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Miletínová E, Piorecký M, Koudelka V, Jiříček S, Tomeček D, Brunovský M, Horáček J, Bušková J. Alterations of sleep initiation in NREM parasomnia after sleep deprivation - A multimodal pilot study. Sleep Med X 2023; 6:100086. [PMID: 37745863 PMCID: PMC10511487 DOI: 10.1016/j.sleepx.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives NREM parasomnias also known as disorders of arousal (DOA) are characterised by abnormal motor and autonomic activation during arousals primarily from slow wave sleep. Dissociative state between sleep and wake is likely responsible for clinical symptoms of DOA. We therefore investigated potential dissociation outside of parasomnic events by using simultaneous 256-channel EEG (hdEEG) and functional magnetic resonance imaging (fMRI). Methods Eight DOA patients (3 women, mean age = 27.8; SD = 4.2) and 8 gender and age matched healthy volunteers (3 women, mean age = 26,5; SD = 4.0) were included into the study. They underwent 30-32 h of sleep deprivation followed by hdEEG and fMRI recording. We determined 2 conditions: falling asleep (FA) and arousal (A), that occurred outside of deep sleep and/or parasomnic event. We used multimodal approach using data obtained from EEG, fMRI and EEG-fMRI integration approach. Results DOA patients showed increase in delta and beta activity over postcentral gyrus and cuneus during awakening period. This group expressed increased connectivity between motor cortex and cingulate during arousals unrelated to parasomnic events in the beta frequency band. They also showed lower connectivity between different portions of cingulum. In contrast, the greater connectivity was found between thalamus and some cortical areas, such as occipital cortex. Conclusion Our findings suggest a complex alteration in falling asleep and arousal mechanisms at both subcortical and cortical levels in response to sleep deprivation. As this alteration is present also outside of slow wave sleep and/or parasomnic episodes we believe this could be a trait factor of DOA.
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Affiliation(s)
- E. Miletínová
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - M. Piorecký
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Czech Republic
| | - V. Koudelka
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Czech Republic
| | - S. Jiříček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - D. Tomeček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - M. Brunovský
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - J. Horáček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - J. Bušková
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
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Zheng JH, Ma JJ, Sun WH, Wang ZD, Chang QQ, Dong LR, Shi XX, Li MJ. Excessive Daytime Sleepiness in Parkinson's Disease is Related to Functional Abnormalities in the Left Angular Gyrus. Clin Neuroradiol 2023; 33:121-127. [PMID: 35768695 DOI: 10.1007/s00062-022-01190-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Excessive daytime sleepiness (EDS) is a common non-motor symptom in Parkinson's disease (PD), but its neuropathology remains elusive. Our goal is to explore the potential neural substrates of EDS in a large sample of individuals with PD. METHODS We recruited 48 PD patients with and 87 PD patients without EDS. We used resting-state functional magnetic resonance imaging to compare amplitudes of low-frequency fluctuations (ALFF) between the two groups. We also explored functional connectivity (FC) between the entire brain and regions where ALFF differed between the two groups as well as FC between selected regions of interest. Age, Part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) score and use of dopamine receptor agonists were treated as covariates in the comparisons. RESULTS EDS was associated with significantly lower ALFF in the left angular gyrus, and ALFF in this region correlated negatively with score on the Epworth Sleepiness Scale in patients with PD. EDS was also associated with significantly lower FC between the left angular gyrus and right cerebellum, based on seed-to-voxel and inter-ROI analyses. CONCLUSION Our results suggest that EDS in PD patients is associated with reduced spontaneous neural activity in the left angular gyrus and with reduced FC between the left angular gyrus and cerebellum. These findings may help understand and treat EDS in PD.
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Affiliation(s)
- Jin Hua Zheng
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Henan University, Henan Province, Zhengzhou, China
| | - Jian Jun Ma
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China. .,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China. .,Department of Neurology, People's Hospital of Henan University, Henan Province, Zhengzhou, China.
