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Ebrahim YM, Sadek MA, Sabry MO, Lotfy RM, El-Dessouki AM, Abou-Hussein D, El-Shiekh RA, ElBishbishy RM. Integrative sleep management: from molecular pathways to conventional and herbal treatments. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2025:10.1007/s00210-025-04183-y. [PMID: 40338321 DOI: 10.1007/s00210-025-04183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 04/13/2025] [Indexed: 05/09/2025]
Abstract
Sleep is regarded as one of the most crucial factors in keeping a healthy lifestyle. To function normally, a person needs at least 6-8 h of sleep per day. Sleep influences not only our mood but also the efficiency with which we complete tasks. Sleep disorders exhibit diverse etiologies across different conditions and populations, with genetic and environmental factors playing a significant role in their development. Many issues emerge as a result of inadequate sleep. Unhealthy food and lifestyle choices have increased our susceptibility to sleep disorders. A well-balanced diet rich in essential vitamins and minerals can have a profound impact on sleep patterns, enhancing both the duration and quality of rest. The primary categories of sleep disorders include insomnia, sleep apnea (SA), narcolepsy, parasomnias, circadian rhythm disorders, and restless legs syndrome (RLS). The drugs used to treat sleep disorders are primarily habit-forming and have a history of withdrawal effects. This insufficiency in medication has prompted the hunt for newer, better options. Nutraceuticals are well-suited to the treatment of such illnesses. Its non-toxic, non-habit-forming properties, and practical efficiency have made it an outstanding choice. This review provides nutraceuticals used in sleep disorders. A comprehensive literature search was conducted utilizing several databases, including Google Scholar, Elsevier, Springer Nature, Wiley, PubMed, and EKB. Nutraceuticals are products that employ food or dietary components to treat or prevent disease. In the therapy of sleep disorders, nutraceuticals such as Artemisia annua, valerian, rosemary, jujube, Passionflower, lemon balm, ashwagandha, kava-kava, lavender, and chamomile have been shown to have remarkable benefits. These remedies exert their effects through multiple mechanisms, both directly by modulating neurotransmitter and hormonal pathways within sleep circuits, and indirectly by enhancing sleep quality through the alleviation of stress, inflammation, and oxidative stress. Clinical studies were piloted to validate the efficacy of natural sleep aids. Future research should focus on elucidating the precise mechanisms through which natural products influence sleep.
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Affiliation(s)
- Yasmina M Ebrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Mohamed A Sadek
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
- Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Miral O Sabry
- Faculty of Science, National University of Singapore, Singapore Institute of Manufacturing Technology (SIMTech), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Rana M Lotfy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed M El-Dessouki
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, 12566, Giza, Egypt
| | - Dina Abou-Hussein
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Riham A El-Shiekh
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt.
| | - Rana M ElBishbishy
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt
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2
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Irfan M, Schenck CH. Current Perspectives on Nonrapid Eye Movement Parasomnias. Semin Neurol 2025. [PMID: 40132982 DOI: 10.1055/a-2565-3317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
Non-REM (NREM) parasomnias comprise abnormal sleep-related behaviors, autonomic nervous system function, and emotional experiences that typically arise out of deep NREM sleep. Categorized broadly as disorders of arousal (DoA), confusional arousals (CoA), sleepwalking (SW), and sleep terrors (ST) share common pathophysiological mechanisms and contributing factors. Sexsomnia is classified as a variant of CoA and SW, while sleep-related eating disorder is classified as a separate NREM parasomnia. These parasomnias emerge due to incomplete dissociation of wakefulness from NREM sleep, resulting in partial arousal characterized by decreased consciousness during motor and emotional manifestations. The behaviors emerge as a result of the interplay of various predisposing and priming factors with the additional layer of precipitating conditions. Cyclic alternating patterns and abnormal slow wave synchronization increase susceptibility to developing these behaviors in the background of genetic predisposition. We will discuss current diagnostic criteria, differential diagnoses, implications, and management of these parasomnias. Recent scientific developments in this area will be discussed, especially in reference to etiopathogenesis and treatment strategies of lesser-studied subtypes such as sexsomnia. The mainstay of treatment comprises alleviating the contributing factors and treating any comorbid sleep disorders that may curtail sleep duration and also increase abnormal arousal. Behavioral interventions can be beneficial, although sometimes less established pharmacotherapy is also utilized.
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Affiliation(s)
- Muna Irfan
- Department of Neurology, Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Department of Psychiatry, Hennepin Health Care, University of Minnesota Medical School, Minneapolis, Minnesota
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Tomic T, Mombelli S, Oana S, Ferini-Strambi L, Raballo A, Manconi M, Galbiati A, Castelnovo A. Psychopathology and NREM sleep parasomnias: A systematic review. Sleep Med Rev 2025; 80:102043. [PMID: 39721218 DOI: 10.1016/j.smrv.2024.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 11/18/2024] [Accepted: 12/05/2024] [Indexed: 12/28/2024]
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are abnormal motor and/or emotional behaviors originating from "deep" slow-wave sleep and with a multifactorial origin. The relationship between NREM parasomnias and psychopathology has been a topic of ongoing debate, but a comprehensive and systematic perspective has been lacking. This systematic review, conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA-P) guidelines, aims to fill this gap in the literature. Databases including PubMed, Scopus, Embase, and Web of Science were searched from their inception until March 2024. Only studies written in English were included. We selected case-control studies that reported either psychopathological or neurodevelopmental data in NREM sleep parasomnias, or NREM sleep parasomnia data across different mental disorders, across children and adults. Our review found that psychopathological and neurodevelopmental issues are common in NREM parasomnias, with a higher prevalence in affected patients compared to non-affected individuals. Additionally, NREM parasomnias are more common among patients with various psychopathological conditions than in the general population. Medications did not significantly bias these results. These findings suggest that psychopathological aspects should become a core focus of research and treatment strategies for NREM parasomnias.
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Affiliation(s)
- Tijana Tomic
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Samantha Mombelli
- Center for Advanced Research in Sleep Medicine, Research center of the Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada
| | - Stan Oana
- RoNeuro Institute for Neurological Research and Diagnostics, Cluj-Napoca, Romania
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Raballo
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Cantonal Sociopsychiatric Organisation, Mendrisio, Switzerland
| | - Mauro Manconi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Galbiati
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Castelnovo
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Herzog R, Crosbie F, Aloulou A, Hanif U, Chennaoui M, Léger D, Andrillon T. A continuous approach to explain insomnia and subjective-objective sleep discrepancy. Commun Biol 2025; 8:423. [PMID: 40075150 PMCID: PMC11903875 DOI: 10.1038/s42003-025-07794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 02/20/2025] [Indexed: 03/14/2025] Open
Abstract
Understanding insomnia is crucial for improving its diagnosis and treatment. However, many subjective complaints about insomnia do not align with objective measures of sleep quality, as is the case in subjective-objective sleep discrepancy (SOSD). We address this discrepancy by measuring sleep intrusions and instability in polysomnographic recordings from a large clinical database. Using machine learning, we develop personalized models to infer hypnodensities-a continuous and probabilistic measure of sleep dynamics-, and analyze them via information theory to measure intrusions and instability in a principled way. We find that insomnia with SOSD involves sleep intrusions during intra-sleep wakefulness, while insomnia without SOSD shows wake intrusions during sleep, indicating distinct etiologies. By mapping these metrics to standard sleep features, we provide a continuous and interpretable framework for measuring sleep quality. This approach integrates and values subjective insomnia complaints with physiological data for a more accurate view of sleep quality and its disorders.
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Affiliation(s)
- Rubén Herzog
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Flynn Crosbie
- Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé publique), Paris, France
| | - Anis Aloulou
- Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé publique), Paris, France
- APHP, Hôtel-Dieu, Centre du sommeil et de la Vigilance, Paris, France
| | - Umaer Hanif
- Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé publique), Paris, France
| | - Mounir Chennaoui
- Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé publique), Paris, France
- Institut de recherche biomédicale des armées (IRBA), Brétigny-sur-Orge, Paris, France
| | - Damien Léger
- Université Paris Cité, VIFASOM (Vigilance Fatigue Sommeil et Santé publique), Paris, France
- APHP, Hôtel-Dieu, Centre du sommeil et de la Vigilance, Paris, France
| | - Thomas Andrillon
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, Australia.
