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Sleep Violence Epidemiology
Last edited |
10/22/2008
Prior
our study, there were no epidemiological data available from either the general
population or sleep centers to confirm or quantify the frequency of Violent
Behavior during Sleep
The consequences for
patients exhibiting Violent Behavior during Sleep range from benign acting out during sleep to
self-mutilating injuries, murder or suicide.
There are patients with Violent Behavior during Sleep who remain untreated for several years before
seeking medical consultation and instead pursue idiosyncratic and often
ineffective remedies to attempt to suppress their acting out behaviors.
Until recently, a
common assumption was that most acts of violence perpetrated during sleep were
attributable to night terrors or sleepwalking episodes.
In the eighties, Schenk et al. described a new syndrome, REM-sleep Behavior
Disorder (RBD), characterized as "injuries or disruptive behaviors
emerging during REM sleep, which ordinarily exhibits a generalized skeletal
muscle atonia".
In normal REM sleep, this protective measure of atonia was said to prevent the
physical acting out of the dream but in subjects suffering from
REM-sleep Behavior Disorder this atonia
is absent, often resulting in injurious behavior to self or others (13, 14).
Aggression
associated with sleep was also reported in other types of sleep disorders but
not as an essential diagnostic feature.
Such was the case of somnambulism (3, 5,
6, 15, 16) and night terrors (15, 16), both parasomnias occurring during NREM
sleep.
Violent behavioral patterns might also occur in subjects suffering from
nocturnal seizures (14, 16-19), in the transitional period between sleep and
complete wakefulness (sleep drunkenness) (10, 20) or in some neurological
diseases (21-23).
RESEARCH
We
investigated the prevalence of violent or injurious behaviors occurring in sleep
and the associated psychiatric risk factors in a representative UK sample of
2078 men and 2894 women.
These individuals were between the ages of 15 to 100 (representing 79.8% of
those contacted).
They participated in a telephone interview directed by the
Sleep-EVAL expert system specially designed for conducting such diagnostic
telephone surveys.
Results
Two percent (2.1%, n=106) of respondents
reported currently experiencing violent or injurious behavior during sleep (VBS).
The VBS group experienced
more sleep terrors and daytime sleepiness than the non-VBS group.
Sleep talking,
bruxism, and
hypnic jerks were more frequent within the VBS than the other group, as were
hypnagogic hallucinations (especially the experience of being attacked), the
incidence of smoking, caffeine and bedtime alcohol intake.
The VBS group also reported
current features of anxiety and mood disorders significantly more frequently,
and reported being hospitalized more often during the previous 12 months, than
the non-VBS group.
Higher
risks of reporting Violent Behavior during Sleep were found in subjects with
mood or anxiety disorders only when co-occurring with other symptoms.
We have
showed a number of sleep, mental disorder and other general health factors
that characterize those experiencing episodes of violent behavior during sleep.
These
findings suggest that specific factors, perhaps reflecting an interaction of
lifestyle and hereditary contributions, may be responsible for the observed
variability in this rare but potentially serious condition.
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Sleep-EVAL
Research
