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Recurrent isolated sleep paralysis: Polysomnographic and clinical findings

Polysomnographische und klinische Befunde bei Personen mit wiederkehrender isolierter Schlaflähmung

Summary

Question of the study

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.

patients and methods

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).

Results

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.

Conclusions

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.

Zusammenfassung

Fragestellung

Die Schlaflähmung ist ein typisches Symptom der Narkolepsie und findet sich bei etwa 25% der narkoleptischen Patienten. Sie stellt aber auch eine eigenständige Schlafstörung dar, die als REM-Schlaf bezogene Parasomnie klassifiziert wird. Wir verglichen klinische und elektrophysiologische Daten von Patienten mit wiederkehrender isolierter Schlaflähmung (RISP) mit denen narkoleptischer Patienten und gesunder Kontrollpersonen.

Patienten und Methodik

Die Ergebnisse eines strukturierten Interviews, Fragebogendaten, polysomnographische Aufzeichnungen, Multipler Schlaflatenz-Test (MSLT) und HLA DR2(15) Befunde wurden verglichen für nach Alter und Geschlecht angepassten Patienten mit RISP (n=10; mittleres Alter 48,2 Jahre; 4 Männer, 6 Frauen), Narkolepsie (NAR, n=10; mittleres Alter 51,5 Jahre; 4 Männer, 6 Frauen) und gesunde Kontrollen (CON, n=10; mittleres Alter 51,5 Jahre; 5 Männer, 5 Frauen).

Ergebnisse

Die nächtlichen Schlaflatenzen waren für RISP verlängert (Durchschnittswerte: RISP 40,6±25,3 Minuten; NAR 19.5±8,8 Minuten: CON 19,2±15,6 Min). Die Verteilung der REM-Latenzen war weitgehend unauffällig. Bei RISP wurden keine Einschlaf-REM-Episoden (Latenz <20 Minuten) beobachtet und kurze (<50 Minuten) REM-Latenzen waren selten. In einigen Fällen waren REM-Schlaf-Episoden fragmentiert oder verkürzt. Die Verteilung der NREM-Schlafstadient war normal. Im MSLT waren die Schlaflatenzen für die Stadien 1 und 2 bei RISP länger als bei narkoleptischen Patienten, und während Einschlaf-REM-Episoden bei narkoleptischen Patienten sehr häufig auftraten, waren solche Ereignisse bei Patienten mit RISP ausgesprochen selten. Tagesschläfrigkeit, gemessen mit der Epworth Schläfrigkeitsskala (ESS), unterschied sich nicht zwischen RISP (Median 9 Punkte) und CON (median 6,5 Punkte), war bei NAR allerdings signifikant erhöht (Median 20,5 Punkte). Bei der HLA-Typisierung waren 7 von 10 Patienten mit RISP DR 2(15) negativ.

Schlussfolgerungen

Patienten mit RISP und Narkolepsie unterscheiden sich in kritischen HLA-Allelen und in Schlüsselvariablen des Schlafs wie Schlaflatenz und REM-Latenz. Nach den Ergebnissen unserer Untersuchungen sind Einschlaf-REM-Episoden für RISP kein typisches Merkmal. Entgegen anderer Studien zeigen RISP-Patienten keine erhöhte Tagschlafneigung im Vergleich zu gesunden Kontrollen.

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Correspondence to Björn W. Walther.

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Walther, B.W., Schulz, H. Recurrent isolated sleep paralysis: Polysomnographic and clinical findings. Somnologie 8, 53–60 (2004). https://doi.org/10.1111/j.1439-054X.2004.00017.x

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Keywords

  • isolated sleep paralysis
  • sleep latency
  • REM latency
  • HLA typing
  • MSLT
  • de|Schlüsselwörter
  • isolierte Schlaflähmung
  • Schlaflatenz
  • REM-Latenz
  • HLA-Typisierung
  • MSLT