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Castelnovo A, Mainieri G, Loddo G, Balafas S, Brombin C, Balella G, Montini A, Di Serio C, Manconi M, Provini F. Spectral dynamics prior to motor events differ between NREM sleep parasomnias and healthy sleepers. Sleep 2025; 48:zsae252. [PMID: 39453616 DOI: 10.1093/sleep/zsae252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 10/21/2024] [Indexed: 10/26/2024] Open
Abstract
STUDY OBJECTIVES The umbrella term "Disorders of Arousal" (DoA), encompassing sleepwalking, confusional arousals, and sleep terrors, refers to parasomnias manifesting during nonrapid eye movement (NREM) sleep, commonly thought to arise from an aberrant arousal process. While previous studies have detailed electroencephalographic (EEG) changes linked to DoA episodes, it remains uncertain how these alterations differ from a physiological arousal process. This study directly compared brain activity between DoA episodes and arousals associated with physiological movements (motor arousal) in individuals with DoA and healthy sleepers. METHODS Fifty-three adult participants with DoA (25 males, 32.2 ± 15.5 years) and 33 control participants (14 males, 31.4 ± 11.4 years) underwent one or more home EEG recordings. A semiparametric regression model was employed to elucidate the complex relationship between EEG activity across channels, within and across different groups, including motor arousals in DoA (n = 169), parasomnia episodes in DoA (n = 361), and motor arousals in healthy sleepers (n = 137). RESULTS Parasomnia episodes and motor arousals in both groups were preceded by a diffuse increase in slow-wave activity (SWA) and beta power, and a widespread decrease in sigma power. However, motor arousals in DoA displayed lower beta and central sigma than in healthy sleepers. Within participants with DoA, episodes were preceded by lower beta, frontal sigma, and higher SWA than motor arousals. CONCLUSIONS Our findings suggest that the arousal process is altered in participants with DoA, and that specific EEG patterns are required for DoA episodes to emerge. These insights will help guide future research into the underlying circuits and objective markers of DoA.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Italian Switzerland, Ospedale Civico, Lugano, Ente Ospedaliero Cantonale (EOC), Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, Bologna, Italy
| | - Spyros Balafas
- University Center for Statistics in the Biomedical Sciences, Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Giulia Balella
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Angelica Montini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Clelia Di Serio
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- University Center for Statistics in the Biomedical Sciences, Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
- Clinical Trial Unit (CTU), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Italian Switzerland, Ospedale Civico, Lugano, Ente Ospedaliero Cantonale (EOC), Switzerland
- Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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6
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Idir Y, Lopez R, Barbier A, Saint-Auret S, Morain E, Vollhardt R, Ben Haj Kacem I, Le Coz A, Gales A, Dodet P, Leu-Semenescu S, Dauvilliers Y, Arnulf I, Oudiette D. Talking to sleepwalkers? Response to communication efforts in disorders of arousals. Sleep 2025; 48:zsae272. [PMID: 39569604 PMCID: PMC11807887 DOI: 10.1093/sleep/zsae272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 10/18/2024] [Indexed: 11/22/2024] Open
Abstract
STUDY OBJECTIVES Disorders of arousal (DoA) are diagnosed on the basis of clinical criteria, including inappropriate or absent responsiveness to communication attempts. Surprisingly, the ability of patients to interact with others during DoA episodes has not been systematically investigated. To address this gap, we conducted three studies. METHODS First, we used a retrospective questionnaire to assess verbal responsiveness during episodes in 61 adult patients with DoA (Study 1). Second, we used auditory stimulation during polysomnographically verified N3 sleep to trigger DoA episodes in 14 patients. We then asked questions to test the possibility of verbal interactions during the episodes (Study 2). Third, we assessed the presence and quality of conversations with a bed partner in 364 home video-recorded episodes from 19 patients (Study 3). RESULTS In Study 1, most patients (81%) reported occasional conversations during parasomnia episodes. Patients' ongoing mental content influenced both their responses to questions during episodes and their perception of the outside world (including their surroundings and the identity of their interlocutor ). In Study 2, auditory stimulation had a limited effect in inducing episodes (7/157 trials). One patient indirectly responded to our verbal prompts in a DoA episode. In Study 3, we found 37 video instances of discussion between patients and their partner. CONCLUSIONS Overall, our findings suggest that DoA episodes are not a uniform state but may instead encompass varying states of consciousness, characterized by different levels of responsiveness and a complex interplay between internal and external information processing. These results highlight the limitations of current diagnostic criteria for DoA.
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Affiliation(s)
- Yannis Idir
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Régis Lopez
- Department of Neurology, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Unit, CHU Montpellier, University Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Amélie Barbier
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
- Laboratoire d’anthropologie sociale, Collège de France, EHESS, EPHE, CNRS, Université de recherche PSL, Paris, France
| | - Sony Saint-Auret
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Emmanuel Morain
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Raphaël Vollhardt
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Inès Ben Haj Kacem
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Arthur Le Coz
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Ana Gales
- Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy and Rare Hypersomnias, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pauline Dodet
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
- Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy and Rare Hypersomnias, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Smaranda Leu-Semenescu
- Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy and Rare Hypersomnias, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yves Dauvilliers
- Department of Neurology, National Reference Centre for Orphan Diseases, Narcolepsy-Rare Hypersomnias, Sleep Unit, CHU Montpellier, University Montpellier, Montpellier, France
- Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Isabelle Arnulf
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
- Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy and Rare Hypersomnias, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Delphine Oudiette
- Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris, France
- Service des Pathologies du Sommeil, National Reference Centre for Narcolepsy and Rare Hypersomnias, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
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Siclari F. Consciousness in non-REM-parasomnia episodes. J Sleep Res 2025; 34:e14275. [PMID: 38952031 PMCID: PMC11744254 DOI: 10.1111/jsr.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
Sleepwalking and related parasomnias are thought to result from incomplete awakenings out of non-rapid eye movement (non-REM) sleep. Non-REM parasomnia behaviours have been described as unconscious and automatic, or related to vivid, dream-like conscious experiences. Similarly, some observations have suggested that patients are unresponsive during episodes, while others that they can interact with their surroundings. To better grasp and characterise the full spectrum of consciousness and environmental (dis)connection associated with behavioural episodes, 35 adult patients with non-REM sleep parasomnias were interviewed in-depth about their experiences. The level of consciousness during parasomnia episodes was reported to be variable both within and between individuals, ranging from minimal or absent consciousness and largely automatic behaviours (frequently/always present in 36% of patients) to preserved conscious experiences characterised by delusional thinking of varying degrees of specificity (65%), often about impending danger, variably formed, uni- or multisensory hallucinations (53%), impaired insight (77%), negative emotions (75%), and variable, but often pronounced, amnesia (30%). Patients described their experiences as a dream scene during which they felt awake ("awake dreaming"). The surroundings were either realistically perceived, misinterpreted (in the form of perceptual illusions or misidentifications of people), or entirely hallucinated as a function of the prevailing delusion. These observations suggest that the level of consciousness, amnesia and sensory disconnection during non-REM parasomnia episodes is variable and graded. In their full-fledged expression, non-REM parasomnia experiences feature several core features of dreams. They therefore represent a valuable model for the study of consciousness, sleep-related sensory disconnection and dreaming.
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Affiliation(s)
- Francesca Siclari
- The Netherlands Institute for NeuroscienceAmsterdamThe Netherlands
- Center for Investigation and Research on SleepLausanne University Hospital (CHUV)LausanneSwitzerland
- The Sense Innovation and Research Center, Lausanne and SionLausanneSwitzerland
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8
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Osorio-Forero A, Foustoukos G, Cardis R, Cherrad N, Devenoges C, Fernandez LMJ, Lüthi A. Infraslow noradrenergic locus coeruleus activity fluctuations are gatekeepers of the NREM-REM sleep cycle. Nat Neurosci 2025; 28:84-96. [PMID: 39587312 DOI: 10.1038/s41593-024-01822-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/15/2024] [Indexed: 11/27/2024]
Abstract
The noradrenergic locus coeruleus (LC) regulates arousal levels during wakefulness, but its role in sleep remains unclear. Here, we show in mice that fluctuating LC neuronal activity partitions non-rapid-eye-movement sleep (NREMS) into two brain-autonomic states that govern the NREMS-REMS cycle over ~50-s periods; high LC activity induces a subcortical-autonomic arousal state that facilitates cortical microarousals, whereas low LC activity is required for NREMS-to-REMS transitions. This functional alternation regulates the duration of the NREMS-REMS cycle by setting permissive windows for REMS entries during undisturbed sleep while limiting these entries to maximally one per ~50-s period during REMS restriction. A stimulus-enriched, stress-promoting wakefulness was associated with longer and shorter levels of high and low LC activity, respectively, during subsequent NREMS, resulting in more microarousal-induced NREMS fragmentation and delayed REMS onset. We conclude that LC activity fluctuations are gatekeepers of the NREMS-REMS cycle and that this role is influenced by adverse wake experiences.
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Affiliation(s)
- Alejandro Osorio-Forero
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Georgios Foustoukos
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Romain Cardis
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Najma Cherrad
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Christiane Devenoges
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Laura M J Fernandez
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Anita Lüthi
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland.
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9
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Milinski L, Nodal FR, Emmerson MKJ, King AJ, Vyazovskiy VV, Bajo VM. Cortical evoked activity is modulated by the sleep state in a ferret model of tinnitus. A cross-case study. PLoS One 2024; 19:e0304306. [PMID: 39630799 PMCID: PMC11616861 DOI: 10.1371/journal.pone.0304306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 11/13/2024] [Indexed: 12/07/2024] Open
Abstract
Subjective tinnitus is a phantom auditory perception in the absence of an actual acoustic stimulus that affects 15% of the global population. In humans, tinnitus is often associated with disturbed sleep and, interestingly, there is an overlap between the brain areas involved in tinnitus and regulation of NREM sleep. We used eight adult ferrets exposed to mild noise trauma as an animal model of tinnitus. We assessed the phantom percept using two operant paradigms sensitive to tinnitus, silent gap detection and silence detection, before and, in a subset of animals, up to six months after the mild acoustic trauma. The integrity of the auditory brainstem was assessed over the same period using auditory brainstem response recordings. Following noise overexposure, ferrets developed lasting, frequency-specific impairments in operant behaviour and evoked brainstem activity. To explore the interaction between sleep and tinnitus, in addition to tracking the behavioural markers of noise-induced tinnitus and hearing impairment after noise overexposure, we evaluated sleep-wake architecture and spontaneous and auditory-evoked EEG activity across vigilance states. Behavioural performance and auditory-evoked activity measurements after noise overexposure suggested distinct degrees of tinnitus and hearing impairment between individuals. Animals that developed signs of tinnitus consistently developed sleep impairments, suggesting a link between the emergence of noise-induced hearing loss and/or tinnitus and sleep disruption. However, neural markers of tinnitus were reduced during sleep, suggesting that sleep may transiently mitigate tinnitus. These results reveal the importance of sleep-wake states in tinnitus and suggest that understanding the neurophysiological link between sleep and tinnitus may provide a new angle for research into the causes of phantom percepts and inform future treatments.
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Affiliation(s)
- Linus Milinski
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Fernando R. Nodal
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Matthew K. J. Emmerson
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Andrew J. King
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Vladyslav V. Vyazovskiy
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Victoria M. Bajo
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
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10
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Barateau L, Baillieul S, Andrejak C, Bequignon É, Boutouyrie P, Dauvilliers Y, Gagnadoux F, Geoffroy PA, Micoulaud-Franchi JA, Montani D, Monaca C, Patout M, Pépin JL, Philip P, Pilette C, Tamisier R, Trzepizur W, Jaffuel D, Arnulf I. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res 2024; 86:101105. [PMID: 38861872 DOI: 10.1016/j.resmer.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/13/2024]
Abstract
Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.
