NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors
Abstract
:1. Introduction
2. Results
3. Discussion
4. Material and Methods
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AHI | apnoea–hypopnoea index |
BMI | body mass index |
CBT | cognitive behavioural therapy |
CNS | central nervous system |
DSM-5 | Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition |
ESS | Epworth Sleepiness Scale |
HLA | human leukocyte antigen |
ICSD-3 | International Classification of Sleep Disorders (third edition) |
NREM | non-rapid-eye-movement |
OSA | obstructive sleep apnoea |
REM | rapid eye movement |
RLS | restless legs syndrome |
sd | standard deviation |
SBS | sexualised behaviour in sleep |
SES | socioeconomic status |
SIMD | Scottish Index of Multiple Deprivation |
SRED | sleep-related eating disorder |
SSRI | selective serotonin reuptake inhibitors |
SWS | slow-wave sleep |
vPSG | video polysomnography |
References
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Childhood Onset (N = 156/307, 50.8%) | Adolescence Onset (N = 25/307, 8.1%) | Adult Onset (N = 126/307, 41.1%) | p-Value | ||
---|---|---|---|---|---|
Age at presentation (years) (N) | 31.1 ± 9.9 (N = 151) | 29.5 ± 9.0 (N = 25) | 39.5 ± 15.0 (N = 120) | <0.001 | |
Gender (N/T, %) | Male | 65/156 (41.7%) | 6/25 (24.0%) | 62/126 (49.2%) | 0.06 |
Female | 91/156 (58.3%) | 19/25 (76.0%) | 64/126 (50.8%) | ||
SIMD deprivation score (n/5) (N) | 3.1 ± 1.4 (N = 155) | 3.1 ± 1.3 (N = 24) | 2.8 ± 1.3 (N = 121) | 0.21 | |
BMI (kg/m2) (N) | 27.1 ± 6.2 (N = 137) | 27.1 ± 4.9 (N = 24) | 28.4 ± 6.6 (N = 102) | 0.26 | |
ESS (n/24) (N) | 8.5 ± 5.3 (N = 135) | 8.0 ± 3.7 (N = 23) | 9.1 ± 5.9 (N = 108) | 0.59 | |
Subjective hours of sleep per night (h) (N) | 6.3 ± 2.0 (N = 54) | 5.9 ± 1.7 (N = 14) | 5.8 ± 1.7 (N = 43) | 0.46 | |
Current smoker (N/T, %) | 32/156 (20.5%) | 3/25 (12.0%) | 37/126 (29.4%) | 0.08 | |
Daily caffeine consumption (N/T, %) | 71/156 (45.5%) | 7/25 (28.0%) | 43/126 (34.1%) | 0.07 | |
Alcohol consumption (N/T, %) | None | 62/156 (39.7%) | 12/25 (48.0%) | 69/126 (54.8%) | 0.17 |
Occasionally | 78/156 (50.0%) | 11/25 (44.0%) | 48/126 (38.1%) | ||
Regularly | 16/156 (10.3%) | 2/25 (8.0%) | 9/126 (7.0%) | ||
Marital status (N/T, %) | Single | 78/146 (53.4%) | 15/25 (60.0%) | 40/104 (38.5%) | 0.34 |
Married | 56/146 (38.4%) | 9/25 (36.0%) | 52/104 (50.0%) | ||
Widower | 1/146 (0.7%) | 0/25 (0.0%) | 2/104 (1.9%) | ||
Divorced | 8/146 (5.5%) | 1/25 (4.0%) | 9/104 (8.7%) | ||
Separated | 3/146 (2.1%) | 0/25 (0.0%) | 1/104 (1.0%) | ||
Shift work (N/T, %) | 20/156 (12.8%) | 6/25 (24.0%) | 23/126 (18.3%) | 0.22 | |
Unrefreshed by sleep (N/T, %) | 80/156 (51.3%) | 11/25 (44.0%) | 55/126 (43.7%) | 0.41 |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | ||
