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Neurotherapeutics : the Journal of the... Jan 2021Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss... (Review)
Review
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.
Topics: Humans; Parasomnias; Sleep; Sleep Arousal Disorders
PubMed: 33527254
DOI: 10.1007/s13311-021-01011-y -
Current Biology : CB Nov 2018Arnulf describes the fascinating behavior of sleepwalking and its associated parasomnias. (Review)
Review
Arnulf describes the fascinating behavior of sleepwalking and its associated parasomnias.
Topics: Female; Humans; Male; Parasomnias; Polysomnography; Somnambulism
PubMed: 30458142
DOI: 10.1016/j.cub.2018.09.062 -
Tidsskrift For Den Norske Laegeforening... Sep 2009Parasomnias are undesirable experiences or motoric phenomena that occur in association with sleep. We have described characteristics of parasomnia subtypes. (Review)
Review
BACKGROUND
Parasomnias are undesirable experiences or motoric phenomena that occur in association with sleep. We have described characteristics of parasomnia subtypes.
MATERIAL AND METHOD
This review is based on the authors' research and clinical experience, and articles identified by non-systematic searches of Pubmed.
RESULTS
Parasomnias are categorized into disorders of arousal (non-REM sleep parasomnias), e.g. sleepwalking, sleep terrors and confusional arousals, parasomnias associated with REM sleep, e.g. nightmare disorder, REM sleep behaviour disorder and recurrent isolated sleep paralysis, and other parasomnias, e.g. sleep-related groaning, exploding head syndrome, sleep-related hallucinations and sleep-related eating disorder. Prevalences for the subtypes vary.
INTERPRETATION
Most parasomnias are especially common in children. Drug treatment is seldom necessary, but may be indicated in severe cases.
Topics: Adult; Child; Humans; Night Terrors; Parasomnias; Sleep, REM; Somnambulism
PubMed: 19844286
DOI: 10.4045/tidsskr.08.0380 -
Annals of the Academy of Medicine,... Apr 2022In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but... (Review)
Review
INTRODUCTION
In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours.
METHODS
This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias.
RESULTS
Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area.
CONCLUSION
NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Topics: Adult; Humans; Parasomnias; Singapore; Sleep; Somnambulism
PubMed: 35506406
DOI: 10.47102/annals-acadmedsg.2021449 -
Current Opinion in Psychiatry Mar 2019To provide an update of the most recent studies on Smith-Magenis syndrome (SMS) with a focus on the unique pattern of behavioral and sleep disturbances associated with... (Review)
Review
PURPOSE OF REVIEW
To provide an update of the most recent studies on Smith-Magenis syndrome (SMS) with a focus on the unique pattern of behavioral and sleep disturbances associated with the condition.
RECENT FINDINGS
The recent literature on SMS has focused on the characteristic severe behavioral and sleep disturbances. A better understanding of the underlying pathophysiological mechanisms and common clinical course has helped further characterize SMS, while much is left to be discovered in regard to effective treatment/management.
SUMMARY
SMS is a difficult to manage genetic condition defined by pervasive and progressive behavioral and sleep disturbances with a unique pattern that can often be easily discerned from other neurodevelopmental disorders. Common behavioral features include maladaptive/self-injurious, aggressive, stereotypic, and the newly appreciated food seeking behaviors associated with SMS. In addition, there is a sleep disturbance defined by an altered circadian rhythm with frequent nighttime waking and daytime sleepiness, causing patients and families significant distress. Small studies have suggested some treatment/management approaches to the behavioral and sleep disturbances, however, much remains to be discovered.
Topics: Aggression; Disease Progression; Female; Humans; Male; Psychopathology; Sleep Disorders, Circadian Rhythm; Smith-Magenis Syndrome; Somnambulism; Stereotyped Behavior
PubMed: 30557269
DOI: 10.1097/YCO.0000000000000474 -
Atlanta Medical and Surgical Journal Jul 1857
PubMed: 35825197
DOI: No ID Found -
Edinburgh Medical Journal Feb 1879
PubMed: 29639667
DOI: No ID Found -
British Journal of Clinical Pharmacology Oct 2021Antipsychotics and lithium are widely used in psychiatry, particularly in schizophrenia and bipolar disorders. Recently, some cases of somnambulism or sleep-related...
AIMS
Antipsychotics and lithium are widely used in psychiatry, particularly in schizophrenia and bipolar disorders. Recently, some cases of somnambulism or sleep-related eating disorder (SRED) have been reported in patients treated with these drugs. This study investigated the risk of reporting somnambulism or SRED associated with the use of antipsychotics and lithium.
METHODS
The World Health Organization pharmacovigilance database (VigiBase), comprising >18 million adverse events, was queried. All somnambulism or SRED reports related to antipsychotics or lithium were identified. The association between antipsychotics or lithium and somnambulism or SRED was computed using the proportional reporting ratio (PRR) and information component.
RESULTS
Among the 5784 cases reporting somnambulism or SRED, 508 suspected at least 1 antipsychotic or lithium. Most patients were aged 18-64 years (62.0%), and 37.0% were men. In most cases (77.6%), antipsychotic or lithium were the only drug class involved, and 53.3% of cases suspected quetiapine. Somnambulism was reported in 88.6% of cases and SRED in 18.1%. A significant association was found for second-generation antipsychotics (PRR 3.44, 95% confidence interval 3.13) and lithium (PRR 2.03, [1.22; 3.37]), but not for first-generation antipsychotics (PRR 0.99, [0.68; 1.44]).
CONCLUSIONS
We found a significant signal of somnambulism or SRED related to second-generation antipsychotics and lithium. While case reports mentioned mostly quetiapine and olanzapine, almost all second-generation antipsychotics were associated with somnambulism or SRED.
Topics: Antipsychotic Agents; Humans; Lithium; Male; Olanzapine; Pharmacovigilance; Somnambulism
PubMed: 33713370
DOI: 10.1111/bcp.14818 -
Annals of the New York Academy of... 2008Spontaneous brain activity has recently received increasing interest in the neuroimaging community. However, the value of resting-state studies to a better understanding... (Review)
Review
Spontaneous brain activity has recently received increasing interest in the neuroimaging community. However, the value of resting-state studies to a better understanding of brain-behavior relationships has been challenged. That altered states of consciousness are a privileged way to study the relationships between spontaneous brain activity and behavior is proposed, and common resting-state brain activity features observed in various states of altered consciousness are reviewed. Early positron emission tomography studies showed that states of extremely low or high brain activity are often associated with unconsciousness. However, this relationship is not absolute, and the precise link between global brain metabolism and awareness remains yet difficult to assert. In contrast, voxel-based analyses identified a systematic impairment of associative frontoparieto-cingulate areas in altered states of consciousness, such as sleep, anesthesia, coma, vegetative state, epileptic loss of consciousness, and somnambulism. In parallel, recent functional magnetic resonance imaging studies have identified structured patterns of slow neuronal oscillations in the resting human brain. Similar coherent blood oxygen level-dependent (BOLD) systemwide patterns can also be found, in particular in the default-mode network, in several states of unconsciousness, such as coma, anesthesia, and slow-wave sleep. The latter results suggest that slow coherent spontaneous BOLD fluctuations cannot be exclusively a reflection of conscious mental activity, but may reflect default brain connectivity shaping brain areas of most likely interactions in a way that transcends levels of consciousness, and whose functional significance remains largely in the dark.
Topics: Animals; Brain; Consciousness; Consciousness Disorders; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Wakefulness
PubMed: 18591474
DOI: 10.1196/annals.1417.015