Schlafwandeln und andere Non-REM-Parasomnien

Zusammenfassung

Parasomnien umfassen eine große Gruppe unterschiedlicher motorischer Phänomene während des Schlafes. Entsprechend der Interna­tionalen Klassifikation von Schlafstörungen II (ICSD II) werden Parasomnien in Formen unterteilt, die aus dem Non-REM-Schlaf heraus auftreten und Formen, die aus dem REM-Schlaf auftreten. Als andere Parasomnien werden die Formen bezeichnet, bei denen keine feste Zuordnung zu einem Schlafstadium möglich ist. Schlafwandeln, Schlaftrunkenheit und der Pavor nocturnus sind die klinisch wichtigsten Formen der Non-REM Parasomnien. Hauptmerkmal dieser Formen ist der Beginn aus dem Schlafstadium Non-REM 3, dem durch hohen Anteil an Deltaaktivität gekennzeichneten Tiefschlaf. Die Gesamtprävalenz der Non-REM-Parasomnien bei Erwachsenen wird mit ca. 4% angegeben. Damit ist diese Form der Parasomnien eine klinisch relevante, aber vermutlich unterdiagnostizierte Gruppe von Schlafstörungen. Als besondere Form der Parasomnie gilt neben den Non-REM-Parasomnien die schlafbezogene Essstörung. Diese in die Gruppe der anderen Parasomnien klassifizierte Schlafstörung tritt aus Non-REM-Stadium 2 und 3 auf. Für alle hier beschriebenen Parasomnien gilt, dass assoziierte Symptome wie Tagesschläfrigkeit, Traumerinnern und nächtliche autonome Aktivierungen häufiger zu finden sind als allgemein angenommen wurde. Die wichtigsten Differenzialdiagnosen des Schlafwandelns und der gesamten Gruppe der Non-REM-Parasomnien sind die REM-Schlaf-assoziierten Parasomnien, wie die REM-Schlaf-Verhaltensstörung und epileptische Anfälle aus dem Schlaf, bspw. bei Patienten mit nächtlicher Frontallappenepilepsie. Da die nächtlichen, motorischen Symptome keine ausreichende und sichere Differenzierung der verschiedenen Differenzialdiagnosen zulassen, stellt die videobasierte Polysomnografie im Schlaflabor den Gold-Standard in der technischen Diagnosestellung dar. Ebenso dient die videobasierte Polysomnografie der Entscheidung zur erweiterten video-basierten elektroenzephalografischen Diagnostik. Vor diesem Hintergrund ist für die Diagnosestellung von Schlafwandeln und Non-REM-Parasomnien die enge Zusammenarbeit zwischen Schlafmedizinern und Epileptologen empfehlenswert.

Abstract

Parasomnias comprise a great variety of motor phenomena during sleep. According to the International Classification of Sleep Disorders II (ICSDII) parasomnias are subclassified into forms originating from Non-REM sleep stages or from the REM-sleep-stage. A third group comprises other parasomnias, which are not clearly originating form a definite sleep stage. Sleep walking, sleep terrors and confusional arousals are clinically the most important forms of Non-REM parasom­nias. The hallmark of all these forms is an arousal from Non-REM sleep stage 3 (slow wave sleep). The overall prevalence of Non-REM parasomnia is about 4% in the general population. Therefore they represent a common but underdiagnosed group of sleep disorders. Sleep related eating (SRED) is classified as a distinct form of other parasomnias in which the mechanism of arousal varies from Non-REM sleep stage 2 to 3. Daytime symptoms, recalling dreams and autonomic activation during parasomnic episodes is much more frequent than formerly postulated.

The most important differential diagnoses of sleep walking and other Non-REM parasomnias are forms of REM-sleep parasomnias as the REM behavorial disorder, and epileptic seizures during sleep, for example in patients withnocturnal frontal lobe epilepsy. Since abnormal sleep related motor symptoms are not specific enough to exclude the differential diagnoses, video based polysomnography is the gold standard to differentiate these different sleep disorders and to decide if further electrophysiological diagnostic procedures such as video-electroencephalopathy is needed. For that reason, cooperation of sleep specialists and epileptologists is highly recommended.

Schlüsselwörter

Schlafwandeln - Parasomnien - Epilepsie

Keywords

sleep walking - parasomnias - epilepsy

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