Depression and the relationship between sleep disturbances, nightmares, and suicidal ideation in treatment-seeking Canadian Armed Forces members and veterans.

BACKGROUND: Research on the relationship between insomnia and nightmares, and suicidal ideation (SI) has produced variable findings, especially with regard to military samples. This study investigates whether depression mediated the relationship between: 1) sleep disturbances and SI, and 2) trauma-related nightmares and SI, in a sample of treatment-seeking Canadian Armed Forces (CAF) personnel and veterans (N = 663). METHOD: Regression analyses were used to investigate associations between sleep disturbances or trauma-related nightmares and SI while controlling for depressive symptom severity, posttraumatic stress disorder (PTSD) symptom severity, anxiety symptom severity, and alcohol use severity. Bootstrapped resampling analyses were used to investigate the mediating effect of depression. RESULTS: Approximately two-thirds of the sample (68%; N = 400) endorsed sleep disturbances and 88% (N = 516) reported experiencing trauma-related nightmares. Although sleep disturbances and trauma-related nightmares were both significantly associated with SI on their own, these relationships were no longer significant when other psychiatric conditions were included in the models. Instead, depressive symptom severity emerged as the only variable significantly associated with SI in both equations. Bootstrap resampling analyses confirmed a significant mediating role of depression for sleep disturbances. CONCLUSIONS: The findings suggest that sleep disturbances and trauma-related nightmares are associated with SI as a function of depressive symptoms in treatment-seeking CAF personnel and veterans. Treating depression in patients who present with sleep difficulties may subsequently help mitigate suicide risk.

It's Not a Nightmare: Understanding Sleep Terrors.

Sleep terrors, one of the non-rapid eye movement parasomnias, are interesting nighttime phenomena that can be distressing for parents. For most children, this behavior is temporary and does not cause significant problems. However, some psychiatric conditions may have a higher prevalence of parasomnias, including sleep terrors. Although sleep terrors may be a benign and common event in children, a basic mental health examination should include a sleep-related screening to possibly identify underlying issues. Nurses must be knowledgeable about sleep terrors and able to provide education and support when parents share their concerns. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 11-14.].

Sleep problems and internet addiction among children and adolescents: a longitudinal study.

Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four-wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014. The sleep problems of the student participants were measured by parental reports on the Sleep Habit Questionnaire, which catalogues early insomnia, middle insomnia, disturbed circadian rhythm, periodic leg movements, sleep terrors, sleepwalking, sleep talking, nightmares, bruxism, snoring and sleep apnoea. The severity of internet addiction was measured by students' self-reports on the Chen Internet Addiction Scale. Based on the results of time-lag models, dyssomnias (odds ratio = 1.31), especially early and middle insomnias (odds ratio = 1.74 and 2.24), sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm (odds ratio = 2.40), regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence.

[Nightmares in the bedroom of science: mapping of a neglected sleep disorder]. / Rémálmok a tudomány hálószobájában: Egy elhanyagolt alvászavar feltérképezése.

Nightmares are intense and unpleasant dream experiences that characterize approximately 4 percent of the adult population at least on a weekly basis. Nightmare frequency is often co-morbid with other mental complaints; however, recent results indicate that nightmare disorder is independent from waking mental dysfunctions. Nightmare disorder is intimately related to poor subjective sleep quality, and according to polysomnographic studies nightmare subjects' sleep is characterized by increased sleep fragmentation and hyper-arousal. These findings suggest that instead of the psychopathological perspective nightmare disorder should be viewed as a specific sleep disorder that requires targeted treatment. Nevertheless, in order to choose the adequate treatment procedure clinicians should examine the co-morbid mental disorders as well taking into consideration the severity of nightmare distress, the latter supposed to be the mediator between nightmare frequency and waking mental dysfunctions.

Self-reported developmental changes in the frequency and characteristics of somnambulistic and sleep terror episodes in chronic sleepwalkers.

