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Perretti C, Gales A, Leu-Semenescu S, Dodet P, Bianquis C, Groos E, Puligheddu M, Maranci JB, Arnulf I. Latency to N3 interruption in arousal disorders. Sleep 2024; 47:zsae033. [PMID: 38306685 DOI: 10.1093/sleep/zsae033] [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: 10/03/2023] [Revised: 12/17/2023] [Indexed: 02/04/2024] Open
Abstract
STUDY OBJECTIVES To help expert witnesses in criminal cases using the "sleepwalking defense," we studied the time of first and last interruptions from stage N3 in patients with arousal disorders, including sexsomnia, as well as their determinants. METHODS The epochs of lights off, sleep onset, first N3 interruption (with and without behaviors), and last N3 interruption were determined by videopolysomnography on two consecutive nights in 163 adults with disorders of arousal, including 46 with and 117 without sexsomnia. RESULTS The first N3 interruption (independently of concomitant behavior) occurred as early as 8 minutes after sleep onset and within 100 minutes of falling asleep in 95% of cases. The first motor arousal from N3 occurred as early as 25 minutes after lights off time, a timing more variable between participants (between 30 and 60 minutes after lights off time in 25% of participants and within 60 minutes of falling asleep in 50%). These latencies did not differ between the groups with and without sexsomnia. No correlation was found between these latencies and the young age, sex, or clinical severity. The latency of motor arousals was shorter when they were associated with a fast-wave EEG profile and were not preceded by another type of N3 arousal. CONCLUSIONS The first motor arousal may occur early in the night in patients with arousal disorders, with or without sexsomnia, suggesting that abnormal behaviors occurring as early as 25 minutes after lights off time in clinical and criminal cases can be a parasomnia manifestation.
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Affiliation(s)
- Carlos Perretti
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ana Gales
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- DreamTeam, Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Pauline Dodet
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Heath Faculty, Sorbonne University, Paris, France
- DreamTeam, Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Clara Bianquis
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Elisabeth Groos
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Jean-Baptiste Maranci
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Heath Faculty, Sorbonne University, Paris, France
- DreamTeam, Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Isabelle Arnulf
- Sleep Clinic, Pitie-Salpetriere Hospital, APHP-Sorbonne, Paris, France
- Heath Faculty, Sorbonne University, Paris, France
- DreamTeam, Paris Brain Institute (ICM), INSERM, CNRS, Paris, France
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Lopez R, Dauvilliers Y. Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications. Sleep Med Rev 2024; 73:101888. [PMID: 38150767 DOI: 10.1016/j.smrv.2023.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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3
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Lopez R, 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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4
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Pressman MR. Forensic Evaluation of a Single Episode of a Disorder of Arousal in a Sleepwalking Defense: Cognitive Function Versus Prior Clinical History. Sleep Sci 2023; 16:e354-e361. [PMID: 38196760 PMCID: PMC10773509 DOI: 10.1055/s-0043-1773787] [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: 06/23/2022] [Accepted: 11/09/2022] [Indexed: 01/11/2024] Open
Abstract
Introduction The clinical diagnosis of disorders of arousal (DOA) is based primarily on a clinical history including amnesia for episodes. The presence of amnesia means the patient cannot provide direct evidence. In a forensic setting, when the defendant has been charged criminally with violent actions or sexual related assaults allegedly during sleep, a sleepwalking defense may be presented. As opposed to clinical history, the prosecution generally focuses on the single episode of alleged DOA that resulted in the criminal charges against the defendant. The prosecution will argue that this episode of complex behavior was not consistent with a DOA. A past history of purported episodes is not proof that a recent single episode must be a DOA. However, most sleepwalking defenses rely heavily on standard clinical evaluations despite the fact they have no direct connection with the current criminally charged episode. The International Classification of Sleep Disorders (ICSD-3) General Diagnostic Criteria C for DOAs that states "limited or no associated cognition" should be present. Recent real time studies of DOAs have shown that during DOA episodes the prefrontal cortex (PRC) is deactivated while the motor cortex remains active. Conclusion The PFC is the location of almost all executive functions including inhibition, planning, memory, and many others. Thus, when the PFC is deactivated, these higher cognitive functions are not available. The presence of higher cognitive functions during an alleged episode of DOA would be inconsistent with a deactivated PFC and thus inconsistent with generally accepted brain activity during a NREM parasomnia. This would be direct evidence that the episode could not be a DOA but occurred during wakefulness. Clinical trial No.
