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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: 0] [Impact Index Per Article: 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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2
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Hefnawy MT, Amer BE, Amer SA, Moghib K, Khlidj Y, Elfakharany B, Mouffokes A, Alazzeh ZJ, Soni NP, Wael M, Elsayed ME. Prevalence and Clinical Characteristics of Sleeping Paralysis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53212. [PMID: 38425633 PMCID: PMC10902800 DOI: 10.7759/cureus.53212] [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: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Sleep paralysis (SP) is a mixed state of consciousness and sleep, combining features of rapid eye movement (REM) sleep with those of wakefulness. The exact cause of SP is unknown, and its prevalence varies among the studies. We aim to identify SP's global prevalence, the affected population's characteristics, and the SP's clinical picture. We searched three databases (PubMed, Scopus, and Web of Science (WoS)) using a unique search strategy to identify eligible studies. All observational studies identifying the prevalence or frequency of sleeping paralysis were included. No exclusions are made based on country, race, or questionnaire. The analysis was performed using the latest version of R software (R Core Team, Vienna, Austria). The analysis included 76 studies from 25 countries with 167,133 participants. The global prevalence of SP was 30% (95% CI (22%, 39%)). There were similar frequencies of isolated SP and SP (33%, 95% CI (26%, 42%), I2 = 97%, P <0.01; 31%, 95% CI (21%, 43%), I2 = 100%, P = 0, respectively). A subgroup analysis showed that the majority of those who experienced SP were psychiatric patients (35%, 95% CI (20%, 55%), I2 = 96%, P <0.01). The prevalence among non-psychiatric patients was among students (34%, 95% CI (23%, 47%), I2 = 100%, P = 0). Auditory and visual hallucinations were reported in 24.25% of patients. Around 4% had only visual hallucinations. Meta-regression showed no association between the frequency of SP and sex. Publication bias was detected among the included studies through visual inspection of funnel plot asymmetry. Our findings revealed that 30% of the population suffered from SP, especially psychiatric patients and students. The majority of SP cases lacked associated hallucinations, while a noteworthy proportion experienced combined visual and auditory hallucinations.
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Affiliation(s)
- Mahmoud T Hefnawy
- Faculty of Medicine, Zagazig University, Zagazig, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Basma E Amer
- Faculty of Medicine, Banha University, Banha, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Samar A Amer
- Family Medicine, Royal College of General Practice, London, GBR
- Faculty of Public Health and Community Medicine, Zagazig University, Zagazig, EGY
| | | | - Yehya Khlidj
- Faculty of Medicine, University of Algiers Benyoucef Benkhedda, Algiers, DZA
| | - Bahaa Elfakharany
- Faculty of Allied Medical Sciences, Pharos University, Alexandria, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Adel Mouffokes
- Internal Medicine, Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, DZA
| | - Zainab J Alazzeh
- Faculty of Medicine, Jordanian University of Science and Technology, Ar-Ramtha, JOR
| | - Nishant P Soni
- Medicine, Gujarat Medical Education and Research Society Medical College and Hospital, Ahmedabad, IND
| | - Muhannad Wael
- Urology, Saint Joseph Hospital, Jerusalem, PSE
- Faculty of Medicine, An-Najah National University, Nablus, PSE
| | - Mohamed E Elsayed
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, DEU
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3
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Liu L, Wang W, Gao N, Jia T, Guo L, Geng L, Ma Y. Risk factors of disturbed sleep phases to posterior circulation cerebral infarctions: A single-center retrospective study. Medicine (Baltimore) 2023; 102:e35479. [PMID: 37832098 PMCID: PMC10578694 DOI: 10.1097/md.0000000000035479] [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: 03/22/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Posterior circulation stroke differs from anterior circulation stroke in terms of etiological, clinical, and prognostic properties. Sleep architecture is impaired in patients with acute stroke, which may correlate with disease severity and outcome, and the correlation between the location of cerebral infarction (CI) and sleep phase disturbance remains unknown. This study aimed to assess the correlation between disturbed sleep phases in CI and posterior circulation cerebral infarction (PCCI). We retrospectively enrolled 192 patients with first-onset acute CI, who were assigned to the anterior circulation cerebral infarction (n = 101) and PCCI (n = 91) groups. The polysomnograms in both groups were analyzed by phase. The proportions of sleep phases were significantly different between the 2 groups (P < .05). The awake (W) and non-rapid eye movement 3 (N3) phases were independently associated with PCCI in multivariate analysis. The W phase may be a risk factor for PCCI (odds ratio = 1.60, 95% CI 1.30-1.97), while the N3 phase may be a protective factor for PCCI (odds ratio = 0.498, 95% CI 0.353-0.703). This study demonstrated that CI causes different degrees of sleep phase disturbances, and the percentages of W and N3 phase disturbances were independent factors associated with PCCI. The former was a risk factor, whereas the latter was a protective factor. This study demonstrated the correlation between cerebral infarction and sleep phase disturbances from a new perspective and suggested that cerebral infarcts may alter the structure of sleep.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Weiping Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Nan Gao
