National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
Rev Neurol (Paris). 2023 Oct;179(7):675-686. doi: 10.1016/j.neurol.2023.07.003. Epub 2023 Aug 23.
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
夜间躁动是指从简单运动到意识部分或完全丧失的攻击性行为等广泛的症状。准确识别其病因对于适当的治疗干预至关重要。在儿童和年轻成年人中，区分非快速眼动 (NREM) 睡眠障碍和心因性非睡眠障碍表现，即睡眠相关解离障碍 (SRDD)，具有挑战性。本综述旨在总结 NREM 睡眠障碍和 SRDD 的当前临床、神经生理学和流行病学知识，并提出这些夜间表现的病理生理假说。梦游、睡惊症和意识模糊性觉醒是 NREM 睡眠障碍的三种主要表现形式，具有共同的临床特征。睡眠障碍通常发生在入睡后 30 分钟至 3 小时，持续时间通常较短，不超过几分钟，涉及非刻板、笨拙的行为，且常伴有遗忘。NREM 睡眠障碍的患病率从儿童的 15-30%降至成人的 2-4%。睡眠障碍是从最深 NREM 睡眠中不完全觉醒的表现，其特征是大脑活动分离，运动和边缘结构呈现类似觉醒的激活，而额顶区域保留睡眠。SRDD 是一种不太为人知的疾病，其特征是戏剧性的、通常非常长的发作，伴有频繁的攻击性行为和潜在的危险行为。SRDD 发作经常发生在安静的清醒状态下，在入睡之前。这些分离表现经常发生在心理创伤的背景下。SRDD 的病理生理学尚不清楚，但可能涉及由于易变的睡眠-觉醒边界，在易感个体中大脑连接的短暂变化。我们假设，SRDD 和 NREM 睡眠障碍分别是在睡眠开始和觉醒过程中睡眠-觉醒状态分离时，有利于睡眠相关分离状态的形式。
