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Carlos H. Schenck - One of the best experts on this subject based on the ideXlab platform.
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NonREM Disorders of Arousal and Related Parasomnias: an Updated Review
Neurotherapeutics, 2021Co-Authors: Muna Irfan, Carlos H. Schenck, Michael J HowellAbstract: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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The spectrum of disorders causing violence during sleep
Sleep Science and Practice, 2019Co-Authors: Carlos H. SchenckAbstract:Violent behavior during sleep is a common problem, affecting > 2% of the population > 15 years old as found in two large epidemiologic studies. The differential diagnosis of sleep related injury and violence includes: REM sleep behavior disorder (RBD); NREM sleep Parasomnias (sleepwalking, sleep terrors); Parasomnia overlap disorder (RBD + NREM sleep Parasomnias); obstructive sleep apnea; sexsomnia (sleep related abnormal sexual behaviors); sleep related dissociative disorder; trauma-associated sleep disorder/post-traumatic stress disorder; periodic limb movement disorder; rhythmic movement disorder; nocturnal scratching disorder; nocturnal seizures; and miscellaneous/mixed conditions. Careful clinical interviews, preferably with bed partners participating, and extensive, hospital-based, technologist-attended, overnight video-polysomnography (for one or more nights), is crucial for determining the accurate diagnosis that will guide proper therapy. Most of the disorders mentioned above are classified as Parasomnias in the International Classification of Sleep Disorders, 3rd Edition, with Parasomnias defined as abnormal behavioral, experiential and/or autonomic nervous system activity during entry into sleep, during any stage of sleep, and during emergence from any stage of sleep. Parasomnias are often manifestations of “state dissociation” in which components of one state of being (wake, REM sleep, NREM sleep) intrude into, and become admixed, with other states of being, with clinical consequences. There are forensic implications related to the Parasomnias, with inadvertent and unintentional assaults, murder, and “pseudo-suicide” resulting from aggressive and violent behaviors arising from sleep with suspended awareness and judgement.
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REM sleep behavior disorder: relevance to epileptologists
Zeitschrift für Epileptologie, 2019Co-Authors: Carlos H. SchenckAbstract:Background Rapid eye movement (REM) sleep behavior disorder (RBD) is a Parasomnia that features loss of the generalized skeletal muscle atonia of mammalian REM sleep, with release of injurious dream-enacting behaviors. Video-polysomnography is necessary to confirm the diagnosis. Objective Our aim was to provide a relevant update on RBD for electroencephalography (EEG) and epilepsy specialists. Methods This study comprised a focused literature review. Results Typical and atypical RBD clinical profiles are presented and discussed. Official diagnostic criteria are listed and experimental animal models are reviewed. The differential diagnosis, including nocturnal seizures, is considered, and EEG, evoked potential, and sleep spindle findings are presented. Emphasis is placed on idiopathic RBD as a common herald of future alpha-synucleinopathy neurodegeneration (Parkinson’s disease, dementia with Lewy bodies, multiple system atrophy). Furthermore, we describe the formation of the International RBD Study Group in 2009 with yearly research symposia. Conclusion RBD comprises a fascinating, multidimensional Parasomnia that needs to be considered in the differential diagnosis of nocturnal epilepsy with abnormal sleep-related behaviors in order to facilitate identifying the correct diagnosis and to initiate proper therapy. Hintergrund Die REM-Schlaf-Verhaltensstörung („rapid eye movement sleep behavior disorder“, RBD) stellt eine Parasomnie dar, die gekennzeichnet ist durch den Verlust der generalisierten Skelettmuskelatonie im REM-Schlaf bei Säugetieren, mit Freisetzung selbst- oder fremdgefährdender Verhaltensweisen im Rahmen des Ausagierens von Trauminhalten. Zur Diagnosesicherung ist eine Videopolysomnographie erforderlich. Ziel Ziel der Arbeit war es, Epileptologen und Neurologen einen Überblick über den aktuellen Wissenstand zur RBD zu geben. Methoden Die vorliegende Studie umfasst eine fokussierte Literaturübersicht. Ergebnisse Es werden typische und atypische klinische Profile der RBD vorgestellt und erörtert. Dabei werden die offiziellen Diagnosekriterien aufgeführt und experimentelle Tiermodelle dargestellt. Differenzialdiagnosen einschließlich nächtlicher Anfälle werden betrachtet und EEG, evozierte Potenziale und Schlafspindelbefunde präsentiert. Im Vordergrund steht die idiopathische RBD als üblicher Vorbote einer Neurodegeneration im Rahmen einer Alpha-Synukleinopathie (M. Parkinson, Lewy-Körperchen-Demenz, Multisystematrophie). Darüber hinaus wird die Entstehung einer internationalen RBD-Arbeitsgruppe (International RBD Study Group) im Jahr 2009 mit jährlichen Forschungssymposien beschrieben. Schlussfolgerung Die RBD bezeichnet eine faszinierende multidimensionale Parasomnie, die miteinbezogen werden muss in die Differenzialdiagnose schlafgebundener abnormer Verhaltensweisen, und die abgegrenzt werden muss gegen schlaf-assoziierte epileptische Anfälle, um dann – nach korrekter Diagnosestellung – eine adäquate Therapie zu ermöglichen.
