Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain
Introduction: Disorders of Arousal (DoA) are NREM parasomnias that have been typically regarded as self-limited childhood manifestations. It is now clear that DoA can persist in adults, often presenting with distinctive characteristics. So far, few studies have described the clinical course and char...
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| Format: | Article |
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Frontiers Media S.A.
2019-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00526/full |
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| author | Tommaso Baldini Giuseppe Loddo Elisa Sessagesimi Francesco Mignani Fabio Cirignotta Susanna Mondini Laura Licchetta Laura Licchetta Francesca Bisulli Francesca Bisulli Paolo Tinuper Paolo Tinuper Federica Provini Federica Provini |
| author_facet | Tommaso Baldini Giuseppe Loddo Elisa Sessagesimi Francesco Mignani Fabio Cirignotta Susanna Mondini Laura Licchetta Laura Licchetta Francesca Bisulli Francesca Bisulli Paolo Tinuper Paolo Tinuper Federica Provini Federica Provini |
| author_sort | Tommaso Baldini |
| collection | DOAJ |
| description | Introduction: Disorders of Arousal (DoA) are NREM parasomnias that have been typically regarded as self-limited childhood manifestations. It is now clear that DoA can persist in adults, often presenting with distinctive characteristics. So far, few studies have described the clinical course and characteristics of DoA in adulthood, therefore a large part of their semiology is ignored. The aim of this study is to describe the clinical manifestations of DoA in an adult population and to provide a pathophysiological interpretation of their features.Methods: We screened our database for all 1,600 adult (≥15 years) patients with sleep-related motor behaviors between 1995 and 2016. We identified 45 patients with typical DoA episodes, of whom a complete history, neurological examination and diagnostic video-polysomnography (VPSG) were available. All patients provided a detailed description of their episodes (with particular regards to semiology, frequency, and association with stressful life events) in different life periods. VPSG recordings were reviewed and DoA episodes were identified and assigned to three different categories according to their complexity.Results: Our population was composed of 45 adult patients ranging between 15 and 76 years. Sleepwalking was reported by 86% of patients, possibly associated with complex interactions with the environment and violent behaviors in 53% of cases; distressing mental contents were reported by 64%. Recall of the episodes was reported in 77% of patients. Non-restorative sleep was reported in 46% of patients. Stress was a potential episode trigger in 80% of patients. VPSG recordings documented 334 DoA episodes. According to our classification of motor patterns, 282 episodes (84%) were Simple Arousal Movements (SAMs), 34 (10%) Rapid Arousal Movements (RAMs) and 18 (5%) Complex Arousal Movements (CAMs).Discussion: Our study confirms that DoA in adulthood present with distinctive characteristics, such as non-restorative sleep, violence and complex, or bizarre behaviors. Alternative classifications of DoA based on motor patterns could be useful to characterize DoA episodes in adults, as different motor patterns often coexist in the same individual and minor episodes are more common but generally underreported by patients. Prospective studies are needed for a definitive characterization of DoA in adulthood throughout the life course. |
| first_indexed | 2024-12-11T21:57:30Z |
| format | Article |
| id | doaj.art-989ddce781864cd790c1abc0a4cc0d36 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-11T21:57:30Z |
| publishDate | 2019-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-989ddce781864cd790c1abc0a4cc0d362022-12-22T00:49:15ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-05-011010.3389/fneur.2019.00526450057Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping BrainTommaso Baldini0Giuseppe Loddo1Elisa Sessagesimi2Francesco Mignani3Fabio Cirignotta4Susanna Mondini5Laura Licchetta6Laura Licchetta7Francesca Bisulli8Francesca Bisulli9Paolo Tinuper10Paolo Tinuper11Federica Provini12Federica Provini13Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyRadiology Unit, Experimental, Diagnostic and Specialty Medicine, University Hospital S. Orsola-Malpighi, Bologna, ItalyIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyUnit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, ItalyUnit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, ItalyIRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, ItalyIntroduction: Disorders of Arousal (DoA) are NREM parasomnias that have been typically regarded as self-limited childhood manifestations. It is now clear that DoA can persist in adults, often presenting with distinctive characteristics. So far, few studies have described the clinical course and characteristics of DoA in adulthood, therefore a large part of their semiology is ignored. The aim of this study is to describe the clinical manifestations of DoA in an adult population and to provide a pathophysiological interpretation of their features.Methods: We screened our database for all 1,600 adult (≥15 years) patients with sleep-related motor behaviors between 1995 and 2016. We identified 45 patients with typical DoA episodes, of whom a complete history, neurological examination and diagnostic video-polysomnography (VPSG) were available. All patients provided a detailed description of their episodes (with particular regards to semiology, frequency, and association with stressful life events) in different life periods. VPSG recordings were reviewed and DoA episodes were identified and assigned to three different categories according to their complexity.Results: Our population was composed of 45 adult patients ranging between 15 and 76 years. Sleepwalking was reported by 86% of patients, possibly associated with complex interactions with the environment and violent behaviors in 53% of cases; distressing mental contents were reported by 64%. Recall of the episodes was reported in 77% of patients. Non-restorative sleep was reported in 46% of patients. Stress was a potential episode trigger in 80% of patients. VPSG recordings documented 334 DoA episodes. According to our classification of motor patterns, 282 episodes (84%) were Simple Arousal Movements (SAMs), 34 (10%) Rapid Arousal Movements (RAMs) and 18 (5%) Complex Arousal Movements (CAMs).Discussion: Our study confirms that DoA in adulthood present with distinctive characteristics, such as non-restorative sleep, violence and complex, or bizarre behaviors. Alternative classifications of DoA based on motor patterns could be useful to characterize DoA episodes in adults, as different motor patterns often coexist in the same individual and minor episodes are more common but generally underreported by patients. Prospective studies are needed for a definitive characterization of DoA in adulthood throughout the life course.https://www.frontiersin.org/article/10.3389/fneur.2019.00526/fulldisorder of arousal (DoA)NREM sleepparasomniapathophysiologysleep-related behaviorsadults |
| spellingShingle | Tommaso Baldini Giuseppe Loddo Elisa Sessagesimi Francesco Mignani Fabio Cirignotta Susanna Mondini Laura Licchetta Laura Licchetta Francesca Bisulli Francesca Bisulli Paolo Tinuper Paolo Tinuper Federica Provini Federica Provini Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain Frontiers in Neurology disorder of arousal (DoA) NREM sleep parasomnia pathophysiology sleep-related behaviors adults |
| title | Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain |
| title_full | Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain |
| title_fullStr | Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain |
| title_full_unstemmed | Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain |
| title_short | Clinical Features and Pathophysiology of Disorders of Arousal in Adults: A Window Into the Sleeping Brain |
| title_sort | clinical features and pathophysiology of disorders of arousal in adults a window into the sleeping brain |
| topic | disorder of arousal (DoA) NREM sleep parasomnia pathophysiology sleep-related behaviors adults |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.00526/full |
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