Sleep-Related Eating Disorder in Two Patients with Early-Onset Parkinson’s Disease

remember these events the next morning [2, 4] . Finally, SRED may be associated with morning anorexia, sleep disruption, excessive weight gain and other adverse effects from excessive food intake, such as metabolic and dental problems. There is some controversy as to whether SRED and NES are similar disorders situated at opposite ends of a common spectrum of pathophysiology, with different levels of consciousness, or wheth er they are distinct disorders with separate underlying pathophysiologies [1] . Although this diagnostic issue remains unresolved, the International Classification of Sleep Disorders, 2nd Edition, by not including a level of consciousness criterion for the parasomnia SRED, has not definitively distinguished between these two disorders, thus encouraging further research [1] . Herein we describe 2 patients with Parkinson’s disease (PD) with typical symptoms of SRED. They belong to a cohort of 45 PD patients that was prospectively followed at a tertiary outpatient clinic for sleep disorders. The clinical evaluation of both patients was performed by movement disorders and sleep specialists, a psychiatrist and a neuropsychologist. We performed an audio-video polysomnography (PSG) which included extended electroenDear Sir, Nocturnal eating disorders involve nearly nightly feeding episodes during either multiple nocturnal awakenings or during partial arousals from sleep, and are defined as excessive caloric intake with loss of control over consumption [1] . There are two major subtypes, one viewed more as an insomnia disorder, and the other more as a parasomnia. Nocturnal eating syndrome (NES) is characterized by the consumption of 50% or more of daily calories after the evening meal and/or eating after awakenings from sleep, with morning anorexia [1] . NES is considered a circadian delay of food intake with normal circadian timing of sleep onset [2] . Unrestrained binge eating is uncommon with NES, which is viewed as an insomnia disorder, with multiple, modest feedings being considered to occur to help re-induce sleep. Sleep-related eating disorder (SRED) is a parasomnia characterized by recurrent episodes of involuntary binge eating and drinking during the sleep period. The affected individuals often eat peculiar and at times bizarre combinations of high caloric food. Due to diminished or absent consciousness during these episodes, patients may ingest toxic substances or suffer injuries during food preparation (e.g. cutting oneself, burning oneself with very hot food or liquids) [2, 3] . In addition, they may not Received: April 26, 2011 Accepted: May 23, 2011 Published online: August 12, 2011