---|---|---|---|---|---|
Family history (N/T, %) | 56/156 (35.9%) | 12/25 (48.0%) | 27/126 (21.4%) | 0.005 | |
Occurrence in early sleep (N/T, %) | 73/156 (46.8%) | 6/25 (24.0%) | 31/126 (24.6%) | 0.001 | |
Number of behaviours (N/T, %) | Single | 26/149 (17.4%) | 1/25 (4.0%) | 38/118 (32.2%) | 0.001 |
Multiple | 123/149 (82.6%) | 24/25 (96.0%) | 80/118 (67.8%) | ||
Duration of disorder (N/T, %) | <1 year | 0/147 (0.0%) | 2/24 (8.3%) | 29/115 (25.2%) | <0.001 |
1–5 years | 2/147 (1.4%) | 3/24 (12.5%) | 38/115 (33.0%) | ||
5–10 years | 12/147 (8.2%) | 6/24 (25.0%) | 28/115 (24.4%) | ||
>10 years | 133/147 (90.5%) | 13/24 (54.2%) | 20/115 (17.4%) | ||
Frequency of behaviours (N/T, %) | <1/month | 12/138 (8.7%) | 2/23 (8.7%) | 16/97 (16.5%) | 0.41 |
1/month–1/week | 36/138 (26.1%) | 6/23 (26.1%) | 27/97 (27.8%) | ||
>1/week | 90/138 (65.2%) | 15/23 (65.2%) | 54/97 (55.7%) | ||
More distress to (N/T, %) | Myself | 65/134 (48.5%) | 13/19 (68.4%) | 55/105 (52.4%) | 0.49 |
My partner | 14/134 (10.5%) | 2/19 (10.5%) | 13/105 (12.4%) | ||
Both | 55/134 (41.0%) | 4/19 (21.1%) | 37/105 (35.2%) | ||
Amnesia for behaviour (N/T, %) | Aware | 3/125 (2.4%) | 0/21 (0.0%) | 7/101 (6.9%) | <0.001 |
Partial amnesia | 33/125 (26.4%) | 14/21 (66.7%) | 19/101 (18.8%) | ||
Full amnesia | 89/125 (71.2%) | 7/21 (33.3%) | 75/101 (74.3%) | ||
Epilepsy-related (N/T, %) | 1/156 (0.6%) | 0/25 (0.0%) | 1/126 (0.8%) | 1.00 |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | ||
---|---|---|---|---|---|
Sleepwalking (N/T, %) | Simple | 66/156 (42.3%) | 13/25 (52.0%) | 34/126 (27.0%) | <0.001 |
Complex * | 64/156 (41.0%) | 9/25 (36.0%) | 45/126 (35.7%) | ||
Night terrors (N/T, %) | 90/156 (57.7%) | 18/25 (72.0%) | 42/126 (33.3%) | <0.001 | |
SRED (N/T, %) | 12/156 (7.7%) | 1/25 (4.0%) | 15/126 (11.9%) | 0.40 | |
SBS (N/T, %) | 17/156 (10.9%) | 2/25 (8.0%) | 31/126 (24.6%) | 0.005 | |
Sleep-talking (N/T, %) | 88/156 (56.4%) | 12/25 (48.0%) | 49/126 (38.9%) | 0.014 | |
Dream mentation (N/T, %) | 62/156 (39.7%) | 12/25 (48.0%) | 25/126/ (19.8%) | <0.001 | |
Violence in sleep (N/T, %) | To self | 14/156 (9.0%) | 5/25 (20.0%) | 11/126 (8.7%) | 0.22 |
To others | 30/156 (19.2%) | 6/25 (24.0%) | 16/126 (12.7%) | ||
To both | 9/156 (5.8%) | 2/25 (8.0%) | 8/126 (6.4%) | ||
Other sleep disorders (N/T, %) | Insomnia | 6/156 (3.9%) | 0/25 (0.0%) | 4/126 (3.2%) | 0.046 |
Bruxism | 4/156 (2.6%) | 2/25 (8.0%) | 7/126 (5.6%) | ||
OSA | 14/156 (9.0%) | 1/25 (4.0%) | 21/126 (16.7%) | ||
RLS | 3/156 (1.9%) | 0/25 (0.0%) | 2/126 (1.6%) | ||
Sleep paralysis | 15/156 (9.6%) | 4/25 (16.0%) | 11/126 (8.7%) |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | |
---|---|---|---|---|