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Affiliation(s)
- Mark R. Pressman
- Pressman Sleep and Science Forensics, LLC, Ardmore, Pennsylvania, United States
- Lankenau Institute of Medical Research, Wynnewood, Pennsylvania, United States
- Department of Medicine, Sidney Kimmel Medical College Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Charles Widger School of Law, Villanova University, Villanova, Pennsylvania, United States
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5
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Mainieri G, Loddo G, Baldelli L, Montini A, Mondini S, Provini F. 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; 12:372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, 40100 Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Angelica Montini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
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6
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Disorders of Arousal and timing of the first period of slow wave sleep: Clinical and forensic implications. Sleep Med X 2022; 4:100057. [PMID: 36187082 PMCID: PMC9520070 DOI: 10.1016/j.sleepx.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/27/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
The timing of first period of slow wave sleep (SWS) is often used as a proxy for determining if and when Disorders of Arousal (DOA) such as sleepwalking are likely to occur or did occur in the past. In criminal cases employing a “sleepwalking defense” the prosecution may argue that nocturnal violence or sexually aggressive behavior occurred too early in the sleep period to be associated with SWS. Expert witness opinion on the expected latency to SWS (LSWS) has varied from minutes after sleep onset to ≥60 min. A search of PubMed was conducted for LSWS and for any reports of DOAs occurring from stage N2. A total of 21 studies reported LSWS in normal controls, clinically diagnosed sleepwalkers, in otherwise normal sleepers following different types of sleep deprivation and due to the effects of alcohol. Five studies reported episodes of DOA from N2 sleep. The shortest mean LSWS of 6.4 min was found with a combination of total sleep deprivation and alcohol. In a group of normal research subjects, a LSWS mean of 10.7 min was noted. LSWS in DOA patients occurred as early as a mean of 12.4 min. Two sleep studies performed on Kenneth Parks, acquitted of the murder of his mother-in-law by a sleepwalking defense, reported LSWSs of 9.7 and 10 min. Sleep deprivation but not alcohol was found to decrease LSWS significantly. Expert opinions on LSWS should be based on scientific peer reviewed publications documenting empirical sleep evidence and can be much shorter than is generally reported. Detailed review of methods and problems of determining the onset of Slow Wave Sleep. Reviews the application of latency to slow wave sleep in criminal cases invoking a sleepwalking defense. Reviews the influence of sleep deprivation and alcohol on slow wave sleep and sleepwalking.
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7
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Gigliotti F, Esposito D, Basile C, Cesario S, Bruni O. Sleep terrors-A parental nightmare. Pediatr Pulmonol 2022; 57:1869-1878. [PMID: 33647192 DOI: 10.1002/ppul.25304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
Sleep terrors (STs) are sleep disorders characterized by abrupt arousal from sleep with autonomic hyperactivity and inappropriate behavior. Though a common condition in childhood that usually affects children between 4 and 12 years of age, STs, however, may be present even in adulthood. The exact etiology of STs is not known yet, however, several hypotheses have been proposed over the years, identifying some potential genetic, neurodevelopmental, or other causes. Nevertheless, a useful pathophysiological model identified a common cascade of predisposing, priming, and precipitating factors, which could help to explain and sometimes prevent STs. Establishing a correct diagnosis is mandatory for appropriate management, as several conditions (such as other parasomnias or nocturnal seizures) may mimic STs. Furthermore, we also described some conditions which can be comorbid to STs, like some medical or psychological disorders. A number of treatment options have been proposed, ranging from only sleep hygiene practices to pharmacological therapies; we reviewed some of the most prominent ones. In spite of the fact that STs have long been considered benign disorders, which tend to reduce spontaneously over the years, they may have unexpected consequences on the child but also on the caregivers.
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Affiliation(s)
- Federica Gigliotti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Dario Esposito
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Consuelo Basile
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Serena Cesario
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
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8
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Idir Y, Oudiette D, Arnulf I. Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new. J Sleep Res 2022; 31:e13596. [PMID: 35388549 DOI: 10.1111/jsr.13596] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 01/03/2023]
Abstract
Disorders of arousal (DOA) is an umbrella term initially covering classical sleepwalking, sleep terrors, and confusional arousals, and now including a wider spectrum of specialised forms of non rapid eye movement (non REM) parasomnias such as sexsomnia, sleep-related eating disorder, and sleep-related choking syndrome. Growing evidence has shown that DOA are not restricted to children but are also prevalent in adults (2%-4% of the adult population). While DOA run in family, genetics studies remain scarce and inconclusive. In addition to the risk of injury on themselves and others (including sexual assaults in sexsomnia), adults with DOA frequently suffer from excessive daytime sleepiness, pain, and altered quality of life. The widespread view of DOA as automatic and amnesiac behaviours has now been challenged by subjective (dream reports) and objective (dream-enacting behaviours documented on video-polysomnography) observations, suggesting that sleepwalkers are 'dream walking' during their episodes. Behavioural, experiential, cognitive, and brain (scalp electroencephalography [EEG], stereo-EEG, high density-EEG, functional brain imaging) data converge in showing a dissociated pattern during the episodes. This dissociated pattern resembles the new concept of local arousal with a wake-like activation in motor and limbic regions and a preserved (or even increased) sleep intensity over a frontoparietal network. EEG and behavioural criteria supporting the DOA diagnosis with high sensitivity and specificity are now available. However, treatment is still based on controlling priming and precipitating factors, as well as on clinicians' personal experience with sedative drugs. Placebo-controlled trials are needed to improve patients' treatment. DOA deserve more attention from sleep researchers and clinicians.