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Parasomnia Overlap Disorder: RBD and NREM Parasomnias
Rapid-Eye-Movement Sleep Behavior Disorder, 2018Co-Authors: Carlos H. Schenck, Michael J HowellAbstract:Parasomnia overlap disorder (POD) was formally described and named in 1997 with a series of 33 cases of RBD combined with a disorder of arousal from NREM sleep (confusional arousals, sleepwalking, sleep terrors) that emerged idiopathically or symptomatically with neurological and other disorders. The presenting complaint was sleep-related injury; mean age was 34 years, and mean age of Parasomnia onset was 15 years (range 1–66 years); 70% were males. POD is classified as a subtype of RBD in the International Classification of Sleep Disorders, 3rd edition. An updated classification of POD also includes RBD-sleep-related eating disorder, RBD-sexsomnia, RBD-rhythmic movement disorder, and POD with Parkinson’s disease and other neurological disorders, including the newly identified autoimmune tauopathy with antibodies against IgLON5 (“anti-IgLON5 syndrome”) manifesting as RBD, NREM Parasomnia, sleep-related breathing disturbance and striking, and progressive neurological features. POD may be a distinct pathophysiological entity, and not just a variant of RBD, given its typically younger age of onset and apparent lack of progression to neurodegeneration that contrasts with typical RBD in middle-aged and older adults. POD is usually controlled with bedtime clonazepam and other therapies.
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Non-Rapid Eye Movement Sleep and Overlap Parasomnias
Continuum (Minneapolis Minn.), 2017Co-Authors: Muna Irfan, Carlos H. Schenck, Michael J HowellAbstract: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.
Claudio L Bassetti - One of the best experts on this subject based on the ideXlab platform.
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demographic clinical and polysomnographic characteristics of childhood and adult onset sleepwalking in adults
European Neurology, 2017Co-Authors: Panagiotis Bargiotas, Iris Arnet, Michael Frei, Christian R Baumann, Kaspar Schindler, Claudio L BassettiAbstract:BACKGROUND Sleepwalking (SW) is found to affect children predominantly, but it can persist or appear de novo even among adults. In this study, we assessed the demographic, clinical and polysomnographic profile, trigger factors and associated comorbidities of adult-onset (AO-SW) and childhood-onset (CO-SW) adult sleepwalkers. METHODS In adult sleepwalkers, a structured clinical interview, a battery of questionnaires, video-polysomnography (v-PSG) and standard electroencephalography (EEG) were performed. RESULTS Among 63 sleepwalkers, 45% had ≥1 episodes/month, 54% had partial recall of the episodes and 36% reported trigger factors for SW. Almost all subjects reported co-occurring Parasomnias. In v-PSG, 4% exhibited episodes of SW, 17% confusional arousals, 21% had an increased apnea-hypopnea-index and 6% exhibited features of an overlap Parasomnia disorder. In our cohort, 73% reported CO-SW and 27% AO-SW. In subjects with AO-SW, positive family history for Parasomnias was found in 33% (vs. 49% in CO-SW), neurological comorbidities in 44% (vs. 14%), psychiatric comorbidities in 25% (vs. 33%), EEG abnormalities in 50% (vs. 29%). Violence during SW episodes was more frequent in males and in subjects with CO-SW (45% for self-injury and 44% for violent behaviour vs. 33 and 29% respectively in the AO-SW group). CONCLUSIONS Adult SW represents a complex and potentially dangerous condition. The characteristics of AO-SW often differ from those of CO-SW.
