Clinical profiles of late-onset psychiatric patients exhibiting incidental REM sleep without atonia.

Rapid eye movement (REM) sleep without atonia (RWA), which is a hallmark of REM sleep behavior disorder (RBD) on polysomnography (PSG), may represent specific characteristics of prodromal Parkinson's disease (PD)/dementia with Lewy bodies (DLB), even when dream-enactment behavior is absent. We investigated the clinical profiles associated with PD/DLB in late-onset psychiatric patients exhibiting incidental RWA. Among patients who underwent PSG in our psychiatric ward, eight with incidental RWA, nine with idiopathic RBD, and seven with PD or DLB who had preceding RBD were included. Clinical variables, including the percentage of RWA in the total REM sleep (%RWA), were compared among the three groups. The frequency of depressive disorders as a primary psychiatric diagnosis and antidepressant usage were significantly higher in the incidental RWA group than in the other groups. There were no differences in the prevalence of supportive features of DLB among the three groups. The median %RWA was significantly lower in the incidental RWA group than in the other groups. Although the cardiac 123I-metaiodobenzylguanidine uptake was significantly higher in the incidental RWA group compared with the other groups, the groups showed overlap in the specific binding ratios on dopamine transporter imaging. All patients in the three groups exhibited cingulate island sign ratios on brain perfusion single-photon emission computed tomography within a threshold of 0.281, which is the optimal cut-off value for a diagnosis of DLB. In this series, late-onset psychiatric patients with incidental RWA partially shared common clinical profiles with idiopathic RBD and PD/DLB.

Sexsomnia: sleep sex research and its legal implications.

"Sleep sex," also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of "sane" or "insane" automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.

Hábitos de sueño de la población infantil del Grau de Gandía. Un estudio descriptivo / Sleep habits of the children in the Grau de Gandia. A descriptive study

El insomnio es es trastorno de sueño infantil más frecuente y puede aparecer en la edad lactante o en la etapa preescolar, siendo de utilidad para la detección precoz el uso de cuestionarios de sueño, como la versión española del Pediatric Sleep Questionnaire (PSQ). Nos planteamos conocer la prevalencia de los trastornos de sueño en una población de 3 a 6 años del Grau de Gandía, utilizando para ello la versión española del PSQ mediante una encuesta autocumplimentada por los padres de los alumnos de los diferentes colegios. Se ha realizado un estudio descriptivo de corte transversal, recogiéndose 144 encuestas válidas, realizándose la entrada de los datos en una base de datos EXCEL para su posterior descripción. Un 23,4% de los niños presentan insomnio en función de las respuestas dadas, siendo importante la presencia de otras parasomnias como somniloquias (70%), ronquidos (7.2%), bruxismo (22.3%), trastornos por movimientos rítmicos (7.1%) y un 4.1% de los niños presentan síntomas desatencionales independientemente de que se presente o no síntomas de hiperactividad, un 2.08% de las encuestas respondían a un TDHA combinado y un 6.25% sintomatología de hiperactividad-impulsividad. Nuestro estudio proporcióna datos similares a otros estudios poblacionales realizados en el medio escolar, tanto en este rango de edad como en superiores, respecto al insomnio, parasomnias, hábitos de sueño y los TDHA, siendo la etiología más frecuente la falta de educación del hábito de sueño, por lo que el papel de la enfermera es fundamental en la orientación y formación a los padres (AU)

Insomnia is the most common sleep disorder in chilhood and it may occur to unweaned babies or during the infant period. In order to be able to detect as early as possible this disease, it is useful to make sleep questionnaires, such as the Spanish Version of the Pediatric Sleep Questionnaire (PSQ). We considered to know the prevalence of sleep disorders in a population from 3 to 6 years old from the "Grau de Gandia", using de Spanish Version of PSQ by means of an autofilled survey answered by the parents of the students from the different schools. We performed a cross sectional study, collecting 144 valid surveys, performing data entry in a EXCEL database for further description. A 23.4% of the children have insomnia based on the responses and it is significant the presence of other parasomnias such as somniloquy (70%), snoring (7.2%), bruxism (22.3%), rhythmic movement disorders (7.1% ) and a 4.1% of the children have symptoms of attention deficit regardless of havingr or not symptoms of hyperactivity. A 2.08% of the survey responded to a combined ADHD and a 6.25% of the children had symptoms of hyperactivity-impulsivity. Our study provides similar data to other population studies carried out at schools at this age range and also in higher, with regard to insomnia, parasomnias, sleep habits and ADHD, being the lack of education of the habit of sleep the most common etiology, so the role of the nurse is fundamental in the orientation and training for parents (AU)

Prevalence and correlates of frequent nightmares: a community-based 2-phase study.

STUDY OBJECTIVES: To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese. DESIGN: A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects. SETTING: Community. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (p < 0.05). CONCLUSIONS: Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares.

REM sleep behaviour disorder (RBD) and its associations in young patients.

STUDY OBJECTIVES: To retrospectively examine the characteristics of a population of patients <50 years of age with clinical and polysomnographic features diagnostic for RBD. METHODS: Review of our sleep centre's database for patients with RBD diagnosed over the last 7 years. Ninety-one patients were separated into two groups according to their age at the time of diagnosis (<50 y and 50 y). Clinical and polysomnographic data were reviewed. RESULTS: Sixty-two were male; mean age was 52+/-19 y. Thirty-nine were <50 y. In the group <50 y there was a male predominance but in a smaller proportion (M:F=1.4:1) compared with the group 50 (M:F=3:1). Seventy-six patients complained of abnormal behaviour (AB) during sleep, 12 with narcolepsy complained of excessive daytime sleepiness (EDS) with the AB being elicited only during consultation, and three complained of both EDS and AB. All patients, except one in the group 50, described AB related to vivid dreams with violent content. The majority of the patients had the idiopathic form of RBD in both groups (51.2% group <50, 63.4% group 50). The secondary form was associated with narcolepsy in 38.4% of patients in the group <50 y and with a synucleinopathy in 28.8% of patients in the group 50. A strong association was noted between RBD and non-REM parasomnias. CONCLUSIONS: In a population of patients with RBD presenting to a regional sleep laboratory, more than one-third of patients were <50 y at time of diagnosis. The commonest associated disorder was narcolepsy in patients <50 y, and synucleinopathy in those 50 y. The coexistence of RBD with a NREM parasomnia was not uncommon in cases of idiopathic RBD affecting patients <50 y.