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Affiliation(s)
- Yannis Idir
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
| | - Delphine Oudiette
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
| | - Isabelle Arnulf
- Sorbonne University, Paris, France.,Institut du Cerveau - Paris Brain Institute - ICM, INSERM, CNRS, Paris, France.,APHP-Sorbonne, Pitie-Salpetriere University Hospital Sleep Disorders Unit, Paris, France
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9
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Thompson W, Pressman M. Commentary on: Munro NA. Alcohol and parasomnias: The statistical evaluation of the parasomnia defense in sexual assault, where alcohol is involved. J Forensic Sci. 2020;65(4):1235–41. doi: 10.1111/1556‐4029.14322. J Forensic Sci 2022; 67:1320-1322. [DOI: 10.1111/1556-4029.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Affiliation(s)
- William Thompson
- Department of Criminology, Law and Society University of California Irvine California USA
| | - Mark Pressman
- Jefferson Medical College of Thomas Jefferson University Philadelphia Pennsylvania USA
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10
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Malinowski JE, Scheel D, McCloskey M. Do animals dream? Conscious Cogn 2021; 95:103214. [PMID: 34653784 DOI: 10.1016/j.concog.2021.103214] [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: 03/31/2021] [Revised: 07/22/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
The understanding of biological functions of sleep has improved recently, including an understanding of the deep evolutionary roots of sleep among animals. However, dreaming as an element of sleep may be particularly difficult to address in non-human animals because in humans dreaming involves a non-wakeful form of awareness typically identified through verbal report. Here, we argue that parallels that exist between the phenomenology, physiology, and sleep behaviors during human dreaming provide an avenue to investigate dreaming in non-human animals. We review three alternative measurements of human dreaming - neural correlates of dreaming, 'replay' of newly-acquired memories, and dream-enacting behaviors - and consider how these may be applied to non-human animal models. We suggest that while animals close in brain structure to humans (such as mammals and birds) may be optimal models for the first two of these measurements, cephalopods, especially octopuses, may be particularly good candidates for the third.
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Affiliation(s)
- J E Malinowski
- School of Psychology, University of East London, Stratford, UK.
| | - D Scheel
- Institute of Culture & Environment, Alaska Pacific University, Anchorage, AK, USA.
| | - M McCloskey
- Institute of Culture & Environment, Alaska Pacific University, Anchorage, AK, USA.
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11
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Fisher BS, LeBoeuf K. Mental Health and the Law. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Montini A, Loddo G, Baldelli L, Cilea R, Provini F. Sleep-Related Hypermotor Epilepsy vs Disorders of Arousal in Adults: A Step-Wise Approach to Diagnosis. Chest 2021; 160:319-329. [PMID: 33529771 DOI: 10.1016/j.chest.2021.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) are sleep-related events characterized by complex, often bizarre, and violent behaviors. DoA are involuntary motor manifestations of various complexities occurring during incomplete awakening from non-rapid eye movement sleep. SHE is a focal epilepsy characterized by stereotyped hyperkinetic or/and asymmetric tonic/dystonic seizures usually arising from non-rapid eye movement sleep. Even if many aspects regarding DoA and SHE have been clarified, the differential diagnosis remains challenging, because DoA and SHE share some semiologic features and genetic background. The clinical history, collected from the patient and his/her witness, represents the first and common milestone in the diagnosis. Validated questionnaires constitute suitable screening tools that could guide further analysis. The worldwide availability of homemade video recordings has increased the possibility of adding more objective information to the clinical history alone. The confirmed diagnosis relies on video-polysomnographic recording although it requires time, economic resources, and specific skills for the analysis. In this review we propose a simple diagnostic algorithm for the differential diagnosis between DoA and SHE in adults, based on the most updated knowledge, from the simpler tool to the most specific and tailored one.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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13
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Baltzan M, Yao C, Rizzo D, Postuma R. Dream enactment behavior: review for the clinician. J Clin Sleep Med 2020; 16:1949-1969. [PMID: 32741444 PMCID: PMC8034224 DOI: 10.5664/jcsm.8734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
NONE Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
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Affiliation(s)
- Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L’île de Montréal, Montréal, Canada
- Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L’île de Montréal, Montréal, Canada
- Institut de Médecine du Sommeil, Montréal, Canada
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | - Dorrie Rizzo
- Faculty of Medicine, Department of Family Medicine, McGill University, Montréal, Canada
- Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux de l’ouest de l’île, Montréal, Canada
| | - Ron Postuma
- Research Institute of McGill University Health Centre, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, 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: 100] [Impact Index Per Article: 20.0] [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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Cramer Bornemann MA, Schenck CH, Mahowald MW. A Review of Sleep-Related Violence. Chest 2019; 155:1059-1066. [DOI: 10.1016/j.chest.