Disorders of Arousal: A Chronobiological Perspective

Mainieri, Greta; Loddo, Giuseppe; Provini, Federica

doi:10.3390/clockssleep3010004

Cited by 10 publications

(5 citation statements)

References 89 publications

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“…The results of our work confirm the view of NREM parasomnias as a complex state, with intermingled features of both wakefulness and SWS. Sleep as a local phenomenon has been demonstrated also in normal subjects, reinforcing the consideration that DoA patients embody the ultimate deregulation of a dysfunctional arousal process, where the tip of the iceberg is the clinical motor episode, 59 with evidence of the coexistence of wake-like and sleep-like activity even in the same areas. 17 The presence of broadband alterations with a specific local topographic distribution in the pre-episode disclosed in our study might provide diagnostic utility as well as a deeper understanding of DoA networks and pathophysiology.…”

Section: Discussionmentioning

confidence: 53%

“…DoA patients, conversely, appear mentally sleeping but physically awake, a response which embodies at the same time the double nature of the arousal. 59 Among studies focused on the pre-arousal activity in DoA ( Table 1 ), only few included controls and showed a higher spectral power in delta band before DoA episodes, 19–21 suggesting a greater difficulty in fully awakening in DoA. However, homogeneous studies directly comparing DoA and healthy subjects are lacking and potential differences in the pre-arousal period should be searched in the presence of topographic distribution, different power of EEG bands, along with differences in connectivity pathways.…”

Section: Discussionmentioning

confidence: 99%

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EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study

Mainieri¹,

Loddo²,

Castelnovo³

et al. 2022

NSS

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Purpose Disorders of arousal (DoA) are characterized by incomplete awakening from NREM sleep, with the admixture of both deep sleep and wake EEG activity. Previous observations suggested that changes in EEG activity could be detected in the seconds preceding DoA episodes. The aims of this work were to characterize the topography of EEG spectral changes prior to DoA episodes and to investigate whether or not behavioral complexity could be predicted by changes in EEG immediately preceding behavioral onsets. Patients and Methods We collected 103 consecutive video-polysomnographic recordings of 53 DoA adult patients and classified all episodes as simple, rising and complex arousal movements. For each episode, a 5-second window preceding its motor onset (“pre-event”) and a 60-second window from 2 to 3 minutes before the episodes (“baseline”) were compared. Subsequently, a between-group comparison was performed for the pre-event of simpler versus the more complex episodes. Results Spectral analysis over 325 DoA episodes showed an absolute significant increase prior to DoA episodes in all frequency bands excluding sigma, which displayed the opposite effect. In normalized maps, the increase was relatively higher over the central/anterior areas for both slow and fast frequency bands. No significant differences emerged from the comparison between simpler and more complex episodes. Conclusion Taken together, these results show that deep sleep and wake-like EEG rhythms coexist over overlapping areas before DoA episodes, suggesting an alteration of local sleep mechanisms. Episodes of different complexity are preceded by a similar EEG activation, implying that they possibly share a similar pathophysiology.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study

Mainieri¹,

Loddo²,

Castelnovo³

et al. 2022

NSS

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“…During SW, patients leap out of bed and wander about the room or the house, or more rarely, may even walk outside. SW patients may perform routine activities like dressing, washing, preparing for school, urinating (sometimes at inappropriate locations), but can also engage in more dangerous actions like moving the furniture, manipulating sharp objects, or jumping out a window [ 1 , 11 , 12 , 13 , 14 , 15 ]. Prolonged cases associated with sleep driving have been described [ 16 ].…”

Section: Diagnosis Of Doamentioning

confidence: 99%

Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults

et al. 2023

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Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.

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“…Classically, DoA are intended to be based on a genetic predisposition, on which priming factors influencing the homeostasis of SWS as well as precipitating factors such as apnea, noise or touch produce the episodes [6]. Unresolved priming factors, perpetuating in adulthood, might lead to the persistence of the episodes [8]. Prospective studies with a long follow-up are essential to depict the natural history of NREM parasomnias and the possible factors leading to a better or worse prognosis.…”

Section: Real Picture or More Severe Phenotypes?mentioning

confidence: 99%

“…Over the years, both epidemiologic and clinical reports from tertiary adult sleep centers have shown that DoA might persist in adulthood, appear de novo in some cases or even last through elderly life [7]. These aspects have led to the suggestion of a fourth P, i.e., "perpetuating" factors, responsible for the persistence of DoA throughout the life span [8]. Long follow-up studies are lacking for DoA, so several aspects have not been unraveled yet.…”

Section: Introductionmentioning

confidence: 99%

Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype?

Mainieri

Loddo

Baldelli

et al. 2023

JCM

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Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.

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Disorders of Arousal: A Chronobiological Perspective

Cited by 10 publications

References 89 publications

EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study

EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study

Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults

Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype?

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