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Rach H, Kilic-Huck U, Geoffroy PA, Bourcier T, Braun S, Comtet H, Ruppert E, Hugueny L, Hebert M, Reynaud E, Bourgin P. The electroretinography to identify biomarkers of idiopathic hypersomnia and narcolepsy type 1. J Sleep Res 2024:e14278. [PMID: 38993053 DOI: 10.1111/jsr.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/17/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024]
Abstract
Hypersomnia spectrum disorders are underdiagnosed and poorly treated due to their heterogeneity and absence of biomarkers. The electroretinography has been proposed as a proxy of central dysfunction and has proved to be valuable to differentiate certain psychiatric disorders. Hypersomnolence is a shared core feature in central hypersomnia and psychiatric disorders. We therefore aimed to identify biomarkers by studying the electroretinography profile in patients with narcolepsy type 1, idiopathic hypersomnia and in controls. Cone, rod and retinal ganglion cells electrical activity were recorded with flash-electroretinography in non-dilated eye of 31 patients with idiopathic hypersomnia (women 84%, 26.6 ± 5.9 years), 19 patients with narcolepsy type 1 (women 63%, 36.6 ± 12.7 years) and 43 controls (women 58%, 30.6 ± 9.3 years). Reduced cone a-wave amplitude (p = 0.039) and prolonged cone (p = 0.022) and rod b-wave (p = 0.009) latencies were observed in patients with narcolepsy type 1 as compared with controls, while prolonged photopic negative response-wave latency (retinal ganglion cells activity) was observed in patients with idiopathic hypersomnia as compared with controls (p = 0.033). The rod and cone b-wave latency clearly distinguished narcolepsy type 1 from idiopathic hypersomnia and controls (area under the curve > 0.70), and the photopic negative response-wave latency distinguished idiopathic hypersomnia and narcolepsy type 1 from controls with an area under the curve > 0.68. This first original study shows electroretinography anomalies observed in patients with hypersomnia. Narcolepsy type 1 is associated with impaired cone and rod responses, whereas idiopathic hypersomnia is associated with impaired retinal ganglion cells response, suggesting different phototransduction alterations in both hypersomnias. Although these results need to be confirmed with a larger sample size, the electroretinography may be a promising tool for clinicians to differentiate hypersomnia subtypes.
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Affiliation(s)
- Héloïse Rach
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Ulker Kilic-Huck
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Pierre A Geoffroy
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, Paris, France
- Université de Paris, NeuroDiderot, Inserm, FHU I2-D2, Paris, France
| | - Tristan Bourcier
- Department of Ophthalmology & Gepromed, Education Department, Strasbourg University Hospital, Strasbourg, France
| | - Sophie Braun
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Henri Comtet
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Elisabeth Ruppert
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Laurence Hugueny
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Marc Hebert
- Centre de Recherche CERVO, Centre Intégré Universitaire de Santé et des Services Sociaux de la Capitale Nationale, Québec, Quebec, Canada
- Département d'Ophtalmologie et d'Oto-Rhino-Laryngologie-Chirurgie Cervico-Faciale, Faculté de Médecine, Université Laval, Québec, Quebec, Canada
| | - Eve Reynaud
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
| | - Patrice Bourgin
- Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, Strasbourg, France
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, Strasbourg University Hospital, Strasbourg, France
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Slonkova J, Togtokhjargal A, Revendova KZ, Bartos V, Hanzlikova P, Volny O. Hypocretin-1/orexin-A, sleep and excessive daytime sleepiness in patients with nonconvulsive status epilepticus: A cross-sectional cohort study. Sleep Med 2024; 119:192-200. [PMID: 38701718 DOI: 10.1016/j.sleep.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL). METHODS Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2). RESULTS From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (rs = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (rs = -0.57, p = 0.03). MSLT had significant negative correlation with TST (rs = -0.5369, p = 0.0478), with SE (rs = -0.5897, p = 0.0265), with apnea-hypopnea index (rs = -0.7631, p = 0.0002) and with deoxygenation index (rs = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (rs = 0.6284, p = 0.0161) and between ESS and t90 (rs = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved. CONCLUSIONS Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.
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Affiliation(s)
- Jana Slonkova
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic.
| | | | - Kamila Zondra Revendova
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic
| | - Vladimir Bartos
- University Hospital Ostrava, Institute of Laboratory Medicine, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Biomedical Sciences, Ostrava, Czech Republic
| | - Pavla Hanzlikova
- University Hospital Ostrava, Institute of Radiodiagnostics, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Imaging Methods, Ostrava, Czech Republic
| | - Ondrej Volny
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic
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Bouâouda H, Jha PK. Orexin and MCH neurons: regulators of sleep and metabolism. Front Neurosci 2023; 17:1230428. [PMID: 37674517 PMCID: PMC10478345 DOI: 10.3389/fnins.2023.1230428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Sleep-wake and fasting-feeding are tightly coupled behavioral states that require coordination between several brain regions. The mammalian lateral hypothalamus (LH) is a functionally and anatomically complex brain region harboring heterogeneous cell populations that regulate sleep, feeding, and energy metabolism. Significant attempts were made to understand the cellular and circuit bases of LH actions. Rapid advancements in genetic and electrophysiological manipulation help to understand the role of discrete LH cell populations. The opposing action of LH orexin/hypocretin and melanin-concentrating hormone (MCH) neurons on metabolic sensing and sleep-wake regulation make them the candidate to explore in detail. This review surveys the molecular, genetic, and neuronal components of orexin and MCH signaling in the regulation of sleep and metabolism.
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Affiliation(s)
- Hanan Bouâouda
- Pharmacology Institute, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Pawan Kumar Jha
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Eckhardt C, Fanciulli A, Högl B, Heidbreder A, Eschlböck S, Raccagni C, Krismer F, Leys F, Kiechl S, Ransmayr G, Frauscher B, Seppi K, Wenning G, Stefani A. Analysis of sleep, daytime sleepiness, and autonomic function in multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med 2023; 19:63-71. [PMID: 36004744 PMCID: PMC9806784 DOI: 10.5664/jcsm.10268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Sleep disorders, daytime sleepiness, and autonomic dysfunction are commonly reported among patients with multiple system atrophy and Parkinson disease (PD). We aimed to assess sleep and autonomic function in these patients to evaluate the relationships between sleep disorders, excessive daytime sleepiness, and autonomic function. METHODS Twenty patients with multiple system atrophy (n = 7) and PD (n = 13) underwent clinical assessment including questionnaires for autonomic function and sleep. Cardiovascular autonomic function tests and 2-night video-polysomnography were followed by administration of the Multiple Sleep Latency Test. Rapid eye movement sleep without atonia was quantified in the chin, flexor digitorum superficialis, tibial anterior, and sternocleidomastoid muscles. RESULTS Rapid eye movement sleep behavior disorder was associated with orthostatic hypotension (P = .017) and constipation (P = .019) in PD. Patients with orthostatic hypotension had higher rapid eye movement sleep without atonia indices than those without orthostatic hypotension (P < .001). The Sleep Innsbruck Barcelona rapid eye movement sleep without atonia index ("any" chin and/or flexor digitorum superficialis) correlated with systolic/diastolic blood pressure fall upon tilt-table examination in patients with multiple system atrophy (P < .05) and with gastrointestinal (P = .010), urinary (P = .022), and total Scales for Outcomes in Parkinson's Disease-Autonomic Dysfunction scores (P = .006) in all patients. Patients with a pathological deep breathing ratio showed higher Sleep Innsbruck Barcelona indices (P = .031). Objective daytime sleepiness was exclusively present in PD (P = .034) and correlated with levodopa-equivalent dosage (P = .031). CONCLUSIONS The relationship of autonomic dysfunction with rapid eye movement sleep without atonia in PD and multiple system atrophy is accounted for by shared brainstem neuropathology and likely identifies patients in a more advanced stage of disease. Excessive daytime sleepiness is found exclusively in PD and may be secondary to levodopa treatment and not related to α-synuclein disease. CITATION Eckhardt C, Fanciulli A, Högl B, et al. Analysis of sleep, daytime sleepiness, and autonomic function and multiple system atrophy and Parkinson disease: a prospective study. J Clin Sleep Med. 2023;19(1):63-71.