BACKGROUND: Far from being benign, somnambulistic episodes can be frequent and/or severe and potentially injurious. Episodes may also be accompanied by sleep mentation with variable degrees of retrograde amnesia. The present study investigated how somnambulistic episodes unfold from childhood through adulthood, a topic that remains understudied. METHODS: Adult sleepwalkers with a diagnosis of primary somnambulism and a childhood onset of the disorder (n = 113) were assessed for changes in frequency of their episodes, recall of episode-related sleep mentation and aggressive episodes during childhood, adolescence and adulthood. In addition, sleepwalkers (n = 52) with childhood-onset of sleep terrors were assessed for developmental changes in sleep terror frequency. RESULTS: Results indicate that the frequency of somnambulistic episodes remains unchanged during childhood and adolescence before increasing during adulthood. An opposite trend was observed for sleep terrors. The frequency of aggressive somnambulistic episodes and of sleep mentation associated with somnambulism increased from childhood to adolescence and into adulthood. By contrast, the recall of sleep mentation associated with sleep terrors did not change over time. Additionally, a higher frequency of aggressive somnambulistic episodes predicted a higher frequency of sleep mentation associated with somnambulism. These patterns were similar across men and women. CONCLUSION: Our study demonstrates that in chronic sleepwalkers, sleep mentation associated with somnambulistic episodes increases with age while episodes worsen in frequency and severity from childhood to adulthood. These findings add to the limited literature in the field and provide valuable insights into how key clinical characteristics of somnambulism evolve across the lifespan.

Sleep terrors-A parental nightmare.

Sleep terrors (STs) are sleep disorders characterized by abrupt arousal from sleep with autonomic hyperactivity and inappropriate behavior. Though a common condition in childhood that usually affects children between 4 and 12 years of age, STs, however, may be present even in adulthood. The exact etiology of STs is not known yet, however, several hypotheses have been proposed over the years, identifying some potential genetic, neurodevelopmental, or other causes. Nevertheless, a useful pathophysiological model identified a common cascade of predisposing, priming, and precipitating factors, which could help to explain and sometimes prevent STs. Establishing a correct diagnosis is mandatory for appropriate management, as several conditions (such as other parasomnias or nocturnal seizures) may mimic STs. Furthermore, we also described some conditions which can be comorbid to STs, like some medical or psychological disorders. A number of treatment options have been proposed, ranging from only sleep hygiene practices to pharmacological therapies; we reviewed some of the most prominent ones. In spite of the fact that STs have long been considered benign disorders, which tend to reduce spontaneously over the years, they may have unexpected consequences on the child but also on the caregivers.

Early maternal separation, nightmares, and bad dreams: results from the Hungarostudy Epidemiological Panel.

Early maternal separation is a particularly stressful experience. Current models of nightmare production emphasize negative emotionality as having a central role in determining dream affect. Our aim is to test the hypothesis that persons who experienced early maternal separation (before one year of age and lasting at least one month) report more frequent nightmare experiences and bad dreams as adults. In the frame of the Hungarostudy Epidemiological Panel, 5020 subjects were interviewed. Significant associations were found between early maternal separation and both frequent nightmare experience in adulthood and increased frequency of oppressive and bad dreams. Current depression scores fully mediated the association between early separation and nightmares, but not the association between early separation and negative dream affect. We interpret these findings as a trait-like enhancement of negative emotionality in adults who experienced early maternal separation. This enhancement influences the content of dreams and, when it takes the form of depression, also influences the frequency of nightmares.

Sleep Terrors: An Updated Review.

BACKGROUND: Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE: To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. METHODS: A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS: It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. CONCLUSION: Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.

Nightmare disorder and REM sleep behavior disorder in inflammatory arthritis: Possibility beyond neurodegeneration.

OBJECTIVES: To investigate the prevalence of REM sleep behavior disorder (RBD) in patients with inflammatory arthritis (IA) to ascertain if RBD could be an internal red flag signaling a fluctuating state of inflammation based on the theory of "protoconsciousness". MATERIALS & METHODS: One hundred and three patients with a confirmed diagnosis of IA were consecutively recruited. The patients underwent general (IA activity, functional status, laboratory tests) and neurological evaluations. A neurologist investigated RBD and REM sleep parasomnias in a semi-structured interview. Sleep quality was assessed with the Pittsburgh Sleep Quality Index, while the risk of obstructive sleep apnea syndrome (OSAS) was evaluated with the Berlin questionnaire. Beck Depression Inventory II and State-Trait Anxiety Inventory investigated depression and anxiety. RESULTS: Patients had a mean age of 53.7 ± 14.6 years, 65% were women; 57.3% were in a clinically active phase of IA. Two women fulfilled ICSD-3 criteria for RBD appearing 11 years after and 20 years before IA onset respectively. 31 patients scored positive for nightmare disorder (ND), 8 for recurrent isolated sleep paralysis. 65 (63.1%) patients reported poor sleep quality and 25 (24.3%) resulted at high risk for OSAS. 32 (31.0%) patients scored positively for depression or anxiety. CONCLUSIONS: The prevalence of RBD in patients with IA did not differ from that in the general population, whereas ND presented a 2-fold increased prevalence. Whether RBD can be considered a red flag signaling an internal danger remains an open question, while ND may be a new player in this intriguing relation.

