Non-REM Parasomnias and REM Sleep Behaviour Disorder
Parasomnias are undesirable physical events or experiences associated with sleep. Episodes are usually classified according to the stage of sleep during or from which they occur. Parasomnias frequently involve complex behaviours that may appear purposeful
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Sofia Eriksson and Matthew Walker
14.1 Introduction Parasomnias are undesirable physical events or experiences associated with sleep. Episodes are usually classified according to the stage of sleep during or from which they occur. Parasomnias frequently involve complex behaviours that may appear purposeful but are not conscious or under deliberate control. Patients are often unaware of episodes that may, however, result in injury and sleep disruption with subsequent daytime symptoms such as excessive daytime somnolence. The consequences of parasomnias are not limited to the patient but often affect the bed partner as well. People are often amnesic for their parasomnia but, with both non-REM parasomnias and REM sleep behaviour disorder (RBD), patients may recall some dream mentation. Onset of non-REM (NREM) parasomnias usually occurs in childhood and can be seen in up to 20% of children. The majority grow out of this parasomnia in their teens, but up to 25% of patients continue to have episodes, and over 2–3% of the population may still have events in adulthood (Ohayon et al. 2012). NREM parasomnias may also first manifest in adulthood. In contrast to NREM parasomnias that are more common in childhood, RBD is more common in older patients, and there is a male predominance (Boeve et al. 2007). RBD results from the loss of normal muscle atonia during REM sleep, resulting in dream enactment. This loss of REM atonia can result from degeneration affecting brainstem nuclei, and thus RBD is strongly associated with certain neurodegenerative conditions, such as Parkinson’s disease or multisystem atrophy (Boeve et al. 2007). However, RBD may develop months or years before the onset of any
S. Eriksson (*) · M. Walker National Hospital for Neurology and Neurosurgery, London, UK UCL Institute of Neurology, London, UK e-mail: [email protected] © Springer-Verlag GmbH Germany, part of Springer Nature 2018 H. Selsick (ed.), Sleep Disorders in Psychiatric Patients, https://doi.org/10.1007/978-3-642-54836-9_14
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underlying neurological disorder. RBD is less common than NREM parasomnia but may affect up to 0.5% of the population (Ohayon et al. 1997) and is more prevalent in the elderly with a mean onset of 50–65 years.
14.2 Description of Sleep Disorders The International Classification of Sleep Disorders (ICSD-3) divides parasomnias into NREM-related parasomnias, REM-related parasomnias, other parasomnias and isolated symptoms and normal variants (American Academy of Sleep Medicine 2014). This chapter will focus on NREM parasomnias and RBD.
14.2.1 NREM Parasomnias NREM parasomnias usually arise from deep NREM sleep (slow-wave sleep, N3 or NIII-IV), and episodes typically take place during the first third of the night when slow-wave sleep is most predominant. There are several different types of NREM parasomnias; the most common are night terrors, sleepwalking (somnambulism) and confusional arousal, occasionally with violent or aggressive behaviour. Abnormal sexual behaviour and s
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