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Abstract
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Parasomnias are abnormal behaviors occurring during sleep. In older adults, rapid eye movement (REM) sleep behavior disorder (RBD) is the most common parasomnia, with a community prevalence of approximately 1% to 2% using polysomnography (PSG)1 and 7% to 13% using questionnaires.2,3 It is characterized by dream enactment behaviors (eg, yelling, punching, kicking) in the setting of loss of normal atonia during REM sleep, which can lead to injury to patients and their bed partners.4 It is well recognized that RBD is a harbinger of neurodegeneration secondary to accumulation of α-synuclein, increasing the risk for future development of Parkinson disease (PD), dementia with Lewy bodies, and multiple system atrophy.5 Because of its prevalence, characteristic clinical presentation, efficient diagnostic confirmation after PSG, and prognostic implications, RBD has been the most extensively studied parasomnia in older adults.
However, elderly individuals can also have other types of REM (eg, nightmare disorder) or non-REM parasomnias (eg, confusional arousals, sleepwalking, sleep-related eating disorders), which have received comparatively little attention. Non-REM parasomnias result from a disorder in the arousal mechanism on awakening from deep sleep, non-REM stage 3 (N3), leading to an incomplete arousal in which the brain may display mixed activity patterns of both wakefulness and sleep.6 The events may go unnoticed because patients may simply sit up and look around in bed (confusional arousal) or wander around the home and eventually go back to bed or fall back asleep in a different room (sleepwalking). Diagnostic confirmation of sleepwalking may be more elusive than RBD, given poor recall of events by patients and fewer diagnostic findings during PSG.
Sleepwalking is much more prevalent in children than in adults, with high remission rates by adolescence,7 but some patients can have persisting events well into adulthood.8 Patients with RBD occasionally leave the bed during dream enactment9 and may be injured from falls. By contrast, sleepwalking has been commonly presumed to be a largely benign condition, at least in most children and adolescents. However, adult sleepwalkers have a higher frequency of daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and altered quality of life in addition to injuries requiring medical care in up to 17%.8 Sleepwalking has also been associated with PD10,11 and with more comorbid depression, higher disease severity, and functional disability in these patients ...
Language: en |