Scholarlink

Background <p>Violent behaviors during sleep may be caused by various mental health and sleep disorders that require thorough investigation. A diagnosis could have significant implications in forensic medicine.</p> Methods <p>We present the case of a 60-year-old truck driver with no history of sleep or mental health disorders, violent behavior during sleep or wakefulness, or marital discord. He developed insomnia after retiring. He was prescribed 0.25&#xa0;mg of alprazolam at bedtime. Four days later, he woke up at 5:30 a.m. with his hands wrapped around his wife’s neck. He had severely strangled and choked her. She survived. The judge requested expertise in psychiatry and sleep medicine. The perpetrator was interviewed and underwent video-polysomnography with and without alprazolam.</p> Results <p>The perpetrator had no identified psychiatric disorder. Video-polysomnography revealed no parasomnia, such as arousal disorder or rapid eye movement (REM) sleep behavior disorder, and no epilepsy. However, it did show severe obstructive sleep apnea (OSA), with apneas in REM sleep lasting 100&#xa0;s. The OSA worsened after alprazolam administration. This event was diagnosed as sudden confusional arousal induced by apnea and exacerbated by severe hypoxemia and benzodiazepine use, which can lead to aggressive behavior. Charges against the perpetrator were dropped. He experienced no further behavioral episodes while undergoing treatment for OSA and after alprazolam withdrawal, and he now lives happily with his wife.</p> Conclusion <p>This case illustrates the challenges of diagnosing violent nocturnal behaviors. In this case, it was only chance that prevented a tragic fatal outcome and made it possible to distinguish attempted murder from involuntary behavior.</p> Clinical trial number <p>Not applicable.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Strangulation during the night: diagnosis of sleep-associated violence

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月3日

查看全文
  • Carolina Guerreiro,
  • François Chedru,
  • Carlos H. Schenck,
  • Isabelle Arnulf

摘要

Background

Violent behaviors during sleep may be caused by various mental health and sleep disorders that require thorough investigation. A diagnosis could have significant implications in forensic medicine.

Methods

We present the case of a 60-year-old truck driver with no history of sleep or mental health disorders, violent behavior during sleep or wakefulness, or marital discord. He developed insomnia after retiring. He was prescribed 0.25 mg of alprazolam at bedtime. Four days later, he woke up at 5:30 a.m. with his hands wrapped around his wife’s neck. He had severely strangled and choked her. She survived. The judge requested expertise in psychiatry and sleep medicine. The perpetrator was interviewed and underwent video-polysomnography with and without alprazolam.

Results

The perpetrator had no identified psychiatric disorder. Video-polysomnography revealed no parasomnia, such as arousal disorder or rapid eye movement (REM) sleep behavior disorder, and no epilepsy. However, it did show severe obstructive sleep apnea (OSA), with apneas in REM sleep lasting 100 s. The OSA worsened after alprazolam administration. This event was diagnosed as sudden confusional arousal induced by apnea and exacerbated by severe hypoxemia and benzodiazepine use, which can lead to aggressive behavior. Charges against the perpetrator were dropped. He experienced no further behavioral episodes while undergoing treatment for OSA and after alprazolam withdrawal, and he now lives happily with his wife.

Conclusion

This case illustrates the challenges of diagnosing violent nocturnal behaviors. In this case, it was only chance that prevented a tragic fatal outcome and made it possible to distinguish attempted murder from involuntary behavior.

Clinical trial number

Not applicable.