Narcolepsia na infância: a atuação multidisciplinar com a psicologia do sono do diagnóstico ao tratamento em um relato de caso / Child narcolepsy: the multidisciplinary approach with sleep psychology from diagnostics to treatment in a case report / Narcolepsia en la infancia: actuación multidisciplinar con la psicología del sueño desde el diagnóstico hasta el tratamiento en un caso clínico

A narcolepsia, distúrbio neurológico crônico caracterizado pela sonolência diurna excessiva, pode ser associada à cataplexia, fragmentação do sono, alucinações relacionadas ao sono e paralisia do sono. Frequentemente, é confundida com outros transtornos, como Transtorno do Déficit de Atenção com Hiperatividade (TDAH), epilepsia e até esquizofrenia, assim, por vezes, é diagnosticada inadequadamente. Objetiva-se relatar o diagnóstico diferencial bem-sucedido da narcolepsia na infância e suas dificuldades, realizado por uma equipe multidisciplinar, enfocando a atuação da psicologia do sono em avaliação e intervenção. Um menino de 10 anos foi recebido no Ambulatório de Narcolepsia e Apneia do Sono Infantil (AMBNAP), alocado no Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte (UFRN) com queixas de sonolência diurna excessiva, sono fragmentado e episódios de perda de tônus muscular. Foi submetido a entrevistas psiquiátrica e psicológica pormenorizadas, a exames, aplicação de escalas específicas para rastreio e diagnóstico de transtornos de sono e diário de sono, solicitação de recursos de mídia e de relatório escolar e avaliação neurológica. A partir da investigação multidisciplinar, o diagnóstico foi de Narcolepsia e Síndrome da Apneia Obstrutiva do Sono (SAOS). O paciente foi submetido a técnicas da Terapia Cognitivo-Comportamental (TCC) e segue em acompanhamento, apresentando resultados satisfatórios. Este estudo evidencia que uma equipe multidisciplinar especializada na área de sono atuando em conjunto com a Psicologia do Sono oportuniza o diagnóstico e intervenções precoces eficazes para o tratamento do distúrbio do sono na infância.(AU)

Narcolepsy is a chronic neurologic disorder characterized by excessive daytime sleepiness which can be associated with cataplexy, sleep fragmentation, sleep-related hallucinations, and sleep paralysis. This sleep disorder is often confused with other disorders such as Attention Deficit Hyperactivity Disorder (ADHD), epilepsy, and even schizophrenia, and is, thus, misdiagnosed. This study aims to report the successful differential diagnosis for childhood narcolepsy carried out by a multidisciplinary team and its challenges, with a focus on the role of sleep psychology in assessment and intervention. A 10-year-old child was received at the Child Narcolepsy and Sleep Apnea Clinic (AMBNAP), located at the Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte (UFRN), with complaints of hypersomnolence, fragmented sleep, and episodes of loss of muscle tone. He underwent detailed psychiatric and psychological interviews, analysis of exams, application of specific scales for screening and diagnosis of sleep disorders and sleep diary, request of media resources and school report, and neurological assessment. From the multidisciplinary investigation, excluding of other neurological diagnoses, the diagnosis was Narcolepsy and Obstructive Sleep Apnea Syndrome (OSAS). The patient was submitted to Cognitive Behavioral Therapy (CBT) techniques, such as psychoeducation, scheduled naps, cognitive therapy for dysfunctional beliefs, and sleep hygiene strategies, and continues to be followed up, with satisfactory results since the first two months of intervention. The findings presented in this study show that a multidisciplinary team specialized in the sleep area, acting alongside Sleep Psychology provides early diagnosis and interventions for the sleep disorder treatment in childhood.(AU)

