Sleep-related Rhythmic Movement Disorder Research Articles

Sleep Related Rhythmic Movement Disorder in older children and adults and their association with comorbid conditions – experience from two centres and literature review

Sleep related rhythmic movement disorders (SRRMD) are highly prevalent among infants and children and tend to disappear into adolescence and adulthood. However, few reports have identified patients who had rhythmic movements at wake-sleep transition persisting into adulthood. This is a case series of SRRMD diagnosed on video-polysomnography from retrospective chart review of patients, who were 6 years or older, seen in Sleep Neurology clinics in two centres by the senior author, over a 10 years period. In addition, an updated review of all papers published on the topic, since year 2000 is being reported. A total of nine patients (2 females) with SRRMD were included in this series with age ranging between 9 and 62 years. Five patients had comorbid primary sleep disorders and four others had associated neurodevelopmental disorders. Association with other primary sleep disorders like sleep apnea and restless legs syndrome and relief with treatment of the latter, has been highlighted.

Sleep related rhythmic movement disorder: phenotypic characteristics and treatment response in a paediatric cohort

ObjectiveTo describe phenotypic, polysomnographic characteristics, impact, and treatment response in children with sleep related rhythmic movement disorder (SR-RMD). BackgroundThere is limited research on SR-RMD. We have developed a systematic clinical evaluation of children with SR-RMD to improve understanding and treatment. MethodsA retrospective chart review of 66 children at a UK tertiary hospital. Baseline assessment included validated screening questionnaires to study autism spectrum characteristics, general behaviour and sensory profile. A standardised questionnaire assessed impact on sleep quality and daytime wellbeing of child and family. Polysomnography data were collated. ResultsChildren were aged 0.9–16.3 years (78.8% male). 51.5% had a neurodevelopmental disorder, most commonly autism spectrum disorder. High rates of behavioural disturbance and sensory processing differences were reported, not confined to children with neurodevelopmental disorders. Parents reported concerns about risk of injury, loss of sleep and persistence into adulthood. Daytime wellbeing was affected in 72% of children and 75% of other family members. Only 31/48 children demonstrated rhythmic movements during video-polysomnography, occupying on average 6.1% of time in bed. Most clusters occurred in the settling period but also arose from N1, N2 and REM sleep and wake after sleep onset. Melatonin was prescribed to 52 children, all but one were extended-release preparations. 24/27 children with available data were reported to improve with melatonin. ConclusionsSR-RMD places a significant burden on child and family wellbeing. Our novel findings of sensory processing differences in this population and parent reported therapeutic response to extended-release melatonin offer potential avenues for future research.

Sleep-related rhythmic movement disorder in children: a mini-review.

Sleep-related rhythmic movement disorder (SRRMD) occurs in both infants and children. This disorder rarely occurs or persists in adolescence or adulthood. Rhythmic movement during sleep in children is often asymptomatic and considered a benign condition. It is classified as SRRMD when movement significantly disrupts sleep, results in daytime functional impairment, or causes self-inflicted body injury. Several studies have demonstrated that SRRMD occurs in all sleep stages. Few studies have investigated rhythmic movement disorder (RMD) in children. SRRMD is a clinical diagnosis supported by home video recordings. When the clinical history is insufficient to provide a definitive diagnosis of SRRMD, and other sleep-related conditions or seizure disorders are suspected, video-polysomnography is indicated. There are currently no clinical guidelines for treating SRRMD.

Atypical Sleep-related Rhythmic Movement Disorder (P1-1.Virtual)

Atypical Sleep-related Rhythmic Movement Disorder (P1-1.Virtual)

Sleep-Related Rhythmic Movement Disorder in Young Children with Down Syndrome: Prevalence and Clinical Features.

