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Citation
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Loddo G, Fragiacomo F, Mainieri G, Mondini S, Buzzi G, Calandra-Buonaura G, Provini F. J. Clin. Sleep Med. 2021; ePub(ePub): ePub. |
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Abstract
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STUDY OBJECTIVES: To describe clinical and video-polysomnographic features of disorders of arousal (DoA) in older adults.
METHODS: Four consecutive males, complaining of nocturnal motor behaviors, underwent a clinical interview, neurological examination, laboratory tests, brain magnetic resonance imaging and nocturnal in-lab or 24-48h home video-polysomnography (VPSG). The patients repeated an evaluation after 6 months of follow-up, in two cases including a 48h home-VPSG.
RESULTS: Patients were 65-72 years old, one of them has Parkinson disease. Sleep-related behavioral episodes had begun from 12-55 years before our observation. Three patients presented with a positive family history for DoA. Sleep motor episodes were described as suddenly raising head or trunk, sitting in bed, screaming, speaking, gesturing and, in only one patient, sleepwalking. When questioned, all patients seemed confused, rarely reporting any dream-like content. We recorded 25 DoA episodes arising from NREM sleep of different intensity and complexity. The semiology of the episodes was similar to that described in younger subjects, consisting of Sleep Terrors and Confusional Arousals. All patients presented physiological REM muscle atonia. Medication therapy reduced the frequency of the episodes in 2/4 patients.
CONCLUSIONS: DoA may begin in adulthood and persist or arise in older adults sometimes causing sleep-related injuries. Motor patterns of DoA in older adults are similar to those of younger patients. A combined clinical examination and VPSG recording are crucial in establishing a definitive diagnosis of nocturnal motor behavior in all older adults and especially in those affected by neurodegenerative diseases.
Language: en |