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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. SchenckAbstract: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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rem sleep behavior disorder and other rem Parasomnias in women
2020Co-Authors: Cynthia Bodkin, Carlos H. SchenckAbstract:Parasomnias are unwanted physical events, experiences, and autonomic nervous system activity that occur during sleep or during sleep-wake transitions. Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is a parasomnia where the normal REM atonia is diminished or absent, with release of dream enactment behavior. RBD is more common in men, however it is not rare in women and needs to be considered in cases of sleep related injury. It is important to recognize the unique features of RBD and the relationships to neurodegenerative disorders. Finally, REM Parasomnias are treatable with the proper identification and treatment of underlying co-morbid sleep disorders, the discontinuation of inducing agents, as well as the judicious use of pharmacotherapy and environmental modification.
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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. SchenckAbstract: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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parasomnia overlap disorder with sexual behaviors during sleep in a patient with obstructive sleep apnea
Journal of Clinical Sleep Medicine, 2016Co-Authors: Rodolfo Soca, Joseph C Keenan, Carlos H. SchenckAbstract:Sleep-related abnormal sexual behaviors (sexsomnia) are classified as a subtype of NREM sleep Parasomnias. Sexsomnia has been reported as part of parasomnia overlap disorder (POD) in two other pati...
Bjørn Bjorvatn - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Parasomnias in patients with obstructive sleep apnea a registry based cross sectional study
Frontiers in Psychology, 2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity. Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last three months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption). Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of Parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other Parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR=2.0, 95% CI= 1.12-3.55). The other Parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age. Conclusions: We found no increase in Parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the Parasomnias were not associated with OSA severity.
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Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study
Frontiers Media S.A., 2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity.Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption).Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of Parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other Parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR = 2.0, 95% CI = 1.12–3.55). The other Parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age.Conclusions: We found no increase in Parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the Parasomnias were not associated with OSA severity
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Table_1_Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study.DOCX
2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity.Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption).Results: In all, 34.7% had apnea-hypopnea index (AHI)
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Parasomnias are more frequent in shift workers than in day workers
Chronobiology International, 2015Co-Authors: Bjørn Bjorvatn, Ståle Pallesen, Nils Mageroy, Bente E Moen, Siri WaageAbstract:The aim of this study was to investigate whether different shift work schedules were associated with nonrapid eye movement (NREM)- and/or REM-related Parasomnias. A total of 2198 nurses with different work schedules participated in a longitudinal cohort study. The parasomnia questions were included in the fourth wave of the data collection, with a response rate of 74.1%. Logistic regression analyses with the different Parasomnias as dependent variables were conducted. Nurses working two shift (day and evening) and nurses working three shift (day, evening and night) rotational schedules had increased risk of confusional arousal, a NREM-related parasomnia, compared to nurses working daytime only (odds ratios = 2.10 and 1.71, respectively). Similarly, nurses working two and three shift rotational schedules had increased risk of nightmares, a REM-related parasomnia (odds ratios = 1.64 and 1.57, respectively). The other Parasomnias were not significantly associated with work schedule. Working night shifts only was not associated with any of the Parasomnias. In conclusion, confusional arousal and nightmares were more commonly reported by nurses working rotational shift work schedules compared to nurses working daytime only. This is likely related to the circadian rhythm misalignment and sleep deprivation caused by such shift schedules.
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Prevalence of different Parasomnias in the general population
Sleep medicine, 2010Co-Authors: Bjørn Bjorvatn, Janne Grønli, Ståle PallesenAbstract:Abstract Objective To estimate lifetime and current prevalence (defined as having experienced the specific parasomnia at least once during the last 3 months) of different Parasomnias in the general population. In addition, to study the relationship between the different Parasomnias and gender, depressive mood, and symptoms of sleep apnea, insomnia and restless legs, as well as estimating the prevalence of having multiple Parasomnias. Methods Population based cross-sectional study. One thousand randomly selected adults (51% female), 18 years and above, participated in a telephone interview in Norway. Results Lifetime prevalence of the different Parasomnias varied from about 4% to 67%. For sleep walking lifetime prevalence was 22.4% and current prevalence 1.7%. For the other Parasomnias, lifetime and current prevalence were as follows: sleep talking 66.8% and 17.7%, confusional arousal 18.5% and 6.9%, sleep terror 10.4% and 2.7%, injured yourself during sleep 4.3% and 0.9%, injured somebody else during sleep 3.8% and 0.4%, sexual acts during sleep 7.1% and 2.7%, nightmare 66.2% and 19.4%, dream enactment 15.0% and 5.0%, sleep related groaning 31.3% and 13.5%, and sleep-related eating 4.5% and 2.2%. Depressive mood was associated with confusional arousal, sleep terror, sleep-related injury, and nightmare. There were few associations between the Parasomnias and gender and symptoms of sleep apnea, insomnia, and restless legs, respectively. About 12% reported having five or more Parasomnias. Conclusions This is one of few population based studies investigating the prevalence of Parasomnias. Several Parasomnias were highly prevalent in the general population. The data need to be interpreted with caution due to methodological issues, i.e., low response rate and single questions.
