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Abstract：
OBJECTIVE: To formulate the first classification of sleep related disorders and abnormal sexual behaviors and experiences.
METHODS: A computerized literature search was conducted, and other sources, such as textbooks, were searched.
RESULTS: Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of \"sleepsex\" (\"sexsomnia\") in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy.
CONCLUSIONS: A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.
METHODS: A computerized literature search was conducted, and other sources, such as textbooks, were searched.
RESULTS: Many categories of sleep related disorders were represented in the classification: parasomnias (confusional arousals/sleepwalking, with or without obstructive sleep apnea; REM sleep behavior disorder); sleep related seizures; Kleine-Levin syndrome (KLS); severe chronic insomnia; restless legs syndrome; narcolepsy; sleep exacerbation of persistent sexual arousal syndrome; sleep related painful erections; sleep related dissociative disorders; nocturnal psychotic disorders; miscellaneous states. Kleine-Levin syndrome (78 cases) and parasomnias (31 cases) were most frequently reported. Parasomnias and sleep related seizures had overlapping and divergent clinical features. Thirty-one cases of parasomnias (25 males; mean age, 32 years) and 7 cases of sleep related seizures (4 males; mean age, 38 years) were identified. A full range of sleep related sexual behaviors with self and/or bed partners or others were reported, including masturbation, sexual vocalizations, fondling, sexual intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and ictal automatism. Adverse physical and/or psychosocial effects from the sleepsex were present in all parasomnia and sleep related seizure cases, but pleasurable effects were reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most (9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in contrast to 28.6% (2/7) of sleep related seizure cases. Polysomnography (without penile tumescence monitoring), performed in 26 of 31 parasomnia cases, documented sexual moaning from slow wave sleep in 3 cases and sexual intercourse during stage 1 sleep/wakefulness in one case (with sex provoked by the bed partner). Confusional arousals (CAs) were diagnosed as the cause of \"sleepsex\" (\"sexsomnia\") in 26 cases (with obstructive sleep apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3% (28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90% (9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was effective in controlling comorbid OSA and CAs in both treated cases. All five treated patients with sleep related sexual seizures responded to anticonvulsant therapy. The hypersexuality in KLS, which was twice as common in males compared to females, had no reported effective therapy.
CONCLUSIONS: A broad range of sleep related disorders associated with abnormal sexual behaviors and experiences exists, with major clinical and forensic consequences.
摘要：
目的：制定睡眠相关障碍和异常性行为和经历的第一分类。
方法：进行了计算机文献检索，和其他来源，比如教科书，被搜查了。
结果：分类中代表了许多类别的睡眠相关障碍：失眠症（混乱性唤醒/梦游，有或没有阻塞性睡眠呼吸暂停；REM睡眠行为障碍）；与睡眠相关的癫痫发作；克莱因-莱文综合征（KLS）；严重的慢性失眠；不宁腿综合征；发作性睡病；持续性性唤起综合征的睡眠恶化；与睡眠相关的勃起；与睡眠相关的分离性障碍；夜间精神障碍；其他状态。Kleine-Levin综合征（78例）和失眠症（31例）最常见。与睡眠相关的癫痫发作和睡眠相关的癫痫发作具有重叠和不同的临床特征。31例失眠症（25例男性；平均年龄，32岁）和7例睡眠相关癫痫发作（男性4例；平均年龄，38年）被确定。报告了与自我和/或同床伴侣或他人的全方位睡眠相关性行为，包括手淫,性发声，抚摸着,性交高潮,性侵犯/强奸,性过度兴奋,性高潮,和自动发作。在所有睡眠状态和睡眠相关的癫痫发作病例中都存在睡眠性的身体和/或心理社会不良影响。但5名同床伴侣和3名睡眠相关癫痫患者报告了令人愉快的效果。法医后果很普遍，发生在35.5%(11/31)的失眠症病例中，大多数（9/11）涉及未成年人。所有失眠症病例都报告了睡眠性健忘症，与睡眠相关的癫痫发作病例占28.6%(2/7)。多导睡眠图（无阴茎肿胀监测），在31例失眠症病例中的26例进行了检查，记录了3例慢波睡眠中的性呻吟和1例睡眠/觉醒中的性交（由床伴引起的性行为）。26例（伴有阻塞性睡眠呼吸暂停[OSA]合并症）被诊断为“睡眠性”（“性失眠”）的原因。和梦游两种情况，总计90.3%(28/31)的病例为NREM睡眠失眠症。其他3例患者以REM行为障碍为推测病因。就寝时间氯硝西泮治疗对90％（9/10）的失眠症患者有效；经鼻持续气道正压通气治疗可有效控制两种治疗病例的OSA和CA合并症。所有5名接受治疗的睡眠相关性癫痫患者均对抗惊厥治疗有反应。KLS中的性欲过高,这在男性中是女性的两倍，没有报告有效的治疗。
结论：存在与异常性行为和经历相关的广泛的睡眠相关障碍，具有重大的临床和法医后果。
方法：进行了计算机文献检索，和其他来源，比如教科书，被搜查了。
结果：分类中代表了许多类别的睡眠相关障碍：失眠症（混乱性唤醒/梦游，有或没有阻塞性睡眠呼吸暂停；REM睡眠行为障碍）；与睡眠相关的癫痫发作；克莱因-莱文综合征（KLS）；严重的慢性失眠；不宁腿综合征；发作性睡病；持续性性唤起综合征的睡眠恶化；与睡眠相关的勃起；与睡眠相关的分离性障碍；夜间精神障碍；其他状态。Kleine-Levin综合征（78例）和失眠症（31例）最常见。与睡眠相关的癫痫发作和睡眠相关的癫痫发作具有重叠和不同的临床特征。31例失眠症（25例男性；平均年龄，32岁）和7例睡眠相关癫痫发作（男性4例；平均年龄，38年）被确定。报告了与自我和/或同床伴侣或他人的全方位睡眠相关性行为，包括手淫,性发声，抚摸着,性交高潮,性侵犯/强奸,性过度兴奋,性高潮,和自动发作。在所有睡眠状态和睡眠相关的癫痫发作病例中都存在睡眠性的身体和/或心理社会不良影响。但5名同床伴侣和3名睡眠相关癫痫患者报告了令人愉快的效果。法医后果很普遍，发生在35.5%(11/31)的失眠症病例中，大多数（9/11）涉及未成年人。所有失眠症病例都报告了睡眠性健忘症，与睡眠相关的癫痫发作病例占28.6%(2/7)。多导睡眠图（无阴茎肿胀监测），在31例失眠症病例中的26例进行了检查，记录了3例慢波睡眠中的性呻吟和1例睡眠/觉醒中的性交（由床伴引起的性行为）。26例（伴有阻塞性睡眠呼吸暂停[OSA]合并症）被诊断为“睡眠性”（“性失眠”）的原因。和梦游两种情况，总计90.3%(28/31)的病例为NREM睡眠失眠症。其他3例患者以REM行为障碍为推测病因。就寝时间氯硝西泮治疗对90％（9/10）的失眠症患者有效；经鼻持续气道正压通气治疗可有效控制两种治疗病例的OSA和CA合并症。所有5名接受治疗的睡眠相关性癫痫患者均对抗惊厥治疗有反应。KLS中的性欲过高,这在男性中是女性的两倍，没有报告有效的治疗。
结论：存在与异常性行为和经历相关的广泛的睡眠相关障碍，具有重大的临床和法医后果。
