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Lu R, Li R, Chen Y, Zhang Y, Kang W, Zhao A, Lin X, Hu Y, Liu S, Xu Z, Lu Z, Li S. A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children. Sleep Med 2024; 117:1-8. [PMID: 38460489 DOI: 10.1016/j.sleep.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE Parasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study. METHODS Two rounds of cross-sectional studies were conducted among 21,704 children aged 3-11; one taking place in Shanghai and the other in Sanya, Hainan province. Children's sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay. RESULTS A total of 38.2 % of children had sleep onset delay. Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children. CONCLUSIONS Parasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.
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Affiliation(s)
- Ruoyu Lu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Rong Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Yiting Chen
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ye Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Wenhui Kang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Anda Zhao
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Xiaoya Lin
- Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Child Health Advocacy Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shijian Liu
- Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; Department of Clinical Epidemiology and Biostatistics, Child Health Advocacy Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Zhaohui Lu
- Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Shenghui Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China; Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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2
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Henning O, Markhus R, Dornish EEJ, Kostov KH, Heimisdottir F, Nakken KO. Strange episodes during sleep - epilepsy or parasomnia? Tidsskr Nor Laegeforen 2024; 144:23-0579. [PMID: 38506017 DOI: 10.4045/tidsskr.23.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
In some forms of epilepsy, the seizures occur almost exclusively during sleep. This is particularly the case with hypermotor frontal lobe seizures. Clinically it can be difficult to distinguish such seizures from parasomnias and psychogenic non-epileptic seizures. This clinical review article aims to highlight the importance of making the correct diagnosis, as these conditions require completely different treatment.
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Affiliation(s)
- Oliver Henning
- EEG-laboratoriet, Spesialsykehuset for epilepsi, Oslo universitetssykehus
| | - Rune Markhus
- EEG-laboratoriet, Spesialsykehuset for epilepsi, Oslo universitetssykehus
| | | | | | | | - Karl O Nakken
- Spesialsykehuset for epilepsi, Oslo universitetssykehus
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3
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Abstract
Sleep-related eating disorder is a non-rapid-eye movement parasomnia typified by recurrent episodes of eating/drinking following arousals, with associated partial/complete amnesia. Adverse health consequences and quality of life impairments are common. The condition can be idiopathic but most often accompanies unrecognized/untreated comorbid sleep disorders and/or is induced by psychoactive medications. As such, management consists of addressing comorbidities and removing potentially offending medications. While a thorough clinical history is often sufficient, additional sleep testing may help identify coexisting sleep disorders and/or other phenomena that may cause arousals. Limited data suggest benefit from topiramate and other medications in idiopathic or otherwise refractory cases.
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Affiliation(s)
- Melissa C Lipford
- Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - R Robert Auger
- Center for Sleep Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Guirguis N, Henien M, Verma K, Soriano S. Parasomnia as a Rare Side Effect of a Common Medication. Ann Am Thorac Soc 2024; 21:512-515. [PMID: 38426823 DOI: 10.1513/annalsats.202306-548cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024] Open
Affiliation(s)
- Nancy Guirguis
- Department of Pulmonary, Critical Care & Sleep Medicine and
| | - Mena Henien
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois; and
| | - Kaninika Verma
- Department of Pulmonary, Critical Care & Sleep Medicine and
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5
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Di Laudo F, Mainieri G, Provini F. Parasomnias During the COVID-19 Pandemic. Sleep Med Clin 2024; 19:177-187. [PMID: 38368064 DOI: 10.1016/j.jsmc.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.
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Affiliation(s)
- Felice Di Laudo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy
| | - Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy.
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6
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Andersen ML, Schenck CH, Tufik S. Understanding Sexual Parasomnias: A Review of the Current Literature on Their Nature, Diagnosis, Impacts, and Management. Sleep Med Clin 2024; 19:21-41. [PMID: 38368067 DOI: 10.1016/j.jsmc.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Sexual behavior during sleep, known as sexual parasomnias, has captured the interest of researchers and clinicians. These parasomnias involve various sexual activities that occur unconsciously during sleep. Although relatively rare, they can profoundly affect well-being and relationships and can carry legal consequences. Understanding their nature, prevalence, and causes is crucial for advancing knowledge in this field. This article revisits the topic of sexsomnia, presenting new data and discussing cases published from 2007 to 2023. By analyzing these cases, we aim to enhance recognition, diagnosis, and management of sexsomnia, reducing stigma and providing better support for affected individuals.
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Affiliation(s)
- Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Sleep Institute, São Paulo, Brazil.
| | - Carlos H Schenck
- Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center and University of Minnesota Medical School, R7701 Park Avenue, Minneapolis, MN 55415, USA
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Sleep Institute, São Paulo, Brazil
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Abstract
Parasomnias are defined as abnormal movements or behaviors that occur in sleep or during arousals from sleep. Parasomnias vary in frequency from episodic events that arise from incomplete sleep state transition. The framework by which parasomnias are categorized and diagnosed is based on the International Classification of Sleep Disorders-Third Edition, Text Revision (ICSD-3-TR), published by the American Academy of Sleep Medicine. The recent Third Edition, Text Revision (ICSD-3-TR) of the ICSD provides an expert consensus of the diagnostic requirements for sleep disorders, including parasomnias, based on an extensive review of the current literature.
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Affiliation(s)
- Alon Y Avidan
- Department of Neurology, UCLA Sleep Disorders Center, UCLA, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA 90095-1769, USA.
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8
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Fortune DG, Richards HL. Exploding Head Syndrome: A Systematic Scoping Review. Sleep Med Clin 2024; 19:121-142. [PMID: 38368060 DOI: 10.1016/j.jsmc.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Exploding head syndrome (EHS) has historically been viewed as a disorder predominantly affecting older people and being more common in females. Through a comprehensive review of data since 2005, this scoping review provides updated evidence from 4082 participants reporting EHS across a variety of study designs on: how EHS presents; key information on comorbidity and correlates of EHS; how EHS is experienced in terms of symptoms and beliefs; causal theories arising from the research reviewed; and evidence-based information on how research has reported on the management of EHS. Since 2005, EHS has attracted increasing research interest; however, there are significant gaps in the research that are hindering a better understanding of EHS that might be helpful for clinicians.
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Affiliation(s)
- Dónal G Fortune
- Department of Psychology, University of Limerick, Ireland; Health Service Executive, CHO3, Mid West Region, Ireland; Health Research Institute, University of Limerick, Ireland.
| | - Helen L Richards
- Department of Psychology, University of Limerick, Ireland; Mercy University Hospital, Grenville Place, Cork, Ireland
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9
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Molina CD, Rivera A, Avidan AY. Educational Resources to Support Patients with Parasomnias. Sleep Med Clin 2024; 19:199-210. [PMID: 38368066 DOI: 10.1016/j.jsmc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
This article serves to help reduce patient burden in searching for credible information about parasomnias-abnormal behaviors during sleep-including sleepwalking, night terrors, and rapid eye movement sleep behavior disorder. It exhibits a compiled list of accessible online resources about parasomnias as well as detailed descriptions about each resource. By increasing patient accessibility to clinically validated resources, patients are more empowered to take an active role in managing their conditions, collaborating with their health-care practitioners in clinical management, enrolling in registries, and joining newsletters sponsored by these resources.