Sleep-related Rhythmic Movement Disorder (RMD) affects around 1% of UK pre-school children. Little is known about RMD in Down syndrome (DS). We aimed to determine: (a) the prevalence of RMD in children with DS aged 1.5–8 years; (b) phenotypic and sleep quality differences between children with DS and RMD and sex- and age-matched DS controls; and (c) night-to-night variability in rhythmic movements (RMs). Parents who previously reported RMs from a DS research registry of 202 children were contacted. If clinical history suggested RMD, home videosomnography (3 nights) was used to confirm RMs and actigraphy (5 nights) was used to assess sleep quality. Phenotype was explored by demographic, strengths and difficulties, Q-CHAT-10/social communication and life events questionnaires. Eight children had confirmed RMD. Minimal and estimated maximal prevalence were 4.10% and 15.38%, respectively. Sleep efficiency was significantly lower in RMD-cases (69.1%) versus controls (85.2%), but there were no other phenotypic differences. There was considerable intra-individual night-to-night variability in RMs. In conclusion, RMD has a high prevalence in children with DS, varies from night to night and is associated with poor sleep quality but, in this small sample, no daytime phenotypic differences were found compared to controls. Children with DS should be screened for RMD, which is amenable to treatment.

Sensory stimulation in the treatment of children with sleep-related rhythmic movement disorder: a feasibility and acceptability study

BackgroundSleep-related rhythmic movement disorder is characterized by repetitive gross-motor movements at sleep onset or during sleep, which result in clinical consequences such as impact on daytime functioning and injury. No well-established therapies exist today. Substituting the patient’s movements with external sensory stimulation may offer a treatment modality. The aim of the current study was to test the feasibility and acceptability of vestibular stimulation using a rocking bed (Somnomat) in children with rhythmic movement disorder and to assess children’s movement preference.MethodsChildren with rhythmic movement disorder (n = 6, Age: 5–14 years) were studied over three nights in a sleep laboratory: adaptation night (normal bed) and randomised-order baseline (Somnomat) and intervention nights (Somnomat). Child’s preferred movement direction (head-to-toe or side-to-side) and frequency (between 0.25 and 2 Hz), determined during an afternoon protocol, were applied using the Somnomat for 1 h after lights out, and in response to subsequent episodes of rhythmic movement during intervention nights. Comfort assessed using a questionnaire, and objective sleep parameters assessed using videosomnography, were compared.ResultsThe participants’ sometimes violent rhythmic movements did not disturb device performance. All children rated intervention nights equally or more comfortable than baseline nights. Self-reported sleep quality, as well as the number and duration of movement episodes did not significantly differ between baseline and intervention nights.ConclusionsProviding rocking movements using the Somnomat is both technically feasible and acceptable to the target population. The therapeutic value of this novel stimulus substitution for rhythmic movement disorder should now be evaluated in a larger sample over a longer period in the home setting.Trial registrationThe trial was retrospectively registered at clinicaltrials.gov (NCT03528096) on May 17th 2018.

Sleep-related rhythmic movement disorder: a case report of head banging alopecia

Sleep-related rhythmic movement disorder: a case report of head banging alopecia

Analysis of sleep-related rhythmic movement disorder in children using automatic 3D detections

Analysis of sleep-related rhythmic movement disorder in children using automatic 3D detections

A Novel Approach to Assess Sleep-Related Rhythmic Movement Disorder in Children Using Automatic 3D Analysis.

Background: Unlike other episodic sleep disorders in childhood, there are no agreed severity indices for rhythmic movement disorder. While movements can be characterized in detail by polysomnography, in our experience most children inhibit rhythmic movement during polysomnography. Actigraphy and home video allow assessment in the child’s own environment, but both have limitations. Standard actigraphy analysis algorithms fail to differentiate rhythmic movements from other movements. Manual annotation of 2D video is time consuming. We aimed to develop a sensitive, reliable method to detect and quantify rhythmic movements using marker free and automatic 3D video analysis. Method: Patients with rhythmic movement disorder (n = 6, 4 male) between age 5 and 14 years (M: 9.0 years, SD: 4.2 years) spent three nights in the sleep laboratory as part of a feasibility study (https://clinicaltrials.gov/ct2/show/NCT03528096). 2D and 3D video data recorded during the adaptation and baseline nights were analyzed. One ceiling-mounted camera captured 3D depth images, while another recorded 2D video. We developed algorithms to analyze the characteristics of rhythmic movements and built a classifier to distinguish between rhythmic and non-rhythmic movements based on 3D video data alone. Data from 3D automated analysis were compared to manual 2D video annotations to assess algorithm performance. Novel indices were developed, specifically the rhythmic movement index, frequency index, and duration index, to better characterize severity of rhythmic movement disorder in children. Result: Automatic 3D video analysis demonstrated high levels of agreement with the manual approach indicated by a Cohen’s kappa >0.9 and F1-score >0.9. We also demonstrated how rhythmic movement assessment can be improved using newly introduced indices illustrated with plots for ease of visualization. Conclusion: 3D video technology is widely available and can be readily integrated into sleep laboratory settings. Our automatic 3D video analysis algorithm yields reliable quantitative information about rhythmic movements, reducing the burden of manual scoring. Furthermore, we propose novel rhythmic movement disorder severity indices that offer a means to standardize measurement of this disorder in both clinical and research practice. The significance of the results is limited due to the nature of a feasibility study and its small number of samples. A larger follow up study is needed to confirm presented results.