Longitudinal study of bad dreams in preschool-aged children: prevalence, demographic correlates, risk and protective factors.

STUDY OBJECTIVES: To (1) clarify the epidemiology of bad dreams in children and investigate risk and protective factors related to (2) the child's sleep, (3) parental sleep-enabling practices, and (4) the child's temperament. DESIGN: Longitudinal with 6 time points from 5 months to 6 years. SETTING: Subjects' homes. PARTICIPANTS: Representative sample of 987 children in the Province of Quebec. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Longitudinal logistic regression analysis models with primary endpoints of presence or absence of parent-rated bad dreams at 29 months, 41 months, 50 months, 5 years, and 6 years and predictor variables of demographic characteristics, parent ratings of child's sleep characteristics, parental sleep-enabling practices (e.g., cosleeping), and child's psychological characteristics at 5 and 17 months (anxiousness, temperament). Mothers' ratings indicated lower than expected prevalence of frequent bad dreams (1.3% to 3.9%). Demographic correlates of bad dreams were high family income, absence of siblings at 29 months, and a non-immigrant mother. The best predictor at 41 and 50 months was the presence of bad dreams the preceding year, whereas at 5 and 6 years, it was their earlier presence at 29 months. Early protective factors were parental practices favoring emotional nurturance after night awakenings (29 and 41 months); early risk factors were sleep-onset emotional nurturance (29 months), difficult temperament (5 months), and anxiousness (17 months). CONCLUSIONS: Bad dreams in preschoolers are less prevalent than thought but, when present, are trait-like in nature and associated with personality characteristics measured as early as 5 months. A stress-diathesis model may best account for the observed pattern of predictive factors.

Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation.

IMPORTANCE: Childhood sleepwalking and sleep terrors are 2 parasomnias with a risk of serious injury for which familial aggregation has been shown. OBJECTIVES: To assess the prevalence of sleepwalking and sleep terrors during childhood; to investigate the link between early sleep terrors and sleepwalking later in childhood; and to evaluate the degree of association between parental history of sleepwalking and presence of somnambulism and sleep terrors in children. DESIGN, SETTING, AND PARTICIPANTS: Sleep data from a large prospective longitudinal cohort (the Quebec Longitudinal Study of Child Development) of 1940 children born in 1997 and 1998 in the province were studied from March 1999 to March 2011. MAIN OUTCOMES AND MEASURES: Prevalence of sleep terrors and sleepwalking was assessed yearly from ages 1 1/2 and 2 1/2 years, respectively, to age 13 years through a questionnaire completed by the mother. Parental history of sleepwalking was also queried. RESULTS: The peak of prevalence was observed at 1 1/2 years for sleep terrors (34.4% of children; 95% CI, 32.3%-36.5%) and at age 10 years for sleepwalking (13.4%; 95% CI, 11.3%-15.5%). As many as one-third of the children who had early childhood sleep terrors developed sleepwalking later in childhood. The prevalence of childhood sleepwalking increases with the degree of parental history of sleepwalking: 22.5% (95% CI, 19.2%-25.8%) for children without a parental history of sleepwalking, 47.4% (95% CI, 38.9%-55.9%) for children who had 1 parent with a history of sleepwalking, and 61.5% (95% CI, 42.8%-80.2%) for children whose mother and father had a history of sleepwalking. Moreover, parental history of sleepwalking predicted the incidence of sleep terrors in children as well as the persistent nature of sleep terrors. CONCLUSIONS AND RELEVANCE: These findings substantiate the strong familial aggregation for the 2 parasomnias and lend support to the notion that sleepwalking and sleep terrors represent 2 manifestations of the same underlying pathophysiological entity.

Arousal reactions in sleepwalking and night terrors in adults: the role of respiratory events.

STUDY OBJECTIVES: The aim of the study was to determine the role of respiratory events, assessed by means of esophageal pressure monitoring, during arousals from slow wave sleep in adult patients with parasomnias. DESIGN: N/A. SETTING: N/A. PATIENTS: Ten patients with parasomnias (sleepwalking, night terrors, or both) and 10 control subjects matched for gender and age underwent 3 consecutive nights of polysomnography. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: By increasing sleep fragmentation, esophageal pressure monitoring has a deleterious effect on sleep architecture in patients with parasomnias and in control subjects. Respiratory events occur more frequently in parasomniacs than in controls. Respiratory effort seems to be responsible for the occurrence of a great number of arousal reactions in parasomniacs and is involved in triggering the parasomnia episodes. CONCLUSION: Sleep-disordered breathing seems to be frequently associated with parasomnias during slow wave sleep, emphasizing the utility of performing esophageal pressure monitoring in cases of sleep walking or night terrors.

