Disorders of arousals are common sleep disorders characterized by complex motor behaviours that arise episodically out of slow-wave sleep. Psychological distress has long been associated with disorders of arousal, but this link remains controversial, especially in children and adolescents. The aim of this multi-centre study was to characterize behavioural and emotional problems in a sample of children/adolescents with disorders of arousal, and to explore their relationship with the severity of nocturnal episodes. The parents of 41 children/adolescents with a diagnosis of disorders of arousal (11.5 ± 3.3 years old, 61% males) and of a group of 41 age- and gender-matched control participants filled in the Child Behavior Checklist, along with the Sleep Disturbance Scale for Children and the Paris Arousal Disorders Severity Scale. Multilevel t-tests revealed significantly higher total scores and sub-scores of the Child Behavior Checklist for the patient group compared with the control group. Thirty-four percent of the patients obtained pathological total scores, and 12% of them borderline scores. The severity of emotional/behavioural problems in the patient group was positively correlated with the severity of the nocturnal episodes. Interestingly, children/adolescents with disorders of arousal also obtained higher excessive daytime sleepiness and insomnia symptoms sub-scores at the Sleep Disturbance Scale for Children. These results confirmed the hypothesis that behavioural/emotional problems are surprisingly common in children/adolescents with disorders of arousal. Further studies are warranted to investigate the causal relationship between pathological manifestations, subtler sleep abnormalities, and diurnal emotional/behavioural problems in children/adolescents with disorders of arousal.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Katherine Turner
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Alessandro Rossi
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
| | - Andrea Galbiati
- Department of Neurology, Sleep Disorders Center, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Alessandra Gagliardi
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Centre Cantonal de l'Autisme, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland
| | - Paola Proserpio
- Claudio Munari Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Department of Neuroscience - Rehabilitation-Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy.,Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Istituto Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Istituto Mondino Foundation, Pavia, Italy
| | - Luigi Ferini Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Maria Paola Canevini
- Department of Health Sciences, University of Milan, Milan, Italy.,Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
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NREM sleep arousal-related disorders reflect cognitive impairment in Parkinson's disease. Sleep Med 2020; 75:491-496. [PMID: 33011475 DOI: 10.1016/j.sleep.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sleep disorders and cognitive impairment are frequently reported in Parkinson's disease (PD) as non-motor disabling symptoms. While it is known that REM sleep Behaviour Disorder (RBD) in PD is associated with motor and cognitive decline, little is known about the neurobiological significance of NREM sleep arousal-related disorders. OBJECTIVES to evaluate the cognitive and clinical correlates of arousal-related disorders in PD. METHODS Clinical data and video-polysomnography were analysed from one hundred-seventy consecutive subjects with PD. Based on the neuropsychological assessment, the subjects were divided into three groups: no cognitive impairment (PD; n = 58), mild cognitive impairment (PD-MCI; n = 58) and overt dementia (PDD; n = 54). RESULTS Arousal-related disorders by history were reported in 32.9% of the subjects: 10.3% PD, 31.6% PD-MCI and 59.3% PDD (p = 0.001). Video-PSG captured arousal-related disorders in 1.7% PD, 21.2% MCI-PD and 35.6% PDD (p = 0.001). Arousal-related disorders and RBD were recorded in the same night in 7.7% PD, 9.8% MCI-PD and 15.6% PDD (p = 0.04). Patients with arousal-related disorders captured at V-PSG have a longer disease duration (p = 0.003), higher UPDRS score (p = 0.039), longer duration of treatment with levodopa (p = 0.017) and dopamine agonists (p = 0.018), worse H&Y staging (p = 0.001), lower MMSE score (p = 0.019) and more frequently hallucinations (p = 0.004). In multivariate analysis, cognitive impairment significantly increases the risk of arousal-related disorders (OR 3.387-95% CI 1.395-8.220, p = 0.007). CONCLUSION Arousal-related disorders appear to be a marker of cognitive decline in PD. Recognizing arousal-related disorders should make clinicians aware of a possible cognitive decline in PD and eventually modify the therapeutic approach.
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Carpentier N, O'Reilly C, Carrier J, Poirier G, Paquet J, Gibbs SA, Zadra A, Desautels A. Spindles insufficiency in sleepwalkers' deep sleep. Neurophysiol Clin 2020; 50:339-343. [PMID: 32896465 DOI: 10.1016/j.neucli.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Sleepwalkers have consistently shown N3 sleep discontinuity, especially after sleep deprivation. In healthy subjects, sleep spindles activity has been positively correlated to sleep stability. We aimed to compare spindles density during N3 sleep between sleepwalkers and healthy controls. METHODS Two cohorts of 10 and 21 adult sleepwalkers respectively controlled with 10 and 18 healthy volunteers underwent one baseline and one recovery sleep recording after 38h (cohort 1) and 25h (cohort 2) of sleep deprivation. For the two recordings, we performed an automatic detection of spindles (11-16Hz) from EEG signal during N3 sleep, restricted to the first sleep cycle and repeated for all cycles. For better interpretation of results, we extended the analysis to N2 sleep and we also measured the density of slow waves oscillation (SWO) (0.5-4Hz) during the same periods. RESULTS Compared to controls, sleepwalkers showed significantly lower spindle densities during N3 sleep considering the first sleep cycle (both cohorts) or all cycles (cohort 1). SWO densities did not differ (cohort 1) or were lower (cohort 2) for sleepwalkers. The effect of sleep deprivation did not interact with the effect of group on spindles and SWO densities. CONCLUSION This work suggests that the instability of N3 sleep inherent to sleepwalkers may be underpinned by a specific alteration of spindles activity.
