Recurrent Isolated Sleep Paralysis: Polysomnographic and Clinical Findings. Polysomnographische und klinische Befunde bei Personen mit wiederkehrender isolierter Schlaflahmung

Abstract

Question of the study Sleep paralysis is one of the typical symptoms of narcolepsy, found in about 25% of narcoleptic patients. It also represents a separate sleep disorder classified as a REM sleep-related parasomnia. We compared clinical and electrophysiological data of patients with recurrent isolated sleep paralysis (RISP) with those of narcoleptic patients and healthy control subjects. Patients and methods Structured interview data, polygraphic sleep recording, Multiple Sleep Latency Test (MSLT) and human leukocyte antigen (HLA) DR2(15) typing were compared in sex-and age-matched patients with RISP (n ¼ 10, mean age: 48.2 years, 4 males/6 females), narcolepsy (NAR, n ¼ 10, mean age: 51.5 years, 4 males/6 females) and healthy controls (CON, n ¼ 10, mean age: 51.5 years, 5 males/5 females). Results Night sleep latencies were prolonged in RISP (mean: 40.6 ± 25.3 min; NAR: 19.5 ± 8.8 min; CON: 19.2 ± 15.6 min). No sleep onset REM (SOREM) episodes (latency <20 min) were observed in RISP patients, and short (<50 min) REM sleep latencies were rare. In some cases REM sleep episodes were fragmented or abbreviated. The distribution of REM latencies was largely inconspicuous. The distribution of NREM sleep stages was normal. In the MSLT, latencies for sleep stages 1 and 2 were longer in RISP than in narcoleptic patients, and while SOREM phases were abundant in narcoleptic patients, such events were extremely rare in RISP patients. Daytime sleepiness, assessed by the Epworth Sleepiness Scale (ESS), did not differ between RISP (median: 9) and CON (median: 6.5) but was significantly increased in NAR (median: 20.5). HLA typing showed that seven out of 10 RISP patients were HLA DR2(15) negative. None of the patients with RISP had ever experienced cataplectic attacks. Conclusions RISP and NAR patients differ in critical HLA alleles and in key sleep variables such as sleep latency and REM latency. According to our findings, SOREM episodes are not a typical feature of RISP. In contrast to other studies, RISP patients do not show excessive daytime sleepiness compared with healthy controls.Keywords isolated sleep paralysis -sleep latency -REM latency -HLA typing -MSLT. ZusammenfassungFragestellung Die Schlaflähmung ist ein typisches Symptom der Narkolepsie und findet sich bei etwa 25% der narkoleptischen Patienten. Sie stellt aber auch eine eigenständige Schlafstörung dar, die als REM-Schlaf bezogene Parasomnie klassifiziert wird. Wir verglichen klinische und elektrophysiologische Daten von Patienten mit wiederkehrender isolierter Schlaflähmung (RISP) mit denen narkoleptischer Patienten und gesunder Kontrollpersonen. Patienten und Methodik Die Ergebnisse eines strukturierten Interviews, Fragebogendaten, polysomnographische Aufzeichnungen, Multipler Schlaflatenz-Test (MSLT) und HLA DR2(15) Befunde wurden verglichen für nach Alter und Geschlecht angepassten Patienten mit RISP (n ¼ 10; mittleres Alter 48,2 Jahre; 4 Männer, 6 Frauen), Narkolepsie (NAR, n ¼ 10; mittleres Alter 51,5 Jahre; 4 Männer, 6 Frauen) und gesunde Kontrollen (C...

Chronotype-Dependent Sleep Loss Is Associated with a Lower Amplitude in Circadian Rhythm and a Higher Fragmentation of REM Sleep in Young Healthy Adults

“…Deep sleep occurs mainly during the first half of sleep, while REM sleep predominates in the second half [12,13]. Disturbances in regular sleeping patterns are associated with pathological conditions such as sleep paralysis [14] and REM sleep behaviour disorder [15,16]. Fitbit wearables contain accelerometers and photoplethysmography sensors and Fitbit applies proprietary algorithms to detect sleep parameters and sleep stages based on movement and heart-rate patterns [17].…”

Sleep Paralysis among Professional Firefighters and a Possible Association with PTSD—Online Survey-Based Study

“…It is believed that this disorder is related to the abnormal overlap between the REM sleep phase (rapid eye movement sleep) and the waking state [8]. The term Isolated Sleep Paralysis (ISP) is used when episodes of SP are not a symptom of any other medical conditions (e.g., narcolepsy, seizure disorders, substance use) but is an isolated disorder [3].…”

Parasomnien

“…Die Pathophysiologie ist bisher vollkommen unklar. Eine deutsche Untersuchung konnte in multiplen Schlaflatenztests keine Sleep-Onset-REM-Phasen wie bei Narkolepsiepatienten finden 29 .…”