- Department of Cardiology, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Tongle Jia
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liying Geng
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, Hebei, China
| | - Yaning Ma
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, Hebei, China
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Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med 2023; 19:1661-1668. [PMID: 37128719 PMCID: PMC10476037 DOI: 10.5664/jcsm.10642] [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: 01/26/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
STUDY OBJECTIVES Vivid dreams are dreams that feel real or are associated with dream enactment behavior. They are prevalent in veterans, especially in those with psychiatric disorders such as post-traumatic stress disorders. Such psychiatric disorders have known association with abnormalities in rapid eye movement (REM) sleep. Vivid dreams are also described in neurological conditions, such Lewy body dementias, which are also associated with REM sleep abnormality. Although vivid dreams occur in neuropsychiatric disorders that have REM sleep abnormalities, there are no studies that have directly investigated an association between vivid dreams and REM sleep. We sought to study vivid dreams and REM sleep in veterans. METHODS Veterans undergoing polysomnography at our hospital were invited to enroll. Participants completed a dream-related questionnaire the morning after their polysomnography. RESULTS We prospectively enrolled 505 veterans. After a night in the sleep laboratory, 196 of 504 (39%) reported experiencing a dream, and, of those, 117 of 190 (62%) described their dream as vivid. Discrepancies in patient totals are secondary to missing questionnaire data. Our novel finding is that participants with a high percentage of REM sleep (above 25%) were more than twice likely to report a vivid dream than participants with a lower percentage of REM sleep (P < .0001). Nonvivid dreams were not associated with a high percentage of REM sleep. CONCLUSIONS Vivid dreams are associated with a high percentage of REM sleep. Further research into the role of REM sleep abnormalities in vivid dreams may help to advance understanding of neuropsychiatric disorders. CITATION Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med. 2023;19(9):1661-1668.
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Affiliation(s)
- Deema Fattal
- Neurology Department, University of Iowa, Iowa City, Iowa
- Iowa City VA Medical Center, Iowa City, Iowa
| | - Nicole Platti
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
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5
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Ibrahim A, Ferri R, Cesari M, Frauscher B, Heidbreder A, Bergmann M, Högl B, Stefani A. Large muscle group movements during sleep in healthy people: normative values and correlation to sleep features. Sleep 2023; 46:zsad129. [PMID: 37129552 PMCID: PMC10424171 DOI: 10.1093/sleep/zsad129] [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: 12/23/2022] [Revised: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
STUDY OBJECTIVES To investigate the frequency and characteristics of large muscle group movements (LMMs) during sleep in healthy adults. METHODS LMMs were scored following the International Restless Legs Syndrome Study Group criteria in 100 healthy participants aged 19-77 years. A LMM was defined as a temporally overlapping increase in EMG activity and/or the occurrence of movement artifacts in at least two channels. LMM indices and durations in total sleep time (TST), NREM and REM sleep, and association with arousals, awakenings, and/or respiratory events were calculated. Correlations of LMMs indices and durations with sleep architecture, respiratory and motor events, and subjective sleep quality were investigated. RESULTS Median LMMs index in TST was 6.8/h (interquartile range (IQR), 4.5-10.8/h), median mean duration 12.4 s (IQR 10.7-14.4 s). Mean LMMs duration was longer in NREM (median 12.7 s, IQR 11.1-15.2 s) versus REM sleep (median 10.3 s, IQR 8.0-13.5s), p < 0.001. LMMs associated with awakening increased with age (p = 0.029). LMMs indices in TST were higher in men than women (p = 0.018). LMMs indices correlated positively with N1 sleep percentage (ρ = 0.49, p < 0.001), arousal index (ρ = 0.40, p = 0.002), sleep stages shift index (ρ = 0.43, p < 0.001, apnea index (ρ = 0.36, p = 0.017), and video-visible movements indices (ρ = 0.45, p < 0.001), and negatively with N3 sleep (ρ = -0.38, p= 0.004) percentage. CONCLUSIONS This is the first study providing normative data on LMMs frequency in healthy adults. LMMs are a ubiquitous phenomenon often associated with other events. Correlation with arousals and respiratory events suggests a potential clinical significance of LMMs in adults that awaits further investigation.
