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. 2022 May 1;18(5):1355-1364.
doi: 10.5664/jcsm.9862.

Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias

Smaranda Leu-Semenescu  1   2 , Jean-Baptiste Maranci  1   2   3 , Régis Lopez  2   4   5 , Xavier Drouot  6 , Pauline Dodet  1   2 , Ana Gales  1   2 , Elisabeth Groos  1   2 , Lucie Barateau  2   4   5 , Patricia Franco  2   7   8 , Michel Lecendreux  2   9 , Yves Dauvilliers  2   4   5 , Isabelle Arnulf  1   2   3
Affiliations

Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias

Smaranda Leu-Semenescu et al. J Clin Sleep Med. .

Abstract

Study objectives: To assess the frequency, determinants, and clinical impact of clinical rapid eye movement (REM) and non-REM (NREM) parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia compared with healthy controls.

Methods: Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 idiopathic hypersomnia) and 595 healthy controls.

Results: Except for sleep-related eating disorder, current NREM parasomnias were rare in all patient groups and controls. Sleep-related eating disorder was more frequent in NT1 patients (7.9% vs 1.8% in NT2 patients, 2.1% in patients with idiopathic hypersomnia, and 1% in controls) and associated with disrupted nighttime sleep (odds ratio = 3.9) and nocturnal eating in full awareness (odds ratio = 6.9) but not with sex. Clinical REM sleep behavior disorder was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (odds ratio = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms, and antidepressant use. Frequent (> 1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2, and 27.8% with idiopathic hypersomnia (vs 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness.

Conclusions: In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except for sleep-related eating disorder) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and are associated with male sex, disrupted nighttime sleep, depressive symptoms, and antidepressant use.

Citation: Leu-Semenescu S, Maranci J-B, Lopez R, et al. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med. 2022;18(5):1355-1364.

Keywords: REM sleep behavior disorder; antidepressants; idiopathic hypersomnia; narcolepsy; nightmare disorder; sleep talking; sleep terrors; sleep-related eating disorder; sleepwalking.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France; Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; and the Sleep Disorder Unit, Mondor Hospital, Créteil. This study was funded by PHRC AOM07-138 from the French Health Ministry (promoter: Assistance Publique-Hôpitaux de Paris; principal investigator: I.A.). Isabelle Arnulf received an honorarium from UCB Pharma for speaking engagements and was a consultant for Idorsia Pharma and Ono Pharma. These financial disclosures are unrelated to the present study and topic. Yves Dauvilliers received funds for seminars, board engagements, and travel to conferences from UCB Pharma, Jazz Pharma, Theranexus, Flamel, and Bioprojet Pharma. Régis Lopez received funds for speaking from UCB Pharma and Shire Pharma. Lucie Barateau and Smaranda Leu-Semenescu received funds for travel to conferences from UCB Pharma. Patricia Franco had speaking engagements with UCB Pharma and was a consultant for Biocodex Pharma. Michel Lecendreux has received consulting fees and honoraria and has been on advisory boards for Bioprojet Pharma, Jazz Pharma, UCB Pharma, and Alvadel Pharma. Ana Gales has received honoraria for speaking engagements from EISAI Pharma. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Spearman correlation matrix between parasomnias in NT1, NT2, and IH.
The color of each box indicates the strength of the correlation (darkest = highest, as indicated in the right column), and asterisks indicate the significance of the correlation (*P < .01, **P < .001). IH = idiopathic hypersomnia, NT1 = narcolepsy type 1, NT2 = narcolepsy type 2, RBD = REM sleep behavior disorder, REM = rapid eye movement, SRED = sleep-related eating disorder.
See this image and copyright information in PMC

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