Additional categories of sleep-related eating disorders and the current status of treatment.
Sleep-related eating disorders distinct from daytime eating disorders have recently been shown to be associated with sleepwalking (SW), periodic limb movement (PLM) disorder and triazolam abuse in a series of 19 adults. We now report eight other primary or combined etiologies identified by clinical evaluations and polysomnographic monitoring of 19 additional adults (mean age 40 years; 58% female): i) obstructive sleep apnea (OSA), with eating during apnea-induced confusional arousals (n = 3); ii) OSA-PLM disorder (n = 1); iii) familial SW and sleep-related eating (n = 2); iv) SW-PLM disorder (n = 1); v) SW-irregular sleep/wake pattern disorder (n = 1); vi) familial restless legs syndrome and sleep-related eating (n = 2); vii) anorexia nervosa with nocturnal bulimia (n = 2) and viii) amitriptyline treatment of migraines (n = 1). In our cumulative series of 38 patients (excluding six with simple obesity from daytime overeating), 44% were overweight (i.e. > 20% excess weight) from sleep-related eating. Nightly sleep-related binge eating (without hunger or purging) had occurred in 84% of patients. Onset of sleep-related eating was also closely linked with i) acute stress involving reality-based concerns about the safety of family members or about relationship problems (n = 6), ii) abstinence from alcohol and opiate/cocaine abuse (n = 2) and iii) cessation of cigarette smoking (n = 2). Current treatment data indicate a primary role of dopaminergic agents (carbidopa/L-dopa; bromocriptine), often combined with codeine and clonazepam, in controlling most cases involving SW and/or PLM disorder. Fluoxetine was effective in two of three patients. Nasal continuous positive airway pressure therapy controlled sleep-related eating in two OSA patients.
Schenck
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Minnesota Regional Sleep Disorders Center, Minneapolis 55415.
Hurwitz
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O'Connor
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Mahowald
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MW
D000328:Adult; D000368:Aged; D002675:Child, Preschool; D002985:Clinical Protocols; D002998:Clonazepam / Q000008:administration & dosage / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015259:Dopamine Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005190:Family; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D017286:Polysomnography; D011175:Positive-Pressure Respiration; D012148:Restless Legs Syndrome / Q000150:complications / Q000628:therapy; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000175:diagnosis; D013009:Somnambulism / Q000150:complications* / Q000523:psychology / Q000628:therapy; D013315:Stress, Psychological / Q000523:psychology
D015259:Dopamine Agents; D002998:Clonazepam