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PSG Sleep Violence
Last edited |
10/22/2008
In the
last decade, 16 polysomnographic (PSG) studies involving at least five cases with
violent or injurious behaviors during sleep can be found in the MEDLINE
Nine of them included
exclusively (or almost) REM behavioral disorder (RBD) (7-15).
Two studies were devoted to
sleepwalking and/or sleep terrors patients (16,17).
Only one compared different
parasomnias involving violent or injurious behaviors during sleep (see Table 1)
(18).
Kavey et al. (16) studied 10
sleepwalkers with episodes of violent behavior or self-injury.
Recorded sleepwalking episodes
occurred all in the NREM sleep but were not limited to the first third of the
night as suggested by the classifications; near half of recorded episodes
occurred in the latter 2/3 of the night.
Moldofsky et al. (17) studied 64
consecutive patients with sleepwalking or sleep terrors.
They further divided the
patients within three groups: those who committed serious violence during sleep
to other individuals, property or self; those with harmful but not destructive
behavior and nonviolent behavior during sleep.
The serious violent group was
composed mainly of men (22/26). Both violent and harmful behaviors were more
likely to occur with drug abuse (caffeine, alcohol, drugs).
The best predictors of violent
group membership were being a man and having <2% stage 4 sleep.
Schenck et al. (18) studied 100
consecutive adults patients with a main complaint of nocturnal injury to
themselves and/or their bedpartners.
About half of them were with
night terrors/ sleepwalking, 36 had RBD, seven a dissociative disorder, two
nocturnal seizures and one sleep apnea and periodic limb movements disorder.
Some results in the night
terrors/ sleepwalking group were different of the current opinion about this
disorder.
-
First, in about one third of
cases, the disorder begun in late adolescence or adulthood;
-
Second,
all NREM sleep stages are commonly involved;
-
third, elaborate dreamlike
mentation can be present with substantial recall of nocturnal behaviors;
-
forth, a current mental
disorder was present in only one third of this group.
In the RBD group, prodromal
symptoms appeared 10 to 40 years before the full manifestation of the disorder
in 25% of the studied cases.
This prodrome is characterized
by sleep talking, yelling, or limbjerking during sleep.
The initial sample of Schenck et
al. (7) to describe RBD included four men and one woman, all aged 60 years or
over.
Four of them had neurological
disorders.
In all studies, RBD is observed
almost exclusively in men and is frequently associated with a neurological
disorder.
The polysomnographic results
showed a higher REM density than normal in all studies on RBD.
Some studies reported excessive
slow-wave sleep for the age of patients (7,8,11,13,14) but this was not found in
other studies (19).
This could be due to the heterogeneity of neurological
diseases observed in RBD patients.
A study investigated 12
nonepileptic young patients with episodic nocturnal wanderings (20), a disorder
that shares many similarities with sleepwalking/night terrors but thought to
have an epileptiform etiology because it is responding to anticonvulsants.
Nocturnal seizures are difficult
to capture on EEG and may have uncertain significance since they can be also
observed in many other neurological conditions and also in normal subjects.
In this study, the epileptiform
etiology have been confirmed only in four of the twelve patients.
Table
1. Summary of the samples including subjects with violent or injurious behaviors
during sleep
|
Authors |
N of cases |
M/F |
Age range |
Sleep diagnosis |
|
Schenck et al
(1986)(7) |
5 |
4/1 |
60-72 |
RBD* |
|
Schenck et al
(1987)(8) |
5 |
5/0 |
57-75 |
RBD |
|
Maselli et al
(1988)(20) |
12 |
7/5 |
19-29
|
Episodic
nocturnal wandering |
|
Shimizu et al
(1990)(9) |
14 |
10/4 |
48-73 |
RBD |
|
Sforza et
al.(1988)(10) |
6 |
5/1 |
42-69 |
RBD |
|
Culebras
&Moore (1989)(11) |
6 |
4/2 |
64-74 |
RBD |
|
Schenck et al
(1989)(18) |
100 |
71/29 |
18-79 |
Sleepwalking/Night terrors (n=54) |
|
RBD
(n=36)Others (n=10) |
|
|
|
|
|
Kavey et al
(1990)(16) |
10 |
6/4 |
18-40 |
Sleepwalking |
|
Schenck et
al.(1990)(12) |
70 |
63/7 |
10-77 |
RBD |
|
Schenck &Mahowald
(1991)(13) |
20 |
17/3 |
20-81 |
17 RBD,3 Sleep
walking/Night |
|
terrors |
|
|
|
|
|
Tachibana et
al (1991)(19) |
7 |
3/4 |
61-81 |
RBD |
|
Schenck et
al.(1992)(43) |
17 |
12/5 |
8-74 |
Narcolepsy +RBD |
|
Lapierre &Montplaisir
(1992)(14) |
5 |
3/2 |
44-65 |
RBD |
|
Moldofsky et
al (1995)(17) |
64 |
39/25 |
18-71 |
Sleepwalking
or Night terrors |
|
Comella et al
(1998)(15) |
9/61 |
7/2 |
|
9 RBD,52
Parkinson disease |
RBD*: REM Behavior Disorder
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