Sleep-related Eating Disorder Research Articles

Associations between self-reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders.

To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia-specific questions were included. Patients responding "often" or "always" to parasomnia-specific questions were considered "symptom-positive," whereas a "few times" or "never" were considered "symptom-negative" (controls). The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder. Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.

Clinical safety of daridorexant in insomnia treatment: Analysis of FDA adverse event reports

ObjectiveDaridorexant, a novel dual orexin receptor antagonist, was approved by the FDA in 2022 for the treatment of insomnia in adults. The aim of this study is to delve into the adverse events (AEs) of daridorexant by analyzing data from the FAERS database, to assess its safety and effectiveness in clinical applications. MethodsThis study selected data from the FAERS database from the first quarter of 2022 to the third quarter of 2023. Various data analysis methods were used, including the Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), and Empirical Bayesian Geometric Mean (EBGM), to assess AEs related to daridorexant. ResultsThe study analyzed a total of 2,624,030 AE reports, of which 1318 were related to daridorexant. It identified 59 preferred terms (PTs) involving 23 system organ classes (SOCs). Signal mining identified new potential AEs related to daridorexant, including sleep-related psychiatric symptoms (nightmare, abnormal dreams, sleep terror, etc.), emotional and perceptual abnormalities (hallucination, depression, agitation), physiological and behavioral responses (palpitations, dry mouth, energy increased, etc.), suicide risk (suicidal ideation, intentional overdose), and other special concern AEs (tachyphrenia, sleep-related eating disorder, hypersensitivity). ConclusionAlthough some new potential AEs have been identified, these findings need further verification in broader datasets and long-term studies due to limitations in data sources and analysis methods. Future research should comprehensively assess the safety and effectiveness of daridorexant, providing more accurate guidance for medical professionals in the treatment of insomnia.

Current evidence and future perspectives in the exploration of sleep-related eating disorder-a systematic literature review.

Sleep-related eating disorder (SRED) is a non-REM parasomnia with potentially significant negative effects on general health (dangerous activities during night eating episodes, obesity, or metabolic syndrome, for example). Although the history of SRED encompasses more than six decades, public awareness and even the awareness of the mental health specialists of this disorder is very limited, a phenomenon that hinders the development of research in this field. Therefore, a systematic review based on PRISMA 2020 guidelines explored the available evidence for SRED found in four electronic databases (PubMed, Cochrane Collaboration, Google Scholar, and Clarivate/Web of Science). A number of 94 primary and secondary reports were retrieved, investigating aspects regarding the risk factors, epidemiology, clinical data and differential diagnosis, epidemiology, structured evaluation, and treatment of SRED. Based on the results of these reports, Z-drugs, but also certain benzodiazepines, antidepressants, antipsychotics, and psychostimulants may trigger the onset of SRED. Psychiatric and neurologic disorders have also been associated with SRED, either as risk factors or comorbid conditions. Cerebral glucose metabolism dysfunctions, neurotransmitter dysfunctions, and genetic factors have been invoked as pathogenetic contributors. Structured assessment of SRED is possible, but there is a dearth of instruments dedicated to this purpose. Data on the prevalence and treatment of SRED exist, but good-quality epidemiological studies and clinical trials are still missing. In conclusion, future research is expected to address the shortcomings of SRED exploration by creating the conditions for better quality and larger group clinical research. The need for such investigation is granted by the importance of this pathology and its negative functional consequences.

Is Sleep-Related Eating Disorder (SRED) a NREM Parasomnia or a Heterogenous Disease?

Sleep-related eating disorder (SRED) is a relatively rare but probably underestimated disorder, where affected patients exhibit nocturnal eating episodes with impaired consciousness and subsequent amnesia. SRED has originally been classified as NREM (non-rapid eye movement) parasomnia, with an obviously high number of concomitant sleep disorders. We suggest that SRED may represent a heterogenous disease, based on accumulating data in recent studies. Some SRED patients may be better classified as sleep-related movement disorders with an underlying dopaminergic dysfunction. Hypnotic drugs may play a crucial role in triggering amnestic SRED in both parasomnic and sleep-related movement-disordered SRED.

Rethinking the Role of Orexin in the Regulation of REM Sleep and Appetite.

