NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients

Drakatos, Panagis; Marples, Lucy; Muza, Rexford; Higgins, Seán; Gildeh, Nadia; Macavei, Raluca; Dongol, Eptehal; Nesbitt, Alexander; Rosenzweig, Ivana; Lyons, Elaine; d’Ancona, G; Steier, Joerg; Williams, Adrian J.; Kent, Brian D.; Leschziner, Guy

doi:10.1016/j.sleep.2018.03.021

Cited by 56 publications

(77 citation statements)

References 41 publications

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“…that the real diagnostic yield of performing vPSG in parasomnia patients may be significantly lower than our estimate. Although there are some data to support the notion that treating comorbid sleep pathology in parasomnia patients can improve control of parasomnia events (Drakatos et al, 2018;Guilleminault et al, 2005), it may be the case that the OSA and PLMS identified in this cohort are coincident phenomena rather than precipitating factors. Only a small minority of parasomnia events within our cohort were immediately preceded by either sleep-disordered breathing or PLMS; a prospective study with more rigorous attention given to relationships between sleep-disrupting pathology and parasomnia events could yield a stronger relationship.…”

Section: Polysomnography Resultsmentioning

confidence: 79%

“…The lack of validated methods of diagnosing NREM parasomnia through vPSG questions the importance of abrupt arousals from NREM3 accompanied by more subtle behaviours, such as raising the head, sympathetic activation, such as tachycardia, or rhythmic delta activity on EEG, which are not specific to this disorder; consequently, it may be the case that the real diagnostic yield of performing vPSG in parasomnia patients may be significantly lower than our estimate. Although there are some data to support the notion that treating comorbid sleep pathology in parasomnia patients can improve control of parasomnia events (Drakatos et al, ; Guilleminault et al, ), it may be the case that the OSA and PLMS identified in this cohort are coincident phenomena rather than precipitating factors. Only a small minority of parasomnia events within our cohort were immediately preceded by either sleep‐disordered breathing or PLMS; a prospective study with more rigorous attention given to relationships between sleep‐disrupting pathology and parasomnia events could yield a stronger relationship.…”

Section: Discussionmentioning

confidence: 81%

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Video polysomnographic findings in non‐rapid eye movement parasomnia

Drakatos

Marples

Muza

et al. 2018

Journal of Sleep Research

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Although video polysomnography (vPSG) is not routinely recommended for the evaluation of typical cases of non‐rapid eye movement (NREM) parasomnias, it can aid diagnosis of unusual cases, other sleep disorders and complicated cases with REM behaviour disorder (RBD), and in differentiating parasomnias from epilepsy. In this study, we aimed to assess vPSG findings in consecutive patients with a clinical diagnosis of NREM‐parasomnia covering the whole phenotypic spectrum. Five hundred and twelve patients with a final diagnosis of NREM parasomnia who had undergone vPSG were retrospectively identified. vPSGs were analysed for features of NREM parasomnia and for the presence of other sleep disorders. Two hundred and six (40.0%) patients were clinically diagnosed with sleepwalking, 72 (14.1%) with sleep terrors, 39 (7.6%) with confusional arousals, 15 (2.9%) with sexsomnia, seven (1.4%) with sleep‐related eating disorder, 122 (23.8%) with mixed phenotype, and 51 (10.0%) with parasomnia overlap disorder (POD). The vPSG supported the diagnosis of NREM parasomnia in 64.4% of the patients and of POD in 98%. In 28.9% of the patients, obstructive sleep apnea (OSA) or/and periodic limb movements during sleep (PLMS) were identified, most commonly in older, male, sleepy and obese patients. vPSG has a high diagnostic yield in patients with NREM parasomnia and should be routinely performed when there is diagnostic doubt, or in patients where there is a suspicion of OSA and PLMS.

