This study examined sleep patterns in twins, paying special attention to the mirroring phenomenon. Concordance and discordance of sleep related patterns (parasomnias) in a group of 27 monozygotic (MZ) mirror image twins were compared to sleep patterns in a group of 53 MZ non-mirror image twins and a group of 24 dizygotic (DZ) twin pairs. Sleep patterns had the lowest concordance among MZ mirror twins. “Mirroring” was observed not only in facial features but also in some physiological patterns such as sleep and sleep deviations. These facts suggest that mirroring in MZ twins is not merely a superficial epiphenomenon, but a reflection of a biological polarization. Biological polarization in this context is a descriptive term emphasizing the role of biological (physiological, biochemical or even genetic) versus psychological or environmental factors causing not only mirror body image but opposite tendencies in the development of personality, professional and sex orientation and, most importantly, the opposite presentation of pathology.

A preliminary analysis of twins or triplets with heart defects, ascertained in five centres, confirms earlier suggestions that monozygotic (MZ) twins are over represented among twins with heart defects, even after excluding persistent ductus arteriosus and conjoined twins. An MZ twin individual has a risk of cardiovascular malformation approximately twice that of DZ twins and singletons. It is suggested that the twinning process itself affects one of the pair. Disturbance of laterality (‘mirror imaging’) is probably a more important mechanism than twin-twin transfusion. Inappropriate use of the twin method in the past has caused the importance of genetic factors in the etiology of congenital heart defects to be underestimated. Neverthless, twins do provide a useful illustration of the likely importance of epigenetic factors in heart development.