Childhood parasomnias and psychotic experiences at age 12 years in a United Kingdom birth cohort.

STUDY OBJECTIVES: To examine associations between specific parasomnias and psychotic experiences in childhood. DESIGN: Birth cohort study. Information on the presence of frequent nightmares in children was obtained prospectively from mothers during multiple assessments conducted when children were aged between 2.5 and 9 y. Children were interviewed at age 12 y about nightmares, night terrors, sleepwalking, and psychotic experiences (delusions, hallucinations, and thought interference) occurring in the previous 6 mo. SETTING: Assessments were completed in participants' homes or a University clinic within the UK. PATIENTS OR PARTICIPANTS: There were 6,796 children (3,462 girls, 50.9%) who completed the psychotic experiences interview. MEASUREMENTS AND RESULTS: Children who were reported by their mothers as experiencing frequent nightmares between 2.5 and 9 y of age were more likely to report psychotic experiences at age 12 y, regardless of sex, family adversity, emotional or behavioral problems, IQ and potential neurological problems (odds ratio (OR) = 1.16, [95% confidence intervals (CI) = 1.00, 1.35], P = 0.049). Children reporting any of the parasomnias at age 12 y also had higher rates of concurrent psychotic experiences than those without such sleeping problems, when adjusting for all confounders (OR = 3.62 [95% CI = 2.57, 5.11], P < 0.001). Difficulty getting to sleep and night waking were not found to be associated with psychotic experiences at age 12 y when controlling for confounders. CONCLUSION: Nightmares and night terrors, but not other sleeping problems, in childhood were associated with psychotic experiences at age 12 years. These findings tentatively suggest that arousal and rapid eye movement forms of sleep disorder might be early indicators of susceptibility to psychotic experiences.

Impact of frequency of nightmares comorbid with insomnia on depression in Japanese rural community residents: a cross-sectional study.

OBJECTIVE: Nightmares and insomnia are known to be associated with the development and aggravation of depression. Our community-based study was conducted to clarify the relation between the impacts of nightmares and insomnia on depression. METHODS: A cross-sectional questionnaire-based survey was administered to residents of a rural community in Japan. In all, 2822 participants responded to questions assessing personal characteristics, the Pittsburgh Sleep Quality Index (PSQI) for assessing insomnia, and a 12-item version of the Center for Epidemiological Studies Depression scale (CES-D) for evaluating depression. Nightmare frequency was assessed using an item for nightmares on the PSQI. RESULTS: Nightmares more frequently occurred in participants with insomnia than those without (P < .01). Multiple regression analysis revealed that the scores of both nightmares and insomnia were significantly associated with the increase in depression score (nightmares (ß = 0.09, P < .01); insomnia (ß = 0.39, P < .01)). Participants with coexisting nightmares and insomnia showed higher depression scores than participants with insomnia alone or those with nightmares who did not have insomnia (P < .01). CONCLUSIONS: Insomnia and nightmares independently and additively impact the aggravation of depression.

Correspondence between reported and actigraphic sleep measures in preschool children: the role of a clinical context.

STUDY OBJECTIVES: The aim of this study was to assess the role of clinical context in determining the correspondence between actigraphic and reported sleep measures in preschool children. METHODS: Sleep was assessed using actigraphy and parental reports in a clinical sample of 109 preschool children between the ages 4 and 6 years suffering from significant nighttime fears and in a sample of 30 healthy controls. RESULTS: In comparison to actigraphy, parents in both groups indicated that their children fell asleep earlier and overestimated their sleep period. These gaps were significantly larger in the control group than the clinical group. Parents from both groups similarly underestimated the time their child was awake during the night in comparison to actigraphy. Significant correlations were found in both groups between parental reports and actigraphy sleep schedule measures. Low correlations were found for wake after sleep onset in both groups and for the number of night wakings. CONCLUSIONS: Clinicians and researchers should be highly aware that parental reports on their children's sleep may not be accurate, and that accuracy may be affected by the context of the study. The use of complimentary sleep assessment tools in clinical and research settings should be encouraged.

Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic.

