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Ribeiro L, Psimaras D, Vollhardt R, Honnorat J, Méneret A, Demeret S, Celier A, Valyraki NE, Cousyn L, Le Guennec L, Arnulf I, Gales AZ. REM and NREM Sleep Parasomnia in Anti-NMDA Receptor Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200203. [PMID: 38917379 PMCID: PMC11216806 DOI: 10.1212/nxi.0000000000200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/01/2023] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Encephalitis with anti-N-methyl-d-aspartate receptor antibodies (anti-NMDARe) is a rare disorder characterized by cognitive impairment, psychosis, seizures, and abnormal movements. Abnormal behaviors during REM sleep have not been described in anti-NMDARe. METHODS Patients were monitored by video-polysomnography on a first night followed by multiple sleep latency tests and 18 hours of bed rest. RESULTS Two patients with anti-NMDARe developed during the acute and postacute phase parasomnias including REM sleep behavior disorder and continuous finalistic quiet gesturing during a mixed N2/R sleep. The parasomnia disorder was improved by gabapentin and clonazepam. DISCUSSION Video-polysomnography avoids misdiagnosing these parasomnia behaviors for seizure or movement disorders and allows adequate treatment.
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Affiliation(s)
- Luis Ribeiro
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Dimitri Psimaras
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Raphael Vollhardt
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Jerome Honnorat
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Aurélie Méneret
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Sophie Demeret
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Adam Celier
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Nefeli E Valyraki
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Louis Cousyn
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Loic Le Guennec
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Isabelle Arnulf
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Ana Z Gales
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
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Biscarini F, Barateau L, Pizza F, Plazzi G, Dauvilliers Y. Narcolepsy and rapid eye movement sleep. J Sleep Res 2024:e14277. [PMID: 38955433 DOI: 10.1111/jsr.14277] [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: 05/07/2024] [Revised: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
Since the first description of narcolepsy at the end of the 19th Century, great progress has been made. The disease is nowadays distinguished as narcolepsy type 1 and type 2. In the 1960s, the discovery of rapid eye movement sleep at sleep onset led to improved understanding of core sleep-related disease symptoms of the disease (excessive daytime sleepiness with early occurrence of rapid eye movement sleep, sleep-related hallucinations, sleep paralysis, rapid eye movement parasomnia), as possible dysregulation of rapid eye movement sleep, and cataplexy resembling an intrusion of rapid eye movement atonia during wake. The relevance of non-sleep-related symptoms, such as obesity, precocious puberty, psychiatric and cardiovascular morbidities, has subsequently been recognized. The diagnostic tools have been improved, but sleep-onset rapid eye movement periods on polysomnography and Multiple Sleep Latency Test remain key criteria. The pathogenic mechanisms of narcolepsy type 1 have been partly elucidated after the discovery of strong HLA class II association and orexin/hypocretin deficiency, a neurotransmitter that is involved in altered rapid eye movement sleep regulation. Conversely, the causes of narcolepsy type 2, where cataplexy and orexin deficiency are absent, remain unknown. Symptomatic medications to treat patients with narcolepsy have been developed, and management has been codified with guidelines, until the recent promising orexin-receptor agonists. The present review retraces the steps of the research on narcolepsy that linked the features of the disease with rapid eye movement sleep abnormality, and those that do not appear associated with rapid eye movement sleep.
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Affiliation(s)
- Francesco Biscarini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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Mombelli S, Ricordeau F, Gillard L, Lecca R, Vidal T, Pereira B, Beudin P, Vitello N, Bastuji H, Peter-Derex L, Fantini ML. Psychobehavioural profile in narcolepsy type 1 with and without REM sleep behaviour disorder. J Sleep Res 2024; 33:e13925. [PMID: 37222001 DOI: 10.1111/jsr.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/25/2023]
Abstract
REM sleep behaviour disorder (RBD) is common in narcolepsy type 1 (NT1). Abnormalities in the reward system have been observed in NT1, possibly related to impaired orexin projections towards the mesolimbic reward system, but also in RBD when associated with Parkinson's disease. Our study aimed to explore the psychobehavioural profile of NT1 patients with and without RBD compared with healthy controls (HC). Forty patients with NT1 were compared with 20 sex- and age-matched HC. All patients with NT1 underwent a video-polysomnography including a measure of REM sleep without atonia (RSWA). The following neuropsychobehavioural variables were assessed: apathy, impulsivity, depression, cognition, subjective and objective attention, sensation-seeking, and behavioural addictions. The patient population included 22 patients with NT1-RBD and 18 patients with NT1-noRBD. Compared with the healthy controls, patients with NT1 had higher scores of apathy, impulsivity, and depression; a lower score on global cognition, and poorer self-perceived attention. No differences were found between patients with NT1 with and without RBD in all neuropsychological variables, except for impaired objective attention in patients with NT1-RBD. In patients with NT1, a positive correlation was observed between RSWA and both apathy and impulsivity subscale. Moreover, in patients with NT1-RBD, RSWA was positively correlated with depression. Patients with NT1 showed higher depression, apathy, and impulsivity compared with controls. These measures correlate with the severity of RSWA, suggesting a transdiagnostic association between RBD and abnormalities of the reward system at least for patients with NT1.
