Las pesadillas en pacientes pediátricos y adolescentes. Revisión del tema a propósito de 2 casos clínicos / Nightmares in pediatric and adolescent patients. Review of the topic regarding 2 clinical cases

Los sueños en niños y adultos son frecuentes, pero con contenido perturbador y un aumento en la frecuencia, deben ser una alarma para el médico y la familia. Las pesadillas son un tipo de parasomnia, principalmente asociada con el sueño REM. Las pesadillas son más frecuentes en el insomnio y también pueden causar insomnio debido al miedo al sueño. Están relacionados con altos niveles de ansiedad, miedo a conciliar el sueño o déficits cognitivos secundarios a la privación del sueño y, por lo tanto, pueden aumentar la vulnerabilidad al desarrollo de otros trastornos mentales. Las pesadillas tienen relevancia clínica porque deterioran la salud física y mental y están relacionadas con una mayor tasa de suicidio. La consulta debe guiarnos como una bandera roja para evaluar el estado de salud; la cantidad y calidad del sueño; y factores como comorbilidades asociadas, consumo de drogas o síntomas de abstinencia, o vulnerabilidades. Esta revisión se basó en dos casos clínicos, un niño que se presentó en la pandemia y un adolescente que presentó inicio abrupto de pesadillas.

Dreams in children and adults are frequent, but with disturbing content and an increase in frequency, they should be an alarm for the doctor and the family. Nightmares are a type of parasomnia, mostly associated with REM sleep. Nightmares are more frequent in insomnia and can also themselves cause insomnia due to fear of sleep. They are related to high levels of anxiety, fear of falling asleep or cognitive deficits secondary to sleep deprivation and, therefore, may increase vulnerability to the development of other mental disorders. Nightmares have clinical relevance because they deteriorate physical and mental health and are related to a higher suicide rate. The consultation should guide us as a red flag to evaluate the state of health; the quantity and quality of sleep; and factors such as associated comorbidities, drug use or withdrawal symptoms, or vulnerabilities. In this review based on two clinical cases, a child who presented in the pandemic and an adolescent who presented abrupt onset and nightmares.

Recent advance in sleep-related eating disorders / 中华神经医学杂志

Sleep-related eating disorder (SRED) is a sleep disorder characterized by repeated involuntary eating and drinking. The clinic of this disease is not rare, but few reports are noted in China; doctors and patients lack of knowledge. This paper reviews the literature on SRED, summarizes the shortcomings of existing research, and proposes future research directions, aiming to provide references for researchers to further explore this field.

A case of confusional arousal in an elderly man / 中华神经科杂志

Confusional arousal (CA) is a rare non-rapid eye movement sleep-related parasomnia and rarely reported in China, leading to misdiagnosis and mistreatment in clinic. A detailed collection of clinical symptoms and simultaneous video polysomnography is very important for diagnosis and differential diagnosis of CA. A elderly patient with CA was diagnosed according to the International classification of sleep disorders, third edition diagnostic criteria. The summary and analysis of the patient is conducted to improve the understanding of CA, meanwhile to avoid misdiagnosis and mistreatment.

Recent advance in exploding head syndrome / 中华神经医学杂志

Exploding head syndrome (EHS) is a sleep disorder that is easily missed diagnosed and misdiagnosed in Neurology. Its long-term existence can seriously affect the quality of life of patients; therefore, early and accurate identification of EHS and early intervention are very important. This article summarizes the recent advance in EHS in recent years from the aspects of etiology, pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment and prognosis as follows, in order to deepen the understanding of clinical colleagues.

Recent advance in exploding head syndrome / 中华神经医学杂志

Exploding head syndrome (EHS) is a sleep disorder that is easily missed diagnosed and misdiagnosed in Neurology. Its long-term existence can seriously affect the quality of life of patients; therefore, early and accurate identification of EHS and early intervention are very important. This article summarizes the recent advance in EHS in recent years from the aspects of etiology, pathogenesis, epidemiology, clinical manifestations, diagnosis, treatment and prognosis as follows, in order to deepen the understanding of clinical colleagues.

