Abstract
Although video polysomnography (vPSG) is not routinely recommended for the evaluation of typical cases of non‐rapid eye movement (NREM) parasomnias, it can aid diagnosis of unusual cases, other sleep disorders and complicated cases with REM behaviour disorder (RBD), and in differentiating parasomnias from epilepsy. In this study, we aimed to assess vPSG findings in consecutive patients with a clinical diagnosis of NREM‐parasomnia covering the whole phenotypic spectrum. Five hundred and twelve patients with a final diagnosis of NREM parasomnia who had undergone vPSG were retrospectively identified. vPSGs were analysed for features of NREM parasomnia and for the presence of other sleep disorders. Two hundred and six (40.0%) patients were clinically diagnosed with sleepwalking, 72 (14.1%) with sleep terrors, 39 (7.6%) with confusional arousals, 15 (2.9%) with sexsomnia, seven (1.4%) with sleep‐related eating disorder, 122 (23.8%) with mixed phenotype, and 51 (10.0%) with parasomnia overlap disorder (POD). The vPSG supported the diagnosis of NREM parasomnia in 64.4% of the patients and of POD in 98%. In 28.9% of the patients, obstructive sleep apnea (OSA) or/and periodic limb movements during sleep (PLMS) were identified, most commonly in older, male, sleepy and obese patients. vPSG has a high diagnostic yield in patients with NREM parasomnia and should be routinely performed when there is diagnostic doubt, or in patients where there is a suspicion of OSA and PLMS.
Highlights
We aimed to evaluate the diagnostic utility of video‐ polysomnographic (vPSG) both in non‐rapid eye movement (NREM) parasomnia and parasomnia overlap disorder (POD), in the identification of other sleep disorders that may serve as precipitants of parasomnia behaviours
Mixed, mixed phenotypes of NREM parasomnia; SRED, sleep‐related eating disorder; POD, parasomnia overlap disorder; OSA, obstructive sleep apnea; PLMS, periodic limb movements during sleep; NT1, narcolepsy type 1; NT2, narcolepsy type 2; IH, idiopathic hypersomnia; vPSG, video‐ polysomnography; NREM, non‐rapid eye movement; NREM‐A, spontaneous arousals from NREM3 with typical parasomnia behaviours; NREM‐a, spontaneous arousals accompanied by more subtle behaviours, such as raising the head, sympathetic activation, such as tachycardia, or rhythmic delta activity on EEG; RWA, REM without atonia; TST, total sleep time; WASO, wake after sleep onset time; SO, sleep onset; SE, sleep efficiency; AI, arousal index; AHI, apnea–hypopnea index; PLM index (PLMI), periodic limb movement index
The principal findings in this cohort were that there is a significant likelihood of concomitant sleep‐disrupting pathology in parasomnia patients, that vPSG can be a useful adjunct in confirming the diagnosis of NREM parasomnia, and that priming factors that increase the likelihood of parasomnia events occurring are identifiable in a sizeable minority of patients
Summary
The current American Academy of Sleep Medicine (AASM) guidelines on the use of vPSG in parasomnia suggest that it be reserved for patients with violent or potentially injurious behaviours, cases where there is a failure to respond to therapy, or cases with an atypical or forensic presentation (Kapur et al, 2017). These guidelines do not comment on the identification of concomitant sleep pathology in patients with parasomnia, such as obstructive sleep apnea (OSA) and periodic limb movements during sleep (PLMS). We aimed to evaluate the diagnostic utility of vPSG both in NREM parasomnia and POD, in the identification of other sleep disorders that may serve as precipitants of parasomnia behaviours
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