Aktuelle Neurologie 2014; 41(04): 225-236
DOI: 10.1055/s-0034-1372567
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Schlafwandeln und andere Non-REM-Parasomnien

Sleep Walking and other Non-REM-Parasomnias
P. Young
1   Department für Neurologie, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Münster
,
G. Möddel
1   Department für Neurologie, Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen, Münster
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2014 (online)

Zusammenfassung

Parasomnien umfassen eine große Gruppe unterschiedlicher motorischer Phänomene während des Schlafes. Entsprechend der Interna­tionalen Klassifikation von Schlafstörungen II (ICSD II) werden Parasomnien in Formen unterteilt, die aus dem Non-REM-Schlaf heraus auftreten und Formen, die aus dem REM-Schlaf auftreten. Als andere Parasomnien werden die Formen bezeichnet, bei denen keine feste Zuordnung zu einem Schlafstadium möglich ist. Schlafwandeln, Schlaftrunkenheit und der Pavor nocturnus sind die klinisch wichtigsten Formen der Non-REM Parasomnien. Hauptmerkmal dieser Formen ist der Beginn aus dem Schlafstadium Non-REM 3, dem durch hohen Anteil an Deltaaktivität gekennzeichneten Tiefschlaf. Die Gesamtprävalenz der Non-REM-Parasomnien bei Erwachsenen wird mit ca. 4% angegeben. Damit ist diese Form der Parasomnien eine klinisch relevante, aber vermutlich unterdiagnostizierte Gruppe von Schlafstörungen. Als besondere Form der Parasomnie gilt neben den Non-REM-Parasomnien die schlafbezogene Essstörung. Diese in die Gruppe der anderen Parasomnien klassifizierte Schlafstörung tritt aus Non-REM-Stadium 2 und 3 auf. Für alle hier beschriebenen Parasomnien gilt, dass assoziierte Symptome wie Tagesschläfrigkeit, Traumerinnern und nächtliche autonome Aktivierungen häufiger zu finden sind als allgemein angenommen wurde. Die wichtigsten Differenzialdiagnosen des Schlafwandelns und der gesamten Gruppe der Non-REM-Parasomnien sind die REM-Schlaf-assoziierten Parasomnien, wie die REM-Schlaf-Verhaltensstörung und epileptische Anfälle aus dem Schlaf, bspw. bei Patienten mit nächtlicher Frontallappenepilepsie. Da die nächtlichen, motorischen Symptome keine ausreichende und sichere Differenzierung der verschiedenen Differenzialdiagnosen zulassen, stellt die videobasierte Polysomnografie im Schlaflabor den Gold-Standard in der technischen Diagnosestellung dar. Ebenso dient die videobasierte Polysomnografie der Entscheidung zur erweiterten video-basierten elektroenzephalografischen Diagnostik. Vor diesem Hintergrund ist für die Diagnosestellung von Schlafwandeln und Non-REM-Parasomnien die enge Zusammenarbeit zwischen Schlafmedizinern und Epileptologen empfehlenswert.

Abstract

Parasomnias comprise a great variety of motor phenomena during sleep. According to the International Classification of Sleep Disorders II (ICSDII) parasomnias are subclassified into forms originating from Non-REM sleep stages or from the REM-sleep-stage. A third group comprises other parasomnias, which are not clearly originating form a definite sleep stage. Sleep walking, sleep terrors and confusional arousals are clinically the most important forms of Non-REM parasom­nias. The hallmark of all these forms is an arousal from Non-REM sleep stage 3 (slow wave sleep). The overall prevalence of Non-REM parasomnia is about 4% in the general population. Therefore they represent a common but underdiagnosed group of sleep disorders. Sleep related eating (SRED) is classified as a distinct form of other parasomnias in which the mechanism of arousal varies from Non-REM sleep stage 2 to 3. Daytime symptoms, recalling dreams and autonomic activation during parasomnic episodes is much more frequent than formerly postulated.

The most important differential diagnoses of sleep walking and other Non-REM parasomnias are forms of REM-sleep parasomnias as the REM behavorial disorder, and epileptic seizures during sleep, for example in patients withnocturnal frontal lobe epilepsy. Since abnormal sleep related motor symptoms are not specific enough to exclude the differential diagnoses, video based polysomnography is the gold standard to differentiate these different sleep disorders and to decide if further electrophysiological diagnostic procedures such as video-electroencephalopathy is needed. For that reason, cooperation of sleep specialists and epileptologists is highly recommended.

