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1.
Fertil Steril ; 113(1): 4-5, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32033721

RESUMO

There are conditions that are rare and that most providers are unaware of or conditions that consist of a series of symptoms for which there is no agreement that they are even a medical condition. These include painful nocturnal erections, post-orgasmic illness syndrome, body dysmorphic disorder, and post-finasteride syndrome. While some have a psychiatric basis, others clearly have an organic pathophysiology, while for others, there remains much controversy. This month's Views and Reviews will inform the reader of these conditions so they may recognize affected patients and direct them towards appropriate resources for their care.


Assuntos
Andrologia/métodos , Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Doenças Raras/diagnóstico , Andrologia/normas , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/psicologia , Humanos , Masculino , Parassonias do Sono REM/diagnóstico , Parassonias do Sono REM/psicologia , Doenças Raras/psicologia , Síndrome
2.
Fertil Steril ; 113(1): 6-12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32033724

RESUMO

This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful erections, and idiopathic stuttering priapism, a variant of recurrent ischemic priapism in which no cause is discernible. The disorders are closely related although they are distinct clinically and pathologically. The main subject areas of discussion are recognition, clinical evaluation and management although current concepts surrounding their causes and mechanisms are also addressed. It is acknowledged that despite the perceived rarities of these disorders they are impactful in terms of their disease profiles and consequences. Future advances in their management will require continued development of evidence-based treatments.


Assuntos
Ereção Peniana/fisiologia , Priapismo/diagnóstico , Priapismo/fisiopatologia , Parassonias do Sono REM/diagnóstico , Parassonias do Sono REM/fisiopatologia , Humanos , Masculino , Ereção Peniana/psicologia , Priapismo/psicologia , Parassonias do Sono REM/psicologia , Doenças Raras/diagnóstico , Doenças Raras/fisiopatologia , Doenças Raras/psicologia
3.
Handb Clin Neurol ; 161: 381-396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307615

RESUMO

Rapid eye movement (REM) sleep behavior disorder (RBD), sleep paralysis, and nightmare disorder are the three REM sleep parasomnias outlined by the International Classification of Sleep Disorders. In this review we address the clinical neurophysiology of these disorders. The majority of neurophysiologic studies have been conducted in RBD, and fewer studies have evaluated patients with nightmare disorder or isolated sleep paralysis. Neurophysiologic studies of REM sleep parasomnias mostly used polysomnography (PSG), or were performed on animals to shed light on the pathophysiology of these disorders. Fewer studies used electoencephalography or electromyography outside the context of PSG, evoked potentials, or autonomic neurophysiologic studies. In this chapter, the main neurophysiologic findings in REM sleep parasomnias are described and their implications and relevance are discussed.


Assuntos
Parassonias do Sono REM/fisiopatologia , Animais , Humanos
5.
Sleep Med Clin ; 13(2): 191-202, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29759270

RESUMO

Patient education and behavioral management represent the first treatment approaches to the patient with parasomnia, especially in case of disorders of arousal (DOA). A pharmacologic treatment of DOA may be useful when episodes are frequent and persist despite resolution of predisposing factors, are associated with a high risk of injury, or cause significant impairment, such as excessive sleepiness. Approved drugs for DOA are still lacking. The most commonly used medications are benzodiazepines and antidepressants. The pharmacologic treatment of rapid eye movement sleep behavior disorder is symptomatic, and the most commonly used drugs are clonazepam and melatonin.


Assuntos
Parassonias/tratamento farmacológico , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Humanos , Parassonias do Sono REM/tratamento farmacológico , Paralisia do Sono/tratamento farmacológico
6.
Sleep Med ; 43: 34-39, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29482809

