0843 Sexsomnia in a female patient with nightmares and obstructive sleep apnea: a case report

Abstract

Introduction: Sexsomnia has been described as various sleeprelated abnormal sexual behaviors primarily associated with confusional arousals and more rarely linked to rapid eye movement (REM) sleep behavior disorder (RBD). Clinical descriptions are based on case reports and review series, which leads to diagnostic ambiguity, challenges with appropriate classification, and forensic and legal ramifications Report of Cases: We report a 34 year old female with a past medical history of polycystic ovarian syndrome and childhood post-traumatic stress disorder. Family history significant for parent with lifelong parasomnias. The patient was referred to Sleep Medicine with concern for snoring, sleepiness, and sleep behaviors. The patient reports sleep talking since childhood which predate trauma, traumatic themed nightmares, and ex-husband and current spouse reporting sleep-related masturbation, sexual advances described as coital-like pelvic movements which often lead to intercourse and subsequent amnesia. In addition, spouse describes bruxism and ongoing night terrors. Physical examination notable for body mass index 44 kg/m2, high arched palate, Mallampati class III, and 18 inch neck circumference. The patient underwent a polysomnagram which demonstrated fragmented sleep architecture, total arousal index up to 20.3/hr, and totalsleep time in stage N3 20%, Four awakenings fromN3, and findings of N3 partial arousal. The patient was observed in v-PSG to have periods of nocturnal lagophthalmos, finger movements, and vocalizations during NREM sleep. However, many of these observations were in the setting of respiratory events. The apnea-hypopnea index was 16.9/hr and a minimum oxygen saturation of 81% and mean saturation of 95%. A total of 3.1 minutes were spent less than or equal to 90%. TCO2 was without concern for hypoventilation. The patient was started on Auto CPAP 5-15cmH2O with resolution of snoring and some improvement to sleepiness. However, spouse reports ongoing sexsomnia in the same frequency despite treatment of obstructive sleep apnea. Conclusion(s): This case reports a female adult with persistent sexsomnia despite early treatment of obstructive sleep apnea which highlights the possibility of co-occurring sleep disorder. The case does support current limited literature around sexsomnias having features of partial arousals from NREM sleep given the co-occuring history of night terrors, elevated N3 awakenings, and evidence of cortico-cortical dissociation.