RBD & other Parasomnias. Lauren A. Tobias MD Instructor of Medicine Yale University School of Medicine

Transcription

1 RBD & other Parasomnias Lauren A. Tobias MD Instructor of Medicine Yale University School of Medicine

2 Disclosures I have nothing to disclose

3

4 Outline Clinical overview & ICSD III Pathophysiology Disorders of Arousal (NREM parasomnias) REM- Behavior Disorder (RBD) Other parasomnias Take- home points

5

6 Parasomnias Undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousal from sleep. - Interna@onal Classifica@on of Sleep Disorders 3 (ICSD- 3)

7 Clinical Overview Unusual behavior/experience in sleep, in some cases only witnessed by others May include movements, behaviors, dreams and autonomic Not typical to have excessive sleepiness or insomnia Variable: of night - motor and autonomic ac@vity - recall for event May result in injury to self or bedpartner

8 ICSD- 3 Classifica@on of Parasomnias REM Parasomnias RBD Recurrent Isolated Sleep Paralysis Nightmare Disorder Disorders of arousal (from NREM sleep) Confusional arousals Sleepwalking (somnambulism) Sleep terrors Sleep Related Ea@ng Disorder Other Parasomnias Sleep Related Groaning (Catathrenia) Exploding Head Syndrome Sleep Related Hallucina@ons Sleep Enuresis Parasomnia Due to Medical Condi@on Parasomnia Due to Drug or Substance Parasomnia, Unspecified Isolated Symptoms & Normal Variants Sleep Talking

9 Non-REM Disorders of Arousal

10 REM Parasomnias Nightmares

11

12 Nocturnal Spells: Overlapping States RBD Hypnagogic Sleep Paralysis Cataplexy Lucid Dreams Sleep Phenomena Disorders of Arousal: Sleepwalking Confusional arousals Sleep terrors Wake REM Seizures (eg. nocturnal frontal lobe epilepsy) NREM Psychogenic Spells Adapted from: Avidan Y and Kaplish N. Clin Chest Med 2010; 31(2):

13 Disorders of Arousal

14 Confusional Arousals up to 30 minutes (typically <10 minutes) Can have episodes per night Motor simple, typically non- goal oriented Stay in bed No/minimal autonomic Eyes opened or closed Slow Lible to no of event Injury risk low Difficult to console, eventually return to normal sleep

15 Sleep- Related Abnormal Sexual Behaviors (sleepsex, sexomnia) Most have a history parasomnia and a family history of sleepwalking Occasional forensic implica@ons Next- day amnesia ISCD- 3: variant of confusional arousal

16 Sleepwalking (sonambulism) Sudden arousal from sleep Eyes typically open, may give simple responses Behaviors may be simple or more elaborate/goal- directed Glassy eyed, slow speech, clumsy movements, blunted response to without motor impairment up to 20 minutes (typically <10 minutes) episodes night possible of event vague or absent, confusion upon awakening Dreaming absent while sleepwalking

17 Sleepwalking I have seen her rise from her bed, throw her night- gown upon her, unlock her closet, take forth paper, fold it, write upon't, read it, a>erwards seal it, and again return to bed; yet all this while in a most fast sleep. ACT V SCENE I, Shakespeare, Macbeth Henry Fuseli ( ) Lady Macbeth

18 Sleepwalking Frequency ojen Males = females Strong family history Up to 20% of children (most common 4-12 years of age) 1/3 of cases in adults (3-4% prevalence) Danger risk mainly personal injury

19

20 Sleep Terrors (night terrors) Sudden arousal from sleep Cry or piercing scream with intense autonomic accvacon é HR, é RR, Unresponsive to external Prolonged inconsolability Amnesia for event typical 5% of children, 1-2% of adults

21 Sleep Terrors

22

23 Sleep Terrors vs. Nightmares CHARACTERISTIC SLEEP TERROR NIGHTMARE Timing during the night First third (Deep slow wave sleep) Movements Common Rare Severity Severe Mild Common Rare Autonomic discharge Severe and intense Mild Amnesia Present Absent Last third (REM Sleep) State on waking Confused/disoriented well Injuries Common Rare Violence Common Rare Displacement from bed Common Very rare

24 What provokes disorders of arousal? Psychiatric disorders Sleep Irregular sleep- wake schedules Pain OSA, Nocturnal Asthma Disorders of Arousal Stress Alcohol GERD Fever