Is the first seizure truly epileptic?

Transient loss of consciousness (T-LOC) with abnormal posture or movements reflects a temporary dysfunction of the brain, either primary or secondary. In a period of high technological medical access, patients with T-LOC constitute a challenge to improve the medical "art of listening." The difficulty in dealing with isolated paroxysmal phenomena is associated with the probability of the occurrence of a second event and therefore the entrance of the patient into a chronic disorder. We present a detailed analysis of symptoms that should help the general practitioner in the differential diagnosis among three main entities in the adult populations: syncope, epileptic seizure, and psychogenic seizure (dissociative convulsion).

Is REM sleep behaviour disorder (RBD) a risk factor of dementia in idiopathic Parkinson's disease?

OBJECTIVE: To study the sequence of occurrence of REM-sleep behaviour disorder (RBD) and dementia and their frequency among a population of patients with idiopathic Parkinson's disease (PD). METHODS: We performed a cross-sectional study on 65 PD patients seen in a movement disorder clinic and their bed partner, and asked them to complete the validated Mayo Sleep Questionnaire for RBD and sleep disorders. The diagnosis of PD with dementia (PD-D) was based on a clinical diagnosis of dementia; following DSM-IV criteria and MMSE score less than 25 and a battery of cognitive tests. RESULTS: From the 65 patients that completed the study, twenty-four met the clinical diagnosis of RBD. Ten of the 24 (42%) RBD patients met the clinical criteria of PD-D, whereas the remaining 14 patients were non-demented at the time of the study. The frequency of RBD was significantly higher in the PD-D group (n = 10, 77%) compared to the PD-ND group (n = 14, 27%, chi squared test: p = 0.0008). PD non-RBD had a lower occurrence of dementia (7.3%, 3 of 41) compared to those suffering from RBD (42%, 10 of 24). Of the 65 PD patients, 13 were diagnosed with PD-D and the remaining 52 were non-demented PD (PD-ND) patients. PD with RBD showed a faster decline in the number of dementia-free patients compared to the non-RBD patients (Log Rank test: p < 0.001). RBD preceded, coincided or followed the onset of the motor symptoms. CONCLUSION: This study shows that RBD and dementia have a significant coincidence in the course of PD, and RBD not only precedes or coincides with the motor signs, but can occur during the course of the progression of the PD, suggesting a degenerative process of the dopaminergic and cholinergic neurons of the brainstem nuclei, progressing at a different pace in each patient.

Sleep-wake cycle disturbances in protein-energy malnutrition: effect of nutritional rehabilitation.

A standard sleep questionnaire was given to the parents of 26 infants with protein-energy malnutrition who underwent polysomnographic evaluation. These investigations were repeated approximately 2 months after enrolment in a nutritional rehabilitation programme based on World Health Organization guidelines. Anthropometric values and serum serotonin levels were also measured. After nutritional rehabilitation there was a significantly higher percentage of non-rapid eye movement (REM) sleep; 2nd REM time, and latency times for sleep and REM sleep increased. Percentages of REM sleep and serum serotonin levels decreased significantly. Protein-energy malnutrition seems to affect the sleep-wake cycle; disturbed serotonin levels may be among the factors responsible.

XIV Reunión Anual de la Asociación Ibérica de Patología del Sueño: Almería, 26, 27 y 28 de mayo / No disponible

No disponible

Hypnic headache: clinical features, pathophysiology, and treatment.

Hypnic headache has been described in several case reports since 1981 and is regarded as an idiopathic headache disorder. In this review of 71 cases in the literature, the clinical features, neurophysiologic including polysomnographic findings, and treatment procedures are analyzed and the pathophysiology of this condition, which remains however speculative, is discussed. There is some evidence that hypnic headache is related to REM sleep. The analysis shows that hypnic headache most probably is an entity among the idiopathic headache disorders unassociated with structural lesions and does not belong to the trigeminal-autonomic cephalalgias. Lithium shows the best efficacy; indomethacin, flunarizine, and caffeine may also be useful.

[Comorbidity in narcoleptic patients]. / Untersuchung zur Komorbidität bei Narkolepsiepatienten.

BACKGROUND AND OBJECTIVE: Narcolepsy is a rare disease which remains undiagnosed in 90 %. The international literature so far has paid little attention to comorbid disorders. PATIENTS AND METHODS: In preparation for a German Narcolepsy Register this pilot study evaluated data from hospital records of 106 narcolepsy patients (60 men, 46 women, 8-83 years, mean 45.1 years) retrospectively emphasising comorbid diseases. RESULTS: The parasomnias sleepwalking and nightmares were 6 times as frequent as in the general population. With respect to the HLA findings the extremely high frequency of REM behavior disorder contributes to the assumption of a common pathomechanism. Obstructive sleep apnea and periodic limb movement disorder (PLMD) occurred much less than described in literature, while the results on obesity, headache and depression are in line with published findings. CONCLUSION: Diagnosis of one of these comorbid disorders should always be followed by thorough investigation for symptoms of narcolepsy i. e. excessive daytime sleepiness, sleep attacks and cataplexy.