Injurious sleep behavior disorders (parasomnias) affecting patients on intensive care units

Carlos H Schenck, Mark Mahowald

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63 Scopus citations


There are no previous reports on parasomnias (sleep behavior disorders) affecting patients on intensive care units (ICUs). During 8 years of clinical practice, we evaluated over 200 adults with complaints of injurious, sleep-related behaviors, 20 of whom had ICU admissions while their parasomnias had been active and generally undiagnosed/untreated. Mean age during ICU confinement was 62.8 (±SD 13.1) years; 85,0% (17/20) were males. Patients underwent comprehensive clinical examinations along with extensive polysomnographic and audiovisual monitoring (electrooculogram, 9 channel EEG with paper speeds of 15 and 30 mm/sec, electromyogram [submental and 4 limbs], EKG, airflow). The polysomnographic studies were diagnostic for the REM sleep behavior disorder (vigorous dream-enactment during rapid eye movement [REM] sleep) in 85.0% (17/20) of patients, and for night terrors/sleepwalking in 15.0% (3/20). Three groups of parasomnia-ICU relationships were identified: i) Parasomnias originating in ICUs, stroke-induced (n=3); ii) Admission to ICUs resulting from parasomnia-induced injuries: C2 odontoid process fracture and C3 spinous process fracture with severe concussion (n=2); iii) Parasomnias in patients admitted to ICUs for various other medical problems (n=15). Physicians should be thus alerted about the possibility of injurious, but usually treatable, parasomnias in ICU patients.

Original languageEnglish (US)
Pages (from-to)219-224
Number of pages6
JournalIntensive Care Medicine
Issue number4
StatePublished - Apr 1 1991


  • Intensive care unit
  • Night terrors
  • Parasomnias
  • Polysomnography
  • REM sleep behavior disorder
  • Sleep injury
  • Sleepwalking


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