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Assembly

Nocturnal Groaning

Author
Ee-Rah Sung, VCU Medical Center, Richmond VA; Department of Internal Medicine
Alex Dworetz, VCU Medical Center, Richmond VA; Department of Neurology
Maha Alattar, VCU Medical Center, Richmond VA; Department of Neurology


Case

A 21-year-old man presented with abnormal nocturnal vocalizations that were described as repetitive deep-throated groaning. The vocalizations were disruptive to his bed partner and led to un-refreshing sleep. He had witnessed brief pauses in his breathing lasting several seconds but reported no gasping arousals or snoring. He had no prior medical history and was not taking medications. Physical examination was remarkable for Mallampati class III airway. His polysomnogram (PSG) recorded intermittent nocturnal groaning that is displayed in the 30-second epoch in Figure 2. This is contrasted to the 30-second epoch shown in Figure 1 (without nocturnal groaning).

Figure 1. Sleep without “nocturnal groaning.”
Figure 1. Sleep without “nocturnal groaning.”
Figure 2. Sleep with “nocturnal groaning.”
Figure 2. Sleep with “nocturnal groaning.”

Question

Which of the following is the diagnosis?

A. Central sleep apnea (CSA)
B. Catathrenia
C. REM sleep behavior disorder (RBD)
D. Somniloquy

Answer