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Affiliation(s)
- Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Analytical Neurophysiology Lab, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Melanie Bergmann
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Manners J, Appleton SL, Reynolds AC, Melaku YA, Gill TK, Lovato N, Sweetman A, Bickley K, Adams R, Lack L, Scott H. The Good Sleeper Scale-15 items: a questionnaire for the standardised assessment of good sleepers. J Sleep Res 2023; 32:e13717. [PMID: 36065002 DOI: 10.1111/jsr.13717] [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: 05/22/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples.
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Affiliation(s)
- Jack Manners
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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7
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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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8
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Hermann W, Flemming T, Brandt MD, Langner S, Reichmann H, Storch A. Asymmetry of Periodic Leg Movements in Sleep (PLMS) in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:255-266. [PMID: 31609696 DOI: 10.3233/jpd-191667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Periodic limb movements in sleep (PLMS) are repetitive movements usually of the legs strongly associated with Restless-legs syndrome (RLS), which appear more frequently in males, older age and other sleep disturbances, such as sleep-disordered breathing (SDB). Patients with Parkinson's disease (PD) suffer from various sleep disturbances including REM sleep behavior disorder, RLS and PLMS. Although a dopaminergic pathophysiology of PLMS is discussed, no systematic data on PLMS side-to-side distribution in PD and its correlation with asymmetry of motor symptoms are available. OBJECTIVE This study aimed at elucidating PLMS asymmetry in correlation to that of motor symptoms in PD compared to SDB and RLS. METHODS Cross-sectional, retrospective analysis of two polysomnography (PSG) recordings per patient scoring PLMS separately for both legs. RESULTS Of 105 patients (44 PD, 44 age- and sex-matched SDB and 17 RLS patients) PLMS measures (number of PLM, PLM-Index, PLM-arousal index) showed significant side-to-side differences in all disease entities in both PSGs (P < 0.001; Wilcoxon rank test). PLM-Index asymmetry (PLM-I difference of >5/h between both sides) was observed less frequently in PD (34% of patients) compared to RLS (77% , P < 0.05) and SDB (59% , P < 0.05; χ2 test). In asymmetric PD patients, predominant side of PLMS was more stable than in SDB and RLS comparing the two PSGs, but we did not detect an agreement between PLMS predominant side with that of motor symptoms in PD patients. CONCLUSIONS Only the minority of PD patients shows asymmetric PLMS distribution with relatively high night-to-night stability but no correlation with motor symptom asymmetry.
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Affiliation(s)
- Wiebke Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - Theresa Flemming
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Moritz D Brandt
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Simona Langner
- Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
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9
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Abstract
Sleep disorders in Parkinson disease have attracted the attention of clinicians and researchers for decades. Recently, major advances in their clinical characterization, polysomnographic description, pathophysiologic understanding, and treatment took place. Parkinson disease encompasses the whole spectrum of sleep medicine: every category of sleep disorder can be observed in these patients. Video polysomnography frequently is indicated, sometimes followed by multiple sleep latency/maintenance of wakefulness tests. Additional studies may include actigraphy, cardiorespiratory polygraphy, and dim light melatonin assessment. Treatment needs to be specific to the underlying sleep disorder and can include medications and nondrug treatments, for example, behavioral therapy and light therapy.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Anichstr. 35, Innsbruck 6020, Austria.
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10
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Roguski A, Rayment D, Whone AL, Jones MW, Rolinski M. A Neurologist's Guide to REM Sleep Behavior Disorder. Front Neurol 2020; 11:610. [PMID: 32733361 PMCID: PMC7360679 DOI: 10.3389/fneur.2020.00610] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
REM Sleep Behavior Disorder (RBD) is a chronic sleep condition characterized by dream enactment and loss of REM atonia. Individuals often present to clinic with complaints of injury to themselves or their bed-partner due to violent movements during sleep. RBD patients have a high risk of developing one of the neurodegenerative α-synucleinopathy diseases: over 70% will develop parkinsonism or dementia within 12 years of their diagnosis. RBD patients also exhibit accelerated disease progression and a more severe phenotype than α-synucleinopathy sufferers without RBD. The disease's low prevalence and the relatively limited awareness of the condition amongst medical professionals makes the diagnosis and treatment of RBD challenging. Uncertainty in patient management is further exacerbated by a lack of clinical guidelines for RBD patient care. There are no binary prognostic markers for RBD disease course and there are no clinical guidelines for neurodegeneration scaling or tracking in these patients. Both clinicians and patients are therefore forced to deal with uncertain outcomes. In this review, we summarize RBD pathology and differential diagnoses, diagnostic, and treatment guidelines as well as prognostic recommendations with a look to current research in the scientific field. We aim to raise awareness and develop a framework for best practice for RBD patient management.