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Parasomnia overlap disorder parkinson s disease and subthalamic deep brain stimulation three case reports
BMC Neurology, 2017Co-Authors: Panagiotis Bargiotas, Julia Muellner, W Michael M Schuepbach, Claudio L BassettiAbstract:Parasomnia overlap disorder (POD) is a distinct Parasomnia and characterized by concomitant manifestation of rapid-eye-movement (REM)- and non-REM (NREM)-Parasomnias. Although not uncommon among patients with Parkinson’s disease, POD is often under-investigated. This is the first report of patients with PD and features of POD that underwent deep brain stimulation. Our patients exhibited different outcomes of POD features after subthalamic deep brain stimulation. We expect that the reporting of these first patients will open the discussion about the need for more detailed and broad-spectrum assessments regarding Parasomnias in PD patients that undergo deep brain stimulation. The implications of our observations are both clinical and neurobiological.
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Parasomnia overlap disorder, Parkinson’s disease and subthalamic deep brain stimulation: three case reports
BMC, 2017Co-Authors: Panagiotis Bargiotas, Julia Muellner, W Michael M Schuepbach, Claudio L BassettiAbstract:Abstract Background Parasomnia overlap disorder (POD) is a distinct Parasomnia and characterized by concomitant manifestation of rapid-eye-movement (REM)- and non-REM (NREM)-Parasomnias. Although not uncommon among patients with Parkinson’s disease, POD is often under-investigated. Case presentation This is the first report of patients with PD and features of POD that underwent deep brain stimulation. Our patients exhibited different outcomes of POD features after subthalamic deep brain stimulation. Conclusions We expect that the reporting of these first patients will open the discussion about the need for more detailed and broad-spectrum assessments regarding Parasomnias in PD patients that undergo deep brain stimulation. The implications of our observations are both clinical and neurobiological
Mark W. Mahowald - One of the best experts on this subject based on the ideXlab platform.
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Violent Parasomnias forensic implications
Handbook of clinical neurology, 2011Co-Authors: Mark W. Mahowald, Carlos H. Schenk, Michel A. Cramer BornemannAbstract:Abstract Parasomnias are defined as unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during the sleep period. Most Parasomnias represent the simultaneous admixture of wakefulness and sleep. This chapter focuses on the clinical features, pathophysiology, diagnosis, and treatment of the two most common Parasomnias: (1) disorders of arousal (confusional arousals, sleepwalking, and sleep terrors), which represent admixtures of wakefulness and nonrapid eye movement sleep; and (2) rapid eye movement (REM)-sleep behavior disorder (RBD), which is a manifestation of admixed wakefulness and REM sleep. Disorders of arousal are very common, perhaps part of the normal human condition, and are not the manifestation of underlying psychiatric disease. RBD is often the harbinger of degenerative neurological conditions, particularly the synucleinopathies (Parkinson's disease, dementia with Lewy bodies, and multiple system atrophy); it is a frequent accompaniment of narcolepsy with cataplexy, and may be induced by numerous medications, particularly the selective serotonin reuptake inhibitors and the serotonin–norepinephrine reuptake inhibitors. Parasomnia behaviors underscore the fact that consciousness, being ever so evanescent, exists on a broad spectrum and is not an easily delineated dichotomous state. Such a dynamic understanding of consciousness has significant scientific, legal, and social implications raising interesting and difficult questions regarding awareness, responsibility, culpability, and even what it means to be human. Emphasis is placed upon the importance of the emerging field of Sleep Forensics in the evaluation of violent, injurious, or alleged criminal behaviors resulting from these Parasomnias.