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Affiliation(s)
- Samantha Mombelli
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - François Ricordeau
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
| | - Léa Gillard
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Rosa Lecca
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Tiphaine Vidal
- CMRR, Neurology Department, University Hospital - Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical Research and Innovation Direction, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Patricia Beudin
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
| | - Nicolas Vitello
- Biostatistics Unit (DRCI) CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Helene Bastuji
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
- Lyon Neuroscience Research Center, CNRS UMR 5292, INSERM U1028 - Neuropain Team, Lyon, France
| | - Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Lyon University Hospital, Lyon 1 University, Lyon, France
- Lyon Neuroscience Research Center, CNRS UMR 5292, INSERM U1028 - PAM Team, Lyon, France
| | - Maria Livia Fantini
- Sleep and EEG, Neurophysiology Unit, Neurology Department, University Hospital and UMR 6602-Université Clermont Auvergne, CNRS, Institute Pascal, Clermont-Ferrand, France
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Pizza F, Vignatelli L, Vandi S, Zenesini C, Biscarini F, Franceschini C, Antelmi E, Ingravallo F, Mignot E, Bruni O, Nobili L, Veggiotti P, Ferri R, Plazzi G. Role of Daytime Continuous Polysomnography in the Diagnosis of Pediatric Narcolepsy Type 1. Neurology 2024; 102:e207815. [PMID: 38165365 PMCID: PMC10834121 DOI: 10.1212/wnl.0000000000207815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/18/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Narcolepsy type 1 (NT1) is still largely underdiagnosed or diagnosed too late in children. Difficulties in obtaining rapid and reliable diagnostic evaluations of the condition in clinical practice partially explain this problem. Predictors of NT1 include cataplexy and sleep-onset REM periods (SOREMPs), documented during nocturnal polysomnography (N-PSG) or through the multiple sleep latency test (MSLT), although low CSF hypocretin-1 (CSF hcrt-1) is the definitive biological disease marker. Obtaining reliable MSLT results is not always feasible in children; therefore, this study aimed to validate daytime continuous polysomnography (D-PSG) as an alternative diagnostic tool. METHODS Two hundred consecutive patients aged younger than 18 years (112 with NT1; 25 with other hypersomnias, including narcolepsy type 2 and idiopathic hypersomnia; and 63 with subjective excessive daytime sleepiness) were randomly split into 2 groups: group 1 (n = 133) for the identification of diagnostic markers and group 2 (n = 67) for the validation of the detected markers. The D-PSG data collected included the number of spontaneous naps, total sleep time, and the number of daytime SOREMPs (d-SOREMP). D-PSG data were tested against CSF hcrt-1 deficiency (NT1 diagnosis) as the gold standard using receiver operating characteristic (ROC) curve analysis in group 1. ROC diagnostic performances of single and combined D-PSG parameters were tested in group 1 and validated in group 2. RESULTS In group 1, the areas under the ROC curve (AUCs) were 0.91 (95% CI 0.86-0.96) for d-SOREMPs, 0.81 (95% CI 0.74-0.89) for the number of spontaneous naps, and 0.70 (95% CI 0.60-0.79) for total sleep time. A d-SOREMP count ≥1 (sensitivity of 95% and specificity of 72%), coupled with a diurnal total sleep time above 60 minutes (sensitivity of 89% and specificity of 91%), identified NT1 in group 1 with high reliability (area under the ROC curve of 0.93, 95% CI 0.88-0.97). These results were confirmed in the validation group with an AUC of 0.88 (95% CI 0.79-0.97). DISCUSSION D-PSG recording is an easily performed, cost-effective, and reliable tool for identifying NT1 in children. Further studies should confirm its validity with home D-PSG monitoring. These alternative procedures could be used to confirm NT1 diagnosis and curtail diagnostic delay.
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Affiliation(s)
- Fabio Pizza
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Luca Vignatelli
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Stefano Vandi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Corrado Zenesini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Francesco Biscarini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Christian Franceschini
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Elena Antelmi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Francesca Ingravallo
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Emmanuel Mignot
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Oliviero Bruni
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Lino Nobili
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Pierangelo Veggiotti
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Raffaele Ferri
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
| | - Giuseppe Plazzi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., F.B.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., L.V., S.V., C.Z., G.P.); Department of Medicine and Surgery (C.F.), University of Parma; Neurology Unit (E.A.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Medical and Surgical Sciences (DIMEC) (F.I.), University of Bologna, Italy; Tanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA; Department of Developmental and Social Psychology (O.B.), Sapienza University, Rome; IRCCS Istituto Giannina Gaslini (L.N.), Genoa; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (L.N.), DINOGMI, University of Genoa; University of Milan (P.V.), Milan; Clinical Neurophysiology Research Unit (R.F.), Oasi Research Institute-IRCCS, Troina; and Department of Biomedical, Metabolic and Neural Sciences (G.P.), University of Modena and Reggio-Emilia, Italy
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5
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Rosenberg R, Braceras R, Macfadden W, Candler S, Black J, Ruoff C. Implications of Oxybate Dosing Regimen for Sleep, Sleep Architecture, and Disrupted Nighttime Sleep in Patients with Narcolepsy: A Commentary. Neurol Ther 2023; 12:1805-1820. [PMID: 37755650 PMCID: PMC10630177 DOI: 10.1007/s40120-023-00543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
Narcolepsy is associated with disrupted nighttime sleep (DNS). Sodium oxybate (SXB; Xyrem®), administered twice nightly, is indicated for the treatment of cataplexy and excessive daytime sleepiness in patients 7 years or older with narcolepsy. Recently, low-sodium oxybate (LXB, Xywav®; for people 7 years of age and older), which contains 92% less sodium than SXB and is dosed twice nightly, and sodium oxybate for extended release (SXB-ER; Lumryz™; for adults), which contains equal sodium to SXB and is dosed once nightly, have also been approved to treat cataplexy or excessive daytime sleepiness in narcolepsy. This paper reviews the evidence regarding the overall impact of oxybate administration, and impact of different oxybate dosing regimens (once nightly, SXB-ER; twice nightly, SXB), on DNS in narcolepsy utilizing polysomnographic data from five clinical trials (three assessing SXB in adults [referred to here as SXB trials 1, 2, and 3], one assessing SXB in children [referred to as the pediatric SXB trial], and one assessing SXB-ER in adults [REST-ON]). Both once-nightly and twice-nightly oxybate regimens similarly improved symptoms of DNS. Regardless of dosing regimen, people with narcolepsy treated with oxybate experience roughly 42-53 arousals and 9-38 awakenings each night, with one of these awakenings on twice-nightly oxybate being due to the second dosing requirement in studies of SXB. Additionally, for SXB, but not SXB-ER, polysomnographic data has been analyzed by half of the night, demonstrating a greater positive impact on sleep architecture in the second half of the night, which might be related to its nonlinear pharmacokinetic profile. We conclude that while once-nightly and twice-nightly oxybate dosing regimens differ in their pharmacokinetic profiles, both improve DNS in patients with narcolepsy to a similar degree.
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Affiliation(s)
| | | | | | | | - Jed Black
- Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA, USA
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Chad Ruoff
- Division of Pulmonary Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA.
