What respiratory physicians should know about parasomnias

Abstract

Parasomnias have significant quality-of-life, prognostic and potentially forensic implications for patients and their bed-partners. Identifying key clinical features will accelerate diagnosis and appropriate management for these patients. Parasomnias are undesirable physical events or experiences that arise out of, or during, sleep. They can include movements, behaviours, emotions, perceptions, dreams or autonomic nervous system activity. While more common during childhood, they can persist into, or present de novo, during adulthood. Parasomnias can arise out of non-rapid eye movement (NREM) sleep, as in confusional arousals, sleepwalking, sleep terrors or sleep-related eating disorder, or out of REM sleep, as in REM behaviour disorder, recurrent isolated sleep paralysis or nightmare disorder. Sleep-related hypermotor epilepsy is an important differential diagnosis to consider in patients presenting with a parasomnia. A thorough clinical history, including a collateral history if available, is crucial to identify characteristic clinical features. Video polysomnography is useful to identify macro- and micro-sleep architectural features, characteristic behavioural events, and any concomitant sleep pathologies. Treatment of parasomnias involves a combined approach of pharmacological and non-pharmacological intervention, including safety measures, sleep hygiene and medicines such as clonazepam or melatonin to improve sleep consolidation and reduce behavioural activity. As parasomnias can not only be disruptive for the patient and their bed-partner but have important prognostic or forensic consequences, an understanding of their pathophysiology, clinical features and management is valuable for any respiratory physician who may encounter them.Educational aimsTo understand the common features of NREM and REM parasomnias.To differentiate between the causes of motor behaviours during sleep.To discuss the treatment approach for NREM and REM parasomnias.

Parasomnije: diferencijalno dijagnostički pristup i značaj polisomnografije

“…faze NREM spavanja, ali to se također vidi i u pacijenata sa SHE, pa treba i sva ostala klinička obilježja pažljivo razmotriti. 20,21,22 REM parasomnije REM parasomnije uključuju poremećaj ponašanja u REM fazi spavanja, noćne more i paralizu spavanja. REM spavanje razlikuje se od NREM spavanja po karakterističnoj moždanoj aktivnosti, a od budnosti po sniženom antigravitacijskom tonusu mišića.…”

Behavioral and psychological treatments for NREM parasomnias: A systematic review

“…A useful model for conceptualizing the treatment of NREM parasomnias is the 3P model which describes the contribution of predisposing, priming, and precipitating factors [8,96]. Table 2 summarizes how the treatments discussed in this review might target specific factors in the 3P model (note that Table 2 does not contain an exhaustive list of factors and further elaboration of factors implicated in NREM parasomnias can be found in several recent reviews) [3,8,97]. Predisposing factors such as age and genetics operate at the trait level, and priming factors such as stress and insufficient sleep occur during the preceding day(s).…”

Prevalence and correlates of excessive fatigue among Moroccan school adolescents: A cross-sectional study

“…Parasomnias are a group of sleep disorders characterized by undesirable behaviors or experiences that occur during sleep or sleep-wake transitions, including sleepwalking, night terrors, and hypnagogic hallucinations ( 13 , 14 ). Parasomnias have been associated with fragmented sleep and poor sleep quality, both of which may contribute to excessive fatigue in adolescents ( 15 ).…”