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Parasomnias associated with sleep-disordered breathing and its therapy, including sexsomnia as a recently recognized Parasomnia
Somnologie - Schlafforschung und Schlafmedizin, 2008Co-Authors: Carlos H. Schenck, Mark W. MahowaldAbstract:Parasomnias are defined in the International Classification of Sleep Disorders-2nd Edition (ICSD-2) as undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Instinctual behaviors can inappropriately emerge with the Parasomnias, including appetite behaviors (feeding, sex), locomotion, aggression, and violence. Sleep disorders and their therapies carry their own risk for Parasomnias, including sleep-disordered breathing (SDB) and its therapy with nCPAP. A Pub Med literature search was conducted for peer-reviewed journal articles with key words "Parasomnia" (and other specific Parasomnias) linked with "sleep apnea" or "sleep disordered breathing." Eight of the 12 Parasomnias found in the ICSD-2 are associated with SDB, along with 3 of the 4 Parasomnia variants in ICSD-2, for a total of 11 of 16 (68.7 %) Parasomnias and their variants being associated with SDB. The list of Parasomnias includes confusional arousals (and its variants, severe morning sleep inertia, and sleep related abnormal sexual behaviors [sexsomnia, sleepsex]); sleepwalking; sleep terrors; sleep related eating disorder; REM sleep behavior disorder (and "OSA pseudo RBD"); Parasomnia overlap disorder (RBD combined with a disorder of arousal); nightmare disorder; sleep related groaning (catathrenia); and sleep enuresis. Sleep Related Movement Disorders include sleep related bruxism and sleep related rhythmic movement disorder. Other conditions include gastrooesophageal reflux disorder with sleep related laryngospasm; cerebral anoxic attacks; nocturnal seizures (Complex Partial Seizures; Nocturnal Frontal Lobe Epilepsy); sleep related anxiety reactions and panic attacks; chronic hiccups; and sleep choking syndrome. A case report is included of a man with moderately severe OSA and with recurrent, unconscious sexsomnia with his wife, who fully responded to nCPAP therapy that normalized his SDB and complete ly eliminated the sexsomnia, which presumably had emerged during OSA confusional arousals. A current classification of sexsomnia, a recently recognized Parasomnia variant, is reviewed, along with comments on OSA-sexsomnia.
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a Parasomnia overlap disorder involving sleepwalking sleep terrors and rem sleep behavior disorder in 33 polysomnographically confirmed cases
Sleep, 1997Co-Authors: Carlos H. Schenck, Jeffrey L Boyd, Mark W. MahowaldAbstract:: A series of 33 patients with combined (injurious) sleepwalking, sleep terrors, and rapid eye movement (REM) sleep behavior disorder (viz. "Parasomnia overlap disorder") was gathered over an 8-year period. Patients underwent clinical and polysomnographic evaluations. Mean age was 34 +/- 14 (SD) years; mean age of Parasomnia onset was 15 +/- 16 years (range 1-66); 70% (n = 23) were males. An idiopathic subgroup (n = 22) had a significantly earlier mean age of Parasomnia onset (9 +/- 7 years) than a symptomatic subgroup (n = 11) (27 +/- 23 years, p = 0.002), whose Parasomnia began with either of the following: neurologic disorders, n = 6 [congenital Mobius syndrome, narcolepsy, multiple sclerosis, brain tumor (and treatment), brain trauma, indeterminate disorder (exaggerated startle response/atypical cataplexy)]; nocturnal paroxysmal atrial fibrillation, n = 1; posttraumatic stress disorder/major depression, n = 1; chronic ethanol/amphetamine abuse and withdrawal, n = 1; or mixed disorders (schizophrenia, brain trauma, substance abuse), n = 2. The rate of DSM-III-R (Diagnostic and Statistical Manual, 3rd edition, revised) Axis 1 psychiatric disorders was not elevated; group scores on various psychometric tests were not elevated. Forty-five percent (n = 15) had previously received psychologic or psychiatric therapy for their Parasomnia, without benefit. Treatment outcome was available for n = 20 patients; 90% (n = 18) had substantial Parasomnia control with bedtime clonazepam (n = 13), alprazolam and/or carbamazepine (n = 4), or self-hypnosis (n = 1). Thus, "Parasomnia overlap disorder" is a treatable condition that emerges in various clinical settings and can be understood within the context of current knowledge on Parasomnias and motor control/dyscontrol during sleep.
Panagiotis Bargiotas - One of the best experts on this subject based on the ideXlab platform.