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Affiliation(s)
- Christine Eckhardt
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Birgit Högl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabine Eschlböck
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Cecilia Raccagni
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- Department of Neurology, Regional Hospital of Bolzano, Bolzano, Italy
| | - Florian Krismer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Fabian Leys
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
| | | | - Birgit Frauscher
- Analytical Neurophysiology Lab and Epilepsy Program, Montreal Neurological Institute and Hospital, McGill University, Montreal H3A 2B4, Quebec, Canada
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Wenning
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Tabikh M, Chahla C, Okdeh N, Kovacic H, Sabatier JM, Fajloun Z. Parkinson disease: Protective role and function of neuropeptides. Peptides 2022; 151:170713. [PMID: 34929264 DOI: 10.1016/j.peptides.2021.170713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 01/07/2023]
Abstract
Neuropeptides are bioactive molecules, made up of small chains of amino acids, with many neuromodulatory properties. Several lines of evidence suggest that neuropeptides, mainly expressed in the central nervous system (CNS), play an important role in the onset of Parkinson's Disease (PD) pathology. The wide spread disruption of neuropeptides has been excessively demonstrated to be related to the pathophysiological symptoms in PD where impairment in motor function per example was correlated with neuropeptides dysregulation in the substantia niagra (SN). Moreover, the levels of different neuropeptides have been found modified in the cerebrospinal fluid and blood of PD patients, indicating their potential role in the manifestation of PD symptoms and dysfunctions. In this review, we outlined the neuroprotective effects of neuropeptides on dopaminergic neuronal loss, oxidative stress and neuroinflammation in several models and tissues of PD. Our main focus was to elaborate the role of orexin, pituitary adenylate cyclase activating polypeptide (PACAP), vasoactive intestinal peptide (VIP), opioids, angiotensin, carnosine and many others in the protection and/or involvement in the neurodegeneration of striatal dopaminergic cells. Further studies are required to better assess the mode of action and cellular mechanisms of neuropeptides in order to shift the focus from the in vitro and in vivo testing to applicable clinical testing. This review, allows a support for future use of neuropeptides as therapeutic solution for PA pathophysiology.
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Affiliation(s)
- Mireille Tabikh
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, 1352, Tripoli, Lebanon
| | - Charbel Chahla
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, 1352, Tripoli, Lebanon
| | - Nathalie Okdeh
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, 1352, Tripoli, Lebanon
| | - Herve Kovacic
- Faculté de Médecine, Université Aix-Marseille, Institut de Neuro-Physiopathologie, UMR 7051, Boulevard Pierre Dramard-CS80011, 13344, Marseille Cedex 15, France
| | - Jean-Marc Sabatier
- Faculté de Médecine, Université Aix-Marseille, Institut de Neuro-Physiopathologie, UMR 7051, Boulevard Pierre Dramard-CS80011, 13344, Marseille Cedex 15, France.
| | - Ziad Fajloun
- Faculty of Sciences 3, Department of Biology, Lebanese University, Campus Michel Slayman Ras Maska, 1352, Tripoli, Lebanon; Laboratory of Applied Biotechnology (LBA3B), Azm Center for Research in Biotechnology and its Applications, EDST, Lebanese University, 1300, Tripoli, Lebanon.
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Fronczek R, Schinkelshoek M, Shan L, Lammers GJ. The orexin/hypocretin system in neuropsychiatric disorders: Relation to signs and symptoms. HANDBOOK OF CLINICAL NEUROLOGY 2021; 180:343-358. [PMID: 34225940 DOI: 10.1016/b978-0-12-820107-7.00021-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hypocretin-1 and 2 (or orexin A and B) are neuropeptides exclusively produced by a group of neurons in the lateral and dorsomedial hypothalamus that project throughout the brain. In accordance with this, the two different hypocretin receptors are also found throughout the brain. The hypocretin system is mainly involved in sleep-wake regulation, but also in reward mechanisms, food intake and metabolism, autonomic regulation including thermoregulation, and pain. The disorder most strongly linked to the hypocretin system is the primary sleep disorder narcolepsy type 1 caused by a lack of hypocretin signaling, which is most likely due to an autoimmune process targeting the hypocretin-producing neurons. However, the hypocretin system may also be affected, but to a lesser extent and less specifically, in various other neurological disorders. Examples are neurodegenerative diseases such as Alzheimer's, Huntington's and Parkinson's disease, immune-mediated disorders such as multiple sclerosis, neuromyelitis optica, and anti-Ma2 encephalitis, and genetic disorders such as type 1 diabetus mellitus and Prader-Willi Syndrome. A partial hypocretin deficiency may contribute to the sleep features of these disorders.
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Affiliation(s)
- Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands; Sleep Wake Centre SEIN, Heemstede, The Netherlands.
| | - Mink Schinkelshoek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands; Sleep Wake Centre SEIN, Heemstede, The Netherlands
| | - Ling Shan
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands; Sleep Wake Centre SEIN, Heemstede, The Netherlands; Department Neuropsychiatric Disorders, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands; Sleep Wake Centre SEIN, Heemstede, The Netherlands
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Erichsen JM, Calva CB, Reagan LP, Fadel JR. Intranasal insulin and orexins to treat age-related cognitive decline. Physiol Behav 2021; 234:113370. [PMID: 33621561 PMCID: PMC8053680 DOI: 10.1016/j.physbeh.2021.113370] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023]
Abstract
The intranasal (IN) administration of neuropeptides, such as insulin and orexins, has been suggested as a treatment strategy for age-related cognitive decline (ARCD). Because dysfunctional neuropeptide signaling is an observed characteristic of ARCD, it has been suggested that IN delivery of insulin and/or orexins may restore endogenous peptide signaling and thereby preserve cognition. IN administration is particularly alluring as it is a relatively non-invasive method that directly targets peptides to the brain. Several laboratories have examined the behavioral effects of IN insulin in young, aged, and cognitively impaired rodents and humans. These studies demonstrated improved performance on various cognitive tasks following IN insulin administration. Fewer laboratories have assessed the effects of IN orexins; however, this peptide also holds promise as an effective treatment for ARCD through the activation of the cholinergic system and/or the reduction of neuroinflammation. Here, we provide a brief overview of the advantages of IN administration and the delivery pathway, then summarize the current literature on IN insulin and orexins. Additional preclinical studies will be useful to ultimately uncover the mechanisms underlying the pro-cognitive effects of IN insulin and orexins, whereas future clinical studies will aid in the determination of the most efficacious dose and dosing paradigm. Eventually, IN insulin and/or orexin administration may be a widely used treatment strategy in the clinic for ARCD.
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Affiliation(s)
- Jennifer M Erichsen
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States.
| | - Coleman B Calva
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
| | - Lawrence P Reagan
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States; Columbia VA Health Care System, Columbia, SC, 29208, United States
| | - Jim R Fadel
- University of South Carolina School of Medicine, Department of Pharmacology, Physiology, and Neuroscience, Columbia, SC 29208, United States
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Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Sanford LD, Tang X. Polysomnographic nighttime features of narcolepsy: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101488. [PMID: 33934047 DOI: 10.1016/j.smrv.2021.101488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies have been conducted to explore nighttime sleep features in narcolepsy, but their relationship to narcolepsy is still imperfectly understood. We conducted a systematic review of the literature exploring polysomnographic differences between narcolepsy patients and healthy controls (HCs) in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO. 108 studies were identified for this review, 105 of which were used for meta-analysis. Meta-analyses revealed significant reductions in sleep latency, sleep efficiency, slow wave sleep percentage, rapid eye movement sleep (REM) latency, cyclic alternating pattern rate, and increases in total sleep time, wake time after sleep onset (WASO), awakening numbers (AWN) per hour, stage shift (SS) per hour, N1 percentage, apnea hypopnea index, and periodic limb movement index in narcolepsy patients compared with HCs. Furthermore, narcolepsy type 1 patients showed more disturbed nighttime sleep compared with narcolepsy type 2 patients. Children and adolescent narcolepsy patients show increased WASO, AWN, and SS compared with adult patients. Macro- and micro-structurally, our study suggests that narcolepsy patients have poor nighttime sleep. Sex, age, body mass index, disease duration, disease type, medication status, and adaptation night are demographic, clinical and methodological factors that contribute to heterogeneity between studies.
