Parasomnias
132 important questions on Parasomnias
How were parasomnias classified in 1979?
- Recognized in the American Sleep Disorders Association classification.
- Defined as dysfunctions linked to sleep and arousals.
- Noted alongside disorders like excessive somnolence and sleep-wake schedule issues.
What is the "state dissociation" concept?
- Refers to coexistence of wakefulness, NREM, and REM sleep states.
- Suggested to explain all parasomnias.
- Supported by neuroimaging and neurophysiological observations.
What distinguishes disorders of arousal from NREM sleep?
- Result from incomplete arousals, mainly from deep sleep.
- Common in first third or half of sleep period.
- Includes confusional arousals, sleepwalking, and sleep terrors.
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Describe confusional arousals.
- Brief, incomplete arousals from sleep with mental confusion.
- Patient remains in bed, may exhibit resistive or violent behavior.
- Lasts typically
What are the features of sleep/night terrors?
- Episodes of extreme fear or agitation arising abruptly from sleep.
- Patients are unresponsive and may cry out, often with autonomic symptoms.
- Typically last a few minutes with no recall of the events.
What characterizes sleep-related eating disorder (SRED)?
- Involves involuntary eating or drinking during arousals from sleep.
- Occurs in an "out of control" manner, with varying consciousness levels.
- Has potential health risks including weight gain and adverse effects.
What is rapid eye movement sleep behaviour disorder (RBD)?
- Involves loss of muscle atonia during REM sleep, leading to dream enactment.
- Abnormal behaviors can include talking, kicking, or violent actions.
- Typically occurs in the latter part of sleep, with limited awareness.
What defines parasomnia overlap disorder (POD)?
- Considered a variant of RBD.
- Patients exhibit features of both NREM parasomnias and RBD.
What are the general characteristics of parasomnias?
They consist of:
- Abnormal physical events during sleep
- Experiences like unpleasant dreams
- Autonomic nervous system activities
- Occurrences during sleep entry or arousal
- Enacted outside full conscious awareness
What was the classification of parasomnias introduced by the American Sleep Disorders Association in 1979?
It recognized parasomnias as:
- Major group of sleep disorders
- Dysfunctions associated with sleep and sleep stages
- Related to central nervous system activation
- Distinct from other sleep disorder types
What triggers confusional arousals?
Triggers include:
- Forced awakening
- Drugs like hypnotics or SSRIs
- Alcohol consumption
- Sleep deprivation
- Circadian rhythm disturbances
What are the symptoms associated with sleep-related eating disorder (SRED)?
Symptoms include:
- Recurrent involuntary eating episodes
- Occurring during sleep arousals
- “Out of control” behavior
- Some partial recall after the episode
- Potential health risks like weight gain or diabetes
Describe the characteristics of rapid eye movement sleep behaviour disorder (RBD).
Characteristics include:
- Loss of muscle atonia during REM sleep
- Acting out dreams with abnormal behaviors
- Involvement of complex motor activities
- Repeated occurrences, primarily in the second half of the night
- Limited awareness of acting behavior
What are the lifetime prevalence and age-related trends for confusional arousals?
The estimated lifetime prevalence is approximately 20%.
- 15%-20% in children, decreasing with age
- Overall prevalence in adults >15 years: 2.9%-4.2%
- Associated with comorbidities or medications
What is known about the prevalence of sleepwalking across different age groups?
Lifetime prevalence of sleepwalking is about 6.9%.
- 5.0% in children vs. 1.5% in adults
- Prevalence in pre-school children: 14.5%
- Peak at age 12: 16.7%
- Persistence in adulthood: up to 25%
What is the secondary form of rapid eye movement sleep behaviour disorder (RBD) associated with?
This disorder is commonly linked to:
- Parkinson's disease (PD) 25%-58%
- Dementia with Lewy bodies (DLB) 70%-80%
- Multiple system atrophy (MSA) 90%-100%
- Autoimmune diseases and medications
- Focal lesions in the brainstem
What is the prevalence and age onset for sleep/night terrors?
Sleep/night terrors are common in children, notably between 5-10 years.
- Overall prevalence: 17.3% (ages 3-13)
- Only 4%-5% in adulthood
- Often associated with sleepwalking and other NREM parasomnias
How does rapid eye movement sleep behaviour disorder (RBD) manifest?