"Catatrenia": un trastorno del sueño poco conocido: descripción de tres casos clínicos pediátricos / Catathrenia: unknown sleep disorder: report 3 cases in pediatric patients

Catatrenia (gemido nocturno) es una condición rara caracterizada por sonidos irregulares que ocurren durante el sueño. Los comportamientos ocurren intermitentemente durante cualquiera de las dos etapas de sueño, REM o NREM y se caracterizan por gemidos prolongados, a menudo muy fuertes, socialmente perturbadores, durante la expiración. Es poco conocido y espera más definición y estudios terapéuticos. Hay pocos reportes y en su mayoría de pacientes adultos. Se presentan 3 casos en pacientes pediátricos.

Catathrenia (nocturnal groaning) is a rare condition characterized by irregular sounds that occur during sleep. The behaviors occur intermittently during either REM or NREM sleep and are characterized by prolonged, often very loud, socially disruptive groaning sounds during expiration. It is poorly understood and awaits further definition and therapeutic studies. There are few reports mostly adult patients are presented below 3 cases in pediatric patients.

Advances in sleep-related hypermotor epilepsy / 浙江大学学报·医学版

Sleep-related hypermotor epilepsy (SHE), formerly known as nocturnal frontal epilepsy, is characterized by asymmetrical tonic or complex hypermotor seizures during sleep, with transient, frequent and clustering attack. The accurate incidence is not known but somehow low, which is estimated about 1.8/100 000. The differential diagnosis between SHE and parasomnias may be challenging due to possible similarities between the two sleep-related manifestations. In a majority of patients, the etiology is unknown. Identified etiologies are heterogeneous and structural abnormalities,which are involved in the severity and prognosis of SHE. In terms of treatment, it mainly includes pharmacological therapy and surgery. Carbamazepine seems to be the drug of choice in SHE patients, and epilepsy surgery provides excellent results in selected drug-resistant SHE cases. This review will focus on diagnosis, pathogenesis, treatment and prognosis of SHE, aiming to promote its early diagnosis and appropriate treatment.

Recurrent sleep paralysis - fear of sleeping / Paralisia do sono recorrente - medo de dormir

ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.

RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.

Alteraciones del sueño y bruxismo / Sleep alterations and bruxism

El sueño es un requerimiento biológico para la vida, sus alteraciones o su ausencia pueden disminuir la calidad de vida, el estado anímico y funcional, afectando seriamente la salud. Un sueño placentero y reparador implica cursar por facetas de profundidad diversa y actividad neuronal compleja. En este artículo se intentan explicar las generalidades del proceso del sueño y algunos de sus trastornos que lo relacionan con aumento de la actividad de los músculos masticatorios (bruxismo). Son presentados aspectos clínicos y neuronales que inducen a un incremento de microdespertares como alteración del sueño, estimulando bruxismo nocturno y bruxismo asociado a apnea nocturna. Son discutidas las posibles relaciones bidireccionales entre bruxismo diurno y nocturno secundarias a modifi caciones en la cantidad y calidad del proceso del sueño. De la misma manera, son sugeridas algunas consideraciones semiológicas y nosológicas para el mejor manejo y control del bruxismo asociado a las alteraciones del sueño, bajo el diagnóstico, atención y supervisión de equipos de atención multi- e interdisciplinarios (AU)

Sleep is a biological requirement for life, its alterations or privation thereof may reduce a person's quality of life, his or her state of mind and physical functions, which signifi cantly aff ects their health. Pleasant and repairing sleep implies going through variable deepness sleep stages, and a complex neuronal activity. This article intends to explain the generalities of the sleep process and certain disorders, particularly those in connection with the activity of the mastication muscles (bruxism). Clinical and neuronal aspects are presented inducing an increase in micro-awakenings such as sleep alterations stimulating nocturnal and bruxism associated with sleep apnea. Bidirectional connections between diurnal and nocturnal bruxism are argued as secondary to changes in the amount and quality of the sleep process. In the same manner, certain considerations associated to semiology and nosology of the diverse bruxism manifestations are considered for the better handling and control of the bruxism associated with sleep alterations under the diagnosis attention and supervision of multi- and interdisciplinary teams (AU)

Characteristic symptoms of exploding head syndrome:one case report and literature review / 中华神经科杂志

Exploding head syndrome(EHS)is a rare sensory parasomnia and rarely reported in China, leading to serious misdiagnosis, mistreatment, and unnecessary testing. A detailed collection of clinical symptoms and longterm polysomnography-electroencephalography monitoring is very important for diagnosis and differential diagnosis of EHS. We diagnosed a patient with EHS according to the International classification of sleep disorders, third edition diagnostic criteria. The electro-clinical feature of the patient and relevant references were analyzed in order to improve the understanding of EHS, meanwhile to prevent unnecessary testing and avoid misdiagnosis and mistreatment.

