Adult NREM Parasomnias: An Update
Abstract
:1. Introduction
2. Prevalence of NREM Parasomnias
3. Sex Differences in NREM Parasomnias
4. Clinical Characteristics of NREM Parasomnias
5. Age of Onset of NREM parasomnias
6. Psychopathology in NREM Parasomnias
7. Pathophysiology of NREM Parasomnias
7.1. Electro-Encaphalographic (EEG) Studies
7.2. Functional Imaging Studies
7.3. Structural Imaging Studies
8. Predisposing, Priming and Precipitating Factors of NREM Parasomnias
8.1. Predisposing Factors
8.2. Priming Factors
8.2.1. Abnormalities in NREM Structure
8.2.2. Sleep Deprivation
8.2.3. Stress and Trauma
8.2.4. Medication
8.2.5. Alcohol
8.3. Precipitating Factors
8.3.1. Other Sleep Disorders
8.3.2. Environmental Factors
9. Diagnosing NREM Parasomnias
10. Treatment of NREM Parasomnias
10.1. Pharmacological Therapy
10.2. Psychological Therapy
10.3. Therapy of a Concomitant Sleep Disorder
11. Medicolegal Issues in NREM Parasomnias
12. Conclusions
Funding
Conflicts of Interest
References
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NREM Parasomnia | Prevalence of Symptoms | ||
---|---|---|---|
Childhood | Current Prevalence | Lifetime Prevalence | |
Confusional arousals | 17% [5] | 6.9% [8] | 18.5% [8] |
Sleepwalking | 14.5% [7] | 1.7% [8] | 6.9% [9]–22.4% [8] |
SRED | - | 2.2% [8] | 4.5% [8] |
16.7% [10] | |||
Night terrors | 17.3% [11]–39.8% [7] | 2.7% [8] | 10.4% [8] |
Sexsomnia | - | 2.7% [8]–6% [12] | 7.1% [8] |
Reference | Type of Article | N | Method of Data Collection |
---|---|---|---|
[7] | Longitudinal study | N = 9142 | Parent-reported behavior |
[8] | Population based cross-sectional study | N = 1000 | Telephone interview |
[9] | Systematic review and meta-analysis following PRISMA guidelines | 51 studies included, N = 100490 | Varied |
[11] | Longitudinal study | N = 1353 | Parent-reported behavior |
[10] | Cross-sectional study | N = 700 | Self-report questionnaire |
[12] | Review of online surveys | Overall N not reported | Varied |
[13] | Cross-sectional study | N = 19961 | Telephone interview |
NREM Parasomnia | Clinical Implications | Clinical Features |
---|---|---|
Confusional arousals | Minimal | Individuals may sit up in bed, look around in a confused manner. Behaviour may progress to sleepwalking if subject leaves the bed |
Sleepwalking | Minimal to moderate | Walking in the bedroom, simple searching behaviours, or jumping out of bed with a startle |
Moderate to severe | Behaviours that seem to engage executive functioning: climbing on a chair to change lightbulbs, driving, moving furniture | |
SRED | Moderate | Involuntary consumption and preparation of food and drink during the night, consumption of bizarre foods or inedible items, involves hazardous activities such as handling knives |
Night terrors | Severe | Sudden episodes of intense fear and dread, frequently accompanied by screaming and / or lashing out in a protective manner as a result of upsetting dream mentation or imagery, heightened autonomic function. Commonly overlap with sleepwalking |
Sexsomnia | Moderate to severe | Sexual arousal with autonomic activation, attempted and / or forced sexual intercourse, groping of bed partner, masturbation or vocalisations, often unusual for the patient in terms of partner, intensity or sexual act |
Diagnostic Manual | Category | Disorder | Diagnostic Criteria |
---|---|---|---|
ICSD-3 | NREM-related parasomnias > Disorders of Arousal (From NREM Sleep) | Confusional arousals | Recurrent episodes; inappropriate or absent responsiveness during episodes; minimal or no dream recall; partial or complete amnesia for events; not better explained by another sleep, mental or medical condition, medication, substance use |
Sleepwalking | |||
Night terrors | |||
NREM-related parasomnias > Clinical and pathophysiological subtype of NREM-related parasomnias | Sleep related abnormal sexual behaviours | ||
NREM-related parasomnias | Sleep-related eating disorder | Repeated episodes of abnormal eating subsequent to an arousal from the main sleep period. At least one of the following is present: consumption of inappropriate foods; potentially injurious behaviours, adverse health consequences. Partial or complete amnesia for events; not better explained by another sleep, mental or medical disorder, medication, substance use | |
Isolated symptoms and normal variants of parasomnias | Sleep talking | Sleep talking, with varying degrees of comprehensibility | |
DSM-5 | NREM | Sleepwalking | Recurrent episodes; minimal or no dream recall; amnesia for events; causes marked distress or impairment in essential areas of functioning; not better explained by another mental or medical condition, medication, substance use |
Sleepwalking with sleep-related eating | |||
Sleep Arousal Disorders | Sleepwalking with sleep-related sexual behaviour | ||
Sleep terrors | |||
ICD-10 | Behavioural syndromes associated with physiological disturbances and physical factors, mental and behavioural disorders > Nonorganic sleep disorders | Sleep walking | Episodes typically during the first third of sleep period, relative unresponsiveness to external stimuli, amnesia for events |
Night terrors |
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Hrozanova, M.; Morrison, I.; Riha, R.L. Adult NREM Parasomnias: An Update. Clocks & Sleep 2019, 1, 87-104. https://doi.org/10.3390/clockssleep1010009
Hrozanova M, Morrison I, Riha RL. Adult NREM Parasomnias: An Update. Clocks & Sleep. 2019; 1(1):87-104. https://doi.org/10.3390/clockssleep1010009
Chicago/Turabian StyleHrozanova, Maria, Ian Morrison, and Renata L Riha. 2019. "Adult NREM Parasomnias: An Update" Clocks & Sleep 1, no. 1: 87-104. https://doi.org/10.3390/clockssleep1010009
APA StyleHrozanova, M., Morrison, I., & Riha, R. L. (2019). Adult NREM Parasomnias: An Update. Clocks & Sleep, 1(1), 87-104. https://doi.org/10.3390/clockssleep1010009