Characterized by:
- Dream-enacting behaviours
- Nightmares during REM sleep
- Lack of muscle atonia
- Can have idiopathic (IRBD) or secondary forms
What are the common neurodegenerative diseases associated with RBD?
Notable associations include:
- Parkinson’s disease (PD)
- Dementia with Lewy bodies (DLB)
- Multiple system atrophy (MSA)
- Progressive supranuclear palsy
What characterizes exploding head syndrome (EHS)?
Sudden loud noises or a sense of explosion in the head occur at wake-sleep transition or upon waking.
- Abrupt arousal often follows
- Sense of fright is common
- Typically painless
How prevalent is sleep-related eating disorder and its associated factors?
Predominantly affects young adult women with a chronic course.
- Prevalence ranges from 4.6% to 16.7% across populations
- Associations with other sleep and psychiatric disorders
- Linked to specific medications and smoking cessation
What are the different types of NREM-related parasomnias?
Three primary types of non-REM-related parasomnias are:
- Confusional arousals
- Sleepwalking
- Sleep terrors
What percentage of patients with Parkinson’s disease experience RBD?
The occurrence rate is typically:
- 25%-58% in sporadic PD
- May precede parkinsonism in 18%-22%
What is the epidemiology of exploding head syndrome?
EHS is a rare disorder with varying prevalence rates.
- Lifetime prevalence approximately 10.8% in healthy individuals
- Higher in psychiatric patients (13.8%) and sleep-disordered breathing (10%)
- Female predominance suggested
What are the primary treatment approaches for patients with parasomnias?
- Patient education and behavioral management are first-line.
- Management of predisposing factors is crucial.
- Ensuring a safe environment prevents sleep-related injuries.
- Pharmacological interventions are considered for frequent, violent events.
What is the proposed pathophysiology of exploding head syndrome?
The exact cause of EHS is unclear.
- Theories include delay in sleep-wake transition
- Ear dysfunctions or labyrinthine issues are considered
- Possible GABAergic transmission impairment
- Calcium channel dysfunction under debate
What factors can precipitate disorders of arousal?
Precipitating factors include:
- Sleep deprivation
- Noises
- Anxiety
What is the estimated prevalence of REM sleep behavior disorder in the general population?
Prevalence is approximately 1%-2%.
- Among those >50 years, varies from 0.74% to 13.7%
- Associated with neurological disorders
- Possible conversion of RBD to neurodegenerative syndrome
What are the clinical features of confusional arousals?
Key features include:
- Brief awakening with eye opening
- Disorientation and possible vocalization
- Occurs mainly in stage N3 NREM sleep
- Amnesia for the episodes is common
When is pharmacological treatment recommended for Disorders of Arousal (DOA)?
- Indicated when episodes are:
- Frequent
- Violent
- Impairing quality of life
- Causing excessive daytime sleepiness
How does exploding head syndrome clinically present and how is it diagnosed?
Diagnosed clinically based on patient-reported symptoms.
- Patients perceive sudden loud noises
- Common accompanying symptoms: tachycardia, fear, muscle jerks
- Polysomnography (PSG) is typically normal
- Differential diagnosis includes various medical conditions
Which medications are known to induce sleepwalking and related disorders?
Certain drugs, particularly:
- Zolpidem
- Antidepressants
- Lipophilic beta-blockers
What is the main pathophysiological mechanism underlying parasomnias?
A principal mechanism is a breakdown of boundaries between wakefulness and sleep regulatory systems.
- Activation of local cortical and subcortical networks
- Disengagement from prefrontal cortex control
- Represents a condition of state dissociation
How does sleepwalking manifest during episodes?
Characteristics of sleepwalking include:
- Leaving bed with complex behaviours
- Eyes may be open, appearing awake
- Difficult to awaken with inappropriate actions
- Sudden onset but gradual termination
What non-pharmacological treatments are recommended for Disorders of Arousal?
- Non-pharmacological interventions include:
- Reassurance
- Environmental safety modification
- Removal of triggering factors
- Scheduled awakenings
- Psychological interventions
What treatments are available for exploding head syndrome?
Most patients require no treatment.