A Case of Re-Emergent Sleepwalking in Adulthood, Primed by Sleep Deprivation and Triggered by Sleep Apnea

Non-rapid eye movement sleep parasomnias including sleepwalking tend to disappear spontaneously during late childhood and adolescent period. Sleepwalking is not as common in adults as in children. Sleepwalking in adults could happen with triggering factors such as hypnotics or metabolic derangement including hypoglycemia. We report a case of an adult patient with recurrent, frequent sleepwalking and complex motor behaviors during sleep in his mid- twenties after spontaneous remission of sleepwalking in the childhood. The triggers were severe sleep deprivation and obstructive sleep apnea. No more sleepwalking was reported after the treatment of sleep apnea by tonsillectomy.

Diagnostic Confusion of Nocturnal Paroxysmal Motor Activity

It is a significant challenge for the clinician to make distinction between nocturnal epilepsy form non-epileptic sleep disorders. Although in some patients, diagnosis is easy to achieve but sometimes not. At times even with help of polysomnogram and electroencephalogram, diagnostic confusion remains. We present two cases of nocturnal paroaxysmal events, which still need elucidate diagnosis.

Sleep disturbance in children with allergic disease

PURPOSE: Although allergic disease has been recognized as a common chronic disease related to the sleep disturbance of children, studies on sleep disturbance in children with allergic disease are scanty in Korea. The aim of this study was to evaluate the sleep disturbance of children with allergic disease. METHODS: Children aged 2 to 12 years were assessed using the sleep questionnaires. From July 2011 to June 2012, surveys were conducted on patients who were diagnosed with allergies in 3 general hospitals and in an elementary school in Seoul and the capital area. The analysis was done in 3 groups according to age. RESULTS: The sleep questionnaires of 1,174 children were evaluated. Children with allergic disease were 341 (209 males and 132 females) and those in the control group were 833 (428 males and 405 females). Parasomnia symptoms were common in young children (ages 2 to 5 years) than in the control group (P<0.05). Symptoms of sleep-disordered breathing were more common in early adolescent children (ages 11 to 12 years) than in the control group (P<0.05). The presence of allergic rhinitis, gender, and body mass index did not correlate with a sleep disturbance in children with allergic disease. CONCLUSION: To our knowledge, this study was the first report of sleep disturbance in children with allergic disease in Korea. This study suggests that children with allergic disease from early children may have poor sleep quality than those without. Therefore, proper treatment of and great interest in sleep disturbance are required for children with allergic disease.

Sleep Forensics: a critical review of the literature and brief comments on the Brazilian legal situation / Medicina do sono Forense: uma revisao critica da literatura e breves comentarios sobre a situacao brasileira

Sleep medicine is a relatively new field among Medical Sciences. Its legal aspects are still obscure, either for lack of knowledge of the biological mechanisms underlying violent behaviour during sleep or the virtual absence of clear legal and uniformly accepted guidelines as to whether to punish or treat those disorders. An updated review of the pertinent literature was performed to determine the most prevalent pathological conditions involving violence and sleep and to identify their most common precipitating factors, attempting to provide some technical support to aid Brazilian medical-experts or assistants in preparing substantial and scientific-based reports in a legal environment.

A medicina do sono é um campo relativamente novo dentro das Ciências Médicas. Seus aspectos legais encontram-se ainda na obscuridade, seja por falta de conhecimento dos mecanismos biológicos do desenvolvimento dos transtornos de comportamento e da violência praticada em estados alterados de sono, seja por virtual ausência de previsão legal do binômio tratamento/punição. Realizamos revisão atualizada da literatura para determinar as condições patológicas mais prevalentes envolvendo violência e sono, identificar seus fatores precipitantes mais comuns e os critérios médico-legais que podem auxiliar eventuais médicos-peritos ou assistentes na elaboração de pareceres abalizados em âmbito legal.