La narcolepsia es un trastorno neurológico crónico caracterizado por somnolencia diurna excesiva que puede asociarse con cataplejía, fragmentación del sueño, alucinaciones relacionadas con el sueño y parálisis del sueño. El trastorno del sueño a menudo se confunde con otros trastornos como el TDAH, la epilepsia e incluso la esquizofrenia, y se diagnostica erróneamente. El objetivo es presentar el diagnóstico diferencial exitoso de la narcolepsia en la infancia y sus dificultades, realizado por un equipo multidisciplinario, con foco en el papel de la psicología del sueño en la evaluación e intervención. El estudiante de 10 años fue recibido en la Clínica de Narcolepsia Infantil y Apnea del Sueño (AMBNAP), ubicada en el Hospital Universitario Onofre Lopes de la Universidad Federal de Rio Grande do Norte, con quejas de hipersomnolencia, sueño fragmentado y episodios de pérdida de tono muscular. Se sometió a entrevistas psiquiátricas y psicológicas detalladas, análisis de exámenes, aplicación de escalas específicas para la detección y diagnóstico de trastornos del sueño y el diario del sueño, solicite recursos de medios y informe escolar y evaluación neurológica. La investigación multidisciplinaria, el diagnóstico fue Narcolepsia y SAOS. El paciente fue sometido a técnicas de terapia cognitivo-conductual (TCC), como psicoeducación, siestas programadas, terapia cognitiva por creencias disfuncionales y estrategias de higiene del sueño, y se le dio seguimiento con resultados satisfactorios. Los resultados demostraron que un equipo multidisciplinario especializado en el campo del sueño, actuando en conjunto con la psicología del sueño, proporciona el diagnóstico y las intervenciones tempranas para el trastorno del sueño de la narcolepsia en la infância.(AU)

Recent Updates on Narcolepsy and Hypersomnia / 신경정신의학

Narcolepsy is a chronic neurological sleep disorder caused by hypocretin neuron loss, resulting in excessive daytime sleepiness, disturbed nocturnal sleep, and intrusions of aspects of rapid eye movement sleep in wakefulness, such as cataplexy, sleep paralysis, and hypnopompic/hypnagogic hallucinations. Narcolepsy disrupts the maintenance and orderly occurrence of the wake and sleep stages. Cataplexy is a highly specific symptom of narcolepsy, but many other symptoms can be observed in a variety of sleep disorders. The diagnosis of narcolepsy type 1 requires a history of excessive daytime sleepiness and one of the following : 1) a low cerebrospinal fluid hypocretin-1 level or 2) cataplexy and a positive multiple sleep latency test result. The diagnosis of narcolepsy type 2 requires a history of excessive daytime sleepiness and a positive mean sleep-latency test result. The mean sleep-latency test must be preceded by nighttime polysomnography to exclude other sleep disorders and to document adequate sleep. The mean sleep-latency test result can be falsely positive in other sleep disorders, such as shift work, sleep apnea, or sleep deprivation, and it is influenced by age, sex, and puberty. Modafinil and armodafinil can reduce the excessive daytime sleepiness without many of the side effects associated with older stimulants. Although there is no cure for narcolepsy, the treatments are often effective and include both behavioral and pharmacologic approaches.

Recurrent sleep paralysis - fear of sleeping / Paralisia do sono recorrente - medo de dormir

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.

RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.

Parasomnia as an Initial Presentation of Narcolepsy

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.

Comparison of Health Related Quality of Life between Type I and Type II Narcolepsy Patients

