Rodriguez Carlos L, Foldvary-Schaefer Nancy
Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States.
Cleveland Clinic Sleep Disorders Center, Neurological Institute, Cleveland, OH, United States.
Handb Clin Neurol. 2019;161:397-410. doi: 10.1016/B978-0-444-64142-7.00063-1.
The nonrapid eye movement (NREM) parasomnias range from age-related developmental phenomena in children to aggressive and injurious motor behaviors in all age groups. These parasomnias are commonly referred to as disorders of arousal and are an important cause of sleep-related injury. Genetic predisposition plays a role in the disorders of arousal, most evident in sleepwalking. Important concepts guiding our current understanding of the pathophysiology of the NREM parasomnias include sleep state instability (a propensity for arousal during NREM sleep), sleep inertia (incomplete awakening from NREM sleep), state dissociation (an ability to simultaneously straddle both NREM sleep and wakefulness), and activation of central pattern generators (permitting expression of subcortically determined motor behaviors without conscious higher cortical input). Management is multifaceted with an emphasis on education and nonpharmacologic measures. The purpose of this chapter is to review wake and NREM neurobiology and update our current understanding of NREM parasomnia pathophysiology, epidemiology, genetics, clinical features, precipitating factors, neurophysiologic evaluation, diagnosis, and clinical management.
非快速眼动（NREM）异态睡眠涵盖了从儿童期与年龄相关的发育现象到所有年龄组中出现的攻击性行为和伤害性运动行为。这些异态睡眠通常被称为觉醒障碍，是与睡眠相关伤害的重要原因。遗传易感性在觉醒障碍中起作用，在梦游症中最为明显。指导我们当前对NREM异态睡眠病理生理学理解的重要概念包括睡眠状态不稳定（NREM睡眠期间易于觉醒的倾向）、睡眠惯性（从NREM睡眠中不完全觉醒）、状态解离（同时跨越NREM睡眠和清醒状态的能力）以及中枢模式发生器的激活（允许在没有有意识的高级皮层输入的情况下表达皮层下决定的运动行为）。管理是多方面的，重点在于教育和非药物措施。本章的目的是回顾觉醒和NREM神经生物学，并更新我们目前对NREM异态睡眠病理生理学、流行病学、遗传学、临床特征、诱发因素、神经生理学评估、诊断和临床管理的理解。