- Reassurance may suffice
- Possible use of benzodiazepines and tricyclic antidepressants
- Ineffective drugs include propranolol, gabapentin
- No clinical trials have been conducted
What is known about the prevalence of recurrent isolated sleep paralysis?
Estimated lifetime prevalence is about 8%.
- Ranges from 2% to 60% in various studies
- More common in females and young adults
- Associated with narcolepsy and PTSD
What are the characteristics of non-REM arousal parasomnias?
Non-REM parasomnias display paroxysmal behaviours from Stage N3 of NREM.
- Impaired consciousness
- Inability to fully wake or sleep
- Includes confusional arousals, sleep terrors, and somnambulism
What differentiates sleep terrors from other parasomnias?
Key distinguishing features:
- Autonomic and behavioral manifestations of fear
- Symptoms include screaming and confusion when awakened
- Unresponsive to external stimuli during episodes
- Can involve violent reactions if restrained
What are the implications of RBD in relation to dementia in Parkinson's disease?
Key implications:
- Linked to cognitive impairment
- Higher rates of mild cognitive impairment (MCI)
- Increased risk of developing dementia
How can scheduled awakenings help in treating Disorders of Arousal?
- Effective when episodes occur consistently.
- Involves waking the child 15-20 minutes before events.
- Can shift sleep state to reduce DOA episodes.
- Efficacy reported in ~60% of cases.
What defines sleep enuresis (SE)?
SE is recurrent involuntary voiding during sleep.
- Primary SE: no prior dry period, occurs >2 times/week
- Secondary SE: previously dry for >6 months
- Can be monosymptomatic or non-monosymptomatic
What pharmacological treatments are used for sleep-related eating disorder (SRED)?
- Effective treatments include:
- Dopaminergic agents
- Antidepressants
- Topiramate
What are the prevalence estimates for nightmare disorder in adults and children?
Occasional nightmares are common in children (60%-75%).
- Adults' prevalence of nightmare disorder at 4%
- Nightmare experiences may approach 100%
- Associated with acute stress and PTSD
How are NREM parasomnias understood in terms of behavioural complexity?
NREM parasomnias are conceptualized as a continuum of behaviours:
- Increasing complexity
- Hierarchical patterns
- Arousal behaviours are primary components followed by agitated conducts and emotional manifestations
What is the significance of isolated REM sleep behaviour disorder (RBD)?
Important aspects of RBD:
- Enacting dreams with increased EMG activity
- Predicts neurodegenerative disorders later, such as:
- Dementia with Lewy bodies
- Multiple system atrophy
What sleep-related eating disorder associations exist with other conditions?
Notable associations include:
- Sleepwalking
- Narcolepsy
- Restless legs syndrome (RLS)
- Depression
What is the epidemiology of sleep enuresis?
SE affects 15%-20% of 5-year-olds, more common in boys.
- 2.1% occurrence in older adult women
- Misinterpretation of high spontaneous resolution rates
- Mild-to-moderate prognosis good in >90% cases
What is the estimated prevalence of exploding head syndrome?
Prevalence is about 10%, higher in younger subjects (16%-18%).
- Associated with sleep paralysis, migraine, insomnia
- Possible links to psychiatric disorders
What factors contribute to the occurrence of NREM parasomnias according to the “3-P” model?
Three critical factors influence NREM parasomnias:
- Predisposing factors
- Priming factors
- Precipitating factors
What factors contribute to NREM-related parasomnias?
Factors include:
- Genetic predisposition
- Priming factors like sleep deprivation and stress
- Triggering factors such as external noises
What is the role of neurodegeneration in RBD associated with multiple system atrophy (MSA)?
In MSA:
- RBD prevalence is very high (90%-100%)
- Severe brainstem cell loss is common
What are the key pharmacological options for treating rapid eye movement sleep behavior disorder (RBD)?
- Symptomatic treatment focuses on:
- Clonazepam
- Melatonin
What are the possible causes of sleep enuresis?
SE may result from three primary mechanisms:
- High nocturnal urine production
- Low bladder capacity or increased detrusor activity
- Disturbed sleep linked to arousal difficulties
How prevalent are sleep-related hallucinations (hypnagogic and hypnopompic)?