OBJECTIVES: Narcolepsy with cataplexy is a rare chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. The aims of the present study were comparing the health-related quality of life (HR-QOL) of patients with type I and type II narcolepy patients, and determining the factors that influence the HR-QOL in narcolepsy patients. METHODS: All patients performed night polysomnography (PSG) and multiple sleep latency test (MSLT). HR-QOL and the severity of subjective symptoms were evaluated using various questionnaires, including the Korean versions of the Medical Outcome Study Short Form-36, the Pittsburg Sleep Quality Index-Korean version, the Korean version Epworth Sleepiness Scale, and the Korean version Beck Depression Inventory-2. RESULTS: We enrolled 21 type I narcolepsy patients and 27 type II patients. Type I patients had short rapid eye movement (REM) latency on night PSG and more sleep onset REM periods on MSLT. The total score of HR-QOL was worse in patients with type I narcolepsy than in the type II narcolepsy patients. There was association between the severities of excessive daytime sleepiness, depression and the degree of worsening of QOL. CSF hypocretin level had no correlation with the scores of HR-QOL. CONCLUSIONS: These findings demonstrate that type I narcolepsy patients are sleepier, depressive, and have more burden on the HR-QOL. And the impairment in QOL of narcolepsy patients is related to the degree of excessive daytime and depressive mood.

Evaluation of Cognitive Functions in Patients with Narcolepsy / 農村醫學 地域保健

OBJECTIVE: This study aimed to evaluate attention, memory and executive function in patients with narcolepsy. METHODS: This study included 23 narcoleptic patients whose diagnosis were confirmed by the International Classification of Sleep Disorders(ICSD) at Chonnam National University Hospital Sleep Disorders Clinic or an other hospital in Korea, from 2005 to 2008, as well as 23 normal controls. All participants were given an IQ test for Korean-Wechsler Adult Intelligence Scale and several neuropsychological function tests (the d2 test for attention function, the Rey Complex Figure Test for nonverbal memory, the Korean-California Verbal Learning Test [K-CVLT] for verbal memory, and the Wisconsin Card Sorting Test for executive function). Clinical features of narcoleptic patients, including the frequency of excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination, were investigated by a structured clinical interview administered by a neuropsychiatist. Excessive daytime sleepiness was evaluated by the Epworth sleepiness scale. RESULTS: Characteristic symptoms of narcolepsy observed in this study included excessive daytime sleepiness (n=23, 100.0%), cataplexy (n=19, 82.6%), hypnagogic hallucination (n=5, 21.7%) and sleep paralysis (n=12, 52.2%). In nocturnal polysomnographic findings, stage 2 sleep and REM latency were found to be significantly decreased in narcoleptic patients compared with the control group, and were accompanied by significant increases in stage 1 sleep. Narcoleptic patients had lower scores than the control group on total number, Total Number-Total Error, Concentration Performance and Fluctuation Rate on the d2 test, which measures attention. Also, there were significant differences between the performance of patient and control groups on the B list of the K-CVLT, which measures verbal memory. CONCLUSION: Narcoleptic patients showed decreased attention and verbal memory performance compared to the control group; however, in many areas, narcoleptic patients still demonstrated normal cognitive function.

Excessive Daytime Sleepiness Case Confounding with Thyrotoxicosis / 수면정신생리

Narcolepsy is a sleep disorder, which is characterized by excessive daytime sleepiness (EDS) that is typically associated with cataplexy, sleep fragmentation and other REM sleep-related phenomenon such as sleep paralysis and hypnagogic hallucination. Narcoleptic symptoms can be developed from various medical or neurological disorders. A 17-year-old male patient admitted for the evaluation of EDS which started three-month ago. He slept more than 18 hours a day with cataplexy and hypnagogic hallucination. He was obese with body mass index (BMI) of 30.4 kg/m2. After admission he was newly diagnosed to the thyrotoxicosis. T3 391.2 ng/dL (60-181), free T4 4.38 ng/dL (0.89-1.76), TSH <0.01 microIU/mL (0.35-5.5) were measured. His pulse rate ranged 70-90 beats per minute and blood pressure ranged 150/100-120/70 mmHg. Polysomnography revealed many fragmentations in sleep with many positional changes (81 times/h). Sleep onset latency was 33.5 min, sleep efficiency was 47.9%, and REM latency from sleep onset was delayed to 153.6 min. REM sleep percent was increased to 27.1%. Periodic limb movement index was 13.4/h. In the multiple sleep latency test (MSLT), average sleep latency was 0.4 min and there were noted 3 SOREMPs (Sleep Onset REM sleep period) on 5 trials. We couldn't discriminate the obvious sleep-wake pattern in the actigraph and his HLA DQB1 *0602 type was negative. His thyroid function improved following treatment with methimazole and propranolol. Vital sign maintained within normal range. Cataplexy was controlled with venlafaxine 75 mg. Subjective night sleep continuity and PLMS were improved with clonazepam 0.5 mg, but the EDS were partially improved with modafinil 200-400 mg. Thyrotoxicosis might give confounding role when we were evaluating the EDS, though sleep fragmentation was one of the major symptoms of narcolepsy, but enormous amount of it made us think of the influence of thyroid hormone. The loss of sleep-wake cycle, limited improvement of EDS to the stimulant treatment, and the cataplexy not supported by HLA DQB1 *0602 should be answered further. We still should rule out idiopathic hypersomnia and measuring CSF hypocretin level would be helpful.