Orexin plays a significant role in the modulation of REM sleep, as well as in the regulation of appetite and feeding. This review explores, first, the current evidence on the role of orexin in the modulation of sleep and wakefulness and highlights that orexin should be considered essentially as a neurotransmitter inhibiting REM sleep and, to a much lesser extent, a wake promoting agent. Subsequently, the relationship between orexin, REM sleep, and appetite regulation is examined in detail, shedding light on their interconnected nature in both physiological conditions and diseases (such as narcolepsy, sleep-related eating disorder, idiopathic hypersomnia, and night eating syndrome). Understanding the intricate relationship between orexin, REM sleep, and appetite regulation is vital for unraveling the complex mechanisms underlying sleep-wake patterns and metabolic control. Further research in this field is encouraged in order to pave the way for novel therapeutic approaches to sleep disorders and metabolic conditions associated with orexin dysregulation.

Non-REM Sleep Parasomnias.

Non-rapid eye movement (non-REM) parasomnias are common across the lifespan. This article describes the manifestations, diagnosis, and management of non-REM parasomnias in adults and discusses the social implications of these conditions. Non-REM parasomnias represent a hybrid state of wakefulness and sleep, often triggered by events that increase the frequency of arousals or make it more difficult to fully arouse from sleep. Sleep deprivation, certain medications, and untreated obstructive sleep apnea are known to provoke parasomnias, particularly in those who are genetically predisposed. Non-REM parasomnias include disorders of arousal (ie, sleepwalking, sleep terrors, and confusional arousals), sleep-related eating disorder, and exploding head syndrome. Clinical overlap exists between sleep-related eating disorder and disorders of arousal, suggesting that sleep-related eating disorder may be a fourth disorder of arousal or a manifestation of sleepwalking. Exploding head syndrome is a unique parasomnia of uncertain etiology. Non-REM parasomnias can range from minor nuisances to severe, life-altering events. While some patients with non-REM parasomnia experience significant consequences during sleep, wakefulness, or both, non-REM parasomnias do not pose a major risk to most patients. For all patients with non-REM parasomnias, safety should be explicitly discussed and addressed. Nonpharmacologic treatment should be prioritized, as increasing total sleep time, avoiding triggering substances, and treating comorbid sleep disorders is often sufficient for the management of non-REM parasomnias. If symptoms persist despite these interventions, treatment with clonazepam or other medications can be considered.

Non-REM parasomnias: a scoping review of dreams and dreamlike mentation

To establish patterns or themes of dreams and dreamlike mentation content reported in all forms of non-rapid eye movement (NREM) parasomnias and to identify gaps in the current understanding of this topic. A scoping review of available evidence on dreams and dreamlike mentation in NREM parasomnias was conducted in accordance with the PRISMA-ScR guidelines. We searched peer-reviewed literature using Google Scholar, PubMed, Ovid (Embase), Ovid Medline®, Global Health, and APA Psych Info. The Mixed Method Appraisal Tool (MMAT) was used to appraise the quality of selected articles. The final analysis included 16 studies. All of the studies were from high-income countries. The studies reported on dreams and dreamlike mentation in NREM parasomnias, but there was scarcity of literature for sexsomnia, sleep-related eating disorder, and confusional arousal. All of the studies had the highest quality as shown by the MMAT (76%-100%). Emotions such as apprehension and misfortune were associated with sleepwalking and sleep terrors. Sleep studies involving collection of dream content immediately following NREM parasomnia could significantly minimize reporting bias and improve dream data quality.

NREM Sleep Parasomnias Commencing in Childhood: Trauma and Atopy as Perpetuating Factors.

Objective/Background: Phenotyping of non-rapid-eye-movement (NREM) parasomnias is currently poorly undertaken. This study aimed to determine whether there are differences phenotypically among childhood-, adolescent-, and adult-onset NREM parasomnias continuing into and presenting in adulthood. Patients/Methods: A retrospective, cohort study of patients presenting with NREM parasomnia between 2008 and 2019 (n = 307) was conducted. Disorders included sleepwalking (n = 231), night terrors (n = 150), sexualised behaviour in sleep (n = 50), and sleep-related eating disorder (n = 28). Results: Compared to the adult-onset NREM behaviours group, the childhood- and adolescent-onset groups were more likely to have a family history of NREM behaviours (p < 0.001), experience a greater spectrum of NREM disorders (p = 0.001), and report a history of sleep-talking significantly more frequently (p = 0.014). Atopy was most prevalent in the childhood-onset group (p = 0.001). Those with childhood-onset NREM parasomnias were significantly more likely to arouse from N3 sleep on video polysomnography (p = 0.0003). Psychiatric disorders were more likely to be comorbid in the adult-onset group (p = 0.012). A history of trauma coinciding with onset of NREM behaviours was significantly more common in the childhood- and adolescent-onset groups (p < 0.001). Conclusions: Significant differences exist across childhood-, adolescent-, and adult-onset NREM parasomnia presenting in adulthood. This study suggests that adult-onset slow-wave sleep disorders may be confounded by psychiatric disorders resulting in nocturnal sleep disruption and that unresolved traumatic life experiences perpetuate NREM disorders arising in childhood and comprise one of the strongest external risk factors for triggering and perpetuating these disorders in adolescence.

