Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders Ohayon M Guilleminault C Priest R J Clin Psychiatry 1999 60 268 276 10221293

Centre de Recherche Philippe Pinel de Montréal, Quebec, Canada.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/1999; 60(4):268-76; quiz 277.
Source: PubMed


Arousal parasomnias (night terrors, sleepwalking, and confusional arousals) have seldom been investigated in the adult general population. Clinical studies of parasomnias, however, show that these disorders may be indicators of underlying mental disorders and may have serious consequences.
A representative sample of the United Kingdom population (N = 4972) was interviewed by telephone with the Sleep-EVAL system.
Night terrors were reported by 2.2% (95% CI = 1.8% to 2.6%) of the sample, sleepwalking by 2.0% (1.6% to 2.4%), and confusional arousals by 4.2% (3.6% to 4.8%). The rate of these 3 parasomnias decreased significantly with age, but no gender difference was observed. Multivariate models identified the following independent factors as associated with confusional arousals (odds ratio [OR]): age of 15-24 years (OR = 4.1), shift work (OR = 2.1), hypnagogic hallucinations (OR = 3.3), deep sleep (OR = 1.6), daytime sleepiness (OR = 1.9), sleep talking (OR = 1.7), daily smoking (OR = 1.7), adjustment disorder (OR = 3.1), and bipolar disorder (OR = 13.0). Factors associated with night terrors were subjective sense of choking or blocked breathing at night (OR = 5.1), obstructive sleep apnea syndrome (OR = 4.1), alcohol consumption at bedtime (OR = 3.9), violent or injury-causing behaviors during sleep (OR = 3.2), hypnagogic hallucinations (OR = 2.2), and nightmares at least 1 night per month (OR = 4.0). Factors associated with sleepwalking were age of 15-24 years (OR = 5.2), subjective sense of choking or blocked breathing at night (OR = 5.1), sleep talking (OR = 5.0), and a road accident in the past year (OR = 3.9) after controlling for possible effects of sleep deprivation, life stress, and mental and sleep disorders.
Arousal parasomnias, especially night terrors and confusional arousals, are often the expression of a mental disorder. Other life or medical conditions, such as shift work or excessive need of sleep for confusional arousals and stressful events for sleepwalking, may also trigger parasomnias. Prevalence rates are based on self-reported data and, consequently, are likely underestimated.

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    • "Furthermore, in a large epidemiological study including participants from United Kingdom, Germany and Italy (n ¼ 13 057), shift or night workers were at higher risk of reporting confusional arousals than day workers (Ohayon et al., 2000). However, sleep terror and sleepwalking were not found to be associated with shift work (Ohayon et al., 1999, 2012). "
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    ABSTRACT: The aim of this study was to investigate whether different shift work schedules were associated with nonrapid eye movement (NREM)- and/or REM-related parasomnias. A total of 2198 nurses with different work schedules participated in a longitudinal cohort study. The parasomnia questions were included in the fourth wave of the data collection, with a response rate of 74.1%. Logistic regression analyses with the different parasomnias as dependent variables were conducted. Nurses working two shift (day and evening) and nurses working three shift (day, evening and night) rotational schedules had increased risk of confusional arousal, a NREM-related parasomnia, compared to nurses working daytime only (odds ratios = 2.10 and 1.71, respectively). Similarly, nurses working two and three shift rotational schedules had increased risk of nightmares, a REM-related parasomnia (odds ratios = 1.64 and 1.57, respectively). The other parasomnias were not significantly associated with work schedule. Working night shifts only was not associated with any of the parasomnias. In conclusion, confusional arousal and nightmares were more commonly reported by nurses working rotational shift work schedules compared to nurses working daytime only. This is likely related to the circadian rhythm misalignment and sleep deprivation caused by such shift schedules.
    No preview · Article · Nov 2015 · Chronobiology International
    • "NREM sleep parasomnias are more frequent during childhood but can occur during adult life as well and manifest as confusional arousals, sleep terrors, or sleep walking (somnambulism). The lifetime prevalence for confusional arousals, sleepwalking, and sleep terrors is 18.5, 18.3, and 1–6.5 %, respectively (AASM ICSD III;Ohayon et al. 1999). NREM sleep parasomnia is commonly associated with sleep-disordered breathing, more frequently flow limitation than frank obstructive hypopnea and apneas. "
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    ABSTRACT: Sleep and wakefulness are regulated by complex brain circuits located in the brain stem, thalamus, subthalamus, hypothalamus, basal forebrain, and cerebral cortex. Wakefulness and NREM and REM sleep are modulated by the interactions between neurotransmitters that promote arousal and neurotransmitters that promote sleep. Various lines of evidence suggest that sleep disorders may negatively affect neuronal plasticity and cognitive function. Pharmacological treatments may alleviate these effects but may also have adverse side effects by themselves. This chapter discusses the relationship between sleep disorders, pharmacological treatments, and brain plasticity, including the treatment of insomnia, hypersomnias such as narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.
    No preview · Article · Jan 2015 · Current Topics in Behavioral Neurosciences
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    • "Consistent with this view, several subsequent studies reported the presence of severe and pervasive psychiatric disorders in adults presenting with SW or with a mixture of SW and sleep terrors (ST) [13] [26] [27]. Self-report epidemiologic investigations indicate that approximately 25% of adult sleepwalkers report a concurrent anxiety or mood disorder [7] and that SW is more frequent among individuals who consume psychotropic medications [28]. However, other studies indicate that a majority of adult sleepwalkers neither show elevated scores on questionnaire measures of psychopathology [29], nor meet criteria for psychiatric or personality disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [11] [30]. "
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    ABSTRACT: Sleepwalking (SW) often has been associated with psychopathology, but the nature and magnitude of this relation remains unclear. The aim of our study was to investigate the presence of psychopathology in a large cohort of sleepwalkers and to determine if levels of psychopathology showed differential relations to specific characteristics of the disorder, including clinical history. One-hundred and five sleepwalkers (39 men, 66 women; mean age, 32.4±9.5years) referred to our sleep disorders clinic for chronic SW underwent a comprehensive clinical investigation that included an overnight polysomnography (PSG) assessment in 90% of cases. All participants also completed a series of questionnaires, including the Beck Depression Inventory, Second Revision (BDI-II), the Beck Anxiety Inventory (BAI), and the Symptom Checklist 90-Revised (SCL-90-R). The proportion of sleepwalkers who scored above the minimal clinical threshold on the BDI-II, BAI, and SCL-90-R was 27%, 40%, and 28%, respectively. Only 15% of sleepwalkers showed moderate to severe symptoms on the BDI-II and 19% on the BAI. Taken as a whole, these profiles are similar to those observed in the general adult population. The presence of psychopathology in sleepwalkers was associated with a negative family history for SW, a higher frequency of nightmares, and with potentially injurious behaviors enacted during somnambulistic episodes. A majority of adult sleepwalkers consulting for the disorder do not report clinically significant levels of depression or anxiety. Overall, sleepwalkers with and without psychopathology appear more similar than dissimilar.
    Full-text · Article · Oct 2013 · Sleep Medicine
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