Sleep related eating disorder (SRED) and night eating syndrome (NES): same or different disorders?

Abstract

Introduction The last revision of the International Classification of Sleep Disorders ( ICDS-2) has considered SRED as a parasomnia and it has established precise diagnostic criteria in order to differentiate it from NES. The presence of a variable level of awareness during the nocturnal eating episodes, consumption of some peculiar food combinations or dangerous behaviors or sleep related-injuries during the night are more typical in SRED. However the overlap between the clinical and polysomnographic features of both disorders is evident and some authors have postulated that they are “opposite poles of a continuous clinical spectrum”. We expose the results of the study of 30 patients with recurrent involuntary eating episodes during the night. Materials and methods 6 males and 24 females. Age range: 19 −67 years. All subjects underwent a semi structured clinical and psychological interview. The behaviours and the severity of the compulsive nocturnal eating was measured using the Night Eating Questionnaire. A video – polysomnographic study ( v-PSG) was done placing a table with food and drinks at the bedside. Results 1. Variable number of nocturnal eating episodes per night (1–20) depending on the emotional state of the patient. Frequent association with depressive - anxious syndrome. 2. Involuntary eating with reward sensation. 3. Variable level of consciousness during the episodes within a single night and across the longitudinal course of the disorder. 4. Consumption of high caloric food but no inedible or toxic substances. Morning anorexia common. 5. 2/3 of the patients were night and evening eaters. 6. Insomnia (100%) and frequent comorbid sleep disorders. 7. Obstructive Sleep apnea treatment with CPAP failed to reduce the number of episodes. However some therapeutic benefit was achieved with dopaminergic agents in patients with concomitant Restless leg syndrome. Conclusion 1. Sleep, eating or mood disorder? Probable observation bias between different specialists. 2. At present there isn’t a clear-cut border between SRED and NES. Our results support the hypothesis that they are ends of a continuum with the same underlying pathophysiology. Acknowledgements All medical staff, nurses and technicians of our Multidisciplinary Marques de Valdecilla Sleep Unit. Thanks to my family.