What respiratory physicians should know about parasomnias.

To understand the common features of NREM and REM parasomnias.To differentiate between the causes of motor behaviours during sleep.To discuss the treatment approach for NREM and REM parasomnias.

Medications as a Trigger of Sleep-Related Eating Disorder: A Disproportionality Analysis.

Sleep-related eating disorder (SRED) is a parasomnia with recurrent, involuntary, amnestic eating episodes during sleep. There is growing evidence of the association between SRED and medications. Therefore, we aimed to rank drugs showing the strongest association. VigiBase® (WHO pharmacovigilance database) was queried for all reports of “Sleep-related eating disorder”. Disproportionality analysis relied on the Reporting Odds Ratio, with its 95% Confidence Interval (CI), and the Information Component. Our VigiBase® query yielded 676 cases of drug-associated SRED. Reports mostly involved zolpidem (243, 35.9%), sodium oxybate (185, 27.4%), and quetiapine (97, 14.3%). Significant disproportionality was found for 35 medications, including zolpidem (387.6; 95%CI 331.2–453.7), sodium oxybate (204.2; 95%CI 172.4–241.8), suvorexant (67.3; 95%CI 38.0–119.2), quetiapine (53.3; 95%CI 43.0–66.1), and several psychostimulants and serotonin-norepinephrine reuptake inhibitors (SNRIs). Patients treated with nonbenzodiazepines or SNRIs were significantly older (mean age: 49.0 vs. 37.5; p < 0.001) and their SRED were more likely to be serious (62.6% vs. 51.4%; p = 0.014) than patients treated with sodium oxybate or psychostimulants. Psychotropic drugs are involved in almost all reports. In patients with SRED, an iatrogenic trigger should be searched for.

Sleepwalking, sleep terrors, sexsomnia and other disorders of arousal: the old and the new.

Disorders of arousal (DOA) is an umbrella term initially covering classical sleepwalking, sleep terrors, and confusional arousals, and now including a wider spectrum of specialised forms of non rapid eye movement (non REM) parasomnias such as sexsomnia, sleep-related eating disorder, and sleep-related choking syndrome. Growing evidence has shown that DOA are not restricted to children but are also prevalent in adults (2%-4% of the adult population). While DOA run in family, genetics studies remain scarce and inconclusive. In addition to the risk of injury on themselves and others (including sexual assaults in sexsomnia), adults with DOA frequently suffer from excessive daytime sleepiness, pain, and altered quality of life. The widespread view of DOA as automatic and amnesiac behaviours has now been challenged by subjective (dream reports) and objective (dream-enacting behaviours documented on video-polysomnography) observations, suggesting that sleepwalkers are 'dream walking' during their episodes. Behavioural, experiential, cognitive, and brain (scalp electroencephalography [EEG], stereo-EEG, high density-EEG, functional brain imaging) data converge in showing a dissociated pattern during the episodes. This dissociated pattern resembles the new concept of local arousal with a wake-like activation in motor and limbic regions and a preserved (or even increased) sleep intensity over a frontoparietal network. EEG and behavioural criteria supporting the DOA diagnosis with high sensitivity and specificity are now available. However, treatment is still based on controlling priming and precipitating factors, as well as on clinicians' personal experience with sedative drugs. Placebo-controlled trials are needed to improve patients' treatment. DOA deserve more attention from sleep researchers and clinicians.