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Affiliation(s)
- Courtney D Molina
- Department of Neurology, UCLA, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA 90095-1769, USA
| | - Adreanne Rivera
- UCLA Clinical Translational Science Institute, 10911 Weyburn Avenue 3rd Road Floor, Los Angeles, CA 90095, USA
| | - Alon Y Avidan
- Department of Neurology, UCLA, David Geffen School of Medicine at UCLA, 710 Westwood Boulevard, RNRC, C153, Mail Code 176919, Los Angeles, CA 90095-1769, USA.
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10
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Bruni O, DelRosso LM, Melegari MG, Ferri R. The Parasomnias. Psychiatr Clin North Am 2024; 47:135-146. [PMID: 38302202 DOI: 10.1016/j.psc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy.
| | - Lourdes M DelRosso
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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11
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Abstract
In sleep-related dissociative disorders, phenomena of the psychiatrically defined dissociative disorders emerge during the sleep period. They occur during sustained wakefulness, either in the transition to sleep or following an awakening from sleep. Behaviors during episodes vary widely, and can result in injury to self or others. Daytime dissociative episodes and a background of trauma are almost always present; there is typically major co-existing psychopathology. Diagnosis is based on both clinical history and polysomnography; differential diagnosis primarily involves other parasomnias and nocturnal seizures. Information available about treatment is limited; in a few reported cases, psychological interventions have proven effective.
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Affiliation(s)
- Alan S Eiser
- Department of Psychiatry, University of Michigan Sleep Disorders Center, University of Michigan, C728 Med Inn Building, SPC 5845, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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12
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Cordani R, Lopez R, Barateau L, Chenini S, Nobili L, Dauvilliers Y. Somnambulism. Sleep Med Clin 2024; 19:43-54. [PMID: 38368068 DOI: 10.1016/j.jsmc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Somnambulism, also called sleepwalking, classified as a non-rapid eye movement sleep parasomnia, encompasses a range of abnormal paroxysmal behaviors, leading to sleepwalking in dissociated sleep in an altered state of consciousness with impaired judgment and configuring a kind of hierarchical continuum with confusional arousal and night terror. Despite being generally regarded as a benign condition, its potential severity entails social, personal, and even forensic consequences. This comprehensive review provides an overview on the current state of knowledge, elucidating the phenomenon of somnambulism and encompassing its clinical manifestations and diagnostic approaches.
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Affiliation(s)
- Ramona Cordani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Regis Lopez
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Sofiene Chenini
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France.
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Abstract
Trauma-associated sleep disorder (TASD) is a recently described parasomnia that develops following a traumatic event. It consists of trauma-related nightmares, disruptive nocturnal behaviors, and autonomic disturbances, and shares similarities with post-traumatic stress disorder and rapid eye movement behavior disorder. The underlying pathophysiology of TASD and how it relates to other parasomnias are still not entirely understood; proposed treatment is similarly nebulous, with prazosin at the forefront along with management of comorbid sleep disorders. The purpose of this article is to characterize and highlight the clinical features of this condition.
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Affiliation(s)
- Daniel A Barone
- Weill Cornell Center for Sleep Medicine, Weill Cornell Medicine, New York-Presbyterian, 425 East 61st Street, 5th Floor, New York, NY 10065, USA.
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Abstract
Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.
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Affiliation(s)
- Brian Holoyda
- Contra Costa County Detention Health Services, Martinez, CA, USA; Department of Psychiatry and Behavioral Medicine; Martinez Detention Facility, 1000 Ward Street, Martinez, CA 94553, USA; Forensic Psychiatrist, Denver, CO, USA.
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Brás J, Schenck CH, Andrade R, Costa AP, Teixeira C, Meira e Cruz M. A challenging case of sexsomnia in an adolescent female presenting with depressive-like symptoms. J Clin Sleep Med 2023; 19:1845-1847. [PMID: 37421331 PMCID: PMC10546004 DOI: 10.5664/jcsm.10714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
Sleep-related sexualized behaviors occur in the parasomnia known as sexsomnia, recognized as a variant of confusional arousals in the International Classification of Sleep Disorders, third edition. These instinctive behaviors of a sexual nature emerge from deep non-rapid eye movement sleep, and patients often present with distinguishing features within this sleep disorder category. There are often adverse psychosocial consequences and not uncommonly medicolegal implications. While associations to psychiatric consequences from the sexsomnia have been demonstrated and efforts to further typify this condition have been made, sexsomnia remains incompletely characterized in the more than 200 published cases to date, with male predominance. We now present the first reported case of an adolescent female with sexsomnia that was triggered by the onset of Crohn's disease and its treatment with azathioprine and with interpersonal consequences leading to an initial psychiatric consultation on account of depressive symptoms. These symptoms were deemed to be secondary to the sexsomnia. In addition to describing unusual and clinically relevant features in this case of sexsomnia, this original case provides insights into triggers, predisposing factors, perpetuating factors, and therapeutic considerations that are important for raising awareness in sleep clinicians, primary care providers, and mental health professionals. CITATION Brás J, Schenck CH, Andrade R, et al. A challenging case of sexsomnia in an adolescent female presenting with depressive-like symptoms. J Clin Sleep Med. 2023;19(10):1845-1847.
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Affiliation(s)
- João Brás
- Department of Psychiatry and Mental Health, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minnesota, Minneapolis
| | - Rui Andrade
- Department of Psychiatry and Mental Health, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Ana Pinto Costa
- Department of Psychiatry and Mental Health, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Carlos Teixeira
- Instituto Politécnico de Saúde do Norte–CESPU, Famalicão, Portugal
| | - Miguel Meira e Cruz
- Instituto Politécnico de Saúde do Norte–CESPU, Famalicão, Portugal
- Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal
- European Sleep Center, Lisbon, Portugal
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El Youssef N, Marchi A, Bartolomei F, Bonini F, Lambert I. Sleep and epilepsy: A clinical and pathophysiological overview. Rev Neurol (Paris) 2023; 179:687-702. [PMID: 37598088 DOI: 10.1016/j.neurol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
The interaction between sleep and epilepsy is complex. A better understanding of the mechanisms linking sleep and epilepsy appears increasingly important as it may improve diagnosis and therapeutic strategies in patients with epilepsy. In this narrative review, we aim to (i) provide an overview of the physiological and pathophysiological processes linking sleep and epilepsy; (ii) present common sleep disorders in patients with epilepsy; (iii) discuss how sleep and sleep disorders should be considered in new therapeutic approaches to epilepsy such as neurostimulation; and (iv) present the overall nocturnal manifestations and differential diagnosis between epileptic seizures and parasomnia.