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Affiliation(s)
- Amber Roguski
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Dane Rayment
- Rosa Burden Centre, Southmead Hospital, Bristol, United Kingdom
| | - Alan L Whone
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Matt W Jones
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, United Kingdom
| | - Michal Rolinski
- Department of Neurology, Southmead Hospital, Bristol, United Kingdom.,Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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11
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Stefani A, Högl B. Sleep in Parkinson's disease. Neuropsychopharmacology 2020; 45:121-128. [PMID: 31234200 PMCID: PMC6879568 DOI: 10.1038/s41386-019-0448-y] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/26/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
Sleep disturbances are common in Parkinson's disease and comprise the entire spectrum of sleep disorders. On the one hand regulation of sleep and wakefulness is affected in Parkinson's disease, leading to the development of disorders, such as insomnia and daytime sleepiness. While on the other hand control of motor activity during sleep is impaired, with subsequent manifestation of parasomnias (mainly REM sleep behavior disorders, but also, albeit more rarely, sleepwalking, and overlap parasomnia). Restless legs syndrome has been reported to be frequent in patients with Parkinson's disease, although there is no consensus on whether it is more frequent in Parkinson's disease than in the general population. The same is true for sleep-related breathing disorders. Regarding the diagnosis of sleep disorders in patients with Parkinson's disease, one of the main challenges is correctly identifying excessive daytime sleepiness as there are many potential confounding factors, for example it is necessary to distinguish sleep-related breathing disorders from medication effects, and to distinguish restless legs syndrome from the concomitant presence of potential mimics specific to Parkinson's disease, such as akathisia, nocturnal leg cramps, nocturnal hypokinesia, early morning dystonia, etc. The correct diagnosis of REM sleep behavior disorder is also not always easy, and video-polysomnography should be performed in order to exclude mimic-like movements at the end of sleep apneas or violent periodic leg movements of sleep. These aspects and specific considerations about diagnosis and treatment of sleep disorders in patients with Parkinson's disease will be reviewed.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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12
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Bušková J, Peřinová P, Miletínová E, Dušek P, Růžička E, Šonka K, Kemlink D. Validation of the REM sleep behavior disorder screening questionnaire in the Czech population. BMC Neurol 2019; 19:110. [PMID: 31164104 PMCID: PMC6549323 DOI: 10.1186/s12883-019-1340-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/23/2019] [Indexed: 11/20/2022] Open
Abstract
Background Idiopathic rapid eye movement sleep behavior disorder (iRBD) affects 1–2% of people over 60 years of age and presents a high risk of developing a neurodegenerative disorder from the group of synucleinopathies, such as Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy. Therefore, screening tools are needed. In 2007, the rapid eye movement sleep behavior disorder screening questionnaire (RBD-SQ) was developed and has been translated into several languages. The aim of study was to assess the validity and reliability of the Czech version of the RBD-SQ in a mixed population of sleep clinic patients, supplemented by healthy volunteers and RBD patients. Methods Participants included 81 iRBD patients, 205 patients with other sleep disorders (obstructive sleep apnea, insomnia, restless legs syndrome and periodic limb movement disorder, other parasomnias, or central hypersomnias including narcolepsy) and 20 healthy volunteers. Results The mean RBD-SQ score in the iRBD patients was 9.4 ± 2.8 points, and in the non-RBD group it was 4.5 ± 3.0 (P < 0.0001). Receiver -operator analysis yielded an area under the curve of 0.864, suggesting good diagnostic performance of the scale. When using a cut-off value for positivity of 5 points, sensitivity was 0.89 and specificity was 0.62. Conclusions The Czech version of the RBD-SQ is a sensitive tool for screening for iRBD patients and helps to identify subjects for complete clinical workup.
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Affiliation(s)
- Jitka Bušková
- Department of Sleep Medicine, National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Peřinová
- Department of Neurology and Center of Clinical Neurosciences, 1stFaculty of Medicine, Charles University, Kateřinská 30, 12000, Praha 2, Czech Republic
| | - Eva Miletínová
- Department of Sleep Medicine, National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Dušek
- Department of Neurology and Center of Clinical Neurosciences, 1stFaculty of Medicine, Charles University, Kateřinská 30, 12000, Praha 2, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neurosciences, 1stFaculty of Medicine, Charles University, Kateřinská 30, 12000, Praha 2, Czech Republic
| | - Karel Šonka
- Department of Neurology and Center of Clinical Neurosciences, 1stFaculty of Medicine, Charles University, Kateřinská 30, 12000, Praha 2, Czech Republic
| | - David Kemlink
- Department of Neurology and Center of Clinical Neurosciences, 1stFaculty of Medicine, Charles University, Kateřinská 30, 12000, Praha 2, Czech Republic.