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Affiliation(s)
- Lucie Barateau
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France.
| | - Sébastien Baillieul
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Claire Andrejak
- Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France; UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France
| | - Émilie Bequignon
- ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France; CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France
| | - Pierre Boutouyrie
- Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France
| | - Frédéric Gagnadoux
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Pierre-Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - David Montani
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christelle Monaca
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France
| | - Maxime Patout
- R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France; Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France
| | - Jean-Louis Pépin
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Pierre Philip
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - Charles Pilette
- Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium
| | - Renaud Tamisier
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Wojciech Trzepizur
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Dany Jaffuel
- Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France; Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France
| | - Isabelle Arnulf
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France
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11
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Hanif U, Cairns A, Mysliwiec V, Bettinardi RG, Elbaz M, Gimenez U, Mignot EJM. Associations between self-reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders. Psychiatry Clin Neurosci 2024; 78:667-677. [PMID: 39210704 DOI: 10.1111/pcn.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
AIM To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. METHODS Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia-specific questions were included. Patients responding "often" or "always" to parasomnia-specific questions were considered "symptom-positive," whereas a "few times" or "never" were considered "symptom-negative" (controls). RESULTS The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder. CONCLUSION Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.
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Affiliation(s)
- Umaer Hanif
- Data Science, BioSerenity, Paris, France
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
| | - Alyssa Cairns
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
| | - Vincent Mysliwiec
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | | | - Emmanuel J M Mignot
- Stanford University Center for Sleep and Circadian Sciences, Stanford University, Palo Alto, California, USA
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12
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Zhu Z, Su Y, Chen J, Zhang J, Liang L, Nie Z, Tang W, Liang Y, Li H. PEDOT:PSS-Based Wearable Flexible Temperature Sensor and Integrated Sensing Matrix for Human Body Monitoring. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 39359155 DOI: 10.1021/acsami.4c11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Flexible temperature sensors have been widely used in electronic skins and health monitoring. Body temperature as one of the key physiological signals is crucial for detecting human body's abnormalities, which necessitates high sensitivity, quick responsiveness, and stable monitoring. In this paper, we reported a resistive temperature sensor designed as an ultrathin laminated structure with a serpentine pattern and a bioinspired adhesive layer, which was fabricated with a composite of poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate)/single-wall carbon nanotubes/reduced graphene oxide (PEDOT:PSS/SWCNTs/rGO) and polydimethylsiloxane (PDMS). The temperature sensor exhibited a high temperature sensitivity of 0.63% °C-1, coupled with outstanding linearity of 0.98 within 25-45 °C. Furthermore, it showed fast response and recovery speeds of 4.8 and 5.8 s, respectively, between 25 and 36 °C. It also demonstrated exceptional stability when subjected to stress and bending disturbances with the maximum bending interference deviation of 0.03%. Additionally, it displayed good cyclic stability over a broad temperature range from 25 to 85 °C, and the standard deviation at 25 °C is 0.14%. A series of experiments including blowing detection, respiratory monitoring with or without a mask, and during rest or sleep were conducted to show the potential of the flexible temperature sensors in human body monitoring. Furthermore, a 4 × 4 flexible temperature sensor matrix was integrated to detect and map objects such as wrenches and blood vessels through human hand skin. The results were consistent with those of infrared measurements. The flexible temperature sensor is capable of real-time temperature monitoring and has the potential in tracking human respiration, assessing sleep quality, and mapping the temperature of various objects.
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Affiliation(s)
- Zhengfang Zhu
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen 518118, Guangdong, China
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| | - Yi Su
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| | - Jing Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| | - Jinyong Zhang
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen 518118, Guangdong, China
| | - Lixin Liang
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen 518118, Guangdong, China
| | - Zedong Nie
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| | - Wei Tang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, Guangdong, China
| | - Yongsheng Liang
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen 518118, Guangdong, China
| | - Hui Li
- College of Big Data and Internet, Shenzhen Technology University, Shenzhen 518118, Guangdong, China
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13
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Correa VM, Biresaw MS, Vitrai J, Szűcs A. NREM parasomnia-related behaviors and adverse childhood experiences. Sleep Med 2024; 121:365-369. [PMID: 39079371 DOI: 10.1016/j.sleep.2024.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/11/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE To assess the prevalence, types, sociodemographic factors, and reported dangerous activities of sleep-related behaviors likely representing NREM parasomnia episodes, as well as their association with adverse childhood experiences in Hungary. METHODS Cross-sectional survey of 1000 adults (aged ≥18 years) representing the Hungarian population, using a non-probability quota sampling with a random walk method and a structured face-to-face interview. A multi-criterion weighting procedure was applied to correct bias along the main sociodemographic variables to the data available. Binary logistic regression estimated the odds of NREM parasomnia-related behaviors associated with sociodemographic factors and adverse childhood experiences. RESULTS The prevalence of NREM parasomnia-related behaviors was 2.7 %, and self-reported sleep-eating was 0.1 % of the population (4.6 % of parasomnia-like activities). For middle-aged adults, the odds of sleep ambulation were significantly lower than for younger adults (OR 0.3; P = 0.03). A participant's family occurrence of reported parasomnia-like activity increased their odds of having it by more than 7 times (OR 7.1; P < 0.001). Nine participants out of those 27 people reporting NREM parasomnia-related behavior episodes, reported childhood adverse experiences, increasing the odds of parasomnia-related behavior by more than six times (OR 6.2; P < 0.001) compared to those not reporting it. CONCLUSION This is the first population survey in Hungary on adult sleep-related behaviors likely representing NREM parasomnia episodes and the potential association with childhood traumatic events preceding them. The related dangerous behaviors call for safety measures and prevention. The significant association between adverse childhood events and NREM parasomnia-related behaviors needs further analysis.
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Affiliation(s)
- Vivian M Correa
- Mental Health Sciences Doctoral School, Semmelweis University, Hungary.
| | | | - József Vitrai
- Department of Preventive Health Science, Széchenyi University of Győr, Hungary
| | - Anna Szűcs
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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14
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Marino M, Mantini D. Human brain imaging with high-density electroencephalography: Techniques and applications. J Physiol 2024. [PMID: 39173191 DOI: 10.1113/jp286639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
Electroencephalography (EEG) is a technique for non-invasively measuring neuronal activity in the human brain using electrodes placed on the participant's scalp. With the advancement of digital technologies, EEG analysis has evolved over time from the qualitative analysis of amplitude and frequency modulations to a comprehensive analysis of the complex spatiotemporal characteristics of the recorded signals. EEG is now considered a powerful tool for measuring neural processes in the same time frame in which they happen (i.e. the subsecond range). However, it is commonly argued that EEG suffers from low spatial resolution, which makes it difficult to localize the generators of EEG activity accurately and reliably. Today, the availability of high-density EEG (hdEEG) systems, combined with methods for incorporating information on head anatomy and sophisticated source-localization algorithms, has transformed EEG into an important neuroimaging tool. hdEEG offers researchers and clinicians a rich and varied range of applications. It can be used not only for investigating neural correlates in motor and cognitive neuroscience experiments, but also for clinical diagnosis, particularly in the detection of epilepsy and the characterization of neural impairments in a wide range of neurological disorders. Notably, the integration of hdEEG systems with other physiological recordings, such as kinematic and/or electromyography data, might be especially beneficial to better understand the neuromuscular mechanisms associated with deconditioning in ageing and neuromotor disorders, by mapping the neurokinematic and neuromuscular connectivity patterns directly in the brain.
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Affiliation(s)
- Marco Marino
- Movement Control and Neuroplasticity Research Group, KU Leuven, Belgium
- Department of General Psychology, University of Padua, Padua, Italy
| | - Dante Mantini
- Movement Control and Neuroplasticity Research Group, KU Leuven, Belgium
- Leuven Brain Institute, KU Leuven, Belgium
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15
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Mana L, Schwartz-Pallejà M, Vila-Vidal M, Deco G. Overview on cognitive impairment in psychotic disorders: From impaired microcircuits to dysconnectivity. Schizophr Res 2024; 269:132-143. [PMID: 38788432 DOI: 10.1016/j.schres.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
Schizophrenia's cognitive deficits, often overshadowed by positive symptoms, significantly contribute to the disorder's morbidity. Increasing attention highlights these deficits as reflections of neural circuit dysfunction across various cortical regions. Numerous connectivity alterations linked to cognitive symptoms in psychotic disorders have been reported, both at the macroscopic and microscopic level, emphasizing the potential role of plasticity and microcircuits impairment during development and later stages. However, the heterogeneous clinical presentation of cognitive impairment and diverse connectivity findings pose challenges in summarizing them into a cohesive picture. This review aims to synthesize major cognitive alterations, recent insights into network structural and functional connectivity changes and proposed mechanisms and microcircuit alterations underpinning these symptoms, particularly focusing on neurodevelopmental impairment, E/I balance, and sleep disturbances. Finally, we will also comment on some of the most recent and promising therapeutic approaches that aim to target these mechanisms to address cognitive symptoms. Through this comprehensive exploration, we strive to provide an updated and nuanced overview of the multiscale connectivity impairment underlying cognitive impairment in psychotic disorders.
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Affiliation(s)
- L Mana
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain.
| | - M Schwartz-Pallejà
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain; Department of Experimental and Health Science, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain; Eurecat, Technology Center of Catalonia, Multimedia Technologies, Barcelona, Spain.
| | - M Vila-Vidal
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain; Computational Biology and Complex Systems Group, Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Spain.
| | - G Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain; Institució Catalana de la Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona 08010, Spain.