Narcolepsy: Clinical Feature, Diagnosis and Treatment / 수면정신생리

Narcolepsy is a central neurologic system disease. It begins early in life with disabling symptoms including excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucination and nocturnal sleep fragmentation. Patient with typical symptoms of narcolepsy is diagnosed by objective data from nocturnal polysomnography and multiple sleep latency tests. Narcolepsy is controlled with various medications. Nowadays, modafinil with favorable side effects profiles compared with traditional stimulant is mainly used. Gamma hydroxyl butyrate is effective in cataplexy. Cataplexy is also controlled with antidepressant such as Venlafaxine, SSRI, and TCA. As the knowledge of pathophysiology of narcolepsy expands, new treatment including immunological method, application of hypocretin and histamine systems have been tried.

Pediatric Narcolepsy: Diagnosis and Treatment

Narcolepsy is chronic devastating disease that characterized by excessive daytime sleepiness, cataplexy, which often precipitated by intense emotion or excitement, hypnagogic, or hypnapompic hallucinations, sleep paralysis and nocturnal disrupted sleep. In child onset narcolepsy, the presentations of narcolepsy can be very variable, making misdiagnosis as seizure disorders or delaying diagnosis as much as several years after disease onset. For the diagnosis of narcolepsy, overnight polysomnography(PSG) and multiple sleep latency test(MSLT) should be evaluated. Test for Cerebrospinal fluid hypocretin(orexin) concentration and human leukocyte antigens(HLA) would be great helpful to confirm the narcolepsy with cataplexy even in early stage of disease in children. The mainstays of treatment are that reducing the excessive daytime sleepiness, preventing the intrusion of the REM related phenomena including cataplexy and consolidating the nighttime sleep. Central nervous system stimulators such as methylphenidate or amphetamine decrease excessive daytime sleepiness and tricyclic antidepressant(TCA) or selective serotonin reuptake inhibitors(SSRI) can prevent cataplexy. Recently, new therapeutic agents such as modafinil and sodium oxybate are emerging in clinical practice with much effectiveness. Counseling for poor school performance, social isolation and depression should be provided. Early diagnosis and treatment can greatly improve the quality of life. Awareness of excessive daytime sleepiness in children or adolescent will allow pediatricians to effectively identify hypersomnia such as narcolepsy.

Narcolepsia: reporte de evidencia y revisión bibliográfica / Narcolepsy: evidence report and bibliographic revision

El sueño es una función fisiológica cuyo mecanismo aún no está bien precisado; sin embargo, la distinción entre sueño normal o sueño lento, y sueño paradójico o sueño REM (Rapid Eye Movements), es un buen aporte a la clínica. La narcolepsia es un trastorno del sueño caracterizado por ataques de somnolencia diurna asociados a un trastorno del sueño REM donde sus componentes normales (sueños y pérdida de tono muscular) se disocian e invaden la vigilia del sujeto. Se narra el caso de un paciente con narcolepsia cuyo principal antecedente es el estar sometido a un estrés emocional intenso. Se realiza una revisión de la bibliografía publicada sobre esta patología, en la que se destaca las principales características para diagnosticar este trastorno del sueño.

