Catathrenia

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Catathrenia
Obstruction ventilation apnee sommeil.svg
Specialty Otorhinolaryngology, sleep medicine, Somnology
Symptoms groaning or moaning during sleep

Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea (breath holding) and expiratory groaning during sleep. It describes a rare condition characterized by monotonous, irregular groans while sleeping. [1] Catathrenia begins with a deep inspiration. The person with catathrenia holds his or her breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. [2] [3] [4] The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. [1] It appears more often during expiration REM sleep than in NREM sleep. [5]

Contents

Catathrenia is distinct from both somniloquy (sleep talking) and obstructive sleep apnea (OSA). The sound is produced during exhalation, as opposed to snoring, which occurs during inhalation.

Etymology

Catathrenia (from the Greek kata, meaning “below”, and threnia, meaning “to lament”). [6]

Classification

Catathrenia has been defined as a parasomnia in the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2), but there is debate about its classification. [1] Importantly, in the latest version of the International Classification of Sleep Disorders (ICSD-3), catathrenia has been included in the category of respiratory disorders, and thus it has been removed from the parasomnia category, as it was in the second version of the manual; nevertheless, a debate about the nature and classification of the disorder, still exist. [7]

Signs and symptoms

Catathrenia itself is not considered life-threatening.

Bed partners generally report hearing the person take a deep breath, hold it, then slowly exhale; often with a high-pitched squeak or groaning sound. [8]

Common characteristics in reported cases

There are reported characteristics that are shared among patients with catathrenia. The main characteristics are:

There are a few other similarities[ citation needed ] amongst people with catathrenia that have not yet been studied properly:

Certain side effects include sore throat, fatigue, and dizziness. [13]

Discrepancies among reported cases

Epidemiology

It was in 1983 when the first case of catathrenia was described. [19] The disorder is especially rare and many sleep specialists and otolaryngologists are still unfamiliar with this atypical sleep pattern. [8] Catathrenia must be distinguished from moaning during epileptic seizures, central sleep apnea, sleep-related laryngospasm, snoring, and stridor. [2] Since polysomnography alone is insufficient to correctly distinguish catathrenia from central sleep apnea, a video-polysomnography with audio recording is necessary to diagnose catathrenia and avoid mistakes. [2] Despite the fact that the incidence of catathrenia might be underestimated due to misdiagnoses, an institution in Norway has found an incidence of 4 out of 1,004 (0.4%) among patients with sleep and/or wake problems over a 1-year period. [20] A previous study in Japan found an incidence of 25 out of 15,052 (0.17%) among patients with sleep and/or wake problems over a 10-year period. [21]

Management

Sleeping in a more upright position seems to lessen catathrenia (as well as sleep apnea).[ citation needed ] Performing regular aerobic exercise, where steady breathing is necessary (running, cycling etc.) may lessen catathrenia. Strength exercise, on the other hand, may worsen catathrenia because of the tendency to hold one's breath while exercising.[ citation needed ] Yoga and/or meditation focused on steady and regular breathing may lessen catathrenia.[ citation needed ]

Some evidence indicates that continuous positive airway pressure can be an effective treatment for catathrenia: [22] [23] in a study, the subject using CPAP significantly decreased the sounds typically produced because of the disorder, which almost disappeared.

Cause

The exact cause of catathrenia is still unknown; [24] there is debate on whether the cause is physical or neurological.

Other nocturnal vocalisation

Multiple studies have described nocturnal vocalisation among animals and have also reported some cases in humans, especially in patients with Parkinson's disease. The nocturnal vocalisation can be groaning, moaning, or different sounds produced while asleep, the most encountered being catathrenia and sleep talking. [14]

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea, British English sleep apnoea or sleep apnœa, is a sleep-related breathing disorder in which repetitive pauses in breathing, periods of shallow breathing, or collapse of the upper airway during sleep results in poor ventilation and sleep disruption. Each pause in breathing can last for a few seconds to a few minutes and occurs many times a night. A choking or snorting sound may occur as breathing resumes. Common symptoms include daytime sleepiness, snoring, and non restorative sleep despite adequate sleep time. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. It is often a chronic condition.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

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<span class="mw-page-title-main">Snoring</span> Vibratory sound made while asleep

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation.

<span class="mw-page-title-main">Night terror</span> Sleep disorder causing feelings of panic or dread

Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

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Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by an individual engaging in sexual acts while in non-rapid eye movement (NREM) sleep. Sexual behaviors that result from sexsomnia are not to be mistaken with normal nocturnal sexual behaviors, which do not occur during NREM sleep. Sexual behaviors that are viewed as normal during sleep and are accompanied by extensive research and documentation include nocturnal emissions, nocturnal erections, and sleep orgasms.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG) is a multi-parameter type of sleep study and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

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<span class="mw-page-title-main">K-complex</span>

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<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