 
  • Literatur

  • 1 Brooks S, Kushida CA. Behavioral parasomnias. Curr Psychiatry Rep 2002; 4: 363-368
  • 2 Parkes JD. The parasomnias. Lancet 1986; 2: 1021-1025
  • 3 Boeve BF, Silber MH, Parisi JE et al. Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology 2003; 61: 40-45
  • 4 Schenck CH, Mahowald MW. Rapid eye movement sleep parasomnias. Neurol Clin 2005; 23: 1107-1126
  • 5 Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 1996; 46: 388-393
  • 6 Frauscher B, Iranzo A, Gaig C et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 2012; 35: 835-847
  • 7 Bassetti C, Vella S, Donati F et al. SPECT during sleepwalking. Lancet 2000; 356: 484-485
  • 8 Terzaghi M, Sartori I, Tassi L et al. Dissociated local arousal states underlying essential clinical features of non-rapid eye movement arousal parasomnia: an intracerebral stereo-electroencephalographic study. J Sleep Res 2012; 21: 502-506
  • 9 Oluwole OS. Lifetime prevalence and incidence of parasomnias in a population of young adult Nigerians. J Neurol 2010; 257: 1141-1147
  • 10 Bjorvatn B, Gronli J, Pallesen S. Prevalence of different parasomnias in the general population. Sleep Med 2010; 11: 1031-1034
  • 11 Petit D, Touchette E, Tremblay RE et al. Dyssomnias and parasomnias in early childhood. Pediatrics 2007; 119: e1016-e1025
  • 12 Touchette E, Petit D, Tremblay RE et al. Risk factors and consequences of early childhood dyssomnias: New perspectives. Sleep Med Rev 2009; 13: 355-361
  • 13 Kales A, Soldatos CR, Bixler EO et al. Hereditary factors in sleepwalking and night terrors. Br J Psychiatry 1980; 137: 111-118
  • 14 Hublin C, Kaprio J, Partinen M et al. Prevalence and genetics of sleepwalking: a population-based twin study. Neurology 1997; 48: 177-181
  • 15 Lecendreux M, Bassetti C, Dauvilliers Y et al. HLA and genetic susceptibility to sleepwalking. Mol Psychiatry 2003; 8: 114-117
  • 16 Winkelmann J, Lichtner P, Putz B et al. Evidence for further genetic locus heterogeneity and confirmation of RLS-1 in restless legs syndrome. Mov Disord 2006; 21: 28-33
  • 17 Santin J, Mery V, Elso MJ et al. Sleep-related eating disorder: a descriptive study in Chilean patients. Sleep Med 2014; 15: 163-167
  • 18 Agargun MY, Cilli AS, Sener S et al. The prevalence of parasomnias in preadolescent school-aged children: a Turkish sample. Sleep 2004; 27: 701-705
  • 19 Guilleminault C, Palombini L, Pelayo R et al. Sleepwalking and sleep terrors in prepubertal children: what triggers them?. Pediatrics 2003; 111: e17-e25
  • 20 Ebrahim IO. Somnambulistic sexual behaviour (sexsomnia). J Clin ­Forensic Med 2006; 13: 219-224
  • 21 Schenck CH, Arnulf I, Mahowald MW. Sleep and sex: what can go wrong? A review of the literature on sleep related disorders and abnormal sexual behaviors and experiences. Sleep 2007; 30: 683-702
  • 22 Reid WH, Ahmed I, Levie CA. Treatment of sleepwalking: a controlled study. Am J Psychother 1981; 35: 27-37
  • 23 Reid WH, Haffke EA, Chu CC. Diazepam in intractable sleepwalking: a pilot study. Hillside J Clin Psychiatry 1984; 6: 49-55
  • 24 Oudiette D, Constantinescu I, Leclair-Visonneau L et al. Evidence for the re-enactment of a recently learned behavior during sleepwalking. PLoS One 2011; 6: e18056
  • 25 Hurwitz TD, Mahowald MW, Schenck CH et al. A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalk­ing and sleep terror. J Nerv Ment Dis 1991; 179: 228-233
  • 26 Kahn A, Van de Merckt C, Rebuffat E et al. Sleep problems in healthy preadolescents. Pediatrics 1989; 84: 542-546
  • 27 Mahowald MW, Rosen GM. Parasomnias in children. Pediatrician 1990; 17: 21-31
  • 28 Hublin C, Kaprio J. Genetic aspects and genetic epidemiology of parasomnias. Sleep Med Rev 2003; 7: 413-421
  • 29 Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997; 20: 972-981
