INTRODUCTION: In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS: This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS: Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
Adult ; Humans ; Parasomnias/diagnosis* ; Singapore ; Sleep/physiology* ; Somnambulism/diagnosis*

Catathrenia is a rare sleep disease characterized by monotonous groaning sounds that appear to be related with prolonged expiration, commonly experienced during rapid eye movement (REM) sleep. Catathrenia is also known as nocturnal groaning or sleep-related groaning and is currently categorized as a sleep-related breathing disorder. We present a rare case of a 19-year-old male with nocturnal groaning during non-REM sleep. We suggest that if catathrenia is suspected, polysomnography should be utilized to differentiate it from various sleep disorders such as snoring, central sleep apnea, sleep talking, parasomnia, and sleep-related movement disorders.
Humans ; Male ; Movement Disorders ; Parasomnias ; Polysomnography ; Respiration ; Sleep Apnea, Central ; Sleep Wake Disorders ; Sleep, REM ; Sleep-Wake Transition Disorders ; Snoring ; Young Adult

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.
Adolescent ; Cataplexy ; Disorders of Excessive Somnolence ; Eye Movements ; Hallucinations ; Humans ; Lethargy ; Male ; Narcolepsy ; Parasomnias ; Polysomnography ; Sleep Arousal Disorders ; Sleep Paralysis

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by sleep interruption or trauma due to abnormal behaviors that occur during REM sleep. The pathophysiology of RBD is known to be a dysfunction of brainstem circuit that causes the loss of skeletal muscle atonia during REM sleep. The diagnosis of RBD is needed to confirm REM sleep without atonia in the polysomnography. The management of RBD includes not only drug treatment, but also to prevent injury from RBD and to follow-up on neurodegenerative diseases that may occur later. RBD is thought to be a prodromal stage of neurodegenerative disease associated with α-synucleoinopathy, such as Parkinson's Disease or multiple system atrophy. This article reviews the symptoms, epidemiology, diagnosis and treatment of RBD, the relevance of neurodegenerative diseases, and recent research trends.
Brain Stem ; Diagnosis ; Epidemiology ; Follow-Up Studies ; Multiple System Atrophy ; Muscle, Skeletal ; Neurodegenerative Diseases ; Parasomnias ; Parkinson Disease ; Polysomnography ; Prodromal Symptoms ; REM Sleep Behavior Disorder ; Sleep, REM

Non-rapid eye movement sleep parasomnias including sleepwalking tend to disappear spontaneously during late childhood and adolescent period. Sleepwalking is not as common in adults as in children. Sleepwalking in adults could happen with triggering factors such as hypnotics or metabolic derangement including hypoglycemia. We report a case of an adult patient with recurrent, frequent sleepwalking and complex motor behaviors during sleep in his mid- twenties after spontaneous remission of sleepwalking in the childhood. The triggers were severe sleep deprivation and obstructive sleep apnea. No more sleepwalking was reported after the treatment of sleep apnea by tonsillectomy.
Adolescent ; Adult ; Child ; Eye Movements ; Humans ; Hypnotics and Sedatives ; Hypoglycemia ; Parasomnias ; Remission, Spontaneous ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Deprivation ; Somnambulism ; Tonsillectomy

It is a significant challenge for the clinician to make distinction between nocturnal epilepsy form non-epileptic sleep disorders. Although in some patients, diagnosis is easy to achieve but sometimes not. At times even with help of polysomnogram and electroencephalogram, diagnostic confusion remains. We present two cases of nocturnal paroaxysmal events, which still need elucidate diagnosis.
Diagnosis ; Electroencephalography ; Epilepsy ; Humans ; Motor Activity* ; Parasomnias ; Polysomnography ; Seizures ; Sleep Wake Disorders