RESUMO

OBJECTIVE: The presence of repeated nightmares in posttraumatic stress disorder (PTSD) has been hypothesized as a dysfunction of rapid eye movement (REM) sleep, but there has been remarkably little agreement about the pathophysiology. This presents a deterrent to more effective treatments. REM sleep abnormalities including elevated REM density also have been replicated in major depressive disorder (MDD). The purpose of this study was to clarify the difference of REM sleep abnormalities between the two disorders for understanding the pathophysiology of sleep disturbances in PTSD. METHODS: Polysomnographic measures were compared among 14 PTSD patients (aged 23.7 ± 5.5 years) and 14 MDD patients (aged 27.9 ± 10.1 years) under drug-naive or drug-free conditions. We defined REM interruption by summing the intrusive wake times during the REM period and adding the subsequent wake times to the last epoch of REM period. The significant polysomnographic measures were correlated with PTSD symptoms within the PTSD group. RESULTS: REM interruption was significantly increased in the PTSD group compared with the MDD group (12.2 vs 2.1 min, p = 0.001). REM density was also significantly increased in the PTSD group compared with the MDD group (30.5 vs 23.1%, p = 0.019). Within the PTSD group, we found significant correlations between the severity of trauma-related nightmare complaints and the percentage of REM interruption (R = 0.62, p = 0.017), but not REM density. CONCLUSIONS: REM sleep abnormalities are different between PTSD and MDD. Increased REM interruption may be a biological marker correlated with nightmare complaints in PTSD patients. Treatments including pharmacotherapy that reduces REM interruption might ameliorate nightmares in PTSD.


Assuntos
Transtorno Depressivo Maior/fisiopatologia , Sonhos/fisiologia , Parassonias do Sono REM/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Polissonografia/métodos , Escalas de Graduação Psiquiátrica , Adulto Jovem
7.
Arch Sex Behav ; 47(3): 815-817, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29222639

RESUMO

Sleep-related painful erections (SRPE) is a rare disorder characterized by recurrent painful nocturnal erections during REM sleep in the absence of pain during daytime erections. Approximately 35 cases of SRPE have been reported in the literature, none of them associated with preceding sexual intercourse. We add the report of a 40-year-old patient with a 6-year history of SRPE which only, but always, occurred after sexual intercourse with ejaculation in the evening before. As a result, the frequency of intercourse diminished, causing relationship problems. A non-pharmacological solution was found in shifting the time of sexual intercourse. The patient refused any proposed pharmacological treatment, because of "not wanting to be a patient at his age."


Assuntos
Coito/fisiologia , Parassonias do Sono REM , Adulto , Humanos , Masculino
8.
J Sex Med ; 15(1): 5-19, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29208538

RESUMO

BACKGROUND: Patients with sleep-related painful erections (SRPEs) have frequent awakenings from deep penile pain during nocturnal erections. This results in severe sleep deprivation. AIM: To review the current literature on SRPEs and discuss the pathophysiologic theories and risks and benefits of medical treatments. METHODS: PubMed was searched using the terms sleep-related painful erections, nocturnal priapism, treatment, and sleep-related erections. OUTCOME: Variables included patient demographics, medical history, diagnostics, hypotheses on pathophysiology, and treatment modalities and their effect on SRPE in the short and long term. RESULTS: The search yielded in 66 SRPE cases that were analyzed, including our mono-institutional series of 24 patients. The phenomenon of SRPEs is not well understood. Theories about pathophysiology concerned increased serum testosterone levels, altered autonomic function, compression of the lateral preoptic area, coexistent obstructive sleep apnea syndrome, the existence of a "compartment syndrome," and psychosomatic factors. Except for polysomnographic findings that showed sleep fragmentation and decreased sleep efficiency in all patients, other diagnostic results varied widely. Multiple agents were tried. Baclofen and, to lesser degree, clonazepam showed noticeable results, most likely due to their influence on the γ-aminobutyric acid system and, hence, suppression of glutamate release. In addition, baclofen relaxes the ischiocavernosus and bulbospongiosus muscles, which are involved in penile erection. CLINICAL IMPLICATIONS: By providing a critical analysis and complete overview on the limited literature about this overlooked and undermanaged condition, this review contributes to a better understanding of the pathophysiology and provides directions for future research on the treatment of SRPE. STRENGTHS AND LIMITATIONS: Because the literature on SRPEs includes only case reports and small case series, the level of evidence of treatment advice is limited. CONCLUSION: The pathophysiology of SRPEs is not yet clarified. Further diagnostic evaluation, including electromyography of the ischiocavernosus and bulbospongiosus muscles to elucidate the pathophysiology, is recommended. Prospective controlled investigations are warranted to assess the efficacy and safety of long-term use of baclofen and develop evidence-based treatment advice. Vreungdenhil S, Weidenaar AC, de Jong IJ, van Driel MF. Sleep-Related Painful Erections: A Meta-Analysis on the Pathophysiology and Risks and Benefits of Medical Treatments. J Sex Med 2018;15:5-19.