Sleep is a physiological function. Its mechanism is not yet specified; nevertheless differences between normal or slow sleep and paradoxical or REM (Rapid Eye Movements) sleep is a good contribution to clinic. Narcolepsy is a sleep disorder with fits of drowsiness as its essential feature, associated to a disorder of REM sleep in which its normal features (dreams and loss of muscle tone) are dissociated and invade the wake phase of the individual. A case of a patient with narcolepsy is told whose main record is being under an intense emotional stress. Published bibliography about this disorder is checked stressing the main features to make the diagnosis of this sleep disorder.

Comparison of Narcolepsy with Cataplexy and without Cataplexy: Clinical Variables, HLA-DQB1*0602, and Hypocretin / 신경정신의학

OBJECTIVES: Narcolepsy is a sleep disorder, characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination. Among these symptoms, cataplexy is one of the most pathognomonic symptoms in narcolepsy. This study was designed to investigate the clinical features, frequency of DQB1*0602 and CSF hypocretin levels in Korean narcoleptics with cataplexy to compare with those who have not cataplexy. METHODS: From August 2003 to July 2005, we selected 72 patients who have narcolepsy confirmed by nocturnal polysomnography and multiple sleep latency test (MSLT) as well as their history and clinical symptoms at Sleep Disorders Clinic of St. Vincent's Hospital, Catholic University of Korea. Patients were divided into 56 cataplexy-positive group (narcolepsy with cataplexy group) and 12 cataplexy-negative group (narcolepsy without cataplexy group). HLA typing was done in all patients for the presence of DQB1*0602, and patients received spinal tapping to measure the level of CSF hypocretin. Clinical variables were examined by semi-structured interview for narcolepsy patients. RESULTS: 1) In cataplexy-positive group, compared with cataplexy-negative group, the frequency of HLA-DQB1*0602 was found to be significantly increased (50 subjects, 89.3% vs. 8 subjects, 50.0%)(p=0.000). 2) In 48 out of 56 cataplexy-positive patients (85.7%), hypocretin levels were decreased (< or =110 pg/ml) or were below the detection limit of assay (<40 pg/ml). However, only 6 out of 16 cataplexy-negative patients (37.5%) exhibited decreased hyopcretin level. The difference between two groups were statistically significant (p=0.000). 3) Cataplexy-positive group, compared to cataplexy-negative group, reported more frequent hypnagogic hallucinations (36 subjects, 64.3% vs. 4 subjects, 25.0%)(p=0.005). However, there were no significant differences in frequency or severity of daytime sleepiness, sleep paralysis and demographic data. 4. In nocturnal polysomnography and MSLT findings, there were no significant differences in all sleep parameters between two groups. CONCLUSION: Higher frequency of HLA-DQB1*0602, and lower hypocretin levels in cataplexy-positive groups than catapelxy-negatives suggest that narcoleptics with cataplexy might be a etiologically different disease entity from narcoleptics without cataplexy. Additionally, Current criteria prevail for the diagnosis of narcolepsy need to be reclassified according to the presence of cataplexy or not.

Calidad y parálisis del sueño en estudiantes de medicina / Dream quality and sleep paralysis in medical students