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16
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Camaioni M, Scarpelli S, Alfonsi V, Gorgoni M, Calzolari R, De Bartolo M, Mangiaruga A, Couyoumdjian A, De Gennaro L. How COVID-19 Affected Sleep Talking Episodes, Sleep and Dreams? Brain Sci 2024; 14:486. [PMID: 38790464 PMCID: PMC11119596 DOI: 10.3390/brainsci14050486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic increased symptoms of stress and anxiety and induced changes in sleep quality, dream activity, and parasomnia episodes. It has been shown that stressful factors and/or bad sleep habits can affect parasomnia behaviors. However, investigations on how COVID-19 has affected sleep, dreams, and episode frequency in parasomnias are rare. The current study focuses on the impact of the pandemic on a specific parasomnia characterized by speech production (sleep talking, ST). METHODS We selected 27 participants with frequent ST episodes (STs) during the pandemic and compared them with 27 participants with frequent STs from a previous study conducted during a pre-pandemic period. All participants performed home monitoring through sleep logs and recorded their nocturnal STs for one week. RESULTS We observed a higher frequency of STs in the pandemic group. Moreover, STs were related to the emotional intensity of dreams, independent of the pandemic condition. The pandemic was associated with lower bizarreness of dreams in the pandemic group. There were no differences in sleep variables between the two groups. CONCLUSION Overall, these results suggest a stressful effect of COVID-19 on the frequency of STs. Both the pandemic and the frequency of STs affect qualitative characteristics of dreams in this population.
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Affiliation(s)
- Milena Camaioni
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Valentina Alfonsi
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Rossana Calzolari
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padova, Italy
| | - Mina De Bartolo
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Anastasia Mangiaruga
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Alessandro Couyoumdjian
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.C.); (S.S.); (V.A.); (M.G.); (M.D.B.); (A.C.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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17
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Cataldi J, Stephan AM, Haba-Rubio J, Siclari F. Shared EEG correlates between non-REM parasomnia experiences and dreams. Nat Commun 2024; 15:3906. [PMID: 38724511 PMCID: PMC11082195 DOI: 10.1038/s41467-024-48337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Sleepwalking and related parasomnias result from incomplete awakenings out of non-rapid eye movement sleep. Behavioral episodes can occur without consciousness or recollection, or in relation to dream-like experiences. To understand what accounts for these differences in consciousness and recall, here we recorded parasomnia episodes with high-density electroencephalography (EEG) and interviewed participants immediately afterward about their experiences. Compared to reports of no experience (19%), reports of conscious experience (56%) were preceded by high-amplitude EEG slow waves in anterior cortical regions and activation of posterior cortical regions, similar to previously described EEG correlates of dreaming. Recall of the content of the experience (56%), compared to no recall (25%), was associated with higher EEG activation in the right medial temporal region before movement onset. Our work suggests that the EEG correlates of parasomnia experiences are similar to those reported for dreams and may thus reflect core physiological processes involved in sleep consciousness.
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Affiliation(s)
- Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - José Haba-Rubio
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland.
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
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18
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Gorgoni M, Giuliani G, Fratino M, Di Piero V. The objective assessment of sleep in cluster headache: State of the art and future directions. J Sleep Res 2024; 33:e14103. [PMID: 37963453 DOI: 10.1111/jsr.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
Several lines of evidence suggest that cluster headache is related to chronobiology and sleep. Nevertheless, the nature of such a relationship is unclear. In this view, the objective evaluation of sleep in cluster headache has strong theoretical and clinical relevance. Here, we provide an in-depth narrative review of the literature on objective sleep assessment in cluster headache. We found that only a small number of studies (N = 12) focused on this topic. The key research aims were directed to assess: (a) the relationship between cluster headache and sleep breathing disorders; (b) the temporal relationship between sleep stages/events and cluster headache attacks; (c) sleep macrostructure in patients with cluster headache. No studies considered sleep microstructure. The reviewed studies are heterogeneous, conducted by a few research groups, and often characterised by relevant methodological flaws. Results are substantially inconclusive considering the main hypothesis. We outline several methodological points that should be considered for future research, and suggest that evaluating sleep microstructure, local sleep electrophysiology and actigraphic measures may strongly increase knowledge on the relationship between sleep and cluster headache.
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Affiliation(s)
- Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giada Giuliani
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariangela Fratino
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- University Consortium for Adaptive Disorders and Head Pain (UCADH), Pavia, Italy
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19
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Ruby P, Evangelista E, Bastuji H, Peter-Derex L. From physiological awakening to pathological sleep inertia: Neurophysiological and behavioural characteristics of the sleep-to-wake transition. Neurophysiol Clin 2024; 54:102934. [PMID: 38394921 DOI: 10.1016/j.neucli.2023.102934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/25/2024] Open
Abstract
Sleep inertia refers to the transient physiological state of hypoarousal upon awakening, associated with various degrees of impaired neurobehavioral performance, confusion, a desire to return to sleep and often a negative emotional state. Scalp and intracranial electro-encephalography as well as functional imaging studies have provided evidence that the sleep inertia phenomenon is underpinned by an heterogenous cerebral state mixing local sleep and local wake patterns of activity, at the neuronal and network levels. Sleep inertia is modulated by homeostasis and circadian processes, sleep stage upon awakening, and individual factors; this translates into a huge variability in its intensity even under physiological conditions. In sleep disorders, especially in hypersomnolence disorders such as idiopathic hypersomnia, sleep inertia may be a daily, serious and long-lasting symptom leading to severe impairment. To date, few tools have been developed to assess sleep inertia in clinical practice. They include mainly questionnaires and behavioral tests such as the psychomotor vigilance task. Only one neurophysiological protocol has been evaluated in hypersomnia, the forced awakening test which is based on an event-related potentials paradigm upon awakening. This contrasts with the major functional consequences of sleep inertia and its potentially dangerous consequences in subjects required to perform safety-critical tasks soon after awakening. There is a great need to identify reproducible biomarkers correlated with sleep inertia-associated cognitive and behavioral impairment. These biomarkers will aim at better understanding and measuring sleep inertia in physiological and pathological conditions, as well as objectively evaluating wake-promoting treatments or non-pharmacological countermeasures to reduce this phenomenon.
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Affiliation(s)
- Perrine Ruby
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Elisa Evangelista
- Sleep disorder Unit, Carémeau Hospital, Centre Hospitalo-universitaire de Nîmes, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Bastuji
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
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20
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Castelnovo A, Schraemli M, Schenck CH, Manconi M. The parasomnia defense in sleep-related homicide: A systematic review and a critical analysis of the medical literature. Sleep Med Rev 2024; 74:101898. [PMID: 38364685 DOI: 10.1016/j.smrv.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/18/2024]
Abstract
This review critically analyzes the forensic application of the Parasomnia Defense in homicidal incidents, drawing from medical literature on disorders of arousal (DOA) and rapid-eye-movement sleep behavior disorder (RBD). A systematic search of PubMed, Scopus, Embase, and Cochrane databases was conducted until October 16, 2022. We screened English-language articles in peer-reviewed journals discussing murders committed during sleep with a Parasomnia Defense. We followed PRISMA guidelines, extracting event details, diagnosis methods, factors influencing the acts, perpetrator behavior, timing, motives, concealment, mental experiences, victim demographics, and court verdicts. Three sleep experts evaluated each case. We selected ten homicides, four attempted homicides, and one homicide/attempted homicide that met inclusion/exclusion criteria. Most cases were suspected DOA as unanimously confirmed by experts. RBD cases were absent. Among aggressors, a minority reported dream-like experiences. Victims were primarily female family members killed in or near the bed by hands and/or with sharp objects. Objective sleep data and important crime scene details were often missing. Verdicts were ununiform. Homicides during DOA episodes, though rare, are documented, validating the Parasomnia Defense's use in forensics. RBD-related fatal aggression seems very uncommon. However, cases often lack diagnostic clarity. We propose updated guidelines to enhance future reporting and understanding of such incidents.
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Affiliation(s)
- Anna Castelnovo
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Matthias Schraemli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, Hennepin County Medical Center, And University of Minnesota Medical School, Minneapolis, MN, United States.
| | - Mauro Manconi
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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21
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Darby RR, Considine C, Weinstock R, Darby WC. Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law. Nat Rev Neurol 2024; 20:183-193. [PMID: 38228905 DOI: 10.1038/s41582-023-00920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of 'forensic neurology', a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency.
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Affiliation(s)
- R Ryan Darby
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Ciaran Considine
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Weinstock
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Darby
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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22
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Bruni O, DelRosso LM, Melegari MG, Ferri R. The Parasomnias. Psychiatr Clin North Am 2024; 47:135-146. [PMID: 38302202 DOI: 10.1016/j.psc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Parasomnias usually present in childhood and resolve spontaneously. The diagnosis of non-rapid eye movement-related parasomnias is mainly based on clinical descriptors and can be challenging. Rapid eye movement-related parasomnias may index an underlying psychiatric disorder. Even if benign, parasomnias can affect quality of life. Pediatricians and child psychiatrists should be familiarized with these sleep disorders and suggest adequate sleep hygiene, avoidance of sleep deprivation, and regular bedtimes even on weekends as the first step in management of these disorders. Clinicians should pursue the opportunity for tailoring treatments and consider referral to a sleep expert when indicated.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy.
| | - Lourdes M DelRosso
- Department of Internal Medicine, University of California San Francisco, Fresno, CA, USA
| | - Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, Rome 00185, Italy
| | - Raffaele Ferri
- Department of Neurology I.C., Sleep Research Centre, Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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23
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Cordani R, Lopez R, Barateau L, Chenini S, Nobili L, Dauvilliers Y. Somnambulism. Sleep Med Clin 2024; 19:43-54. [PMID: 38368068 DOI: 10.1016/j.jsmc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Somnambulism, also called sleepwalking, classified as a non-rapid eye movement sleep parasomnia, encompasses a range of abnormal paroxysmal behaviors, leading to sleepwalking in dissociated sleep in an altered state of consciousness with impaired judgment and configuring a kind of hierarchical continuum with confusional arousal and night terror. Despite being generally regarded as a benign condition, its potential severity entails social, personal, and even forensic consequences. This comprehensive review provides an overview on the current state of knowledge, elucidating the phenomenon of somnambulism and encompassing its clinical manifestations and diagnostic approaches.