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Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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9
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Lindström M, Schinkelshoek M, Tienari PJ, Kukkonen JP, Renkonen R, Fronczek R, Lammers GJ, Itkonen O. Orexin-A measurement in narcolepsy: A stability study and a comparison of LC-MS/MS and immunoassays. Clin Biochem 2021; 90:34-39. [PMID: 33539807 DOI: 10.1016/j.clinbiochem.2021.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Orexin-A and -B are neuropeptides involved in sleep-wake regulation. In human narcolepsy type 1, this cycle is disrupted due to loss of orexin-producing neurons in the hypothalamus. Cerebrospinal fluid (CSF) orexin-A measurement is used in the diagnosis of narcolepsy type 1. Currently available immunoassays may lack specificity for accurate orexin quantification. We developed and validated a liquid chromatography mass spectrometry assay (LC-MS/MS) for CSF orexin-A and B. METHODS We used CSF samples from narcolepsy type 1 (n = 22) and type 2 (n = 6) and non-narcoleptic controls (n = 44). Stable isotope-labeled orexin-A and -B internal standards were added to samples before solid-phase extraction and quantification by LC-MS/MS. The samples were also assayed by commercial radioimmunoassay (RIA, n = 42) and enzymatic immunoassay (EIA, n = 72) kits. Stability of orexins in CSF was studied for 12 months. RESULTS Our assay has a good sensitivity (10 pmol/L = 35 pg/mL) and a wide linear range (35-3500 pg/mL). Added orexin-A and -B were stable in CSF for 12 and 3 months, respectively, when frozen. The median orexin-A concentration in CSF from narcolepsy type 1 patients was <35 pg/mL (range < 35-131 pg/mL), which was lower than that in CSF from control individuals (98 pg/mL, range < 35-424 pg/mL). Orexin-A concentrations determined using our LC-MS/MS assay were five times lower than those measured with a commercial RIA. Orexin-B concentrations were undetectable. CONCLUSIONS Orexin-A concentrations measured by our LC-MS/MS assay were lower in narcolepsy type 1 patients as compared to controls. RIA yielded on average higher concentrations than LC-MS/MS.
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Affiliation(s)
- Mikael Lindström
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Mink Schinkelshoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Pentti J Tienari
- HUS Neurocenter, Helsinki University Hospital, Helsinki, Finland; Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Finland
| | - Jyrki P Kukkonen
- Department of Pharmacology, Institute of Biomedicine, University of Helsinki, Helsinki, Finland
| | - Risto Renkonen
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Sleep-Wake Centre, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Outi Itkonen
- HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Jagadish S, Singer W, Kotagal S. Autonomic dysfunction in childhood hypersomnia disorders. Sleep Med 2020; 78:43-48. [PMID: 33385777 DOI: 10.1016/j.sleep.2020.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/05/2020] [Accepted: 11/29/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Orthostatic intolerance (OI) is a common manifestation of autonomic dysfunction. It is characterized by light-headedness and palpitations in the upright position, with relief when supine. It can affect the quality of life. Other symptoms that may accompany OI include headache, fatigue, nausea, palpitations and abdominal pain. The prevalence and characteristics of autonomic symptoms in childhood hypersomnia disorders of childhood has not been examined, and hence were studied. METHODS The medical records of children and adolescents with hypersomnia disorders were reviewed. Subjects had been diagnosed with narcolepsy types 1 or 2 (NT1 or NT2), idiopathic hypersomnia (IH) or the KLS, or hypersomnia related to medical conditions, were under 18 years of age at sleep diagnosis, and had been evaluated at our sleep center between 2000 and 2018. Those with comorbidities such as obstructive sleep apnea and major depression were excluded. The medical records were reviewed for symptoms at initial presentation suggestive of autonomic dysfunction, such as orthostatic intolerance, headache, fatigue, nausea, palpitations and abdominal pain. If these symptoms had been recorded, the chart was examined further to determine if an autonomic reflex screen (ARS) battery had been conducted. The ARS battery examines both sympathetic and parasympathetic function. It is composed of a tilt table test, heart rate and blood pressure responses to the Valsalva maneuver and deep breathing, a quantitative sudomotor axon reflex test and beat-to-beat blood pressure measurements during the Valsalva maneuver. Results of the ARS battery were interpreted by an autonomic neurology specialist (WS), who was not otherwise involved in the care of the patients. Medications taken at the time of autonomic testing were recorded. RESULTS There were 89 patients with hypersomnia disorders. Forty six patients had NT1, 17 had NT2, 18 had IH, 1 with KLS, and 7 had hypersomnia associated with medical disorders. Thirty three of 89 subjects (37%) had the symptom of OI at initial presentation, hence had undergone autonomic reflex screen testing. The median age at diagnosis of hypersomnia in the 33 subjects with the OI symptom was 14.5 years (interquartile range 12-16) and similar (14.5 years, interquartile range 11.5-16) in the 56 subjects without OI. In the group with OI, 25/33 had not received medications for treating hypersomnia at the time of autonomic testing. OI was not related to the degree of sleepiness- the mean sleep latency in the subjects with OI was 5.3 ± 2.9 min while in those without OI it was 4.5 ± 3.8 min. The symptom of OI was not more likely to occur in any specific type of hypersomnia. OI however tended to occur predominantly in females - the female: male ratio in the OI subgroup was 2:1 (n = 33) while in the subgroup without OI, it was 1: 2.1 (n = 56; p = 0.0015). Additional symptoms recorded in the OI subgroup included lightheadedness in 25/33, palpitations in 6/33, nausea and vomiting in 4/33, fatigue in 25/33, headache in 15/33 and constipation in 3/33. The symptoms of OI were reproduced during the tilt table test in 17/33 subjects; 5 of these patients had a rise in heart rate consistent with postural orthostatic tachycardia syndrome (POTS). CONCLUSION In this retrospective sample, one third of children with hypersomnia disorders exhibited the symptom of OI at initial presentation, with female predominance. A smaller subgroup met criteria for POTS. Screening for autonomic symptoms in children with hypersomnia is important because the former seems to be a treatable co-morbidity that impacts the sense of well-being.
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Affiliation(s)
| | | | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Sex and age differences in the association between anxiety disorders and narcolepsy: A nationwide population-based case control study. J Affect Disord 2020; 264:130-137. [PMID: 32056742 DOI: 10.1016/j.jad.2019.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To examine the association between narcolepsy and anxiety disorders. METHODS This population-based, retrospective case-control study analyzed Taiwan's National Health Insurance Research Database between 2000 and 2013. We included narcoleptic patients aged at least 12 years, diagnosed according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 347. The cases and the propensity score-matched controls were selected in a 1:4 ratio. Each subject with anxiety disorders (ICD-9-CM code 300) was required to visit the outpatient clinic at least three times within a year. Multivariate logistic regression and interaction analyses were used to calculate the association between anxiety disorders and narcolepsy. RESULTS This study enrolled 478 and 1912 subjects with and without narcolepsy, respectively. After adjusting for covariates, patients with anxiety disorders had an approximately 2.7 odds ratio of developing narcolepsy when compared to the control subjects (adjusted odds ratio [aOR)] = 2.7; 95% confidence interval [CI] = 1.699-4.344). Interaction analysis and subgroup analysis showed a higher incidence of previously diagnosed anxiety disorders in narcoleptic patients aged 12 to 17 years and female patients (aOR = 25.9; 95% CI = 15.194-42.896; aOR = 3.6; 95% CI = 1.818-7.062, respectively). LIMITATIONS The narcolepsy and anxiety disorders were not distinguished by validated structural diagnostic instruments. CONCLUSIONS The results of this study revealed higher comorbidity rates of anxiety disorders in narcoleptic patients. The incidence of previously diagnosed anxiety disorders was higher in narcoleptic patients aged 12 to 17 years and female patients.
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Depletion of hypothalamic hypocretin/orexin neurons correlates with impaired memory in a Parkinson's disease animal model. Exp Neurol 2020; 323:113110. [DOI: 10.1016/j.expneurol.2019.113110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
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Cai Z, Liu H, Wang L, Li X, Bai L, Gan X, Li L, Han C. Molecular Evolutionary Analysis of the HCRTR Gene Family in Vertebrates. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8120263. [PMID: 29967787 PMCID: PMC6008884 DOI: 10.1155/2018/8120263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/17/2018] [Accepted: 04/17/2018] [Indexed: 12/02/2022]
Abstract
Hypocretin system is composed of hypocretins (hcrts) and their receptors (hcrtrs), which has multiple vital functions. Hypocretins work via hypocretin receptors and it is reported that functional differentiation occurred in hcrtrs. It is necessary to figure out the evolution process of hypocretin receptors. In our study, we adopt a comprehensive approach and various bioinformatics tools to analyse the evolution process of HCRTR gene family. It turns out that the second round of whole genome duplication in early vertebrate ancestry and the independent round in fish ancestry may contribute to the diversity of HCRTR gene family. HCRTR1 of fishes and mammals are not the same receptor, which means that there are three members in the family. HCRTR2 is proved to be the most ancient one in HCRTR gene family. After duplication events, the structure of HCRTR1 diverged from HCRTR2 owing to relaxed selective pressure. Negative selection is the predominant evolutionary force acting on the HCRTR gene family but HCRTR1 of mammals is found to be subjected to positive selection. Our study gains insight into the molecular evolution process of HCRTR gene family, which contributes to the further study of the system.
