Parasomnias: Diagnosis, Classification and Clinical Features

Abstract

Parasomnias, as described in the recent second edition of the International Classification of Sleep Disorders, are "undesirable physical events or experiences" occurring during sleep transition, during arousal from sleep, or within the sleep period. These events encompass abnormal sleep related movements, behaviors, emotions, perceptions, dreaming, and autonomic nervous system functioning. Parasomnias are classified as: 1) disorders of arousal (from non-rapid eye movement, or NREM, sleep); 2) parasomnias usually associated with REM (rapid eye movement) sleep; and 3) other parasomnias. This sleep disorders in childhood are common, and often more frequent than in adults. Clinicians should be aware that many pediatric parasomnias have benign and self-limited nature. Most of the parasomnias may not persist into late childhood or adolescence. Parasomnias in adults often differ in type from childhood parasomnias and may portend significant psychiatric disturbances or neurodegenerative disorders. A reliable diagnosis can often be made from a detailed history from the patient and, if possible, the parents or bed partner. Detailed overnight investigations of parasomnias are usually not required. The non-REM parasomnias are more common in community although REM parasomnias are more likely to be seen in general neurological practice. Sleep related eating disorder, sleep related dissociative disorders and sleep related sexual behavior and sleep related violence are novel and rarely reported sleep disorders. REM sleep behavior disorder is common and should be sought in all neurodegenerative diseases. They are included among clinical disorders due to the resulting injuries, and adverse health and psychosocial effects, which may affect the bed partner as well as the patient. Finally, parasomnias are common disturbances of sleep that may significantly affect the patient's quality of life and that of the bed partner. Therefore, appropriate diagnostic and therapeutic strategies are warranted.

Keywords

• parasomnia, NREM parasomnias, REM sleep behavior disorder, sleep related sexual behavior

Parasomniler: Tanı, Sınıflama ve Klinik Özellikleri

Öz

Parasomniler, Uluslararası Uyku Sınıflamasının yeni ikinci baskısında, uyku geçişlerinde, uykudan uyanma ya da uyku sırasında ortaya çıkan "istenil-meyen fiziksel olaylar ya da deneyimler" olarak tanımlanmıştır. Bu olaylar; uyku ilişkili anormal hareketler, davranışlar, duygular, algılar, rüyalar ve otonomik sinir sistemi fonksiyonlarını içerir. Parasomniler: 1) uyanıklık tepkisi bozuklukları; 2) REM (rapid eye movement) uykusu ile ilişkili parasomniler; ve 3) diğer parasomniler olarak sınıflandırılırlar. Hekimler, daha çok çocukluk döneminde ortaya çıkan parasomnilerin selim ve kendini sınırlayıcı özellikleri konusunda bilgili olmalıdırlar. Çoğu parasomniler, geç çocukluk ve erişkin döneminde devam etmeyebilirler. Erişkin dönemindeki parasomniler, çocukluk dönemindekilerden farklıdır ve psikiyatrik hastalıklar ve nörodejeneratif hastalıkların habercisi olabilirler. Kesin tanı için, hastadan ve eğer mümkünse eşi ya da ailesinden ayrıntılı anamnez almak gerekir. Ayrıntılı tüm gece incelemesi genellikle parasomni tanısı için gerekli değildir. REM parasomnileri genel nöroloji pratiğinde daha sık saptanmasına karşın, toplumda non-REM parasomnileri daha sık görülür. Uyku ile ilişkili yeme bozukluğu, uyku ile ilişkili dissosiyatif bozukluk ve uyku ile ilişkili cinsel davranış ve şiddet yeni tanımlanmış nadir görülen uyku bozukluklarıdır. Bu bozukluklar, hasta kadar eşinde de travmaya, fiziksel yan etkilere ve psikososyal problemlere yol açabilir. Sonuç olarak, parasomniler yaşam kalitesini etkileyen ve nispeten sık görülen uyku bozuklukları olup, erken dönemde tanılarının konup tedavilerine başlanması zorunludur.

Anahtar Kelimeler

• parasomni, NREM parasomnileri, REM uykusu davranış bozukluğu, uyku ile ilişkili seksüel davranışlar

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