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Affiliation(s)
- Nicolas Carpentier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada; Center for Medicine and Research in Sleep, Department of Neurology, Centre Hospitalier Universitaire de Nancy, Nancy, France.
| | - Christian O'Reilly
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Canada; Department of Psychology, Université de Montréal, Montréal, Canada
| | - Gaétan Poirier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada
| | - Jean Paquet
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada
| | - Steve A Gibbs
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada; Department of Neurosciences, Université de Montréal, Montréal, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada; Department of Psychology, Université de Montréal, Montréal, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Canada; Department of Neurosciences, Université de Montréal, Montréal, Canada
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Guénolé F. [Sleep disorders in babies and children]. SOINS. PEDIATRIE, PUERICULTURE 2020; 41:22-28. [PMID: 33092798 DOI: 10.1016/j.spp.2020.08.005] [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 children develop a characterized sleep disorder, sometimes with severe consequences. Behind the term "insomnia", there is a wide variety of disorders, causes and psychopathological contexts to which the clinician will have to adapt for optimal management, from babies to pre-adolescents.
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Affiliation(s)
- Fabian Guénolé
- Centre hospitalier universitaire de Caen, 14 avenue Clemenceau, 14033 Caen cedex 9, France.
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Ariño H, Muñoz-Lopetegi A, Martinez-Hernandez E, Armangue T, Rosa-Justicia M, Escudero D, Matos N, Graus F, Sugranyes G, Castro-Fornieles J, Compte A, Dalmau J, Santamaria J. Sleep disorders in anti-NMDAR encephalitis. Neurology 2020; 95:e671-e684. [DOI: 10.1212/wnl.0000000000009987] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/26/2020] [Indexed: 02/06/2023] Open
Abstract
ObjectiveTo describe the sleep disorders in anti–NMDA receptor encephalitis (anti-NMDARe).MethodsPatients recovering from anti-NMDARe were invited to participate in a prospective observational single-center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment, and neuropsychological evaluation. Age- and sex-matched healthy participants served as controls.ResultsEighteen patients (89% female, median age 26 years, interquartile range [IQR] 21–29 years) and 21 controls (81% female, median age 23 years, IQR 18–26 years) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study admission (median 183 days after disease onset, IQR 110–242 days), 8 patients still had hypersomnia, 1 had insomnia, and 9 had normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p = 0.02, and Epworth Sleepiness Score, p = 0.04). On V-PSG, sleep efficiency was similar in both groups, but patients more frequently had multiple and longer confusional arousals in non-REM (NREM) sleep (videos provided). In addition, 13 (72%) patients had cognitive deficits; 12 (67%) had psychological, social, or occupational disability; and 33% had depression or mania. Compared with controls, patients had a higher body mass index (median 23.5 [IQR 22.3–30.2] vs 20.5 [19.1–21.1] kg/m2; p = 0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) developed hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction.ConclusionsSleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), are associated with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.
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Abstract
Patient education and behavioral management represent the first treatment approaches to the patient with parasomnia, especially in case of disorders of arousal (DOA). A pharmacologic treatment of DOA may be useful when episodes are frequent and persist despite resolution of predisposing factors, are associated with a high risk of injury, or cause significant impairment, such as excessive sleepiness. Approved drugs for DOA are still lacking. The most commonly used medications are benzodiazepines and antidepressants. The pharmacologic treatment of rapid eye movement sleep behavior disorder is symptomatic, and the most commonly used drugs are clonazepam and melatonin.
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Affiliation(s)
- Paola Proserpio
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Lino Nobili
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child neuropsychiatry, Gaslini Institute, Via Gerolamo Gaslini, Genoa 5-16147, Italy.
