Mathilde Flamand1, Bastien Herlin1, Smaranda Leu-Semenescu2, Valérie Attali3, Claire Launois3, Isabelle Arnulf4. 1. Sleep Disorders Unit, Chest and Sleep Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France. 2. Sleep Disorders Unit, Chest and Sleep Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France; Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM U 1127-CNRS UMR 722, Université Pierre et Marie Curie-Paris 6, Paris, France. 3. Sleep Disorders Unit, Chest and Sleep Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMRS 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; INSERM, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France. 4. Sleep Disorders Unit, Chest and Sleep Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France; Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, INSERM U 1127-CNRS UMR 722, Université Pierre et Marie Curie-Paris 6, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, F-75013 Paris, France. Electronic address: isabelle.arnulf@psl.aphp.fr.
Abstract
BACKGROUND: Choking during sleep may be caused by various respiratory and non-respiratory problems. OBJECTIVE: We aimed at documenting a new, rare cause of hallucinatory choking. METHODS: We documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. RESULTS: The 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. CONCLUSION: Although insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases.
BACKGROUND: Choking during sleep may be caused by various respiratory and non-respiratory problems. OBJECTIVE: We aimed at documenting a new, rare cause of hallucinatory choking. METHODS: We documented the clinical and video-polysomnographic features of 11 adult patients referred for swallowing and choking during sleep. We conducted a systematic search for similar sensations in 68 consecutive adult patients with sleepwalking/sleep terrors and in 37 patients with obstructive sleep apnea. RESULTS: The 11 patients with sleep-related swallowing and choking were all current or former sleepwalkers. The symptoms occurred during the first third of the night. The patients consistently reported a frequent hallucinatory feeling of swallowing an unusual object (ring, nails, pebble, chewing gum, spoon, fork, electrical cables, lizard tail, needles, brush, computer, or gas container) that blocked the upper airways during sleep, followed by attempts to unblock them by spitting or swallowing water. When monitored, the choking sensations were not stereotypic, and occurred exclusively during arousals from N3 sleep, despite normal airway patency and absence of epileptic activity. The patients demonstrated simultaneous intense adrenergic stimulation and emotional distress. Of the 68 sleepwalkers, 13% had occasional choking sensations and 4% once inhaled a fictitious object. In the sleep apnea group, choking was never the motive of referral, but 38% of patients had occasional choking sensations, and 5% once inhaled something fictitious. CONCLUSION: Although insular seizure could also be discussed, these results suggest that sleep-related swallowing and choking syndrome may be a rare, specialized variant of the arousal disorders in some cases.