1113 First Report of NREM Parasomnia in Narcolepsy Type 1

Abstract

Abstract A previously healthy 17-year-old male presented with 3 months of severe hypersomnolence, and frequent episodes of diffuse, symmetrical leg weakness preceded with laughter. He was witnessed by his family to experience amnestic nocturnal spells characterized by confusion, and inappropriate behavior. Significant symptoms include also sleep paralysis, snoring, increased appetite and weight gain of 20 pounds in previous 2 months. An overnight polysomnogram (PSG) demonstrated a total sleep time of 7.18 hours with sleep efficiency of 88%. Sleep onset latency was 9 minutes and REM sleep latency of 3 minutes. There was no evidence of sleep disordered breathing. Patient demonstrated REM sleep without atonia in several epochs, recorded along with dream enactment behavior. Spells characterized by abrupt arousal and confused semiology out of N3 sleep were also captured, along with frequent periodic leg movements during NREM sleep and non-ictal EEG. Multiple Sleep Latency Test revealed a mean sleep onset latency of <1 minute, sleep onset REM periods in 5 out of 5 naps, along with a sixth SOREM on patient's PSG the night prior. Patient met narcolepsy type 1 diagnostic criteria of ICSD-3 with his symptoms, electrographic findings, and unequivocal videographic evidence of cataplexy. The case illustrates concomitant presence of NREM and REM parasomnias representing the first report of parasomnia overlap in NT1. We report the first case of a patient with an overlap diagnosis of Narcolepsy Type I and concomitant REM and NREM parasomnias using video polysomnographic confirmation. This case provides support that the loss of hypocretin signaling in NT1 confers to instability of sleep-wake states, contributing to parasomnia overlap disorder.