Demographic, Clinical and Polysomnographic Characteristics of Childhood- and Adult-Onset Sleepwalking in Adults

Abstract

Background: Sleepwalking (SW) is found to affect children predominantly, but it can persist or appear de novo even among adults. In this study, we assessed the demographic, clinical and polysomnographic profile, trigger factors and associated comorbidities of adult-onset (AO-SW) and childhood-onset (CO-SW) adult sleepwalkers. Methods: In adult sleepwalkers, a structured clinical interview, a battery of questionnaires, video-polysomnography (v-PSG) and standard electroencephalography (EEG) were performed. Results: Among 63 sleepwalkers, 45% had ≥1 episodes/month, 54% had partial recall of the episodes and 36% reported trigger factors for SW. Almost all subjects reported co-occurring parasomnias. In v-PSG, 4% exhibited episodes of SW, 17% confusional arousals, 21% had an increased apnea-hypopnea-index and 6% exhibited features of an overlap parasomnia disorder. In our cohort, 73% reported CO-SW and 27% AO-SW. In subjects with AO-SW, positive family history for parasomnias was found in 33% (vs. 49% in CO-SW), neurological comorbidities in 44% (vs. 14%), psychiatric comorbidities in 25% (vs. 33%), EEG abnormalities in 50% (vs. 29%). Violence during SW episodes was more frequent in males and in subjects with CO-SW (45% for self-injury and 44% for violent behaviour vs. 33 and 29% respectively in the AO-SW group). Conclusions: Adult SW represents a complex and potentially dangerous condition. The characteristics of AO-SW often differ from those of CO-SW.

The spectrum of disorders causing violence during sleep

“…In another study on adults with SW that included data on sleep violence, among 63 SW adults, 45% had ≥1 episodes/month, 54% had partial recall of the episodes and 36% reported trigger factors for SW (Bargiotas et al 2017). In this series, 73% reported childhood-onset SW and 27% adult-onset SW. Violence during SW episodes was more frequent in males and in subjects with childhood-onset SW (45% for self-injury and 44% for violent behavior towards others).…”

Adult NREM Parasomnias: An Update

“…In another study, adult-onset patients were found to suffer from neurological co-morbidities twice as frequently as childhood-onset patients [18]. On the other hand, patients who developed NREM parasomnias in childhood and experienced the behaviours continuously into adulthood were found to suffer from more complex [25], more violent and injurious behaviours than those who developed NREM parasomnias in adulthood, with no prior history of the disorder [18,19]. The timing of onset of the disorder therefore seems to predict important clinical characteristics of adult NREM parasomnia patients.…”

“…Adult males were further found to engage in dangerous, injurious night-time behaviours, violence in sleep, and sexsomnia more frequently than females [18][19][20][21]. However, it is unclear whether sex is associated with nocturnal violence and sexsomnia, or whether the difference lies in referral rates [18].…”

“…Previous research has shown factors that differentiate between childhood-and adulthood-onset of the disorder. Family history of NREM parasomnias is more common in patients with childhood onset of the disorder [18]. One report found that more than 4 out of 5 adult sleepwalkers also had a childhood history of sleepwalking [30].…”

Non-REM Parasomnie

“…Nach der Pubertät verschwinden diese Ereignisse in den meisten Fällen komplett. Unabhängig vom Geschlecht können Arousalstörungen auch im Erwachsenenalter auftreten, dies mit einer Prävalenz, die wahrscheinlich zwischen 2 % und 4 % liegt [1][2][3].…”