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6
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Barateau L, Pizza F, Chenini S, Peter-Derex L, Dauvilliers Y. Narcolepsies, update in 2023. Rev Neurol (Paris) 2023; 179:727-740. [PMID: 37634997 DOI: 10.1016/j.neurol.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
Narcolepsy type 1 (NT1) and type 2 (NT2), also known as narcolepsy with and without cataplexy, are sleep disorders that benefited from major scientific advances over the last two decades. NT1 is caused by the loss of hypothalamic neurons producing orexin/hypocretin, a neurotransmitter regulating sleep and wake, which can be measured in the cerebrospinal fluid (CSF). A low CSF level of hypocretin-1/orexin-A is a highly specific and sensitive biomarker, sufficient to diagnose NT1. Orexin-deficiency is responsible for the main NT1 symptoms: sleepiness, cataplexy, disrupted nocturnal sleep, sleep-related hallucinations, and sleep paralysis. In the absence of a lumbar puncture, the diagnosis is based on neurophysiological tests (nocturnal and diurnal) and the presence of the pathognomonic symptom cataplexy. In the revised version of the International Classification of sleep Disorders, 3rd edition (ICSD-3-TR), a sleep onset rapid eye movement sleep (REM) period (SOREMP) (i.e. rapid occurrence of REM sleep) during the previous polysomnography may replace the diurnal multiple sleep latency test, when clear-cut cataplexy is present. A nocturnal SOREMP is very specific but not sensitive enough, and the diagnosis of cataplexy is usually based on clinical interview. It is thus of crucial importance to define typical versus atypical cataplectic attacks, and a list of clinical features and related degrees of certainty is proposed in this paper (expert opinion). The time frame of at least three months of evolution of sleepiness to diagnose NT1 was removed in the ICSD-3-TR, when clear-cut cataplexy or orexin-deficiency are established. However, it was kept for NT2 diagnosis, a less well-characterized disorder with unknown clinical course and absence of biolo biomarkers; sleep deprivation, shift working and substances intake being major differential diagnoses. Treatment of narcolepsy is nowadays only symptomatic, but the upcoming arrival of non-peptide orexin receptor-2 agonists should be a revolution in the management of these rare sleep diseases.
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Affiliation(s)
- L Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, Inserm, Montpellier, France.
| | - F Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - S Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, Inserm, Montpellier, France
| | - L Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, PAM Team, Inserm U1028, CNRS UMR 5292, Lyon, France
| | - Y Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, Inserm, Montpellier, France.
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7
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Blattner M, Maski K. Narcolepsy and Idiopathic Hypersomnia. Sleep Med Clin 2023; 18:183-199. [PMID: 37120161 DOI: 10.1016/j.jsmc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Narcolepsy types 1 and 2 and idiopathic hypersomnia are primary Central Nervous System (CNS) disorders of hypersomnolence characterized by profound daytime sleepiness and/or excessive sleep need. Onset of symptoms begins typically in childhood or adolescence, and children can have unique presentations compared with adults. Narcolepsy type 1 is likely caused by immune-mediated loss of orexin (hypocretin) neurons in the hypothalamus; however, the causes of narcolepsy type 2 and idiopathic hypersomnia are unknown. Existing treatments improve daytime sleepiness and cataplexy but there is no cure for these disorders.
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Affiliation(s)
- Margaret Blattner
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Kiran Maski
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, BCH3443, Boston, MA 02115, USA.
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8
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Quantification of REM sleep without atonia: A review of study methods and meta-analysis of their performance for the diagnosis of RBD. Sleep Med Rev 2023; 68:101745. [PMID: 36640617 DOI: 10.1016/j.smrv.2023.101745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023]
Abstract
The present review focuses on REM sleep without atonia (RSWA) scoring methods. In consideration of the numerous papers published in the last decade, that used different methods for the quantification of RSWA, their systematic revision is an emerging need. We made a search using the PubMed, Embase, Scopus and Web of Science Databases, from 2010 until December 2021, combining the search term "RSWA" with "scoring methods", "IRBD", "alfasyn disease", and "neurodegenerative disease", and with each of the specific sleep disorders, diagnosed according to current criteria, with the identification of the references of interest for the topic. Furthermore, a Meta-analysis of the diagnostic performance of RSWA scoring methods, in terms of sensitivity and specificity, was carried out. The comparison of the hierarchical summary receiver-operating characteristic curves obtained for visual methods and that obtained for the automated REM sleep atonia index (RAI), shows substantially similar prediction areas indicating a comparable performance. This systematic review and meta-analysis support the validity of a series of visual methods and of the automated RAI in the quantification of RSWA with the purpose to guide clinicians in the interpretation of their results and their correct and efficient use within the diagnostic work-up for REM sleep behavior disorder.
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9
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Bruni O. Approach to a sleepy child: Diagnosis and treatment of excessive daytime sleepiness in children and adolescents. Eur J Paediatr Neurol 2023; 42:97-109. [PMID: 36608412 DOI: 10.1016/j.ejpn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
The aim of this review is to give updated information to pediatric neurologists on the correct diagnostic approach and treatment of excessive daytime sleepiness (EDS) in children and adolescents. Due to the change in the society habits, EDS is becoming an emerging problem for the health system. At the present there are few articles specifically devoted to the evaluation of EDS. EDS is often reported in several manuscripts as a side effect of other sleep disorders (obstructive sleep apnea, circadian disorders, etc.) or of the use of drugs or of the substance abuse or as a consequence of bad sleep habits and poor sleep hygiene. EDS, especially in children, may manifest with paradoxical symptoms like hyperactivity, inattention, and impulsiveness. However, common sign of EDS in children are the propensity to sleep longer than usual, the difficulty waking up in the morning, and falling asleep frequently during the day in monotonous situation. The diagnosis should include subjective (sleep diaries, questionnaires) and objective (polysomnography, multiple sleep latency test, etc.) instruments to avoid misdiagnosis. Narcolepsy is the most studied central disorder of hypersomnolence, and it is a predominantly pediatric disease with a peak age of onset in prepuberty but the diagnosis is often delayed especially in mild forms. The early and correct treatment of narcolepsy and of other form of EDS is extremely important since late and inappropriate treatments can affect the psychosocial development of the children and adolescents.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi, 78-00185, Rome, Italy.
