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Differential Diagnosis of Complex Nocturnal Behaviors

  • Sleep and Neurological Conditions(A Avidan, Section Editor)
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Abstract

Purpose of Review

Complex nocturnal movements and behaviors are the manifestation of numerous disorders encountered in clinical practice, which are challenging to diagnose due to overlapping clinical manifestations and limitations of the clinical history. We review the three most common causes of complex nocturnal behaviors, disorders of arousal (DOAs) from non-rapid eye movement (NREM) sleep, REM sleep behavior disorder (RBD), and sleep hypermotor epilepsy (SHE), and their overlapping manifestations that can stump clinicians.

Recent Findings

Correlation of semiology with electrical signals (electro-clinical correlation) is key to the diagnosis. Emerging science is demonstrating a shared pathophysiology of SHE and DOAs and RBD as a precursor of neurodegenerative disorders, underscoring the importance of diagnostic accuracy in the sleep and EEG laboratory.

Summary

The evaluation of complex nocturnal movements and behaviors requires a detailed clinical history taken from the patient and observers, video recordings, and in most cases, EEG/PSG confirmation.

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Authors and Affiliations

  1. Cleveland Clinic Sleep Disorders Center, Cleveland, OH, USA

    Laura Mora-Munoz & Zahreddin Alsheikhtaha

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Nancy Foldvary-Schaefer

  3. Cleveland Clinic Sleep Disorders and Epilepsy Centers, 9500 Euclid Avenue, S73, Cleveland, OH, 44195, USA

    Nancy Foldvary-Schaefer

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  1. Laura Mora-Munoz
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Mora-Munoz, L., Alsheikhtaha, Z. & Foldvary-Schaefer, N. Differential Diagnosis of Complex Nocturnal Behaviors. Curr Sleep Medicine Rep 8, 74–85 (2022). https://doi.org/10.1007/s40675-022-00238-1

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