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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Ingravallo F, Schenck CH, D'Aloja E, Puligheddu M. Firing a loaded gun during sleep in an elderly man with a "perfect storm" of risk factors including severe obstructive sleep apnea. Sleep Breath 2017; 22:51-54. [PMID: 29038950 DOI: 10.1007/s11325-017-1577-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/23/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We report a case of firing a loaded gun during sleep in a geriatric patient with undiagnosed major sleep disorders and multiple risk factors for sleep violence. Polysomnographic findings, diagnostic challenges, and forensic implications in this unprecedented geriatric case are discussed. METHODS A 75-year-old employed man, married for 32 years, presented to a sleep center reporting to having fired a shot in his bedroom during sleep while his wife was away, without memory of hearing the gunshot. The day before the event, the patient had a normal life, apart from serious worries about recent nearby burglaries that prompted his sleeping with a loaded gun placed behind his bed. The patient underwent a sleep medicine workup, including nocturnal video polysomnography (vPSG). RESULTS The patient and his wife were unaware of any sleep problems. Upon careful questioning, only mild daytime sleepiness and rare episodes of minor abnormal motor behavior were reported. At vPSG, sleep structure was markedly disrupted with only one clear sleep cycle with REM sleep that had preserved REM-atonia; severe obstructive sleep apnea and moderately severe periodic limb movement activity were documented. Brief abnormal movements from REM sleep without apparent precipitant were recorded. CPAP therapy was effective. CONCLUSIONS In this case, there was a "perfect storm" of sleep and psychological risk factors that converged to strongly promote precipitous arousals with sleep-related violence in a patient with documented sleep motor dyscontrol. Primary care physicians, including geriatric specialists, should question patients and their spouses about any symptoms of sleep disorders.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via Irnerio 49, Bologna, Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Ernesto D'Aloja
- Department of Medical Sciences and Public Health, University of Cagliari, SS554bivio Sestu, Monserrato, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, University of Cagliari, SS554bivio Sestu, Monserrato, Cagliari, Italy.,Sleep Disorder Center, University of Cagliari, SS554bivio Sestu, Monserrato, Cagliari, Italy
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Madigand-Tordjman MA, Egler PJ, Bertran F, Jokic M, Guénolé F. [Life-threatening sleepwalking (Elpenor's syndrome) in a 10-year-old child]. Arch Pediatr 2017; 24:557-560. [PMID: 28416429 DOI: 10.1016/j.arcped.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/10/2017] [Indexed: 11/18/2022]
Abstract
Though benign in the majority of cases, sleepwalking sometimes causes injuries due, among other causes, to falls. Such accidents can be life-threatening - a situation that has been termed Elpenor syndrome (in reference to an accident experienced by a character in Homer's epic The Odyssey) - in particular when entailing defenestration. This syndrome has been described in adults and adolescents; we report here a case in a child. OBSERVATION This 10-year-old girl was admitted at night to our hospital after a 3-m fall at home. She was alert (Glasgow score, 15) at admission; a frontal wound and a deformation of the right wrist were noted. Brain CT scans showed a frontal skull fracture and frontal lobe contusion, wrist x-rays showed a displaced right fracture. The patient underwent urgent neurosurgery (wound excision and suture after reduction of skull fracture) and closed reduction and immobilization of the wrist fracture, both under general anesthesia. She underwent a psychiatric assessment in the intensive care unit 3 days after her fall. She was alert, well-oriented in time and space, and spoke fluently. She had no memory of her fall, only remembering going to bed in the evening before the accident and waking up in the ambulance on the way to the hospital. She displayed no sign of a concurrent mental illness and no suicidal ideas. Her parents reported that the evening of the accident she and her two brothers had all fallen asleep about 11:00 pm while watching TV, in the double bed of the guest room, placed just beside its window. At approximately 1:00 am, her father, who was going to bed and had just made noise in the hall, heard a cry from the guest room. He entered the room immediately and saw the opened window and his daughter lying on the outside ground; the brothers only awakened after the fall. The family had returned 2 days before from a 6-month stay in the United States, with jet-lag, sleep deprivation, and a disorganized sleep/wake rhythm in the patient. There was no medication before the accident, no substance use (including caffeine), and no concurrent medical problem. Over the 2 preceding years, the patient had undergone two witnessed episodes of early-nighttime arousal with altered consciousness and calm wandering (including going downstairs on one occasion), both strongly suggesting sleepwalking. There was a history of sleepwalking in her father and her older brother. Life-threatening sleepwalking (Elpenor syndrome) was diagnosed. The child and her parents were educated about sleepwalking; regularization of sleep schedules and sleep extension (avoidance of sleep deprivation, short napping when possible) were prescribed. We also recommended securing the home (bed, windows, and stairways). No pharmacological treatment was instituted. During the following 18 months, the child manifested only one noted sleepwalking episode, without risk-taking. She had no neurological or psychopathological sequela from her accident, of which she never had a memory. CONCLUSION Elpenor syndrome can occur in a child; consequently, it is important to inform parents of children with sleepwalking about the necessity of always securing the night-time environment.
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Affiliation(s)
- M-A Madigand-Tordjman
- Service de psychiatrie de l'enfant et de l'adolescent, CHU de Caen, 4, avenue Georges-Clemenceau, 14033 Caen cedex 9, France
| | - P-J Egler
- Service de psychiatrie de l'enfant et de l'adolescent, CHU de Caen, 4, avenue Georges-Clemenceau, 14033 Caen cedex 9, France
| | - F Bertran
- Unité d'exploration et de traitement des troubles du sommeil, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Inserm U1077, neuropsychologie et neuroanatomie fonctionnelle de la mémoire humaine, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - M Jokic
- Réanimation médicale et chirurgicale pédiatrique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - F Guénolé
- Service de psychiatrie de l'enfant et de l'adolescent, CHU de Caen, 4, avenue Georges-Clemenceau, 14033 Caen cedex 9, France; Inserm U1077, neuropsychologie et neuroanatomie fonctionnelle de la mémoire humaine, 2, rue des Rochambelles, 14032 Caen cedex, France; Université Caen Normandie, pôle de formation et de recherche en santé, 2, rue des Rochambelles, 14032 Caen cedex, France.