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10
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Chen HL, Gao JX, Chen YN, Xie JF, Xie YP, Spruyt K, Lin JS, Shao YF, Hou YP. Rapid Eye Movement Sleep during Early Life: A Comprehensive Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13101. [PMID: 36293678 PMCID: PMC9602694 DOI: 10.3390/ijerph192013101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/05/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
The ontogenetic sleep hypothesis suggested that rapid eye movement (REM) sleep is ontogenetically primitive. Namely, REM sleep plays an imperative role in the maturation of the central nervous system. In coincidence with a rapidly developing brain during the early period of life, a remarkably large amount of REM sleep has been identified in numerous behavioral and polysomnographic studies across species. The abundant REM sleep appears to serve to optimize a cerebral state suitable for homeostasis and inherent neuronal activities favorable to brain maturation, ranging from neuronal differentiation, migration, and myelination to synaptic formation and elimination. Progressively more studies in Mammalia have provided the underlying mechanisms involved in some REM sleep-related disorders (e.g., narcolepsy, autism, attention deficit hyperactivity disorder (ADHD)). We summarize the remarkable alterations of polysomnographic, behavioral, and physiological characteristics in humans and Mammalia. Through a comprehensive review, we offer a hybrid of animal and human findings, demonstrating that early-life REM sleep disturbances constitute a common feature of many neurodevelopmental disorders. Our review may assist and promote investigations of the underlying mechanisms, functions, and neurodevelopmental diseases involved in REM sleep during early life.
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Affiliation(s)
- Hai-Lin Chen
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
| | - Jin-Xian Gao
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
- Sleep Medicine Center of Gansu Provincial Hospital, Lanzhou 730000, China
| | - Yu-Nong Chen
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
| | - Jun-Fan Xie
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
| | - Yu-Ping Xie
- Sleep Medicine Center of Gansu Provincial Hospital, Lanzhou 730000, China
| | - Karen Spruyt
- Université de Paris, NeuroDiderot–INSERM, 75019 Paris, France
| | - Jian-Sheng Lin
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028-CNRS UMR 5292, University Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier–Neurocampus Michel Jouvet, 95 Boulevard Pinel, CEDEX, 69675 Bron, France
| | - Yu-Feng Shao
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
- Integrative Physiology of the Brain Arousal Systems, CRNL, INSERM U1028-CNRS UMR 5292, University Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier–Neurocampus Michel Jouvet, 95 Boulevard Pinel, CEDEX, 69675 Bron, France
- Key Lab of Neurology of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Yi-Ping Hou
- Departments of Neuroscience, Anatomy, Histology, and Embryology, Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Lanzhou University, 199 Donggang Xi Road, Lanzhou 730000, China
- Key Lab of Neurology of Gansu Province, Lanzhou University, Lanzhou 730000, China
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11
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Sumi Y, Masuda F, Kadotani H, Ozeki Y. The prevalence of depression in isolated/idiopathic rapid eye movement sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2022; 65:101684. [DOI: 10.1016/j.smrv.2022.101684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
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12
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Dye TJ, Simakajornboon N. Narcolepsy in Children: Sleep disorders in children, A rapidly evolving field seeking consensus. Pediatr Pulmonol 2022; 57:1952-1962. [PMID: 34021733 DOI: 10.1002/ppul.25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Narcolepsy is a life-long sleep disorder with two distinct subtypes, narcolepsy type I and narcolepsy type II. It is now well recognized that the loss of hypocretin neurons underlies the pathogenesis of narcolepsy type I, however, the pathogenesis of narcolepsy type II is currently unknown. Both genetic and environmental factors play an important role in the pathogenesis of narcolepsy. There is increasing evidence that autoimmune processes may play a critical role in the loss of hypocretin neurons. Infections especially streptococcus and influenza have been proposed as a potential trigger for the autoimmune-mediated mechanism. Several recent studies have shown increased cases of pediatric narcolepsy following the 2009 H1N1 pandemic. The increased cases in Europe seem to be related to a specific type of H1N1 influenza vaccination (Pandemrix), while the increased cases in China are related to influenza infection. Children with narcolepsy can have an unusual presentation at disease onset including complex motor movements which may lead to delayed diagnosis. All classic narcolepsy tetrads are present in only a small proportion of children. The diagnosis of narcolepsy is confirmed by either obtaining cerebrospinal fluid hypocretin or overnight sleep study with the multiple sleep latency test (MSLT). There are limitations of using MSLT in young children such that a negative MSLT test cannot exclude narcolepsy. HLA markers have limited utility in narcolepsy, but it may be useful in young children with clinical suspicion of narcolepsy. For management, both pharmacologic and non-pharmacologic treatments are important in the management of narcolepsy. Pharmacotherapy is primarily aimed to address excessive daytime sleepiness and REM-related symptoms such as cataplexy. In addition to pharmacotherapy, routine screening of behavioral and psychosocial issues is warranted to identify patients who would benefit from bio-behavior intervention.
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Affiliation(s)
- Thomas J Dye
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Narong Simakajornboon
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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13
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Barateau L, Pizza F, Plazzi G, Dauvilliers Y. 50th anniversary of the ESRS in 2022-JSR special issue. J Sleep Res 2022; 31:e13631. [PMID: 35624073 DOI: 10.1111/jsr.13631] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 01/21/2023]
Abstract
This article addresses the clinical presentation, diagnosis, pathophysiology and management of narcolepsy type 1 and 2, with a focus on recent findings. A low level of hypocretin-1/orexin-A in the cerebrospinal fluid is sufficient to diagnose narcolepsy type 1, being a highly specific and sensitive biomarker, and the irreversible loss of hypocretin neurons is responsible for the main symptoms of the disease: sleepiness, cataplexy, sleep-related hallucinations and paralysis, and disrupted nocturnal sleep. The process responsible for the destruction of hypocretin neurons is highly suspected to be autoimmune, or dysimmune. Over the last two decades, remarkable progress has been made for the understanding of these mechanisms that were made possible with the development of new techniques. Conversely, narcolepsy type 2 is a less well-defined disorder, with a variable phenotype and evolution, and few reliable biomarkers discovered so far. There is a dearth of knowledge about this disorder, and its aetiology remains unclear and needs to be further explored. Treatment of narcolepsy is still nowadays only symptomatic, targeting sleepiness, cataplexy and disrupted nocturnal sleep. However, new psychostimulants have been recently developed, and the upcoming arrival of non-peptide hypocretin receptor-2 agonists should be a revolution in the management of this rare sleep disease, and maybe also for disorders beyond narcolepsy.