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Affiliation(s)
- N El Youssef
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - A Marchi
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France
| | - F Bartolomei
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - F Bonini
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France
| | - I Lambert
- AP-HM, Timone hospital, Sleep Unit, Epileptology and Cerebral Rhythmology, Marseille, France; Aix-Marseille University, Inserm, Inst Neurosci Syst (INS), Marseille, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Carvalho DZ, St Louis EK. Sleepwalking Into a Risky Path: Expanding the Concerns for Parasomnias in the Elderly. Mayo Clin Proc 2023; 98:1436-1438. [PMID: 37793720 DOI: 10.1016/j.mayocp.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/22/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Diego Z Carvalho
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN.
| | - Erik K St Louis
- Center for Sleep Medicine, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Neurology, Mayo Clinic, Rochester, MN
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Katz ES, D’Ambrosio C. Catathrenia in children: clinical presentation, polysomnographic features, natural history, and response to therapy. J Clin Sleep Med 2023; 19:1505-1511. [PMID: 37066744 PMCID: PMC10394357 DOI: 10.5664/jcsm.10582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
STUDY OBJECTIVES To determine the clinical presentation, polysomnographic appearance, and the response to therapy of catathrenia in children. METHODS A retrospective analysis was performed in children referred or evaluated at the Boston Children's Hospital Sleep Center between 1998 and 2021 who were documented to have catathrenia either as a chief complaint or an incidental finding. RESULTS Catathrenia was identified in 21 children. The age of onset by parent report was 6.4 ± 4.4 years (range: birth-14 years), but the diagnosis was at 8.3 ± 3.8 years (range: 1.5-14 years). Catathrenia was the chief complaint for 24% of patients and was incidentally identified in 76% referred for breathing concerns. Bruxism was observed in 62% of patients. Catathrenia events most often occur following an electrocortical arousal (79%) and are most common in the second half of the night (73%). Catathrenia was observed exclusively in rapid eye movement (REM) sleep (16%), exclusively in non-REM sleep (32%), and in both sleep states (52%). Treatment of obstructive sleep apnea resulted in resolution or improvement in the obstructive sleep apnea in all patients, but the catathrenia persisted at a reduced level. CONCLUSIONS Most catathrenia in children is diagnosed incidentally during evaluation for sleep-disordered breathing, although the groaning often started many years earlier. Catathrenia events decreased considerably after treatment of obstructive sleep apnea, but persisted in all patients. Catathrenia was also observed in children without signs or symptoms of sleep-disordered breathing, indicating that these are distinct conditions. The majority of children with catathrenia had no sleepiness or behavioral concerns. CITATION Katz ES, D'Ambrosio C. Catathrenia in children: clinical presentation, polysomnographic features, natural history, and response to therapy. J Clin Sleep Med. 2023;19(8):1505-1511.
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Affiliation(s)
- Eliot S. Katz
- Division of Respiratory Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn D’Ambrosio
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine; New Haven, Connecticut
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Malkani R. REM Sleep Behavior Disorder and Other REM Parasomnias. Continuum (Minneap Minn) 2023; 29:1092-1116. [PMID: 37590824 DOI: 10.1212/con.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article reviews rapid eye movement (REM) sleep behavior disorder (RBD) and other REM sleep parasomnias, particularly recurrent isolated sleep paralysis and nightmare disorder. LATEST DEVELOPMENTS People with RBD have dream enactment behaviors that can be distressing and cause injuries to themselves or a bed partner. Diagnosis of RBD still requires video polysomnography but new evaluative techniques are emerging. Automatic scoring of REM sleep without atonia, the polysomnographic RBD feature, has led to clearer diagnostic cutoff values. Isolated RBD is strongly linked with neurodegenerative disorders, particularly α-synucleinopathies, with a median latency to neurodegenerative disease diagnosis of 8 years. Mounting imaging, electrophysiologic, and pathologic evidence supports neurodegenerative changes in patients with isolated RBD. Safety precautions should be reviewed with patients to reduce the risk of injury. Clonazepam and melatonin are first-line agents for RBD symptoms, and rivastigmine appears to be beneficial for RBD in people with mild cognitive impairment. For nightmare disorder, image rehearsal therapy is effective and can be delivered through online platforms. ESSENTIAL POINTS While RBD symptoms can often be managed, patients with isolated RBD should be monitored for signs and symptoms of impending neurodegenerative disease. Individuals who wish to know about the associated risk should be counseled accordingly to allow planning and involvement in research if they choose. Exercise may have some neuroprotective effects, although no treatment has been shown to modify the neurodegenerative risk.
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Spector AR. Non-REM Sleep Parasomnias. Continuum (Minneap Minn) 2023; 29:1117-1129. [PMID: 37590825 DOI: 10.1212/con.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Non-rapid eye movement (non-REM) parasomnias are common across the lifespan. This article describes the manifestations, diagnosis, and management of non-REM parasomnias in adults and discusses the social implications of these conditions. LATEST DEVELOPMENTS Non-REM parasomnias represent a hybrid state of wakefulness and sleep, often triggered by events that increase the frequency of arousals or make it more difficult to fully arouse from sleep. Sleep deprivation, certain medications, and untreated obstructive sleep apnea are known to provoke parasomnias, particularly in those who are genetically predisposed. Non-REM parasomnias include disorders of arousal (ie, sleepwalking, sleep terrors, and confusional arousals), sleep-related eating disorder, and exploding head syndrome. Clinical overlap exists between sleep-related eating disorder and disorders of arousal, suggesting that sleep-related eating disorder may be a fourth disorder of arousal or a manifestation of sleepwalking. Exploding head syndrome is a unique parasomnia of uncertain etiology. ESSENTIAL POINTS Non-REM parasomnias can range from minor nuisances to severe, life-altering events. While some patients with non-REM parasomnia experience significant consequences during sleep, wakefulness, or both, non-REM parasomnias do not pose a major risk to most patients. For all patients with non-REM parasomnias, safety should be explicitly discussed and addressed. Nonpharmacologic treatment should be prioritized, as increasing total sleep time, avoiding triggering substances, and treating comorbid sleep disorders is often sufficient for the management of non-REM parasomnias. If symptoms persist despite these interventions, treatment with clonazepam or other medications can be considered.
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Shelton AR. Sleep Disorders in Childhood. Continuum (Minneap Minn) 2023; 29:1205-1233. [PMID: 37590830 DOI: 10.1212/con.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides a comprehensive review of pediatric sleep disorders including the clinical features, diagnosis, and treatment of sleep-disordered breathing, insomnia, parasomnias, restless sleep disorder, restless legs syndrome, narcolepsy in childhood, and Kleine-Levin syndrome. LATEST DEVELOPMENTS Our understanding of pediatric sleep pathophysiology continues to evolve, and diagnostic and treatment modalities have expanded. A low-sodium oxybate formulation was approved in July 2020 in the United States to treat cataplexy and excessive daytime sleepiness in patients 7 years old and older with narcolepsy. A validated pediatric hypersomnolence survey for pediatric narcolepsy and idiopathic hypersomnia with high sensitivity, specificity, and interrater reliability is now available. ESSENTIAL POINTS The clinical presentation, diagnostics, and treatment of children with sleep disorders differ from those of adults. Untreated sleep disorders in childhood can lead to adverse physical and psychological consequences in adults. Correctly diagnosing and treating sleep disorders in youth can prevent a significant burden of disease in adulthood.