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Section: Polysomnography Resultsmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 81%

Video polysomnographic findings in non‐rapid eye movement parasomnia

Drakatos

Marples

Muza

et al. 2018

Journal of Sleep Research

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“…A recent fairly large retrospective study (Drakatos et al., 2019) suggested the possibility that psychological management may reduce DOA clinical manifestations in adults, contradicting previous studies based on very small samples of adult DOA patients (Guilleminault, Kirisoglu, et al, 2005). Positive future results in this direction in both adults and children will strengthen the hypothesis that psychological distress may influence the course of manifestation of DOA, while negative results will add support to the hypothesis that psychological problems are a direct or indirect consequence of DOA.…”

Section: Limitations and Future Directionsmentioning

confidence: 93%

“…A recent fairly large retrospective study (Drakatos et al, 2019) suggested the possibility that psychological management may reduce DOA clinical manifestations in adults, contradicting previous studies based on very small samples of adult DOA patients (Guilleminault, Kirisoglu, et al, 2005). Positive future results in F I G U R E 3 Graphical representation of a pathophysiological framework of interpretation of disorders of arousal (DOA).…”

Section: Limitations and Future Direc Tionsmentioning

confidence: 94%

Behavioural and emotional profiles of children and adolescents with disorders of arousal

Castelnovo

Turner

Rossi

et al. 2020

Journal of Sleep Research

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Summary Disorders of arousals are common sleep disorders characterized by complex motor behaviours that arise episodically out of slow‐wave sleep. Psychological distress has long been associated with disorders of arousal, but this link remains controversial, especially in children and adolescents. The aim of this multi‐centre study was to characterize behavioural and emotional problems in a sample of children/adolescents with disorders of arousal, and to explore their relationship with the severity of nocturnal episodes. The parents of 41 children/adolescents with a diagnosis of disorders of arousal (11.5 ± 3.3 years old, 61% males) and of a group of 41 age‐ and gender‐matched control participants filled in the Child Behavior Checklist, along with the Sleep Disturbance Scale for Children and the Paris Arousal Disorders Severity Scale. Multilevel t‐tests revealed significantly higher total scores and sub‐scores of the Child Behavior Checklist for the patient group compared with the control group. Thirty‐four percent of the patients obtained pathological total scores, and 12% of them borderline scores. The severity of emotional/behavioural problems in the patient group was positively correlated with the severity of the nocturnal episodes. Interestingly, children/adolescents with disorders of arousal also obtained higher excessive daytime sleepiness and insomnia symptoms sub‐scores at the Sleep Disturbance Scale for Children. These results confirmed the hypothesis that behavioural/emotional problems are surprisingly common in children/adolescents with disorders of arousal. Further studies are warranted to investigate the causal relationship between pathological manifestations, subtler sleep abnormalities, and diurnal emotional/behavioural problems in children/adolescents with disorders of arousal.

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“…Furthermore, it is important that the affected patient and their bedpartner or family understand the role of priming and precipitating factors, so that sleep deprivation, environmental disturbances and stress can be reduced to a minimum. In a recently studied cohort of 512 patients with NREM parasomnias, an intervention utilising advice on safeguarding and sleep hygiene successfully alleviated and resolved the symptoms in 12.9% of the sample [95]. For patients with more severe clinical symptoms, pharmacological and/or psychological therapy may be additionally needed to control the symptoms.…”

Section: Treatment Of Nrem Parasomniasmentioning

confidence: 99%

Adult NREM Parasomnias: An Update

2018

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Our understanding of non-rapid eye movement (NREM) parasomnias has improved considerably over the last two decades, with research that characterises and explores the causes of these disorders. However, our understanding is far from complete. The aim of this paper is to provide an updated review focusing on adult NREM parasomnias and highlighting new areas in NREM parasomnia research from the recent literature. We outline the prevalence, clinical characteristics, role of onset, pathophysiology, role of predisposing, priming and precipitating factors, diagnostic criteria, treatment options and medico-legal implications of adult NREM parasomnias.

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NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients

Cited by 56 publications

References 41 publications

Video polysomnographic findings in non‐rapid eye movement parasomnia

Video polysomnographic findings in non‐rapid eye movement parasomnia

Behavioural and emotional profiles of children and adolescents with disorders of arousal

Adult NREM Parasomnias: An Update

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