NREM parasomnias: A treatment approach based upon a retrospective case series of 512 patients

Panagis Drakatos, Lucy Marples, Rexford Muza, Sean Higgins, Nadia Gildeh, Raluca Macavei, Eptehal M. Dongol, Alexander Nesbitt, Ivana Rosenzweig, Elaine Lyons, Grainne d'Ancona, Joerg Steier, Adrian J. Williams, Brian D. Kent, Guy Leschziner

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Abstract

Background Non-REM parasomnias are not uncommon conditions in the general population. Current treatment options are based on small case series and reports. In this study, we aimed to present the clinical experience from a large cohort of patients. Patients Five hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. Treatment outcome was assessed based on patients’ reports, and treatment approach on a locally accepted hierarchy of interventions. Results Forty percent of patients were diagnosed with sleepwalking, 23.8% with mixed-phenotype and 10% with POD. Ultimately, 97.2% reported adequate control of their symptoms. Moreover, 60.1% were treated with pharmacotherapy and 32.0% without, consistent across all phenotypes (p = 0.09). Benzodiazepines were the most common drugs prescribed (47.1%, p < 0.05). In the end, 37.7% of our patients were receiving a benzodiazepine as part of their successful treatment, 11.7% an antidepressant, 9.2% a z-drug, and 10.7% melatonin. Finally, 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. Conclusion The treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, next treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments.
Original languageEnglish
Pages (from-to)181-188
Number of pages8
JournalSLEEP MEDICINE
Volume53
Early online date10 Apr 2018
DOIs
Publication statusPublished - Jan 2019

Keywords

  • CBT
  • CPAP
  • Melatonin
  • NREM parasomnia
  • POD
  • Treatment

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