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Affiliation(s)
- Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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Qu S, Wang P, Wang M, Li C, Dong X, Xu L, Han F. A comparison of mood, quality of life and executive function among narcolepsy type 1 patients with or without ADHD symptoms in China. Sleep Med 2022; 97:47-54. [DOI: 10.1016/j.sleep.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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15
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The REM-sleep related characteristics of narcolepsy: A nation-wide multi-center study in Turkey, the REMCON study. Sleep Med 2022; 94:17-25. [DOI: 10.1016/j.sleep.2022.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
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16
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Leu-Semenescu S, Maranci JB, Lopez R, Drouot X, Dodet P, Gales A, Groos E, Barateau L, Franco P, Lecendreux M, Dauvilliers Y, Arnulf I. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med 2022; 18:1355-1364. [PMID: 34984974 PMCID: PMC9059608 DOI: 10.5664/jcsm.9862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the frequency, determinants and clinical impact of clinical NREM and REM parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) compared to healthy controls. METHODS Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 IH) and 595 healthy controls. RESULTS Except for sleep-related eating disorder (SRED), current NREM parasomnias were rare in all patient groups and controls. SRED was more frequent in NT1 patients (7.9%, vs. 1.8% in NT2 patients, 2.1% in IH patients and 1% in controls) and associated with disrupted nighttime sleep (odds ratio [OR] = 3.9) and nocturnal eating in full awareness (OR = 6.9) but not with sex. Clinical REM sleep behavior disorder (RBD) was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (OR = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms and antidepressant use. Frequent (>1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2 and 27.8% with IH (vs. 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness. CONCLUSIONS In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except SRED) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and associated with male sex, disrupted nighttime sleep, depressive symptoms and antidepressant use.
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Affiliation(s)
- Smaranda Leu-Semenescu
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Jean-Baptiste Maranci
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
| | - Regis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Xavier Drouot
- Clinical Neurophysiology Department, La Miletrie University Hospital, Poitiers, France
| | - Pauline Dodet
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Ana Gales
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Elisabeth Groos
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Patricia Franco
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Unit, Mother-Children Hospital, Hospices Civils de Lyon, University Lyon1, France, Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Michel Lecendreux
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Center, Hospital Robert-Debré, AP-HP, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Isabelle Arnulf
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
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17
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Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med 2022; 18:289-304. [PMID: 34463249 PMCID: PMC8807887 DOI: 10.5664/jcsm.9638] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. METHODS One hundred two peer-reviewed publications from a PubMed search were included. RESULTS DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. CONCLUSIONS DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research. CITATION Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med. 2022;18(1):289-304.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts,Address correspondence to: Kiran Maski, MD, MPH, Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02130; Phone: +01 857-218-5536; Fax: +01 617-730-0282;
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Redwood City, California
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France,University of Montpellier, INSERM Institute for Neurosciences Montpellier, Montpellier, France
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18
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Current Understanding of Narcolepsy 1 and its Comorbidities: What Clinicians Need to Know. Adv Ther 2022; 39:221-243. [PMID: 34894325 PMCID: PMC8799537 DOI: 10.1007/s12325-021-01992-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Narcolepsy is a chronic neurologic disorder associated with the dysregulation of the sleep–wake cycle that often leads to a decreased quality of life and results in a considerable health burden. There is often a delay to diagnosis of narcolepsy, mainly due to the lack of recognition of this disorder. One of the main factors hindering the diagnosis of narcolepsy is the association of comorbidities, which include other sleep disorders, psychiatric disorders, cardiovascular disorders, and metabolic disorders. The signs and symptoms of these comorbidities often overlap with those of narcolepsy, and some of the medications used for their treatment may obscure the symptoms of narcolepsy, leading to a delay in diagnosis. This review is targeted to clinicians unaccustomed to working with sleep disorders and aims to increase recognition and improve the management of narcolepsy.
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Neurophysiological Aspects of REM Sleep Behavior Disorder (RBD): A Narrative Review. Brain Sci 2021. [PMID: 34942893 DOI: 10.3390/brainsci11121588.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
REM sleep without atonia (RSWA) is the polysomnographic (PSG) hallmark of rapid eye movement (REM) sleep behavior disorder (RBD), a feature essential for the diagnosis of this condition. Several additional neurophysiological aspects of this complex disorder have also recently been investigated in depth, which constitute the focus of this narrative review, together with RSWA. First, we describe the complex neural network underlying REM sleep and its muscle atonia, focusing on the disordered mechanisms leading to RSWA. RSWA is then described in terms of its polysomnographic features, and the methods (visual and automatic) currently available for its scoring and quantification are exposed and discussed. Subsequently, more recent and advanced neurophysiological features of RBD are described, such as electroencephalography during wakefulness and sleep, transcranial magnetic stimulation, and vestibular evoked myogenic potentials. The role of the assessment of neurophysiological features in the study of RBD is then carefully discussed, highlighting their usefulness and sensitivity in detecting neurodegeneration in the early or prodromal stages of RBD, as well as their relationship with other proposed biomarkers for the diagnosis, prognosis, and monitoring of this condition. Finally, a future research agenda is proposed to help clarify the many still unclear aspects of RBD.
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20
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Figorilli M, Lanza G, Congiu P, Lecca R, Casaglia E, Mogavero MP, Puligheddu M, Ferri R. Neurophysiological Aspects of REM Sleep Behavior Disorder (RBD): A Narrative Review. Brain Sci 2021; 11:brainsci11121588. [PMID: 34942893 PMCID: PMC8699681 DOI: 10.3390/brainsci11121588] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
REM sleep without atonia (RSWA) is the polysomnographic (PSG) hallmark of rapid eye movement (REM) sleep behavior disorder (RBD), a feature essential for the diagnosis of this condition. Several additional neurophysiological aspects of this complex disorder have also recently been investigated in depth, which constitute the focus of this narrative review, together with RSWA. First, we describe the complex neural network underlying REM sleep and its muscle atonia, focusing on the disordered mechanisms leading to RSWA. RSWA is then described in terms of its polysomnographic features, and the methods (visual and automatic) currently available for its scoring and quantification are exposed and discussed. Subsequently, more recent and advanced neurophysiological features of RBD are described, such as electroencephalography during wakefulness and sleep, transcranial magnetic stimulation, and vestibular evoked myogenic potentials. The role of the assessment of neurophysiological features in the study of RBD is then carefully discussed, highlighting their usefulness and sensitivity in detecting neurodegeneration in the early or prodromal stages of RBD, as well as their relationship with other proposed biomarkers for the diagnosis, prognosis, and monitoring of this condition. Finally, a future research agenda is proposed to help clarify the many still unclear aspects of RBD.