Objectively confirmed prevalence of sleep-related rhythmic movement disorder in pre-school children

ObjectiveChildhood sleep-related rhythmic movement disorder (RMD) (ie, sleep-related repetitive movements involving large muscle groups) can impair sleep quality, cause local injury, and disturb household members. Previous parental reports indicate prevalence rates in children under three years of age between 5.5 and 67%. We studied the prevalence of RMD with objective home videosomnography. MethodsParents of 707 children having their one-year routine health check (357 male), 740 children having their two-year health check (395 male), and 17 children of unknown age (nine male), were asked if their child showed sleep-related rhythmic movements. If telephone interview confirmed likely RMD, parents completed a standardised clinical questionnaire and three nights of home videosomnography. ResultsAt the one-year health check, 31/707 possible cases of RMD were identified [maximal prevalence: 4.38%; 95% CI (2.81, 5.89)] compared to 11/740 at the two-year check [maximal prevalence: 1.49%, 95% CI (0.61, 2.36)]. Of 42 possible cases, nine had resolved; 14 were uncontactable, or did not wish to participate, and four did not complete the study protocol. In four of 10 remaining one-year olds and four of five remaining two-year olds parental report was objectively confirmed by videosomnography. Minimal prevalence based on objective observation was therefore 0.28% [95% CI (0.08, 1.30)] at one-year check and 0.41% [95% CI (0.08, 1.24)] at two-year check. ConclusionsPrevalence of RMD in a large population of infants and toddlers was lower than previously reported (maximum prevalence 2.87%, minimum prevalence 0.34%). It is important to confirm parental report using objective measures.

Rockin' Yourself Asleep.

BackgroundSleep-related rhythmic movement disorder occurs frequently in childhood with a minority of patients having persistent symptoms in adolescence.Phenomenology ShownWe describe a 14-year-old female showing a typical example of head banging at onset of sleep.Educational ValueSleep-related rhythmic movement disorder usually has a benign and self-limiting nature and medication might only be warranted in cases of severe sleep disruption or frequent injuries.

Sleep-Related Rhythmic Movement Disorder and Obstructive Sleep Apnea in Five Adult Patients

Sleep-related rhythmic movements (SRRMs) are typical in infancy and childhood, where they usually occur at the wake-to-sleep transition. However, they have rarely been observed in adults, where they can be idiopathic or associated with other sleep disorders including sleep apnea. We report a case series of 5 adults with sleep-related rhythmic movement disorder, 4 of whom had a previous history of SRRMs in childhood. SRRMs mostly occurred in consolidated sleep, in association with pathological respiratory events, predominantly longer ones, especially during stage R sleep, and recovered in 1 patient with continuous positive airway pressure therapy. We hypothesize that sleep apneas may act as a trigger of rhythmic motor events through a respiratory-related arousal mechanism in genetically predisposed subjects.