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Affiliation(s)
- Ramona Cordani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Regis Lopez
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Sofiene Chenini
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France.
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24
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Holoyda B. Forensic Implications of the Parasomnias. Sleep Med Clin 2024; 19:189-198. [PMID: 38368065 DOI: 10.1016/j.jsmc.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Although many sleep-related behaviors are benign, others can result in physical or sexual aggression toward bed partners or others. Individuals who engage in sleep-related violence (SRV) and sexual behavior in sleep (SBS) may face legal sanctions for their behavior. Attorneys or legal decision-makers may call on an expert to evaluate a defendant and opine about the veracity of an alleged parasomnia diagnosis, the criminal responsibility of the defendant, and his risk of violence to others. This article reviews the phenomena of SRV and SBS and guides evaluators in the forensic considerations relevant to parasomnias.
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Affiliation(s)
- Brian Holoyda
- Contra Costa County Detention Health Services, Martinez, CA, USA; Department of Psychiatry and Behavioral Medicine; Martinez Detention Facility, 1000 Ward Street, Martinez, CA 94553, USA; Forensic Psychiatrist, Denver, CO, USA.
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25
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Lopez R, Dauvilliers Y. Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications. Sleep Med Rev 2024; 73:101888. [PMID: 38150767 DOI: 10.1016/j.smrv.2023.101888] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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26
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Leung TNH, Wong KL, Chan AKC, Li AM. Common Childhood Sleep Problems and Disorders. Curr Pediatr Rev 2024; 20:27-42. [PMID: 36043722 DOI: 10.2174/1573396318666220827102018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. OBJECTIVE To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. METHODS A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. RESULTS Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. CONCLUSION Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.
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Affiliation(s)
- Theresa Ngan Ho Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kin Lok Wong
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony Kam Chuen Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
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27
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Mogavero MP, Lanza G, DelRosso LM, Ferri R. Psychophysiology of Sleep. NEUROMETHODS 2024:263-286. [DOI: 10.1007/978-1-0716-3545-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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28
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Miletínová E, Piorecký M, Koudelka V, Jiříček S, Tomeček D, Brunovský M, Horáček J, Bušková J. Alterations of sleep initiation in NREM parasomnia after sleep deprivation - A multimodal pilot study. Sleep Med X 2023; 6:100086. [PMID: 37745863 PMCID: PMC10511487 DOI: 10.1016/j.sleepx.2023.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives NREM parasomnias also known as disorders of arousal (DOA) are characterised by abnormal motor and autonomic activation during arousals primarily from slow wave sleep. Dissociative state between sleep and wake is likely responsible for clinical symptoms of DOA. We therefore investigated potential dissociation outside of parasomnic events by using simultaneous 256-channel EEG (hdEEG) and functional magnetic resonance imaging (fMRI). Methods Eight DOA patients (3 women, mean age = 27.8; SD = 4.2) and 8 gender and age matched healthy volunteers (3 women, mean age = 26,5; SD = 4.0) were included into the study. They underwent 30-32 h of sleep deprivation followed by hdEEG and fMRI recording. We determined 2 conditions: falling asleep (FA) and arousal (A), that occurred outside of deep sleep and/or parasomnic event. We used multimodal approach using data obtained from EEG, fMRI and EEG-fMRI integration approach. Results DOA patients showed increase in delta and beta activity over postcentral gyrus and cuneus during awakening period. This group expressed increased connectivity between motor cortex and cingulate during arousals unrelated to parasomnic events in the beta frequency band. They also showed lower connectivity between different portions of cingulum. In contrast, the greater connectivity was found between thalamus and some cortical areas, such as occipital cortex. Conclusion Our findings suggest a complex alteration in falling asleep and arousal mechanisms at both subcortical and cortical levels in response to sleep deprivation. As this alteration is present also outside of slow wave sleep and/or parasomnic episodes we believe this could be a trait factor of DOA.
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Affiliation(s)
- E. Miletínová
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - M. Piorecký
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Czech Republic
| | - V. Koudelka
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Czech Republic
| | - S. Jiříček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - D. Tomeček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - M. Brunovský
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - J. Horáček
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
| | - J. Bušková
- National Institute of Mental Health, Topolova 748, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University in Prague, Ruská 87, Prague, Czech Republic
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29
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Andrillon T, Oudiette D. What is sleep exactly? Global and local modulations of sleep oscillations all around the clock. Neurosci Biobehav Rev 2023; 155:105465. [PMID: 37972882 DOI: 10.1016/j.neubiorev.2023.105465] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/29/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
Wakefulness, non-rapid eye-movement (NREM) and rapid eye-movement (REM) sleep differ from each other along three dimensions: behavioral, phenomenological, physiological. Although these dimensions often fluctuate in step, they can also dissociate. The current paradigm that views sleep as made of global NREM and REM states fail to account for these dissociations. This conundrum can be dissolved by stressing the existence and significance of the local regulation of sleep. We will review the evidence in animals and humans, healthy and pathological brains, showing different forms of local sleep and the consequences on behavior, cognition, and subjective experience. Altogether, we argue that the notion of local sleep provides a unified account for a host of phenomena: dreaming in REM and NREM sleep, NREM and REM parasomnias, intrasleep responsiveness, inattention and mind wandering in wakefulness. Yet, the physiological origins of local sleep or its putative functions remain unclear. Exploring further local sleep could provide a unique and novel perspective on how and why we sleep.
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Affiliation(s)
- Thomas Andrillon
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris 75013, France; Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, VIC 3800, Australia.
| | - Delphine Oudiette
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris 75013, France
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30
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Andrillon T. How we sleep: From brain states to processes. Rev Neurol (Paris) 2023; 179:649-657. [PMID: 37625978 DOI: 10.1016/j.neurol.2023.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
All our lives, we alternate between wakefulness and sleep with direct consequences on our ability to interact with our environment, the dynamics and contents of our subjective experience, and our brain activity. Consequently, sleep has been extensively characterised in terms of behavioural, phenomenological, and physiological changes, the latter constituting the gold standard of sleep research. The common view is thus that sleep represents a collection of discrete states with distinct neurophysiological signatures. However, recent findings challenge such a monolithic view of sleep. Indeed, there can be sharp discrepancies in time and space in the activity displayed by different brain regions or networks, making it difficult to assign a global vigilance state to such a mosaic of contrasted dynamics. Viewing sleep as a multidimensional continuum rather than a succession of non-overlapping and mutually exclusive states could account for these local aspects of sleep. Moving away from the focus on sleep states, sleep can also be investigated through the brain processes that are present in sleep, if not necessarily specific to sleep. This focus on processes rather than states allows to see sleep for what it does rather than what it is, avoiding some of the limitations of the state perspective and providing a powerful heuristic to understand sleep. Indeed, what is sleep if not a process itself that makes up wake up every morning with a brain cleaner, leaner and less cluttered.
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Affiliation(s)
- T Andrillon
- Paris Brain Institute, Sorbonne Université, Inserm, CNRS, 75013 Paris, France; Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, VIC 3800, Australia.
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31
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Lopez R, Micoulaud-Franchi JA, Peter-Derex L, Dauvilliers Y. Nocturnal agitation: From sleep state dissociation to sleep-related dissociative state. Rev Neurol (Paris) 2023; 179:675-686. [PMID: 37625976 DOI: 10.1016/j.neurol.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
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Affiliation(s)
- R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, PAM Team, Inserm U1028, CNRS UMR 5292, Lyon, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
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Norouzi E, Zakei A, Bratty AJ, Khazaie H. The Relationship Between Slow Wave Sleep and Blood Oxygen Saturation Among Patients With Apnea: Retrospective Study. SLEEP MEDICINE RESEARCH 2023; 14:149-154. [DOI: 10.17241/smr.2023.01725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2024] Open
Abstract
Background and Objective Prior research suggests that slow wave sleep (SWS) is disrupted in people with obstructive sleep apnea (OSA). However, it was not clear whether the reduction in SWS is related to abnormal breathing or the extent of OSA as determined by the minimum oxygen saturation. Further, there is limited research on the relationship between oxygen saturation and SWS. The present study examined the relationship between SWS and minimum oxygen saturation levels in patients with OSA.Methods The sample consisted of 589 patients with OSA (mean age: 48.54 years) who completed full-night polysomnography.Results Results showed that there was a significant difference in SWS scores across three apnea-hypopnea index (AHI) groups (AHI score 5–15 for mild apnea, 16–30 for moderate apnea, and >30 for severe apnea). Lower SWS scores were observed in the severe apnea group. Additionally, results indicated that as oxygen saturation decreased, the SWS scores decreased.Conclusions Results from this study indicate that oxygen saturation significantly predicts SWS amounts. These findings suggest that interventions for low oxygen saturation could enhance the amounts of SWS. The clinical ramifications of these findings are worthy of consideration.
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Spector AR. Non-REM Sleep Parasomnias. Continuum (Minneap Minn) 2023; 29:1117-1129. [PMID: 37590825 DOI: 10.1212/con.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Non-rapid eye movement (non-REM) parasomnias are common across the lifespan. This article describes the manifestations, diagnosis, and management of non-REM parasomnias in adults and discusses the social implications of these conditions. LATEST DEVELOPMENTS Non-REM parasomnias represent a hybrid state of wakefulness and sleep, often triggered by events that increase the frequency of arousals or make it more difficult to fully arouse from sleep. Sleep deprivation, certain medications, and untreated obstructive sleep apnea are known to provoke parasomnias, particularly in those who are genetically predisposed. Non-REM parasomnias include disorders of arousal (ie, sleepwalking, sleep terrors, and confusional arousals), sleep-related eating disorder, and exploding head syndrome. Clinical overlap exists between sleep-related eating disorder and disorders of arousal, suggesting that sleep-related eating disorder may be a fourth disorder of arousal or a manifestation of sleepwalking. Exploding head syndrome is a unique parasomnia of uncertain etiology. ESSENTIAL POINTS Non-REM parasomnias can range from minor nuisances to severe, life-altering events. While some patients with non-REM parasomnia experience significant consequences during sleep, wakefulness, or both, non-REM parasomnias do not pose a major risk to most patients. For all patients with non-REM parasomnias, safety should be explicitly discussed and addressed. Nonpharmacologic treatment should be prioritized, as increasing total sleep time, avoiding triggering substances, and treating comorbid sleep disorders is often sufficient for the management of non-REM parasomnias. If symptoms persist despite these interventions, treatment with clonazepam or other medications can be considered.