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Stefani A, Heidbreder A, Brandauer E, Guaita M, Neier LM, Mitterling T, Santamaria J, Iranzo A, Videnovic A, Trenkwalder C, Sixel-Döring F, Wenning GK, Chade A, Poewe W, Gershanik OS, Högl B. Screening for idiopathic REM sleep behavior disorder: usefulness of actigraphy. Sleep 2018; 41:4939057. [PMID: 29554362 PMCID: PMC5995165 DOI: 10.1093/sleep/zsy053] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/04/2018] [Indexed: 12/20/2022] Open
Abstract
Study Objectives To evaluate the utility of multimodal low-cost approaches including actigraphy, a wrist-worn device monitoring rest/activity cycles, in identifying patients with idiopathic REM sleep behavior disorder (iRBD). Methods Seventy patients diagnosed with sleep disorders causing different motor manifestations during sleep (iRBD, sleep apnea, restless legs syndrome) and 20 subjects without any relevant motor manifestation during sleep, underwent video-polysomnography (vPSG) and 2 week actigraphy, completed six validated RBD screening questionnaires, and sleep apps use was assessed. Actigraphy was analyzed automatically, and visually by seven blinded sleep medicine experts who rated as "no," "possible," and "probable" RBD. Results Quantitative actigraphy analysis distinguished patients from controls, but not between patients with different types of motor activity during sleep. Visual actigraphy rating by blinded experts in sleep medicine using pattern recognition identified vPSG confirmed iRBD with 85%-95% sensitivity, 79%-91% specificity, 81%-91% accuracy, 57.7% ± 11.3% positive predictive value, 95.1% ± 3.3% negative predictive value, 6.8 ± 2.2 positive likelihood ratio, 0.14 ± 0.05 negative likelihood ratio and 0.874-0.933 area under the ROC curve (AUC). AUC of the best performing questionnaire was 0.868. Few patients used sleep apps; therefore, their potential utility in the evaluated patients' groups is limited. Conclusions Visual analysis of actigraphy using pattern recognition can identify subjects with iRBD, and is able to distinguish iRBD from other motor activities during sleep, even when patients are not aware of the disease in contrast to questionnaires. Therefore, actigraphy can be a reliable screening instrument for RBD potentially useful in the general population.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth Brandauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marc Guaita
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lisa-Marie Neier
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Joan Santamaria
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Aleksander Videnovic
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Claudia Trenkwalder
- Department of Neurosurgery, University Medical Center, Göttingen, Germany
- Paracelsus-Elena Klinik, Kassel, Germany
| | - Friederike Sixel-Döring
- Paracelsus-Elena Klinik, Kassel, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anabel Chade
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Oscar S Gershanik
- Institute of Neuroscience, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Skorvanek M, Feketeova E, Kurtis MM, Rusz J, Sonka K. Accuracy of Rating Scales and Clinical Measures for Screening of Rapid Eye Movement Sleep Behavior Disorder and for Predicting Conversion to Parkinson's Disease and Other Synucleinopathies. Front Neurol 2018; 9:376. [PMID: 29887829 PMCID: PMC5980959 DOI: 10.3389/fneur.2018.00376] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by repeated episodes of REM sleep-related vocalizations and/or complex motor behaviors. Definite diagnosis of RBD is based on history and polysomnography, both of which are less accessible due to the lack of trained specialists and high cost. While RBD may be associated with disorders like narcolepsy, focal brain lesions, and encephalitis, idiopathic RBD (iRBD) may convert to Parkinson's disease (PD) and other synucleinopathies in more than 80% of patients and it is to date the most specific clinical prodromal marker of PD. Identification of individuals at high risk for development of PD is becoming one of the most important topics for current PD-related research as well as for future treatment trials targeting prodromal PD. Furthermore, concomitant clinical symptoms, such as subtle motor impairment, hyposmia, autonomic dysfunction, or cognitive difficulties, in subjects with iRBD may herald its phenoconversion to clinically manifest parkinsonism. The assessment of these motor and non-motor symptoms in iRBD may increase the sensitivity and specificity in identifying prodromal PD subjects. This review evaluates the diagnostic accuracy of individual rating scales and validated single items for screening of RBD and the role and accuracy of available clinical, electrophysiological, imaging, and tissue biomarkers in predicting the phenoconversion from iRBD to clinically manifest synucleinopathies.