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Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med 2023; 19:499-509. [PMID: 36468650 PMCID: PMC9978420 DOI: 10.5664/jcsm.10374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES This pilot study determined whether transdiagnostic cognitive behavioral therapy for parasomnias (CBTp) reduces parasomnia and activity levels during sleep in a sample of adult sleep clinic outpatients. A secondary objective was to assess whether treatment produces improvements in daytime fatigue/sleepiness, perceived cognition, mood, and depression/anxiety/stress, as well as functional impairment in work and leisure activities. METHODS This was a randomized controlled trial with CBTp and self-monitoring control conditions. Participants were 19 adults with a DSM 5 parasomnia disorder who received individual CBTp virtually from their homes. CBTp consisted of psychoeducation, sleep hygiene and safety instructions, relaxation training, parasomnia techniques, and relapse prevention in a 6-week manualized, structured program. RESULTS Using a repeated measures analysis of variance model, and relative to a self-monitoring control condition, results showed that CBTp produced statistically significant improvements in parasomnia frequency, severity, nocturnal activity, and sleep efficiency. There was a trend toward reduced sleep-onset latency and improved work and social adjustment. Of treated participants, 100% rated themselves as improved at study conclusion. CONCLUSIONS Implications of these findings are that cognitive behavioral interventions for parasomnias are effective in lessening parasomnias. More investigation into this type of treatment is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Impact of Cognitive Behavioral Therapy on Parasomnias; URL: https://clinicaltrials.gov/ct2/show/NCT04633668; Identifier: NCT04633668. CITATION Vincent N, Dirkse D, Giannouli E, McQuarrie A. Transdiagnostic cognitive behavioral therapy for nightmares and parasomnias. J Clin Sleep Med. 2023;19(3):499-509.
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Affiliation(s)
- Norah Vincent
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dale Dirkse
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eleni Giannouli
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda McQuarrie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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Brock MS, Matsangas P, Creamer JL, Powell T, Hansen SL, Foster SN, Self TC, Mysliwiec V. Clinical and polysomnographic features of trauma associated sleep disorder. J Clin Sleep Med 2022; 18:2775-2784. [PMID: 35962771 PMCID: PMC9713908 DOI: 10.5664/jcsm.10214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Trauma associated sleep disorder is a proposed parasomnia that develops after trauma with clinical features of trauma related nightmares, disruptive nocturnal behaviors, and autonomic disturbances. The purpose of this case series is to better characterize the clinical and video-polysomnographic features of patients meeting clinical criteria for this proposed parasomnia. METHODS Semistructured clinical interview and detailed video-polysomnography review of 40 patients. Movements and vocalizations in rapid eye movement sleep were quantified according to the rapid eye movement sleep behavior disorder severity scale. RESULTS Patients (n = 40, 32 males) were service members and veterans with a median age of 38.9 years (range 24-57 years) who reported trauma related nightmares and disruptive nocturnal behaviors at home. On video-polysomnography, 28 (71.8%) patients had disruptive nocturnal behaviors in rapid eye movement sleep consisting of limb, head, and axial movements; vocalizations were present in 8 (20%). On the rapid eye movement sleep behavior disorder severity scale, most (n = 28, 71.8%) had a low rating but those with greater severity (n = 11, 28.2%) had a higher prevalence of posttraumatic stress disorder (P = .013) and markedly less N3 sleep (P = .002). The cohort had a high rate of insomnia (n = 35, 87.5%) and obstructive sleep apnea (n = 19, 47.5%). Most patients were treated with prazosin (n = 29, 72.5%) with concomitant behavioral health interventions (n = 25, 64.1%); 15 (51.7%) patients receiving prazosin reported improved symptomatology. CONCLUSIONS Disruptive nocturnal behaviors can be captured on video-polysomnography during rapid eye movement sleep, although they may be less pronounced than what patients report in their habitual sleeping environment. Clinical and video-polysomnographic correlations are invaluable in assessing patients with trauma associated sleep disorder to document objective abnormalities. This case series provides a further basis for establishing trauma associated sleep disorder as a unique parasomnia. CITATION Brock MS, Matsangas P, Creamer JL, et al. Clinical and polysomnographic features of trauma associated sleep disorder. J Clin Sleep Med. 2022;18(12):2775-2784.
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Affiliation(s)
- Matthew S. Brock
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | | | - Jennifer L. Creamer
- Madigan Army Medical Center, Department of Sleep Medicine, Tacoma, Washington
| | - Tyler Powell
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Shana L. Hansen
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Shannon N. Foster
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Tyler C. Self
- San Antonio Uniformed Services Health Education Consortium, Department of Sleep Medicine, JBSA Lackland, Texas
| | - Vincent Mysliwiec
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Proserpio P, Terzaghi M, Manni R, Nobili L. Drugs Used in Parasomnia. Sleep Med Clin 2022; 17:367-378. [PMID: 36150800 DOI: 10.1016/j.jsmc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Parasomnias, especially disorders of arousal during childhood, are often relatively benign and transitory and do not usually require a pharmacologic therapy. A relevant aspect in both nonrapid eye movement and rapid eye movement parasomnia treatment is to prevent sleep-related injuries by maintaining a safe environment. Physicians should always evaluate the possible presence of favoring and precipitating factors (sleep disorders and drugs). A pharmacologic treatment may be indicated in case of frequent, troublesome, or particularly dangerous events. The aim of this article is to review current available evidence on pharmacologic treatment of different forms of parasomnia.
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Affiliation(s)
- Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Lino Nobili
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa 5-16147, Italy
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Poon SH, Tan WJ, Lee TS. Medicolegal aspects of non-rapid eye movement parasomnias. Ann Acad Med Singap 2022; 51:228-235. [PMID: 35506406 DOI: 10.47102/annals-acadmedsg.2021449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
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Affiliation(s)
- Shi Hui Poon
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
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28
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Deshpande P, Salcedo B, Haq C. Common Sleep Disorders in Children. Am Fam Physician 2022; 105:168-176. [PMID: 35166510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Childhood sleep disorders can disrupt family dynamics and cause cognitive and behavior problems. Early recognition and management can prevent these complications. Behavior subtypes of childhood insomnias affect 10% to 30% of children and result from inconsistent parental limit-setting and improper sleep-onset association. Behavior insomnias are treated using extinction techniques and parent education. Hypnotic medications are not recommended. Obstructive sleep apnea affects 1% to 5% of children. Polysomnography is required to diagnose obstructive sleep apnea; history and physical examination alone are not adequate. Adenotonsillectomy is the first-line treatment for obstructive sleep apnea. Nasal continuous positive airway pressure is the second-line treatment for children who do not respond to surgery or if adenotonsillectomy is contraindicated. Restless legs syndrome can be difficult to recognize and has an association with attention-deficit/hyperactivity disorder. Management of restless legs syndrome includes treatment of iron deficiency, if identified, and removal of triggering factors. Parasomnias affect up to 50% of children and usually resolve spontaneously by adolescence. Management of parasomnias involves parental education, reassurance, safety precautions, and treating comorbid conditions. Delayed sleep phase syndrome is found during adolescence, manifesting as a night owl preference. Treatment of delayed sleep phase syndrome includes sleep hygiene, nighttime melatonin, and morning bright light exposure. Sleep deprivation is of increasing concern, affecting 68% of people in high school.
