Department of Neurology, Minneapolis Veterans Affairs Medical Center/ Pulmonary allergy, Critical Care and Sleep, University of Minnesota, Minneapolis, MN, USA.
Department of Psychiatry, Hennepin Health Care, University of Minnesota, Minneapolis, MN, USA.
Neurotherapeutics. 2021 Jan;18(1):124-139. doi: 10.1007/s13311-021-01011-y. Epub 2021 Feb 1.
Parasomnias are abnormal behaviors and/or experiences emanating from or associated with sleep typically manifesting as motor movements of varying semiology. We discuss mainly nonrapid eye movement sleep and related parasomnias in this article. Sleepwalking (SW), sleep terrors (ST), confusional arousals, and related disorders result from an incomplete dissociation of wakefulness from nonrapid eye movement (NREM) sleep. Conditions that provoke repeated cortical arousals, and/or promote sleep inertia, lead to NREM parasomnias by impairing normal arousal mechanisms. Changes in the cyclic alternating pattern, a biomarker of arousal instability in NREM sleep, are noted in sleepwalking disorders. Sleep-related eating disorder (SRED) is characterized by a disruption of the nocturnal fast with episodes of feeding after arousal from sleep. SRED is often associated with the use of sedative-hypnotic medications, in particular the widely prescribed benzodiazepine receptor agonists. Compelling evidence suggests that nocturnal eating may in some cases be another nonmotor manifestation of Restless Legs Syndrome (RLS). Initial management should focus upon decreasing the potential for sleep-related injury followed by treating comorbid sleep disorders and eliminating incriminating drugs. Sexsomnia is a subtype of disorders of arousal, where sexual behavior emerges from partial arousal from nonREM sleep. Overlap parasomnia disorders consist of abnormal sleep-related behavior both in nonREM and REM sleep. Status dissociatus is referred to as a breakdown of the sleep architecture where an admixture of various sleep state markers is seen without any specific demarcation. Benzodiazepine therapy can be effective in controlling SW, ST, and sexsomnia, but not SRED. Paroxetine has been reported to provide benefit in some cases of ST. Topiramate, pramipexole, and sertraline can be effective in SRED. Pharmacotherapy for other parasomnias continues to be less certain, necessitating further investigation. NREM parasomnias may resolve spontaneously but require a review of priming and predisposing factors.
睡眠相关异常是指源自或与睡眠相关的异常行为和/或体验，通常表现为不同表型的运动活动。本文主要讨论非快速动眼睡眠（NREM）相关的睡眠障碍。梦游症（SW）、睡惊症（ST）、意识模糊性觉醒和相关障碍是由于觉醒与 NREM 睡眠不完全分离引起的。反复引起皮质唤醒并/或促进睡眠惯性的情况会通过损害正常唤醒机制导致 NREM 睡眠障碍。在 NREM 睡眠中，周期性交替模式（觉醒不稳定的生物标志物）的变化在梦游症中被注意到。睡眠相关摄食障碍（SRED）的特征是在睡眠觉醒后出现进食紊乱，打破夜间禁食。SRED 常与镇静催眠药物的使用有关，特别是广泛使用的苯二氮䓬受体激动剂。有强有力的证据表明，在某些情况下，夜间进食可能是不宁腿综合征（RLS）的另一种非运动表现。初始管理应侧重于减少与睡眠相关的伤害风险，然后治疗合并的睡眠障碍并消除可疑药物。性梦行为是觉醒障碍的一种亚型，性行为是从 NREM 睡眠的部分觉醒中出现的。重叠性睡眠障碍包括 NREM 和 REM 睡眠中的异常睡眠相关行为。分离状态是指睡眠结构的崩溃，在此期间会出现各种睡眠状态标志物的混合，而没有任何特定的分隔。苯二氮䓬类药物治疗对 SW、ST 和性梦行为有效，但对 SRED 无效。据报道，帕罗西汀对 ST 的某些病例有效。托吡酯、普拉克索和舍曲林可有效治疗 SRED。其他睡眠障碍的药物治疗仍不太确定，需要进一步研究。NREM 睡眠障碍可能会自发缓解，但需要审查诱发因素和易患因素。
