Figures
- FIGURE 1
A pathophysiological model of disorders of arousal.
Tables
- TABLE 1
International Classification of Sleep Disorders, third edition (ICSD-3) classification of parasomnias
NREM parasomnias Disorders of arousal Confusional arousals Sexsomnia Sleepwalking Sleep terrors Sleep-related eating disorder REM parasomnias REM sleep behaviour disorder Recurrent isolated sleep paralysis Nightmare disorder Other parasomnias Exploding head syndrome Sleep-related hallucinations Sleep enuresis Parasomnia due to a medical disorder Parasomnia due to a medication or substance Parasomnia, unspecified Isolated symptoms and normal variants Sleep talking Information from [1].
- TABLE 2
ICSD-3 criteria for NREM parasomnias
Disorders of arousal# Recurrent episodes of incomplete arousal from sleep: Usually occurring during the first third of the major sleep period The individual may appear confused or disorientated for several minutes after the episode Inappropriate or absent responsiveness Limited or no associated dream imagery Partial or complete amnesia for the episode The episode is not better explained by another sleep disorder, mental disorder, medical disorder, or substance or medication use #: confusional arousals, sleepwalking, sleep terrors. Information from [1].
- TABLE 3
ICSD-3 criteria for RBD
Repeated episodes of sleep vocalisation and/or complex motor behaviours Behaviours are documented by polysomnography to occur during REM sleep, or based on a clinical history of dream enactment, are presumed to occur during REM sleep Presence of REM sleep without atonia on polysomnography Absence of epileptiform activity during REM sleep, unless RBD can be distinguished from any concurrent REM-related seizure disorder The sleep disturbance is not better explained by another sleep disorder, medical or neurological disorder, mental disorder, medicine use or substance use disorder Information from [1].
- TABLE 4
Different features of parasomnias, including DOAs, SHE, idiopathic RBD and nightmares
DOA SHE Idiopathic RBD Nightmares Age of onset (years) 3–8 Any age After 50 Usually 3–6 Course Tends to disappear Usually increases Rare spontaneous remission Variable Episodes per night Usually one Usually several One to several One to several Occurrence during the night First third Any time Last third Last third Episode duration 1–30 min Seconds–3 min 1–2 min Seconds–minutes Motor pattern Variable: sitting up, pulling at bed clothes, speaking, sleepwalking, screaming, usually with eyes opening Highly stereotyped: complex body movements, kicking or cycling of limbs, rocking body movements, asymmetric tonic/dystonic posturing Finger twitching or flexing to complex dream enactment behaviour Most commonly absent, but rarely can consist of simple movements with preserved REM atonia Awareness if awakened Usually absent Variable Usually present Usually present Recall Usually absent Variable Usually present, sometimes with vivid detail Usually present, sometimes with vivid detail PSG features Cyclic alternating pattern, hypersynchronous delta activity, possible periodic limb movements (confusional arousals/sleepwalking), increased autonomic function (sleep terrors) Epileptiform features on sleep EEG REM sleep without atonia Variable: may be normal, may display reduced sleep efficiency and increased wakefulness, may identify sleep disrupting pathology Reproduced and modified from Loddo et al. [33].
Vol 18 Issue 3
Table of Contents
What respiratory physicians should know about parasomnias