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Pani SM, Fraschini M, Figorilli M, Tamburrino L, Ferri R, Puligheddu M. Sleep-related hypermotor epilepsy and non-rapid eye movement parasomnias: Differences in the periodic and aperiodic component of the electroencephalographic power spectra. J Sleep Res 2021; 30:e13339. [PMID: 33769647 PMCID: PMC8518869 DOI: 10.1111/jsr.13339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/13/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
Over the last two decades, our understanding of clinical and pathophysiological aspects of sleep-related epileptic and non-epileptic paroxysmal behaviours has improved considerably, although it is far from complete. Indeed, even if many core characteristics of sleep-related hypermotor epilepsy and non-rapid eye movement parasomnias have been clarified, some crucial points remain controversial, and the overlap of the behavioural patterns between these disorders represents a diagnostic challenge. In this work, we focused on segments of multichannel sleep electroencephalogram free from clinical episodes, from two groups of subjects affected by sleep-related hypermotor epilepsy (N = 15) and non-rapid eye movement parasomnias (N = 16), respectively. We examined sleep stages N2 and N3 of the first part of the night (cycles 1 and 2), and assessed the existence of differences in the periodic and aperiodic components of the electroencephalogram power spectra between the two groups, using the Fitting Oscillations & One Over f (FOOOF) toolbox. A significant difference in the gamma frequency band was found, with an increased relative power in sleep-related hypermotor epilepsy subjects, during both N2 (p < .001) and N3 (p < .001), and a significant higher slope of the aperiodic component in non-rapid eye movement parasomnias, compared with sleep-related hypermotor epilepsy, during N3 (p = .012). We suggest that the relative power of the gamma band and the slope extracted from the aperiodic component of the electroencephalogram signal may be helpful to characterize differences between subjects affected by non-rapid eye movement parasomnias and those affected by sleep-related hypermotor epilepsy.
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Affiliation(s)
- Sara M. Pani
- PhD Program in NeuroscienceDepartment of Biomedical SciencesUniversity of CagliariCagliariItaly
- Sleep CentreDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Matteo Fraschini
- Department of Electrical and Electronic Engineering (DIEE)University of CagliariCagliariItaly
| | - Michela Figorilli
- Sleep CentreDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Ludovica Tamburrino
- Sleep CentreDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | - Monica Puligheddu
- Sleep CentreDepartment of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
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Abstract
Restless sleep disorder is (RSD) a condition characterized by frequent large movements during sleep associated with daytime impairment. RSD has been studied in children aged 6 to 18 years. Polysomnography is necessary for the diagnosis of RSD. The current diagnostic criteria include more than 5 large movements per hour of sleep documented by PSG. The pathophysiology is not known yet, but iron deficiency and sleep instability and increased sympathetic activation are suspected to play a role. Iron supplementation is the only treatment option studied so far.
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Affiliation(s)
- Lourdes M DelRosso
- University of Washington, Seattle Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Rosalia Silvestri
- Sleep Medicine Center, Department of Clinical and Experimental Medicine, University of A.O.U.G. Martino - Pad. H, 1o piano, Via Consolare Valeria, 1, 98125 Messina (ME), Italy
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, Via C Ruggero 73, 94018 Troina, Italy
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Holoyda BJ, Sorrentino RM, Mohebbi A, Fernando AT, Friedman SH. Forensic Evaluation of Sexsomnia. J Am Acad Psychiatry Law 2021; 49:202-210. [PMID: 33579735 DOI: 10.29158/jaapl.200077-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexsomnia is a non-rapid eye movement parasomnic behavior characterized by sexual activity during sleep. Recognized in the most recent editions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Sleep Disorders, sexsomnia is likely to arise with increasing frequency in court as a potential explanation for sexual offending. The forensic psychiatrist has a unique role in the evaluation and management of sexsomnia. The psychosexual evaluation may elucidate the presence or absence of paraphilias and paraphilic disorders and identify any overlap between the alleged sexsomnic behavior and paraphilic interest. In addition, forensic psychiatrists may assess for malingered sexsomnia, provide an opinion regarding criminal responsibility, or evaluate the risk for committing future sexual offenses. Forensic psychiatrists should therefore understand basic information regarding the disorder, as well as how to conduct a psychosexual evaluation effectively in cases of alleged sexsomnia. This article describes the various considerations involved in the forensic evaluation of sexsomnia.
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Affiliation(s)
- Brian J Holoyda
- Dr. Holoyda is Forensic Psychiatrist, Martinez Detention Facility, Martinez, CA, and Psychiatrist, Full Spectrum Health Services, Las Vegas, NV. Dr. Sorrentino is Director, Institute of Sexual Wellness, Weymouth, MA, and Assistant Professor, Harvard School of Medicine, Boston, MA. Dr. Mohebbi is Psychiatrist, Mission Viejo, CA. Dr. Fernando is Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. Dr. Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry, Case Western Reserve University, Department of Psychiatry, Cleveland, OH.
| | - Renée M Sorrentino
- Dr. Holoyda is Forensic Psychiatrist, Martinez Detention Facility, Martinez, CA, and Psychiatrist, Full Spectrum Health Services, Las Vegas, NV. Dr. Sorrentino is Director, Institute of Sexual Wellness, Weymouth, MA, and Assistant Professor, Harvard School of Medicine, Boston, MA. Dr. Mohebbi is Psychiatrist, Mission Viejo, CA. Dr. Fernando is Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. Dr. Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry, Case Western Reserve University, Department of Psychiatry, Cleveland, OH
| | - Amir Mohebbi
- Dr. Holoyda is Forensic Psychiatrist, Martinez Detention Facility, Martinez, CA, and Psychiatrist, Full Spectrum Health Services, Las Vegas, NV. Dr. Sorrentino is Director, Institute of Sexual Wellness, Weymouth, MA, and Assistant Professor, Harvard School of Medicine, Boston, MA. Dr. Mohebbi is Psychiatrist, Mission Viejo, CA. Dr. Fernando is Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. Dr. Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry, Case Western Reserve University, Department of Psychiatry, Cleveland, OH
| | - Antonio T Fernando
- Dr. Holoyda is Forensic Psychiatrist, Martinez Detention Facility, Martinez, CA, and Psychiatrist, Full Spectrum Health Services, Las Vegas, NV. Dr. Sorrentino is Director, Institute of Sexual Wellness, Weymouth, MA, and Assistant Professor, Harvard School of Medicine, Boston, MA. Dr. Mohebbi is Psychiatrist, Mission Viejo, CA. Dr. Fernando is Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. Dr. Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry, Case Western Reserve University, Department of Psychiatry, Cleveland, OH
| | - Susan Hatters Friedman
- Dr. Holoyda is Forensic Psychiatrist, Martinez Detention Facility, Martinez, CA, and Psychiatrist, Full Spectrum Health Services, Las Vegas, NV. Dr. Sorrentino is Director, Institute of Sexual Wellness, Weymouth, MA, and Assistant Professor, Harvard School of Medicine, Boston, MA. Dr. Mohebbi is Psychiatrist, Mission Viejo, CA. Dr. Fernando is Senior Lecturer, Department of Psychological Medicine, University of Auckland, Auckland, New Zealand. Dr. Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry, Case Western Reserve University, Department of Psychiatry, Cleveland, OH
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Maytum J, Garcia J, Leighty D, Belew J. Utility of the Frontal Lobe Epilepsy Parasomnia Scale in Evaluation of Children With Nocturnal Events. J Neurosci Nurs 2021; 53:34-38. [PMID: 33298683 DOI: 10.1097/jnn.0000000000000567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Sleep-related hypermotor epilepsy (SHE) and nocturnal non-rapid eye movement parasomnias are difficult to differentiate. Neurologists and sleep medicine clinicians largely rely on clinical history when evaluating nocturnal spells. When the diagnosis is in question, referral for video electroencephalogram monitoring is the standard. However, there are no guidelines as to when this evaluation is needed. The Frontal Lobe Epilepsy Parasomnia (FLEP) scale was developed to assist clinicians in differentiating the two among adults. The aim of this study was to provide a preliminary evaluation of the FLEP for use with children. METHODS: This was a retrospective pilot instrument validation study with a convenience sample of 17 children seen in neurology or sleep medicine clinics. To determine concurrent validity, FLEP scores were compared with clinical diagnoses by neurology providers confirmed by electroencephalography. RESULTS: With a cutoff score of 2, the modified FLEP distinguished between children with and without SHE. The FLEP tool had a specificity of 0.58, implying that 7 of the 12 children without SHE would have been accurately recommended to follow up for parasomnia management rather than more urgent evaluation of potential frontal lobe epilepsy. CONCLUSIONS: With some minor adaptations for children, the FLEP satisfactorily distinguished between SHE and non-SHE patients.
