Dados do Trabalho

Título

Propranolol-Induced Sleepwalking: A Case Report

Introdução

Sleepwalking is a type of non-REM parasomnia typically observed in children and adolescents; however, it has been reported in approximately 1 to 7% of adults. These episodes generally occur during slow-wave sleep (N3), the deepest stage of non-REM sleep. When sleepwalking occurs in adulthood, identifying potential triggers such as underlying medical conditions or medications is crucial, given the broad spectrum of possible impacts on daily life, mental health, safety, and relationships.

Objetivo

We report a case of a young female who developed nocturnal awakenings suggestive of non-REM parasomnia after initiating pharmacological treatment for migraines.

Métodos

The patient, a 23-year-old female, had a history of migraines progressing over the previous six months. She started on Propranolol 40 mg daily as a prophylactic measure at night. Following the initiation of this medication, her family members reported that she began experiencing nocturnal awakenings, described as "walking around the house" and "talking during the night," while still asleep. These episodes occurred once or twice a week, causing significant disruption to her social and professional life. The patient also had a history of epileptic seizures secondary to cerebral venous thrombosis, which had occurred four years prior to the actual event. An electroencephalogram was performed, yielding normal results, and a video-polysomnography (PSG) did not reveal any pathological nocturnal events. However, four episodes of abrupt awakenings during the N3 stage of sleep were identified throughout the PSG night. Upon discontinuation of Propranolol, the patient reported the cessation of these events.

Resultados

Literature reports suggest that medications such as beta-blockers can trigger sleepwalking. The proposed mechanism is that propranolol, being a lipophilic drug, crosses the blood-brain barrier and interferes with the physiology of melatonin production, a hormone critical for the regulation of the sleep-wake cycle. It works by blocking beta-adrenergic receptors in the pineal gland, thereby preventing norepinephrine from binding and activating the signaling pathway necessary for melatonin synthesis, which may be implicated in the pathophysiology of non-REM parasomnias in these cases.

Conclusões

Therefore, it is crucial to recognize in clinical practice that certain medications can induce parasomnias with adult onset, as such disorders may pose significant risks to the overall health of the patient.

Palavras -chave

Sleepwalking; Parasomnia; Propranolol.