[Disruptive nocturnal behavior in elderly subjects: could it be a parasomnia?].

Smaranda Leu-Semenescu, Isabelle Arnulf
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引用次数: 7

Abstract

Parasomnias are sleep-related abnormal behaviors. They are frequent and overlooked causes of nocturnal disruptive behavior in the elderly, especially when patients are cognitively impaired. Confusion and violence can result in sleep disruption, injuries for the patients or their bed partners, caregivers distress, and they can be a motive for institutionalization. Parasomnias include the NonREM sleep disorders of arousal (sleepwalking, sleep terrors, confusional arousals and sleep-related eating disorder), the REM sleep behavior disorder (RBD) and more rarely the parasomnia overlap syndrome, which associates both NREM and REM parasomnias. Patients with NREM sleep parasomnias are confused, eyes open, with a glazed look during their nocturnal behaviors, and they have a post-episode amnesia. They shout and bolt from the bed (night terrors), look about in a confused manner, walk and speak (sleepwalking), and eat peculiar or inedible food (sleep-related eating disorders). These behaviors, which are frequent in young adults, may be triggered by short-half live hypnotics in elderly. During the parasomnia, the brain is partially awake (enough to perform complex motor and verbal action), and partially asleep (without conscious awareness or responsibility). RBD is characterized by a loss of the normal muscle atonia that accompanies REM sleep. Patients have excessive motor activity such as punching, kicking, or crying out in association with dream content. RBD are frequent in Parkinson's disease and dementia with Lewy bodies and may precede the cognitive or motor symptoms of these diseases by 5 to 10 years. RBD can also be promoted by antidepressants. When combined with thorough clinical interviews, the video-polysomnography is a powerful tool, especially for discriminating the parasomnia from nocturnal frontal lobe epilepsy, sleep apneas and periodic leg movements. Ensuring safety and withdrawing deleterious treatments are useful in patients with violent activities, potential injurious or bothersome to other household members. Clonazepam and melatonin (3-12 mg) are highly effective for treating RBD.

老年受试者的破坏性夜间行为:可能是睡眠异常吗?
睡眠异常是与睡眠相关的异常行为。它们是老年人夜间破坏性行为的常见和被忽视的原因,特别是当患者有认知障碍时。困惑和暴力会导致睡眠中断,病人或他们的床伴受伤,照顾者痛苦,它们可能是机构化的动机。睡眠异常包括非快速眼动睡眠觉醒障碍(梦游、睡眠恐怖、觉醒混乱和睡眠相关的饮食失调)、快速眼动睡眠行为障碍(RBD)和更罕见的睡眠异常重叠综合征,它与非快速眼动和快速眼动睡眠异常相关联。非快速眼动睡眠异常的患者在夜间行为时,眼睛睁着,目光呆滞,并且患有发作后健忘症。他们从床上大喊大叫(夜惊),茫然地四处张望,走路和说话(梦游),吃奇怪的或不能吃的食物(与睡眠有关的饮食失调)。这些在年轻人中很常见的行为,可能在老年人中被半活催眠触发。在睡眠异常期间,大脑部分清醒(足以执行复杂的运动和语言动作),部分睡眠(没有意识或责任)。RBD的特点是伴随着快速眼动睡眠的正常肌肉张力丧失。患者有过度的运动活动,如拳打脚踢,或与梦的内容有关的喊叫。RBD常见于帕金森病和路易体痴呆,可能早于这些疾病的认知或运动症状5至10年。抗抑郁药也可以促进RBD。当与彻底的临床访谈相结合时,视频多导睡眠图是一个强大的工具,特别是在区分睡眠异常与夜间额叶癫痫、睡眠呼吸暂停和周期性腿部运动方面。对于有暴力活动、对其他家庭成员可能造成伤害或麻烦的患者,确保安全并停止有害治疗是有用的。氯硝西泮和褪黑素(3-12毫克)对治疗RBD非常有效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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