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Abstract
Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related parasomnias in this article. Sleepwalking (SW), sleep terrors (ST), confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications, in particular the widely prescribed benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation. Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED. Paroxetine has been reported to provide benefit in some cases of ST. Topiramate, pramipexole, and sertraline can be effective in SRED. Pharmacotherapy for other parasomnias continues to be less certain, necessitating further investigation. NREM parasomnias may resolve spontaneously but require a review of priming and predisposing factors.
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Affiliation(s)
- Muna Irfan
- Department of Neurology, Minneapolis Veterans Affairs Medical Center/ Pulmonary allergy, Critical Care and Sleep, University of Minnesota, Minneapolis, MN USA
| | - Carlos H. Schenck
- Department of Psychiatry, Hennepin Health Care, University of Minnesota, Minneapolis, MN USA
| | - Michael J Howell
- Department of Neurology, Sleep Disorders Center, University of Minnesota Medical Center, Minneapolis, MN USA
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Affiliation(s)
- Sagarika Nallu
- Department of Pediatrics, University of South Florida, Morsani College of Medicine, 17 Davis Blvd. Suite#200, Tampa, FL 33606, USA.
| | - Giselle Y Guerrero
- University of South Florida, 17 Davis Blvd. Suite#200, Tampa, FL 33606, USA
| | | | - Lara M Wittine
- University of South Florida, Morsani Center for Advanced Healthcare, 13330 USF Laurel Drive, Tampa, FL 33612-4799, USA
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Abstract
PURPOSE OF REVIEW Sleep-wake disorders occur in 10% to 28% of children and differ somewhat in pathophysiology and management from sleep-wake disorders in adults. This article discusses the diagnosis and management of key childhood sleep disorders. RECENT FINDINGS The role of sleep in memory consolidation and in the facilitation of learning has been increasingly recognized, even at the toddler stage. Cataplexy, a key feature of narcolepsy type 1, may be subtle in childhood and characterized by transient muscle weakness isolated to the face. Children with obstructive sleep apnea and restless legs syndrome display prominent neurobehavioral symptoms such as daytime inattentiveness and hyperactivity, so it is important to elicit a sleep history when these symptoms are encountered. Systemic iron deficiency occurs in about two-thirds of children with restless legs syndrome and is easily treatable. Parasomnias arising out of non-rapid eye movement (REM) sleep, such as confusional arousals and sleepwalking, may be difficult to distinguish from nocturnal seizures, and, in many cases, video-EEG polysomnography is required to differentiate between causes. SUMMARY Clinicians should routinely integrate the assessment of sleep-wake function into their practices of neurology and child neurology because of the opportunity to improve the quality of life of their patients.
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Lemke MK, Apostolopoulos Y, Hege A, Newnam S, Sönmez S. Can subjective sleep problems detect latent sleep disorders among commercial drivers? Accid Anal Prev 2018; 115:62-72. [PMID: 29549772 DOI: 10.1016/j.aap.2018.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/31/2018] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Long-haul truck drivers experience poor sleep health and heightened accident rates, and undiagnosed sleep disorders contribute to these negative outcomes. Subjective sleep disorder screening tools may aid in detecting drivers' sleep disorders. This study sought to evaluate the value of subjective screening methods for detecting latent sleep disorders and identifying truck drivers at-risk for poor sleep health and safety-relevant performance. MATERIALS AND METHODS Using cross-sectional data from 260 long-haul truck drivers, we: 1) used factor analysis to identify possible latent sleep disorders; 2) explored the construct validity of extracted sleep disorder factors by determining their associations with established sleep disorder risk factors and symptoms; and 3) explored the predictive validity of resulting sleep disorder factors by determining their associations with sleep health and safety-relevant performance. RESULTS Five latent sleep disorder factors were extracted: 1) circadian rhythm sleep disorders; 2) sleep-related breathing disorders; 3) parasomnias; 4) insomnias; 5) and sleep-related movement disorders. Patterns of associations between these factors generally corresponded with known risk factors and symptoms. One or more of the extracted latent sleep disorder factors were significantly associated with all the sleep health and safety outcomes. DISCUSSION Using subjective sleep problems to detect latent sleep disorders among long-haul truck drivers may be a timely and effective way to screen this highly mobile occupational segment. This approach should constitute one component of comprehensive efforts to diagnose and treat sleep disorders among commercial transport operators.
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Affiliation(s)
- Michael K Lemke
- Complexity & Computational Population Health Group, Department of Kinesiology and Health Science, Stephen F. Austin State University, P.O. Box 13015, Nacogdoches, TX, 75962, USA.
| | - Yorghos Apostolopoulos
- Complexity & Computational Population Health Group, Department of Health & Kinesiology, Texas A&M University, 4243 TAMU, College Station, TX, 77843-4243, USA.
| | - Adam Hege
- Department of Health & Exercise Science, Appalachian State University, 111 Rivers Street, Boone, NC, 28608, USA.
| | - Sharon Newnam
- Accident Research Centre, Monash University, 21 Alliance Lane, Clayton, VIC, 3800, Australia.
| | - Sevil Sönmez
- Rosen College of Hospitality Management, University of Central Florida, 9907 Universal Blvd., Orlando, FL, 32819, USA.
