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Precipitating factors of somnambulism

Impact of sleep deprivation and forced arousals

From Centre d'Étude du Sommeil (M.P., J.M., A.Z.), Hôpital du Sacré-Cœur; and Departments of Psychology (M.P., A.Z.) and Psychiatry (J.M.), Université de Montréal, Québec, Canada.

Address correspondence and reprint requests to Dr. Antonio Zadra, Department of Psychology, Université de Montréal, C.P. 6128, succ. Centre-ville, Montreal, Quebec, Canada H3C 3J7 antonio.zadra{at}umontreal.ca

Objective: Experimental attempts to induce sleepwalking with forced arousals during slow-wave sleep (SWS) have yielded mixed results in children and have not been investigated in adult patients. We hypothesized that the combination of sleep deprivation and external stimulation would increase the probability of inducing somnambulistic episodes in sleepwalkers recorded in the sleep laboratory. The main goal of this study was to assess the effects of forced arousals from auditory stimuli (AS) in adult sleepwalkers and control subjects during normal sleep and following post-sleep deprivation recovery sleep.

Methods: Ten sleepwalkers and 10 controls were investigated. After a baseline night, participants were presented with AS at predetermined sleep stages either during normal sleep or recovery sleep following 25 hours of sleep deprivation. One week later, the conditions with AS were reversed.

Results: No somnambulistic episodes were induced in controls. When compared to the effects of AS during sleepwalkers' normal sleep, the presentation of AS during sleepwalkers' recovery sleep significantly increased their efficacy in experimentally inducing somnambulistic events and a significantly greater proportion of sleepwalkers (100%) experienced at least one induced episode during recovery SWS as compared to normal SWS (30%). There was no significant difference between the mean intensity of AS that induced episodes during sleepwalkers' SWS and the mean intensity of AS that awakened sleepwalkers and controls from SWS.

Conclusions: Sleep deprivation and forced arousals during slow-wave sleep can induce somnambulistic episodes in predisposed adults. The results highlight the potential value of this protocol in establishing a video-polysomnographically based diagnosis for sleepwalking.

Abbreviations: AS = auditory stimuli; PLMS = periodic leg movements during sleep; PSG = polysomnography; SWS = slow-wave sleep.

Editorial, page 2274

e-Pub ahead of print on May 7, 2008, at www.neurology.org.

Supported by a grant from the Canadian Institutes of Health Research (CIHR) to A. Zadra and J. Montplaisir and by a graduate fellowship from the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Fonds de la Recherche en Santé du Québec (FRSQ) to M. Pilon.

Disclosure: The authors report no disclosures.

Received July 26, 2007. Accepted in final form October 31, 2007.

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