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Affiliation(s)
- Zhen Cai
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Hehe Liu
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Liyun Wang
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Xinxin Li
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Lili Bai
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Xinmeng Gan
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Liang Li
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
| | - Chunchun Han
- Farm Animal Genetic Resources Exploration and Innovation Key Laboratory of Sichuan Province, Sichuan Agricultural University, Chengdu, Sichuan 611130, China
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Mavanji V, Butterick TA, Duffy CM, Nixon JP, Billington CJ, Kotz CM. Orexin/hypocretin treatment restores hippocampal-dependent memory in orexin-deficient mice. Neurobiol Learn Mem 2017; 146:21-30. [PMID: 29107703 DOI: 10.1016/j.nlm.2017.10.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 12/31/2022]
Abstract
Orexin A is produced in neurons of the lateral, perifornical and dorsomedial regions of the lateral hypothalamic area, which then project widely throughout the central nervous system to regulate arousal state, sleep-wake architecture, energy homeostasis and cognitive processes. Disruption of orexin signaling leads to sleep disturbances and increased body mass index, but recent studies also indicate that orexin neuron activation improves learning and memory. We hypothesized that hippocampal orexin receptor activation improves memory. To test this idea, we obtained orexin/ataxin-3 (O/A3) mice, which become deficient in orexin neurons by about 12 weeks of age. We first measured hippocampal orexin receptor 1 (OX1R) gene expression and protein levels, then tested acquisition and consolidation of two-way active avoidance (TWAA) memory, a hippocampal-dependent learning and memory task. Finally, we determined if exogenous intra-hippocampal OXA treatment could reverse cognitive impairment (as determined by TWAA) in OA/3 mice. We showed that OX1R mRNA expression and protein levels were significantly elevated in O/A3 mice, indicating the potential for preserved orexin responsiveness. The O/A3 mice were significantly impaired in TWAA memory vs. control mice, but OXA treatment (both acute and chronic) reversed these memory deficits. These results demonstrate that orexin plays an important role in hippocampal-dependent consolidation of two-way active avoidance memory, and orexin replacement can rescue the cognitive impairment.
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Affiliation(s)
- Vijayakumar Mavanji
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA
| | - Tammy A Butterick
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Department of Food Science and Nutrition, University of Minnesota, St Paul, MN 55108 USA; Minnesota Obesity Center, St Paul, MN 55108 USA
| | - Cayla M Duffy
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Department of Food Science and Nutrition, University of Minnesota, St Paul, MN 55108 USA; Minnesota's Discovery, Research and Innovation Economy, Brain Conditions, University of Minnesota, Minneapolis, MN 55455
| | - Joshua P Nixon
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Department of Food Science and Nutrition, University of Minnesota, St Paul, MN 55108 USA
| | - Charles J Billington
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Minnesota Obesity Center, St Paul, MN 55108 USA; Department of Medicine, University of Minnesota, Minneapolis, MN 55455 USA
| | - Catherine M Kotz
- Research Service, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Minnesota Obesity Center, St Paul, MN 55108 USA; Geriatric Research Education Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN 55417 USA; Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN 55455 USA.
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Lee MJ, Lee SY, Yuan SS, Yang CJ, Yang KC, Lee TL, Sun CC, Shyu YC, Wang LJ. Comorbidity of narcolepsy and depressive disorders: a nationwide population-based study in Taiwan. Sleep Med 2017; 39:95-100. [PMID: 29157595 DOI: 10.1016/j.sleep.2017.07.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/19/2017] [Accepted: 07/12/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Narcolepsy is a chronic sleep disorder that is likely to have neuropsychiatric comorbidities. Depression is a serious mood disorder that affects individuals' daily activities and functions. The current study aimed to investigate the relationship between narcolepsy and depressive disorders. METHODS The study consisted of patients diagnosed with narcolepsy between January 2002, and December 2011 (n = 258), and age-matched and gender-matched controls (n = 2580) from Taiwan's National Health Insurance database. Both the patients and the controls were monitored through December 31, 2011, to identify the occurrence of a depressive disorder. A multivariate logistic regression model was used to assess the narcolepsy's potential influence on the comorbidity of a depressive disorder. RESULTS During the study period, 32.7%, 24.8%, and 10.9% of the narcoleptic patients were comorbid with any depressive disorder, dysthymic disorder, and major depressive disorder, respectively. When compared to the control subjects, the patients with narcolepsy were at greater risks of having any depressive disorder (aOR 6.77; 95% CI 4.90-9.37), dysthymic disorder (aOR 6.62; 95% CI 4.61-9.57), and major depressive disorder (aOR 6.83; 95% CI 4.06-11.48). Of the narcoleptic patients that were comorbid with depression, >50% had been diagnosed with depression prior to being diagnosed with narcolepsy. CONCLUSIONS This nationwide data study revealed that narcolepsy and depression commonly co-occurred. Since some symptoms of narcolepsy overlapped with those of depressive disorders, the findings serve as a reminder that clinicians must pay attention to the comorbidity of narcolepsy and depression.
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Affiliation(s)
- Min-Jing Lee
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yu Lee
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Sheng Yuan
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Chun-Ju Yang
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kang-Chung Yang
- Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tung-Liang Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chi-Chin Sun
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Molecular Biology, Academia Sinica, Nankang, Taipei, Taiwan; Department of Nursing, Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taiwan; Department of Nutrition and Health Sciences, Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
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Kram DE, Krasnow SM, Levasseur PR, Zhu X, Stork LC, Marks DL. Dexamethasone Chemotherapy Does Not Disrupt Orexin Signaling. PLoS One 2016; 11:e0168731. [PMID: 27997622 PMCID: PMC5173249 DOI: 10.1371/journal.pone.0168731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/05/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Steroid-induced sleep disturbance is a common and highly distressing morbidity for children receiving steroid chemotherapy for the treatment of pediatric acute lymphoblastic leukemia (ALL). Sleep disturbance can negatively impact overall quality of life, neurodevelopment, memory consolidation, and wound healing. Hypothalamic orexin neurons are influential wake-promoting neurons, and disturbances in orexin signaling leads to abnormal sleep behavior. A new class of drug, the orexin receptor antagonists, could be an intriguing option for sleep disorders caused by increased orexinergic output. Our aim was to examine the impact of ALL treatment doses of corticosteroids on the orexin system in rodents and in children undergoing treatment for childhood ALL. METHODS We administered repeated injections of dexamethasone to rodents and measured responsive orexin neural activity compared to controls. In children with newly diagnosed standard risk B-cell ALL receiving dexamethasone therapy per Children's Oncology Group (COG) induction therapy from 2014-2016, we collected pre- and during-steroids matched CSF samples and measured the impact of steroids on CSF orexin concentration. RESULTS In both rodents, all markers orexin signaling, including orexin neural output and orexin receptor expression, were preserved in the setting of dexamethasone. Additionally, we did not detect a difference in pre- and during-dexamethasone CSF orexin concentrations in children receiving dexamethasone. CONCLUSIONS Our results demonstrate that rodent and human orexin physiology is largely preserved in the setting of high dose dexamethasone. The data obtained in our experimental model fail to demonstrate a causative role for disruption of the orexin pathway in steroid-induced sleep disturbance.
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Affiliation(s)
- David E. Kram
- Division of Pediatric Hematology-Oncology, Doernbecher Children’s Hospital/Oregon Health & Science University, Portland, Oregon, United States of America
| | - Stephanie M. Krasnow
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Peter R. Levasseur
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Xinxia Zhu
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Linda C. Stork
- Division of Pediatric Hematology-Oncology, Doernbecher Children’s Hospital/Oregon Health & Science University, Portland, Oregon, United States of America
| | - Daniel L. Marks
- Papé Family Pediatric Research Institute, Oregon Health & Science University, Portland, Oregon, United States of America
- * E-mail:
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Abstract
Sleep and energy balance are essential for health. The two processes act in concert to regulate central and peripheral homeostasis. During sleep, energy is conserved due to suspended activity, movement, and sensory responses, and is redirected to restore and replenish proteins and their assemblies into cellular structures. During wakefulness, various energy-demanding activities lead to hunger. Thus, hunger promotes arousal, and subsequent feeding, followed by satiety that promotes sleep via changes in neuroendocrine or neuropeptide signals. These signals overlap with circuits of sleep-wakefulness, feeding, and energy expenditure. Here, we will briefly review the literature that describes the interplay between the circadian system, sleep-wake, and feeding-fasting cycles that are needed to maintain energy balance and a healthy metabolic profile. In doing so, we describe the neuroendocrine, hormonal/peptide signals that integrate sleep and feeding behavior with energy metabolism.