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Affiliation(s)
- Michela Figorilli
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Patrizia Congiu
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Rosamaria Lecca
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Elisa Casaglia
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Maria P. Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, 27100 Pavia, Italy;
| | - Monica Puligheddu
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Correspondence: ; Tel.: +39-0935-936111
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Maski KP, Colclasure A, Little E, Steinhart E, Scammell TE, Navidi W, Diniz Behn C. Stability of nocturnal wake and sleep stages defines central nervous system disorders of hypersomnolence. Sleep 2021; 44:6123832. [PMID: 33512510 DOI: 10.1093/sleep/zsab021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/22/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We determine if young people with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) have distinct nocturnal sleep stability phenotypes compared to subjectively sleepy controls. METHODS Participants were 5- to 21-year old and drug-naïve or drug free: NT1 (n = 46), NT2 (n = 12), IH (n = 18), and subjectively sleepy controls (n = 48). We compared the following sleep stability measures from polysomnogram recording between each hypersomnolence disorder to subjectively sleepy controls: number of wake and sleep stage bouts, Kaplan-Meier survival curves for wake and sleep stages, and median bout durations. RESULTS Compared to the subjectively sleepy control group, NT1 participants had more bouts of wake and all sleep stages (p ≤ .005) except stage N3. NT1 participants had worse survival of nocturnal wake, stage N2, and rapid eye movement (REM) bouts (p < .005). In the first 8 hours of sleep, NT1 participants had longer stage N1 bouts but shorter REM (all ps < .004). IH participants had a similar number of bouts but better survival of stage N2 bouts (p = .001), and shorter stage N3 bouts in the first 8 hours of sleep (p = .003). In contrast, NT2 participants showed better stage N1 bout survival (p = .006) and longer stage N1 bouts (p = .02). CONCLUSIONS NT1, NT2, and IH have unique sleep physiology compared to subjectively sleepy controls, with only NT1 demonstrating clear nocturnal wake and sleep instability. Overall, sleep stability measures may aid in diagnoses and management of these central nervous system disorders of hypersomnolence.
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Affiliation(s)
- Kiran P Maski
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Alicia Colclasure
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, USA
| | - Elaina Little
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Erin Steinhart
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Thomas E Scammell
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William Navidi
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, USA
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, USA.,Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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22
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Lividini A, Pizza F, Filardi M, Vandi S, Ingravallo F, Antelmi E, Bruni O, Cosentino FII, Ferri R, Guarnieri B, Marelli S, Ferini-Strambi L, Romigi A, Bonanni E, Maestri M, Terzaghi M, Manni R, Plazzi G. Narcolepsy type 1 features across the life span: age impact on clinical and polysomnographic phenotype. J Clin Sleep Med 2021; 17:1363-1370. [PMID: 33666167 DOI: 10.5664/jcsm.9198] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Narcolepsy type 1 (NT1) is a chronic neurological disorder typically arising during adolescence and young adulthood. Recent studies demonstrated that NT1 presents with age-specific features, especially in children. With this study we aimed to describe and to compare the clinical pictures of NT1 in different age groups. METHODS In this cross-sectional, multicenter study, 106 untreated patients with NT1 enrolled at the time of diagnosis underwent clinical evaluation, a semistructured interview (including the Epworth Sleepiness Scale), nocturnal video-polysomnography, and the Multiple Sleep Latency Test. Patients were enrolled in order to establish 5 age-balanced groups (childhood, adolescence, adulthood, middle age, and senior). RESULTS The Epworth Sleepiness Scale score showed a significant increase with age, while self-reported diurnal total sleep time was lower in older and young adults, with the latter also complaining of automatic behaviors in more than 90% of patients. Children reported the cataplexy attacks to be more frequent (> 1/d in 95% of patients). "Recalling an emotional event," "meeting someone unexpectedly," "stress," and "anger" were more frequently reported in adult and older adult patients as possible triggers of cataplexy. Neurophysiological data showed a higher number of sleep-onset rapid eye movement periods on the Multiple Sleep Latency Test in adolescent compared to senior patients and an age-progressive decline in sleep efficiency. CONCLUSIONS Daytime sleepiness, cataplexy features and triggers, and nocturnal sleep structure showed age-related difference in patients with NT1; this variability may contribute to diagnostic delay and misdiagnosis.
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Affiliation(s)
- Althea Lividini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | | | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Biancamaria Guarnieri
- Center of Sleep Medicine, Department of Neurology, Villa Serena Hospital and Villa Serena Foundation for Research, Città S. Angelo, Pescara, Italy
| | - Sara Marelli
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology-Sleep Disorders Centre, Milan, Italy
| | - Andrea Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo Sleep Medicine Centre, Pozzilli, Italy
| | - Enrica Bonanni
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michelangelo Maestri
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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23
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Ferri R, Mogavero MP, Bruni O, Plazzi G, Schenck CH, DelRosso LM. Increased Chin Muscle Tone during All Sleep Stages in Children Taking SSRI Antidepressants and in Children with Narcolepsy Type 1. Sleep 2021; 44:6296039. [PMID: 34111296 DOI: 10.1093/sleep/zsab147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To assess if selective serotonin reuptake inhibitor (SSRI) antidepressants are able to modify the chin EMG tone during sleep also in children. METHODS Twenty-three children and adolescents (12 girls, mean age 14.1 years, SD 2.94) under therapy with antidepressant for their mood disorder were consecutively recruited and had a PSG recording. Twenty-one were taking were taking SSRI and treatment duration was 2-12 months. An age- and sex matched group of 33 control children (17 girls, mean age 14.2 years, SD 2.83) and 24 children with narcolepsy type 1 (12 girls, mean age 13.7 years, SD 2.80) were also included. The Atonia Index was then computed for each NREM sleep stage and for REM sleep, also all EMG activations were counted. RESULTS Atonia Index in all sleep stages was found to be significantly reduced in children with narcolepsy followed by the group taking SSRI antidepressants and the number of EMG activations was also increased in both groups. Fluoxetine, in particular, was found to be significantly associated with reduced Atonia index during NREM sleep stages N1, N2, and N3, and with increased number of EMG activations/hour during sleep stage N3. CONCLUSIONS Similarly to adults, SSRI antidepressants are able to modify the chin EMG tone also in children during REM sleep, as well as during NREM sleep stages. Different pharmacological properties of the different SSRI might explain the differential effect on chin tone during sleep found in this study.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - Maria P Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Giuseppe Plazzi