Phentermine\u2013topiramate extended release for the dual treatment of obesity and sleep-related eating disorder: a case report

BackgroundObesity and eating disorders can present together, and pose diagnostic and therapeutic challenges to the clinician. Generally, lifestyle interventions alone for the treatment of obesity have modest long-term effectiveness. Phentermine–topiramate extended release is a relatively new medication approved for weight reduction. Sleep-related eating disorder is a rare condition that is often underdiagnosed. Both conditions are chronic and require long-term management. There is no definitive treatment for sleep-related eating disorder, and therapeutic options are based on case reports.Case presentationA 35-year-old Caucasian male with a body mass index of 41.7 kg/m2 presented for obesity treatment. History revealed nocturnal episodes of hyperphagia associated with amnesia of overeating and other features of sleep-related eating disorder. Treatment was initiated with phentermine–topiramate extended release. Five months later he lost 5% of his body weight and demonstrated resolution of sleep-related eating disorder behaviors. He reported no adverse side effects. Upon self-discontinuation of the medication, his eating disorder recurred.ConclusionsClinicians intending to help patients reduce body weight should screen for nocturnal eating and other eating disorders. Sleep-related eating disorder can be associated with significant morbidity and excess weight. Patients report adverse effects on quality of life as a result. Phentermine–topiramate extended release may be a good therapeutic option for patients presenting with comorbid obesity and sleep-related eating disorder. More research is needed to explore the efficacy and safety in this patient population.

Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias.

To assess the frequency, determinants, and clinical impact of clinical rapid eye movement (REM) and non-REM (NREM) parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia compared with healthy controls. Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 idiopathic hypersomnia) and 595 healthy controls. Except for sleep-related eating disorder, current NREM parasomnias were rare in all patient groups and controls. Sleep-related eating disorder was more frequent in NT1 patients (7.9% vs 1.8% in NT2 patients, 2.1% in patients with idiopathic hypersomnia, and 1% in controls) and associated with disrupted nighttime sleep (odds ratio = 3.9) and nocturnal eating in full awareness (odds ratio = 6.9) but not with sex. Clinical REM sleep behavior disorder was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (odds ratio = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms, and antidepressant use. Frequent (> 1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2, and 27.8% with idiopathic hypersomnia (vs 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness. In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except for sleep-related eating disorder) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and are associated with male sex, disrupted nighttime sleep, depressive symptoms, and antidepressant use. Leu-Semenescu S, Maranci J-B, Lopez R, etal. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med. 2022;18(5):1355-1364.

TU28. BIGENOMIC ASSOCIATION STUDY OF ACCELEROMETER-DERIVED AND SELF-REPORTED SLEEP PROPERTIES ACROSS UK BIOBANK PARTICIPANTS WITH LIFETIME MAJOR DEPRESSIVE DISORDER

Sleep related eating disorder (SRED) is a parasomnia caused by dysfunction of the mechanisms that normally maintain an overnight fast. The most common consequence of SRED is weight gain but patients also struggle with anxiety, the consumption of inedible substances, sleep related injury, difficulty controlling blood glucose in the setting of diabetes, and poor dentition. As with sleepwalking, the most important strategy for managing amnestic SRED is to identify and treat any underlying sleep disorder, minimize sedating medications as well as optimize the duration and circadian timing of sleep. Pharmacological options for SRED include bedtime pramipexole and topiramate.

A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria.

To identify the most relevant clinical and video-polysomnographic characteristics of patients with sleep-related dissociative disorders (SRDDs) and to propose a framework for new diagnostic criteria. We searched potential SRDD cases from the scientific literature and from a database of patients referred for clinical and video-polysomnographic assessment in a single sleep disorders center for disruptive nocturnal behaviors (n = 731). The most relevant clinical and neurophysiological characteristics of the cases were extracted and a descriptive analysis was performed. Twenty-six SRDD cases (8 new and 18 previously published cases) were reviewed. Almost all cases of SRDDs occurred in a context of past traumatic events or abuse and were associated with at least 1 comorbid psychiatric disorder. We highlighted 4 relevant clinical characteristics of SRDD useful for the differential diagnosis with parasomnias: episodes of long duration of more than 1 hour (90.9%), self-inflicted injuries (83.3%), occurrence while awake close to bedtime (35.7%), and the presence of daytime dissociative symptoms (72.7%). The video-polysomnography documented typical episodes of SRDD with prolonged wakefulness before, during, and after the event in 11/26 cases. New diagnostic criteria for SRDD were proposed, with 3 levels of certainty for the diagnosis based on clinical, video-polysomnographic, and homemade video findings. More than 30 years after its formal identification, SRDD is not currently recognized as an official diagnostic entity. We better delineate the clinical and neurophysiological features of SRDD and propose a framework for its reinstatement in the next revisions of the sleep and psychiatric disorders classifications. Lopez R, Lefevre L, Barateau L, Micoulaud-Franchi J-A, Dauvilliers Y, Schenck CH. A series of 8 cases of sleep-related psychogenic dissociative disorders and proposed updated diagnostic criteria. J Clin Sleep Med. 2022;18(2):563-573.

