Update on sexsomnia, sleep related sexual seizures and forensic implications

The first classification of sleep-related disorders and abnormal sexual behaviors and experiences was published in 2007. Parasomnias (abnormal sleep-related behaviors and experiences) and sleep-related epileptic seizures were the most frequent disorders, after Kleine-Levin syndrome (periodic hypersomnia with abnormal wakeful sexual behaviors). The first two conditions were named sexsomnia (sleepsex) and epileptic (ictal) exsomnia, respectively. Sexsomnia usually emerges during confusional arousals (CAs) from delta non-REM sleep (N3 sleep), either associated or unassociated with obstructive sleep apnea (OSA). We now report an additional 22 cases of sexsomnia and 3 cases of ictal sexsomnia (temporal lobe epilepsy; bupropion-induced seizures) published from 2007-2015, based on a literature search in PubMed and Embase, and also separately for Turkish language publications. Eighteen of the 22 additional cases of sexsomnia had sufficient data provided to allow for comparative analysis. (The 4 other additional cases involved sexsomnia emerging with Parkinson's disease). The demographics of the second group of 18 sexsomnia cases were comparable to those of the first group of 31 cases (published in 2007), in regards to male gender predominance (67% vs. 81%); age at presentation (40 yrs vs. 32 yrs); age of onset (33 yrs vs. 26 yrs); and mean duration of sexsomnia in males (5.6 yrs vs. 8.3 yrs). The female groups were too small to compare. The distribution of sexual behaviors across the groups was generally comparable in regards to sexual vocalizations, masturbation, fondling, and intercourse/attempted intercourse. Amnesia for the sexsomnia by the affected person was 89% vs. 100%. Video-polysomnographic studies wereconducted in nearly all patients in both groups, and provided important diagnostic findings in almost all patients. The mean number of arasomnias per patient was 1.8+1.4 vs. 2.2+1.0, respectively, with the range extending up to 5 parasomnias per patient. In both groups, a non-REM sleep parasomnia (disorder of arousal [DOA]) was the main cause of the sexsomnia (78% vs. 90%). There was a comparable percentage in each group having obstructive sleep apnea (OSA) as the presumed trigger for a DOA with sexsomnia (17% vs. 13%), and there was control of both sexsomnia and OSA with nasal CPAP in 100% (4/4) of treated cases. Overall treatment efficacy was 82% (n=18) in the 22 patients in the combined groups (n=53) for whom treatment was reported. Nine novel findings on sexsomnia were identified. An abstract on 41 consecutive cases of sexsomnia evaluated at a single sleep center in the U.K. was recently published, and the findings are highly congruent with the 53 cumulative cases in the world literature reported herein. Thus, there are now 94 total cases of sexsomnia reported in the world literature. The forensic implications of sexsomnia are discussed.