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VOLUME 7 , ISSUE 4 ( October-December, 2012 ) > List of Articles

REVIEW ARTICLE

Parasomnias: A review with approach to patients in the clinic and management principles

Vikas Singh, Rama K. Maganti

Keywords : Parasomnia, sleep start, confusional arousal, nightmares, sleep bruxism. rhythmic movement disorder, sleep walking, sleep paralysis, sleep enuresis, sleep talking, sleep terror, REM Sleep Behavior Disorder, nocturnal paroxysmal dystonia, nocturnal leg cramps, impaired sleep related penile erections, catathrenia, sleep related eating disorder

Citation Information : Singh V, Maganti RK. Parasomnias: A review with approach to patients in the clinic and management principles. Indian Sleep Med 2012; 7 (4):119-133.

DOI: 10.5958/j.0974-0155.7.4.019

License: CC BY-SA 4.0

Published Online: 01-10-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Parasomnias are characterized by undesirable motor, verbal or experiential phenomenon / behaviors occurring in relation to sleep and sleep wake transition phases. They are believed to occur due to incomplete arousal from different sleep states, abnormal intrusions of wakefulness into different stages of sleep as well as de-afferentation of generators of locomotion from generators of sleep. They are classified as sleep wake transition parasomnias, NREM (non-rapid eye movement), REM (rapid eye movement) parasomnias and miscellaneous group. Accurate diagnosis of various parasomnias is important as they are associated with distinct group of predisposing factors. Associated conditions that require different treatment considerations which may be as innocuous as identification and removal of predisposing factors and reassurance. Correct diagnosis also invokes right differential diagnostic considerations and further investigations. Understanding of the underlying pathophysiology, semiological features and natural history of the particular parasomnia aids in counseling the patient and the parents, safety precautions to be undertaken and addressing psychosocial complications which are one of the most distressing factors for the patients. Correct diagnosis can be established fairly accurately based on careful and detailed clinical interview (including account from parents and bed partner), age of onset, time of occurrence, polysomnographic (PSG) studies and rarely an extended montage to study electrographic characteristics for differentiation with an ictal event. Abbreviations: REM – rapid eye movement, NREM – non-rapid eye movement, PSG – Polysomnography, EEG – electroencephalography, CNS – central nervous system, ICSD – international classification of sleep disorders, EMG – electromyography, BXD – benzodiazepines, TCA – tricyclic antidepressant, PTSD – post-traumatic stress disorder, ISP – isolated sleep paralysis, RISP – recurrent isolated sleep paralysis, RBD – REM sleep behavior disorder, OSA – obstructive sleep apnea, NPD – nocturnal paroxysmal dystonia, UTI – urinary tract infection, NES – nocturnal eating syndrome, RLS – restless leg syndrome, PLMS – periodic limb movement of sleep, RDI – respiratory disturbance index, SPECT – single photon emission computerized tomography, MAO – monoamine oxidase, SRED – sleep related eating disorder, CPAP – continuous positive airway pressure.


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