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Affiliation(s)
- Charu Shukla
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
| | - Radhika Basheer
- Department of Psychiatry, VA Boston Healthcare System, Harvard Medical School, West Roxbury, MA, USA
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18
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Gallone S, Boschi S, Rubino E, De Martino P, Scarpini E, Galimberti D, Fenoglio C, Acutis PL, Maniaci MG, Pinessi L, Rainero I. Is HCRTR2 a genetic risk factor for Alzheimer's disease? Dement Geriatr Cogn Disord 2015; 38:245-53. [PMID: 24969517 DOI: 10.1159/000359964] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUNDS/AIMS Alzheimer's disease (AD) is one of the main types of dementia affecting about 50-55% of all demented patients. Sleep disturbances in AD patients are associated with the severity of dementia and are often the primary reason for institutionalization. These sleep problems partly resemble the core symptoms of narcolepsy, a sleep disorder caused by a general loss of the neurotransmitter hypocretin. The aim of our study was to investigate whether genetic variants in the hypocretin (HCRT) and in the hypocretin receptors 1 and 2 (HCRTR1, HCRTR2) genes could modify the occurrence and the clinical features of AD and to examine if these possible variants influence the role of the protein in sleep regulation. METHODS Using a case-control strategy, we genotyped 388 AD patients and 272 controls for 10 SNPs in the HCRT, HCRTR1 and HCRTR2 genes. In order to evaluate which residues belong to the HCRTR2 binding site, we built a molecular model. RESULTS The genotypic and allelic frequencies of the rs2653349 polymorphism were different (χ(2) = 5.77, p = 0.016; χ(2) = 6.728, p = 0.035) between AD patients and controls. The carriage of the G allele was associated with an increased AD risk (OR 2.53; 95% CI 1.10-5.80). No significant differences were found in the distribution of either genotypic or allelic frequencies between cases and controls in the HCRTR1 polymorphisms rs2271933, rs10914456 and rs4949449 and in the HCRTR2 polymorphism rs3122156. CONCLUSION Our data support the hypothesis that the HCRTR2 gene is likely to be a risk factor for AD. The increased risk inferred is quite small, but in the context of a multi-factorial disease, the presence of this polymorphism may significantly contribute to influencing the susceptibility for AD by interacting with other unknown genetic or environmental factors in sleep regulation.
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Affiliation(s)
- Salvatore Gallone
- Neurology II, Department of Neuroscience, University of Turin, Turin, Italy
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Lim MM, Szymusiak R. Neurobiology of Arousal and Sleep: Updates and Insights Into Neurological Disorders. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0013-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nixon JP, Mavanji V, Butterick TA, Billington CJ, Kotz CM, Teske JA. Sleep disorders, obesity, and aging: the role of orexin. Ageing Res Rev 2015; 20:63-73. [PMID: 25462194 DOI: 10.1016/j.arr.2014.11.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/19/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
The hypothalamic neuropeptides orexin A and B (hypocretin 1 and 2) are important homeostatic mediators of central control of energy metabolism and maintenance of sleep/wake states. Dysregulation or loss of orexin signaling has been linked to narcolepsy, obesity, and age-related disorders. In this review, we present an overview of our current understanding of orexin function, focusing on sleep disorders, energy balance, and aging, in both rodents and humans. We first discuss animal models used in studies of obesity and sleep, including loss of function using transgenic or viral-mediated approaches, gain of function models using exogenous delivery of orexin receptor agonist, and naturally-occurring models in which orexin responsiveness varies by individual. We next explore rodent models of orexin in aging, presenting evidence that orexin loss contributes to age-related changes in sleep and energy balance. In the next section, we focus on clinical importance of orexin in human obesity, sleep, and aging. We include discussion of orexin loss in narcolepsy and potential importance of orexin in insomnia, correlations between animal and human studies of age-related decline, and evidence for orexin involvement in age-related changes in cognitive performance. Finally, we present a summary of recent studies of orexin in neurodegenerative disease. We conclude that orexin acts as an integrative homeostatic signal influencing numerous brain regions, and that this pivotal role results in potential dysregulation of multiple physiological processes when orexin signaling is disrupted or lost.
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Orexin-a system neuromodulation by intrathecal baclofen. J Clin Psychopharmacol 2014; 34:535-7. [PMID: 24875067 DOI: 10.1097/jcp.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kalamatianos T, Markianos M, Margetis K, Bourlogiannis F, Stranjalis G. Higher Orexin A levels in lumbar compared to ventricular CSF: a study in idiopathic normal pressure hydrocephalus. Peptides 2014; 51:1-3. [PMID: 24172541 DOI: 10.1016/j.peptides.2013.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022]
Abstract
Orexin A (ORX-A) is implicated in the regulation of various physiological processes, including sleep/wake cycles and reward/motivation. The hypothalamic ORX-A neurons project throughout the brain and spinal cord. In the present study we established and compared ORX-A levels in lumbar and ventricular cerebrospinal fluid (CSF) samples, drawn from idiopathic normal pressure hydrocephalus (INPH) patients, during respectively, lumbar puncture and shunt placement. Ventricular and lumbar CSF levels of total protein and of the dopamine, serotonin and norepinephrine metabolites HVA, 5-HIAA and MHPG respectively, were also estimated. ORX-A was quantified using a commercially available radioimmunoassay kit. Neurotransmitter metabolites were quantified by high performance liquid chromatography. Expectedly, HVA and 5-HIAA levels were significantly higher and total protein levels lower in ventricular compared to lumbar CSF while there were no differences in MHPG levels. However, in contrast to HVA and 5-HIAA and similar to total protein, lumbar ORX-A levels were significantly higher than ventricular levels. The higher lumbar compared to ventricular ORX-A levels may reflect elevated contributions from the spinal cord. The finding of a ventriculo-lumbar difference for ORX-A should be considered in studies utilizing its CSF levels in assessing Orexin system status.
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Affiliation(s)
- T Kalamatianos
- Department of Neurosurgery, Athens University Medical School, Athens, Greece; Hellenic Centre for Neurosurgery Research "Professor Petros S. Kokkalis", Athens, Greece.