Sedative Hypnotics Induced Parasomnias / 수면정신생리

Parasomnias induced by hypnosedatives are rare but serious side effect. Such parasomnias have not been reported with all hypnosedatives. However, frequent use of hypnosedatives, particularly nonbenzodiazepine receptor agonists is associated with parasomnias. Associated symptoms are sleep eating, sleepwalking with object manipulation, sleep conversations, sleep driving, sleep sex and sleep shopping etc. Mechanisms include high affinity for GABAA receptor, interruption of the consolidation phase of memory formation by drug, pharmacokinetic or pharmacodynamic drug-drug interaction and concomitant administration with alcohol. Managements for parasomnias induced by hypnosedatives involve stopping medication, switch to other medications or nonpharmacological treatment, lowest effective dose of NBRAs (Non-Benzodiazepine Receptor Agonists), taking into consideration drug-drug interactions, identification and treatment of underlying disease states.

Signs, symptoms, parafunctions and associated factors of parent-reported sleep bruxism in children: a case-control study

Bruxism is the non-functional clenching or grinding of the teeth that may occur during sleep or less commonly in daytime. The aim of this study was to investigate the association between clinical signs and symptoms, parafunctions and associated factors of sleep bruxism in children. A population-based case-control study was carried out involving 120 children, 8 years of age, with sleep bruxism and 240 children without sleep bruxism. The sample was randomly selected from public and private schools in the city of Belo Horizonte, MG, Brazil. Groups were matched by gender and social class. The Social Vulnerability Index (SVI) drawn up by the city of Belo Horizonte was employed for social classification. Data collection instruments included clinical forms and pre-tested questionnaires. The diagnosis of sleep bruxism was supported by the American Association of Sleep Medicine (AASM) criteria. The McNemar test, binary and multivariate logistic regression models were used for statistical analysis. The risk factors associated with sleep bruxism included: primary canine wear (OR=2.3 IC 95% 1.2-4.3), biting of objects like pencils or pens (OR=2.0 IC 95% 1.2-3.3) and wake-time bruxism (tooth clenching) (OR=2.3 IC 95% 1.2-4.3). Children that present the parafunctions of object biting and wake-time bruxism were more susceptible to sleep bruxism.

Bruxismo é o ato não funcional de ranger os dentes enquanto se dorme ou apertar os dentes em vigília. O objetivo deste estudo foi investigar a associação entre sinais e sintomas clínicos associados ao bruxismo noturno em crianças. Foi desenvolvido um estudo de base populacional com desenho caso-controle, envolvendo 120 crianças, de 8 anos de idade, com bruxismo e 240 crianças sem bruxismo. A amostra foi selecionada de forma randomizada em escolas públicas e particulares da cidade de Belo Horizonte, Brasil. Os grupos caso e controle foram pareados por gênero e classe social. O Índice de Vulnerabilidade Social (IVS) desenvolvido pela prefeitura da cidade de Belo Horizonte foi utilizado para a classificação social. Como instrumentos de coleta foram utilizados: uma ficha clínica e um questionário pré-testados. O diagnóstico de bruxismo noturno foi baseado nos critérios da American Association of Sleep Medicine (AASM). Os testes estatísticos de McNemar, regressão logística binária e multivariada com modelo de regressão foram utilizados para análise dos dados. Foram considerados fatores de risco para o bruxismo noturno: desgaste em caninos decíduos (OR=2,3 IC 95% 1,2-4,3), morder objetos como lápis e canetas (OR=2,0 IC 95% 1,2-3,3) e apertar os dentes em vigília (OR=2,3 IC 95% 1,2-4,3). Crianças que apresentam outras parafunções tais como: morder objetos e apertar os dentes em vigília são mais susceptíveis ao bruxismo noturno.

