Parasomnias associated with sleep-disordered breathing and its therapy, including sexsomnia as a recently recognized parasomnia

Parasomnias are defined in the International Classification of Sleep Disorders-2nd Edition (ICSD-2) as undesirable physical events or experiences that occur during entry into sleep, within sleep, or during arousals from sleep. Instinctual behaviors can inappropriately emerge with the parasomnias, including appetite behaviors (feeding, sex), locomotion, aggression, and violence. Sleep disorders and their therapies carry their own risk for parasomnias, including sleep-disordered breathing (SDB) and its therapy with nCPAP. A Pub Med literature search was conducted for peer-reviewed journal articles with key words "parasomnia" (and other specific parasomnias) linked with "sleep apnea" or "sleep disordered breathing." Eight of the 12 parasomnias found in the ICSD-2 are associated with SDB, along with 3 of the 4 parasomnia variants in ICSD-2, for a total of 11 of 16 (68.7%) parasomnias and their variants being associated with SDB. The list of parasomnias includes confusional arousals (and its variants, severe morning sleep inertia, and sleep related abnormal sexual behaviors [sexsomnia, sleepsex]); sleepwalking; sleep terrors; sleep related eating disorder; REM sleep behavior disorder (and "OSA pseudo RBD"); parasomnia overlap disorder (RBD combined with a disorder of arousal); nightmare disorder; sleep related groaning (catathrenia); and sleep enuresis. Sleep Related Movement Disorders include sleep related bruxism and sleep related rhythmic movement disorder. Other conditions include gastrooesophageal reflux disorder with sleep related laryngospasm; cerebral anoxic attacks; nocturnal seizures (Complex Partial Seizures; Nocturnal Frontal Lobe Epilepsy); sleep related anxiety reactions and panic attacks; chronic hiccups; and sleep choking syndrome. A case report is included of a man with moderately severe OSA and with recurrent, unconscious sexsomnia with his wife, who fully responded to nCPAP therapy that normalized his SDB and complete ly eliminated the sexsomnia, which presumably had emerged during OSA confusional arousals. A current classification of sexsomnia, a recently recognized parasomnia variant, is reviewed, along with comments on OSA-sexsomnia.