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Bollu PC, Goyal MK, Thakkar MM, Sahota P. Sleep Medicine: Parasomnias. Mo Med 2018; 115:169-175. [PMID: 30228711 PMCID: PMC6139852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parasomnias are abnormal and undesirable behaviors during sleep and are thought to be due to the sleep state instability. Some of them are benign, while some of them point to a possible underlying neurodegenerative process. This article briefly discusses the clinical characteristics, demographics, and pathophysiology of major parasomnias and associated disorders. The classification outlined in this article conforms to the current version of International Classification of Sleep disorders.
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Affiliation(s)
- Pradeep C Bollu
- Pradeep C. Bollu, MD, Munish K. Goyal, MD, Mahesh Thakkar, PhD, and Pradeep Sahota, MD, MSMA member since 2003, are in the Department of Neurology, University of Missouri - Columbia
| | - Munish K Goyal
- Pradeep C. Bollu, MD, Munish K. Goyal, MD, Mahesh Thakkar, PhD, and Pradeep Sahota, MD, MSMA member since 2003, are in the Department of Neurology, University of Missouri - Columbia
| | - Mahesh M Thakkar
- Pradeep C. Bollu, MD, Munish K. Goyal, MD, Mahesh Thakkar, PhD, and Pradeep Sahota, MD, MSMA member since 2003, are in the Department of Neurology, University of Missouri - Columbia
| | - Pradeep Sahota
- Pradeep C. Bollu, MD, Munish K. Goyal, MD, Mahesh Thakkar, PhD, and Pradeep Sahota, MD, MSMA member since 2003, are in the Department of Neurology, University of Missouri - Columbia
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Mohebbi A, Holoyda BJ, Newman WJ. Sexsomnia as a Defense in Repeated Sex Crimes. J Am Acad Psychiatry Law 2018; 46:78-85. [PMID: 29618539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexsomnia and related sexual behaviors during sleep may be diagnosed in individuals accused of sex crimes. Although sexsomnia is now formally recognized in the DSM-5, the variable presentation of such behaviors and the possibility of malingering in medicolegal situations can cause challenges for forensic evaluators and legal professionals alike. Review of the literature reveals a paucity of cases involving allegations of repeated incidents due to abnormal sexual behaviors or experiences in sleep. It is important for experts involved in such cases to understand how the courts have responded to sexsomnia defenses involving diverse alleged incidents. The authors review the case law and discuss methods of examining evaluees with suspected sexsomnia in cases of alleged sexual assault.
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Affiliation(s)
- Amir Mohebbi
- Dr. Mohebbi is a General Psychiatry Resident, Dr. Holoyda is Assistant Professor of Psychiatry, and Dr. Newman is Associate Professor of Psychiatry and Training Director of the Forensic Psychiatry Fellowship Program, Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO.
| | - Brian J Holoyda
- Dr. Mohebbi is a General Psychiatry Resident, Dr. Holoyda is Assistant Professor of Psychiatry, and Dr. Newman is Associate Professor of Psychiatry and Training Director of the Forensic Psychiatry Fellowship Program, Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO
| | - William J Newman
- Dr. Mohebbi is a General Psychiatry Resident, Dr. Holoyda is Assistant Professor of Psychiatry, and Dr. Newman is Associate Professor of Psychiatry and Training Director of the Forensic Psychiatry Fellowship Program, Department of Psychiatry, Saint Louis University School of Medicine, St. Louis, MO
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Guillén Pinto D, Medina Alva P. [Non-epileptic paroxysmal disorder in neonates]. Medicina (B Aires) 2018; 78 Suppl 2:42-46. [PMID: 30199364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Non-epileptic paroxysmal disorders are frequent events in the neonate, generally transient. However, due to their intensity they can be confused as true epileptic seizures. The objective of this review is to update the concepts in relation to tremors, neonatal benign sleep myoclonus (MNBS) and hyperekplexia. The tremors are very frequent, once identified it must be determined if they belong to a hyperexcitability syndrome related to maternal or perinatal factors, in idiopathic cases a good prognosis is expected. MNBS are often confused with epileptic seizures. They are characterized by the fact that myoclonus is brief and occurs only in sleep, children are normal, and the EEG is also normal. Hyperekplexia is a rare, genetically determined disorder characterized by hypertonia and exaggerated startle reactions to a banal stimulus, which can be improved with clonazepam.
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Affiliation(s)
- Daniel Guillén Pinto
- Hospital Cayetano Heredia, Perú
- Universidad Peruana Cayetano Heredia, Perú. E-mail:
| | - Pilar Medina Alva
- Instituto Materno Perinatal de Lima, Perú
- Universidad Peruana Cayetano Heredia, Perú
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McClennon A, Diamond V, Paul SP. It's not epilepsy. Br J Nurs 2017; 26:1006. [PMID: 29034713 DOI: 10.12968/bjon.2017.26.18.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Annie McClennon
- Final Year Medical Student, Deakin University, Geelong, Australia
| | - Vanessa Diamond
- Practice Development Facilitator and Neonatal Lead Nurse, Special Care Baby Unit, Torbay Hospital
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Rémi J, Bötzel K. [Parasomnia and paroxysmal dyskinesia]. Nervenarzt 2017; 88:1141-1146. [PMID: 28831514 DOI: 10.1007/s00115-017-0400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Short involuntary paroxysmal movements or behavioral patterns are an important differential diagnosis to epileptic seizures, especially when occurring for the first time. Typically, these attacks are not witnessed by medically trained personnel and the patient anamnesis or observations by a third party are often not specific enough to differentiate between epileptic seizures and the differential diagnoses. This review presents the epidemiology, the clinical presentation, the necessary diagnostic steps and the differential diagnostic approach to parasomnias and dyskinesias. The focus is on the clinical aspects, and therapeutic principles are also briefly described.
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Affiliation(s)
- J Rémi
- Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland.
| | - K Bötzel
- Neurologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, München, Deutschland
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42
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Abstract
Parasomnia is a common pediatric sleep disorder that can cause parents or caregivers distress when experienced by their children. Based on the International Classification of Sleep Disorders, parasomnias can be divided into two subgroups: non-rapid eye movement (NREM) parasomnias and rapid eye movement (REM) parasomnias. REM sleep parasomnias include nightmares, REM behavior disorder, and sleep paralysis, whereas NREM sleep parasomnias include disorders of arousal such as confusional arousals, sleepwalking, sleep talking, night terrors, and sleep-related eating disorder. This review focuses on the epidemiology, clinical presentation, diagnosis, and treatment of the most common form of parasomnias-NREM arousal parasomnias. Additionally, this review aims to help clinicians distinguish NREM parasomnias from nocturnal frontal lobe seizures, as this distinction is important to avoid diagnostic delays and inappropriate medication exposure. [Pediatr Ann. 2017;46(9):e327-e331.].
