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Articles
May 14, 2012
Letter to the Editor

Prevalence and comorbidity of nocturnal wandering in the US adult general population

May 15, 2012 issue
78 (20) 1583-1589

Abstract

Objective:

To assess the prevalence and comorbid conditions of nocturnal wandering with abnormal state of consciousness (NW) in the American general population.

Methods:

Cross-sectional study conducted with a representative sample of 19,136 noninstitutionalized individuals of the US general population ≥18 years old. The Sleep-EVAL expert system administered questions on life and sleeping habits; health; and sleep, mental, and organic disorders (DSM-IV-TR; International Classification of Sleep Disorders, version 2; International Classification of Diseases–10).

Results:

Lifetime prevalence of NW was 29.2% (95% confidence interval [CI] 28.5%–29.9%). In the previous year, NW was reported by 3.6% (3.3%–3.9%) of the sample: 1% had 2 or more episodes per month and 2.6% had between 1 and 12 episodes in the previous year. Family history of NW was reported by 30.5% of NW participants. Individuals with obstructive sleep apnea syndrome (odds ratio [OR] 3.9), circadian rhythm sleep disorder (OR 3.4), insomnia disorder (OR 2.1), alcohol abuse/dependence (OR 3.5), major depressive disorder (MDD) (OR 3.5), obsessive-compulsive disorder (OCD) (OR 3.9), or using over-the-counter sleeping pills (OR 2.5) or selective serotonin reuptake inhibitor (SSRI) antidepressants (OR 3.0) were at higher risk of frequent NW episodes (≥2 times/month).

Conclusions:

With a rate of 29.2%, lifetime prevalence of NW is high. SSRIs were associated with an increased risk of NW. However, these medications appear to precipitate events in individuals with a prior history of NW. Furthermore, MDD and OCD were associated with significantly greater risk of NW, and this was not due to the use of psychotropic medication. These psychiatric associations imply an increased risk due to sleep disturbance.

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Letters to the Editor
6 August 2012
Nocturnal Wandering is Associated With Conditions Other Than Sleepwalking
Mark R. Pressman, Director, Sleep Medicine Services

As noted by the Ohayon et al. [1], nocturnal wandering (NW) is not synonymous with sleepwalking. NW may also refer to wandering during the night due to epilepsy. Alcohol intoxication is well known to result in drunken behavior while awake but this type of cognitive impairment may be undistinguishable from other forms of NW. Dementia and CNS drug effects can also result in NW.

Alternate explanations of the data are available. The highest OR for NW reported was for obsessive compulsive disorder (OCD). OCD has no known relationship to sleepwalking, nor are there any published reports. However, SSRI medications used to treat OCD are well known to increase tonic EMG levels during REM sleep and are thus most likely associated with REM behavior disorder, not sleepwalking. [2] Sleepwalking is typically associated with amnesia and has a familial pattern, but this is also true of alcoholism.

Ohayon et al.'s study does not provide any direct evidence to support the claim that alcohol causes sleepwalking. Rather there is an association of NW with individuals who report alcohol abuse in their past. Causation for individual subjects cannot be determined from these data. There has never been an empirical, laboratory-based study of alcohol use in clinically diagnosed sleepwalkers. [3]

1. Ohayon, MM, Mahowald MW, Duavilliers Y, Krystal AD, Leger D. Prevelence and comorbitity of nocturnal wandering the US adult general population. Neurology 2012:78;1583-1589.

2. Schenck CH, Mahowald MW, Kim SW, O'Connor KA, Hurwitz TD. Prominent eye movements during NREM sleep and REM sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder. Sleep 1992;15:226-235.

3. Pressman MR, Mahowald MW, Schenck CH, Cramer Borneman MA. Alcohol- Induced Sleepwalking or Confusional Arousals as a Defense to Criminal Behavior: Review of Scientific Evidence, Methods and Forensic Considerations, Journal of Sleep Research 2007;6:198-212.

For disclosures, contact the editorial office at [email protected]

16 August 2012
Notice regarding previously posted letter
Kathleen M. Pieper, Managing Editor

NOTICE: A letter "Alcohol and Nocturnal Wandering" by C Shapiro,P Fenwick, C Idzikowski, A Williams and I Ebrahim was posted previously on this site, but removed because some of the content was plagiarized from a another article.

