Catathrenia

Catathrenia

Catathrenia is a rapid eye movement sleep parasomnia characterized by end-inspiratory apnea (breath holding) and expiratory groaning during sleep. The term originates from the Greek kata (below) and threnia (to lament) and describes a rare condition characterized by monotonous, irregular groans known as nocturnal groaning. Nocturnal vocalization has been observed in both animals and humans, including patients with Parkinson's disease. The vocalization can be groaning, moaning, or other sounds produced while asleep, with catathrenia and sleep talking (somniloquy) being the most common.

• Catathrenia typically occurs during REM sleep, although it may also occur to a lesser degree during NREM sleep. It begins with a deep inspiration followed by breath holding 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 with no sound. Despite a slower breathing rate, no oxygen desaturation usually occurs. Certain side effects include sore throat, fatigue, and dizziness.
• There is ongoing debate about whether the cause of catathrenia is physical or neurological. While some speculate about a direct correlation to high anxiety and stress or the idea that catathrenia is purely psychological, there is only anecdotal evidence for either proposed cause.

Classification

• Catathrenia has been defined as a parasomnia in the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2), but its classification has been debated. In the latest version of the International Classification of Sleep Disorders (ICSD-3), catathrenia has been included in the category of respiratory disorders, removing it from the parasomnia category, as it was in the second version of the manual. However, the debate about the nature and classification of the disorder still exists.

Signs and symptoms

• Because catathrenia itself is not considered life-threatening, there has been very little research done in the medical community, and many experts assume that the way to treat catathrenia is to treat the underlying sleep apnea. However, there is no conclusive evidence published that catathrenia results from sleep apnea, and sleep studies show that not all people with catathrenia have been diagnosed with sleep apnea. While doctors tend to dismiss it as an inconvenience, people with catathrenia routinely describe the condition's highly negative effects on their daily lives, including tiredness, low energy, dizziness and vertigo, work problems, relationship and social issues, and other physical and mental problems that could be associated with low sleep quality.

Epidemiology

The first case of catathrenia was described in 1983. The disorder is rare, and many sleep specialists and otolaryngologists are still unfamiliar with this atypical sleep pattern. Catathrenia must be distinguished from moaning during epileptic seizures, central sleep apnea, sleep-related laryngospasm, snoring, and stridor. 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. 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. 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.

Management

• Sleeping in a more upright position seems to lessen catathrenia (as well as sleep apnea). 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. Yoga and/or meditation focused on steady and regular breathing may lessen catathrenia.
• Some evidence indicates that continuous positive airway pressure (CPAP) can be an effective treatment for catathrenia. In a study, the subject using CPAP significantly decreased the sounds typically produced because of the disorder, which almost disappeared.

See also

Sleep apnea Parasomnia Somniloquy

External links

• American Sleep Association: Catathrenia
• National Sleep Foundation: Catathrenia

Catathrenia Resources
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