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Schlafwandeln, Schlaftrunkenheit und Nachtschreck: die klassischen NREM‑Parasomnien und ihre Differenzialdiagnose im Erwachsenenalter

Sleepwalking, confusional arousals, and sleep terrors: the classic NREM parasomnias and their differential diagnosis in adulthood

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Zusammenfassung

Schlafwandeln, Schlaftrunkenheit (Confusional Arousals) und Pavor nocturnus (Schlafterror, Nachtterror oder Nachtschreck) sowie die schlafbezogene Essstörung sind die häufigsten und klinisch bedeutendsten Formen der NREM-Parasomnien mit einem Beginn aus Schlafstadium N3. Als gemeinsame Kriterien gelten nach der International Classification of Sleep Disorders (ICSD-3) das Auftreten wiederholter Episoden unvollständigen Erwachens, ein unangemessenes oder fehlendes Ansprechen auf externe Stimuli während der Episode, keine oder eingeschränkte Traumerinnerung und partielle oder völlige Amnesie hinsichtlich des Ereignisses. Die Gesamtprävalenz der NREM-Parasomnien bei Erwachsenen wird mit ca. 4 % angegeben.

Durch die Videopolysomnographie mit erweiterter EEG/EMG-Montage ist eine differenzialdiagnostische Abgrenzung gegenüber REM-Parasomnien und Frontallappenepilepsien möglich.

Therapeutisch sind die Aufklärung über die Störung sowie über Maßnahmen, die der Sicherheit des Betroffenen und seines Bettpartners während parasomnischer Ereignisse dienen, sowie das Vermeiden von Situationen (wie z. B. Schlafentzug und Schlaf-Wach-Rhythmusverschiebungen) und Substanzen, die eine Arousalhäufung zur Folge haben, von Bedeutung. Gezielte Therapieoptionen umfassen Verhaltenstherapie, Hypnose und medikamentöse Behandlung, wobei die Datenlage hinsichtlich der Therapiemöglichkeiten eher dürftig ist, vor allem was Langzeitdaten betrifft.

Abstract

Sleepwalking, confusional arousals, and sleep terrors (night terrors, pavor nocturnus) as well as sleep-related eating disorder are the most frequent and clinically relevant forms of NREM-related parasomnias and occur as a result of incomplete arousal from sleep stage N3. According to the International Classification of Sleep Disorders (ICSD-3), the following diagnostic criteria must be met: recurrent episodes of incomplete awakening from sleep, inappropriate or absent responsiveness to the efforts of others to intervene during the episode, limited or no associated cognition or dream imagery, and partial or complete amnesia regarding the episode. The overall prevalence of NREM-related parasomnias is about 4 % in adults.

By means of video-based polysomnography with an extended EEG/EMG montage, NREM-related parasomnias can be differentiated from REM-related parasomnias and epileptic seizures during sleep, such as in frontal lobe epilepsy.

Therapeutic interventions focus on informing the patient about the disorder and about measures to ensure the patient’s and his/her bedpartner’s safety during parasomniac episodes, and how to avoid situations and substances that increase arousals, such as sleep deprivation or sleep–wake rhythm disruptions. More specific approaches comprise behavioral therapy, hypnosis, and pharmacotherapy, although long-term data on therapeutic measures are scarce.

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Authors and Affiliations

  1. Zentrum für ambulante Schlafmedizin/Schlaflabor Rudolfinerhaus, Billrothstr. 78, 1190, Wien, Österreich

    M. Saletu

  2. NRZ Rosenhügel, Rosenhügelstr. 192a, 1130, Wien, Österreich

    M. Saletu

  3. Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    G. M. Saletu-Zyhlarz

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M. Saletu und G.M. Saletu-Zyhlarz geben an, dass kein Interessenkonflikt besteht.

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Saletu, M., Saletu-Zyhlarz, G.M. Schlafwandeln, Schlaftrunkenheit und Nachtschreck: die klassischen NREM‑Parasomnien und ihre Differenzialdiagnose im Erwachsenenalter. Somnologie 19, 226–232 (2015). https://doi.org/10.1007/s11818-015-0028-2

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