  • 30 Brunia CH, van Boxtel GJ. Anticipatory attention to verbal and non-verbal stimuli is reflected in a modality-specific SPN. Exp Brain Res 2004; 156: 231-239
  • 31 Zaiwalla Z. Parasomnias. Clin Med 2005; 5: 109-112
  • 32 Schenck CH, Mahowald MW. Review of nocturnal sleep-related eating disorders. Int J Eat Disord 1994; 15: 343-356
  • 33 Chiang A, Krystal A. Report of two cases where sleep related eating behavior occurred with the extended-release formulation but not the immediate-release formulation of a sedative-hypnotic agent. J Clin Sleep Med 2008; 4: 155-156
  • 34 Provini F, Antelmi E, Vignatelli L et al. Association of restless legs syndrome with nocturnal eating: a case-control study. Move Disord 2009; 24: 871-877
  • 35 Howell MJ, Schenck CH. Restless nocturnal eating: a common feature of Willis-Ekbom Syndrome (RLS). J Clin Sleep Med 2012; 8: 413-419
  • 36 Howell MJ, Schenck CH. Treatment of nocturnal eating disorders. Curr Treat Options Neurol 2009; 11: 333-339
  • 37 Montplaisir J, Petit D, Pilon M et al. Does sleepwalking impair daytime vigilance?. J Clin Sleep Med 2011; 7: 219
  • 38 Oudiette D, Leu S, Pottier M et al. Dreamlike mentations during sleepwalking and sleep terrors in adults. Sleep 2009; 32: 1621-1627
  • 39 Desautels A, Zadra A, Labelle MA et al. Daytime somnolence in adult sleepwalkers. Sleep Med 2013; 14: 1187-1191
  • 40 Zadra A, Pilon M. NREM parasomnias. Handb Clin Neurol 2011; 99: 851-868
  • 41 Broughton RJ, Shimizu T. Sleep-related violence: a medical and forensic challenge. Sleep 1995; 18: 727-730
  • 42 Schenck CH, Mahowald MW. A polysomnographically documented case of adult somnambulism with long-distance automobile driving and frequent nocturnal violence: parasomnia with continuing danger as a noninsane automatism?. Sleep 1995; 18: 765-772
  • 43 Zadra A, Desautels A, Petit D et al. Somnambulism: clinical aspects and pathophysiological hypotheses. Lancet Neurol 2013; 12: 285-294
  • 44 Pilon M, Montplaisir J, Zadra A. Precipitating factors of somnambulism: impact of sleep deprivation and forced arousals. Neurology 2008; 70: 2284-2290
  • 45 Schenck CH, Bundlie SR, Ettinger MG et al. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9: 293-308
  • 46 Schenck CH, Hurwitz TD, Mahowald MW. REM sleep behavior disorder. Am J Psychiatry 1988; 145: 652
  • 47 Provini F, Plazzi G, Tinuper P et al. Nocturnal frontal lobe epilepsy. A clinical and polygraphic overview of 100 consecutive cases. Brain 1999; 122: 1017-1031
  • 48 Bernasconi A, Andermann F, Cendes F et al. Nocturnal temporal lobe epilepsy. Neurology 1998; 50: 1772-1777
  • 49 Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 2002; 25: 120-138
  • 50 Tinuper P, Provini F, Bisulli F et al. Movement disorders in sleep: guidelines for differentiating epileptic from non-epileptic motor phenomena arising from sleep. Sleep Med Rev 2007; 11: 255-267
  • 51 Derry CP, Davey M, Johns M et al. Distinguishing sleep disorders from seizures: diagnosing bumps in the night. Arch Neurol 2006; 63: 705-709
  • 52 Pilon M, Zadra A, Joncas S et al. Hypersynchronous delta waves and somnambulism: brain topography and effect of sleep deprivation. Sleep 2006; 29: 77-84
  • 53 Guilleminault C. Hypersynchronous slow delta, cyclic alternating pattern and sleepwalking. Sleep 2006; 29: 14-15
  • 54 Pressman MR. Hypersynchronous delta sleep EEG activity and sudden arousals from slow-wave sleep in adults without a history of parasomnias: clinical and forensic implications. Sleep 2004; 27: 706-710
  • 55 Malow BA, Kushwaha R, Lin X et al. Relationship of interictal epileptiform discharges to sleep depth in partial epilepsy. Electroencephalogr Clin Neurophysiol 1997; 102: 20-26
  • 56 Malow BA. Paroxysmal events in sleep. J Clin Neurophysiol 2002; 19: 522-534
  • 57 Ohayon MM, Mahowald MW, Dauvilliers Y et al. Prevalence and comorbidity of nocturnal wandering in the U.S. adult general population. Neurology 2012; 78: 1583-1589