Nocturnal eating: Sleep-related eating disorder or night eating syndrome? A videopolysomnographic study

Università Vita-Salute San Raffaele, Milano, Lombardy, Italy
Sleep (Impact Factor: 4.59). 08/2006; 29(7):949-54.
Source: PubMed


To describe the clinical and videopolysomnographic characteristics of nocturnal eating episodes in sleep-related eating disorder.
Descriptive study of outpatients prospectively enrolled in 2 sleep centers.
Videopolysomnographic recordings done in the sleep laboratory.
Thirty-five consecutive drug-free patients with nocturnal eating.
Clinical interviews disclosed abnormal compulsory nocturnal eating episodes in all patients associated with a clinical report of sleepwalking (in 1), somniloquy (in 5), restless legs syndrome (in 8), and periodic limb movements during sleep (in 4). Videopolysomnography documented 45 episodes of nocturnal eating in 26 patients. Eating always occurred after complete awakenings from non-rapid eye movement sleep and only in 1 patient from REM sleep and was characterized by electroencephalographic alpha activity with no dissociated features of state-dependent sleep variables. Patients interviewed during the eating episodes were fully conscious and remembered the events the next day. Pathological periodic limb movements during sleep index was recorded in 22 and restless legs syndrome dyskinesias in 5 patients. Recurring chewing and swallowing movements during sleep were a feature in 29 patients, associated in about half of the events with electroencephalographic arousals.
In our patients, eating episodes occurred with normal consciousness and recall. Chewing or swallowing movements during sleep occurred frequently, resembling rhythmic masticatory-muscle activity in bruxism patients. The presence of periodic limb movements during sleep and chewing activity, the reported efficacy of dopaminergic medications, and the compulsory food-seeking behavior all argue for a dopaminergic dysfunction underlying the pathogenesis of sleep-related eating disorder.