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Stallman HM, Bari A. A biopsychosocial model of violence when sleepwalking: review and reconceptualisation. BJPsych Open 2017; 3:96-101. [PMID: 28446961 PMCID: PMC5405419 DOI: 10.1192/bjpo.bp.116.004390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/08/2017] [Accepted: 03/14/2017] [Indexed: 11/23/2022] Open
Abstract
SUMMARY Violence towards others during sleepwalking is relatively uncommon, but can result in serious injury or even death. Much of the research in this field has focused on the forensic consequences of violence during sleepwalking without sufficient attention to an understanding of the risk factors for violence during sleepwalking and the development of prevention and interventions based on these risk factors. This paper reviews the characteristics of impulsive violence in general and reconceptualises violence during sleepwalking as an extension of this prior vulnerability. We propose a biopsychosocial model of the risk for violence during sleepwalking that is supported through a review of empirical literature both within sleepwalking and violent behaviour more generally. Biological, psychological and social risk factors are hypothesised to mediate the relationship between sleepwalking and violence. Implications for prevention and treatment of this potentially fatal problem are discussed. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Helen M Stallman
- , PhD, DClinPsych, Centre for Sleep Research, School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, South Australia
| | - Andrea Bari
- , PhD, Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, Massachussetts, USA
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Mysliwiec V, Brock MS, Creamer JL, O'Reilly BM, Germain A, Roth BJ. Trauma associated sleep disorder: A parasomnia induced by trauma. Sleep Med Rev 2017; 37:94-104. [PMID: 28363448 DOI: 10.1016/j.smrv.2017.01.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Nightmares and disruptive nocturnal behaviors that develop after traumatic experiences have long been recognized as having different clinical characteristics that overlap with other established parasomnia diagnoses. The inciting experience is typically in the setting of extreme traumatic stress coupled with periods of sleep disruption and/or deprivation. The limited number of laboratory documented cases and symptomatic overlap with rapid eye movement sleep behavior disorder (RBD) and posttraumatic stress disorder (PTSD) have contributed to difficulties in identifying what is a unique parasomnia. Trauma associated sleep disorder (TSD) incorporates the inciting traumatic experience and clinical features of trauma related nightmares and disruptive nocturnal behaviors as a novel parasomnia. The aims of this theoretical review are to 1) summarize the known cases and clinical findings supporting TSD, 2) differentiate TSD from clinical disorders with which it has overlapping features, 3) propose criteria for the diagnosis of TSD, and 4) present a hypothetical neurobiological model for the pathophysiology of TSD. Hyperarousal, as opposed to neurodegenerative changes in RBD, is a component of TSD that likely contributes to overriding atonia during REM sleep and the comorbid diagnosis of insomnia. Lastly, a way forward to further establish TSD as an accepted sleep disorder is proposed.
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Affiliation(s)
- Vincent Mysliwiec
- San Antonio Military Medical Center, Department of Sleep Medicine, 2200 Bergquist Drive, Suite 1, JBSA Lackland, TX 78236, USA.
| | - Matthew S Brock
- San Antonio Military Medical Center, Department of Sleep Medicine, 2200 Bergquist Drive, Suite 1, JBSA Lackland, TX 78236, USA
| | - Jennifer L Creamer
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
| | - Brian M O'Reilly
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
| | - Anne Germain
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, Department of Psychology, Pittsburgh, PA, USA
| | - Bernard J Roth
- Madigan Army Medical Center, Department of Pulmonary, Critical Care, and Sleep Medicine, Tacoma, WA, USA
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Behavioural and Cognitive-Behavioural Treatments of Parasomnias. Behav Neurol 2015; 2015:786928. [PMID: 26101458 PMCID: PMC4458546 DOI: 10.1155/2015/786928] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022] Open
Abstract
Parasomnias are unpleasant or undesirable behaviours or experiences that occur predominantly during or within close proximity to sleep. Pharmacological treatments of parasomnias are available, but their efficacy is established only for few disorders. Furthermore, most of these disorders tend spontaneously to remit with development. Nonpharmacological treatments therefore represent valid therapeutic choices. This paper reviews behavioural and cognitive-behavioural managements employed for parasomnias. Referring to the ICSD-3 nosology we consider, respectively, NREM parasomnias, REM parasomnias, and other parasomnias. Although the efficacy of some of these treatments is proved, in other cases their clinical evidence cannot be provided because of the small size of the samples. Due to the rarity of some parasomnias, further multicentric researches are needed in order to offer a more complete account of behavioural and cognitive-behavioural treatments efficacy.
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Popat S, Winslade W. While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia. NEUROETHICS-NETH 2015. [PMID: 26203309 PMCID: PMC4506454 DOI: 10.1007/s12152-015-9229-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In terms of medical science and legal responsibility, the sleep disorder category of parasomnias, chiefly REM sleep behavior disorder and somnambulism, pose an enigmatic dilemma. During an episode of parasomnia, individuals are neither awake nor aware, but their actions appear conscious. As these actions move beyond the innocuous, such as eating and blurting out embarrassing information, and enter the realm of rape and homicide, their degree of importance and relevance increases exponentially. Parasomnias that result in illegal activity, particularly violence, are puzzling phenomena for medicine and the law. Via a review of the pertinent medical literature, a general overview of the current scientific knowledge of parasomnias will be provided. Though this knowledge is far from complete, it can provide some neurobiological information about the nature of parasomnia, including conclusions about a sleepwalker's level of intention as well as factors that predispose one to such episodes. Although a parasomniac's complete lack of consciousness warrants acquittal from criminal liability, it does not exclude responsibility for subjecting oneself to exacerbating factors that result in these violent parasomnias. Individuals should be held accountable if they could be expected to control these factors. In addition, they should undergo appropriate treatment and management in order to prevent future parasomnia behaviors. Establishing a legal defense for parasomnia will prove difficult due to the strong potential for malingering, so specific criteria will be outlined in order to distinguish between true and fraudulent claims of crimes committed during parasomniac states.
