Diagnostic criteria for disorders of arousal: A video-polysomnography assessment

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ABSTRACT

Study objectives:

To assess video-polysomnographic (vPSG) criteria and their cut-off values for the diagnosis of disorders of arousal (DOA; sleepwalking, sleep terror).

Methods:

One hundred and sixty adult patients with DOA and 50 sex- and age-matched healthy participants underwent a clinical evaluation and vPSG assessment to quantify slow wave sleep (SWS) interruptions (SWS fragmentation index; slow/mixed and fast arousal ratios and indexes per hour) and the associated behaviors. First, a case-control analysis was performed in 100 patients and the 50 controls to define the optimal cut-off values using receiver operating characteristic curves. Their sensitivity was then assessed in the other 60 patients with DOA.

Results:

The SWS fragmentation index and the mixed, slow, slow/mixed arousal indexes and ratios were higher in patients with DOA than controls. The highest area under the curve (AUC) values were obtained for the SWS fragmentation and slow/mixed arousal indexes (AUC = 0.88 and 0.90, respectively). The SWS fragmentation index cut-off value of 6.8/h reached a sensitivity of 79% and a specificity of 82%. The slow/mixed arousal index had a sensitivity of 94% for the 2.5/h cut-off, and 100% specificity for 6/h. Both parameters showed good inter-rater agreement, and their sensitivities were confirmed in the second group of patients. Combining EEG parameters and video-based behavioral analyses increased the correct classification rate up to 91.3%.

Conclusion:

Frequent slow/mixed arousals in SWS and complex behaviors during vPSG are strongly associated with DOA, and could be promising biomarkers for the diagnosis of non-REM parasomnias. This article is protected by copyright. All rights reserved.

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