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lourdes M DelRosso
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Seattle Children's Hospital and University of Washington, Seattle, WA, USA
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24
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Yon MI, Azman F, Yon ME, Tezer FI. Nocturnal Rapid Eye Movement Sleep Without Atonia can Be a Diagnostic Parameter in Differentiating Narcolepsy Type 1 From Type 2. J Clin Neurophysiol 2021; 38:237-241. [PMID: 32141986 DOI: 10.1097/wnp.0000000000000688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE We aimed to compare rapid eye movement sleep without atonia (RSWA), tonic RSWA, and phasic RSWA indices during polysomnography as a potential biomarker between narcolepsy type 1 and type 2. METHODS Medical files, polysomnography, and multiple sleep latency tests of patients with narcolepsy were evaluated retrospectively. A total of three adolescents and 31 adult patients were included. We calculated the total number of rapid eye movement (REM) epochs with tonic and phasic activity in accordance with the American Academy of Sleep Medicine manual scoring rules, version 2.4. We defined tonic RSWA index as the ratio of total number of REM sleep stage epochs with only tonic activity to total REM sleep stage epochs, phasic RSWA index as the ratio of total number of REM sleep stage epochs with only phasic activity to total REM sleep stage epochs, and RSWA index as the ratio of total number of REM stage sleep epochs with RSWA to total REM sleep stage epochs on the polysomnography. RESULTS Clinically and polysomnographically diagnosed 25 patients with narcolepsy type 1 and 9 patients with narcolepsy type 2 were included. The median age of the subjects was 30 (10, 61) and 36 (18, 64), respectively. Eleven narcolepsy type 1 patients (44%) and 4 narcolepsy type 2 patients (44.44%) were women. The RSWA index of ≥ 3% yielded a sensitivity of 76% and specificity of 88.9% (AUC = 0.77 (0.09), 95% confidence interval = 0.58 to 0.97, p = 0.01), and the tonic RSWA index of ≥ 2.2% yielded a sensitivity of 72% and specificity of 77.8% (area under the curve = 0.74 (0.1), 95% confidence interval = 0.54-0.94, p = 0.03). CONCLUSIONS As an electrophysiological biomarker, RSWA and tonic RSWA indices can be sensitive and specific polysomnography parameters in distinguishing narcolepsy type 1 from narcolepsy type 2.
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Affiliation(s)
- Mehmet Ilker Yon
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
| | - Filiz Azman
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
| | - Merve Ecem Yon
- Ankara Yildirim Beyazit Diskapi Training and Research Hospital, Ankara, Turkey
| | - F Irsel Tezer
- Hacettepe University, School of Medicine, Department of Neurology, Ankara, Turkey . Dr. Yon is now with the Department of Neurology, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey; and
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25
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Maski K, Pizza F, Liu S, Steinhart E, Little E, Colclasure A, Diniz Behn C, Vandi S, Antelmi E, Weller E, Scammell TE, Plazzi G. Defining disrupted nighttime sleep and assessing its diagnostic utility for pediatric narcolepsy type 1. Sleep 2021; 43:5816762. [PMID: 32253429 DOI: 10.1093/sleep/zsaa066] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/30/2020] [Indexed: 12/22/2022] Open
Abstract
STUDY OBJECTIVES Disrupted nighttime sleep (DNS) is a core narcolepsy symptom of unconsolidated sleep resulting from hypocretin neuron loss. In this study, we define a DNS objective measure and evaluate its diagnostic utility for pediatric narcolepsy type 1 (NT1). METHODS This was a retrospective, multisite, cross-sectional study of polysomnograms (PSGs) in 316 patients, ages 6-18 years (n = 150 NT1, n = 22 narcolepsy type 2, n = 27 idiopathic hypersomnia, and n = 117 subjectively sleepy subjects). We assessed sleep continuity PSG measures for (1) their associations with subjective and objective daytime sleepiness, daytime sleep onset REM periods (SOREMPs), self-reported disrupted nocturnal sleep and CSF hypocretin levels and (2) their predictive value for NT1 diagnosis. We then combined the best performing DNS measure with nocturnal SOREMP (nSOREMP) to assess the added value to the logistic regression model and the predictive accuracy for NT1 compared with nSOREMP alone. RESULTS The Wake/N1 Index (the number of transitions from any sleep stage to wake or NREM stage 1 normalized by total sleep time) was associated with objective daytime sleepiness, daytime SOREMPs, self-reported disrupted sleep, and CSF hypocretin levels (p's < 0.003) and held highest area under the receiver operator characteristic curves (AUC) for NT1 diagnosis. When combined with nSOREMP, the DNS index had greater accuracy for diagnosing NT1 (AUC = 0.91 [0.02]) than nSOREMP alone (AUC = 0.84 [0.02], likelihood ratio [LR] test p < 0.0001). CONCLUSIONS The Wake/N1 Index is an objective DNS measure that can quantify DNS severity in pediatric NT1. The Wake/N1 Index in combination with or without nSOREMP is a useful sleep biomarker that improves recognition of pediatric NT1 using only the nocturnal PSG.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Shanshan Liu
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA
| | - Erin Steinhart
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Elaina Little
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Alicia Colclasure
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Edie Weller
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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26
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Deng F, Zhang Y, Zhang R, Tang Q, Guo Z, Lv Y, Wang Z, Yang Y. Compromised Dynamic Cerebral Autoregulation in Patients With Central Disorders of Hypersomnolence. Front Neurol 2021; 12:634660. [PMID: 33776891 PMCID: PMC7991911 DOI: 10.3389/fneur.2021.634660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/16/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: We aimed to investigate the dynamic cerebral autoregulation (dCA) in patients with central disorders of hypersomnolence during wakefulness. Methods: Thirty-six patients with central disorders of hypersomnolence were divided into three groups according to polysomnography and multiple sleep latency test results: the idiopathic hypersomnia group (IH), narcolepsy type 1 without rapid-eye-movement sleep behavior disorder group (NT1-RBD), and narcolepsy type 1 with rapid-eye-movement sleep behavior disorder group (NT1 + RBD), with 12 patients in each group. Twelve sex- and age-matched healthy controls were recruited. We assessed the Epworth sleepiness scale (ESS) and dCA of all subjects. dCA was assessed by analyzing the phase difference (PD) using transfer function analysis. The ESS and dCA were analyzed before and after standardized treatment in 24 patients with narcolepsy type 1. Results: The overall PD of the IH, NT1-RBD, and NT1 + RBD groups were lower than that of the control group (P < 0.001). There were no significant differences between the overall PD of the NT1-RBD and NT1 + RBD group (P > 0.05). The ESS scores decreased and the overall PD increased after treatment in 24 patients with narcolepsy type 1 (P < 0.001). Multivariable analysis showed that mean sleep latency in multiple sleep latency test was independently associated with impaired overall PD (P < 0.05). Conclusions: The dCA is impaired in patients with central disorders of hypersomnolence. The impairment of dCA occurs irrespective of NT1-RBD/+RBD. The ESS score and dCA improved in patients with narcolepsy type 1 after medication treatment. The mean sleep latency in multiple sleep latency test was independently associated with impaired dCA. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02752139.
