Video polysomnographic findings in non‐rapid eye movement parasomnia

Drakatos, Panagis; Marples, Lucy; Muza, Rexford; Higgins, Seán; Nesbitt, Alexander; Dongol, Eptehal; Macavei, Raluca; Gnoni, Valentina; Carbonell, Laura Perez; Duncan, Iain; Birdseye, Adam; Dastagir, Sakina; Rosenzweig, Ivana; O’Regan, David; Williams, Adrian J.; Leschziner, Guy; Kent, Brian D.

doi:10.1111/jsr.12772

Cited by 23 publications

(19 citation statements)

References 29 publications

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“…Other possible limitations are confounders that mimic DEB (ie, DEB induced by arousal, lack of sleep, apnea, circadian disruption, and use of medication) that may have been counted as dream enactment in questionnaire-based studies. 301 This can be especially problematic primarily in case reports, as not all articles clearly specify the exclusion criteria when reporting DEB. Therefore, we suggest that all future DEB studies state whether they have excluded potential differential diagnoses.…”

Section: Limitations Of This Reviewmentioning

confidence: 99%

Dream enactment behavior: review for the clinician

Baltzan

Yao

Rizzo

et al. 2020

Journal of Clinical Sleep Medicine

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Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motorsuppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.

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Section: Limitations Of This Reviewmentioning

confidence: 99%

Dream enactment behavior: review for the clinician

Baltzan

Yao

Rizzo

et al. 2020

Journal of Clinical Sleep Medicine

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“…Unfortunately, only 60-70% of vPSGs in patients with NREM parasomnias demonstrate diagnostic features, with half of those studies identifying abrupt arousals from slow wave sleep and sympathetic activation. Complex behaviours typical of NREM parasomnias are only demonstrated in 30-35% of vPSGs [39,40]. However, vPSG can additionally provide valuable information about sleep quality and comorbid sleep disorders, such as OSA or PLMS; our centre found additional fragmentary sleep pathologies in 28.9% of a cohort of 512 patients with NREM parasomnias or POD [40].…”

Section: Assessmentmentioning

confidence: 76%

What respiratory physicians should know about parasomnias

Meurling

Drakatos

Leschziner

2022

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Parasomnias have significant quality-of-life, prognostic and potentially forensic implications for patients and their bed-partners. Identifying key clinical features will accelerate diagnosis and appropriate management for these patients. Parasomnias are undesirable physical events or experiences that arise out of, or during, sleep. They can include movements, behaviours, emotions, perceptions, dreams or autonomic nervous system activity. While more common during childhood, they can persist into, or present de novo, during adulthood. Parasomnias can arise out of non-rapid eye movement (NREM) sleep, as in confusional arousals, sleepwalking, sleep terrors or sleep-related eating disorder, or out of REM sleep, as in REM behaviour disorder, recurrent isolated sleep paralysis or nightmare disorder. Sleep-related hypermotor epilepsy is an important differential diagnosis to consider in patients presenting with a parasomnia. A thorough clinical history, including a collateral history if available, is crucial to identify characteristic clinical features. Video polysomnography is useful to identify macro- and micro-sleep architectural features, characteristic behavioural events, and any concomitant sleep pathologies. Treatment of parasomnias involves a combined approach of pharmacological and non-pharmacological intervention, including safety measures, sleep hygiene and medicines such as clonazepam or melatonin to improve sleep consolidation and reduce behavioural activity. As parasomnias can not only be disruptive for the patient and their bed-partner but have important prognostic or forensic consequences, an understanding of their pathophysiology, clinical features and management is valuable for any respiratory physician who may encounter them.Educational aimsTo understand the common features of NREM and REM parasomnias.To differentiate between the causes of motor behaviours during sleep.To discuss the treatment approach for NREM and REM parasomnias.

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“…PSG with video monitoring is often helpful in the evaluation of parasomnias even if abnormal behaviors do not arise during the sleep study [89]. Under routine conditions, PSG does not typically demonstrate CoA/SW or DEB.…”

Section: Polysomnographymentioning

confidence: 99%

“…Under routine conditions, PSG does not typically demonstrate CoA/SW or DEB. This is due to the intermittent nature of parasomnias as well as the laboratory effect (foreign environment) decreasing N3 sleep compared to the home sleeping environment [89,90]. However, even without abnormal behaviors, PSG facilitates diagnosis as CoA/SW patients often demonstrate NREM sleep instability.…”

Section: Polysomnographymentioning

confidence: 99%

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

2021

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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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Video polysomnographic findings in non‐rapid eye movement parasomnia

Cited by 23 publications

References 29 publications

Dream enactment behavior: review for the clinician

Dream enactment behavior: review for the clinician

What respiratory physicians should know about parasomnias

NonREM Disorders of Arousal and Related Parasomnias: an Updated Review

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