Assuntos
Pênis/fisiopatologia , Priapismo/fisiopatologia , Parassonias do Sono REM/fisiopatologia , Humanos , Masculino , Ereção Peniana/fisiologia , Medição de Risco , Sono/fisiologia , Apneia Obstrutiva do Sono/complicações , Privação do Sono/complicações
9.
Continuum (Minneap Minn) ; 23(4, Sleep Neurology): 1017-1034, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28777174

RESUMO

PURPOSE OF REVIEW: The most common rapid eye movement (REM) parasomnia encountered by neurologists is REM sleep behavior disorder (RBD), and nightmares are so frequent that every neurologist should be able to differentiate them from the dream enactment of RBD. Isolated sleep paralysis is relatively common and is often mistaken for other neurologic disorders. This article summarizes the current state of the art in the diagnosis of RBD, discusses the role of specific questionnaires and polysomnography in the diagnosis of RBD, and reviews recent studies on idiopathic RBD as an early feature of a synucleinopathy, secondary RBD, and its management. Recent diagnostic criteria and implications of nightmares and isolated sleep paralysis are also reviewed. RECENT FINDINGS: Idiopathic RBD can now be considered as part of the prodromal stage of a synucleinopathy. Therefore, an accurate diagnosis is mandatory, and this implies detection of REM sleep without atonia. The polysomnography montage, including EMG of the submentalis and flexor digitorum superficialis muscles, provides a high sensitivity and specificity for the diagnosis. The exact diagnosis is important for patient counseling and for future neuroprotective trials. SUMMARY: REM parasomnias include RBD, sleep paralysis, and nightmares, which have distinct clinical characteristics and different implications regarding diagnostic procedures, management, and prognosis.


Assuntos
Transtorno do Comportamento do Sono REM/fisiopatologia , Parassonias do Sono REM/fisiopatologia , Sono REM/fisiologia , Sono/fisiologia , Humanos , Parassonias/fisiopatologia , Polissonografia/métodos , Transtorno do Comportamento do Sono REM/diagnóstico
12.
J Sleep Res ; 26(1): 38-47, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27460633

RESUMO

Sleep paralysis and lucid dreaming are both dissociated experiences related to rapid eye movement (REM) sleep. Anecdotal evidence suggests that episodes of sleep paralysis and lucid dreaming are related but different experiences. In this study we test this claim systematically for the first time in an online survey with 1928 participants (age range: 18-82 years; 53% female). Confirming anecdotal evidence, sleep paralysis and lucid dreaming frequency were related positively and this association was most apparent between lucid dreaming and sleep paralysis episodes featuring vestibular-motor hallucinations. Dissociative experiences were the only common (positive) predictor of both sleep paralysis and lucid dreaming. Both experiences showed different associations with other key variables of interest: sleep paralysis was predicted by sleep quality, anxiety and life stress, whereas lucid dreaming was predicted by a positive constructive daydreaming style and vividness of sensory imagery. Overall, results suggest that dissociative experiences during wakefulness are reflected in dissociative experiences during REM sleep; while sleep paralysis is related primarily to issues of sleep quality and wellbeing, lucid dreaming may reflect a continuation of greater imaginative capacity and positive imagery in waking states.