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Carbone EA, Menculini G, de Filippis R, D’Angelo M, Zebi L, Steardo L. Sleep Disturbances in Panic Disorder with Comorbid Complex PTSD: A Possible Relationship and Different Psychopathology? Life (Basel) 2023; 13:1636. [PMID: 37629493 PMCID: PMC10455867 DOI: 10.3390/life13081636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Several studies have shown the possible link between trauma and sleep disturbances, particularly in anxiety disorders. This issue could be because sympathetic hyperarousal is central to both disorders, probably caused by a dysregulation of the noradrenergic system. This study aimed to establish if the comorbidity with complex post-traumatic stress disorder (cPTSD) is associated with sleep disturbances in panic disorder (PD) and if the presence of poor sleep quality is associated with a higher psychopathological burden. METHODS Participants (N = 211) with PD completed the International Trauma Questionnaire concerning their most troubling experience, the Hamilton Anxiety Rating Scale (HAM-A), and the Pittsburgh Sleep Quality Index (PSQI) to assess anxiety symptoms and sleep disturbances, respectively. RESULTS The sample was divided into two subgroups based on the presence of cPTSD. No significant differences emerged in the bivariate analyses for what concerns sociodemographic features. As for the scores of the psychopathological scales, the analysis highlighted statistically significant differences between the subgroups. Subjects with cPTSD reported significantly higher HAM-A total scores. As for the disturbances in self-organization (DSO) and PSQI scores, these were all significantly higher in the cPTSD subsample. At the logistic regression, the presence of cPTSD was inserted as the dependent variable, while the PSQI scores of the subscales evaluating subjective sleep quality, sleep duration, sleep efficacy, and the use of hypnotics were used as independent variables. The presence of cPTSD was significantly associated with the PSQI subscores for subjective sleep quality and use of hypnotics. CONCLUSIONS Patients with PD exhibit more severe sleep disturbances and a higher anxiety burden when experiencing prolonged trauma. Therapeutic advances are needed in this field to target these symptomatologic domains.
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Affiliation(s)
- Elvira Anna Carbone
- Department of Medical and Surgical Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Giulia Menculini
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132 Perugia, Italy; (G.M.); (L.Z.)
| | - Renato de Filippis
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
| | - Martina D’Angelo
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
| | - Leonardo Zebi
- Department of Psychiatry, University of Perugia, Piazzale Lucio Severi, 1, 06132 Perugia, Italy; (G.M.); (L.Z.)
| | - Luca Steardo
- Department of Health Sciences, University “Magna Græcia”, 88100 Catanzaro, Italy; (R.d.F.); (M.D.)
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Lopez R, Barateau L, Chenini S, Rassu AL, Dauvilliers Y. Home nocturnal infrared video to record non-rapid eye movement sleep parasomnias. J Sleep Res 2023; 32:e13732. [PMID: 36122661 DOI: 10.1111/jsr.13732] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
To assess the feasibility, the acceptability and the usefulness of home nocturnal infrared video in recording the frequency and the complexity of non-rapid eye movement sleep parasomnias in adults, and in monitoring the treatment response. Twenty adult patients (10 males, median age 27.5 years) with a diagnosis of non-rapid eye movement parasomnia were consecutively enrolled. They had a face-to-face interview, completed self-reported questionnaires to assess clinical characteristics and performed a video-polysomnography in the Sleep Unit. Patients were then monitored at home during at least five consecutive nights using infrared-triggered cameras. They completed a sleep diary and questionnaires to evaluate the number of parasomniac episodes at home and the acceptability of the home nocturnal infrared video recording. Behavioural analyses were performed on home nocturnal infrared video and video-polysomnography recordings. Eight patients treated by clonazepam underwent a second home nocturnal infrared video recording during five consecutive days. All patients had at least one parasomniac episode during the home nocturnal infrared video monitoring, compared with 75% during the video-polysomnography. A minimum of three consecutive nights with home nocturnal infrared video was required to record at least one parasomniac episode. Most patients underestimated the frequency of episodes on the sleep diary compared with home nocturnal infrared video. Episodes recorded at home were often more complex than those recorded during the video-polysomnography. The user-perceived acceptability of the home nocturnal infrared video assessment was excellent. The frequency and the complexity of the parasomniac episodes decreased with clonazepam. Home nocturnal infrared video has good feasibility and acceptability, and may improve the evaluation of the phenotype and severity of the non-rapid eye movement parasomnias and of the treatment response in an ecological setting.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Lucie Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Sofiène Chenini
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Anna Laura Rassu
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy - Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France.,Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
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YAZICI S, ÖNCÜ ÇETİNKAYA B. Sleep Disorders during Adolescence. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1105463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sleep disorders during adolescence period increase each year and adversely affect the physical and mental health of adolescents. After-school social activities and various work outside the school may cause delays in bedtime. In addition, there can be shifts in the circadian rhythm due to a number of biological changes seen in the transition to adolescence, which can result in a wide range of sleep problems, such as not being able to fall asleep at night, difficulty waking up in the morning, daytime sleepiness, sleep deprivation and deterioration in sleep quality. It is important to know the causes of sleep disorders, possible effects on physical health and mental health, and protective and risk-forming factors seen in adolescent period; to intervene in these disorders and to develop preventive measures. Preventive measures, such as increasing awareness about sleep disorders in adolescents, informing families and adolescents about the issue, and organizing school start-up times for this age group, may contribute significantly to solving this important issue, which has increased year-to-year.
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Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, Castelnovo A. Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults. Diagnostics (Basel) 2023; 13:diagnostics13071261. [PMID: 37046480 PMCID: PMC10093221 DOI: 10.3390/diagnostics13071261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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Lei L, Wang Y, Zhao F, Jiang Z, Zhao Y, Yu L, Zhu P, Zou J. Behavioral and cognitive outcomes of habitual snoring in children aged 2-14 years in Chengdu, Sichuan. Am J Otolaryngol 2023; 44:103691. [PMID: 36669275 DOI: 10.1016/j.amjoto.2022.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/18/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Habitual snoring is associated with cognitive, behavioral, and other physiological problems of children. Few studies have reported specifically on the relationships between snoring and those problems in children as noticed by their parents. We aimed to identify the cognitive, behavioral, and sleep-related nocturnal problems in children with HS as noted by their parents. MATERIALS AND METHODS A cross-sectional survey was performed in Chengdu, Sichuan, China. Children aged 2-14 years from four districts were randomly chosen to participate. Questionnaires were completed voluntarily by the children's parents/guardians. RESULTS A total of 1548 questionnaires were analyzed and classified those children as 463 habitual snorers (HS group, 30.4 %), 683 occasional snorers (OS group, 44.8 %), and 402 non-snorers (NS group, 26.4 %). The percentages of children with sleep-related nocturnal symptoms were 94.6 %, 87.3 %, and 66.9 % in the HS, OS, and NS groups. Percentages of children with cognitive problems were 76.2 %, 74.6 %, and 64.9 % in the HS, OS, and NS groups, respectively (P < 0.001). The frequencies of daytime behavioral problems were 68.3 %, 61.5 %, and 46.8%in the HS, OS, and NS groups, respectively (P < 0.001).The average number of sleep-related nocturnal symptoms, cognitive symptoms and daytime behavioral problems was higher in the HS group than in the OS and NS groups. CONCLUSIONS HS is a significant contributor to sleep-related nocturnal symptoms and daytime cognitive and behavioral problems in children, as reported by their parents/guardians. HS and OS are important contributors to poor sleep quality and daytime cognitive and behavioral problems in children.
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Affiliation(s)
- Lei Lei
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Yifei Wang
- West China Medical School, Sichuan University, Sichuan, China
| | - Fanyu Zhao
- West China Medical School, Sichuan University, Sichuan, China
| | - Zijing Jiang
- West China Medical School, Sichuan University, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Lingyu Yu
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China
| | - Ping Zhu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Sichuan, China.
| | - Jian Zou
- Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, Sichuan, China.
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Laroche M, Biabani N, Drakatos P, Selsick H, Leschziner G, Steier J, Young AH, Eriksson S, Nesbitt A, Kumari V, Rosenzweig I, O’Regan D. Group Cognitive Behavioural Therapy for Non-Rapid Eye Movement Parasomnias: Long-Term Outcomes and Impact of COVID-19 Lockdown. Brain Sci 2023; 13:brainsci13020347. [PMID: 36831890 PMCID: PMC9953888 DOI: 10.3390/brainsci13020347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Prior to the COVID-19 pandemic, we demonstrated the efficacy of a novel Cognitive Behavioural Therapy programme for the treatment of Non-Rapid Eye Movement Parasomnias (CBT-NREMP) in reducing NREM parasomnia events, insomnia and associated mood severities. Given the increased prevalence and worsening of sleep and affective disorders during the pandemic, we examined the sustainability of CBT-NREMP following the U.K.'s longest COVID-19 lockdown (6 January 2021-19 July 2021) by repeating the investigations via a mail survey in the same 46 patient cohort, of which 12 responded. The survey included validated clinical questionnaires relating to NREM parasomnia (Paris Arousal Disorder Severity Scale), insomnia (Insomnia Severity Index) and anxiety and depression (Hospital Anxiety and Depression Scale). Patients also completed a targeted questionnaire (i.e., Impact of COVID-19 Lockdown Questionnaire, ICLQ) to assess the impact of COVID-19 lockdown on NREM parasomnia severity, mental health, general well-being and lifestyle. Clinical measures of NREM parasomnia, insomnia, anxiety and depression remained stable, with no significant changes demonstrated in questionnaire scores by comparison to the previous investigatory period prior to the COVID-19 pandemic: p (ISI) = 1.0; p (HADS) = 0.816; p (PADSS) = 0.194. These findings support the longitudinal effectiveness of CBT-NREMP for up to three years following the clinical intervention, and despite of the COVID-19 pandemic.
