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Sleep Deprivation Used To Diagnose Sleepwalking

Health and Medical News - Sleep
Friday, 21 March 2008
Somnambulism (sleepwalking), which regularly involves misperception and unresponsiveness to the environment, mental confusion and amnesia about sleepwalking episodes, affects up to 4 percent of adults. There has been a sharp rise in the number of studies relating sleepwalking to aggressive and injurious behaviors, including homicides, but unlike most sleep disorders, sleepwalking is diagnosed on the basis of the patient's clinical history, since there is no proven way of affirming the diagnosis. Although clinical reports have suggested that sleep deprivation can lead to sleepwalking in predisposed patients, little studies using this way in the laboratory have yielded mixed results. A new, larger study found that sleep deprivation can precipitate sleepwalking in predisposed individuals and can hence serve as a useful item in diagnosing this disorder. The study will be published in the Annals of Neurology (http://www.interscience.wiley.com/journal/ana), the official journal of the American Neurological Association. Led by Antonio Zadra of the UniversitÃ© de MontrÃ©al, in Quebec, Canada, the study included 40 patients referred to a sleep disorder clinic for suspected sleepwalking between August 2003 and March 2007. All patients were examined and underwent one night of baseline sleep recording in the lab. The following day they went about their regular daytime activities, after which they returned to the lab in the evening, where they were constantly supervised to guarantee they did not fall asleep. Recovery sleep took place the following morning, following 25 hours of wakefulness calculated from when they had awakened the preceding morning. All patients were videotaped during each sleep period and the authors evaluated behavioral movements which ranged from playing with the bed sheets to getting up from the bed, to determine if they were sleepwalking episodes. They also scored the complexity of each episode on a 3-point scale. The results showed that while 32 behavioral episodes were recorded from 20 sleepwalkers (50%) during baseline sleep, 92 episodes were recorded from 36 patients (90%) during recovery sleep. Sleep deprivation also significantly increased the proportion of sleepwalkers experiencing at least one complex episode. "By yielding a greater number of episodes with a wider range of complexity, sleep deprivation can facilitate the video-polysomnographically-based diagnosis of somnambulism and its differentiation from other disorders," the authors state. Sleepwalkers are thought to suffer from an impossibility to sustain stable slow-wave sleep (stage 3 and 4 sleep) and the study found that these patients had increased problem passing from slow-wave sleep to another sleep stage or arousal following sleep deprivation, which supports this view. It is also consistent with observations that other factors that deepen sleep, like young age or fever, may help trigger sleepwalking in predisposed individuals. The authors caution that observing behavioral events in the sleep lab following sleep deprivation is not always sufficient to affirm a diagnosis of sleepwalking in a medical-legal context. However, they note that: "Used as a diagnostic item, sleep deprivation shows a high sensitivity for somnambulism and may be clinically useful with a wider range of somnambulistic patients than previously reported." They conclude that the study supports recommending that sleepwalkers maintain a regular sleep schedule and avoid sleep deprivation. Article: "Polysomnographic Diagnosis of Sleepwalking: Effects of Sleep Deprivation," Antonio Zadra, Mathieu Pilon, Jacques Montplaisir, Annals of Neurology, March 2008. Source: Amy Molnar Wiley-Blackwell

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