Elsevier

Sleep Medicine Reviews

Volume 37, February 2018, Pages 105-113
Sleep Medicine Reviews

Clinical Review
Medication induced sleepwalking: A systematic review

https://doi.org/10.1016/j.smrv.2017.01.005Get rights and content

Summary

Medications that trigger sleepwalking may inadvertently put the patient at risk of injury to themselves and/or others, and contribute to poor treatment adherence. The aim of this study was to systematically review the literature to identify drugs that may increase the risk of sleepwalking. A search of CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect was conducted with the keywords ‘sleepwalking’ OR ‘somnambulism’. Of the original 83 sourced papers, 62 met the inclusion criteria and were subsequently included for review. Twenty-nine drugs, primarily in four classes—benzodiazepine receptor agonists and other gamma aminobutyric acid (GABA) modulators, antidepressants and other serotonergic agents, antipsychotics, and β-blockers—were identified as possible triggers for sleepwalking. The strongest evidence for medication-induced sleepwalking was for zolpidem and sodium oxybate. All other associations were based on case reports. This research highlights the importance of considering sleepwalking in risk profiles in clinical trials, particularly for drugs that enhance GABA activity at the GABAA receptor, enhance serotonergic activity, or block the activity of noradrenaline at β receptors. The results also have implications for prescribers to consider sleepwalking as a potential adverse effect and ensure that: 1) the patient is educated about a safe sleep environment; 2) they are encouraged to report the onset or exacerbation of sleepwalking, and 3) alternative treatments are considered if sleepwalking occurs.

Section snippets

Medication induced sleepwalking: A review of the evidence

Sleepwalking, or somnambulism, occurs in non-rapid eye movement (NREM) sleep, predominantly during slow wave sleep (SWS) [1] and appears as a disorder of arousal regulation [see [2] for a review]. While frequently innocuous, it can result in injury to the sleepwalker, to others, and sometimes even death [e.g., [3], [4], [5]]. The estimated prevalence of sleepwalking is 5.0% (95% CI 3.8–6.5) in children and 1.5% (95% CI 1.0–2.3) in adults [6]. There is no difference in lifetime prevalence rates

Method

This systematic review examined studies that reported prescribed medication linked to sleepwalking behavior. The following databases were included in the identification of relevant studies: CINAHL, EMBASE, PsycINFO, PubMed, and ScienceDirect. Initial search terms were ‘sleepwalking’ or ‘somnambulism’. Studies were included if they reported clinical trials, cases studies or case reports involving prescribed drug-induced sleepwalking in any field. Studies were excluded if: 1) they included

Results

Fig. 1 displays the flow of information through the different phases of the systematic review. A total of 62 studies describing medication-induced sleepwalking were identified. All but four studies were case reports. One case study of paroxetine-induced sleepwalking was published in two different journals [38], [39]—only one is discussed [39] in this review.

Table 1 provides a summary of the class of drug, drug name, number of studies for each drug type, year published, study design, number of

Discussion

Drugs that affect neurophysiology during sleep have the potential to trigger sleepwalking in people with and without a prior history of sleepwalking. The aim of this study was to systematically review the literature to identify drugs that have been identified to trigger sleepwalking. Twenty-nine drugs, primarily in four classes (benzodiazepine receptor agonists, antidepressants and other serotonergic agents, antipsychotics, and β-blockers) were identified as possible risk factors for

Conflicts of interest

The authors do not have any conflicts of interest to disclose.

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