Introducción: La parálisis del sueño es un evento de inmovilización corporal estando consciente, ocurre espontáneamente o secundaria a situaciones estresantes o una posible mala calidad de sueño. Objetivo: Determinar la asociación y riesgo de tener parálisis del sueño en los estudiantes de la facultad de medicina, que son malos dormidores. Diseño: Estudio analítico, transversal. Lugar: Facultad de Medicina de la Universidad Nacional Mayor de San Marcos. Participantes: Estudiantes de medicina. Intervenciones: En mayo de 2006, se realizó una muestra no probabilística de estudiantes, por medio de una encuesta que incluía el índice de calidad de sueño de Pittsburg y preguntas sobre parálisis del sueño. Se determinó la asociación entre las variables parálisis del sueño y calidad del sueño y el riesgo (OR) de parálisis del sueño en malos dormidores. Se empleó las pruebas de chi cuadrado para las variables cualitativas y t de student para las cuantitativas, con un 95 por ciento de confiabilidad. Principales medidas de resultados: Experiencias de parálisis del sueño y prevalencia de malos dormidores. Resultados: El promedio de edad fue 22,3+2,7 años; el 55,5 por ciento fue mujer. Las experiencias de parálisis del sueño informadas durante el último mes ocurrieron en 26,6 por ciento (21,6 a 32,1 por ciento) y la prevalencia de malos dormidores fue 48,5 por ciento (42,6 a 54,3 por ciento). No existió asociación entre ellas (x2, p = 0,1; OR = 1,54; IC95: 0,9 a 2,6). Conclusiones: No se halla asociación entre la presentación de parálisis del sueño y una mala calidad de sueño, difiriendo ello con diversos estudios previos, por lo que se sugiere indagar sobre otros factores que pudiesen desencadenarla.

Introduction: Sleep paralysis is a conscious state body immobilization event that appears spontaneously or secondarily to stress situations or to possible bad quality of dream. Objective: To determine medical students association and risk of sleep paralysis in bad sleepers. Design: Analytical, transversal study. Setting: Faculty of Medicine, San Marcos Major National University. Participants: Medical students. Interventions: In May 2006, a non probabilistic sample of medical students was done by a survey including PittsburgÆs Sleep Quality Index and question referred to sleep paralysis. We determined the association between sleep paralysis and dream quality and the sleep paralysis risk in bad sleepers. Chi square test for qualitative variables and student t for quantification were used, with 95 per cent confidence interval. Main outcome measures: Experiences in sleep paralysis and prevalence of bad sleepers. Results: Mean age was 22,3+2,7 years, 55,5 per cent women. Information of sleep paralyses experiences during the last month was given by 26,6 per cent (21,6-32,1 per cent), and bad sleepers prevalence was 48,5 per cent (42,6-54,3 per cent). There was no association between both variables (x2, p = 0,1; OR = 1,54; IC95: 0,9-2,6). Conclusions: There was no association between sleep paralysis and bad dream quality, differing with previous studies; we suggest to investigate on other factors that may release it.

Prevalencia y presentación de la parálisis del sueño en estudiantes de Medicina Humana de la UNMSM / Sleeping paralysis prevalence and presentation in human medicine students

Objetivo: Determinar la prevalencia de vida y las características de parálisis de sueño en estudiantes de 4º año de medicina humana de la UNMSM. Diseño: Estudio observacional, descriptivo, transversal. Lugar: Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Pacientes: Ciento treinta y nueve estudiantes de 4º año de medicina humana de la UNMSM. Intervenciones: Estudio de la prevalencia de vida y características, de tipo longitudinal no concurrente para la prevalencia de un mes, ejecutado en agosto de 2005, mediante una encuesta tipo cuestionario validada por juicio de expertos. Principales medidas de resultado: Prevalencia de vida, características y prevalencia de un mes de la parálisis del sueño en estudiantes de medicina. Resultados: La prevalencia de vida fue de 56 por ciento y la prevalencia en el último mes fue de 33 eventos por cada 100 estudiantes. El 83,2 por ciento tuvo alucinaciones durante los eventos de parálisis del sueño. El 58,8 por ciento tuvo ansiedad junto al evento. La forma de remisión más frecuente fue de manera espontánea (64,4 por ciento). Conclusiones: La prevalencia de parálisis del sueño es mayor en nuestro estudio que en las informadas en otras investigaciones, con un alto porcentaje de presentación de alucinaciones y ansiedad.