0737 SLEEP-RELATED RHYTHMIC MOVEMENT DISORDER AND SLEEP APNEA IN FIVE ADULT PATIENTS

Sleep-related rhythmic movements (SRRMs) are typical in infancy and childhood, where they usually occur at the wake-sleep transition. However, they have rarely been observed in adults, where they can be idiopathic or associated with other sleep disorders. We report a video case series of 5 adults with sleep-related rhythmic movement disorder (SRRMD), 4 of which had a previous history of SRRMs in childhood. All of them underwent a full-night Video-PSG. A total of 411 RMEs were recorded in our 5 subjects, 78% of them occurred during consolidated sleep, of these, 18% in REM sleep. In the great majority of the cases (81.4%), RMEs were preceded by pathological breathing events. In at least 2 cases, the duration of breathing events associated with RMEs was longer than the one of those unassociated. RMEs retreated after CPAP ventilation in one subject. Four out of five subjects reported a previous history of SRRMD during childhood. We speculate that respiratory-related arousals could drive the occurrence of motor events in predisposed subjects. We strongly recommend to investigate the sleep-related breathing pattern by means of a full video-polysomnography in adults with SRRMD, particularly in those with a new-onset disorder or a recent aggravation, as well as in those whose RMEs tend to occur in consolidated sleep. This may speak against an unsafe treatment with benzodiazepines, which can aggravate sleep apnea. When sleep apnea is confirmed, treatment with CPAP might be beneficial also for RMEs. The SAS-CARE study was supported by grants from the Swiss National Science Foundation (SNF Grant 320030_125069) and SwissHeart.

Lung Cancer as the Cause of Sleep-Related Rhythmic Movement Disorder

Sleep-related Rhythmic Movement Disorder (SRMD) generally occurs during the neonatal period or early childhood. However, it has not yet been precisely defined despite various hypotheses with respect to its etiopathogenesis. These types of movements rarely continue during adulthood. SRMD, likely to be idiopathic, may develop due to secondary causes as well. In this study, we highlight adult-onset SRMD in a patient with the diagnosis of lung cancer.

Sleep-related movement disorders

Several movement disorders may occur during nocturnal rest disrupting sleep. A part of these complaints is characterized by relatively simple, non-purposeful and usually stereotyped movements. The last version of the International Classification of Sleep Disorders includes these clinical conditions (i.e. restless legs syndrome, periodic limb movement disorder, sleep-related leg cramps, sleep-related bruxism and sleep-related rhythmic movement disorder) under the category entitled sleep-related movement disorders. Moreover, apparently physiological movements (e.g. alternating leg muscle activation and excessive hypnic fragmentary myoclonus) can show a high frequency and severity impairing sleep quality. Clinical and, in specific cases, neurophysiological assessments are required to detect the presence of nocturnal movement complaints. Patients reporting poor sleep due to these abnormal movements should undergo non-pharmacological or pharmacological treatments.

A Multigenerational Family with Persistent Sleep Related Rhythmic Movement Disorder (RMD) and Insomnia

In the International Classification of Sleep Disorders 2nd Edition (ICSD-2), sleep related rhythmic movement disorder (RMD) is classified as a disorder characterized by rhythmic movements of large muscle groups in different parts of the body. These are repetitive, stereotyped, rhythmic motor behaviors that occur predominantly during drowsiness or sleep,and are typically seen in infants and children. Episodes often occur at sleep onset, at any time during the night, and during quiet wakeful activities at a frequency of 0.5-2 sec), lasting <15 min. The prevalence is high in infants (59%), dropping to 5% at the age of 5 years. When persisting to older childhood or beyond, association with mental retardation, autism, or other significant pathology is reported. Few cases in adults of normal intelligence have been reported in the literature. There is a strong association with attention deficit hyperactivity disorder, suggesting a similar pathogenetic mechanism. There is also one adult case report occurring during strictly REM sleep. Mayer et al reported 24 subjects with RMD that persisted into adolescence and adulthood. Twenty of the subjects were adults, and 16 of them had the condition since childhood. Of these 20, 16 had no other sleep disorders (but 2 had a family history of RMD), and 4 had obstructive sleep apnea. This was the first ever report of familial RMD.

