Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults

Abstract

Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.

Current evidence and future perspectives in the exploration of sleep-related eating disorder–a systematic literature review

“…SRED and DOAs have a certain relationship, supported by the high frequency of present or personal history of sleepwalking in patients with nocturnal eating, the onset of dysfunctional eating in the first half of the night, and possible arousals from the SWS in these patients ( 119 ). Also, RLS, periodic limb movements and OSA, as well as recurrent chewing and swallowing movements during sleep, have been reported in patients with SRED who associated lack of control on the eating behaviors during the night (e.g., the ingestion of unpalatable or toxic items, like cigarettes, dishwashing liquid, or animal food) ( 119 ). All these arguments support the existence of a common pathophysiological background between DOAs and SRED, or at least a common vulnerability terrain.…”

Behavioral and psychological treatments for NREM parasomnias: A systematic review

“…However, treatment is indicated when symptoms are severe, distressing, cause significant sleep disruption, or create a risk of harm to the patient or others. Recommendations which commonly appear in previously published non-systematic reviews include ensuring safety, providing reassurance of the time-limited and benign nature of symptoms, improving sleep hygiene, and addressing priming and precipitating factors [2,4,5,7,8,[13][14][15][16][17][18]. Scheduled awakenings are recommended particularly for the treatment of pediatric NREM parasomnias [2,5,[17][18][19].…”

“…Recommendations which commonly appear in previously published non-systematic reviews include ensuring safety, providing reassurance of the time-limited and benign nature of symptoms, improving sleep hygiene, and addressing priming and precipitating factors [2,4,5,7,8,[13][14][15][16][17][18]. Scheduled awakenings are recommended particularly for the treatment of pediatric NREM parasomnias [2,5,[17][18][19]. Other important considerations include discontinuing medications that can provoke or aggravate NREM parasomnias (e.g., zolpidem) and treating comorbid sleep disorders (e.g., insomnia, RLS, PLMD, OSA) which could contribute to parasomnias [2,18,20].…”

“…Scheduled awakenings are recommended particularly for the treatment of pediatric NREM parasomnias [2,5,[17][18][19]. Other important considerations include discontinuing medications that can provoke or aggravate NREM parasomnias (e.g., zolpidem) and treating comorbid sleep disorders (e.g., insomnia, RLS, PLMD, OSA) which could contribute to parasomnias [2,18,20]. However, no systematic reviews have been undertaken to synthesize the evidence for NREM parasomnia interventions.…”