0708 Systematic Review of Behavioral Treatments for NREM Parasomnias

Introduction NREM parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted in order to summarize the range of behavioral interventions and their efficacy. Methods We conducted a systematic search of the literature to identify all publications describing behavioral treatment of NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). The search was conducted on March 10, 2021 in the following databases: Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), and Web of Science (Clarivate). The search yielded 2411 records. After removing duplicates, 1703 unique records were screened. This yielded 159 publications for full-text review. While reviewing those publications, an additional 83 were identified for screening. Based on the full-text reviews, a total of 66 publications were included in the systematic review, including manuscripts in English (n=63), Dutch (n=2), and German (n=1). Results Most included manuscripts were case studies, case series, or retrospective chart reviews. There were only three randomized controlled trials. Children (< 18 years) were included in 33 publications and adults were included in 36. Numerous behavioral strategies were reported, the most common being hypnosis (n=33) and various types of psychotherapy (n=26). Additional interventions included sleep hygiene (n=15), education/reassurance (n=13), relaxation (n=10), scheduled awakenings (n=9), and sleep extension or scheduled naps (n=8). In many studies, multiple interventions were trialed in combination. Length of follow-up varied considerably both within and between studies (range=0-9 years). Outcome measures were inconsistent across studies and some included only qualitative descriptions. Quantitative outcomes included the frequency of symptoms and patient ratings of symptom severity. Conclusion This review highlights the wide breadth of potential interventions for managing NREM parasomnias without medication. Randomized controlled trials are needed to determine which interventions are most efficacious, including which are best for particular disorders or ages. Future trials should include standardized quantitative measures of symptoms in order to allow comparison across trials. Support (if any)