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demographic clinical and polysomnographic characteristics of childhood and adult onset sleepwalking in adults
European Neurology, 2017Co-Authors: Panagiotis Bargiotas, Iris Arnet, Michael Frei, Christian R Baumann, Kaspar Schindler, Claudio L BassettiAbstract:BACKGROUND Sleepwalking (SW) is found to affect children predominantly, but it can persist or appear de novo even among adults. In this study, we assessed the demographic, clinical and polysomnographic profile, trigger factors and associated comorbidities of adult-onset (AO-SW) and childhood-onset (CO-SW) adult sleepwalkers. METHODS In adult sleepwalkers, a structured clinical interview, a battery of questionnaires, video-polysomnography (v-PSG) and standard electroencephalography (EEG) were performed. RESULTS Among 63 sleepwalkers, 45% had ≥1 episodes/month, 54% had partial recall of the episodes and 36% reported trigger factors for SW. Almost all subjects reported co-occurring Parasomnias. In v-PSG, 4% exhibited episodes of SW, 17% confusional arousals, 21% had an increased apnea-hypopnea-index and 6% exhibited features of an overlap Parasomnia disorder. In our cohort, 73% reported CO-SW and 27% AO-SW. In subjects with AO-SW, positive family history for Parasomnias was found in 33% (vs. 49% in CO-SW), neurological comorbidities in 44% (vs. 14%), psychiatric comorbidities in 25% (vs. 33%), EEG abnormalities in 50% (vs. 29%). Violence during SW episodes was more frequent in males and in subjects with CO-SW (45% for self-injury and 44% for violent behaviour vs. 33 and 29% respectively in the AO-SW group). CONCLUSIONS Adult SW represents a complex and potentially dangerous condition. The characteristics of AO-SW often differ from those of CO-SW.
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Parasomnia overlap disorder parkinson s disease and subthalamic deep brain stimulation three case reports
BMC Neurology, 2017Co-Authors: Panagiotis Bargiotas, Julia Muellner, W Michael M Schuepbach, Claudio L BassettiAbstract:Parasomnia overlap disorder (POD) is a distinct Parasomnia and characterized by concomitant manifestation of rapid-eye-movement (REM)- and non-REM (NREM)-Parasomnias. Although not uncommon among patients with Parkinson’s disease, POD is often under-investigated. This is the first report of patients with PD and features of POD that underwent deep brain stimulation. Our patients exhibited different outcomes of POD features after subthalamic deep brain stimulation. We expect that the reporting of these first patients will open the discussion about the need for more detailed and broad-spectrum assessments regarding Parasomnias in PD patients that undergo deep brain stimulation. The implications of our observations are both clinical and neurobiological.
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Parasomnia overlap disorder, Parkinson’s disease and subthalamic deep brain stimulation: three case reports
BMC, 2017Co-Authors: Panagiotis Bargiotas, Julia Muellner, W Michael M Schuepbach, Claudio L BassettiAbstract:Abstract Background Parasomnia overlap disorder (POD) is a distinct Parasomnia and characterized by concomitant manifestation of rapid-eye-movement (REM)- and non-REM (NREM)-Parasomnias. Although not uncommon among patients with Parkinson’s disease, POD is often under-investigated. Case presentation This is the first report of patients with PD and features of POD that underwent deep brain stimulation. Our patients exhibited different outcomes of POD features after subthalamic deep brain stimulation. Conclusions We expect that the reporting of these first patients will open the discussion about the need for more detailed and broad-spectrum assessments regarding Parasomnias in PD patients that undergo deep brain stimulation. The implications of our observations are both clinical and neurobiological
Fabrice Espa - One of the best experts on this subject based on the ideXlab platform.