Evaluation of the effects of shift work on parasomnia prevalence

ABSTRACT Shift work is increasingly common in industrialized countries but is associated with numerous health problems, especially sleep disorders. This study compared the frequency of NREM (confusional arousal, sleep terrors, sleepwalking, sleep-related eating disorder), REM parasomnias (REM sleep behavior disorder, nightmare disorder), and isolated symptoms/normal variants (sleeptalking) between shift workers and daytime workers. A total of 1473 participants in 3 different professional groups and working different shift schedules (daytime, night, or rotating shifts) were included. Participants completed a questionnaire consisting of 132 questions about parasomnia, occupational stress, history of occupational and traffic accidents, depression, and other sleep disorders. The lifetime parasomnia prevalence was 43.7% and the 1-year parasomnia prevalence was 24.4% overall. The 1-year parasomnia prevalence was 27.5% among shift workers and 13% among daytime workers. This rate was highest among rotating shift workers (27.9%), followed by night shift workers (21.2%), and lowest in daytime workers (13%) (P < .001). The most common parasomnias reported were sleep terrors, confusional arousals, and sleeptalking. Parasomnia prevalence rates among workers with and without a history of occupational accidents were 43.7% and 24.2%, while those of workers with and without a history of car accidents were 47.4% and 23.8%, respectively (P < .001). Shift work was associated with higher parasomnia prevalence. Working rotating shifts in particular was an independent risk factor for parasomnia. The parasomnias most frequently associated with shift work were confusional arousal, sleeptalking, and sleep terrors. It should be kept in mind that higher parasomnia rates may increase the risk of occupational and traffic accidents in this population.

832 Dose-Dependent Quetiapine-Induced Somnambulism and Sleep-Related Eating Disorder

Abstract Introduction Parasomnias are abnormal sleep-related movements that can occur during non-rapid eye movement sleep, rapid eye movement sleep, or transition of sleep. The prevalence of parasomnias in young children ranges from 9–40% which may be underestimated as this relies on parental recall. There are multiple reported cases of pharmacologically-induced parasomnias. Quetiapine is an atypical antipsychotic medication associated with somnambulism and sleep-related eating disorder. Report of case(s) A 9-year-old female with a history of attention deficit hyperactivity disorder, post-traumatic-stress disorder, depression, and sexual abuse during childhood presented to the Sleep Medicine Clinic for two years of worsened sleepwalking and sleep eating. Her medications included Methylphenidate, Quetiapine, Clonidine, and Duloxetine. She has had parasomnias since she was 3-years-old, initially presenting as abnormal sleeping positions (standing or sitting). She was initiated on Seroquel at 4-years-old, but parasomnias worsened over the last two years when Quetiapine was increased from 50 mg to 200 mg for behavioral and mood issues. Her somnambulism began to occur nightly. The family was required to remove all items from her bedroom except for the bed to prevent major injuries. She also had significant changes to her eating habit: she would eat two to three times her normal quantity as well as eating while asleep. The family would find her eating ice cream, chips, grapes, cold tortillas, or anything she was able to access. Fortunately, she did not consume raw meat or other frozen foods. The child did not have any recollection of eating at night. Psychiatry worked with her to cross-taper Quetiapine and Topiramate. At the lower dose of Quetiapine, she had exacerbation of her mood symptoms, paranoia, and insomnia; therefore, Topiramate was discontinued and Quetiapine was titrated to 150 mg with improvement in mood symptoms, insomnia, and resolution of sleep-related eating disorder. She continues to have somnambulism. Conclusion This case illustrates that quetiapine-induced somnambulism and sleep-related eating disorder can be dose-dependent; thus, important for clinicians to educate patients and/or family members of adverse effects while titrating quetiapine. Support (if any):

A safety signal of somnambulism with the use of antipsychotics and lithium: A pharmacovigilance disproportionality analysis