Objective: To determine life prevalence and characteristics of sleeping paralysis in San Marcos University human medicine fourth year students. Design: Observational, descriptive, cross-sectional study. Setting: Faculty of Medicine, San Marcos Major National University. Participants: One hundred thirty nine fourth year medicine students. Interventions: Life and characteristics sleeping paralysis non-concurrent longitudinal study for incidence density, done in August 2005, using a survey type questionnaire validated by experts. Main outcome measures: Sleeping paralysis life prevalence, characteristics, and one month prevalence in medical students. Results: Life prevalence was 56 per cent; prevalence in the last month was 33 events per 100 students; 83,2 per cent had hallucinations during the sleep paralysis events, 58,8 per cent experienced anxiety. Remission was usually spontaneous (64,4 per cent). Conclusions: The prevalence of sleeping paralysis in medical students is greater than that reported in previous investigations, with a high percentage of hallucinations and anxiety.

Un trastorno del sueño poco frecuente pero interesante: la narcolepsia / A not very frecuent but interesting sleep disorder: the narcolepsy

Revisar y brindar información sobre las investigaciones, datos clínicos, posibles causas y tratamiento de un trastorno del sueño, la narcolepsia, entidad de difícil diagnóstico, con el fin de ampliar el conocimiento a la población médica en general.Los síntomas que la caracterizan son: 1. ataques o crisis irresistibles de sueño, que aparecen de forma súbita durante el día, a los que se impone una somnolencia diurna excesiva, 2. crisis de cataplejía, 3. parálisis de sueño y 4, alucinaciones hipnagógicas, asociados con alteraciones del sueño de movimientos oculares rápidos.En su etiología existen factores relacionados con la inmunidad, la genética y la herencia (antígenos HLA-DR2 o el HLA-DQ1), neuromoduladores y neurotransmisores (hipocretinas, asociada su reducción en el LCR con la cataplejía), la nutrición, sustancias tóxicas y procesos infecciosos del SNC.El diagnóstico puede demorar de 1 año a decenas de años, siendo la cataplejía el indicador más importante para identificarla.El estudio polisomnográfico de sueño nocturno seguido, por un test de latencias múltiple de sueño puede ser de gran utilidad en el diagnóstico.Para su tratamiento se necesitan diversos tipos de fármacos que mejoren somnolencia diurna, las crisis de hipersomnia, la cataplejía y la parálisis del sueño.La narcolepsia es de difícil diagnóstico pero se puede llegar a éste con el estudio clínico del paciente y el apoyo de los exámenes polisomnográfico (estudio de sueño nocturno seguido por una prueba de latencias múltiples de sueño), inmunogenético y del líquido cefaloraquídeo de los enfermos

Gender Differences in Narcolepsy Symptomatology among Adolescents / 수면정신생리

OBJECTIVES: Narcolepsy is characterized by excessive sleepiness, cataplexy, sleep paralysis and hypnagogic hallucination. As there have been few researches on narcolepsy symptomatology in adolescents, we examined gender differences and prevalence of narcolepsy tetrad among students attending high school. METHODS: Total 20, 407 subjects, ages 14-19 years filled out Ullanlinna Narcolepsy Scale (UNS). Subjects whose UNS scores were equal to or more than 14 were interviewed by telephone using semi-structured questionnaire. Variables included questions to evaluate tetrad of narcolepsy. RESULTS: UNS scores were higher in female than male (11.1+/-5.2 vs. 9.6+/-4.5, p or = 14 were significantly higher in female subjects than male ones. However, no significant gender difference was observed in the frequencies of severe sleep attack and cataplexy-like symptoms. Sleep paralysis was most frequently reported during sleep. There was significant correlation between sleep paralysis and hypnagogic hallucination (r=0.235, p< 0.01). CONCLUSIONS: Our findings were that female adolescents complained more frequently narcolepsy symptoms than male subjects. Female adolescents might be more sensitive than male ones to physical complaints such as sleepiness or muscle weakness.