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Zakharov AV, Poverennova IE, Kalinin VA, Khivintseva EV. Parasomnias Associated with Disordered Arousal from Slow-Wave Sleep: Mechanism of Occurrence and Neurophysiological Characteristics. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s11055-020-00897-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ledard N, Artru E, Colmenarez Sayago P, Redolfi S, Golmard JL, Carrillo-Solano M, Arnulf I. Adrenergic reactions during N3 sleep arousals in sleepwalking and sleep terrors: The chicken or the egg? J Sleep Res 2019; 29:e12946. [PMID: 31742835 DOI: 10.1111/jsr.12946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/03/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
To understand the mechanisms of N3 sleep interruptions in patients with sleepwalking episodes and/or sleep terrors (SW/ST), we evaluated whether autonomic reactions preceded or accompanied behavioural arousals from NREM sleep stage N3. In 20 adult patients with SW/ST and 20 matched controls without parasomnia, heart rate and pulse wave amplitude were measured beat-to-beat during the 10 beats preceding and during the 15 beats succeeding a motor arousal from N3 sleep. Respiratory rate and amplitude were measured during the same 25 successive beats. In patients with SW/ST, the N3 arousals were associated with a 33% increase in heart rate, a 57% decrease in pulse wave amplitude (indicating a major vasoconstriction), a 24% increase in respiratory rate and a doubling of respiratory amplitude. Notably, tachycardia and vasoconstriction started 4 s before motor arousals. A similar profile (tachycardia and vasoconstriction gradually increasing from the 4 s preceding arousal and post-arousal increase of respiratory amplitude, but no polypnea) was also observed, with a lower amplitude, during the less frequent 38 quiet N3 arousals in control subjects. Parasomniac arousals were associated with greater tachycardia, vasoconstriction and polypnea than quiet arousals, with the same pre-arousal gradual increases in heart rate and vasoconstriction. Autonomic arousal occurs 4 s before motor arousal from N3 sleep in patients with SW/ST (with a higher adrenergic reaction than in controls), suggesting that an alarming event during sleep (possibly a worrying sleep mentation or a local subcortical arousal) causes the motor arousal.
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Affiliation(s)
- Nahema Ledard
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Sorbonne University, Paris, France
| | - Emilie Artru
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital (APHP), Paris, France
| | | | - Stefania Redolfi
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Sorbonne University, Paris, France
| | - Jean-Louis Golmard
- Sorbonne University, Paris, France.,Department of Biostatistics, Pitié-Salpêtrière University Hospital (APHP), Paris, France
| | | | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière University Hospital (APHP), Paris, France.,Sorbonne University, Paris, France
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Nigam M, Zadra A, Boucetta S, Gibbs SA, Montplaisir J, Desautels A. Successful Treatment of Somnambulism With OROS-Methylphenidate. J Clin Sleep Med 2019; 15:1683-1685. [PMID: 31739860 PMCID: PMC6853387 DOI: 10.5664/jcsm.8040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022]
Abstract
None Somnambulism is a non-rapid eye movement sleep parasomnia with potential for significant injury as well as functional nighttime and daytime impairment. Clonazepam is frequently used as first line pharmacotherapy. However, the optimal treatment of somnambulism has not been established. In this article, we present the cases of two patients with severe somnambulism who showed a significant therapeutic response to osmotic release oral system methylphenidate (OROS-MPH). In addition to its practical therapeutic implications, this first report of the successful treatment of somnambulism with OROS-MPH may provide additional insight into the neurobiological underpinnings of this medical condition.
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Affiliation(s)
- Milan Nigam
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Soufiane Boucetta
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Steve A. Gibbs
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
- Neurology Service, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
- Department of Neurosciences, Université de Montréal, Montéeal, Québec, Canada
- Neurology Service, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
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Castelnovo A, Lopez R, Proserpio P, Nobili L, Dauvilliers Y. NREM sleep parasomnias as disorders of sleep-state dissociation. Nat Rev Neurol 2019; 14:470-481. [PMID: 29959394 DOI: 10.1038/s41582-018-0030-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-rapid eye movement (NREM) sleep parasomnias (or NREM parasomnias) are fascinating disorders with mysterious neurobiological substrates. These conditions are common and often severe, with social, personal and forensic implications. The NREM parasomnias include sleepwalking, sleep terrors and confusional arousals - collectively termed disorders of arousal (DOAs) - as well as less well-known entities such as sleep-related sexual behaviours and eating disorders. Affected patients can exhibit waking behaviours arising abruptly out of NREM sleep. Although the individual remains largely unresponsive to the external environment, their EEG shows both typical sleep-like and wake-like features, and they occasionally report dreaming afterwards. Therefore, these disorders offer a unique natural model to explore the abnormal coexistence of local sleep and wake brain activity and the dissociation between behaviour and various aspects of consciousness. In this article, we critically review major findings and updates on DOAs, focusing on neurophysiological studies, and offer an overview of new clinical frontiers and promising future research areas. We advocate a joint effort to inform clinicians and the general public about the management and follow-up of these conditions. We also strongly encourage collaborative multicentre studies to add more objective polysomnographic criteria to the current official diagnostic definitions and to develop clinical practice guidelines, multidisciplinary research approaches and evidence-based medical care.
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Affiliation(s)
- Anna Castelnovo
- Center for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Régis Lopez
- Reference National Center for Narcolepsy-Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
| | - Paola Proserpio
- Claudio Munari Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Claudio Munari Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy. .,Department of Neuroscience, DINOGMI, University of Genoa, Genoa, Italy.
| | - Yves Dauvilliers
- Reference National Center for Narcolepsy-Hypersomnia, Sleep Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.
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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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