Sleep Violence and Polysomnography

In the last decade, 16 polysomnographic (PSG) studies involving at least five cases with violent or injurious behaviors during sleep can be found in the MEDLINE.

  • Nine of them included exclusively (or almost) REM behavioral disorder (RBD) (7-15).
  • Two studies were devoted to sleepwalking and/or sleep terrors patients (16,17).
  • Only one compared different parasomnias involving violent or injurious behaviors during sleep (see Table 1) (18).

Kavey et al. (16) studied 10 sleepwalkers with episodes of violent behavior or self-injury. Recorded sleepwalking episodes occurred all in the NREM sleep but were not limited to the first third of the night as suggested by the classifications; near half of recorded episodes occurred in the latter 2/3 of the night.

Moldofsky et al. (17) studied 64 consecutive patients with sleepwalking or sleep terrors. They further divided the patients within three groups: those who committed serious violence during sleep to other individuals, property or self; those with harmful but not destructive behavior and nonviolent behavior during sleep. The serious violent group was composed mainly of men (22/26). Both violent and harmful behaviors were more likely to occur with drug abuse (caffeine, alcohol, drugs). The best predictors of violent group membership were being a man and having <2% stage 4 sleep.

Schenck et al. (18) studied 100 consecutive adults patients with a main complaint of nocturnal injury to themselves and/or their bedpartners. About half of them were with night terrors-sleepwalking, 36 had RBD, seven a dissociative disorder, two nocturnal seizures and one sleep apnea and periodic limb movements disorder. In the night terrors-sleepwalking group, some results were different of the current opinion about this disorder:

  • First, in about one third of cases, the disorder begun in late adolescence or adulthood;
  • Second, all NREM sleep stages are commonly involved;
  • Third, elaborate dreamlike mentation can be present with substantial recall of nocturnal behaviors;
  • Forth, a current mental disorder was present in only one third of this group.

In the RBD group, prodromal symptoms appeared 10 to 40 years before the full manifestation of the disorder in 25% of the studied cases. This prodrome is characterized by sleep talking, yelling, or limbjerking during sleep.
The initial sample of Schenck et al. (7) to describe RBD included four men and one woman, all aged 60 years or over. Four of them had neurological disorders.
In all studies, RBD is observed almost exclusively in men and is frequently associated with a neurological disorder. The polysomnographic results showed a higher REM density than normal in all studies on RBD. Some studies reported excessive slow-wave sleep for the age of patients (7,8,11,13,14) but this was not found in other studies (19). This could be due to the heterogeneity of neurological diseases observed in RBD patients. A study investigated 12 non-epileptic young patients with episodic nocturnal wanderings (20), a disorder that shares many similarities with sleepwalking/night terrors but thought to have an epileptiform etiology because it is responding to anticonvulsants. Nocturnal seizures are difficult to capture on EEG and may have uncertain significance since they can be also observed in many other neurological conditions and also in normal subjects. In this study, the epileptiform etiology have been confirmed only in four of the twelve patients.

Table 1. Summary of the samples including subjects with violent or injurious behaviors during sleep RBD*: REM Behavior Disorder
Authors N of cases M/F Age range Sleep diagnosis
Schenck et al (1986)(7) 5 4/1 60-72 RBD*
Schenck et al (1987)(8) 5 5/0 57-75 RBD
Maselli et al (1988)(20) 12 7/5 19-29 Episodic nocturnal wandering
Shimizu et al (1990)(9) 14 10/4 48-73 RBD
Sforza et al.(1988)(10) 6 5/1 42-69 RBD
Culebras &Moore (1989)(11) 6 4/2 64-74 RBD
Schenck et al (1989)(18) 100 71/29 18-79 Sleepwalking/Night terrors (n=54)
RBD (n=36)Others (n=10)
Kavey et al (1990)(16) 10 6/4 18-40 Sleepwalking
Schenck et al.(1990)(12) 70 63/7 10-77 RBD
Schenck &Mahowald (1991)(13) 20 17/3/td> 20-81 17 RBD,3 Sleep walking/Night
Tachibana et al (1991)(19) 7 3/4 61-81 RBD
Schenck et al.(1992)(43) 17 12/5 8-74 Narcolepsy +RBD
Lapierre &Montplaisir (1992)(14) 5 3/2 44-65 RBD
Moldofsky et al (1995)(17) 64 39/25 18-71 Sleepwalking or Night terrors
Comella et al (1998)(15) 9/61 7/2 9 RBD,52 Parkinson disease


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Content of this page is extracted from:
Ohayon MM. Violence and Sleep. Sleep and Hypnosis, 2000; 2: 1-6.