Antipsychotics and lithium are widely used in psychiatry, particularly in schizophrenia and bipolar disorders. Recently, some cases of somnambulism or sleep-related eating disorder (SRED) have been reported in patients treated with these drugs. This study investigated the risk of reporting somnambulism or SRED associated with the use of antipsychotics and lithium. The World Health Organization pharmacovigilance database (VigiBase), comprising >18million adverse events, was queried. All somnambulism or SRED reports related to antipsychotics or lithium were identified. The association between antipsychotics or lithium and somnambulism or SRED was computed using the proportional reporting ratio (PRR) and information component. Among the 5784 cases reporting somnambulism or SRED, 508 suspected at least 1 antipsychotic or lithium. Most patients were aged 18-64 years (62.0%), and 37.0% were men. In most cases (77.6%), antipsychotic or lithium were the only drug class involved, and 53.3% of cases suspected quetiapine. Somnambulism was reported in 88.6% of cases and SRED in 18.1%. A significant association was found for second-generation antipsychotics (PRR 3.44, 95% confidence interval 3.13) and lithium (PRR 2.03, [1.22; 3.37]), but not for first-generation antipsychotics (PRR 0.99, [0.68; 1.44]). We found a significant signal of somnambulism or SRED related to second-generation antipsychotics and lithium. While case reports mentioned mostly quetiapine and olanzapine, almost all second-generation antipsychotics were associated with somnambulism or SRED.

The efficacy of add-on ramelteon and subsequent dose reduction in benzodiazepine derivatives/Z-drugs for the treatment of sleep-related eating disorder and night eating syndrome: a retrospective analysis of consecutive patients.

The objective of this study was to determine the efficacy of ramelteon in treating abnormal eating behavior in patients with sleep-related eating disorder and/or night eating syndrome. We retrospectively reviewed the medical records of patients with sleep-related eating disorder/night eating syndrome at the Yoyogi Sleep Disorder Center from November 2013 to November 2018. We categorized patients as ramelteon treatment responders when the frequency of nighttime eating per week decreased to less than half of that before treatment. Forty-nine patients were included in the analysis. The mean frequency of eating behavior (per week) (standard deviation) at baseline and post-ramelteon treatment was significantly different, at 5.3 (2.2) and 3.2 (3.0), respectively (P < .001). Twenty-one patients (42.9%) were classified as responders. Adverse events, all of which were mild daytime somnolence, were observed in 5 patients. There were significantly more individuals using benzodiazepine derivatives and Z-drugs before treatment and those with coexisting delayed sleep-wake phase disorder in the responder group than in the nonresponder group (P < .001 and P < .05, respectively). The mean benzodiazepine derivatives and Z-drugs dose significantly decreased from baseline to post-ramelteon treatment within the responder group (P < .05). This trend was not observed in the nonresponder group. Meanwhile, the sleep midpoint of patients with sleep-related eating disorder/night eating syndrome and delayed sleep-wake phase disorder did not significantly change after treatment. Our results indicate that ramelteon is a candidate treatment for sleep-related eating disorder/night eating syndrome. The effects of ramelteon might have occurred primarily through the reduction in benzodiazepine derivatives and Z-drugs rather than through the improvement in sleep-wake rhythm dysregulation.

Zolpidem for Insomnia: A Double-Edged Sword. A Systematic Literature Review on Zolpidem-Induced Complex Sleep Behaviors.

Background:Being a nonbenzodiazepine, zolpidem is believed to have a favorable side-effect profile and is widely prescribed for insomnia. However, in the past few years, numerous neuropsychiatric adverse reactions, particularly complex sleep behaviors (CSBs), have been reported with zolpidem.Objective:To conduct a systematic review of zolpidem-associated CSBs.Data Sources:An electronic search was conducted using MEDLINE, Embase, PubMed, and Cochrane database of systematic reviews to extract relevant articles till July 2020.Study Eligibility Criteria:Any type of literature article (case report, case series, and observational or interventional study) reporting CSBs associated with zolpidem.Results:In this review, we present aggregate summarized data from 148 patients presenting with zolpidem-induced CSBs (79 patients from 23 case reports and 5 case series; 69 patients out of 1454 taking zolpidem [4.7%] from three observational clinical studies). Various types of CSBs associated with zolpidem were reported, most common being sleepwalking/somnambulism and sleep-related eating disorder. On causality assessment, around 88% of cases were found to have a probable association with zolpidem.Limitations:Extraction of data from observational studies and spontaneous reports, due to nonavailability of any randomized controlled trials relevant to the study objective.Conclusion and Implication of Key Findings:Zolpidem-induced CSBs, although not very common, may develop when the drug is used at therapeutic doses for insomnia. Doctors need to be alert to monitor such adverse effects of zolpidem and exercise caution while prescribing it.