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Arousal Reactions in Sleepwalking and Night Terrors in Adults: The Role of Res- piratory Events ParasomniaS
2002Co-Authors: Fabrice Espa, B Ondze, Yves Dauvilliers, Michel Billiard, Alain BessetAbstract:Study Objectives: The aim of the study was to determine the role of respiratory events, assessed by means of esophageal pressure monitoring, during arousals from slow wave sleep in adult patients with Parasomnias. Design: N/A Setting: N/A Patients: Ten patients with Parasomnias (sleepwalking, night terrors, or both) and 10 control subjects matched for gender and age underwent 3 consecutive nights of polysomnography. Interventions: N/A Measurements and Results: By increasing sleep fragmentation, esophageal pressure monitoring has a deleterious effect on sleep architecture in patients with Parasomnias and in control subjects. Respiratory events occur more frequently in Parasomniacs than in controls. Respiratory effort seems to be responsible for the occurrence of a great number of arousal reactions in Parasomniacs and is involved in triggering the Parasomnia episodes. Conclusion: Sleep-disordered breathing seems to be frequently associated with Parasomnias during slow wave sleep, emphasizing the utility of performing esophageal pressure monitoring in cases of sleep walking or night terrors.
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Arousal reactions in sleepwalking and night terrors in adults: the role of respiratory events.
Sleep, 2002Co-Authors: Fabrice Espa, B Ondze, Yves Dauvilliers, Michel Billiard, Alain BessetAbstract:STUDY OBJECTIVES: The aim of the study was to determine the role of respiratory events, assessed by means of esophageal pressure monitoring, during arousals from slow wave sleep in adult patients with Parasomnias. DESIGN: N/A. SETTING: N/A. PATIENTS: Ten patients with Parasomnias (sleepwalking, night terrors, or both) and 10 control subjects matched for gender and age underwent 3 consecutive nights of polysomnography. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: By increasing sleep fragmentation, esophageal pressure monitoring has a deleterious effect on sleep architecture in patients with Parasomnias and in control subjects. Respiratory events occur more frequently in Parasomniacs than in controls. Respiratory effort seems to be responsible for the occurrence of a great number of arousal reactions in Parasomniacs and is involved in triggering the Parasomnia episodes. CONCLUSION: Sleep-disordered breathing seems to be frequently associated with Parasomnias during slow wave sleep, emphasizing the utility of performing esophageal pressure monitoring in cases of sleep walking or night terrors.
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sleep architecture slow wave activity and sleep spindles in adult patients with sleepwalking and sleep terrors
Clinical Neurophysiology, 2000Co-Authors: Fabrice Espa, B Ondze, Patrice Deglise, M Billiard, A BessetAbstract:OBJECTIVES: A very strong SWS intensity reflected by both an increased level of SWA and an abnormal sleep spindles distribution would be responsible for the major difficulty of Parasomniac subjects in waking up from SWS, leading to episodes of Parasomnia. METHODS: Eleven adult Parasomniac subjects, 6 females and 5 males, with sleepwalking (SW) and/or sleep terrors (ST) and 11 age- and sex-matched control subjects underwent polysomnography (PSG) during 2 consecutive nights. After an habituation and selection night followed by a 16 h period of controlled wakefulness, the sleep EEGs of the Parasomniac and control subjects were analyzed on the second night by computer-aided visual scoring (integrated digital filtering analysis, IDFA) and spectral analysis (fast Fourier transform, FFT). Throughout the night subject behaviour was controlled and recorded by means of a video infra-red camera and videotape recorder. RESULTS: Fifteen episodes of Parasomnia were recorded during the second night in the 11 subjects. Sleep analysis showed significantly (P<0.05) decreased sleep efficiency and stage 2 sleep (absolute values and percentage of total sleep time) and increased (P<0.05) slow wave sleep (absolute values and percentage of total sleep time). Arousal index and wake-time after sleep onset were significantly higher in Parasomniac subjects. Sleep fragmentation was mainly concentrated in stages 3 and 4. The slow wave activity (SWA) absolute values averaged during the 2 min immediately preceding an episode of Parasomnia were significantly higher than the SWA averaged during 2 min in the same stage 10 min before an episode of Parasomnia. Moreover, SWA was higher in the slow wave sleep (SWS) episodes preceding the episode of Parasomnia than in the episodes preceding an awakening without an episode of Parasomnia. The temporal course of SWA showed a slower exponential decay in both groups, but the time constant of the curve was larger in Parasomniacs than in controls. Finally, in control subjects the sleep spindle index increased from the beginning to the end of the night while it was equally distributed in Parasomniacs. CONCLUSIONS: An abnormal deep sleep associated with a high SWS fragmentation might be responsible for the occurrence of SW or ST episodes.
