Recurrent isolated sleep paralysis: Polysomnographic and clinical findings
Tóm tắt
Sleep paralysis is one of the typical symptoms of narcolepsy, found in about 25% of narcoleptic patients. It also represents a separate sleep disorder classified as a REM sleep-related parasomnia. We compared clinical and electrophysiological data of patients with recurrent isolated sleep paralysis (RISP) with those of narcoleptic patients and healthy control subjects. Structured interview data, polygraphic sleep recording, Multiple Sleep Latency Test (MSLT) and human leukocyte antigen (HLA) DR2(15) typing were compared in sex- and age-matched patients with RISP (n=10, mean age: 48.2 years, 4 males/6 females), narcolepsy (NAR, n=10, mean age: 51.5 years, 4 males/6 females) and healthy controls (CON, n=10, mean age: 51.5 years, 5 males/5 females). Night sleep latencies were prolonged in RISP (mean: 40.6±25.3 min; NAR: 19.5±8.8 min; CON: 19.2±15.6 min). No sleep onset REM (SOREM) episodes (latency <20 min) were observed in RISP patients, and short (<50 min) REM sleep latencies were rare. In some cases REM sleep episodes were fragmented or abbreviated. The distribution of REM latencies was largely inconspicuous. The distribution of NREM sleep stages was normal. In the MSLT, latencies for sleep stages 1 and 2 were longer in RISP than in narcoleptic patients, and while SOREM phases were abundant in narcoleptic patients, such events were extremely rare in RISP patients. Daytime sleepiness, assessed by the Epworth Sleepiness Scale (ESS), did not differ between RISP (median: 9) and CON (median: 6.5) but was significantly increased in NAR (median: 20.5). HLA typing showed that seven out of 10 RISP patients were HLA DR2(15) negative. None of the patients with RISP had ever experienced cataplectic attacks. RISP and NAR patients differ in critical HLA alleles and in key sleep variables such as sleep latency and REM latency. According to our findings, SOREM episodes are not a typical feature of RISP. In contrast to other studies, RISP patients do not show excessive daytime sleepiness compared with healthy controls.
Tài liệu tham khảo
Aldrich MS: Narcolepsy. New Engl J Med: 323, 389–394, 1990.
Bell CC, Shakoor B, Thompson B, Dew D, et al.: Prevalence of isolated sleep paralysis in black subjects. J Natl Med Assoc 81: 805–808, 1989.
Buzzi G, Cirignotta F: Isolated sleep paralysis: a Web survey. Sleep Res Online 3: 61–66, 2000.
Cheyne JA: Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects. J Sleep Res 11: 169–177, 2002.
Cheyne JA, Newby-Clark IR, Rueffer SD: Relations among hypnagogic and hypnopompic experiences associated with sleep paralysis. J Sleep Res 8: 313–317, 1999.
Dahlitz M, Parkes JD: Sleep paralysis. Lancet 341: 406–407, 1993.
Dahmen N, Kasten M, Mueller MJ, Mittag K: Frequency and dependence on body posture of hallucinations and sleep paralysis in a community sample. J Sleep Res 11: 179–180, 2002.
Everett HC: Sleep paralysis in medical students. J Nerv Ment Dis 3: 283–287, 1963.
Folkard S, Condon R, Herbert M: Night shift paralysis. Experientia 40: 510–512, 1984.
Fukuda K: Sleep paralysis and sleep on set REM period in normal individuals. In: Ogilvie, RD and Harsh, JR (eds): Sleep onset mechanisms: normal and abnormal processes. American Psychological Association, Washington DC, pp. 161–181, 1984.
Fukuda K, Miyasita A, Inugami M, Ishihara K: High prevalence of isolated sleep paralysis: Kanashibari phenomenon in Japan. Sleep 10: 279–286, 1987.
Geisler P, Crönlein T, Tracik F, Zulley J: The MSLT-30: an ‘easy-to-use’ variant of the MSLT with improved diagnostic value. J Sleep Res 7: 100, 1998.
Hishikawa Y, Shimizu T: Physiology of REM sleep, cataplexy, and sleep paralysis. Adv Neurol 67: 245–271, 1995.
[ICSD]. International classification of sleep disorders, revised: Diagnostic and coding manual. American Sleep Disorders Association, Rochester, MN, 1997.
Johns MW: A new method for measuring daytime sleepines: the Epworth Sleepiness Scale. Sleep 14: 540–545, 1991.
Kleßmann E: Die Mendelssohns. Bilder aus einer deutschen Familie [The Mendelssohns. Pictures from a German Family]. Insel, Frankfurt/Main, pp. 41–42, 1993.
Neely S, Rosenberg R, Spire JP, Antel J et al.: HLA antigens in narcolepsy. Neurology 37: 1858–1860, 1987.
Ness RC: The old hag phenomenon as sleep paralysis: a biocultural interpretation. Culture Med Psych 2: 15–39, 1978.
Ohaeri JU, Odejide AO, Ikuesan BA, Adeyemi JD: The patterns of isolated sleep paralysis among nigerian medical students. J. Natl Med Assoc 81: 808–810, 1989.
Ohaeri JU, Odejide AO, Ikuesan BA, Adeyemi JD: The patterns of isolated sleep paralysis among Nigerian nursing students. J. Natl Med Assoc 84: 67–70, 1992.
Ohayon MM, Zulley J, Guilleminault C, Smirne S: Prevalence and pathologic associations of sleep paralysis in the general population. Neurology 52: 1194, 1999.
Paradis CM, Friedmann S, Hatch M: Isolated sleep paralysis in African Americans with panic disorders. Cult Divers Ment Health 3: 69–76, 1997.
Penn NE, Kripke DF, Scharff J: Sleep paralysis among medical students. J Psychol 107: 247–252, 1981.
Rechtschaffen A, Kales A: A manual of standardized terminology, technique and scoring system for sleep stages of human subject. Brain Information Service. National Institutes of Health, 1968.
Snyder S: Isolated sleep paralysis after rapid time zone change (jet lag) syndrome. Chronobiologia 10: 377–379, 1983.
Takeuchi T, Fukada K, Saski Y, Inugami M, Murphy TI: Factors related to the occurrence of isolated sleep paralysis elicited during a multi-phasic sleep-wake schedule. Sleep 125: 89–96, 2002.
Takeuchi T, Miyasita A, Sasaki Y, Inugami M, Fukuda K: Isolated sleep paralysis elicited by sleep interruption. Sleep 15: 217–225, 1992.
Waller JA: A treatise on the incubus, or nightmare, disturbed sleep, terrific dreams, and noctumal visions: with the means of removing these distressing complaints. Cox, London, 1816. [Johann Waller: Abhandlung von dem Alpdrücken, dem gestörten Schlafe, erschreckenden Träumen und nächtlichen Erscheinungen. Nebst der Heilart dieser Zufälle. German edition and translation by Elias Wolf. Philipp Heinrich Guilhaum. Frankfurt/Main, 1820].
Wing YK, Chiu H, Leung T, Ng J: Sleep paralysis in the elderly. J Sleep Res 8: 151–155, 1999.
Wing YK, Lee ST, Chen CN: Sleep paralysis in Chinese: ghost oppression phenomenon in Hong Kong Sleep 17: 609–613, 1994.
Yoss RE, Daly DD: Criteria for the diagnosis of the narcoleptic syndrome. Proc Mayo Clin 32: 320–328, 1957.