Transtornos relacionados ao sono e comportamentos sexuais anômalos / Sleep Disorders and abnormal sexual behaviors

Esse artigo se baseia nas publicações de Schenck, especialista no assunto. Parassonias são comportamentos sexuais anômalos relacionados ao sono, caracterizados por movimentos complexos, emoções, percepções, sonhos e atividade do sistema nervoso autônomo. Podem provocar lesões, interrupção do sono, efeitos adversos à saúde e psicossociais. O diagnóstico é clínico: história médica e antecedentes (relatos de parcerias ou familiares e vídeos domésticos). Polissonografia é reservada para casos atípicos. O tratamento inclui medidas protetivas, esclarecimento ao familiar/cônjuge, controle dos fatores precipitantes, medicamento (clonazepam) e psicoterapia. A sexônia é uma parassonia (subtipo não REM), melhor estudada. Masturbação e tentativas inadequadas de obter relações sexuais (seguidas de amnésia ou lembrança vaga) são frequentes. A frequência em clínicas do sono é de 7,6% (homens 11,0%; mulheres 4,0%). Esses comportamentos surgem no curso de longa história de parassonia, desencadeando despertares confusionais. Terapia nasal com pressão positiva contínua nas vias aéreas pode controlar. Em homens, ereção peniana, associada à sexônia, é referida pela parceria. Providência importante é inquirir sobre sexônia, quando houver suspeita, uma vez que o paciente e/ou sua parceria não costumam falar, a menos que sejam solicitados ou por questões legais. Revisão de 18 casos médico-legais sobre violência relacionada ao sono e comportamento sexual durante o sono encontrou 9 casos em que sexônia foi alegada pela defesa. Foram apresentadas avaliações dos réus, as quais diferiram de caso para caso, alertando para a necessidade de consenso internacional. Abuso de álcool desqualifica a "defesa baseada em parassonia [sexônia]" em casos médico-legais.

Perioperative Management of Insomnia, Restless Legs, Narcolepsy, and Parasomnias.

Obstructive sleep apnea (OSA) has been shown to increase risk of adverse perioperative events. More recently, investigators have begun to examine other common sleep disorders to assess how they may be impacted by the perioperative environment, as well as influence postoperative outcomes. There are a number of mechanisms by which such common sleep disorders (eg, insomnia, restless legs syndrome, narcolepsy, and parasomnias) may have consequences in the perioperative setting, both related to the underlying pathophysiology of the diseases as well as their treatments. This review will highlight the current state of the literature and offer recommendations for management of these conditions during the perioperative journey.

Sleep Disorders.

Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.

Parasomnias and movement disorders in children and adolescents.

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

Psychopathology and treatment of night eating syndrome: a review.

The article reviews the international literature about psychopathological aspects and treatments of Night Eating Syndrome (NES). Studies were found using Medline; data from recent international books and conferences about ED are included, but single case descriptions are not included in the study. NES seems to be consistently related to mood disorders and anxiety. There is a low overlap between other eating disorders, including binge eating disorder (BED), and NES. The relationship between the syndrome and substance abuse is unclear and needs further study. Sleep architecture seems not to be severely altered among those with NES. A limited number of treatment studies for NES have been published or presented. Most of the literature focuses on pharmacological treatment, with fewer psychotherapeutic approaches reported at this time. Larger, multi-site treatment studies would serve to confirm the findings of this first wave of clinical trials.

Catathrenia: parasomnia or uncommon feature of sleep disordered breathing?

OBJECTIVE: We report a series of seven consecutive cases of catathrenia (sleep related groaning) that differ from limited previous reports in the literature with regard to sleep stage and response to treatment. BACKGROUND: Catathrenia was recently defined as a parasomnia in the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2), but there is debate about its classification, and its response to CPAP is unknown. METHODS: We present 7 consecutive patients presenting with catathrenia over a 5-year period. They were all young women, ranging in age from 20 to 34 years with a body mass index (BMI) <25. They underwent standard clinical evaluation, questionnaires, physical exam, craniofacial evaluations, and nocturnal polysomnography. All seven were titrated on continuous passive airway pressure (CPAP) treatment for sleep disordered breathing then offered surgical treatment if unable to tolerate or adhere to CPAP recommendations. RESULTS: Groaning was present throughout all stages of sleep. The mean (SD) AHI and RDI were 3.2 (0.56) and 13.1 (2.4) respectively. CPAP resolved groaning in all cases. 5 patients (71%) elected subsequent surgical intervention. Three of the 4 that followed up after surgery required adjuvant oral appliance treatment, but all four ultimately had resolution of groaning. CONCLUSIONS: Catathrenia may have subtypes related to sleep stage specificity or presence of sleep disordered breathing. In our heterogeneous group of non-obese women with a normal AHI and elevated RDI, CPAP and select soft tissue surgeries of the upper airway (often augmented with an oral appliance) successfully treated nocturnal groaning.

[Sleep disorders in infancy--aspects of diagnosis and somatic background]. / Schlafstörungen im Kleinkindesalter--Diagnostik, Differenzialdiagnostik und somatische Hintergründe.

Sleep-related disturbed breathing and parasomnia in very young children are in the focus of epidemiological interest. The cardinal symptom, i.e. snoring, in connection with nocturnal perspiration, mouth breathing, susceptibility to infection of the upper respiratory tract and tiredness during the day or hypermotility, can be an indication of obstructive sleep apnea (OSA). The common treatment is adenotomy unless there is indication of allergic swelling of the nasal mucous membrane. Other anatomic predispositions for OSA must be considered (tonsillar hypertrophy, midfacial hypoplasia, micro- and retrognathia, e.g. in patients with Down's syndrome or patients with preoperated cleft lip face palate). Inhalative nasal corticoids are a possible alternative to adenotomy in light to medium grade cases of OSA. Tonsillotomy is indicated only in serious OSA cases, tonsillectomy is only justified in cases of chronic tonsillitis or more than 4-6 cases of angina in the last 12 months. Treatment with nasal CPAP is tolerated well also in childhood. Patients with central hypoventilation syndromes, insufficiency of the respiratory musculature or obesitas hypoventilation syndrome can usually be ventilated by non-invasive approach using a nasal mask. Patients suffering from parasomnia should always be asked if they snore at night because if OSA is diagnosed and treated, there are very good prospects of curing somnambulism as well. Like with narcolepsy and REM sleep, a close HLA association has also been identified for family somnambulism. In cases of parasomnia which becomes manifest only after very young age frontal lobe epilepsy should be suspected and searched by polysomnographic and simultaneous continuous nocturnal video surveillance. If reversive development or unclear motoric and utterance phenomena are observed, sleep-bound convulsive disorder should be looked for. Syncopal events can require comprehensive cardiological diagnosis, including exclusion of nightly disorders of the cardiac rhythm.