Hypnagogic hallucinations occur in up to 25%.
- Hypnopompic hallucinations at about 7%.
- Frequently associated with sleep disorders and psychiatric conditions
- Visual hallucinations more common in females
What role does intracerebral EEG analysis play in understanding arousal parasomnias?
Intracerebral EEG shows:
- Local dissociated electrophysiological states during NREM sleep
- Coexistence of wake- and sleep-like EEG patterns
- Insights into brain activation during confusional arousals
What is the role of video-polysomnography in diagnosing parasomnias?
Video-polysomnography (vPSG) assists by:
- Providing detailed recordings of sleep episodes
- Differentiating between various parasomnias and other sleep disorders
- Enhancing understanding of complex sleep behaviors
What is the secondary form of rapid eye movement sleep behaviour disorder (RBD) associated with?
The secondary form of RBD is linked to:
- Parkinson’s disease (PD) (25%-58%)
- Dementia with Lewy bodies (DLB) (70%-80%)
- Multiple system atrophy (MSA) (90%-100%)
- Autoimmune diseases (e.g., narcolepsy)
- Certain medications (e.g., antidepressants)
What factors should be investigated in evaluating Disorders of Arousal?
- Each patient should assess:
- Genetic background
- Sleep deprivation
- Caffeine and alcohol intake
- Medications and their interactions
- Other sleep disorders
What is the definition of Exploding Head Syndrome (EHS)?
Exploding Head Syndrome is characterized by:
- An abrupt perception of loud noise or explosion.
- Occurs at wake-sleep transition or upon waking at night.
- Often induces fright, but typically painless.
What is the prevalence of sleep enuresis in children and adolescents?
Common in childhood with 10%-16% in 5-year-olds.
- Declines with age, but higher prevalence in adolescence (2.2% in 19-year-olds)
- Often underappreciated in older populations
What are the neurophysiological findings during confusional arousals?
Neurophysiological features include:
- Local fast wake-like EEG activation
- Contrast with slow waves in different cortical areas
- Can occur without behavioural manifestations
How are disorders of arousal categorized in relation to psychiatric disorders?
Disorders of arousal are considered:
- Idiopathic non-REM sleep parasomnias
- Not linked to psychiatric, psychological, and neurological disorders
- Episodes may occur due to sleep deprivation, noises, and anxiety
What role do psychological interventions play in treating Disorders of Arousal?
- Various strategies include:
- Hypnotherapy for relaxation
- Cognitive Behavioral Therapy (CBT)
- Mindfulness-Based Stress Reduction (MBSR)
How prevalent is Exploding Head Syndrome?
EHS prevalence is around:
- 10.8% in healthy individuals.
- 13.8% among psychiatric patients.
- 18% in college students.
- Under-reported overall.
What are the main categories of parasomnias?
- Non-rapid eye movement (NREM)-related parasomnias.
- Rapid eye movement (REM)-related parasomnias.
- Other parasomnias.
What is the lifetime prevalence of confusional arousals?
The lifetime prevalence of confusional arousals is approximately:
- 20% (American Academy of Sleep Medicine, 2014)
- 15%-20% in children
- 2.9%-4.2% in adults over 15 years
How does the connectivity of the amygdala relate to parasomnia episodes?
Dysregulated connectivity involves:
- Increased amygdala activation
- Enhanced connectivity with autonomic centres
- Reduced connectivity with the prefrontal cortex during episodes
What can coexistent obstructive sleep apnea and periodic leg movements cause?
They may produce:
- Partial arousals
- Episodes of disorders of arousals
- Sleepwalking variants (e.g., sleep-related eating disorder, sleep driving)
- Particularly in predisposed individuals
What initial approaches are recommended for treating patients with parasomnias?
Treatment primarily involves:
- Patient education
- Behavioral management
- Addressing predisposing factors
- Preventing sleep-related injuries by ensuring safety
What theories describe the pathophysiology of Exploding Head Syndrome?
Pathophysiological theories include:
- Delay in the reticular formation activity.
- Ear dysfunctions affecting middle ear components.
- Impairment in GABAergic transmission.
- Transient calcium channel dysfunction.
How does the prevalence of sleepwalking differ between children and adults?
