Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new.
Yannis IdirDelphine OudietteIsabelle ArnulfPublished in: Journal of sleep research (2022)
Disorders of arousal (DOA) is an umbrella term initially covering classical sleepwalking, sleep terrors, and confusional arousals, and now including a wider spectrum of specialised forms of non rapid eye movement (non REM) parasomnias such as sexsomnia, sleep-related eating disorder, and sleep-related choking syndrome. Growing evidence has shown that DOA are not restricted to children but are also prevalent in adults (2%-4% of the adult population). While DOA run in family, genetics studies remain scarce and inconclusive. In addition to the risk of injury on themselves and others (including sexual assaults in sexsomnia), adults with DOA frequently suffer from excessive daytime sleepiness, pain, and altered quality of life. The widespread view of DOA as automatic and amnesiac behaviours has now been challenged by subjective (dream reports) and objective (dream-enacting behaviours documented on video-polysomnography) observations, suggesting that sleepwalkers are 'dream walking' during their episodes. Behavioural, experiential, cognitive, and brain (scalp electroencephalography [EEG], stereo-EEG, high density-EEG, functional brain imaging) data converge in showing a dissociated pattern during the episodes. This dissociated pattern resembles the new concept of local arousal with a wake-like activation in motor and limbic regions and a preserved (or even increased) sleep intensity over a frontoparietal network. EEG and behavioural criteria supporting the DOA diagnosis with high sensitivity and specificity are now available. However, treatment is still based on controlling priming and precipitating factors, as well as on clinicians' personal experience with sedative drugs. Placebo-controlled trials are needed to improve patients' treatment. DOA deserve more attention from sleep researchers and clinicians.
Keyphrases
- sleep quality
- resting state
- high density
- functional connectivity
- physical activity
- working memory
- obstructive sleep apnea
- end stage renal disease
- depressive symptoms
- newly diagnosed
- palliative care
- chronic pain
- young adults
- ejection fraction
- randomized controlled trial
- chronic kidney disease
- placebo controlled
- white matter
- body mass index
- squamous cell carcinoma
- spinal cord injury
- radiation therapy
- emergency department
- mental health
- peritoneal dialysis
- pain management
- study protocol
- combination therapy
- mass spectrometry
- rectal cancer
- spinal cord
- photodynamic therapy
- adverse drug
- phase ii study