| | - M Markianos
- Department of Neurology, Eginition Hospital, Athens University Medical School, Athens, Greece
| | - K Margetis
- Department of Neurosurgery, Athens University Medical School, Athens, Greece
| | - F Bourlogiannis
- Hellenic Centre for Neurosurgery Research "Professor Petros S. Kokkalis", Athens, Greece
| | - G Stranjalis
- Department of Neurosurgery, Athens University Medical School, Athens, Greece; Hellenic Centre for Neurosurgery Research "Professor Petros S. Kokkalis", Athens, Greece
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Katzav A, Arango MT, Kivity S, Tanaka S, Givaty G, Agmon-Levin N, Honda M, Anaya JM, Chapman J, Shoenfeld Y. Passive transfer of narcolepsy: Anti-TRIB2 autoantibody positive patient IgG causes hypothalamic orexin neuron loss and sleep attacks in mice. J Autoimmun 2013; 45:24-30. [DOI: 10.1016/j.jaut.2013.06.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 01/07/2023]
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Luca G, Haba-Rubio J, Dauvilliers Y, Lammers GJ, Overeem S, Donjacour CE, Mayer G, Javidi S, Iranzo A, Santamaria J, Peraita-Adrados R, Hor H, Kutalik Z, Plazzi G, Poli F, Pizza F, Arnulf I, Lecendreux M, Bassetti C, Mathis J, Heinzer R, Jennum P, Knudsen S, Geisler P, Wierzbicka A, Feketeova E, Pfister C, Khatami R, Baumann C, Tafti M. Clinical, polysomnographic and genome-wide association analyses of narcolepsy with cataplexy: a European Narcolepsy Network study. J Sleep Res 2013; 22:482-95. [PMID: 23496005 DOI: 10.1111/jsr.12044] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 01/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Gianina Luca
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Yves Dauvilliers
- INSERM-1061; Montpellier France
- Department of Neurology; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Gui-de-Chauliac Hospital; Montpellier France
| | - Gert-Jan Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | | | - Claire E. Donjacour
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden the Netherlands
| | - Geert Mayer
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Sirous Javidi
- Hephata-Clinic for Neurology; Schwalmstadt-Treysa Germany
| | - Alex Iranzo
- Neurology Service; Hospital Clinic; Barcelona Spain
| | | | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit - Clinical Neurophysiology Department; Gregorio Marañón University Hospital; Madrid Spain
| | - Hyun Hor
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Zoltan Kutalik
- Department of Medical Genetics; University of Lausanne; Lausanne Switzerland
- Swiss Institute of Bioinformatics; Lausanne Switzerland
| | - Giuseppe Plazzi
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Francesca Poli
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Fabio Pizza
- Department of Neurological Sciences; University of Bologna/IRCCS; Istituto delle Scienze Neurologiche di; Bologna Italy
| | - Isabelle Arnulf
- National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Sleep Disorders Unit; Pitié-Salpêtrière Hospital; Paris France
| | - Michel Lecendreux
- Pediatric Sleep Center; National Reference Network for Orphan Diseases (Narcolepsy and Idiopathic Hypersomnia); Robert-Debré Hospital; Paris France
| | - Claudio Bassetti
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Johannes Mathis
- Department of Neurology; Inselspital, Bern University Hospital and University of Bern; Bern Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
| | - Poul Jennum
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Stine Knudsen
- Department of Clinical Neurophysiology; University of Copenhagen; Glostrup Denmark
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy; Sleep Disorders and Research Center; University Hospital Regensburg; Regensburg Germany
| | - Aleksandra Wierzbicka
- Third Department of Psychiatry; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Eva Feketeova
- Department of Neurology; Faculty of Medicine; Safarikiensis University and Louis Pasteur Faculty Hospital Kosice; Kosice Slovakia
| | - Corinne Pfister
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
| | - Ramin Khatami
- Sleep Medicine; Barmelweid Clinic; Barmelweid Switzerland
| | - Christian Baumann
- Department of Neurology; University Hospital Zurich; Zurich Switzerland
| | - Mehdi Tafti
- Center for Integrative Genomics (CIG); University of Lausanne; Lausanne Switzerland
- Center for Investigation and Research in Sleep (CIRS); Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
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Bridoux A, Moutereau S, Covali-Noroc A, Margarit L, Palfi S, Nguyen JP, Lefaucheur JP, Césaro P, d'Ortho MP, Drouot X. Ventricular orexin-A (hypocretin-1) levels correlate with rapid-eye-movement sleep without atonia in Parkinson's disease. Nat Sci Sleep 2013; 5:87-91. [PMID: 23847436 PMCID: PMC3704548 DOI: 10.2147/nss.s41245] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients with Parkinson's disease frequently complain of sleep disturbances and loss of muscle atonia during rapid-eye-movement (REM) sleep is not rare. The orexin-A (hypocretin-1) hypothalamic system plays a central role in controlling REM sleep. Loss of orexin neurons results in narcolepsy-cataplexy, a condition characterized by diurnal sleepiness and REM sleep without atonia. Alterations in the orexin-A system have been also documented in Parkinson's disease, but whether these alterations have clinical consequences remains unknown. METHODS Here, we measured orexin-A levels in ventricular cerebrospinal fluid from eight patients with Parkinson's disease (four males and four females) who underwent ventriculography during deep brain-stimulation surgery and performed full-night polysomnography before surgery. RESULTS Our results showed a positive correlation between orexin-A levels and REM sleep without muscle atonia. CONCLUSION Our results suggest that high levels of orexin-A in Parkinson's disease may be associated with loss of REM muscle atonia.
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Affiliation(s)
- Agathe Bridoux
- Service de Physiologie, Groupe Henri Mondor, Créteil, France ; Faculté de Médecine, Université Paris Est Créteil, Créteil, France
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Slats D, Claassen JA, Verbeek MM, Overeem S. Reciprocal interactions between sleep, circadian rhythms and Alzheimer's disease: focus on the role of hypocretin and melatonin. Ageing Res Rev 2013; 12:188-200. [PMID: 22575905 DOI: 10.1016/j.arr.2012.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/04/2012] [Accepted: 04/23/2012] [Indexed: 01/02/2023]
Abstract
AD, sleep and circadian rhythm physiology display an intricate relationship. On the one hand, AD pathology leads to sleep and circadian disturbances, with a clear negative influence on quality of life. On the other hand, there is increasing evidence that both sleep and circadian regulating systems exert an influence on AD pathology. In this review we describe the impairments of both sleep regulating systems and circadian rhythms in AD and their link to clinical symptoms, as this may increase knowledge on appropriate diagnosis and adequate treatment of sleep problems in AD. Furthermore we discuss how sleep regulating systems, and especially neurotransmitters such as melatonin and hypocretin, may affect AD pathophysiology, as this may provide a role for lack of sleep and circadian rhythm deterioration in the onset of AD.
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Wijnans L, Lecomte C, de Vries C, Weibel D, Sammon C, Hviid A, Svanström H, Mølgaard-Nielsen D, Heijbel H, Dahlström LA, Hallgren J, Sparen P, Jennum P, Mosseveld M, Schuemie M, van der Maas N, Partinen M, Romio S, Trotta F, Santuccio C, Menna A, Plazzi G, Moghadam KK, Ferro S, Lammers GJ, Overeem S, Johansen K, Kramarz P, Bonhoeffer J, Sturkenboom MCJM. The incidence of narcolepsy in Europe: before, during, and after the influenza A(H1N1)pdm09 pandemic and vaccination campaigns. Vaccine 2012; 31:1246-54. [PMID: 23246544 DOI: 10.1016/j.vaccine.2012.12.015] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND In August 2010 reports of a possible association between exposure to AS03 adjuvanted pandemic A(H1N1)pdm09 vaccine and occurrence of narcolepsy in children and adolescents emerged in Sweden and Finland. In response to this signal, the background rates of narcolepsy in Europe were assessed to rapidly provide information for signal verification. METHODS We used a dynamic retrospective cohort study to assess the narcolepsy diagnosis rates during the period 2000-2010 using large linked automated health care databases in six countries: Denmark, Finland, Italy, the Netherlands, Sweden and the United Kingdom. RESULTS Overall, 2608 narcolepsy cases were identified in almost 280 million person years (PY) of follow up. The pooled incidence rate was 0.93 (95% CI: 0. 90-0.97) per 100,000 PY. There were peaks between 15 and 30 year of age (women>men) and around 60 years of age. In the age group 5-19 years olds rates were increased after the start of pandemic vaccination compared to the period before the start of campaigns, with rate ratios (RR) of 1.9 (95% CI: 1.1-3.1) in Denmark, 6.4 (95% CI: 4.2-9.7) in Finland and 7.5 (95% CI: 5.2-10.7) in Sweden. Cases verification in the Netherlands had a significant effect on the pattern of incidence over time. CONCLUSIONS The results of this incidence study provided useful information for signal verification on a population level. The safety signal of increased narcolepsy diagnoses following the start of the pandemic vaccination campaign as observed in Sweden and Finland could be observed with this approach. An increase in narcolepsy diagnoses was not observed in other countries, where vaccination coverage was low in the affected age group, or did not follow influenza A(H1N1)pdm09 vaccination. Patient level analyses in these countries are being conducted to verify the signal in more detail.
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Affiliation(s)
- Leonoor Wijnans
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Ahnaou A, Drinkenburg WHIM. Neuropeptide-S evoked arousal with electroencephalogram slow-wave compensatory drive in rats. Neuropsychobiology 2012; 65:195-205. [PMID: 22538299 DOI: 10.1159/000336998] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 01/30/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Neuropeptide S (NPS) exerts a dual arousal and anxiolytic effect in rodents, which may indicate the potential of a novel class of therapeutic agents in psychiatry. The purpose of this study is to fully describe the nature of electroencephalogram (EEG)-defined waking that mediates these arousal effects. METHODS Effects of the intracerebroventricular infusion of NPS at 2 different doses were characterized over 20 h on sleep-wake architecture and EEG spectral components in rats that were chronically implanted with epidural electrodes for continuous measurement of sleep polygraphic and EEG variables. RESULTS NPS (1 and 10 nmol) increased active waking (+88 and +87%, respectively), decreased light slow-wave sleep (lSWS) (-84 and -68%, respectively), deep slow-wave sleep (dSWS) (-47 and -33%, respectively) and rapid-eye-movement sleep (-71 and -70%, respectively) during the first 2 h after infusion. The wake-promoting effect of NPS is consistent with a marked lengthening in latency to sleep onset, a decrease in the number of state transitions from wakefulness to lSWS, and a delayed lSWS compensatory response. Interestingly, NPS significantly enhanced waking EEG theta oscillations and slow wave activity during dSWS. CONCLUSION The findings suggest that NPS enhanced a consolidated waking associated with a subsequent compensatory EEG slow-wave homeostatic drive rather than rebound sleep duration. The characteristics of NPS-induced waking coupled with enhanced EEG theta oscillations without rebound in sleep are desirable therapeutic features in wake-promoting agents.
