title: Sexual behaviors during sleep associated with polysomnographically confirmed parasomnia overlap disorder.
abstract: Parasomnia overlap disorder (POD) refers to a sleep disorder characterized by the association of REM sleep behavior disorder (RBD) with NREM sleep parasomnia in the same patient. Sexual behaviors during sleep (SBS) can include most wakeful sexual activities and are classified in the ICSD-2 as a variant of confusional arousals and sleepwalking, both NREM parasomnias. A case of SBS associated with sleepwalking and possible RBD has been previously described, but it was not confirmed by polysomnography (PSG). We report two patients with SBS associated with POD documented by PSG. In one patient (60-year-old female) SBS was video-polysomnographically demonstrated: a few minute episode of masturbation occurring during slow-wave sleep (SWS) and preceded by hypersynchronous delta pattern. During the episode, the EEG pattern showed the persistence of delta rhythms with increasing alpha activity. When awoken by technicians, the patient was not aware of her sexual behavior and did not report any dream. The other patient, a 41-year-old male with a history of sleepwalking and RBD, was legally charged with repeatedly sexually fondling a young girl during the night. The POD was documented by PSG. The parasomnia defense, including sleepsex, was accepted by the Court and the patient was acquitted. This is an unprecedented report of SBS in patients with PSG-confirmed POD and of SBS documented during video-PSG.
authors.affiliation: Sleep Disorder Center, Department of Neurosciences, University of Turin, Italy. alessandro.cicolin@unito.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cicolin
authors.forename: Antonella
authors.initials: A
authors.lastname: Tribolo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giordano
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Chiarot
authors.forename: Elena
authors.initials: E
authors.lastname: Peila
authors.forename: Anna
authors.initials: A
authors.lastname: Terreni
authors.forename: Caterina
authors.initials: C
authors.lastname: Bucca
authors.forename: Roberto
authors.initials: R
authors.lastname: Mutani
mesh_terms: D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual; D003415:Crime; D005104:Expert Testimony; D005260:Female; D006801:Humans; D008297:Male; D008418:Masturbation; D008875:Middle Aged; D020447:Parasomnias / Q000175:diagnosis* / Q000503:physiopathology*; D017286:Polysomnography; D020187:REM Sleep Behavior Disorder / Q000175:diagnosis* / Q000503:physiopathology*