Adult sleepwalking is serious condition that impacts health-related quality of life

Public release date: 28-Feb-2013
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Contact: Lynn Celmer
lcelmer@aasmnet.org
630-737-9700
American Academy of Sleep Medicine

Left untreated it may induce violent behaviors, self-injury or injury to bed partners, sleep disruption, excessive daytime sleepiness, fatigue and psychological distress

DARIEN, IL A new study found that adult sleepwalking is a potentially serious condition that may induce violent behaviors and affect health-related quality of life.

"We found a higher frequency of daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms and altered quality of life in patients with sleepwalking compared to the control group," said Yves Dauvilliers, MD, PhD, the study's principal investigator and lead author. Dr. Dauvilliers is professor of physiology and neurology and director of the sleep lab at Gui-de-Chauliac Hospital in Montpellier, France. "What would usually be considered a benign condition, adult sleepwalking is a potentially serious condition and the consequences of sleepwalking episodes should not be ignored."

Results show that 22.8 percent of sleepwalkers presented with nightly episodes and 43.5 percent presented with weekly episodes. Additionally, a positive history of violent sleep related behaviors was found in 58 percent, including 17 percent who experienced at least one episode involving injuries to the sleepwalker or bed partner that required medical care. Reported injuries included bruises, nose bleeds and fractures, and one participant had sustained multiple fractures and serious head trauma after jumping out of a third-floor window.

Sleepwalking is a common parasomnia affecting up to four percent of adults. It involves complex behaviors that occur during arousals from non-rapid eye movement (NREM) sleep. During an episode of sleepwalking the brain is partially awake, resulting in complex behaviors, and partially in NREM sleep with no conscious awareness of actions.

According to the authors, this is the largest prospective cohort study on adult sleepwalkers seen in a clinic, using face-to-face clinical interviews, standardized questionnaires, and objective assessment by polysomnography to investigate the clinical characteristics, consequences and comorbidities of sleepwalking.

The study, appearing in the March issue of the journal SLEEP, involved a prospective case-control study of 100 adult patients in whom primary sleepwalking was diagnosed from June 2007 to January 2011. Exclusion criteria included a positive clinical history of REM sleep behavior disorder (RBD), a similar parasomnia that involves violent dream-related behaviors emerging during REM sleep. The age of the sleepwalkers ranged from 18 to 58 years with a median age of 30. Results were compared with 100 healthy control subjects.

Triggering factors that increased both the frequency and severity of episodes were reported in 59 percent, related mainly to stressful events, strong positive emotions, sleep deprivation, and less frequently to drug or alcohol intake or intense evening physical activity. All of these factors promote increased slow wave sleep (SWS) and NREM sleep instability.

"Sleepwalking is an underdiagnosed condition that may be clearly associated with daytime consequences and mood disturbances leading to a major impact on quality of life," said Dauvilliers. "The burden of sleepwalking in adults needs to be highlighted and emphasized."

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To request a copy of the study, "Functional Impairment in Adult Sleepwalkers: A Case-Control Study" or to arrange an interview with an AASM spokesperson, please contact Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or lcelmer@aasmnet.org.

The monthly, peer-reviewed, scientific journal SLEEP is published online by the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The AASM is a professional membership society that is the leader in setting standards and promoting excellence in sleep medicine health care, education and research.

The American Academy of Sleep Medicine considers sleep disorders an illness that has reached epidemic proportions. Board-certified sleep medicine physicians in an AASM-accredited sleep center provide effective treatment. AASM encourages patients to talk to their doctors about sleep problems or visit www.sleepeducation.com for a searchable directory of sleep centers.

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 28-Feb-2013
[ | E-mail | Share ]

Contact: Lynn Celmer
lcelmer@aasmnet.org
630-737-9700
American Academy of Sleep Medicine

Left untreated it may induce violent behaviors, self-injury or injury to bed partners, sleep disruption, excessive daytime sleepiness, fatigue and psychological distress

DARIEN, IL A new study found that adult sleepwalking is a potentially serious condition that may induce violent behaviors and affect health-related quality of life.

"We found a higher frequency of daytime sleepiness, fatigue, insomnia, depressive and anxiety symptoms and altered quality of life in patients with sleepwalking compared to the control group," said Yves Dauvilliers, MD, PhD, the study's principal investigator and lead author. Dr. Dauvilliers is professor of physiology and neurology and director of the sleep lab at Gui-de-Chauliac Hospital in Montpellier, France. "What would usually be considered a benign condition, adult sleepwalking is a potentially serious condition and the consequences of sleepwalking episodes should not be ignored."

Results show that 22.8 percent of sleepwalkers presented with nightly episodes and 43.5 percent presented with weekly episodes. Additionally, a positive history of violent sleep related behaviors was found in 58 percent, including 17 percent who experienced at least one episode involving injuries to the sleepwalker or bed partner that required medical care. Reported injuries included bruises, nose bleeds and fractures, and one participant had sustained multiple fractures and serious head trauma after jumping out of a third-floor window.

Sleepwalking is a common parasomnia affecting up to four percent of adults. It involves complex behaviors that occur during arousals from non-rapid eye movement (NREM) sleep. During an episode of sleepwalking the brain is partially awake, resulting in complex behaviors, and partially in NREM sleep with no conscious awareness of actions.

According to the authors, this is the largest prospective cohort study on adult sleepwalkers seen in a clinic, using face-to-face clinical interviews, standardized questionnaires, and objective assessment by polysomnography to investigate the clinical characteristics, consequences and comorbidities of sleepwalking.

The study, appearing in the March issue of the journal SLEEP, involved a prospective case-control study of 100 adult patients in whom primary sleepwalking was diagnosed from June 2007 to January 2011. Exclusion criteria included a positive clinical history of REM sleep behavior disorder (RBD), a similar parasomnia that involves violent dream-related behaviors emerging during REM sleep. The age of the sleepwalkers ranged from 18 to 58 years with a median age of 30. Results were compared with 100 healthy control subjects.

Triggering factors that increased both the frequency and severity of episodes were reported in 59 percent, related mainly to stressful events, strong positive emotions, sleep deprivation, and less frequently to drug or alcohol intake or intense evening physical activity. All of these factors promote increased slow wave sleep (SWS) and NREM sleep instability.

"Sleepwalking is an underdiagnosed condition that may be clearly associated with daytime consequences and mood disturbances leading to a major impact on quality of life," said Dauvilliers. "The burden of sleepwalking in adults needs to be highlighted and emphasized."

###

To request a copy of the study, "Functional Impairment in Adult Sleepwalkers: A Case-Control Study" or to arrange an interview with an AASM spokesperson, please contact Communications Coordinator Lynn Celmer at 630-737-9700, ext. 9364, or lcelmer@aasmnet.org.

The monthly, peer-reviewed, scientific journal SLEEP is published online by the Associated Professional Sleep Societies LLC, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The AASM is a professional membership society that is the leader in setting standards and promoting excellence in sleep medicine health care, education and research.

The American Academy of Sleep Medicine considers sleep disorders an illness that has reached epidemic proportions. Board-certified sleep medicine physicians in an AASM-accredited sleep center provide effective treatment. AASM encourages patients to talk to their doctors about sleep problems or visit www.sleepeducation.com for a searchable directory of sleep centers.

---

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-02/aaos-asi022813.php

Advanced breast cancer edges up in younger women - Herald Online

CHICAGO ? Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million - an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body - advanced disease - increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

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Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

Source: http://www.heraldonline.com/2013/02/26/4649441/advanced-breast-cancer-edges-up.html

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