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Affiliation(s)
- Matthias Laroche
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
| | - Nazanin Biabani
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
| | - Hugh Selsick
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
- Insomnia and Sleep Medicine Behavioural Clinic, Royal London Hospital for Integrated Medicine, London WCIN 3HR, UK
| | - Guy Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
- Department of Neurology, Guy’s Hospital, London SE1 9RT, UK
- Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
| | - Joerg Steier
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
| | - Sofia Eriksson
- National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Alexander Nesbitt
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
- Department of Neurology, Guy’s Hospital, London SE1 9RT, UK
| | - Veena Kumari
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
- Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box 089, De Crespigny Park, London SE5 8AF, UK
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
| | - David O’Regan
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London SE1 9RT, UK
- Faculty of Life Sciences and Medicine, King’s College, London WC2R 2LS, UK
- Correspondence: david.o’
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Psychobiological personality traits of children and adolescents with disorders of arousal. J Psychiatr Res 2023; 158:42-48. [PMID: 36571910 DOI: 10.1016/j.jpsychires.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/17/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Disorders of arousal (DOA) are parasomnias that emerge from incomplete arousal out of Non-Rem Sleep (NREM) and lead to a broad variety of emotional and motor behaviours. Increasing evidence supports the hypothesis that specific psychopathological traits contribute to the multifactorial origin of these phenomena. The aim of the current multicenter study was to compare the personality profile of children and adolescents with and without DOA using the Junior Temperament and Character Inventory (JTCI). METHODS We enrolled 36 patients with a diagnosis of DOA (mean age of 11 ± 3 years, 64% males), and 36 healthy age and gender matched control subjects (mean age of 11.2 ± 3.6, years, 67% males). Their parents completed the Paris Arousal Disorder Severity Scale (PADSS), the Sleep Disturbance Scale for Children (SDSC) and the JTCI. RESULTS Patients with DOA reached significantly higher levels compared to their control group in total PADSS (p < 0.0001) and in total SDSC (p < 0.0001). They also displayed higher scores in novelty seeking (p = 0.005), harm avoidance (p = 0.01), self-transcendence (p = 0.006) JTCI subscales, and lower scores on the self-directedness subscale (p = 0.004). CONCLUSION Our pediatric sample with DOA exhibited specific psychobiological personality traits compared to age and gender matched subjects without DOA. These results shed light on new possible etiopathogenetic mechanisms, as TCI traits have been linked to specific genetic variants and brain circuits, like the reward system. Prospective studies are required to assess the effect of targeted psychological/psychiatric treatment on DOA symptomatology.
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Gauld C, Martin VP, Richaud A, Baillieul S, Vicente L, Perromat JL, Zreik I, Taillard J, Geoffroy PA, Lopez R, Micoulaud-Franchi JA. Systematic Item Content and Overlap Analysis of Self-Reported Multiple Sleep Disorder Screening Questionnaires in Adults. J Clin Med 2023; 12:852. [PMID: 36769500 PMCID: PMC9918039 DOI: 10.3390/jcm12030852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Sleep disorders are defined on the basis of diagnostic criteria presented in medical classifications. However, no consensus has emerged on the exact list of operational symptoms that should be systematically investigated in the field of sleep medicine. We propose a systematic analysis of sleep symptoms that figure in a set of self-reported multiple sleep disorder screening questionnaires for adult populations, to identify the content overlap of symptoms that probe the presence of central sleep symptoms, and to highlight the potential level of heterogeneity among sleep disorder questionnaires. The method comprises three steps: (i) the selection of self-reported multiple sleep disorder screening questionnaires; (ii) item extraction and selection; (iii) the extraction of symptoms from items. Frequency of sleep symptoms and content overlap (Jaccard Index) are analyzed. We extracted 469 items that provide 60 different symptoms from 12 questionnaires. Insomnia, somnolence, and sleep-related breathing symptoms were found in all the questionnaires. The mean overlap among all questionnaires evaluated with the Jaccard Index is 0.44, i.e., moderate similarity. Despite limitations related to the selection of questionnaires and the symptom extraction and harmonization, this study underlines the need to standardize sleep symptom contents for sleep medicine in order to enhance the practicability, reliability, and validity of sleep disorder diagnoses.
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Affiliation(s)
- Christophe Gauld
- Service Psychopathologie du Développement de l’Enfant et de l’Adolescent, Hospices Civils de Lyon & Université de Lyon 1, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Vincent P. Martin
- CNRS, Bordeaux INP, LaBRI, UMR 5800, University of Bordeaux, 33400 Talence, France
- CNRS, SANPSY, UMR 6033, University of Bordeaux, 33000 Bordeaux, France
| | - Alexandre Richaud
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France
| | - Sébastien Baillieul
- HP2 Laboratory, INSERM U1042, Grenoble Alpes University, 38400 Grenoble, France
- Pôle Thorax et Vaisseaux, Grenoble Alpes University Hospital, 38700 Grenoble, France
| | - Lucie Vicente
- CNRS, SANPSY, UMR 6033, University of Bordeaux, 33000 Bordeaux, France
| | | | - Issa Zreik
- CNRS, SANPSY, UMR 6033, University of Bordeaux, 33000 Bordeaux, France
| | - Jacques Taillard
- CNRS, SANPSY, UMR 6033, University of Bordeaux, 33000 Bordeaux, France
| | - Pierre Alexis Geoffroy
- Département de Psychiatrie et d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, 75018 Paris, France
- GHU Paris-Psychiatry & Neurosciences, 1 Rue Cabanis, 75014 Paris, France
- NeuroDiderot, Inserm, Université de Paris, FHU I2-D2, 75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), Université de Montpellier, 34000 Montpellier, France
- Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, 34000 Montpellier, France
| | - Jean-Arthur Micoulaud-Franchi
- CNRS, SANPSY, UMR 6033, University of Bordeaux, 33000 Bordeaux, France
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France
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Mainieri G, Loddo G, Baldelli L, Montini A, Mondini S, Provini F. Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, 40100 Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Angelica Montini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
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Petit JM, Strippoli MPF, Stephan A, Ranjbar S, Haba-Rubio J, Solelhac G, Heinzer R, Preisig M, Siclari F, Do KQ. Sleep spindles in people with schizophrenia, schizoaffective disorders or bipolar disorders: a pilot study in a general population-based cohort. BMC Psychiatry 2022; 22:758. [PMID: 36463186 PMCID: PMC9719140 DOI: 10.1186/s12888-022-04423-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sleep spindles have been involved in sleep stabilization and sleep-related memory mechanisms and their deficit emerged as possible biomarker in schizophrenia. However, whether this sleep phenotype is also present in other disorders that share psychotic symptoms remains unclear. To address this gap, we assessed sleep spindles in participants of a prospective population-based cohort who underwent psychiatric assessment (CoLaus|PsyCoLaus) and polysomnographic recording (HypnoLaus). METHODS Sleep was recorded using ambulatory polysomnography in participants (N = 1037) to the PsyCoLaus study. Sleep spindle parameters were measured in people with a lifelong diagnosis of schizophrenia (SZ), schizoaffective depressive (SAD), schizoaffective manic (SAM), bipolar disorder type I (BP-I) and type II (BP-II). The associations between lifetime diagnostic status (independent variables, SZ, SAD, SAM, BPD-I, BPD-II, controls) and spindle parameters (dependent variables) including density, duration, frequency and maximum amplitude, for all (slow and fast), slow- and fast-spindle were assessed using linear mixed models. Pairwise comparisons of the different spindle parameters between the SZ group and each of the other psychiatric groups was performed using a contrast testing framework from our multiple linear mixed models. RESULTS Our results showed a deficit in the density and duration of sleep spindles in people with SZ. They also indicated that participants with a diagnosis of SAD, SAM, BP-I and BP-II exhibited different sleep spindle phenotypes. Interestingly, spindle densities and frequencies were different in people with a history of manic symptoms (SAM, BP-I, and BP-II) from those without (SZ, SAD). CONCLUSIONS Although carried out on a very small number of participants due to the low prevalence of these disorders in general population, this pilot study brought new elements that argued in favor of a deficit of sleep spindles density and duration in people with schizophrenia. In addition, while we could expect a gradual change in intensity of the same sleep spindle parameters through psychotic diagnoses, our results seem to indicate a more complex situation in which the frequency of sleep spindles might be more impacted by diagnoses including a history of mania or hypomania. Further studies with a larger number of participants are required to confirm these effects.
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Affiliation(s)
- Jean-Marie Petit
- Center for Psychiatric Neuroscience (CNP), CHUV, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Route de Cery 11c, CH-1008, Prilly, Switzerland.
| | - Marie-Pierre F. Strippoli
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Aurélie Stephan
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Serateh Ranjbar
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - José Haba-Rubio
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Geoffroy Solelhac
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphaël Heinzer
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Francesca Siclari
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kim Q. Do
- grid.414250.60000 0001 2181 4933Center for Psychiatric Neuroscience (CNP), CHUV, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Route de Cery 11c, CH-1008 Prilly, Switzerland
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Mora-Munoz L, Alsheikhtaha Z, Foldvary-Schaefer N. Differential Diagnosis of Complex Nocturnal Behaviors. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00238-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Walsh SM, Forward CL, Flaherty GT. Parasomnias during trans-meridian and long-distance travel: Critical literature review and clinical practice recommendations. J Sleep Res 2022; 31:e13672. [PMID: 35726362 PMCID: PMC9786733 DOI: 10.1111/jsr.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Parasomnias are undesirable events that occur during sleep. They can be classified into rapid eye movement parasomnias and non-rapid eye movement parasomnias. Those who experience parasomnias may be anxious about travel for many reasons, including the occurrence of unwanted events during the trip, increased exposure to environmental trigger factors, and the propensity for harm to occur due to unfamiliar surroundings while travelling. There is a paucity of literature examining this area. This review summarizes the relevant literature and the clinical experience of the authors to compile clinical practice recommendations. The clinical features of parasomnias and how they relate to trans-meridian and long-distance travel are described. Triggers for non-rapid eye movement parasomnias, particularly the use of sedative hypnotic drugs, alcohol, drug withdrawal, sleep deprivation, emotional stress and environmental stimulations, are described. Management of parasomnias whilst travelling is reviewed, with a particular focus on trigger minimalization. The role for clonazepam and melatonin is outlined. At the pre-travel health consultation, the physician is strongly advised to screen the traveller for co-morbid sleep conditions, which exacerbate parasomnias. Areas for further research are explored, including the extent to which these sleep disorders impact on the travel experience.