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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rapid eye movement sleep Parasomnias
Neurologic Clinics, 2005Co-Authors: Carlos H. Schenck, Mark W. MahowaldAbstract:Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that Parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of the sleep states) and secondary (disorders of other organ systems that manifest themselves during sleep). Primary sleep Parasomnias can be classified according to the sleep state of origin: rapid eye movement sleep, non-rapid eye movement sleep, and miscellaneous (those not respecting sleep state). Secondary sleep Parasomnias are classified by the organ system involved.
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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.
Ståle Pallesen - One of the best experts on this subject based on the ideXlab platform.
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prevalence of Parasomnias in patients with obstructive sleep apnea a registry based cross sectional study
Frontiers in Psychology, 2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity. Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last three months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption). Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of Parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other Parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR=2.0, 95% CI= 1.12-3.55). The other Parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age. Conclusions: We found no increase in Parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the Parasomnias were not associated with OSA severity.
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Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study
Frontiers Media S.A., 2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity.Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption).Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of Parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other Parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR = 2.0, 95% CI = 1.12–3.55). The other Parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age.Conclusions: We found no increase in Parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the Parasomnias were not associated with OSA severity
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Table_1_Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study.DOCX
2018Co-Authors: Ragnhild S. Lundetræ, Ingvild W. Saxvig, Ståle Pallesen, Harald Aurlien, Sverre Lehmann, Bjørn BjorvatnAbstract:Objective: To assess the prevalence of Parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity.Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different Parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the Parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption).Results: In all, 34.7% had apnea-hypopnea index (AHI)
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Parasomnias are more frequent in shift workers than in day workers
Chronobiology International, 2015Co-Authors: Bjørn Bjorvatn, Ståle Pallesen, Nils Mageroy, Bente E Moen, Siri WaageAbstract:The aim of this study was to investigate whether different shift work schedules were associated with nonrapid eye movement (NREM)- and/or REM-related Parasomnias. A total of 2198 nurses with different work schedules participated in a longitudinal cohort study. The parasomnia questions were included in the fourth wave of the data collection, with a response rate of 74.1%. Logistic regression analyses with the different Parasomnias as dependent variables were conducted. Nurses working two shift (day and evening) and nurses working three shift (day, evening and night) rotational schedules had increased risk of confusional arousal, a NREM-related parasomnia, compared to nurses working daytime only (odds ratios = 2.10 and 1.71, respectively). Similarly, nurses working two and three shift rotational schedules had increased risk of nightmares, a REM-related parasomnia (odds ratios = 1.64 and 1.57, respectively). The other Parasomnias were not significantly associated with work schedule. Working night shifts only was not associated with any of the Parasomnias. In conclusion, confusional arousal and nightmares were more commonly reported by nurses working rotational shift work schedules compared to nurses working daytime only. This is likely related to the circadian rhythm misalignment and sleep deprivation caused by such shift schedules.
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Prevalence of different Parasomnias in the general population
Sleep medicine, 2010Co-Authors: Bjørn Bjorvatn, Janne Grønli, Ståle PallesenAbstract:Abstract Objective To estimate lifetime and current prevalence (defined as having experienced the specific parasomnia at least once during the last 3 months) of different Parasomnias in the general population. In addition, to study the relationship between the different Parasomnias and gender, depressive mood, and symptoms of sleep apnea, insomnia and restless legs, as well as estimating the prevalence of having multiple Parasomnias. Methods Population based cross-sectional study. One thousand randomly selected adults (51% female), 18 years and above, participated in a telephone interview in Norway. Results Lifetime prevalence of the different Parasomnias varied from about 4% to 67%. For sleep walking lifetime prevalence was 22.4% and current prevalence 1.7%. For the other Parasomnias, lifetime and current prevalence were as follows: sleep talking 66.8% and 17.7%, confusional arousal 18.5% and 6.9%, sleep terror 10.4% and 2.7%, injured yourself during sleep 4.3% and 0.9%, injured somebody else during sleep 3.8% and 0.4%, sexual acts during sleep 7.1% and 2.7%, nightmare 66.2% and 19.4%, dream enactment 15.0% and 5.0%, sleep related groaning 31.3% and 13.5%, and sleep-related eating 4.5% and 2.2%. Depressive mood was associated with confusional arousal, sleep terror, sleep-related injury, and nightmare. There were few associations between the Parasomnias and gender and symptoms of sleep apnea, insomnia, and restless legs, respectively. About 12% reported having five or more Parasomnias. Conclusions This is one of few population based studies investigating the prevalence of Parasomnias. Several Parasomnias were highly prevalent in the general population. The data need to be interpreted with caution due to methodological issues, i.e., low response rate and single questions.
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