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Affiliation(s)
- Shreeya Popat
- The University of Texas Southwestern Medical School, Dallas, TX USA ; Plan II Honors Program, The University of Texas, Austin, TX USA
| | - William Winslade
- Plan II Honors Program, The University of Texas, Austin, TX USA ; The Institute for the Medical Humanities, The University of Texas Medical Branch, Galveston, TX USA
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Pressman MR, Broughton R. NREM Arousal Parasomnias. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Electroencephalographic slow waves prior to sleepwalking episodes. Sleep Med 2014; 15:1468-72. [DOI: 10.1016/j.sleep.2014.07.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/04/2014] [Accepted: 07/14/2014] [Indexed: 11/18/2022]
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Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014; 10:927-35. [PMID: 25126042 DOI: 10.5664/jcsm.3976] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). SEARCH METHODS We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. SELECTION CRITERIA Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. DATA EXTRACTION AND ANALYSIS Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. RESULTS Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. CONCLUSION SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Poli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emma V Gilmore
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; ; IRRCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Carlos H Schenck
- University of Minnesota, Minnesota Regional Sleep Disorders Centre, Minneapolis, MN
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; ; IRRCS Institute of Neurological Sciences, Bologna, Italy
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Abstract
The military population is particularly vulnerable to a multitude of sleep-related disorders owing to the type of work performed by active duty servicemembers (ADSMs). Inadequate sleep, due to insufficient quantity or quality, is increasingly recognized as a public health concern. Traditionally, ADSMs have been encouraged that they can adapt to insufficient sleep just as the body adapts to physical training, but there is a substantial body of scientific literature which argues that this is not possible. Additionally, the military work environment creates unique challenges with respect to treatment options for common sleep disorders like obstructive sleep apnea, restless legs syndrome, and parasomnias. This review highlights sleep disorders which are prevalent in the modern military force and discusses the impact of poor sleep on overall performance. Medical treatments and recommendations for unit leaders are also discussed.
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Violent somnambulism: A parasomnia of young men with stereotyped dream-like experiences. Med Hypotheses 2014; 83:47-52. [DOI: 10.1016/j.mehy.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/28/2014] [Accepted: 04/06/2014] [Indexed: 12/30/2022]
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Morrison I, Rumbold JM, Riha RL. Medicolegal aspects of complex behaviours arising from the sleep period: A review and guide for the practising sleep physician. Sleep Med Rev 2014; 18:249-60. [DOI: 10.1016/j.smrv.2013.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 07/26/2013] [Accepted: 07/27/2013] [Indexed: 11/16/2022]
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Delgado-Rodrigues RN, Allen AN, Santos LGD, Schenck CH. Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:164-9. [PMID: 24604372 DOI: 10.1590/0004-282x20130181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 08/16/2013] [Indexed: 11/21/2022]
Abstract
Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.
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Affiliation(s)
- Raimundo Nonato Delgado-Rodrigues
- Centro de Distúrbios do Sono, Hospital Universitário de Brasília, Universidade de Brasília, BrasíliaDF, Brazil, Professor of Neurology, MD, PhD, Centro de Distúrbios do Sono, Hospital Universitário de Brasília, Universidade de Brasília, Brasília DF, Brazil
| | - Alexander N Allen
- North Central Thames Foundation School, London, England, BA, BMBCH, Foundation Doctor, North Central Thames Foundation School, London, England
| | - Leandro Galuzzi dos Santos
- Brazilian Supreme Court, BrasíliaDF, Brazil, Judge of Instruction Brazilian Supreme Court, Brasília DF, Brazil
| | - Carlos H Schenck
- University of Minnesota, Minnesota Regional Sleep Disorders Centre, Minneapolis, USA
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Arnulf I, Zhang B, Uguccioni G, Flamand M, Noël de Fontréaux A, Leu-Semenescu S, Brion A. A scale for assessing the severity of arousal disorders. Sleep 2014; 37:127-36. [PMID: 24470702 DOI: 10.5665/sleep.3322] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Arousal disorders may have serious health consequences. OBJECTIVE To develop a scale assessing the severity of arousal disorders (Paris Arousal Disorders Severity Scale, PADSS). SETTING University hospital. DESIGN Controlled study. PARTICIPANTS Consecutive patients (older than 15 y), with sleepwalking (SW) and/or sleep terrors (ST), subjects with previous SW/ST, normal controls and patients with rapid eye movement sleep behavior disorder. INTERVENTION The self-rated scale listed 17 parasomniac behaviors (PADSS-A), assessed their frequency from never to twice or more per night (PADSS-B) and evaluated the consequences (PADSS-C: disturbed sleep, injuries, fatigue, and psychological consequences). The clinimetric properties and face validity of the scale were tested. RESULTS Half of the 73 patients with SW/ST (more men than women) had injured themselves or others, whereas 15% had concomitant sexsomnia and 23% had amnestic eating behaviors. The total PADSS score (range: 0-50) was 19.4 ± 6.3 (range: 8-36) in this group, 11.7 ± 5.9 in 26 subjects with previous SW/ST, 8.8 ± 3.2 in 26 patients with RBD, and 2.0 ± 3.5 in 53 normal controls (P < 0.05). The PADSS demonstrated high sensitivity (83.6%), specificity (87.8%), internal consistency, and test-retest reliability (0.79). The best cutoff for the total score was at 13/14. Exploratory factor analysis revealed two components: wandering and violence/handling. The complexity of behaviors emerging from N3 sleep (scored on videopolysomnography) positively correlated with scores for the PADSS-total, PADSS-A, PADSS-C, and the "violence/handling" factor. CONCLUSION This scale had reasonable psychometric properties and could be used for screening and stratifying patients and for evaluating the effects of treatments.