Assuntos
Sonhos/fisiologia , Paralisia do Sono/fisiopatologia , Sono REM/fisiologia , Vigília/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parassonias do Sono REM/fisiopatologia , Adulto Jovem
13.
Zhonghua Nan Ke Xue ; 22(4): 330-4, 2016 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-30088410

RESUMO

Objective: To investigate the pathogenesis and management of sleep-related painful erections(SRPE). Methods: This study included 9 SRPE patients aged 39- 59( mean 47. 8) years and with a mean disease course of 13. 5 ± 1. 2 months. We conducted blood urine routine examinations, collected four blood coagulation indexes, obtained IIEF-5 scores and sexual hormone levels, and recorded the nocturnal penile tumescence( NPT) and results of polysomnographic sleep monitoring of the patients. After 1,4,8,12,and 24 weeks of individualized treatment for each patient, we performed telephone follow-up for therapeutic effects and adverse drug reactions. Results: All the 9 patients were diagnosed with primary SRPE after excluding other diseases,6 of them treated with chlorimipramine or chlorimipramine combined with other medicine and the other 3 by antiandrogen therapy. Complete pain remission was achieved by 77. 78% at 4 weeks and 66. 67% at 24 weeks. The 3 patients treated by antiandrogen therapy experienced recurrence at 24 weeks but relieved after 1 week of adjusted treatment. Conclusion: Chlorimipramine, combination of chlorimipramine with medicine, and antiandrogen therapy are all evidently effective for the treatment of primary SRPE.


Assuntos
Dor , Ereção Peniana , Parassonias do Sono REM/diagnóstico , Parassonias do Sono REM/tratamento farmacológico , Adulto , Humanos , Masculino , Pessoa de Meia-Idade
14.
Arch Sex Behav ; 45(1): 241-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26392186

RESUMO

Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2-4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient.


Assuntos
Ereção Peniana/efeitos dos fármacos , Priapismo/complicações , Parassonias do Sono REM/tratamento farmacológico , Apneia Obstrutiva do Sono/complicações , Sono/fisiologia , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Masculino , Pessoa de Meia-Idade , Paroxetina/uso terapêutico , Ereção Peniana/fisiologia , Polissonografia , Priapismo/fisiopatologia , Parassonias do Sono REM/complicações , Parassonias do Sono REM/fisiopatologia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/terapia
15.
Sleep Med ; 16(7): 827-30, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26004681

RESUMO

BACKGROUND: The International Classification of Sleep Disorders-Third Edition (ICSD-3) classifies catathrenia among the respiratory disorders and not as a parasomnia as in ICSD-2. Few patients have been reported during these years, and the clinical description of the sound is different from group to group. In fact, there is no full agreement about its nature, origin, meaning, and treatment. METHODS AND RESULTS: In this paper we review the literature on catathrenia focusing on the characteristics of the sound, demographics of the patients, aetiology, response to treatment, etc., in order to support its classification as a respiratory disorder or a parasomnia. We also discuss the possibility of Catathrenia being not one disorder but two variants or two different disorders.


Assuntos
Parassonias/diagnóstico , Parassonias do Sono REM/diagnóstico , Transtornos Respiratórios/diagnóstico , Sons Respiratórios , Diagnóstico Diferencial , Humanos
16.
PLoS One ; 10(3): e0120973, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25756280

RESUMO

OBJECTIVE: To characterize parasomnia behaviors on arousal from NREM sleep in Parkinson's Disease (PD) and Multiple System Atrophy (MSA). METHODS: From 30 patients with PD, Dementia with Lewy Bodies/Dementia associated with PD, or MSA undergoing nocturnal video-polysomnography for presumed dream enactment behavior, we were able to select 2 PD and 2 MSA patients featuring NREM Parasomnia Behviors (NPBs). We identified episodes during which the subjects seemed to enact dreams or presumed dream-like mentation (NPB arousals) versus episodes with physiological movements (no-NPB arousals). A time-frequency analysis (Morlet Wavelet Transform) of the scalp EEG signals around each NPB and no- NPB arousal onset was performed, and the amplitudes of the spectral frequencies were compared between NPB and no-NPB arousals. RESULTS: 19 NPBs were identified, 12 of which consisting of 'elementary' NPBs while 7 resembling confusional arousals. With quantitative EEG analysis, we found an amplitude reduction in the 5-6 Hz band 40 seconds before NPBs arousal as compared to no-NPB arousals at F4 and C4 derivations (p<0.01). CONCLUSIONS: Many PD and MSA patients feature various NREM sleep-related behaviors, with clinical and electrophysiological differences and similarities with arousal parasomnias in the general population. SIGNIFICANCE: This study help bring to attention an overlooked phenomenon in neurodegenerative diseases.


