Sexsomnia: an umbrella review of clinical, neurophysiological and diagnostic evidence.

Abstract

Background: Sexsomnia is a NREM parasomnia involving involuntary sleep-related sexual behaviors that has attracted increasing clinical and forensic attention. However, the existing literature remains fragmented and largely dominated by case reports and small clinical series.

Objective: This umbrella review aims to synthesize review-level evidence by integrating clinical and neurophysiological insights while identifying critical gaps in diagnosis and management.

Methods: Following PRISMA 2020 guidelines, major databases were systematically searched up to January 2025. Systematic, narrative, and scoping reviews were included and assessed using the AMSTAR 2 tool.

Results: Nine reviews were analyzed. Sexsomnia is consistently described as a disorder of arousal emerging from N2/N3 sleep, characterized by sexual automatisms and subsequent amnesia. Neurophysiological findings support a model of state dissociation between motor activation and incomplete cortical awakening. Key triggers include sleep deprivation, alcohol consumption, and obstructive sleep apnea. Diagnostic challenges persist, particularly in differentiating involuntary behaviors from deliberate acts.

Conclusion: Despite recognition as a clinical entity, sexsomnia lacks standardized diagnostic criteria and robust empirical evidence. Future research should focus on establishing consensus diagnostic frameworks and validating objective assessment tools.