Comparison of clinical features between primary and drug-induced sleep-related eating disorder

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Open Access Full Text Article Comparison of clinical features between primary and drug-induced sleep-related eating disorder This article was published in the following Dove Press journal: Neuropsychiatric Disease and Treatment 26 May 2016 Number of times this article has been viewed Yoko Komada 1 Yoshikazu Takaesu 2 Kentaro Matsui 3 Masaki Nakamura 3 Shingo Nishida 3 Meri Kanno 3,† Akira Usui 3 Yuichi Inoue 1,3 Department of Somnology, Department of Psychiatry, Tokyo Medical University, 3Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan 1 2 Meri Kanno passed away on March 1, 2016 † Introduction Correspondence: Yoko Komada Department of Somnology, Tokyo Medical University, 6-1-1 Shishinjuku, Shinjuku-ku, Tokyo 160-8402, Japan Tel +81 3 3351 6141 Fax +81 3 3351 6208 Email Sleep-related eating disorder (SRED) is a behavioral disorder in which recurrent episodes of dysfunctional eating after arousal, usually within 2–3 hours of sleep onset, occur almost nightly.1–3 Typical SRED frequently features partial loss of consciousness during eating episodes, with subsequent impaired recall.1 The prevalence rate of SRED in the general population has been reported to be 1%–4.6%.4,5 Several reports have shown that SRED often occurs in persons with previous or current episodes of sleepwalking, and the two disorders share some common clinical features.6 Both SRED and sleepwalking showed a similar timing of episode particularly during the first half of the night, numerous arousals from stage N3 sleep.6 Based on this information, SRED has been considered to occur as a result of a dysfunction in sustaining stable slow-wave sleep, which is similar to sleepwalking.7 Night eating syndrome (NES) is another important condition in the disordered nighttime eating spectrum, showing episodes of hyperphagia with full consciousness just before or during the nocturnal sleep period.8 Although SRED and NES have been accepted as distinct disease categories, many of their features overlap.9 On the other 1275 submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2016:12 1275–1280 Dovepress © 2016 Komada et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/NDT.S107462 Powered by TCPDF (www.tcpdf.org) Purpose: The aim of this study was to ascertain the clinical characteristics of drug-induced sleep-related eating disorder (SRED). Patients and methods: We retrospectively reviewed the medical records of 30 patients with primary SRED (without any comorbid sleep disorders and who were not taking any possible causative medications), and ten patients with drug-induced SRED (occurrence of SRED episodes after starting nightly medication of sedative drugs, which completely resolved after dose reduction or discontinuation of the sedatives). Results: All patients with drug-induced SRED took multiple types of sedatives, such as benzodiazepines or benzodiazepine receptor agonists. Clinical features of drug-induced SRED compared with primary SRED were as follows: higher mean age of onset (40 years old in druginduced SRED vs 26 years old in primary SRED), significantly higher rate of patients who had total amnesia during most of their SRED episodes (75.0% vs 31.8%), significantly lower rate of comorbidity of night eating syndrome (0% vs 63.3%), and significantly lower rate of history of sleepwalking (10.0% vs 46.7%). Increased doses of benzodiazepine receptor agonists may be responsible for drug-induced SRED. Conclusion: The clinical features of drug-induced SRED were different from those of primary SRED, possibly reflecting differences in the underlying mechanisms between these two categories of SREDs. Keywords: nocturnal eating syndrome, night eating, eating disorder, hypnotics, amnesia, sleepwalking, benzodiazepine Dovepress Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Komada et al hand, there have been numerous reports on SRED related to the use of various psychotropic medications, including hypnotics (particularly benzodiazepines and benzodiazepine receptor agonists [BZDs]), antipsychotics, or their combinations.10–15 Recently, we indicated that the prevalence of SRED in psychiatric outpatients was as high as 8.4%, and the hypnosedative effects of the drugs could be responsible for the occurrence of the disorder.16 However, to date, similarities and differences in the clinical features of drug-induced SRED and primary SRED (without comorbid sleep disorders and not taking any possible causative medications), such as sex distribution, age of onset, time period of the episodes, level of amnesia, and rate of comorbidity of NES, have not been examined. Identification of differences in these factors may be helpful for establishing a differential diagnosis of these two conditions, as well as for gaining a better understanding of the pathophysiological mechanisms of SRED. We therefore performed this retrospective study to compare clinical features between patients with drug-induced SRED and those with primary SRED. Patients and methods All procedures of the study were conducted in accordance with the guidelines outlined in the Declaration of Helsinki. The protocol of this study was reviewed and approved by the ethics committee of the Neuropsychiatric Research Institute (Tokyo, Japan). Written informed consent for participation was obtained from all the subjects after providing a thorough explanation on the study. We retrospectively investigated the medical records of patients who visited the outpatient clinic of Japan Somnology Center in Tokyo between May 2003 and April 2011 and who were seeking treatment for eating behaviors during nocturnal sleep periods. A definitive diagnosis of SRED was made for these patients by at least two sleep disorder specialist physicians according to the criteria in the International Classification of Sleep Disorders.1 Thirty patients were diagnosed as having primary SRED (without any comorbid sleep disorders, such as restless legs syndrome (RLS) and sleep apnea syndrome (SAS), and were not takin (...truncated)