Sleep onset latency (min) (N) | 26.0 ± 19.9 (N = 112) | 20.7 ± 19.2 (N = 18) | 30.1 ± 46.1 (N = 84) | 0.46 |
Wake time after sleep onset (min) (N) | 77.8 ± 52.9 (N = 111) | 80.3 ± 70.3 (N = 18) | 88.9 ± 72.6 (N = 84) | 0.47 |
Total sleep (min) (N) | 355.3 ± 66.2 (N = 112) | 360.7 ± 87.5 (N = 18) | 335.6 ± 102.1 (N = 84) | 0.22 |
Sleep efficiency (%) (N) | 77.1 ± 12.9 (N = 112) | 78.0 ± 18.6 (N = 18) | 74.5 ± 20.9 (N = 84) | 0.53 |
Total number of awakenings (n) (N) | 31.0 ± 14.6 (N = 112) | 32.8 ± 11.9 (N = 18) | 36.9 ± 38.5 (N = 84) | 0.31 |
Periodic leg movements per hour (n) (N) | 3.5 ± 9.9 (N = 112) | 2.5 ± 5.2 (N = 18) | 6.7 ± 17.9 (N = 83) | 0.20 |
Stage REM latency (min) (N) | 136.2 ± 85.8 (N = 109) | 103.7 ± 40.6 (N = 17) | 108.5 ± 73.1 (N = 78) | 0.04 |
AHI (n) (N) | 10.2 ± 11.7 (N = 112) | 12.1 ± 15.8 (N = 18) | 19.3 ± 26.9 (N = 85) | 0.005 |
Stage REM (%) (N) | 17.6 ± 7.5 (N = 111) | 18.3 ± 7.4 (N = 18) | 16.1 ± 12.2 (N = 83) | 0.48 |
Stage N1 (%) (N) | 3.6 ± 4.3 (N = 111) | 3.0 ± 6.1 (N = 18) | 6.3 ± 13.2 (N = 83) | 0.09 |
Stage N2 (%) (N) | 57.6 ± 13.1 (N = 111) | 61.7 ± 9.3 (N = 18) | 56.0 ± 17.8 (N = 83) | 0.32 |
Stage N3 (%) (N) | 13.4 ± 11.9 (N = 111) | 6.3 ± 7.8 (N = 18) | 10.2 ± 13.5 (N = 83) | 0.03 |
Presence of behaviour-related arousal from N3 stage | 30 (N = 72) | 1 (N = 3) | 22 (N = 40) | 0.36 |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | |
---|---|---|---|---|
Asthma (N/T, %) | 21/156 (13.5%) | 5/25 (20.0%) | 17/126 (13.5) | 0.61 |
Atopy (N/T, %) | 26/156 (16.7%) | 0/25 (0.0%) | 6/126 (4.8%) | 0.001 |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | ||
---|---|---|---|---|---|
Psychiatric comorbidity (N/T, %) | |||||
Any psychiatric comorbidity | 58/156 (37.2%) | 12/25 (48.0%) | 69/126 (54.8%) | 0.012 | |
Depression | 57/156 (36.5%) | 15/25 (60.0%) | 55/126 (43.7%) | 0.07 | |
Anxiety | 57/156 (36.5%) | 14/25 (56.0%) | 55/126 (43.7%) | 0.14 | |
Self-harm | 3/156 (1.9%) | 1/25 (4.0%) | 4/126 (3.2%) | 0.63 | |
Suicide attempt/ideation | 11/156 (7.1%) | 0/25 (0.0%) | 11/126 (8.7%) | 0.37 | |
Chronic pain | 8/156 (5.1%) | 2/25 (8.0%) | 9/126 (7.1%) | 0.71 | |
Chronic fatigue | 1/156 (0.6%) | 0/25 (0.0%) | 2/126 (1.6%) | 0.68 | |
Traumatic experience (N/T, %) * | |||||
Abortion | 6/156 (3.9%) | 0/25 (0.0%) | 4/126 (3.2%) | 1.00 | |
Miscarriage | 2/156 (1.3%) | 0/25 (0.0%) | 3/126 (2.4%) | 0.78 | |
Victim of assault | 15/156 (9.6%) | 2/25 (8.0%) | 9/126 (7.1%) | 0.78 | |
Army or police officer | 7/156 (4.5%) | 0/25 (0.0%) | 5/126 (4.0%) | 0.82 | |
PTSD | 9/156 (5.8%) | 3/25 (12.0%) | 7/126 (5.6%) | 0.48 | |
Trauma * | 43/156 (27.6%) | 9/25 (36.0%) | 39/126 (31.0%) | 0.63 | |
Trauma age | Childhood | 37/47 (78.7%) | 11/11 (100.0%) | 17/42 (40.5%) | <0.001 |
Adult | 10/47 (21.3%) | 0/11 (0.0%) | 25/42 (59.5%) | ||