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Affiliation(s)
- Matej Skorvanek
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Eva Feketeova
- Department of Neurology, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia
- Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia
| | - Monica M. Kurtis
- Movement Disorders Unit, Department of Neurology, Hospital Ruber Internacional, Madrid, Spain
| | - Jan Rusz
- Department of Neurology, Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Karel Sonka
- Department of Neurology, Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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Abstract
So-called idiopathic rapid eye movement (REM) sleep behaviour disorder (RBD), formerly seen as a rare parasomnia, is now recognized as the prodromal stage of an α-synucleinopathy. Given the very high risk that patients with idiopathic RBD have of developing α-synucleinopathies, such as Parkinson disease (PD), PD dementia, dementia with Lewy bodies or multiple system atrophy, and the outstandingly high specificity and very long interval between the onset of idiopathic RBD and the clinical manifestations of α-synucleinopathies, the prodromal phase of this disorder represents a unique opportunity for potentially disease-modifying intervention. This Review provides an update on classic and novel biomarkers of α-synuclein-related neurodegeneration in patients with idiopathic RBD, focusing on advances in imaging and neurophysiological, cognitive, autonomic, tissue-specific and other biomarkers. We discuss the strengths, potential weaknesses and suitability of these biomarkers for identifying RBD and neurodegeneration, with an emphasis on predicting progression to overt α-synucleinopathy. The role of video polysomnography in providing quantifiable and potentially treatment-responsive biomarkers of neurodegeneration is highlighted. In light of all these advances, and the now understood role of idiopathic RBD as an early manifestation of α-synuclein disease, we call for idiopathic RBD to be reconceptualized as isolated RBD.
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Irfan M, Schenck CH, Howell MJ. Non-Rapid Eye Movement Sleep and Overlap Parasomnias. Continuum (Minneap Minn) 2017; 23:1035-1050. [PMID: 28777175 DOI: 10.1212/con.0000000000000503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the spectrum of non-rapid eye movement (non-REM) sleep parasomnias, including sleepwalking, confusional arousals, and sleep terrors, which represent the range of phenotypic disorders of arousal from non-REM sleep that occurs in children and adults. RECENT FINDINGS The International Classification of Sleep Disorders, Third Edition (ICSD-3) classifies parasomnias according to the sleep stage they emerge from: REM, non-REM, or other. Demographics, clinical features, and diagnosis of non-REM parasomnias are reviewed in this article, and an up-to-date synopsis of guidelines for management strategies to assist in the treatment of these sleep disorders is provided. SUMMARY The non-REM parasomnias are most common in children and adolescents but may persist into adulthood. They can be distinguishable from REM parasomnias and nocturnal epilepsies, and, importantly, may lead to injury. Additionally, other parasomnias in this spectrum include sleep-related eating disorder and sexsomnia. Overlap parasomnia disorder includes one or more manifestations of a non-REM parasomnia seen in combination with REM sleep behavior disorder, representing an apparent erosion of the normally distinct stages of non-REM and REM sleep. A similar yet much more extreme dissociation of states underlies agrypnia excitata and status dissociatus, which represent rare, severe dissociations between non-REM, REM, and wake states resulting clinically in oneiric behaviors and severe derangement of normal polysomnographic wake and sleep stage characteristics. Management of non-REM and overlap parasomnias and state dissociation disorders include ensuring bedroom safety and prescription of clonazepam or hypnosis, in select cases, although in children and adolescents with noninjurious behaviors, non-REM parasomnias are often age-limited developmental disorders, which may ultimately remit by adulthood, and, in these cases, counseling and education alone may suffice. Timely and accurate recognition of the non-REM and overlap parasomnias is crucial to limiting potential patient injury.
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Högl B, Stefani A. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations. Mov Disord 2017; 32:669-681. [DOI: 10.1002/mds.26929] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Birgit Högl
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - Ambra Stefani
- Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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Stallman HM, Kohler M. Prevalence of Sleepwalking: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0164769. [PMID: 27832078 PMCID: PMC5104520 DOI: 10.1371/journal.pone.0164769] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/30/2016] [Indexed: 02/07/2023] Open
Abstract
Sleepwalking is thought to be a common arousal disorder; however, the epidemiology of this disorder has not yet been systematically examined. A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted for 'sleepwalking' OR 'somnambulism' in any field, to identify studies that reported the epidemiology of sleepwalking or sleepwalking disorders. Fifty-one studies assessed the prevalence rates of sleepwalking in a total sample of 100 490. The meta-analysis showed the estimated lifetime prevalence of sleepwalking was 6.9% (95% CI 4.6%-10.3%). The current prevalence rate of sleepwalking-within the last 12 months-was significantly higher in children 5.0% (95% CI 3.8%-6.5%) than adults 1.5% (95% CI 1.0%-2.3%). There was no evidence of developmental trends in sleepwalking across childhood. The significant risk of bias across all studies suggests these results should be used cautiously. Further epidemiological research that addresses methodological problems found in studies of sleepwalking to date is needed.
