Do patients with systemic lupus erythematosus experience night terrors, especially with central nervous system involvement or high‑dose glucocorticoid therapy?

Night Terrors in Lupus Patients

Night terrors are not a recognized manifestation of systemic lupus erythematosus (SLE), even in patients with CNS involvement or on high-dose glucocorticoids. The established neuropsychiatric manifestations of lupus do not include night terrors (also called sleep terrors), which are distinct parasomnia events.

Recognized Neuropsychiatric Manifestations in SLE

The American College of Rheumatology nomenclature for neuropsychiatric lupus syndromes specifically categorizes psychiatric manifestations into defined syndromes, and night terrors are not among them 1, 2, 3:

• Lupus psychosis (delusions and hallucinations) occurs in 1-5% of patients, typically presenting early in disease course 1, 2
• Acute confusional state with fluctuating consciousness and decreased attention 1, 3
• Mood disorders including depression and anxiety 1, 4
• Cognitive dysfunction affecting memory, attention, and executive function 1
• Seizure disorders (generalized tonic-clonic or partial seizures) 1

Sleep Disturbances in Lupus

While night terrors are not documented, sleep disorders are highly prevalent in SLE, occurring in 55-85% of patients 5:

• Sleep disturbances correlate with disease activity, pain, and fatigue 5
• Depression is the most frequently reported psychosocial factor associated with sleep problems 5
• These represent general sleep disruption (insomnia, poor sleep quality) rather than specific parasomnias like night terrors 5

Corticosteroid-Induced Psychiatric Effects

High-dose corticosteroids (prednisone ≥1 mg/kg) cause psychiatric disturbances in 10% of patients, but these manifest primarily as mood disorders (93%) rather than psychosis or parasomnias 1, 3:

• Depression, hypomania, and overt psychosis are the most common presentations 6
• Other manifestations include bipolar changes, delirium, panic attacks, anxiety, insomnia, and restlessness 6
• Night terrors are not listed among corticosteroid-induced neuropsychiatric disorders 6

Clinical Pitfalls

If a lupus patient reports symptoms resembling "night terrors," consider these alternative diagnoses 1, 3, 7:

• Seizure disorder (particularly nocturnal seizures) - requires EEG evaluation 1
• Acute confusional state - requires exclusion of CNS infection via lumbar puncture 1, 3
• Delirium from metabolic disturbances or infection 1, 7
• Steroid-induced psychiatric symptoms (anxiety, panic, insomnia) 6
• Primary sleep disorders unrelated to lupus 5

Diagnostic Approach

When evaluating concerning nocturnal symptoms in lupus patients 3, 7:

• Obtain detailed description of episodes (consciousness level, recall, timing, duration)
• Perform EEG to exclude seizure disorder 1, 3
• Order brain MRI if focal neurological signs present 3
• Conduct lumbar puncture to exclude CNS infection 3
• Assess for metabolic disturbances and medication effects 1, 7
• Evaluate for depression and anxiety, which commonly affect sleep in SLE 4, 5