Catathrenia: Parasomnia or breathing disorder?

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Individuals with catathrenia experience a moaning, groaning, or high-pitched squeak during sleep.
Individuals with catathrenia experience a moaning, groaning, or high-pitched squeak during sleep.

The bed partner will be the first one to complain of this unusual sleep disorder, as it can be very distressing to them. Catathrenia, classified initially as a parasomnia, is now thought to be a sleep-disordered breathing pattern and is classified as such in the third edition of the International Classification of Sleep Disorders. Sleeping partners report a moaning, groaning, or high-pitched squeak coming from the person lying beside them.

Patients are unaware that this occurs but are socially impacted when they sleep overnight outside of their home. This is often when they first learn that there is an abnormality. The groaning often sounds sexual or morose, which can be even more embarrassing. As this disorder can occur in young children, overnight sleeping with friends can be humiliating.

The breathing pattern of patients with catathrenia is one of deep inhalation followed by a pause and then a slow exhale with moaning, groaning, or a high-pitched squeal. This differs from snoring, which occurs during inhalation. Acoustic analysis shows that catathrenia and snoring are clearly different, because catathrenia has a laryngeal origin and snoring has a guttural origin. It is a rare disorder, although there is some thought that it may be underreported or unrecognized. The disorder may also be confused with sleep talking, snoring, or sleep apnea.

A current Facebook search shows 123 members in a group called Catathrenia (Night Groaning). This group, along with other social media groups, were asked to participate in research about this disorder. Patients were asked to give information about their sleep history, including questions about family history, the use of CPAP therapy, frequency of events, etc. I joined this group to get more insight into the complaints of these patients. If you have true interest in this sleep disorder, you will find it very interesting.

Catathrenia can occur at any age and appears to be more common in males. Although it can happen in any stage of sleep, it seems to be more dominant during rapid eye movement (REM) sleep. Many patients have a small jaw and high Mallampati scores. A family history is noted in about 15% of those with the disorder. Interestingly, it appears to occur frequently in those who have participated in sports where holding breath is common, such as in swimming and weight lifting. 

CPAP therapy does appear to help many patients with this disorder, giving more credence that this may be  a sleep-disordered breathing abnormality. However, it has not been successful in all cases. Cognitive behavioral therapy and pharmacotherapy modalities have been tried with varied results. Ear plugs, or sleeping separately, are helpful for those bothered the most — usually the family or bed partner.

Sharon M. O'Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, NC. 

References

  1. Alonso J, Camancho M, Chhetri DK, Guilleminault C, Zaghi S. Catathrenia (nocturnal groaning): a social media survey and state-of-the-art review. J Clin Sleep Med. 2017;13(4):613-622.
  2. Guilleminault C, Hagen CC, Khaja AM. Catathrenia: parasomnia or uncommon feature of sleep-disordered breathing? SLEEP. 2008;31(1):132-139.
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