Nocturnal panic attacks: clinical features and respiratory connections

Abstract

The clinical and therapeutic aspects of nocturnal panic attacks (NPAs) remain poorly understood. Some authors present NPAs as a more severe and less cognitive form of panic disorder (PD), whereas others treat it as a different manifestation of conventional panic attack. Overall, few articles address NPA relative to the large amount of literature regarding PD. Important aspects regarding the management of NPAs, such as the appropriate pharmacological and psychological treatment, rely on relatively few studies. This review provides an update and review of the most relevant articles regarding conceptualization of NPA, differential diagnosis, comorbidities, treatments, etiological theories and new investigations developed by various research centers. We also discuss the etiological hypotheses of NPAs, focusing on the suffocation false alarm theory and conditioned fear. NPA patients may represent a subtype of PD with specific agoraphobic features, respiratory connections and unique therapeutic aspects.

Keywords::

• clinical feature
• cognitive–behavioral therapy
• comorbidity
• differential diagnosis
• nocturnal panic disorder
• panic disorder
• pharmacological treatment
• sleep quality
• tricyclic antidepressant

Financial & competing interests disclosure

This work was supported by the Brazilian Council for Scientific and Technological Development (CNPq), Grant 470382/2006-6. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was utilized in the production of this manuscript. The writing assistance for English editing was provided by San Francisco Edit (http://www.sfedit.net).