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    • "Furthermore, the beneficial effects of dopaminergic agents in SRED, the association of nocturnal eating with increased sleep related motor activity (periodic limb movements in sleep and rhythmic masticatory muscle activity) (Vetrugno et al. 2006), and a demonstration of nocturnal eating/drinking syndrome secondary to neuroleptic-induced RLS (Horiguchi et al. 1999), seem to support a dopaminergic involvement in this condition. Due to patients' descriptions of the nocturnal eating episodes as occurring without hunger and associated with feelings of being ''out of control'', we speculate that nocturnal eating behavior in RLS patients may represent the symptom of a comorbid obsessive/compulsive disorder, possibly related to dopaminergic mechanisms. "
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    ABSTRACT: The purpose of the study was to evaluate psychological comorbidity in drug-naive or drug-free primary restless legs syndrome (p-RLS) patients with nocturnal eating disorder (NED), and to analyze the association of comorbid p-RLS and NED with obsessive-compulsive, mood and anxiety symptoms, and personality. Participants comprised 20 consecutive female outpatients with p-RLS, 10 without NED and 10 with NED, and 10 female controls matched for age. Both patients and controls were evaluated by the Hamilton Depression and the Anxiety Rating Scales, the State-Trait Anxiety Inventory, the Maudsley Obsessive Compulsive Inventory and the temperament and character inventory-revised. Compared to controls, p-RLS patients without and with NED had higher trait anxiety and current anxiety and obsessive-compulsive symptoms. p-RLS patients with NED also had significantly higher doubting compared to p-RLS patients without NED. Furthermore, groups differed for harm avoidance (HA), with p-RLS patients with and without NED having higher scores than controls. Untreated p-RLS patients, particularly those with nocturnal eating, report anxiety and obsessive-compulsive symptoms, perceive stressful situations as dangerous and threatening and tend to respond with anxiety to such situations. They have higher tendency to respond intensely to aversive stimuli, inhibiting behavior to avoid punishment, novelty, and frustrative omission of expected rewards. We hypothesize that higher levels of HA, a biologically determined personality trait, might constitute a diathesis predisposing individuals to display obsessive-compulsive symptoms, namely increasingly severe compulsive nocturnal eating.
    No preview · Article · Aug 2015 · Journal of Neural Transmission
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    • "Reduced sleep efficiency [1] [28] and a variable number of eating-related awakenings have been reported [1,27–29]. Recurrent electromyographic (EMG) activities of the masseter and orbicularis oris muscles have been recorded that have been defined as repetitive masticatory and swallowing behavior , after video recording confirmation [28]. Unfortunately, given the relatively recent publication of the current diagnostic criteria for NES [3], there are only a few studies on polysomnographic characteristics of these patients; moreover, before the publication of the new diagnostic criteria of SRED in the ICSD-3 [4], there was an evident overlap between the diagnosis of SRED and NES that did not allow separation of the polysomnographic features of NES from those of SRED [1]. "
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    ABSTRACT: Objective: Nocturnal eating behavior is shared by patients affected by a parasomnia, sleep-related eating disorder (SRED), and several eating disorders such as night eating syndrome (NES) and binge-eating disorder (BED); however, the differential clinical features of these patients have been poorly studied, with persisting difficulties in defining the borders between these pathologies. The aim of this study was to evaluate polysomnographic and personality characteristics of nocturnal eaters to further differentiate the syndromes. Methods: During a period of six months, consecutive patients complaining of nocturnal eating were asked to participate to the study. Twenty-four patients who were found to eat during the polysomnographic recording (PSG) study, and gender-matched control subjects were included. All subjects underwent a fullnight video-PSG study and a psychometric assessment including the Eating Disorder Inventory (EDI-2), the self-rating Bulimic Investigatory Test–Edinburgh (BITE), the Temperament and Character Inventory (TCI), and the Barratt Impulsivity Scale (BIS). Results: Nocturnal eaters showed a mild reduction in sleep efficiency and duration due to a moderate sleep fragmentation, whereas the percentage of each sleep stage was not significantly affected. Nocturnal eaters scored higher at many subscales of the EDI-2, at the BITE symptoms subscale, and at the BIS attentional impulsivity subscale. Conclusion: The psychological characteristics found in our patients with NES seem to be typical for patients affected by eating disorders, and support the hypothesis that the nocturnal behavior of these individuals is due to an eating disorder; however, specific traits also allow differentiation of NES from BED.
    Full-text · Article · May 2015 · Sleep Medicine
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    • "The level of consciousness, often impaired in SRED but normal in NES, is the most useful criterion distinguishing NES and SRED, though it is still a matter of debate. Additionally, NE episodes seem to occur along a spectrum of consciousness levels [3]. In a previous work [4] we investigated the occurrence of NE in both SRED and NES in a large group of RLS patients living in Emilia-Romagna, a region of northern Italy, and we found a significant association between SRED and RLS when the patients were compared to an ageand sex-matched control group (33% vs 1%, respectively). "
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    ABSTRACT: We aimed to investigate the prevalence of night eating syndrome (NES) in a large cohort of patients with restless legs syndrome (RLS). Our cross-sectional study included 120 patients examined at the University of Bologna Centre for Sleep Disorders, Bologna, Italy, and met all four International RLS criteria for the diagnosis of RLS. Each patient underwent a semistructured telephone interview investigating demographic data and general health status, RLS features and severity, presence of excessive daytime sleepiness, and presence of NES. The sample included 37 men and 83 women with a mean age of 63.8±11.5years. There were 31% of patients who reported episodes of nocturnal eating (NE); among them, 17% fulfilled the new diagnostic criteria for NES. Comparing RLS patients with and without NE, there were no differences in RLS features. However, RLS patients with NE were older (67.2±11.6 vs 62.4±11; P=.038), were in a higher body mass index (BMI) range (27.7±3.8 vs 26.1±4.1kg/m(2); P=.023), were taking more drugs for concomitant diseases (89% vs 72%; P=.031), were more likely to report insomnia (40% vs 23%; P=.041), and were using more hypnotic agents (37.8% vs 19.3%; P=.050) and dopaminergic drugs (65% vs 46%; P=.041). When comparing those RLS patients with NES diagnostic criteria and those without NES, no differences emerged in demographic, clinical, and RLS features; however, NES patients were in a higher BMI range (28.3±4.1 vs 26.2±3.9kg/m(2), P=.037), were more frequently smokers (43% vs 17%; P=.027), and were more frequently using hypnotic agents (30% vs 24%; P=.025). Lastly, no differences were found when comparing patients with a NES diagnosis and those with NE not fitting the diagnostic criteria for NES, except for a higher use of benzodiazepine drugs (BDZ) in this latter subgroup (29% vs zero; P=.014). A nocturnal compulsion to eat seems to be an intrinsic part of the clinical spectrum of RLS manifestations and an odd risk factor for increases in BMI in RLS patients. However, it is still not clear if NE in RLS would fit in one of the two known categorized syndromes of NE (i.e., sleep-related eating disorder [SRED] or NES) or if it represents a different strictly RLS-related eating behavior.
    Full-text · Article · Dec 2013 · Sleep Medicine
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