Sleepwalking has different prevalence rates:
- Children: 5.0% (3.8%-6.5%)
- Adults: 1.5% (1.0%-2.3%)
What insights does the study of neurotransmitters provide regarding state dissociation in arousal disorders?
Insights include:
- Altered serotonin system linked to sleepwalking
- Involvement of cholinergic and GABA pathways
- Potential role of the hypocretin system in wake stabilization
Who is most affected by NREM-related parasomnias?
- Children, adolescents, and young adults.
- Episodes such as confusional arousals, sleepwalking, and sleep terrors.
- Occur mostly during stage N3 sleep.
What are some characteristics of rapid eye movement (REM) sleep behaviour disorder (RBD)?
Features of RBD include:
- Dream-enacting behaviours
- Nightmares linked to REM sleep
- Absence of muscle atonia
- Diagnosis relies on history and video-polysomnography (vPSG)
What is essential for the management of disorders of arousal (DOA) and REM sleep behavior disorder (RBD)?
Key management strategies include:
- Addressing potential triggering factors
- Ensuring a safe sleeping environment
- Considering pharmacological treatment if necessary
What are the common symptoms associated with EHS episodes?
During EHS episodes, symptoms may include:
- Tachycardia (83%)
- Fear (81%)
- Muscle jerks/twitches (68%)
- Visual symptoms in 10%-27% of patients.
At what ages do sleep/night terrors typically first appear?
Sleep/night terrors generally first occur:
- Ages 5-10 years
- Can appear at older ages
- Generally associated with family history
What evidence supports the complexity of sleep continuity in NREM parasomnias?
Evidence includes:
- Emergence from slow-wave sleep
- Abrupt increased rhythmic slow wave production
- Commonly precedes episodes in children
Describe confusional arousals.
- Brief episodes of partial awakening.
- Behaviors include looking around or thrashing about.
- Often accompanied by amnesia for the events.
What medications have been shown to induce parasomnias?
Several medications linked to parasomnias include:
- Antidepressants
- Lipophilic beta-blockers
- Zolpidem, which may induce sleepwalking and related disorders
When might pharmacological treatment be indicated for disorders of arousal (DOA)?
Consider pharmacological treatment when:
- Episodes are frequent and violent
- Significant impairment of quality of life occurs
- Daytime sleepiness is excessive
How is Exploding Head Syndrome diagnosed?
Diagnosis is primarily based on:
- Clinical presentation of loud noise sensation.
- Normal polysomnography (PSG).
- Rule out other conditions such as brain tumors or PTSD.
What is the estimated prevalence of sleep-related eating disorder (SRED) in university students?
Prevalence rates of SRED in university students are:
- 4.6% (unselected group)
- 8.7% (outpatient eating disorders)
- 16.7% (inpatient eating disorders)
What is the main physiopathological mechanism underlying parasomnias?
The primary mechanism involves a breakdown of the boundaries between:
- Wakefulness
- Sleep regulatory systems
- Coexistence of wake- and sleep-like activities
What distinguishes sleepwalking from other NREM-related parasomnias?
- Involves leaving bed and complex behaviors.
- Patients may have open eyes and appear “fully awake.”
- Difficult to awaken and may perform inappropriate actions.
What is the prevalence of RBD in MSA patients?
The prevalence of RBD in MSA is significant:
- 90%-100% of patients exhibit RBD
- Brainstem cell loss is widespread and severe in MSA
What are the most commonly used medications for treating disorders of arousal (DOA)?
Common medications include:
- Benzodiazepines
- Antidepressants
- Some cases report effectiveness of dopaminergic agents
What treatments are available for Exploding Head Syndrome?
Treatment options include:
- Reassurance (often sufficient).
- Benzodiazepines (e.g., clonazepam).
- Tricyclic antidepressants (e.g., clomipramine).
- Anecdotal effectiveness of other drugs.
What is the general population prevalence for Rapid Eye Movement Sleep Behavior Disorder (RBD)?
The general population prevalence of RBD is estimated to be:
- 1%-2%
- Higher in individuals over 50 years (0.74% to 13.7%)
What are non-REM parasomnias?
Non-REM parasomnias, or arousal parasomnias, include:
- Confusional arousals
- Sleep terrors
- Sleepwalking
- Other sleep-related behaviors
How do sleep terrors present differently from sleepwalking?
