title: Injurious sleep behavior disorders (parasomnias) affecting patients on intensive care units.
abstract: There are no previous reports on parasomnias (sleep behavior disorders) affecting patients on intensive care units (ICUs). During 8 years of clinical practice, we evaluated over 200 adults with complaints of injurious, sleep-related behaviors, 20 of whom had ICU admissions while their parasomnias had been active and generally undiagnosed/untreated. Mean age during ICU confinement was 62.8 (+/- SD 13.1) years; 85.0% (17/20) were males. Patients underwent comprehensive clinical examinations along with extensive polysomnographic and audiovisual monitoring (electrooculogram, 9 channel EEG with paper speeds of 15 and 30 mm/sec, electromyogram [submental and 4 limbs], EKG, airflow). The polysomnographic studies were diagnostic for the REM sleep behavior disorder (vigorous dream-enactment during rapid eye movement [REM] sleep) in 85.0% (17/20) of patients, and for night terrors/sleepwalking in 15.0% (3/20). Three groups of parasomnia-ICU relationships were identified: i) Parasomnias originating in ICUs, stroke-induced (n = 3); ii) Admission to ICUs resulting from parasomnia-induced injuries: C2 odontoid process fracture and C3 spinous process fracture with severe concussion (n = 2); iii) Parasomnias in patients admitted to ICUs for various other medical problems (n = 15). Physicians should be thus alerted about the possibility of injurious, but usually treatable, parasomnias in ICU patients.
authors.affiliation: Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: C H
authors.initials: CH
authors.lastname: Schenck
authors.forename: M W
authors.initials: MW
authors.lastname: Mahowald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002998:Clonazepam / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000188:drug therapy; D012895:Sleep, REM
chemical_list: D002998:Clonazepam