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Abstract
PURPOSE OF REVIEW This article reviews the spectrum of non-rapid eye movement (non-REM) sleep parasomnias, including sleepwalking, confusional arousals, and sleep terrors, which represent the range of phenotypic disorders of arousal from non-REM sleep that occurs in children and adults. RECENT FINDINGS The International Classification of Sleep Disorders, Third Edition (ICSD-3) classifies parasomnias according to the sleep stage they emerge from: REM, non-REM, or other. Demographics, clinical features, and diagnosis of non-REM parasomnias are reviewed in this article, and an up-to-date synopsis of guidelines for management strategies to assist in the treatment of these sleep disorders is provided. SUMMARY The non-REM parasomnias are most common in children and adolescents but may persist into adulthood. They can be distinguishable from REM parasomnias and nocturnal epilepsies, and, importantly, may lead to injury. Additionally, other parasomnias in this spectrum include sleep-related eating disorder and sexsomnia. Overlap parasomnia disorder includes one or more manifestations of a non-REM parasomnia seen in combination with REM sleep behavior disorder, representing an apparent erosion of the normally distinct stages of non-REM and REM sleep. A similar yet much more extreme dissociation of states underlies agrypnia excitata and status dissociatus, which represent rare, severe dissociations between non-REM, REM, and wake states resulting clinically in oneiric behaviors and severe derangement of normal polysomnographic wake and sleep stage characteristics. Management of non-REM and overlap parasomnias and state dissociation disorders include ensuring bedroom safety and prescription of clonazepam or hypnosis, in select cases, although in children and adolescents with noninjurious behaviors, non-REM parasomnias are often age-limited developmental disorders, which may ultimately remit by adulthood, and, in these cases, counseling and education alone may suffice. Timely and accurate recognition of the non-REM and overlap parasomnias is crucial to limiting potential patient injury.
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Adams H, Greaves K, Paul SP. Avoiding mistaken epilepsy diagnosis in newborns. Emerg Nurse 2016; 24:14. [PMID: 27615339 DOI: 10.7748/en.24.5.14.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Parents of newborns can be reassured if healthcare professionals are aware of benign neonatal sleep myoclonus (BNSM) so it is not mistaken for epilepsy.
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45
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Goraya JS, Singla G, Mahey H. Benign neonatal sleep myoclonus: frequently misdiagnosed as neonatal seizures. Indian Pediatr 2015; 52:713-714. [PMID: 26388639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
18 neonates aged 5-60 days with Benign neonatal sleep myoclonus were identified. Fifteen neonates had been misdiagnosed as neonatal seizures before referral. All treatments were withdrawn once the diagnosis of benign neonatal sleep myoclonus was made. Benign neonatal sleep myoclonus should be considered early in the differential diagnosis of neonatal seizures.
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Affiliation(s)
- Jatinder Singh Goraya
- Divisions of Pediatric Neurology and #Neonatology, Department of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
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46
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Adachi H. [Parasomnia]. Nihon Rinsho 2015; 73:949-953. [PMID: 26065125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In elderly people, various abnomal behaviors could be accompanied during the sleep or around the bed time. There are many opportunities to receive consultation in a general or liaison psychiatry for diagnosis and treatment to these problems. REM sleep behavior disorder (RBD) is higher prevalence part of parasomnia at elderly people. Especially, RED has received a lot of attention in recent years from the relevance with α-synucleinopathy. On the other hand, new onset of non-REM parasomnia is lower frequency at the point of elderly people, however, it is important to understand the clinical features about parasomnias for differentiation from epilepsy and delirium.
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47
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Faludi B, Kovács N, Janszky J, Komoly S. [CHARACTERISTICS AND DIFFERENTIAL DIAGNOSTICS OF SLEEP RELATED PATHOLOGICAL MOVEMENTS. UPDATE 2013]. Ideggyogy Sz 2015; 68:165-177. [PMID: 26182607 DOI: 10.18071/isz.68.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Wide variety of the movements (from the physiologic body position changes to different pathologic events) can be seen during the sleep period. The most important types of these movements are the sleep related events (from the parasomnias to the restless leg related movements), the movement disorders and the epilepsy related events. To differentiate between these events is required special skill, which is based on appropriate characterisation of the events (for example timing, repetition, pattern), the polysomnographic and video-EEG examination and validated questionnaires (FLEP scale). The appropriate differential diagnostics and therapy must be based on the knowledge of the relationship of the sleep architecture and movement events. This review would like to provide guideline for the understanding and recognizing the nature of the sleep related movements.
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Abstract
BACKGROUND The International Classification of Sleep Disorders-Third Edition (ICSD-3) classifies catathrenia among the respiratory disorders and not as a parasomnia as in ICSD-2. Few patients have been reported during these years, and the clinical description of the sound is different from group to group. In fact, there is no full agreement about its nature, origin, meaning, and treatment. METHODS AND RESULTS In this paper we review the literature on catathrenia focusing on the characteristics of the sound, demographics of the patients, aetiology, response to treatment, etc., in order to support its classification as a respiratory disorder or a parasomnia. We also discuss the possibility of Catathrenia being not one disorder but two variants or two different disorders.
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Affiliation(s)
- Jorge Iriarte
- Sleep Unit and Clinical Neurophysiology Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain.
| | - Arantza Campo
- Pneumology Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Manuel Alegre
- Sleep Unit and Clinical Neurophysiology Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Secundino Fernández
- ENT Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Elena Urrestarazu
- Sleep Unit and Clinical Neurophysiology Department, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Affiliation(s)
- Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Francesc Graus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Neurology, Hospital Clinic, Barcelona, Spain
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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50
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Fois C, Wright MAS, Sechi G, Walker MC, Eriksson SH. The utility of polysomnography for the diagnosis of NREM parasomnias: an observational study over 4 years of clinical practice. J Neurol 2015; 262:385-93. [PMID: 25408370 PMCID: PMC4330461 DOI: 10.1007/s00415-014-7578-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/16/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022]
Abstract
Polysomnography (PSG) is considered the gold standard for diagnosis of non-rapid eye movement (NREM) parasomnias, however its diagnostic yield has been rarely reported. We aimed to assess the diagnostic value of polysomnography in different categories of patients with suspected NREM parasomnia and define variables that can affect the outcome. 124 adults referred for polysomnography for suspected NREM parasomnia were retrospectively identified and divided into clinical categories based on their history. Each polysomnography was analysed for features of NREM parasomnia or different sleep disorders and for presence of potential precipitants. The impact on the outcome of number of recording nights and concomitant consumption of benzodiazepines and antidepressants was assessed. Overall, PSG confirmed NREM parasomnias in 60.5 % patients and showed a different sleep disorder in another 16 %. Precipitants were found in 21 % of the 124 patients. However, PSG showed limited value when the NREM parasomnia was clinically uncomplicated, since it rarely revealed a different diagnosis or unsuspected precipitants (5 % respectively), but became essential for people with unusual features in the history where different or overlapping diagnoses (18 %) or unsuspected precipitants (24 %) were commonly identified. Taking benzodiazepines or antidepressants during the PSG reduced the diagnostic yield. PSG has a high diagnostic yield in patients with suspected NREM parasomnia, and can reveal a different diagnosis or precipitants in over 40 % of people with complicated or atypical presentation or those with a history of epilepsy. We suggest that PSG should be performed for one night in the first instance, with leg electrodes and respiratory measurements and after benzodiazepine and antidepressant withdrawal.
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Affiliation(s)
- Chiara Fois
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Mary-Anne S. Wright
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
| | - GianPietro Sechi
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Matthew C. Walker
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
| | - Sofia H. Eriksson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, 33 Queen Square, Box 29, London, WC1N 3BG UK
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