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The Utility of polysomnography for the diagnosis of NREM parasomnias: an observational study over 4 years of clinical practice

Fois, Chiara and Wright, Mary Anne S. and Sechi, Gianpietro and Walker, Matthew C. and Eriksson, Sofia (2015) The Utility of polysomnography for the diagnosis of NREM parasomnias: an observational study over 4 years of clinical practice. Journal of Neurology, Vol. 262 (2), p. 385-393. ISSN 0340-5354. eISSN 1432-1459. Article.

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DOI: 10.1007/s00415-014-7578-2

Abstract

Polysomnography (PSG) is considered the gold standard for diagnosis of non-rapid eye movement (NREM) parasomnias, however its diagnostic yield has been rarely reported. We aimed to assess the diagnostic value of polysomnography in different categories of patients with suspected NREM parasomnia and define variables that can affect the outcome. 124 adults referred for polysomnography for suspected NREM parasomnia were retrospectively identified and divided into clinical categories based on their history. Each polysomnography was analysed for features of NREM parasomnia or different sleep disorders and for presence of potential precipitants. The impact on the outcome of number of recording nights and concomitant consumption of benzodiazepines and antidepressants was assessed. Overall, PSG confirmed NREM parasomnias in 60.5 % patients and showed a different sleep disorder in another 16 %. Precipitants were found in 21 % of the 124 patients. However, PSG showed limited value when the NREM parasomnia was clinically uncomplicated, since it rarely revealed a different diagnosis or unsuspected precipitants (5 % respectively), but became essential for people with unusual features in the history where different or overlapping diagnoses (18 %) or unsuspected precipitants (24 %) were commonly identified. Taking benzodiazepines or antidepressants during the PSG reduced the diagnostic yield. PSG has a high diagnostic yield in patients with suspected NREM parasomnia, and can reveal a different diagnosis or precipitants in over 40 % of people with complicated or atypical presentation or those with a history of epilepsy. We suggest that PSG should be performed for one night in the first instance, with leg electrodes and respiratory measurements and after benzodiazepine and antidepressant withdrawal.

Item Type:Article
ID Code:10373
Status:Published
Refereed:Yes
Uncontrolled Keywords:Polysomnography, sleep study, NREM parasomnias, arousal disorders, sleepwalking, epilepsy
Subjects:Area 06 - Scienze mediche > MED/26 Neurologia
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Medicina Clinica e Sperimentale
Publisher:Springer
ISSN:0340-5354
eISSN:1432-1459
Copyright Holders:© The Author(s) 2014
Deposited On:25 Nov 2014 12:07

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