An unusual clinical phenomenon: A case of bedtime ritual with apparent sexual overtones

A 6-year-old boy attended a psychology clinic with a history of separation anxiety, delayed bedtime and problematic daytime behaviour. In addition, his mother described that at bedtime he would rock over a particular soft toy (teddy bear) on the floor of his bedroom with the bear straddled between his legs in what appeared to be a sexualized ritual. Clinical history taking and a psychological assessment led to a diagnosis of Separation Anxiety and sleep related Rhythmic Movement Disorder (RMD). Systematic desensitization, token-reward systems and play therapy were used to reduce separation anxiety. Alternative bedtime rocking routines without sexual overtones were developed and resulted in reduced time for sleep initiation, increased total sleep time and improved daytime behaviour. This case study demonstrates a case of severe RMD used as a self-soothing and anxiety-reduction strategy which was initially misinterpreted as a sexualized activity. Caution should be exercised in misinterpreting similar case presentations. Correct diagnosis was increased in this case with a psychologist with expertise in sleep and therefore presents a potentially unmet clinical need for sleep psychologists.

A Case of Childhood Sleep-Related Rhythmic Movement Disorder

A Case of Childhood Sleep-Related Rhythmic Movement Disorder Tae Yeon Kim, M.D., Hyun Hee Lee, M.D., Sung Ku Kim, M.D., Kon Hee Lee, M.D. Department of Pediatrics, Kangnam Sacred Heart Hospital, School of Medicine Hallym University Sleep-related rhythmic movement disorder (SRMD) is defined by uniformed, repetitive movements, which occurs from onset of sleep to light sleep and sometimes during deep sleep. We experienced a 21 month-old girl complained of the rhythmic movements during sleep. After controlling her circadian rhythm for 45days, her symptoms dramatically improved; there was no more hitting her head or legs on the floor. We considered that rhythmic movement would be related to circadian rhythm without medication.

Near resolution of sleep related rhythmic movement disorder after CPAP for OSA

Sleep related rhythmic movement disorder (RMD) is characterized by repetitive, stereotyped, and rhythmic motor behaviors that involve large muscle groups and occur predominantly during drowsiness and light sleep, though they can appear in any sleep stage [1]. Diagnosis is often but not always straightforward, especially when RMD involves movement patterns other than the most classic body rocking or head banging, or when the patient presents initially in adulthood rather than childhood. We describe an adult diagnosed with RMD only after being treated for restless legs syndrome (RLS) and referred for evaluation of obstructive sleep apnea. Furthermore, treatment of this patient’s obstructive sleep apnea dramatically reduced the RMD.

Parasomnias associated with sleep-disordered breathing and its therapy, including sexsomnia as a recently recognized parasomnia

Parasomnias are defined in the International Classification of Sleep Disorders-2nd Edition (ICSD-2) as undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Instinctual behaviors can inappropriately emerge with the parasomnias, including appetite behaviors (feeding, sex), locomotion, aggression, and violence. Sleep disorders and their therapies carry their own risk for parasomnias, including sleep-disordered breathing (SDB) and its therapy with nCPAP. A Pub Med literature search was conducted for peer-reviewed journal articles with key words "parasomnia" (and other specific parasomnias) linked with "sleep apnea" or "sleep disordered breathing." Eight of the 12 parasomnias found in the ICSD-2 are associated with SDB, along with 3 of the 4 parasomnia variants in ICSD-2, for a total of 11 of 16 (68.7 %) parasomnias and their variants being associated with SDB. The list of parasomnias includes confusional arousals (and its variants, severe morning sleep inertia, and sleep related abnormal sexual behaviors [sexsomnia, sleepsex]); sleepwalking; sleep terrors; sleep related eating disorder; REM sleep behavior disorder (and "OSA pseudo RBD"); parasomnia overlap disorder (RBD combined with a disorder of arousal); nightmare disorder; sleep related groaning (catathrenia); and sleep enuresis. Sleep Related Movement Disorders include sleep related bruxism and sleep related rhythmic movement disorder. Other conditions include gastrooesophageal reflux disorder with sleep related laryngospasm; cerebral anoxic attacks; nocturnal seizures (Complex Partial Seizures; Nocturnal Frontal Lobe Epilepsy); sleep related anxiety reactions and panic attacks; chronic hiccups; and sleep choking syndrome. A case report is included of a man with moderately severe OSA and with recurrent, unconscious sexsomnia with his wife, who fully responded to nCPAP therapy that normalized his SDB and complete ly eliminated the sexsomnia, which presumably had emerged during OSA confusional arousals. A current classification of sexsomnia, a recently recognized parasomnia variant, is reviewed, along with comments on OSA-sexsomnia.