Schenck C H, Boyd J L, Mahowald M W
Department of Psychiatry, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Sleep. 1997 Nov;20(11):972-81. doi: 10.1093/sleep/20.11.972.
A series of 33 patients with combined (injurious) sleepwalking, sleep terrors, and rapid eye movement (REM) sleep behavior disorder (viz. "parasomnia overlap disorder") was gathered over an 8-year period. Patients underwent clinical and polysomnographic evaluations. Mean age was 34 +/- 14 (SD) years; mean age of parasomnia onset was 15 +/- 16 years (range 1-66); 70% (n = 23) were males. An idiopathic subgroup (n = 22) had a significantly earlier mean age of parasomnia onset (9 +/- 7 years) than a symptomatic subgroup (n = 11) (27 +/- 23 years, p = 0.002), whose parasomnia began with either of the following: neurologic disorders, n = 6 [congenital Mobius syndrome, narcolepsy, multiple sclerosis, brain tumor (and treatment), brain trauma, indeterminate disorder (exaggerated startle response/atypical cataplexy)]; nocturnal paroxysmal atrial fibrillation, n = 1; posttraumatic stress disorder/major depression, n = 1; chronic ethanol/amphetamine abuse and withdrawal, n = 1; or mixed disorders (schizophrenia, brain trauma, substance abuse), n = 2. The rate of DSM-III-R (Diagnostic and Statistical Manual, 3rd edition, revised) Axis 1 psychiatric disorders was not elevated; group scores on various psychometric tests were not elevated. Forty-five percent (n = 15) had previously received psychologic or psychiatric therapy for their parasomnia, without benefit. Treatment outcome was available for n = 20 patients; 90% (n = 18) had substantial parasomnia control with bedtime clonazepam (n = 13), alprazolam and/or carbamazepine (n = 4), or self-hypnosis (n = 1). Thus, "parasomnia overlap disorder" is a treatable condition that emerges in various clinical settings and can be understood within the context of current knowledge on parasomnias and motor control/dyscontrol during sleep.
在8年时间里收集了33例患有合并性（伤害性）梦游症、夜惊症和快速眼动（REM）睡眠行为障碍（即“异态睡眠重叠障碍”）的患者。患者接受了临床和多导睡眠图评估。平均年龄为34±14（标准差）岁；异态睡眠发作的平均年龄为15±16岁（范围1 - 66岁）；70%（n = 23）为男性。特发性亚组（n = 22）异态睡眠发作的平均年龄（9±7岁）显著早于症状性亚组（n = 11）（27±23岁，p = 0.002），后者的异态睡眠始于以下情况之一：神经系统疾病，n = 6 [先天性莫比乌斯综合征、发作性睡病、多发性硬化症、脑肿瘤（及其治疗）、脑外伤、不确定疾病（夸张的惊吓反应/非典型猝倒）]；夜间阵发性心房颤动，n = 1；创伤后应激障碍/重度抑郁症，n = 1；慢性乙醇/苯丙胺滥用及戒断，n = 1；或混合性疾病（精神分裂症、脑外伤、物质滥用），n = 2。《精神疾病诊断与统计手册》第三版修订本（DSM - III - R）轴I精神障碍的发生率并未升高；各种心理测量测试的组分数值也未升高。45%（n = 15）的患者此前曾因异态睡眠接受过心理或精神治疗，但并无效果。有20例患者有治疗结果；90%（n = 18）通过睡前服用氯硝西泮（n = 13）、阿普唑仑和/或卡马西平（n = 4）或自我催眠（n = 1）使异态睡眠得到了有效控制。因此，“异态睡眠重叠障碍”是一种可治疗的病症，出现在各种临床环境中，并且可以在当前关于异态睡眠以及睡眠期间运动控制/失调的知识背景下得到理解。
