Parasomnia Among Psychiatric Outpatients: A Clinical, Epidemiologic, Cross-Sectional Study
J Clin Psychiatry 2008;69:1374-1382
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Epidemiologic studies from general population and
clinical case series suggest association of parasomnias with mental illnesses
and psychotropic medications. This cross-sectional study aimed at determining
the prevalence rate of sleepwalking, sleep-related eating disorder (SRED),
rapid eye movement sleep behavior-like disorder (RSBD-like disorder), and
sleep-related injury (SRI) and their associated factors in an adult psychiatric
Method: Subjects aged 18 to 65 years who were attending an
outpatient clinic in Hong Kong from May 2006 through June 2006 were included in
this cross-sectional study. A 3-phase design was employed, including a
structured questionnaire on parasomnias, followed by clinical interviews of
both questionnaire-positive and -negative groups, and polysomnography for
subjects having active parasomnias in recent 1 year. In addition, the principal
psychiatric diagnoses, medical illnesses, and detailed drug history over recent
1 year were retrieved from the computerized records.
Results: Twelve hundred thirty-five subjects completed the
phase 1 interview. The estimated prevalence of the lifetime diagnoses of
sleepwalking, SRED, SRI, sleep violence, and RSBD-like disorder were 8.5%,
4.0%, 21.0%, 3.6%, and 5.8%, respectively, while the 1-year prevalence of these
conditions were 2.9%, 2.4%, 8.8%, 2.5%, and 3.8%, respectively. These
conditions were associated with depression and a constellation of sleep
disturbances. Specific combinations of psychotropics were found to pose risk in
particular parasomnias: sedative antidepressants and nonbenzodiazapine
hypnotics in sleepwalking, regular zolpidem and antidepressants in SRED, and
selective serotonin reuptake inhibitors in RSBD-like disorder.
Conclusions: Sleepwalking, SRED, RSBD-like disorder, and SRI
were common and underrecognized among the psychiatric population in this study.
Their occurrences were likely contributed by interacting effect of mental
illnesses, sleep disturbances, and specific psychotropic medications. Further
prospective study is warranted for clarification of the etiology and clinical
management of these potentially dangerous and "hidden" parasomnias.