Trauma severity | Mild | 12/49 (24.5%) | 2/11 (18.2%) | 7/42 (16.7%) | 0.69 |
Severe | 37/49 (75.5%) | 9/11 (81.8%) | 35/42 (83.3%) |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | |
---|---|---|---|---|
CBT (N/T, %) | 13/156 (8.3%) | 1/25 (4.0%) | 8/126 (6.4%) | 0.74 |
Counselling (N/T, %) | 19/156 (12.2%) | 7/25 (28.0%) | 10/126 (7.9%) | 0.02 |
Neuropsychological review (N/T, %) | 8/156 (5.1%) | 0/25 (0.0%) | 6/126 (4.8%) | 0.77 |
Psychiatrist (N/T, %) | 21/156 (13.5%) | 3/25 (12.0%) | 12/126 (9.5%) | 0.61 |
Hypnosis (N/T, %) | 3/156 (1.9%) | 1/25 (4.0%) | 1/126 (0.8%) | 0.36 |
Medication (N/T, %) | 122/156 (78.2%) | 21/25 (84.0%) | 92/126 (73.0%) | 0.39 |
Childhood Onset | Adolescence Onset | Adult Onset | p-Value | |
---|---|---|---|---|
Amitriptyline (N/T, %) (10–100 mg) | 26/156 (16.7%) | 2/25 (8.0%) | 8/126 (6.4%) | 0.02 |
Effective (N/T, %) | 7/26 (26.9%) | 1/2 (50.0%) | 1/8 (12.5%) | 0.57 |
Lack of effect (N/T, %) | 10/26 (38.5%) | 0/2 (0.0%) | 3/8 (37.5%) | |
Sertraline * (N/T, %) (25–150 mg) | 22/156 (14.1%) | 5/25 (20.0%) | 10/126 (7.9%) | 0.11 |
Effective (N/T, %) | 13/22 (59.1%) | 0/5 (0.0%) | 7/10 (70.0%) | 0.05 |
Lack of effect (N/T, %) | 0/22 (0.0%) | 1/5 (20.0%) | 0/10 (0.0%) | |
Melatonin (N/T, %) (1–4 mg) | 21/156 (13.5%) | 5/25 (20.0%) | 12/126 (9.5%) | 0.25 |
Effective (N/T, %) | 11/21 (52.4%) | 3/5 (60.0%) | 3/12 (25.0%) | 0.12 |
Lack of effect (N/T, %) | 5/21 (23.8%) | 0/5 (0.0%) | 6/12 (50.0%) | |
Clonazepam (N/T, %) (0.25–2 mg) | 86/156 (55.1%) | 11/25 (44.0%) | 52/126 (41.3%) | 0.06 |
Effective (N/T, %) | 42/86 (48.8%) | 6/11 (54.5%) | 25/52 (48.1%) | 0.17 |
Lack of effect (N/T, %) | 7/86 (8.1%) | 3/11 (27.3%) | 10/52 (19.2%) | |
Zopiclone (N/T, %) (3.75–7.5 mg) | 17/156 (10.9%) | 6/25 (24.0%) | 15/126 (11.9%) | 0.20 |
Effective (N/T, %) | 13/17 (76.5%) | 1/6 (16.7%) | 4/15 (26.7%) | 0.43 |
Lack of effect (N/T, %) | 2/17 (11.8%) | 0/6 (0.0%) | 3/15 (20.0%) |
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Walsh, C.; Mitchell, L.; Hrozanova, M.; Kotoulas, S.-C.; Derry, C.; Morrison, I.; Riha, R.L. NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors. Clocks & Sleep 2022, 4, 549-560. https://doi.org/10.3390/clockssleep4040043
Walsh C, Mitchell L, Hrozanova M, Kotoulas S-C, Derry C, Morrison I, Riha RL. NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors. Clocks & Sleep. 2022; 4(4):549-560. https://doi.org/10.3390/clockssleep4040043
Chicago/Turabian StyleWalsh, Cara, Lee Mitchell, Maria Hrozanova, Serafeim-Chrysovalantis Kotoulas, Christopher Derry, Ian Morrison, and Renata L. Riha. 2022. "NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors" Clocks & Sleep 4, no. 4: 549-560. https://doi.org/10.3390/clockssleep4040043