Sleep-Related Eating Disorder / 수면정신생리

Sleep-related eating disorder (SRED) is a newly recognized parasomnia that describes a clinical condition of compulsive eating under an altered level of consciousness during sleep. Recently, it is increasingly recognized in clinical practice. The exact etiology of SRED is unclear, but it is assumed that SRED might share features of both sleepwalking and eating disorder. There have been also accumulating reports of SRED related to the administration of various psychotropic drugs, such as zolpidem, triazolam, olanzapine, and combinations of psychotropics. Especially, zolpidem in patients with underlying sleep disorders that cause frequent arousals, may cause or augment sleep related eating behavior. A thorough sleep history is essential to recognition and diagnosis of SRED. The timing, frequency, and description of food ingested during eating episodes should be elicited, and a history of concurrent psychiatric, medical, sleep disorders must also be sought and evaluated. Interestingly, dopaminergic agents as monotherapy were effective in some trials. Success with combinations of dopaminergic and opioid drugs, with the addition of sedatives, has also been reported in some case reports.

Overview of sleep & sleep disorders.

Sleep is defined on the basis of behavioural and physiological criteria dividing it into two states: non rapid eye movement (NREM) sleep which is subdivided into three stages (N1, N2, N3); and rapid eye movement (REM) sleep characterized by rapid eye movements, muscle atonia and desynchronized EEG. Circadian rhythm of sleep-wakefulness is controlled by the master clock located in the suprachiasmatic nuclei of the hypothalamus. The neuroanatomical substrates of the NREM sleep are located principally in the ventrolateral preoptic nucleus of the hypothalamus and those of REM sleep are located in pons. A variety of significant physiological changes occur in all body systems and organs during sleep as a result of functional alterations in the autonomic and somatic nervous systems. The international classification of sleep disorders (ICSD, ed 2) lists eight categories of sleep disorders along with appendix A and appendix B. The four major sleep complaints include excessive daytime sleepiness, insomnia, abnormal movements or behaviour during sleep and inability to sleep at the desired time. The most important step in assessing a patient with a sleep complaint is obtaining a detailed history including family and previous histories, medical, psychiatric, neurological, drug, alcohol and substance abuse disorders. Some important laboratory tests for investigating sleep disorders consist of an overnight polysomnography, multiple sleep latency and maintenance of wakefulness tests as well as actigraphy. General physicians should have a basic knowledge of the salient clinical features of common sleep disorders, such as insomnia, obstructive sleep apnoea syndrome, narcolepsy-cataplexy syndrome, circadian rhythm sleep disorders (e.g., jet leg, shift work disorder, etc.) and parasomnias (e.g., partial arousal disorders, REM behaviour disorder, etc.) and these are briefly described in this chapter. The principle of treatment of sleep disorders is first to find cause of the sleep disturbance and vigorously treat the co-morbid conditions causing the sleep disturbance. If a satisfactory treatment is not available for the primary condition or does not resolve the problem, the treatment should be directed at the specific sleep disturbance. Most sleep disorders, once diagnosed, can be managed with limited consultations. The treatment of primary sleep disorders, however, is best handled by a sleep specialist. An overview of sleep and sleep disorders viz., Basic science; international classification and approach; and phenomenology of common sleep disorders are presented.

Parasomnia Overlap Disorder Associated With Pontine Glioblastoma

Parasomnia overlap disorder is characterized by coexisting rapid eye movement (REM) sleep behavior disorder and non-REM parasomnia. We report herein an 8-year-old boy with REM sleep behavior disorder, sleep talking, and confusional arousal. Polysomnography revealed REM sleep without atonia, and arousal disorder. Neurological examination revealed bilateral ptosis, lateral gaze palsy, facial palsy, vertical nystagmus, and dysmetria. A pontine glioblastoma was found on brain magnetic resonance imaging, which could have been responsible for his neurologic deficit and sleep problem.

Exploding Head Syndrome

Exploding head syndrome (EHS) is characterized by a sudden loud imagined noise or sense of a violent explosion in the head occurring as the patient is falling asleep or waking during the night. EHS is classified as "other parasomnia" on the ICSD-2 (International Classification of Sleep Disorders), and the neurophysiologic mechanisms underlying this hypnagogic phenomenon are unknown. EHS is a rare type of other parasomnia that has not been reported in Korea. We report two cases of EHS that presented with typical clinical symptoms.