Information & Authors

Information

Published In

Neurology®
Volume 78Number 20May 15, 2012
Pages: 1583-1589
PubMed: 22585435

Publication History

Received: October 13, 2011
Accepted: January 17, 2012
Published online: May 14, 2012
Published in print: May 15, 2012

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Authors

Affiliations & Disclosures

M.M. Ohayon, MD, DSc, PhD
From the Stanford Sleep Epidemiology Research Center (M.M.O.), School of Medicine, Stanford University, Stanford, CA; Minnesota Regional Sleep Disorders Center (M.W.M.), Department of Neurology, Hennepin County Medical Center, The University of Minnesota Medical School, Minneapolis; Centre de Référence Nationale Maladie Rare–Narcolepsie et Hypersomnie Idiopathique (Y.D.), Service de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France; Duke University School of Medicine (A.D.K.), Durham, NC; and Université Paris Descartes (D.L.), APHP, Hôtel-Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
Disclosure
Scientific Advisory Boards:
1.
Sanofi-Aventis, scientific advisory board Pfizer Inc,scientific advisory board
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Sleep, editorial advisory board, 1998-present; Sleep Medicine, editorial advisory board, 2000- present; Journal of Psychiatry Research, Assistant Editor, 2006-present
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
Panelist at a FDA-PERI co-sponsored workshop on The Safety and Efficacy of Hypnotic Drugs, 2011
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
1) Grant from Neurocrines Biosciences for educational activities 2) Research gift from Jazz Pharmaceuticals
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
M.W. Mahowald, MD
From the Stanford Sleep Epidemiology Research Center (M.M.O.), School of Medicine, Stanford University, Stanford, CA; Minnesota Regional Sleep Disorders Center (M.W.M.), Department of Neurology, Hennepin County Medical Center, The University of Minnesota Medical School, Minneapolis; Centre de Référence Nationale Maladie Rare–Narcolepsie et Hypersomnie Idiopathique (Y.D.), Service de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France; Duke University School of Medicine (A.D.K.), Durham, NC; and Université Paris Descartes (D.L.), APHP, Hôtel-Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editorial advisory board: Sleep and Sleep Medicine (resigned from both one year ago)
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Y. Dauvilliers, MD, PhD
From the Stanford Sleep Epidemiology Research Center (M.M.O.), School of Medicine, Stanford University, Stanford, CA; Minnesota Regional Sleep Disorders Center (M.W.M.), Department of Neurology, Hennepin County Medical Center, The University of Minnesota Medical School, Minneapolis; Centre de Référence Nationale Maladie Rare–Narcolepsie et Hypersomnie Idiopathique (Y.D.), Service de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France; Duke University School of Medicine (A.D.K.), Durham, NC; and Université Paris Descartes (D.L.), APHP, Hôtel-Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
Disclosure
Scientific Advisory Boards:
1.
UCB; Sanofi-Aventis; Cephalon; Bioprojet, and; Novartis
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
UCB; Sanofi-Aventis; Cephalon; Bioprojet, and; Novartis Speakers’ Bureaus:; UCB; Sanofi-Aventis; Cephalon; Bioprojet, and; Novartis
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
A.D. Krystal, MD, MS
From the Stanford Sleep Epidemiology Research Center (M.M.O.), School of Medicine, Stanford University, Stanford, CA; Minnesota Regional Sleep Disorders Center (M.W.M.), Department of Neurology, Hennepin County Medical Center, The University of Minnesota Medical School, Minneapolis; Centre de Référence Nationale Maladie Rare–Narcolepsie et Hypersomnie Idiopathique (Y.D.), Service de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France; Duke University School of Medicine (A.D.K.), Durham, NC; and Université Paris Descartes (D.L.), APHP, Hôtel-Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
Disclosure
Scientific Advisory Boards:
1.