Assuntos
Atrofia de Múltiplos Sistemas/fisiopatologia , Doença de Parkinson/fisiopatologia , Parassonias do Sono REM/fisiopatologia , Idoso , Eletroencefalografia , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia
17.
Curr Psychiatry Rep ; 17(5): 34, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25795266

RESUMO

"Sleep sex," also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of "sane" or "insane" automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.


Assuntos
Intoxicação Alcoólica , Automatismo , Psiquiatria Legal , Legislação Médica , Simulação de Doença , Parassonias do Sono REM , Delitos Sexuais/legislação & jurisprudência , Transtornos do Despertar do Sono , Transtornos da Transição Sono-Vigília , Consumo de Bebidas Alcoólicas , Automatismo/diagnóstico , Automatismo/terapia , Canadá , Diagnóstico Diferencial , Feminino , Psiquiatria Legal/métodos , Psiquiatria Legal/tendências , Humanos , Jurisprudência , Masculino , Simulação de Doença/diagnóstico , Simulação de Doença/terapia , Ontário , Ereção Peniana , Fatores Desencadeantes , Prevalência , Parassonias do Sono REM/diagnóstico , Parassonias do Sono REM/epidemiologia , Parassonias do Sono REM/etiologia , Autorrelato , Delitos Sexuais/psicologia , Comportamento Sexual , Transtornos do Despertar do Sono/diagnóstico , Transtornos do Despertar do Sono/epidemiologia , Transtornos do Despertar do Sono/etiologia , Transtornos da Transição Sono-Vigília/diagnóstico , Transtornos da Transição Sono-Vigília/epidemiologia , Transtornos da Transição Sono-Vigília/etiologia
18.
Urologia ; 82(3): 184-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-24803352

RESUMO

Sleep-related painful erections (SRPE) are an uncommon condition characterized by recurrent nocturnal penile tumescence accompanied by penile pain without penile pathology, which occurs during the rapid eye movement (REM) sleep stage. A report of a 59-year-old patient with SRPE is described. Turgid painful erections (five to seven episodes of tumescence) during the sleep hours caused pain together with burning and tingling sensations in the penis and perineal zone during the daytime hours. Swelling of the pubic and perineal area was recurrent. Sleep loss, chronic fatigue, mild anxiety, lack of concentration and decreased work occurred along with this condition. Polysomnographic findings indicated REM sleep fragmentation. Attempts to treat this condition with muscle relaxants or anxiolytics did not prompt an improvement of this disorder, but a single daily dose of gabapentin 300 mg in combination with 1 mg clonazepam at bedtime improved total sleep time and reduced full sleep erections.


Assuntos
Doenças dos Genitais Masculinos/complicações , Parassonias do Sono REM/complicações , Doença Crônica , Ritmo Circadiano , Humanos , Masculino , Pessoa de Meia-Idade
19.
Artigo em Inglês | MEDLINE | ID: mdl-25109404

RESUMO

Split-night polysomnography is performed at our centre in all patients with ALS who require assessment for nocturnal hypoventilation and their response to non-invasive ventilation. The purpose of this study was to determine how successful this practice has been, reflected by whether a complete assessment was achieved by a single split-night polysomnogram. We undertook a systematic, retrospective review of all consecutive split-night polysomnograms in ALS patients between 2005 and 2012. A total of 47 cases were reviewed. Forty-three percent of patients had an incomplete test, resulting in a recommendation to repeat the polysomnogram. Poor sleep efficiency and absence of REM sleep in the diagnostic portion of the study were strongly associated with incomplete studies. Clinical variables that reflect severity of ALS (FVC, PaCO2, ALSFRS-R) and use of REM-suppressing antidepressants or sedative-hypnotics were not associated with incomplete split-night polysomnogram. In conclusion, a single, split-night polysomnogram is frequently inconclusive for the assessment of nocturnal hypoventilation and complete titration of non-invasive positive pressure ventilation in patients with ALS. Poor sleep efficiency and absence of REM sleep are the main limitations of split-night polysomnography in this patient population.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Polissonografia/métodos , Respiração com Pressão Positiva , Parassonias do Sono REM/diagnóstico , Parassonias do Sono REM/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Capacidade Vital
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