| | - Wen Hua Sun
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhi Dong Wang
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qing Qing Chang
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Lin Rui Dong
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiao Xue Shi
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ming Jian Li
- Department of Neurology, Henan Provincial People's Hospital, 450003, Zhengzhou, Henan Province, China.,Department of Neurology, People's Hospital of Henan University, Henan Province, Zhengzhou, China
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3
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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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4
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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: 2] [Impact Index Per Article: 1.0] [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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5
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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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6
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Gong L, Xu R, Qin M, Liu D, Zhang B, Bi Y, Xi C. New potential stimulation targets for noninvasive brain stimulation treatment of chronic insomnia. Sleep Med 2020; 75:380-387. [PMID: 32950883 DOI: 10.1016/j.sleep.2020.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) was recently used as a therapeutic application in patients with insomnia. Most of the previous NIBS treatments for insomnia directly selected the dorsolateral prefrontal cortex (DLPFC) as the stimulation site. As the NIBS target is an important factor in the efficacy of NIBS, it is necessary to detect more potential cortical sites for NIBS in insomnia. METHODS A neuroimaging study-based meta-analysis was used to examine sleep-related brain regions. A sleep-associated brain region-based functional connectivity (FC) map was constructed in 50 patients with chronic insomnia disorder (CID) without any comorbidity. We also combined the meta-analysis and FC results to examine the potential surface targets for NIBS for CID. RESULTS The results identified the bilateral supplementary motor area (SMA), left superior temporal gyrus (STG), bilateral DLPFC, precentral lobule, supramarginal gyrus, angular gyrus, superior frontal gyrus, middle temporal gyrus and middle occipital gyrus as potential brain stimulation targets for insomnia treatment. Notably, the bilateral SMA, right DLPFC and left STG were identified in the FC and meta-analyses. In addition, the SMA and DLPFC were positively and STG was negatively connected with other sleep related brain regions, which indicated inhibitory and excitatory stimulation for NIBS treatment for CID, respectively. CONCLUSION Our study suggests the SMA, DLPFC and STG as preferentially selected brain targets of NIBS for CID treatment. We recommend an inhibitory stimulation over SMA and DLPFC, and an excitatory stimulation over STG for NIBS treatment. Future studies should test these new targets using NIBS treatment for insomnia.
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Affiliation(s)
- Liang Gong
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Ronghua Xu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Minhuang Qin
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Duan Liu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Bei Zhang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Youcai Bi
- Department of Neurology, Zigong Fourth People's Hospital, Zigong, Sichuan, 643000, China.
| | - Chunhua Xi
- Department of Neurology, The Third Affiliated Hospital of Anhui Medical University, Heifei, Anhui, 230061, China.
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Chopra A, Patel RS, Baliga N, Narahari A, Das P. Sleepwalking and sleep-related eating associated with atypical antipsychotic medications: Case series and systematic review of literature. Gen Hosp Psychiatry 2020; 65:74-81. [PMID: 32535329 DOI: 10.1016/j.genhosppsych.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sleep walking (SW) is a parasomnia behavior characterized by repetitious occurrence of ambulation during a partial arousal from non-rapid eye movement (NREM) sleep. Sleep-related eating (SRE) is one of the complex sleep behaviors that may accompany SW. Emerging evidence suggests that NREM parasomnias can be associated with atypical antipsychotic medication use. METHODS We present a case series (n = 5) and a systematic review of the literature of cases of SW, with or without SRE (n = 23), associated with atypical antipsychotic use. RESULTS Twenty-eight cases of SW, with and without SRE, with a mean age of 44.8 years (S.D. = 15.04) and a male predominance (75%; n = 21) were identified. Quetiapine was the most commonly implicated medication with SW and SRE (n = 14). Remission from SW/SRE was noted in all cases with measures including antipsychotic dosage reduction, discontinuation of medication, switching to an alternate medication, and use of continuous positive airway pressure (CPAP) for comorbid obstructive sleep apnea (OSA) treatment. CONCLUSIONS Sleep walking (SW), with or without sleep related eating (SRE), can be a rare but reversible side effect associated with use of atypical antipsychotics. More research is warranted to elucidate the mechanisms underlying SW and SRE associated with atypical antipsychotic use.
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Affiliation(s)
- Amit Chopra
- Psychiatry and Behavioral Health Institute, Department of Sleep Medicine, Allegheny Health Network, Pittsburgh, PA, United States.
| | - Rikinkumar S Patel
- Department of Psychiatry, Griffin Memorial Hospital, Norman, OK, United States
| | - Nisha Baliga
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.
| | - Anoop Narahari
- Psychiatry and Behavioral Health Institute, Allegheny Health Network, Pittsburgh, PA, United States.
| | - Piyush Das
- Department of Sleep Medicine, CentraCare, MN, United States.
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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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9
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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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10
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Zakharov AV, Poverennova IE, Kalinin VA, Khivintseva EV. Disorders of arousal: the mechanism of occurrence, neurophysiological features. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:50-55. [DOI: 10.17116/jnevro201911904250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Abstract
Our understanding of non-rapid eye movement (NREM) parasomnias has improved considerably over the last two decades, with research that characterises and explores the causes of these disorders. However, our understanding is far from complete. The aim of this paper is to provide an updated review focusing on adult NREM parasomnias and highlighting new areas in NREM parasomnia research from the recent literature. We outline the prevalence, clinical characteristics, role of onset, pathophysiology, role of predisposing, priming and precipitating factors, diagnostic criteria, treatment options and medico-legal implications of adult NREM parasomnias.
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