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Affiliation(s)
- Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
| | - Bin Zhang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guangzhou 510120, China
| | - Ginevra Uguccioni
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
| | - Mathilde Flamand
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
| | - Alix Noël de Fontréaux
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
| | - Smaranda Leu-Semenescu
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
| | - Agnès Brion
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Centre de Recherche de l'Institut du Cerveau et de la Moëlle épinière - Pierre and Marie Curie University; Inserm UMR_S 975; CNRS UMR 7225, Paris, France
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Abstract
OBJECTIVE To test whether laboratory-based research differentiating sleepwalkers (SW) from controls (C) can be applied in an uncontrolled forensic case as evidence the alleged crime was committed during an arousal from sleep in which the mind is not fully conscious due to a SW disorder. METHODS A PSG study recorded 8 months after the defendant was charged was analyzed independently by spectral analysis. Slow wave activity (SWA) and cyclic alternating pattern (CAP) rates were computed. Clinical interviews and police records were reviewed for data re: the defendant's sleep prior to the event and use of drugs, alcohol, and stimulants. RESULTS The SWA distribution was abnormally low and flat, significantly lower than published controls; in the first NREM cycle, CAP rate 55 was above normal. Two weeks of prior sleep deprivation was confirmed from interviews and defendant's observed daytime sleepiness. Caffeine intake the day before the event was calculated at 826 mg over 14 hours. Snoring and a mild breathing disorder were present in the PSG. CONCLUSION Testimony based on spectral analysis of PSG recorded following an alleged criminal event supported a SW explanation for the non-rational behaviors charged. The defendant was acquitted of all charges and has been successfully treated.
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Affiliation(s)
- Rosalind D Cartwright
- Rush University Medical Center, Graduate College, Neuroscience Program, Chicago, IL 60611, USA.
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Larisa Fabres O. Violencia durante el sueño. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Zadra A, Desautels A, Petit D, Montplaisir J. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol 2013; 12:285-94. [PMID: 23415568 DOI: 10.1016/s1474-4422(12)70322-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Somnambulism, or sleepwalking, can give rise to a wide range of adverse consequences and is one of the leading causes of sleep-related injury. Accurate diagnosis is crucial for proper management and imperative in an ever-increasing number of medicolegal cases implicating sleep-related violence. Unfortunately, several widely held views of sleepwalking are characterised by key misconceptions, and some established diagnostic criteria are inconsistent with research findings. The traditional idea of somnambulism as a disorder of arousal might be too restrictive and a comprehensive view should include the idea of simultaneous interplay between states of sleep and wakefulness. Abnormal sleep physiology, state dissociation, and genetic factors might explain the pathophysiology of the disorder.
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Affiliation(s)
- Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Pilon M, Desautels A, Montplaisir J, Zadra A. Auditory arousal responses and thresholds during REM and NREM sleep of sleepwalkers and controls. Sleep Med 2012; 13:490-5. [PMID: 22341611 DOI: 10.1016/j.sleep.2011.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND It has been suggested that sleepwalkers are more difficult to awaken from sleep than are controls. However, no quantified comparisons have been made between these two populations. The main goal of this study was to assess arousal responsiveness via the presentation of auditory stimuli (AS) in sleepwalkers and controls during normal sleep and recovery sleep following sleep deprivation. METHODS Ten adult sleepwalkers and 10 age-matched control subjects were investigated. After a screening night, participants were presented with AS during slow-wave sleep (SWS), REM, and stage 2 sleep either during normal sleep or daytime recovery sleep following 25 h of sleep deprivation. The AS conditions were then reversed one week later. RESULTS When compared to controls sleepwalkers necessitated a significantly higher mean AS intensity (in dB) to induce awakenings and arousal responses during REM sleep whereas the two groups' mean values did not differ significantly during SWS and stage 2 sleep. Moreover, when compared to controls sleepwalkers had a significantly lower mean percentage of AS that induced arousal responses during REM sleep while the opposite pattern of results was found during SWS. CONCLUSIONS The data indicate that sleepwalkers have a higher auditory awakening threshold than controls, but only for REM sleep. These findings may reflect a compensatory mechanism of the homeostatic process underlying sleep regulation during sleepwalkers' REM sleep in reaction to their difficulties maintaining consolidated periods of NREM sleep.
