Sleep-related eating disorders: Polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorders

C. H. Schenck, T. D. Hurwitz, S. R. Bundlie, M. W. Mahowald

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134 Scopus citations

Abstract

Over a 5-yr period, 19 adults presented to our sleep disorders center with histories of involuntary, nocturnal, sleep-related eating that usually occurred with other problematic nocturnal behaviors. Mean age (± SD) at presentation was 37.4 (± 9.1) yr (range 18-54); 73.7% of the patients (n = 14) were female. Mean age of sleep-related eating onset was 24.7 (± 12.9) yr (range 5-44). Eating occurred from sleep nightly in 57.9% (n = 11) of patients. Chief complaints included excessive weight gain, concerns about choking while eating or about starting fires from cooking and sleep disruption. Extensive polysomnographic studies, clinical evaluations and treatment outcome data identified three etiologic categories for the sleep-related eating: (a) sleepwalking (SW), 84.2% (n = 16); (b) periodic movements of sleep (PMS), 10.5% (n = 2) and (c) triazolam abuse (0.75 mg hs), 5.3% (n = 1). DSM-III Axis 1 psychiatric disorders (affective, anxiety) were present in 47.4% (n = 9) of the patients, and only two patients had a daytime eating disorder (anorexia nervosa), each in remission for 3-7 yr. Nearly half of all patients fulfilled established criteria for being overweight, based on the body mass index. Onset of sleep-related eating was linked directly to the onset of SW, PMS, triazolam abuse, nicotine abstinence, chronic autoimmune hepatitis, narcolepsy, encephalitis or acute stress. In the SW group, 72.7% (8/11) of patients had nocturnal eating and other SW behavior suppressed by clonazepam (n = 7) and/or bromocriptine (n = 2) treatment. Both patients with PMS likewise responded to treatment with combinations of carbidopa/L-dopa, codeine and clonazepam. Thus, sleep-related eating disorders can generally be controlled with treatment of the underlying sleep disorder.

Original languageEnglish (US)
Pages (from-to)419-431
Number of pages13
JournalSleep
Volume14
Issue number5
DOIs
StatePublished - 1991

Keywords

  • Affective disorders
  • Body mass index
  • Bromocriptine
  • Carbidopa/L-dopa
  • Chronic autoimmune hepatitis
  • Clonazepam
  • Eating disorders
  • HLA-DR2-negative narcolepsy
  • Narcolepsy
  • Periodic movements of sleep
  • Sleep-related (nocturnal) eating disorders
  • Sleep-related injury
  • Sleepwalking
  • Triazolam abuse

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