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  • Print publication year: 2010
  • Online publication date: November 2010

Case 10 - Odd sleep-related behaviors

from Part IV - Parasomnias

Summary

This chapter discusses the case of a 54-year-oldwoman with disturbing respiratory noise during nocturnal sleep. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. EMG investigation of laryngeal muscle activity was subsequently performed during wakefulness and sleep, placing fine-wire electrodes in the posterior cricoarytenoid, cricothyroid and thyroarytenoid muscles. The specialist made a diagnosis of nocturnal inspiratory stridor based on the characteristics of the noise present only during sleep, particularly during NREM sleep. A diagnosis of REM-sleep behavior disorder (RBD) was also made due to the characteristic clinical history of violent motor behaviors during sleep associated with polysomnography (PSG) evidence of REM sleep without atonia. Tracheostomy and continuous positive airway pressure (CPAP) are effective treatments of stridor; however, they do not always prevent death in multiple-system atrophy.

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Suggested reading

Historical
BokeyK.Conversion disorder revisited: severe parasomnia discovered. Aust N Z J Psychiatry 1993; 27: 694.
Review
SchenckCH, MahowaldMW.Rapid eye movement sleep parasomnias. Neurol Clin 2005; 23: 1107–26.
General
AASM (American Academy of Sleep Medicine). International Classification of Sleep Disorders, 2nd edn.: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2005.
KushidaCA, ClerkAA, KirschCM, et al. Prolonged confusion with nocturnal wandering arising from NREM and REM sleep: a case report. Sleep 1995; 18: 757–64.
LombardiC, VetrugniR, ProviniF, et al. Harlequin syndrome: an association with overlap parasomnia. J Neurol Neurosurg Psychiatry 2004; 75: 341–2.
MahowaldMW, SchenckCH.Dissociated states of wakefulness and sleep. Neurology 1992; 42: 44–52.
SchenckCH, BoydJL, MahowaldMW.A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997; 20: 972–81.
YoungP.Genetic aspects of parasomnias. Somnologie 2008; 12: 7–13.

Historical

BokeyK.Conversion disorder revisited: severe parasomnia discovered. Aust N Z J Psychiatry 1993; 27: 694.

Review

SchenckCH, MahowaldMW.Rapid eye movement sleep parasomnias. Neurol Clin 2005; 23: 1107–26.

General

AASM (American Academy of Sleep Medicine). International Classification of Sleep Disorders, 2nd edn.: Diagnostic and Coding Manual. Westchester, Illinois: American Academy of Sleep Medicine, 2005.
KushidaCA, ClerkAA, KirschCM, et al. Prolonged confusion with nocturnal wandering arising from NREM and REM sleep: a case report. Sleep 1995; 18: 757–64.
LombardiC, VetrugniR, ProviniF, et al. Harlequin syndrome: an association with overlap parasomnia. J Neurol Neurosurg Psychiatry 2004; 75: 341–2.
MahowaldMW, SchenckCH.Dissociated states of wakefulness and sleep. Neurology 1992; 42: 44–52.
SchenckCH, BoydJL, MahowaldMW.A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep 1997; 20: 972–81.
YoungP.Genetic aspects of parasomnias. Somnologie 2008; 12: 7–13.