Adult-Onset Sleepwalking Secondary to Hyperthyroidism: Polygraphic Evidence

Abstract

Sleepwalking is a disorder characterized by complex motor behaviors arising from slow wave sleep usually occurring in children. The adult onset of sleepwalking suggests the presence of an external precipitating factor leading to the occurrence of the disorder. Hyperthyroidism has been reported to be the possible cause of sleepwalking in a few cases. We present the case of a 36-year-old man who reported a sudden appearance of nocturnal episodes of sleepwalking. He underwent a complete video polysomnography (VPSG), which showed a polygraphic pattern arising from stage N3 sleep related to the presence of simple motor behaviors. Routine blood tests showed a mild hyperthyroidism. After 4 months of thyrostatic treatment, the patient reported no more sleepwalking events. A VPSG performed at the last follow-up showed the absence of pathological electroclinical events arising from stage N3 sleep. Therefore, we hypothesize that there is a link between sleepwalking and thyroid dysfunction in our patient.

Dream enactment behavior: review for the clinician

“…Graves' disease, an HLA-DQA1-related autoimmune hyperthyroidism, was associated with sleepwalking in 2 studies, where all symptoms were resolved after thyrostatic treatments. 160,161 Guillain-Barre syndrome is an autoimmune disorder targeting primarily the myelin sheath. Varied sleep disturbances have been reported, with reduced sleep time and increased sleep fragmentation commonly seen in 2 hospitalbased studies, 162,163 with some patients displaying RBD-like movements as well as status dissociatis.…”

Disorders of Arousal: A Chronobiological Perspective

“…Systemic conditions such as febrile illness [ 64 , 65 ], chronic pain, migraine [ 66 ] and endocrinological conditions such as hyperthyroidism have been related to the clinical occurrence of DoA episodes [ 67 ]. In migraine, a chronic depletion of serotonin leaves place to increased levels of the neurotransmitter during the attacks and a similar mechanism has been theorized in sleepwalking [ 68 , 69 ].…”

Neurologic Manifestations of Systemic Disease: Sleep Disorders

“…On the other side of the thyroid spectrum, hyperthyroidism is most closely associated with insomnia, occurring in 37% of patients [14]. Arousal disorders-specifically, sleep walking-also occur, especially in the setting of thyrotoxicosis [15], proposed to arise from frequent arousals and impairment of attaining slow-wave sleep as the direct result of thyroid hormone.…”

“…Beyond the treatment of the specific sleep disorder, sleep problems usually remit following appropriate treatment of the underlying thyroid disorder [15].…”