Abstract

Introduction

Isolated sleep paralysis (ISP) occurs when rapid eye movement (REM)-based atonia intrudes into wakefulness, outside the context of narcolepsy, substance abuse, mental disorder or other medical conditions. No “gold standard” assessment and diagnostic instrument currently exists.

Report of Case

A 63-year old female with hypersomnia and positive airway pressure (PAP)-controlled obstructive sleep apnea was referred for recurrent episodes of paralysis during sleep-wake transitions, lasting 15-20 seconds, occurring every 2-3 years since the age of 15, and associated with fear and anxiety. Episodes were more frequent in the last 2 years after significant sleep deprivation and starting a weight loss supplement, BIO-X4, which contains green tea and probiotics. No cataplexy, or history of traumatic brain injury and stroke were identified. Epworth Sleepiness Scale score was 14 on armodafinil. Reported sleep amounts were regularly scheduled 6-7-hour periods, with no suggestion of circadian dysfunction. In 2016, polysomnogram showed Apnea-Hypopnea index of 2.6/hour, Respiratory Disturbance Index of 13.8/hour with oxygen nadir of 92% in the setting of hypersomnia. Continuous PAP of 11 cmH20 was initiated after a successful titration with controlled residual AHI during follow-ups. Multiple Sleep Latency Test during the same time revealed mean sleep latency of 5.5 minutes and no sleep-onset REM with 5 naps. Brain imaging and electroencephalogram were both normal as well as drug panel, blood counts, metabolic profile and thyroid function. Decreased episodes and severity of recurrent ISP were reported after discontinuation of the supplement. Apart from anxiety related to the episodes, the patient denied any interference with daytime function.

Conclusion

Isolated sleep paralysis is an important sleep disorder that requires proper evaluation to rule out competing diagnoses and consideration of therapeutic interventions. Likely associated with a lack of understanding and available literature, the prevalence in the general population is likely higher than what is currently perceived.

中文翻译：

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第1227章恐怖的案例

摘要

介绍

当基于快速眼动（REM）的Atonia进入发作性睡病，药物滥用，精神障碍或其他医疗状况之外的清醒状态时，就会发生孤立性睡眠麻痹（ISP）。当前不存在“金标准”评估和诊断工具。

案件报告

一名63岁的女性患有失眠和气道正压（PAP）控制的阻塞性睡眠呼吸暂停，自15岁开始每2-3年发生一次睡眠-觉醒过渡过程中持续出现麻痹，发作持续15-20秒。 ，并伴有恐惧和焦虑。在出现明显的睡眠不足和开始服用减肥补品BIO-X4后的最近两年中发作更为频繁，其中含有绿茶和益生菌。未发现脑瘫，脑外伤和中风史。在Armodafinil上的Epworth Sleepiness Scale评分为14。报告的睡眠量是定期安排的6-7小时时段，没有暗示昼夜功能障碍。2016年，多导睡眠图显示呼吸暂停-呼吸不足指数为2.6 /小时，呼吸障碍指数为13。失眠时，氧气最低点为8 /小时8。在随访过程中成功滴定并控制残留AHI后，开始进行11 cmH2O的连续PAP。同一时间的多次睡眠潜伏期测试显示平均睡眠潜伏期为5.5分钟，且没有睡午觉5次小睡。脑部成像和脑电图均正常，且药物检查，血细胞计数，代谢谱和甲状腺功能均正常。据报道，补品中止后，复发性ISP的发作和严重程度降低。除了与发作有关的焦虑外，患者否认对白天功能有任何干扰。同一时间的多次睡眠潜伏期测试显示平均睡眠潜伏期为5.5分钟，且没有睡午觉5次小睡。脑部成像和脑电图均正常，且药物检查，血细胞计数，代谢谱和甲状腺功能均正常。据报道，补品中止后，复发性ISP的发作和严重程度降低。除了与发作有关的焦虑外，患者否认对白天功能有任何干扰。同一时间的多次睡眠潜伏期测试显示平均睡眠潜伏期为5.5分钟，且没有睡午觉5次小睡。脑部成像和脑电图均正常，且药物检查，血细胞计数，代谢谱和甲状腺功能均正常。据报道，补品中止后，复发性ISP的发作和严重程度降低。除了与发作有关的焦虑外，患者否认对白天功能有任何干扰。

结论

孤立性睡眠麻痹是一种重要的睡眠障碍，需要进行适当评估以排除竞争性诊断和考虑治疗干预措施。可能与缺乏了解和现有文献有关，普通人群中的患病率可能高于目前的认识。