- Patients exhibit severe fear and autonomic manifestations.
- Incomplete responses to external stimuli.
- May involve vocalizations and prolonged inconsolability.
How is RBD associated with neurodegenerative diseases characterized?
RBD is characterized by:
- Cell loss in neuronal structures regulating REM sleep
- Common in PD, DLB, and MSA
- Presence of unpleasant dreams and dream-enacting behaviours
What is the primary treatment for REM sleep behavior disorder (RBD)?
Treatment primarily involves:
- Clonazepam
- Melatonin
- Symptomatic management strategies may also apply
What is Sleep Enuresis (SE)?
Sleep Enuresis is defined as:
- Recurrent involuntary voiding during sleep.
- Types: primary (never dry) and secondary (previously dry).
- Diagnosis applicable to persons >5 years old.
Which drugs are predominantly used for treating nightmare disorder?
The most common treatments include:
- Prazosin
- Cannabinoids
In which populations is recurrent sleep paralysis more common?
Recurrent sleep paralysis is typically more common in:
- Females
- Young adults
- Patients with narcolepsy, PTSD, panic attacks
How do the behavioral patterns of NREM parasomnias present?
NREM parasomnias exhibit:
- A hierarchical modality of behaviors
- Arousal behaviors as primary components
- Abnormal agitated conducts
- Distressed emotional manifestations
What is rapid eye movement sleep behavior disorder (RBD)?
- A REM-related parasomnia.
- Characterized by dream-enacting movements.
- Associated with increased chin or limb EMG activity.
What factors contribute to the link between RBD and cognitive impairment in PD patients?
Contributing factors include:
- Duration and severity of parkinsonism
- Akinetic-rigid subtype more frequent in patients with RBD
- Asymptomatic abnormalities in neuropsychological testing
How common is Sleep Enuresis among children and adults?
Sleep Enuresis statistics show:
- 15%-20% prevalence in 5-year-olds.
- More common in boys.
- In adults, 2.1% prevalence, more common in women.
How can sleep enuresis be treated?
Effective treatments for sleep enuresis are:
- Desmopressin
- Anticholinergic drugs
- Imipramine
What lifetime prevalence of nightmares occurs in the general population?
Nightmare experiences in the general population are common, with:
- Up to 100% lifetime prevalence
- Adults show prevalence of about 4% for nightmare disorder
What factors contribute to the occurrence of NREM parasomnias?
Key contributing factors include:
- Predisposing factors
- Priming factors
- Precipitating factors
What other disorders should be differentiated from parasomnias?
- Nocturnal seizures.
- Psychiatric diseases.
- Obstructive sleep apnea and periodic leg movements.
What is the significance of a family pattern in disorders of arousal?
Familial patterns are common:
- While most disorders of arousal are idiopathic
- There is an association with specific genetic markers like HLA-DQB1*05 subtype
What are the potential causes of Sleep Enuresis?
Possible causes of Sleep Enuresis include:
- High nocturnal urine production.
- Low bladder capacity/increased detrusor activity.
- Disturbed sleep due to arousal.
What is the prevalence of Exploding Head Syndrome in the general population?
The prevalence of Exploding Head Syndrome is approximately:
- 10% in the general population
- Higher (16%-18%) in younger subjects
What phenomenon is associated with arousal parasomnias?
State dissociation is characterized by:
- Local dissociated electrophysiological states
- Coexistence of wake- and sleep-like EEG patterns
- Alterations of consciousness during episodes
What role does genetics play in NREM-related parasomnias?
- Genetic predisposition is significant.
- Sleep deprivation and stress can serve as priming factors.
- Triggers often include internal and external noises.
What percentage of PD patients with RBD are male?
The percentage of male PD patients with RBD is:
- Between 65% and 75%
- Male preponderance is a notable observation
What factors should be investigated and avoided in parasomnia treatment?
Important factors include:
- Inadequate sleep routines
- Co-existing sleep disorders
- Medications disrupting sleep
What evaluations are conducted for diagnosing Sleep Enuresis?
Evaluation for Sleep Enuresis involves:
- Complete enuresis history.
- Sleep history.
