Sonambulismo. estudio

ORIGINAL

Análisis espectral de la variabilidad del ritmo cardíaco y
activación cardíaca durante el despertar en el sonambulismo
P. Busek a, J. Vankova a, J. Opavsky b, J. Salinger b, I. Stepanova a, S. Nevsimalova a
SPECTRAL ANALYSIS OF THE VARIATIONS IN HEART RATE
AND CARDIAC ACTIVATION ON WAKING UP IN SLEEPWALKING
Summary. Introduction. In sleepwalking, a disorder that is characterisedby partial waking, the subject experiences an
alteration of the microstructure of sleep that can affect autonomous activity during sleep and the waking state. Aims. In order
to evaluate any possible upset in the regulation of autonomous functioning in sleepwalkers during sleep and the waking state,
we conducted a spectral analysis of their heart rate variability (HRV) during both sleep and thewaking state. Subjects and
methods. Spectral analysis of HRV was conducted in the group of 10 sleepwalkers and 10 normal controls during sleep and
during the waking state in both the horizontal and vertical positions. Their pattern of cardiac activation was also analysed
during different types of arousal. Results. There were no differences between the group of sleepwalkers and the control groupin the parameters used in the spectral analysis of HRV during sleep and in the horizontal position during the waking state.
Sleepwalkers showed a greater shift in the sympathovagal balance in favour of sympathetic activity, as a response to
standing. During the 5-minute sequences immediately before the start of pathological arousal in sleepwalkers, the total
energy in the spectral analysis ofHRV was seen to increase. No differences were found between the patterns of cardiac
activation displayed by the groups of patients and normal subjects during several different types of arousal. Conclusions.
Autonomous reactivity was seen to be altered as a response to the orthostatic load in sleepwalkers, which could be the
consequence of the instability of these patients’ sleep. The increasein the total energy in the spectral analysis of HRV
immediately before pathological arousal during NREM 4 sleep in sleepwalkers suggests that autonomous activation precedes
cortical arousal. [REV NEUROL 2005; 41: 338-43]
Key words. Arousal disorders. Autonomous nervous system. Heart rate variability. Parasomnias. Sleepwalking. Waking.

INTRODUCCIÓN
El sonambulismo tiene una incidencia muyalta. Se estima que
un 40% de los niños lo presentan alguna vez, pero sólo en un
2-3% aparece más de un episodio al mes. Generalmente, el trastorno empieza al final de la infancia o en la adolescencia y suele desaparecer antes de le edad adulta [1,2]. Los episodios del
sonambulismo se manifiestan con un levantamiento de la cama
y el paciente puede pasear tranquilamente con los ojos abiertos
porla habitación. El sonambulismo pertenece a los trastornos
del alertamiento que se caracterizan por un alertamiento parcial
o incompleto. Durante el episodio, el estado comportamental es
similar al de la vigilia y el estado neurofisiológico corresponde
al sueño profundo. Las causas del sonambulismo son factores
tónicos o constitucionales del sueño, como los factores genéticos –se estudia unaposible asociación del alelo HLA DQB1*05
a este trastorno–, factores madurativos, psicológicos, privación
del sueño, fármacos, etc. [3-6]. Los factores fásicos o precipitantes pueden ser exógenos, como ruido, luz, tacto, o endógenos, como reflujo, apnea, fiebre o tensión de la vejiga urinaria
repleta.
Desde el punto de vista patofisiológico, el episodio del sonambulismo es un estado disociadode vigilia y sueño, que consiste en una activación incompleta cortical en respuesta a un
Aceptado: 04.05.05.
a

Instituto de Neurología. Facultad de Medicina. Universidad Carolina.
Praga. b Instituto de Fisioterapia y Algoterapia. Facultad de Cultura Física.
Universidad de Palacky. Olomouc, República Checa.
Correspondencia: Petr Busek, MD, PhD. Department of Neurology. 1st Medical...