Sleep-related painful erection (SRPE) is characterized by deep penile pain accompanied with erection occurring rapid eye movement (REM) movement period. Two (47-year-old and 40-year-old, respectively) male visited with the complaint of painful penile erection occurring during sleep. They had no problems with erection during daytime sexual activities except for mild premature ejaculation in one patient. Urologic inspections revealed no focal abnormalities. Polysomnography with simultaneous penile erection monitoring showed several episodes of awakening with painful erection which are time-locked to onset of REM sleep periods. According to the diagnostic criteria in international classification of sleep disorders, each patient was diagnosed to have chronic, severe SRPE. Despite of a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile. A polysomnography accompanied with penile erection recording may help confirm diagnosis.
Adult ; Classification ; Diagnosis ; Humans ; Male ; Penile Erection ; Polysomnography ; Premature Ejaculation ; Prevalence ; REM Sleep Parasomnias* ; Sexual Behavior ; Sleep Wake Disorders ; Sleep, REM

PURPOSE: Although allergic disease has been recognized as a common chronic disease related to the sleep disturbance of children, studies on sleep disturbance in children with allergic disease are scanty in Korea. The aim of this study was to evaluate the sleep disturbance of children with allergic disease. METHODS: Children aged 2 to 12 years were assessed using the sleep questionnaires. From July 2011 to June 2012, surveys were conducted on patients who were diagnosed with allergies in 3 general hospitals and in an elementary school in Seoul and the capital area. The analysis was done in 3 groups according to age. RESULTS: The sleep questionnaires of 1,174 children were evaluated. Children with allergic disease were 341 (209 males and 132 females) and those in the control group were 833 (428 males and 405 females). Parasomnia symptoms were common in young children (ages 2 to 5 years) than in the control group (P<0.05). Symptoms of sleep-disordered breathing were more common in early adolescent children (ages 11 to 12 years) than in the control group (P<0.05). The presence of allergic rhinitis, gender, and body mass index did not correlate with a sleep disturbance in children with allergic disease. CONCLUSION: To our knowledge, this study was the first report of sleep disturbance in children with allergic disease in Korea. This study suggests that children with allergic disease from early children may have poor sleep quality than those without. Therefore, proper treatment of and great interest in sleep disturbance are required for children with allergic disease.
Adolescent ; Allergy and Immunology ; Body Mass Index ; Child* ; Chronic Disease ; Hospitals, General ; Humans ; Hypersensitivity ; Korea ; Male ; Parasomnias ; Rhinitis ; Seoul ; Sleep Apnea Syndromes ; Surveys and Questionnaires

Sleepwalking is a rare parasomnia in the elderly. We report two cases of the patients who presented complex motor behaviors during sleep triggered by hypoglycemia. A 76-year-old male patient with diabetes mellitus presented to the sleep clinic for recurrent sleepwalking with amnesia. Night polysomnogram showed REM sleep without atonia with sleep talking and distal arm movements. While taking clonazepam, he had a few more episodes of sleepwalking. The last episode finally revealed severe hypoglycemia when he was found very far from his house. The second patient, a 67-year-old male showed four episodes of nocturnal confusion and sleepwalking lasting 20 minutes during sleep. His blood glucose and HbA1c were low. After decrease of the dose of oral hypoglycemic agent, no more recurrent sleepwalking occurred. Our cases showed hypoglycemia can induce sleepwalking in the older adults, rather than decreased mentality. Metabolic workup should perform for evaluation of sleepwalking, especially in the elderly.
Adult ; Aged ; Amnesia ; Arm ; Blood Glucose ; Clonazepam ; Diabetes Mellitus ; Humans ; Hypoglycemia* ; Male ; Parasomnias ; Polysomnography ; Sleep, REM ; Sleep-Wake Transition Disorders ; Somnambulism*

OBJECTIVE: Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy. METHODS: Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records. RESULTS: Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients. CONCLUSION: Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.
Arm ; Diagnosis ; Drinking ; Electrophysiology ; Female ; Fingers ; Humans ; Male ; Medical Records ; Neural Conduction ; Paralysis ; Parasomnias ; Paresthesia ; Posture ; Prognosis ; Radial Nerve ; Radial Neuropathy* ; Retrospective Studies ; Stroke ; Wrist*