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Affiliation(s)
- Helen M. Stallman
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, 5001, Australia
- * E-mail:
| | - Mark Kohler
- Centre for Sleep Research, University of South Australia, Adelaide, South Australia, 5001, Australia
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Abstract
Background REM sleep behavior disorder (RBD) is parasomnia characterized by dream enactment and enabled by disruption of physiological muscle atonia during REM sleep. Over the past few years, diagnostic criteria and the methods used to confirm diagnosis have been updated. Objective In this review article, the current knowledge regarding RBD diagnosis and treatment is presented. Methods A selective literature search was carried out. Results and discussion Although several RBD screening questionnaires have been developed, diagnosis can only be definitely confirmed on the basis of polysomnography. New methods for scoring electromyography (EMG) activity during REM sleep have been proposed during recent years and cutoff values have been established. The latest cutoff values for scoring EMG activity during REM sleep are included in the International Classification of Sleep Disorders (ICSD). The cutoff of 27 % muscle activity during REM sleep suggested by the Sleep Innsbruck Barcelona (SINBAR) group was also included in the third edition of the ICSD. The best-researched treatments for RBD are clonazepam and melatonin.
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Heidbreder A, Frauscher B, Mitterling T, Boentert M, Schirmacher A, Hörtnagl P, Schennach H, Massoth C, Happe S, Mayer G, Young P, Högl B. Not Only Sleepwalking But NREM Parasomnia Irrespective of the Type Is Associated with HLA DQB1*05:01. J Clin Sleep Med 2016; 12:565-70. [PMID: 26951409 DOI: 10.5664/jcsm.5692] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/29/2015] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES Despite the high prevalence and clinical relevance of NREM parasomnias, data on supportive genetic markers are scarce, and mainly refer to sleepwalking only. METHODS We retrospectively analyzed clinical, polysomnographic, and HLA findings of 74 adults (37 men) with NREM parasomnia gathered from four neurological sleep centers. Parasomniac events were classified according to ICSD-2 criteria. HLA DQB1 genotyping was compared to regional-matched reference allele-frequencies. RESULTS Fifty-six patients had more than 2 different parasomnia type: 11 sleepwalking, 4 sleep terrors, 3 confusional arousals only. Parasomniac events were documented during video-polysomnography (V-PSG) in 70% (49/70) of subjects (71.4% confusional arousals, 8.2% sleep terrors, 4.1% sleepwalking, 16.3% ≥ 2 NREM parasomnia types). Violent behavior during V-PSG occurred in 8.5% (6/71). NREM parasomnia onset was reported after the age of 30 years in 6.8% (5/74). The HLA DQB1*05:01 allele was present in 41% (29/71) compared to 24.2% in the regional-matched reference allele group (p < 0.05). This haplotype prevalence did not differ within the NREM parasomnia type. Epworth Sleepiness Score was 10 or higher in 28.6%. CONCLUSIONS This is a large polysomnography-based case series of patients with NREM parasomnia. In patients with suspected sleepwalking or sleep terrors, polysomnography is highly useful in detecting arousals from NREM sleep as a marker of NREM parasomnia. We confirmed previous findings by demonstrating a high prevalence of the HLA DQB1*05:01 genotype for different types of NREM parasomnias. Our findings therefore support a common genetic background, and corroborate the importance of video-polysomnography in the work-up of parasomnia.