Abbott, 2) Cephalon; Eisai; Eli Lilly; GlaxoSmithKline; Jazz; Merck; Neurocrine; Novartis; Phillips-Respironics; Sanofi-Aventis; Sunovion/Sepracor; Somaxon; Transcept; Kingsdown Inc.; Actelion
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Somaxon; Sunovion; Cephalon
Editorial Boards:
1.
SLEEP, Associate Editor; Biological Psychiatry, Editorial Board; Mind and Brain, Editorial Board; SRP Journal of URology, Editorial Board; Current Psychiatry Reviews, Editorial Board; Journal of ECT and Related Therapies, Editorial Board; Stanford Journal of Sleep Epidemiology, Editorial Board
Patents:
1.
Use of near-infrared optical imaging to optimize the dosing of transcranial magnetic stimulation.
Publishing Royalties:
1.
Clinical Manual of Electroconvulsive Therapy; American Psychiatric Publishing Inc. 2010
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Abbott; AstraZeneca; Cephalon; Eisai; Eli Lilly; GlaxoSmithKline; Jazz; Johnson and Johnson; Merck; Neurocrine; Novartis; Pfizer; Phillips-Respironics; Roche; Sanofi-Aventis; Somnus; Sunovion/Sepracor; Somaxon; Takeda; Transcept; Kingsdown Inc.
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Sanofi-Aventis; Cephalon; GlaxoSmithKline; Merck; Neurocrine; Pfizer; Sunovion/Sepracor; Somaxon; Takeda; Transcept; Phillips-Respironics; Neurogen; Evotec; Astellas; Abbott; Neuronetics
Research Support, Government Entities:
1.
NIH; U01MHAR052155 (PI-Krystal) 2009-2011; NHLBI R01HL096492 (PI-Krystal) 2009-2013; NIAMS R01 AR052368 (PI: Edinger) 2006-2011; NIMH R01 MH078961-01A2 (PI: Edinger) 2008-2013; NIDDK R01 DK087717 (PI: Krystal) 2010-2013; NINR R21 NR010539 (PI: Krystal) 2007-2010; 5U01 AR 052186 (PI:Weinfurt) 2004-2009; R01 MH067057 (PI: Edinger) 2004-2009; NIMH R01 MH076856 (PI: Carney) 2008–2009; NIMH R01 MH091053-01A1 (PI: Edinger)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
Attentiv
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
Astra-Zeneca: Expert witness 2009-present
D. Léger, MD, PhD
From the Stanford Sleep Epidemiology Research Center (M.M.O.), School of Medicine, Stanford University, Stanford, CA; Minnesota Regional Sleep Disorders Center (M.W.M.), Department of Neurology, Hennepin County Medical Center, The University of Minnesota Medical School, Minneapolis; Centre de Référence Nationale Maladie Rare–Narcolepsie et Hypersomnie Idiopathique (Y.D.), Service de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France; Duke University School of Medicine (A.D.K.), Durham, NC; and Université Paris Descartes (D.L.), APHP, Hôtel-Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
Disclosure
Scientific Advisory Boards:
1.
Sanofi-Aventis; Lundbeck; Actelion; GSK; Lilly; Pfizer; Merck; Philips Respironics; Vanda; Bioprojets; APL; Zyken; Air Liquide international
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Journal of Sleep Research; Medecine du Sommeil; Sleep Medecine Review
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Sanofi-Aventis; Lundbeck; Actelion; GSK; Lilly; Pfizer; Merck; Philips Respironics; Vanda; Bioprojets; APL; Zyken; Air Liquide International
Speakers’ Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Sanofi-Aventis; Lundbeck; Actelion; GSK; Lilly; Pfizer; Merck; Philips Respironics; Vanda; Bioprojets; APL; Zyken; Air Liquide International
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Study funding: Supported by NIH grant R01NS044199, the Arrillaga Foundation, the Bing Foundation, and an educational grant from Neurocrines Biosciences (M.M.O.). The sponsors had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data. There was no editorial direction or censorship from the sponsors. The sponsors have not seen the manuscript and had no role in the decision to submit the paper for publication.
Correspondence & reprint requests to Dr. Ohayon: [email protected]

Author Contributions

All authors were involved in the conception and design or analysis and interpretation of data, have contributed to the drafting and revisions of the manuscript, and have approved the submitted version.

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