OBJECTIVE: Many patients with panic disorder (PD) experience nocturnal panic attacks. We investigated the differences in demographic variables and symptom characteristics as well as response to treatment among patients with primary day panic (DP), primary nocturnal panic (NP), and the coexistence of DP and NP (DP/NP), and discuss whether NP is a distinct disease category. METHOD: One hundred one consecutive untreated patients with PD were enrolled and subsequently divided into the NP, DP, and DP/NP groups. The presence of 13 panic attack symptom items as well as scores on the Panic Disorder Severity Scale (PDSS) and the Pittsburgh Sleep Quality Index (PSQI) were compared among the groups. After 3 months of regular treatment, PDSS scores were assessed again to evaluate treatment response. RESULTS: Nocturnal panic attacks of the participants were mostly reported to occur in the first tertile of nocturnal sleep. The number of males, onset age, and presence of choking sensation were significantly higher, and the PDSS score was significantly lower in the NP group compared with the other groups. The DP/NP group showed the highest PDSS score, and participants in this group were prescribed the highest doses of medication among all groups. Only diagnostic sub-category was significantly associated with treatment response. The total score for PDSS and PSQI correlated significantly only in the NP group. CONCLUSIONS: DP/NP could be a severe form of PD, while primary NP could be a relatively mild subcategory that may partially share common pathophysiology with adult type night terror.

Functional impairment in adult sleepwalkers: a case-control study.

STUDY OBJECTIVES: To investigate the restorative quality of sleep and daytime functioning in sleepwalking adult patients in comparison with controls. DESIGN: Prospective case-control study. SETTING: Data were collected at the Sleep Disorders Center, Hôpital-Gui-de Chauliac, Montpellier, France between June 2007 and January 2011. PARTICIPANTS: There were 140 adult sleepwalkers (100 (median age 30 y, 55% male) in whom primary SW was diagnosed) who underwent 1 night of video polysomnography. All patients participated in a standardized clinical interview and completed a battery of questionnaires to assess clinical characteristics of parasomnia, daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and health-related quality of life. Results were compared with those of 100 sex- and age-matched normal controls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Of the sleepwalkers, 22.3% presented with daily episodes and 43.5% presented with weekly episodes. Median age at sleepwalking onset was 9 y. Familial history of sleepwalking was reported in 56.6% of sleepwalkers and violent sleep related behaviors in 57.9%, including injuries requiring medical care for at least one episode in 17%. Significant associations were found between sleepwalking and daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms, and altered quality of life. Early-onset sleepwalkers had higher frequency of violent behaviors and injuries. Sleepwalkers with violent behaviors had higher frequency of sleep terrors and triggering factors, with greater alteration in health-related quality of life. CONCLUSION: Adult sleepwalking is a potentially serious condition that may induce violent behaviors, self-injury or injury to bed partners, sleep disruption, excessive daytime sleepiness, fatigue, and psychological distress, all of which affect health-related quality of life. CITATION: Lopez R; Jaussent I; Scholz S; Bayard S; Montplaisir J; Dauvilliers Y. Functional impairment in adult sleepwalkers: a case-control study. SLEEP 2013;36(3):345-351.

Families with sleepwalking.

BACKGROUND: Studies on families with sleepwalking are uncommonly published but can give further information on the phenotype of patients with chronic sleepwalking. SUBJECTS AND METHODS: Out of 51 individuals referred for chronic sleepwalking during a 5-year period, we obtained sufficient information on 7 families with direct relatives who reported sleepwalking with or without sleep terrors. Among 70 living direct family members, we obtained questionnaire responses from 50 subjects and identified 34 cases with a history of sleepwalking. Of the 50 subjects, 16 completed only questionnaires, while all the others also completed a clinical evaluation and nocturnal sleep recordings. RESULTS: There was a positive history of sleepwalking on either the paternal or maternal side of the family over several generations in our 7 families. Thirty-three clinically evaluated subjects had evidence of sleep-disordered breathing (SDB), with associated craniofacial risk factors for SDB (particularly maxillary and/or mandibular deficiencies). There was a complete overlap with the report of parasomnias and the presence of SDB. In cases with current sleepwalking, treatment of SDB coincided with clear improvement of the parasomnia. CONCLUSION: All of our subjects with parasomnias presented with familial traits considered as risk factors for SDB. These anatomical risk factors are present at birth and even subtle SDB can lead to sleep disruption and instability of NREM sleep. The question raised is: are factors leading to chronic sleep disruption the familial traits responsible for familial sleepwalking?