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Affiliation(s)
- Sinead M. Walsh
- School of MedicineNational University of Ireland GalwayGalwayIreland,Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Cameron L. Forward
- Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Gerard T. Flaherty
- School of MedicineNational University of Ireland GalwayGalwayIreland,School of MedicineInternational Medical UniversityKuala LumpurMalaysia
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Predictive coding, multisensory integration, and attentional control: A multicomponent framework for lucid dreaming. Proc Natl Acad Sci U S A 2022; 119:e2123418119. [PMID: 36279459 PMCID: PMC9636904 DOI: 10.1073/pnas.2123418119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Lucid dreaming (LD) is a mental state in which we realize not being awake but are dreaming while asleep. It often involves vivid, perceptually intense dream images as well as peculiar kinesthetic sensations, such as flying, levitating, or out-of-body experiences. LD is in the cross-spotlight of cognitive neuroscience and sleep research as a particular case to study consciousness, cognition, and the neural background of dream experiences. Here, we present a multicomponent framework for the study and understanding of neurocognitive mechanisms and phenomenological aspects of LD. We propose that LD is associated with prediction error signals arising during sleep and occurring at higher or lower levels of the processing hierarchy. Prediction errors are resolved by generating a superordinate self-model able to integrate ambiguous stimuli arriving from sensory periphery and higher-order cortical regions. While multisensory integration enables lucidity maintenance and contributes to peculiar kinesthetic experiences, attentional control facilitates multisensory integration by dynamically regulating the balance between the influence of top-down mental models and the precision weighting of bottom-up sensory inputs. Our novel framework aims to link neural correlates of LD with current concepts of sleep and arousal regulation and provide testable predictions on interindividual differences in LD as well as neurocognitive mechanisms inducing lucid dreams.
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Walsh C, Mitchell L, Hrozanova M, Kotoulas SC, Derry C, Morrison I, Riha RL. NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors. Clocks Sleep 2022; 4:549-560. [PMID: 36278536 PMCID: PMC9624320 DOI: 10.3390/clockssleep4040043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 12/03/2022] Open
Abstract
Objective/Background: Phenotyping of non-rapid-eye-movement (NREM) parasomnias is currently poorly undertaken. This study aimed to determine whether there are differences phenotypically among childhood-, adolescent-, and adult-onset NREM parasomnias continuing into and presenting in adulthood. Patients/Methods: A retrospective, cohort study of patients presenting with NREM parasomnia between 2008 and 2019 (n = 307) was conducted. Disorders included sleepwalking (n = 231), night terrors (n = 150), sexualised behaviour in sleep (n = 50), and sleep-related eating disorder (n = 28). Results: Compared to the adult-onset NREM behaviours group, the childhood- and adolescent-onset groups were more likely to have a family history of NREM behaviours (p < 0.001), experience a greater spectrum of NREM disorders (p = 0.001), and report a history of sleep-talking significantly more frequently (p = 0.014). Atopy was most prevalent in the childhood-onset group (p = 0.001). Those with childhood-onset NREM parasomnias were significantly more likely to arouse from N3 sleep on video polysomnography (p = 0.0003). Psychiatric disorders were more likely to be comorbid in the adult-onset group (p = 0.012). A history of trauma coinciding with onset of NREM behaviours was significantly more common in the childhood- and adolescent-onset groups (p < 0.001). Conclusions: Significant differences exist across childhood-, adolescent-, and adult-onset NREM parasomnia presenting in adulthood. This study suggests that adult-onset slow-wave sleep disorders may be confounded by psychiatric disorders resulting in nocturnal sleep disruption and that unresolved traumatic life experiences perpetuate NREM disorders arising in childhood and comprise one of the strongest external risk factors for triggering and perpetuating these disorders in adolescence.
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Affiliation(s)
- Cara Walsh
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Lee Mitchell
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Maria Hrozanova
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Serafeim-Chrysovalantis Kotoulas
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Christopher Derry
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
| | - Ian Morrison
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
- Department of Neurology, Ninewells Hospital, Dundee DD1 9SY, Scotland, UK
| | - Renata L. Riha
- Sleep Research Unit, Department of Sleep Medicine, The University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, Scotland, UK
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Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, Pizzarotti S, Zilioli A, Misirocchi F, Mutti C. Sleep medicine: Practice, challenges and new frontiers. Front Neurol 2022; 13:966659. [PMID: 36313516 PMCID: PMC9616008 DOI: 10.3389/fneur.2022.966659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
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Affiliation(s)
- Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- *Correspondence: Liborio Parrino
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szucs
- Department of Behavioral Sciences, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Nicoletta Azzi
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
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Gnoni V, Duncan I, Wasserman D, Higgins S, Drakatos P, Birdseye A, Pérez-Carbonell L, Nesbitt A, Koutroumanidis M, Leschziner G, Rosenzweig I. Nocturnal visual hallucinations in patients with disorders of arousal: a novel behavioral and EEG pattern. Croat Med J 2022; 63. [PMID: 36325668 PMCID: PMC9648088 DOI: 10.3325/cmj.2022.63.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate clinical and video-polysomnography (VPSG) findings of hallucinatory experiences in patients suffering from disorders of arousal (DOA) in the absence of other pathologies. METHODS The authors retrospectively reviewed the records of 370 adults with DOA. Thirty (8.1%) patients concomitantly reported complex nocturnal visual hallucinations. VPSG recordings were scrutinized, and motor behavioral and electroencephalogram (EEG) patterns were classified according to previous descriptions of DOA. RESULTS Thirty DOA patients reported seeing images of objects, people, and animals; either distorted, static, or mobile. The images disappeared with increased illumination in 80% of patients, and 23.3% reported preceding dream imagery. In addition to the classical DOA patterns on VPSG, a distinct pattern of behavioral and EEG manifestation associated with complex hallucinatory episodes was identified in 16 (53.3%) DOA patients. This consisted of low-voltage mixed-frequency EEG activity before eye opening that persisted while patients were observed staring or visually tracking before the onset of motor behavior. CONCLUSION A novel, distinct behavioral and EEG pattern in patients with DOA and history of reported complex nocturnal visual hallucinations was identified. This may represent a unique phenotype of dissociation between sleep states that merits further investigation.
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Affiliation(s)
- Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK
| | - Iain Duncan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK
| | - Danielle Wasserman
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK
| | - Panagis Drakatos
- Sleep Disorders Centre, Guy's Hospital, London, UK,Faculty of Life Sciences and Medicine King’s College London, London, UK
| | | | | | - Alexander Nesbitt
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK,Department of Neurology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Guy Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK,Department of Neurology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK,Sleep Disorders Centre, Guy's Hospital, London, UK
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50
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Laganière C, Gaudreau H, Pokhvisneva I, Kenny S, Bouvette-Turcot AA, Meaney M, Pennestri MH. Sleep terrors in early childhood and associated emotional-behavioral problems. J Clin Sleep Med 2022; 18:2253-2260. [PMID: 35686369 PMCID: PMC9435351 DOI: 10.5664/jcsm.10080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES While sleep terrors are associated with emotional-behavioral problems in school-aged children and adults, little is known about these associations in early childhood, when sleep terrors prevalence is at its highest. Moreover, studies using a longitudinal design and controlling for confounding variables are scarce. This study's objective was to determine whether the frequency of sleep terrors in toddlers predicts emotional-behavioral problems during the preschool years. METHODS Participants (n = 324) were enrolled in the prospective Maternal Adversity Vulnerability and Neurodevelopment cohort study. The frequency of sleep terrors in children was assessed at 12, 18, 24, and 36 months using maternal reports. Children's emotional-behavioral problems were measured at 48 and 60 months using the Child Behavior Checklist. Relevant confounders linked to the child, mother, and environment were also taken into consideration. RESULTS The frequency of sleep terrors was relatively stable across early childhood (16.7-20.5%). A generalized estimating equation revealed that the frequency of sleep terrors in early childhood was associated with increased emotional-behavioral problems at 4 and 5 years of age, more specifically with internalizing problems (P < .001), after controlling for child's sex, time point, family socioeconomic status, maternal depressive symptoms, and nighttime sleep duration. The frequency of sleep terrors was further associated with the emotionally reactive, anxious/depressed, and somatic complaints scales (P < .01). CONCLUSIONS This longitudinal study provides further support for a high prevalence of sleep terrors in early childhood. Our findings show meaningful associations between higher frequency of sleep terrors and emotional-behavioral problems as early as toddlerhood, especially internalizing problems. CITATION Laganière C, Gaudreau H, Pokhvisneva I, et al. Sleep terrors in early childhood and associated emotional-behavioral problems. J Clin Sleep Med. 2022;18(9):2253-2260.
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Affiliation(s)
- Christine Laganière
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Hélène Gaudreau
- Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Samantha Kenny
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Andrée-Anne Bouvette-Turcot
- Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
| | - Michael Meaney
- Douglas Mental Health University Institute, Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Hélène Pennestri
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Hôpital en Santé Mentale Rivière-des-Prairies, Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Ile-de-Montréal, Montreal, Quebec, Canada
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