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Affiliation(s)
- A Ahnaou
- Janssen Research and Development, Department of Neurosciences, Johnson and Johnson Pharmaceutical Companies, Beerse, Belgium.
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Economou NT, Manconi M, Ghika J, Raimondi M, Bassetti CL. Development of Parkinson and Alzheimer Diseases in Two Cases of Narcolepsy-Cataplexy. Eur Neurol 2012; 67:48-50. [DOI: 10.1159/000334733] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/30/2011] [Indexed: 11/19/2022]
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Schmidt FM, Arendt E, Steinmetzer A, Bruegel M, Kratzsch J, Strauss M, Baum P, Hegerl U, Schönknecht P. CSF-hypocretin-1 levels in patients with major depressive disorder compared to healthy controls. Psychiatry Res 2011; 190:240-3. [PMID: 21757240 DOI: 10.1016/j.psychres.2011.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 05/13/2011] [Accepted: 06/05/2011] [Indexed: 01/25/2023]
Abstract
Depressive patients exhibit symptoms of impaired regulation of wakefulness with hyperarousal and agitation as well as difficulties to falling asleep and preserving sleep continuity. Changes in hypocretin (hcrt) levels as polypeptides with impact on arousal and sleep-wake-regulation have been discussed in affective disorders but have not been investigated in patients with solely unipolar depression in comparison to healthy controls. In the present study, cerebrospinal fluid (CSF) levels of hcrt-1 for the first time were analyzed in patients with major depressive disorder (MDD) without psychiatric comorbidities and compared with levels in healthy controls. In 17 inpatients with MDD (mean Hamilton Depression Rating Scale 13.9 ± 7.4) and 10 healthy controls, CSF-hcrt-1 levels were measured using a fluorescence immunoassay (FIA). The mean hcrt-1 CSF levels in patients with MDD (74.3 ± 17.8pg/ml) did not differ compared to that of healthy controls (82.8 ± 22.1pg/ml). Hcrt-1 levels did not correlate with the severity of depressive episode, the symptoms of depression or the number of episodes. Although autonomic and neurohumoral signs of hyperarousal are common in MDD, hcrt-1 levels in CSF were not found to be altered in MDD compared to healthy controls. Whether hcrt-1 levels are altered in depressive patients exhibiting impaired vigilance regulation has to be investigated in further studies combining measures of CSF-hcrt-1 with electroencephalography.
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Affiliation(s)
- Frank Martin Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
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Progressive changes of orexin system in a rat model of 6-hydroxydopamine-induced Parkinson's disease. Neurosci Bull 2011; 26:381-7. [PMID: 20882064 DOI: 10.1007/s12264-010-0410-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Sleep disturbance, which is characterized by excessive daytime sleepiness and sleep attacks, is frequently observed in patients with Parkinson's disease (PD). Loss of orexin neurons in hypothalamus and the resultant decreased level of orexin in cerebrospinal fluid (CSF) found in narcolepsy patients may also play an essential role in the pathogenesis of sleep disturbance. The present study aimed to investigate the possible changes in the orexin system during PD progression. METHODS After the establishment of a rat PD model by injecting 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle, the numbers of orexin-A- and tyrosine hydroxylase (TH)-positive neurons, and the levels of orexin-A fibers and orexin-A in CSF were examined by immunohistochemistry and ELISA assay, respectively. RESULTS Compared to the TH-containing neurons that exhibited fast degeneration in response to 6-OHDA, orexin-A-containing neurons were less sensitive to 6-OHDA. The number of orexin-A-positive neurons began to decrease at day 21 after operation, and at day 49, it decreased by 30% of the initial level. The orexin-A level in CSF of PD rats did not show any obvious fluctuations compared to the control, and there was no obvious reduction in the density of orexin-A-positive fibers in brain areas such as tuberomammillary nucleus. CONCLUSION These results reveal for the first time the dynamic changes of orexin system during the progression of PD. This may provide valuable information for drug development to reverse the loss of orexin neurons and sleep disturbance in PD patients.
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Yan A, Zhang L, Tang Z, Zhang Y, Qin C, Li B, Li W, Lin H. Orange-spotted grouper (Epinephelus coioides) orexin: molecular cloning, tissue expression, ontogeny, daily rhythm and regulation of NPY gene expression. Peptides 2011; 32:1363-70. [PMID: 21600944 DOI: 10.1016/j.peptides.2011.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/04/2011] [Accepted: 05/04/2011] [Indexed: 01/27/2023]
Abstract
Orexin-A and -B, collectively called orexins, are hypothalamic neuropeptides involved in the regulation of food intake, sleep and energy balance. In this study, the full-length cDNA of prepro-orexin was isolated from the hypothalamus of orange-spotted grouper (Epinephelus coioides) using RT-PCR and RACE. The grouper prepro-orexin cDNA is 711 bp in length and encodes a 149-amino acid precursor protein that contains a 46-amino acid signal peptide, a 43-amino acid mature orexin-A peptide, a 27-amino acid mature orexin-B peptide and a 33-amino acid C terminus of unknown function. The tissue distribution and ontogeny of prepro-orexin were examined by quantitative real-time PCR. We found that the prepro-orexin mRNA is widely expressed in brain and peripheral tissues, with abundant expression in the hypothalamus. During the embryonic development, prepro-orexin mRNA was first detected in neurula stage embryos, and its expression gradually increased during the remainder of embryogenesis. Our analysis of grouper hypothalamic prepro-orexin expression showed that prepro-orexin mRNA levels were greater in the light phase than in the dark phase and increased significantly at meal-time. Intraperitoneal injection of orexin-A caused a dose-related increase in hypothalamus NPY mRNA expression level after 4h. Orexin-A also increased NPY mRNA expression level from static hypothalamic fragments incubation. Our results imply that orexin may be involved in feeding in the orange-spotted grouper and orexin-A is a stimulator of NPY mRNA expression in vivo and in vitro.
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Affiliation(s)
- Aifen Yan
- State Key Laboratory of Biocontrol, Institute of Aquatic Economic Animals, and the Guangdong Province Key Laboratory for Aquatic Economic Animals, Sun Yat-sen University, Guangzhou 510275, China
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Abstract
Many neurochemical systems interact to generate wakefulness and sleep. Wakefulness is promoted by neurons in the pons, midbrain, and posterior hypothalamus that produce acetylcholine, norepinephrine, dopamine, serotonin, histamine, and orexin/hypocretin. Most of these ascending arousal systems diffusely activate the cortex and other forebrain targets. NREM sleep is mainly driven by neurons in the preoptic area that inhibit the ascending arousal systems, while REM sleep is regulated primarily by neurons in the pons, with additional influence arising in the hypothalamus. Mutual inhibition between these wake- and sleep-regulating regions likely helps generate full wakefulness and sleep with rapid transitions between states. This up-to-date review of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.
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Affiliation(s)
- Rodrigo A España
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston Salem, NC, USA
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Plazzi G, Moghadam KK, Maggi LS, Donadio V, Vetrugno R, Liguori R, Zoccoli G, Poli F, Pizza F, Pagotto U, Ferri R. Autonomic disturbances in narcolepsy. Sleep Med Rev 2011; 15:187-96. [PMID: 20634114 DOI: 10.1016/j.smrv.2010.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/14/2010] [Accepted: 05/21/2010] [Indexed: 11/24/2022]
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Fronczek R, van Geest S, Frölich M, Overeem S, Roelandse FWC, Lammers GJ, Swaab DF. Hypocretin (orexin) loss in Alzheimer's disease. Neurobiol Aging 2011; 33:1642-50. [PMID: 21546124 DOI: 10.1016/j.neurobiolaging.2011.03.014] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 01/11/2011] [Accepted: 03/16/2011] [Indexed: 01/19/2023]
Abstract
Sleep disturbances in Alzheimer's disease (AD) patients are associated with the severity of dementia and are often the primary reason for institutionalization. These sleep problems partly resemble core symptoms of narcolepsy, a sleep disorder caused by a general loss of the neurotransmitter hypocretin. AD is a neurodegenerative disorder targeting different brain areas and types of neurons. In this study, we assessed whether the neurodegenerative process of AD also affects hypothalamic hypocretin/orexin neurons. The total number of hypocretin-1 immunoreactive neurons was quantified in postmortem hypothalami of AD patients (n = 10) and matched controls (n = 10). In addition, the hypocretin-1 concentration was measured in postmortem ventricular cerebrospinal fluid of 24 AD patients and 25 controls (including the patients and controls in which the hypothalamic cell counts were performed). The number of hypocretin-1 immunoreactive neurons was significantly decreased by 40% in AD patients (median [25th-75th percentiles]); AD 12,935 neurons (9972-19,051); controls 21,002 neurons (16,439-25,765); p = 0.049). Lower cerebrospinal fluid (CSF) hypocretin-1 levels were found in AD patients compared with controls (AD: 275 pg/mL [197-317]; controls: 320 pg/mL [262-363]; p = 0.038). Two AD patients with documented excessive daytime sleepiness showed the lowest CSF hypocretin-1 concentrations (55 pg/mL and 76 pg/mL). We conclude that the hypocretin system is affected in advanced AD. This is reflected in a 40% decreased cell number, and 14% lower CSF hypocretin-1 levels.