- Physical examination and laboratory studies.
How often do hypnagogic hallucinations occur compared to hypnopompic hallucinations?
Hypnagogic hallucinations occur more frequently, with a prevalence of:
- Up to 25%
- Hypnopompic hallucinations at 7%
How do local activations occur during NREM parasomnias?
Local activations during NREM parasomnias show:
- Fast wake-like EEG activity
- Coexistence with slow waves in other areas
- Occurring without behavioral manifestations
How does video-polysomnography (vPSG) assist in diagnosing parasomnias?
- Provides clear clinical findings of sleep disorders.
- Helps differentiate between various parasomnias and related conditions.
- Enhances understanding of abnormal behaviors during sleep.
How does RBD manifest in patients with genetic forms of PD?
In genetic forms of PD, RBD is:
- Mild in Parkin2 mutation cases
- Rare in LRRK2 mutations
- Absent in PARK 6 families
What psychological interventions have been proposed for the treatment of DOA?
Proposed psychological interventions include:
- Hypnotherapy
- Cognitive Behavioral Therapy (CBT)
- Mindfulness-Based Stress Reduction (MBSR)
What is the distinction between monosymptomatic and non-monosymptomatic enuresis?
Distinctions include:
- Monosymptomatic: only sleep enuresis present.
- Non-monosymptomatic: includes additional lower urinary tract symptoms.
What is the estimated prevalence of sleep enuresis in 5-year-olds?
Sleep enuresis prevalence in 5-year-olds is estimated at:
- 10%-16%
- More prevalent in adolescents and adults than commonly thought
What is the significance of neurotransmitters in NREM parasomnias?
Neurotransmitter involvement includes:
- Alteration of the serotonin system
- Possible roles of cholinergic and GABA pathways
- Hypocretin hypothalamic system may affect wake stabilization
What role do neurotransmitters play in RBD symptoms?
RBD symptoms are likely the result of:
- Complex neurotransmitter dysfunction
- Involvement of GABAergic, glutamatergic, and cholinergic systems
- No strong evidence pointing to a single neurotransmitter deficit
What is the effectiveness of scheduled awakenings for DOA episodes?
Scheduled awakenings may be effective in:
- Reducing episodes in ~60% of cases
- Involves nightly vigil and intervention by parents
What treatments are recommended for Sleep Enuresis?
Recommended treatments for Sleep Enuresis consist of:
- Educational strategies.
- Behavioral therapy or urotherapy.
- Medication may be necessary for non-monosymptomatic cases.
What are common associations with sleep-related eating disorder (SRED)?
SRED is associated with:
- Sleep disorders (narcolepsy, sleepwalking)
- Neurological disorders (Parkinsonism)
- Psychiatric disorders (anxiety, depression)
What is the role of the amygdala in arousal parasomnias?
The amygdala is linked to:
- Fearful emotional activation
- Increased connectivity with autonomic activating centers
- Disconnection with the prefrontal cortex during arousal
Why is polysomnography (PSG) with audiovisual recording essential for diagnosing RBD?
PSG is necessary to:
- Confirm RBD diagnosis
- Exclude other conditions (e.g., sleep apnea, periodic limb movements)
- Provide a comprehensive assessment of sleep patterns
Why are pharmacological treatments for DOA often unnecessary?
Many cases of DOA are:
- Benign phenomena
- Self-limited and disappear naturally
- Pharmacological interventions often have little evidence backing them
How is consciousness altered during NREM parasomnia episodes?
Consciousness alterations in NREM parasomnias are due to:
- Fluid boundaries of consciousness
- Fluctuations of consciousness levels
- Abnormal spatial and temporal connectivity
What is the significance of managing sleep comorbidities in parasomnia treatment?
Managing comorbid sleep disorders can lead to:
- Satisfactory control of nocturnal manifestations
- Fewer episodes of parasomnia
What are the implications of sleep and wake-like activity in the brain?
These implications include:
- Altered consciousness during arousal parasomnias
- Non-distinction of behavioral states
- Possible survival advantages in evolutionary terms
What evidence exists regarding the efficacy of behavioral interventions for DOA?
Evidence is lacking; findings are primarily based on:
- Expert opinion
- Case reports
- Few case series with no randomized controlled trials
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