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Affiliation(s)
- Mathieu Pilon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur, Montréal, Québec, Canada
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Shneerson JM, Ekirch AR. The Clinical Features of Sleep Violence in Arousal Disorders: A Historical Review. Sleep Med Clin 2011. [DOI: 10.1016/j.jsmc.2011.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Pressman MR. Sleep driving: Sleepwalking variant or misuse of z-drugs? Sleep Med Rev 2011; 15:285-92. [DOI: 10.1016/j.smrv.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 10/18/2022]
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Krishnan V, Shaman Z. Legal issues encountered when treating the patient with a sleep disorder. Chest 2011; 139:200-7. [PMID: 21208882 DOI: 10.1378/chest.09-1962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
As our understanding of sleep medicine grows, so does our obligation to protect patients and society from the potential harms of sleep disorders. Harm to self and others can take the form of violent behaviors during sleep or from sleep arousals, or from errors in judgment and motor skills due to excessive daytime sleepiness. Motor vehicle accidents and industrial accidents represent the majority of deaths and injuries due to sleep disorders. Errors in judgment and mental capacity can also lead to significant problems in terms of financial costs to businesses, inefficiencies in the workplace, and harm to others (as in the case of medical errors). Sleepiness can be so debilitating to an individual that he or she may qualify for disability compensation. The sleep specialist plays three basic roles in the interaction between the medical and legal fields: the educator, the medical examiner, and the expert witness. The education of the public, court officials, and patients is necessary to increase awareness of sleep disorders and their risks. The medical examination of the patient and subsequent treatment of the sleep disorder can help to minimize the risks of sleep disorders. Finally, if necessary, the sleep specialist may be called upon to provide expert testimony about the medical evidence provided and the likelihood that a sleep disorder contributed to an alleged criminal act.
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Affiliation(s)
- Vidya Krishnan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, 2500 MetroHealth Dr, Cleveland, OH 44109, USA.
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Abstract
Two case examples and a review of the sleep literature illustrate the potential of antipsychotic medication to trigger sleepwalking episodes in the context of schizophrenia. Causative hypotheses are briefly reviewed, as well as risk factors, differential diagnosis, and management. Sleepwalking may contribute to delusions, aggression, and accidental suicide. It is important to investigate sleep disorders in schizophrenia. They are not rare and may contribute to behavior that increases the stigma and isolation of individuals with schizophrenia.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.
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Abstract
Parasomnias are undesirable physical or experiential events that occur in and around sleep. Treatments include reassurance in some cases, various forms of cognitive-behavioral therapy (CBT), and pharmacologic agents. Cognitive restructuring, imagery rehearsal, relaxation, hypnosis, desensitization, and anticipatory awakenings are some of the common CBT and nonpharmacologic interventions. Medications that are used belong to a wide variety of pharmacologic classes, such as alpha-blockers (prazosin), tricyclic antidepressants (imipramine and clomipramine), selective serotonin reuptake inhibitors, benzodiazepines (diazepam and clonazepam), anticonvulsants (topiramate and gabapentin), desmopressin acetate, and anticholinergic agents (oxybutynin and tolterodine). Data on efficacy are only available from randomized trials on CBT and prazosin for nightmares and on pharmacologic and alarm therapy for enuresis. No large-scale randomized trials are available to assess the efficacy of the other treatments, and most data come from anecdotal case reports, case series, or small open-label trials.
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Affiliation(s)
- Hrayr Attarian
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maguire Building, Room 2700, 2160 South First Avenue, Maywood, IL 60153, USA.
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Siclari F, Khatami R, Urbaniok F, Nobili L, Mahowald MW, Schenck CH, Cramer Bornemann MA, Bassetti CL. Violence in sleep. Brain 2010; 133:3494-509. [DOI: 10.1093/brain/awq296] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jaar O, Pilon M, Carrier J, Montplaisir J, Zadra A. Analysis of slow-wave activity and slow-wave oscillations prior to somnambulism. Sleep 2010; 33:1511-6. [PMID: 21102993 PMCID: PMC2954701 DOI: 10.1093/sleep/33.11.1511] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
UNLABELLED STUDY OBJECTIVIES: several studies have investigated slow wave sleep EEG parameters, including slow-wave activity (SWA) in relation to somnambulism, but results have been both inconsistent and contradictory. The first goal of the present study was to conduct a quantitative analysis of sleepwalkers' sleep EEG by studying fluctuations in spectral power for delta (1-4 Hz) and slow delta (0.5-1 Hz) before the onset of somnambulistic episodes. A secondary aim was to detect slow-wave oscillations to examine changes in their amplitude and density prior to behavioral episodes. PARTICIPANTS twenty-two adult sleepwalkers were investigated polysomnographically following 25 h of sleep deprivation. RESULTS analysis of patients' sleep EEG over the 200 sec prior to the episodes' onset revealed that the episodes were not preceded by a gradual increase in spectral power for either delta or slow delta over frontal, central, or parietal leads. However, time course comparisons revealed significant changes in the density of slow-wave oscillations as well as in very slow oscillations with significant increases occurring during the final 20 sec immediately preceding episode onset. CONCLUSIONS the specificity of these sleep EEG parameters for the occurrence and diagnosis of NREM parasomnias remains to be determined.
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Affiliation(s)
- Olivier Jaar
- Centre d'étude du sommeil, Hôpital du Sacré-Cæur, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Mathieu Pilon
- Centre d'étude du sommeil, Hôpital du Sacré-Cæur, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Julie Carrier
- Centre d'étude du sommeil, Hôpital du Sacré-Cæur, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Montplaisir
- Centre d'étude du sommeil, Hôpital du Sacré-Cæur, Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Antonio Zadra
- Centre d'étude du sommeil, Hôpital du Sacré-Cæur, Montréal, Québec, Canada
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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