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Rhythmic movement disorder (RMD) is a neurological disorder characterized by repetitive movements of large muscle groups immediately before and during sleep often involving the head and neck. It was independently described first in 1905 by Zappert as jactatio capitis nocturna and by Cruchet as rhythmie du sommeil. The majority of RMD episodes occur during NREM sleep, although REM movements have been reported. RMD is often associated with other psychiatric conditions or mental disabilities. The disorder often leads to bodily injury from unwanted movements. Because of these incessant muscle contractions, patients' sleep patterns are often disrupted. It differs from restless legs syndrome in that RMD involves involuntary muscle contractions before and during sleep while restless legs syndrome is the urge to move before sleep. RMD occurs in both males and females, often during early childhood with symptoms diminishing with age. Many affected individuals also have other sleep related disorders, like sleep apnea. The disorder can be differentially diagnosed into small subcategories, including sleep related bruxism, thumb sucking, hypnagogic foot tremor, and rhythmic sucking, to name a few. In order to be considered pathological, the ICSD-II requires that in the sleep-related rhythmic movements should “markedly interfere with normal sleep, cause significant impairment in daytime function, or result in self-inflicted bodily injury that requires medical treatment ”.

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References

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  2. 1 2 3 Okura, Mutsumi; Muraki, Hisae (2013-08-01). "WS1-3. Attended video–audio polysomnographic study about patients with catathrenia (sleep related groaning)". Clinical Neurophysiology. 124 (8): e29. doi:10.1016/j.clinph.2013.02.071. ISSN   1388-2457. S2CID   54382541.
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  5. 1 2 Koo, Dae Lim; Hong, Seung Bong; Joo, Eun Yeon (2012). "Acoustic characteristic of catathrenia and snoring: Different subtypes of catathrenia". Sleep Medicine. 13 (7): 961–964. doi:10.1016/j.sleep.2012.04.002. PMID   22613219.
  6. ↑ Langley, R. J.; Hill, L.; Hill, E. A.; Urquhart, D. S. (2017). "The curious incident of groaning in the night-time". Breathe (Sheffield, England). 13 (2): 123–126. doi:10.1183/20734735.017816. PMC   5467869 . PMID   28620432.
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  8. 1 2 Zaghi, Soroush; Guilleminault, Christian; Chhetri, Dinesh K.; Camacho, Macario; Alonso, Jose (2017-04-15). "Catathrenia (Nocturnal Groaning): A Social Media Survey and State-of-the-Art Review". Journal of Clinical Sleep Medicine. 13 (4): 613–622. doi:10.5664/jcsm.6556. ISSN   1550-9389. PMC   5359339 . PMID   28095968.
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  12. 1 2 American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
  13. ↑ "Why Catathrenia Isn't Taken as Seriously as Other Sleeping Disorders". Zeesnoring. March 2017. Retrieved 7 June 2018.
  14. 1 2 Abbasi, Adnan; Morgenthaler, Timothy I.; Slocumb, Nancy; Tippmann-Peikert, Maja; Olson, Eric; Ramar, Kannan (2012). "Nocturnal moaning and groaning—catathrenia or nocturnal vocalizations". Sleep and Breathing. 16 (2): 367–373. doi:10.1007/s11325-011-0503-3. PMID   21380609. S2CID   5655092.
  15. 1 2 Khaja, Aliuddin M.; Hagen, Chad C.; Guilleminault, Christian (2008-06-01). "Catathrenia is Not Expiratory Snoring". Sleep. 31 (6): 774–775. doi: 10.1093/sleep/31.6.774 . ISSN   0161-8105. PMC   2442405 . PMID   18548821.
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  18. ↑ Khaja, Aliuddin M.; Hagen, Chad C.; Guilleminault, Christian (2008-01-01). "Catathrenia: Parasomnia or Uncommon Feature of Sleep Disordered Breathing?". Sleep. 31 (1): 132–139. doi: 10.1093/sleep/31.1.132 . ISSN   0161-8105. PMC   2225555 . PMID   18220087.
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  20. ↑ Øverland, Britt; Akre, Harriet; Berdal, Hanne; Skatvedt, Olav (2012-01-01). "Sleep-related groaning: Prevalence and characteristics in a cohort of patients with suspected obstructive sleep apnea". Acta Oto-Laryngologica. 132 (1): 90–95. doi:10.3109/00016489.2011.624119. ISSN   0001-6489. PMID   22074488. S2CID   30889814.
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  22. ↑ Iriarte, J., Alegre, M., Urrestarazu, E., Viteri, C., Arcocha, J., & Artieda, J. (2006). Continuous positive airway pressure as treatment for catathrenia (nocturnal groaning). Neurology, 66(4), 609-610.
  23. ↑ Ortega-Albas, J. J., Diaz, J. R., Serrano, A. L., & de Entrambasaguas, M. (2006). Continuous positive airway pressure as treatment for catathrenia (nocturnal groaning). Neurology, 67(6), 1103-1103.
  24. ↑ Alonso, Jose; Camacho, Macario; Chhetri, Dinesh K.; Guilleminault, Christian; Zaghi, Soroush (April 15, 2017). "Catathrenia (Nocturnal Groaning): A Social Media Survey and State-of-the-Art Review". Journal of Clinical Sleep Medicine. 13 (4): 613–622. doi:10.5664/jcsm.6556. PMC   5359339 . PMID   28095968.
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