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Affiliation(s)
- Rolf Fronczek
- Netherlands Institute for Neurosciences, an Institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef, Amsterdam, The Netherlands.
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Haq IZ, Naidu Y, Reddy P, Chaudhuri KR. Narcolepsy in Parkinson's disease. Expert Rev Neurother 2010; 10:879-84. [PMID: 20518604 DOI: 10.1586/ern.10.56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-motor symptoms in Parkinson's disease (PD), such as excessive daytime sleepiness, 'sleep attacks', insomnia, restless legs syndrome and rapid eye movement sleep behavior disorder, are common and provide a challenge to treatment. These sleep symptoms are also described in patients suffering from the sleep/wake disorder, narcolepsy. The International Classification of Sleep Disorders (ICSD-2) narcolepsy criteria uses a number of markers for diagnosis, of which lack or deficiency of cerebrospinal fluid (CSF) hypocretin-1 levels is a key marker. Hypocretin neurons prominently located in the lateral hypothalamus and perifornical nucleus have been proposed to interact with mechanisms involving sleep and arousal. Low hypocretin-1 levels in the CSF have been shown to correlate with hypothalamic hypocretin cell loss in narcolepsy and other forms of hypersomnia; therefore, it has been proposed that degenerative damage to hypocretin neurons (such as in PD) may be detected by low CSF hypocretin-1 concentrations, and may also explain the sleep symptoms experienced by some PD patients. To date, there is mixed conflicting data describing hypocretin-1 levels in the CSF of patients with parkinsonism associated with sleep symptoms, with most studies showing no significant decrease when compared with controls. However, hypocretin-1 CSF deficiency has been shown in some studies to be more prominent in PD patients with sleep symptoms versus those without. Notably, the hypocretin system has been shown not to be selectively disrupted, with one study showing melanin concentrating hormone cell loss in the same patients with hypocretin loss. It is likely that hypocretin deficiency in PD patients occurs secondary to collateral damage caused by the neurodegenerative process involving the hypothalamus. Awareness of narcoleptic events in PD is important for driving related advice, in addition to the possible use of dopamine D3 receptor active agonists.
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Affiliation(s)
- Imran Z Haq
- Guy's, King's & St Thomas' School of Medicine, King's College, London, UK
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Alóe F, Alves RC, Araújo JF, Azevedo A, Bacelar A, Bezerra M, Bittencourt LRA, Bustamante G, Cardoso TAMDO, Eckeli AL, Fernandes RMF, Goulart L, Pradella-Hallinan M, Hasan R, Sander HH, Pinto LR, Lopes MC, Minhoto GR, Moraes W, Moreira GA, Pachito D, Pedrazolli M, Poyares D, Prado L, Rizzo G, Rodrigues RN, Roitman I, Silva AB, Tavares SMA. [Brazilian guidelines for the diagnosis of narcolepsy]. ACTA ACUST UNITED AC 2010; 32:294-304. [PMID: 20585744 DOI: 10.1590/s1516-44462010005000014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022]
Abstract
This manuscript contains the conclusion of the consensus meeting on the diagnosis of narcolepsy based on the review of Medline publications between 1980-2010. Narcolepsy is a chronic disorder with age at onset between the first and second decade of life. Essential narcolepsy symptoms are cataplexy and excessive sleepiness. Cataplexy is defined as sudden, recurrent and reversible attacks of muscle weakness triggered by emotions. Accessory narcolepsy symptoms are hypnagogic hallucinations, sleep paralysis and nocturnal fragmented sleep. The clinical diagnosis according to the International Classification of Sleep Disorders is the presence of excessive sleepiness and cataplexy. A full in-lab polysomnography followed by a multiple sleep latency test is recommended for the confirmation of the diagnosis and co-morbidities. The presence of two sleep-onset REM period naps in the multiple sleep latency test is diagnostic for cataplexy-free narcolepsy. A positive HLA-DQB1*0602 with lower than 110pg/mL level of hypocretin-1 in the cerebrospinal fluid is required for the final diagnosis of cataplexy- and sleep-onset REM period -free narcolepsy.
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Affiliation(s)
- Flávio Alóe
- Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Bjartmar L, Alkhori L, Ruud J, Mohammed AH, Marcusson J, Hallbeck M. Long-term treatment with antidepressants, but not environmental stimulation, induces expression of NP2 mRNA in hippocampus and medial habenula. Brain Res 2010; 1328:25-33. [DOI: 10.1016/j.brainres.2010.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 02/28/2010] [Accepted: 03/02/2010] [Indexed: 11/29/2022]
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Abstract
The hypocretins or orexins are endogenous neuropeptides synthesized in discrete lateral, perifornical and dorsal hypothalamic neurones. These multi-functional neuropeptides modulate energy homeostasis, arousal, stress, reward, reproduction and cardiovascular function. This review summarizes the role of hypocretins in modulating non-sleep-related energy expenditure with specific focus on the augmentation of whole body energy expenditure as well as hypocretin-induced physical activity and sympathetic outflow. We compare the efficacy of hypocretin-1 and 2 on energy expenditure and evaluate whether the literature implicates hypocretin signalling though the hypocretin-1 and -2 receptor as having shared and or functionally specific physiological effects. Thus far data suggest that hypocretin-1 has a more robust stimulatory effect relative to hypocretin-2. Furthermore, hypocretin-1 receptor predominantly mediates behaviours known to influence energy expenditure. Further studies on the hypocretin-2 receptor are needed.
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Affiliation(s)
- J A Teske
- Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Sand T, Schrader H. [Narcolepsy and other hypersomnias]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:2007-10. [PMID: 19823207 DOI: 10.4045/tidsskr.08.0655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Narcolepsy is currently categorized into three groups; narcolepsy with and without emotionally triggered loss of muscle tone (cataplexy), and narcolepsy secondary to other medical conditions. Many patients with hypersomnia are diagnosed too late. The article presents a review of this field. MATERIAL AND METHODS Sources are literature identified through a non-systematic Pub-Med search and the authors' personal experience with diagnosing and treating patients with narcolepsy and other hypersomnias. RESULTS Sleep attacks and emotionally triggered loss of muscle tone are the most important symptoms of narcolepsy with cataplexy. Loss of hypocretin-producing cells is considered to be the cause. Absence of the tissue antigen HLA DQB1*0602 renders narcolepsy an unlikely diagnosis. Narcolepsy without cataplexy occurs less frequently and may have another biological basis. A differential diagnostic evaluation is important to determine whether hypersomnia is associated with obstructive sleep apnea, neurological disease or psychiatric disorders. Polysomnography and multiple sleep latency tests are important diagnostic tools. Hypocretine levels in the cerebrospinal fluid should be measured in most patients. Methylphenidate and other CNS-stimulants are the most potent drugs for treatment of sleep attacks. Tricyclic antidepressive drugs and some newer drugs may be efficient in cataplexy. INTERPRETATION Narcolepsy may affect education and work-life. Medication is available. Regular general practitioners should refer patients suspected of having narcolepsy for evaluation in a sleep centre or a hospital with established routines for diagnosis of sleep disorders.
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Affiliation(s)
- Trond Sand
- Institutt for nevromedisin, Norges teknisk-naturvitenskapelige universitet og Avdeling for nevrologi og klinisk nevrofysiologi, St. Olavs hospital, 7006 Trondheim, Norway.
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Thannickal TC. A decade of hypocretin/orexin: Accomplishments in sleep medicine. Sleep Med Rev 2009; 13:5-8. [DOI: 10.1016/j.smrv.2008.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/07/2008] [Indexed: 02/04/2023]
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