A Case of Narcoleptic Patient with Psychotic Symptoms / 신경정신의학

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and disrupted nocturnal sleep. We report a patient with a diagnosis of schizophrenia who was subsequently diagnosed as narcolepsy. A case of a 22-year-old woman with concomitant narcolepsy and psychotic symptoms was discussed from a perspective of the diagnosis and therapeutic challenges, particularly on pharmacological treatment dealing with issues raised by their coexistence.

A Case of Eyeball Perforation Through Self-injury Found in a Narcoleptic Patient

PURPOSE: Narcolepsy is a specific neurologic syndrome consisting of excessive daytime drowsiness, cataplexy, and the additional phenomena of sleep paralysis and intense dreamlike hallucinations at sleep-wake transitions. We are reporting a patient with narcolepsy whose repeated self-injury caused traumatic eyeball perforation. METHODS: A 26-year-old male with narcolepsy injured himself, which resulted in eyeball perforation in his both eyes. We diagnosed him as traumatic corneal laceration, traumatic cataract, and vitreous opacity due to lens material in vitreous in both eyes. RESULTS: After improvement of narcoleptic symptom and healing of corneal perforation, we performed cataract extraction and pars plana vitrectomy under local anesthesia. During operation, we found preretinal gliosis at superior portion of optic disc and subretinal hemorrhage in the right eye. We observed successful improvement in visual acuity through intraocular lens implantation.

Two Cases of Isolated Sleep Paralysis

We report two patients with frequent isolated sleep paralysis (SP). They have neither cataplexy nor daytime sleepiness, and there was no HLA DR2 or DQ1 association. We elicited one episode of sleep paralysis from a patient by a sleep interruption schedule. The polysomnographic recording during SP showed abundant alpha rhythm with persistent atonia, which indicate a concurrence of REM-atonia and wakefulness. The frequency of SP was markedly reduced by a use of clomipramine

Sleep disorders in Suadi health care workers

The objective of the study was to screen for sleep habits and various sleep disorders, using a standard questionnaire. Patients and The questionnaire was designed to assess sleep habits, the degree of daytime sleepiness using the Epworth Sleepiness Scale [ESS], and specific sleep problems. A random sample of Saudi employees working as medical or paramedical personnel was selected. There were 163 respondents [65%] comprising 33 females and 130 males. The mean ESS score was 9.4. Sixty-four respondents [39.3%] had an ESS score of more than 10, i.e., excessive daytime sleepiness [EDS]. When subjects with poor sleep habits and/or sleep problems were excluded, there were 65 "normal" sleepers, with a mean ESS score of 8.9 +/- 3.6. This did not differ from the rest of the sample population, who had a score of 9.8 +/- 3.7 [P=0.15]. Subjects with inadequate sleep or insomnia consisted of 17 females [51.5%] and 45 males [34.6%]. There were seven subjects, all males [5.4%], with habitual snoring. Ten males [7.7%] and two females [6.1%] reported having breathing pauses while asleep. Symptoms of restless leg syndrome, sleep paralysis, and cataplexy were reported by 21 [12.9%], 26 [16.0%] and two [1.2%] subjects, respectively. The prevalence of EDS in the Saudi population is higher compared to that reported from other populations when a Western ESS normal range is used. Nevertheless, the range of normal score of ESS is probably broader for Saudis compared to other populations. In general, sleep disorders are common but unrecognized in our community

A Case of Narcolepsy Diagnosed by Multiple Sleep Latency Test

Narcolepsy is a serious, lifelong, disabling disorder characterized by a tetrad of symptoms including excessive daytime sleepiness, cataplexy, hypnagogic hallucination, and sleep paralysis. We experienced a 14 year old boy with a narcolepsy diagnosed by typical clinical symptoms above mentioned and multiple sleep latency test. A brief review of the related literatures was also made.