Disorders of arousal from non-rapid eye movement sleep in adults
- Nancy Foldvary-Schaefer, DO, MS
Nancy Foldvary-Schaefer, DO, MS
- Professor of Neurology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
- Director, Cleveland Clinic Sleep Disorders Center
Disorders of arousal from non-rapid eye movement (NREM) sleep are parasomnias that include confusional arousals, sleepwalking, sleep terrors, and their variants. They are classified as distinct entities, but in reality, they represent a spectrum of sleep-related behaviors that occur as a result of incomplete transition out of deep NREM sleep.
While disorders of arousal typically present in childhood, they may continue into adulthood, remit and recur in adulthood, or present de novo in adults. NREM disorders of arousal must be distinguished from other sleep-related conditions that occur in adults, including rapid eye movement (REM) sleep behavior disorder (RBD), movement disorders of sleep, and nocturnal seizures.
Disorders of arousal are an important cause of sleep-related injury in adults. Management consists primarily of education, environmental and behavioral modifications to promote safety, and identification of predisposing and triggering factors to minimize the number of episodes.
The clinical features, diagnosis, and management of disorders of arousal in adults will be reviewed here. A more general approach to abnormal movements and behaviors during sleep is presented elsewhere. Other parasomnias in adults and disorders of arousal and other parasomnias in children are also reviewed separately. (See "Approach to abnormal movements and behaviors during sleep" and "Rapid eye movement sleep behavior disorder" and "Sleepwalking and other parasomnias in children".)
Disorders of arousal are more prevalent in children than adults, and estimates in adults are largely drawn from survey studies.
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- PATHOPHYSIOLOGY AND GENETICS
- Association with nocturnal frontal lobe epilepsy
- CLINICAL FEATURES
- Clinical manifestations
- - Confusional arousals
- Sleep-related abnormal sexual behavior
- - Sleep terrors
- - Sleepwalking
- Sleep-related eating disorder
- Common precipitating factors
- Polysomnographic features
- DIFFERENTIAL DIAGNOSIS
- Nocturnal seizures
- REM sleep behavior disorder
- Parasomnia overlap disorder
- SUMMARY AND RECOMMENDATIONS