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Forensic sleep medicine: Violence, sleep nocturnal wandering: Sleep-related violence



Forensic sleep medicine: Violence, sleep nocturnal wandering: Sleep-related violence



Sleep (Rochester) 18(9): 731-739



We hypothesized that sleep-related violent behavior associated with parasomnias occurs as the result of a diathesis and is precipitated by stressors and mediated by disturbed nonrapid eye movement (NREM) sleep physiology. Sixty-four consecutive adult patients (mean age 30 years) who were investigated for sleepwalking or sleep terrors were categorized according to clinical history into three groups: serious violence during sleep to other people or to property or self (n = 26); harmful, but not destructive behavior (n = 12); and nonviolent behavior (n = 26). Log linear analysis showed that a diathesis (childhood parasomnia and/or family history of parasomnia) and a stressor (psychologic distress, substance abuse and sleep schedule disorder) predicted the presence of sleepwalking or night terror. Serious violent acts were more likely to occur with males (p lt 0.004) who showed sleep schedule disorder (p lt 0.03). Both harmful and serious violent sleep behavior occurred with drug abuse (p lt 0.009). In comparison to all other groups, those who were violent to other people were males who experienced more stressors (p lt 0.02), drank excessive caffeinated beverages, abused drugs (p lt 0.03) and showed less stage 4 sleep (p lt 0.02) and less alpha (7.5-11 Hz) electroencephalogram NREM sleep (p lt 0.02) on polysomnography. Being male and having lt 2% stage 4 sleep provided 89% sensitivity, 80% specificity and 81% diagnostic accuracy for individuals who were violent to others. The forensic implications of these findings are discussed.

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Accession: 008699049

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