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Affiliation(s)
- Anna Heidbreder
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany.,Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Mitterling
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Boentert
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Anja Schirmacher
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Paul Hörtnagl
- Central Institute for Blood-Transfusion and Immunology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood-Transfusion and Immunology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Massoth
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Svenja Happe
- Department of Neurology, Clinic Maria Frieden Telgte, Telgte, Germany and University of Göttingen, Göttingen, Germany
| | - Geert Mayer
- Hephata-Klinik Schwalmstadt-Treysa, Schwalmstadt- Treysa, Germany and Philipps University Marburg, Department of Neurology, Marburg, Germany
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Muenster, Germany
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Howell M. Darwin's Predisposition and the Restlessness that Drives Sleepwalking. Sleep 2015; 38:1667-8. [PMID: 26446122 DOI: 10.5665/sleep.5134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/01/2015] [Indexed: 11/03/2022] Open
Affiliation(s)
- Michael Howell
- Department of Neurology, University of Minnesota, Minneapolis, MN; University of Minnesota Medical Center, Fairview, Minneapolis, MN; Sleep Medicine Clinic, University of Minnesota Medical Center Fairview, Minneapolis, MN, Minnesota Regional Sleep Disorders Center, Minneapolis, MN; Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Minneapolis, MN
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Mitterling T, Högl B, Schönwald SV, Hackner H, Gabelia D, Biermayr M, Frauscher B. Sleep and Respiration in 100 Healthy Caucasian Sleepers--A Polysomnographic Study According to American Academy of Sleep Medicine Standards. Sleep 2015; 38:867-75. [PMID: 25515109 PMCID: PMC4434553 DOI: 10.5665/sleep.4730] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/07/2014] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVES Despite differences between American Academy of Sleep Medicine (AASM) and Rechtschaffen and Kales scoring criteria, normative values following the current AASM criteria are lacking. We investigated sleep and respiratory variables in healthy adults over the lifespan, and established polysomnographic normative values according to current standards. DESIGN Prospective polysomnographic investigation. SETTING Academic referral hospital sleep laboratory. PARTICIPANTS One hundred healthy sleepers aged 19-77 y were selected from a representative population sample by a two-step screening. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS All subjects underwent one full-night polysomnography. Sleep and arousals were scored according to AASM standards. Respiration was scored according to AASM 2007 and 2012 criteria in order to compare both methods. Percentile curves showed age-related differences in sleep architecture: a decrease was found for sleep efficiency [≤ 30 y: 87.0 (71.9-94.1)% versus > 60 y: 79.7 (44.5-90.9)%], total sleep time [≤ 30 y: 413.5 (345.6-451.9) min versus > 60 y: 378.3 (216.0-440.0) min], the percentages of N3 [≤ 30 y 20.7 (15.2-37.5)% versus > 60 y: 14.9 (2.4-35.6)%] and rapid eye movement sleep [≤ 30 y 15.5 (7.5-23.6)% versus. > 60 y: 10.3 (1.9-21.9)%], whereas the percentage of wake time after sleep onset increased with age [≤ 30 y 6.0 (1.9-22.8)% versus > 60 y: 15.2 (6.3-48.7)%]. The apnea-hypopnea index (AHI) was higher when applying the AASM 2012 criteria [AHI AASM 2007 0.7 (0.0-21.5)/h versus 2012: 1.7 (0.0-25)/h; P < 0.001]. Eight percent of subjects had an AHI > 15/h. CONCLUSIONS This study provides normative data on sleep macrostructure, microstructure, and respiration in adults following AASM standards. Furthermore, we demonstrated that respiration scoring according to AASM 2012 results in higher AHIs, and challenge the use of age-independent respiratory cutoff values.
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Affiliation(s)
- Thomas Mitterling
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Heinz Hackner
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - David Gabelia
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Marlene Biermayr
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Birgit Frauscher
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Diagnostic value of the REM sleep behavior disorder screening questionnaire in Parkinson's disease. Sleep Med 2014; 16:186-9. [PMID: 25534709 DOI: 10.1016/j.sleep.2014.08.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/23/2014] [Accepted: 08/02/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to validate the rapid eye movement (REM) sleep behavior disorder (RBD) screening questionnaire (RBDSQ) in 2 independent samples of patients with Parkinson's disease (PD) using different settings when performing the investigations. METHODS The RBDSQ was administered to two independent samples of 52 and 75 consecutive PD patients investigated with video-polysomnography (vPSG). RESULTS In sample A, the RBDSQ identified 46/52 (88.5%) patients correctly. In sample B, 50/75 (66.7%) patients were identified correctly. Considering a cut-off score of ≥ 5 as a positive test result, sample A showed a sensitivity of 0.90 and a specificity of 0.87, sample B showed a sensitivity of 0.68 and a specificity of 0.63. Main differences between both groups were that patients of sample A underwent a sleep history including RBD assessment prior to administration of the RBDSQ, whereas in sample B the RBDSQ was administered during routine work-up. CONCLUSIONS The diagnostic value of the RBDSQ strongly depends on the clinical setting and may be influenced by the individual's awareness on RBD. This finding is a critical issue which deserves clarification before use of this and other questionnaires can be recommended in epidemiological studies.
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