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

Kaynakça

1. Plante DT, Winkelman JW. Parasomnias. Psychiatr Clin North Am 2006; 29: 969- 987.
2. Mahowald MW, Schenck CH. Non-rapid eye movement sleep parasomnias. Neurol Clin 2005; 23:1077-1106.
3. Bornemann MA, Mahowald MW, Schenck CH. Parasomnias. Clinical features and forensic implications. Chest 2006; 130: 605-610.
4. Mahowald MW, Schenck CH. Parasomnias: sleepwalking and the law. Sleep Med Rev 2000; 4: 321-339.
5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. text revision.Washington, DC: American Psychiatric Association; 2000.
6. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual, 2nd edn (ICSD-2). Westchester, IL: American Academy of Sleep Medicine, 2005.
7. Aksu M, Sevim S, Fırat H, Uçar ZZ. Uyku Hastalıkları Çalıșma Kılavuzu. Türkiye Uyku Tıbbı Derneği Yayını 2008.
8. Stores G. Aspects of parasomnias in children and adolescents. Arch Dis Child 2009; 94:63-69.

9. Mason TB, Pack AI. Pediatric parasomnias. Sleep 2007; 30:141-151.
10. Pressman MR. Factors that predispose, prime and NREM parasomnias in adults: Clinical and forensic implications. Sleep Med Rev 2007; 11:5-30.
11. Agargun MY, Cilli AS, Sener S, Bilici M, Ozer OA, Selvi Y et al. The prevalence of parasomnias in preadolescent school-aged children: a Turkish sample. Sleep 2004; 27:701-705.
12. Hughes JR. A review of sleepwalking (somnambulism): The enigma of neurophysiology and polysomnography with differential diagnosis of complex partial seizures. Epilepsy Behav 2007; 11:483-491.
13. Owens J, Spirito A, Nobile C, Arrigan M. Incidence of parasomnias in children with obstructive sleep apnea. Sleep 1997; 20:1193-1196.
14. Guilleminault C, Palombini L, Pelayo R, Chervin RD. Sleepwalking and sleep terrors in prepubertal children: what triggers them? Pediatrics. 2003; 111:17- 25.
15. Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: What can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 2007; 30:683-702.
16. Stores G. Clinical diagnosis and misdiagnosis of sleep disorders. J Neurol Neurosurg Psychiatry 2007; 78:1293-1297.
17. Szabadi E. Drugs for sleep disorders: mechanisms and therapeutic prospects. Br J Clin Pharmacol 2006; 61:761-766.
18. Pilon M, Montplaisir J, Zarda A. Precipitating factors of somnambulism: Impact of sleep deprivation and forced arousals. Neurology 2008; 70:2284-2290.
19. Pressman MR. Disorders of arousal from sleep and violent behavior: The role of physical contact and proximity. Sleep 2007; 30:1039-1047.
20. Howell MJ, Schenck CH, Crow SJ. A review of nighttime eating disorders. Sleep Med Rev 2009; 13:23-34.
21. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9:293-308.
22. Gagnon JF, Postuma RB, Mazza S, Doyon J, Montplaisir J. Rapid-eye- movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 2006; 5:424-432.
23. Boeve BF, Silber MH, Saper CB, Ferman TJ, Dickson DW, Parisi JE and et al. Pathophysiology of REM sleep behaviour disorder and relevance to neurodegenerative disease. Brain 2007; 130:2770-2788.
24. Desseilles M, Dang-Vu T, Schabus M, Sterpenich V, Maquet P, Schwartz S. Neuroimaging Insights into the pathophysiology of sleep disorders. Sleep 2008; 31:777-794.
25. Ohayon MM, Caulet M, Priest RG. Violent behavior during sleep. J Clin Psychiatry 1997; 58: 369-376.
26. Fantini ML, Ferini-Strambi L, Montplaisir J. Idiopathic REM sleep behavior disorder: toward a better nosologic definition. Neurology 2005; 64:780-786.
27. Hickey MG, Demaerschalk BM, Caselli RJ, Parish JM, Wingerchuk DM. “Idiopathic” Rapid-Eye-Movement (REM) Sleep Behavior Disorder is associated with future development of neurodegenerative diseases. Neurologist 2007; 13:98-101.
28. Kumru H, Santamaria J, Tolosa E, Iranzo A. Relation between subtype of Parkinson’s disease and REM sleep behavior disorder. Sleep Med 2007; 8:779- 783.
29. Iranzo A, Molinuevo JL, Santamaría J, Serradell M, Martí MJ, Valldeoriola F et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol 2006; 7:572- 577.
30. Sheldon SH, Jacobsen J. REM-sleep motor disorder in children. J Child Neurol 1998; 13:257-260.
31. Stiasny-Kolster K, Mayer G, Schafer S, Moller JC, Heinzel-Gutenbrunner M, Oertel WH. The REM Sleep Behavior Disorder Screening Questionnaire - A new diagnostic ınstrument. Mov Dis 2007; 22:2386-2393.
32. Anderson KN, Jamieson S, Graham AJ, Shneerson JM. REM sleep behaviour disorder treated with melatonin in a patient with Alzheimer’s disease. Clin Neurol Neurosurg 2008; 110:492-495.
33. Dauvilliers Y, Rompré S, Gagnon JF, Vendette M, Petit D, Montplaisir J. REM sleep characteristics in narcolepsy and REM Sleep Behavior Disorder. Sleep 2007; 30:844-849.
34. Dahlitz M, Parkes JD. Sleep paralysis. Lancet 1993; 341:406-407.
35. Guilleminault C, Hagen CC, Khaja AM. Catathrenia: Parasomnia or uncommon feature of sleep disordered breathing? Sleep 2008; 31:132-139.
36. Tuncel D, Orhan FO. Sleep related eating dısorder: A case report. Anatolian Journal of Clinical Investigation 2008; 2:28-30.
37. Andersena ML, Poyaresa D, Alvesb RSC, Skomroc R, Tufika S. Sexsomnia: Abnormal sexual behavior during sleep. Brain Res Rev 2007; 56:271-282.
38. Psikiyatride Güncel Yaklașımlar – Current Approaches in Psychiatry
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