Night terrors, sleepwalking, and confusional arousals in the general population: Their frequency and relationship to other sleep and mental disorders

Background: Arousal parasomnias (night terrors, sleepwalking, and confusion al arousals) have seldom been investigated in the adult general population. Clinical studies of parasomnias, however, show that these disorders may be indicators of underlying mental disorders and may have serious consequence s. Method: A representative sample of the United Kingdom population (N = 4972) was interviewed by telephone with the Sleep-EVAL system. Results: Night tenors were reported by 2.2% (95% CI = 1.8% to 2.6%) of the sample, sleepwalking by 2.0% (1.6% to 2.4%), and confusional arousals by 4. 2% (3.6% to 4.8%). The rate of these 3 parasomnias decreased significantly with age, but no gender difference was observed. Multivariate models identi fied the following independent factors as associated with confusional arous als (odds ratio [OR]): age of 15-24 years (OR = 4.1), shift work (OR = 2.1) , hypnagogic hallucinations (OR = 3.3), deep sleep (OR = 1.6), daytime slee piness (OR = 1.9), sleep talking (OR = 1.7), daily smoking (OR = 1.7), adju stment disorder (OR = 3.1), and bipolar disorder (OR = 13.0). Factors assoc iated with night terrors cr ere subjective sense of choking or blocked brea thing at night (OR = 5.1), obstructive sleep apnea syndrome (OR = 4.1), alc ohol consumption at bedtime (OR = 3.9), violent or injury-causing behaviors during sleep (OR = 3.2), hypnagogic hallucinations (OR = 2.2), and nightma res at least 1 night per month (OR = 4.0). Factors associated with sleepwal king were age of 15-24 years (OR = 5.2), subjective sense of choking or blo cked breathing at night (OR = 5.1), sleep talking (OR = 5.0), and a road oc cident in the past year (OR = 3.9) after controlling for possible effects o f sleep deprivation. life stress, and mental and sleep disorders. Conclusion: Arousal parasomnias, especially night terrors and confusional a rousals, are often the expression of a mental disorder. Other life or medic al conditions, such as shift work or excessive need of sleep for confusiona l arousals and stressful events for sleepwalking, may also trigger parasomn ias. prevalence rates are based on self-reported data and, consequently, ar e likely underestimated.