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To describe an association of Tourette's syndrome with rapid eye movement sleep behaviour disorder (RBD) in a prepubescent boy.
A four year longitudinal single-case study.
The co-existence of Tourette's syndrome and RBD was confirmed after polysomnographic studies using the standard criteria. The authors propose possible overlap in the pathophysiological mechanisms underlying the two disorders.
To explain relatively common phenomenon of laughing during sleep and help to better define criteria for differentiating between physiological and pathological sleep-laughing.
Observational study of patients who underwent a sleep assessment in a referential tertiary health facility.
A total of ten patients exhibited sleep laughing, nine of whom had episodes associated with rapid eye movement (REM) sleep. Also, in one of the patients sleep-laughing was one of the symptoms of REM sleep Behaviour Disorder, and in another patient sleep-laughing was associated with NREM sleep arousal parasomnia.
The collected data and review of literature suggests that hypnogely in majority of the cases presents as a benign physiological phenomenon related to dreaming and REM sleep. Typically, these dreams are odd, bizarre or even unfunny for a person when awake. Nevertheless, they bring a sense of mirth and a genuine behavioural response. In a minority of cases, sleep-laughing appears to be a symptom of neurological disorders affecting the central nervous system. In these patients the behavioural substrate differs when compared to physiological laughing, and the sense of mirth is usually absent.
If the notions of dream and nightmare are centuries old, going back to ancient Egyptian and Jewish civilizations, the distinction between nightmares and parasomnias is recent. As parasomnias became distinguishable from nightmares, a possible link between such episodic nocturnal phenomena and seizure disorders was proposed. In 1999, Ohayon et al. in their epidemiological studies on sleepwalking and sleep terrors found that obstructive sleep apnea syndrome was the most common sleep disorder associated with parasomnias between the ages of 15 and 24 years. Epileptic disorders were shown to be rarely involved in abnormal behavior during non-rapid eye movement (NREM) sleep, but when sleep-related seizure disorders are present, specific seizure entities are implicated. Nocturnal polysomnography has allowed the dissociation of NREM from REM sleep abnormal behavior. The initial description of what is now known as REM sleep behavior disorder (RBD) came from Japanese researchers.
Fibromyalgia is a pain amplification syndrome produced by persistent afferent sensory stimulation and manifested as a central sensitization syndrome. Multiple studies including neuroimaging studies have consistently shown that fibromyalgia syndrome (FM) pain emanates from changes in the brain and spinal cord using the same mechanism that makes sunburnt skin sensitive to light touch. The role of sleep in the etiopathogenesis of fibromyalgia is underscored by the fact that up to 90% of FM patients have non-restorative sleep. The sleep disturbance should be investigated to ascertain whether periodic limb movement syndrome, sleep apnea, bruxism or acid reflux disease is present. FM is modified by hormonal, cytokine, neurotransmitter, and autonomic influences. The overwhelming majority with FM have sleep disorders, with the alpha-delta abnormality being the principal pathology. Managing sleep pathology in FM appropriately ameliorates the symptoms and signs of the syndrome more than almost any other intervention.