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Affiliation(s)
- Fang Deng
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yanan Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ran Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qi Tang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zhenni Guo
- Department of Neurology, Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
| | - Yudan Lv
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
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27
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Coffey AA, Joyal AA, Yamanaka A, Scammell TE. The Impacts of Age and Sex in a Mouse Model of Childhood Narcolepsy. Front Neurosci 2021; 15:644757. [PMID: 33746708 PMCID: PMC7969886 DOI: 10.3389/fnins.2021.644757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/12/2021] [Indexed: 11/13/2022] Open
Abstract
Narcolepsy is a sleep disorder caused by selective death of the orexin neurons that often begins in childhood. Orexin neuron loss disinhibits REM sleep during the active period and produces cataplexy, episodes of paralysis during wakefulness. Cataplexy is often worse when narcolepsy develops in children compared to adults, but the reason for this difference remains unknown. We used orexin-tTA; TetO DTA mice to model narcolepsy at different ages. When doxycycline is removed from the diet, the orexin neurons of these mice express diphtheria toxin A and die within 2-3 weeks. We removed doxycycline at 4 weeks (young-onset) or 14 weeks (adult-onset) of age in male and female mice. We implanted electroencephalography (EEG) and electromyography (EMG) electrodes for sleep recordings two weeks later and then recorded EEG/EMG/video for 24 h at 3 and 13 weeks after removal of doxycycline. Age-matched controls had access to doxycycline diet for the entire experiment. Three weeks after doxycycline removal, both young-onset and adult-onset mice developed severe cataplexy and the sleep-wake fragmentation characteristic of narcolepsy. Cataplexy and maintenance of wake were no worse in young-onset compared to adult-onset mice, but female mice had more bouts of cataplexy than males. Orexin neuron loss was similarly rapid in both young- and adult-onset mice. As age of orexin neuron loss does not impact the severity of narcolepsy symptoms in mice, the worse symptoms in children with narcolepsy may be due to more rapid orexin neuron loss than in adults.
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Affiliation(s)
- Alissa A. Coffey
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Adam A. Joyal
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Akihiro Yamanaka
- Department of Neuroscience II, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Thomas E. Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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28
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Quaedackers L, Pillen S, Overeem S. Recognizing the Symptom Spectrum of Narcolepsy to Improve Timely Diagnosis: A Narrative Review. Nat Sci Sleep 2021; 13:1083-1096. [PMID: 34262379 PMCID: PMC8273742 DOI: 10.2147/nss.s278046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Narcolepsy is a chronic sleep disorder with a strong negative impact on quality of life, especially when untreated. Diagnostic delay is a persistent problem, with obvious detrimental effects on patients. A diagnosis of narcolepsy may be delayed because of its broad symptom presentation which is much more encompassing than the classical "tetrad" of sleepiness, cataplexy, hallucinations, and sleep paralysis. Furthermore, symptoms can vary over time. Presentation of symptoms can also be markedly different between children and adults. Finally, common sleep-related comorbidities increase the risk of narcolepsy being masked by overlapping symptoms or treatment. In this review, we provide a detailed description of the broad and dynamic symptom spectrum of narcolepsy, with specific attention to the different manifestations in both adults and children. The overarching goal is to help not only sleep specialists, but general practitioners, pediatricians, and other caregivers with early recognition and prompt diagnosis of this severe but treatable disorder.
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Affiliation(s)
| | - Sigrid Pillen
- Sleep Medicine Center Kempenhaeghe, Heeze, the Netherlands
| | - Sebastiaan Overeem
- Biomedical Diagnostics Laboratory, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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29
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Antelmi E, Plazzi G. Rapid eye movement sleep behavior disorder and sodium oxybate: efficacy and viewpoint. Sleep 2020; 43:5903783. [DOI: 10.1093/sleep/zsaa149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elena Antelmi
- Neurology Unit, Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
- IRCCS delle Scienze Neurologiche, Bologna, Italy
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30
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Antelmi E, Filardi M, Pizza F, Vandi S, Moresco M, Franceschini C, Tinazzi M, Ferri R, Plazzi G. REM Sleep Behavior Disorder in Children With Type 1 Narcolepsy Treated With Sodium Oxybate. Neurology 2020; 96:e250-e254. [PMID: 33177222 PMCID: PMC7905776 DOI: 10.1212/wnl.0000000000011157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/25/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To study the effect of stable treatment with sodium oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1). Methods Nineteen children and adolescents with NT1 (9 female, mean age 12.5 ± 2.7 years, mean disease duration 3.4 ± 1.6 years) underwent neurologic investigations and video-polysomnography (v-PSG) at baseline and after 3 months of stable treatment with SO. v-PSG was independently analyzed by 2 sleep experts to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI). Results Compared to baseline, RAI significantly improved (p < 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep-stage architecture. Conclusions RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep. Classification of Evidence This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.
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Affiliation(s)
- Elena Antelmi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Marco Filardi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Fabio Pizza
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Stefano Vandi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Monica Moresco
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Christian Franceschini
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Michele Tinazzi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Raffaele Ferri
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy
| | - Giuseppe Plazzi
- From the Neurology Unit (E.A., M.T.), Movement Disorders Division, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona; Department of Biomedical and Neuromotor Sciences (E.A., M.F., F.P., M.M., G.P.), University of Bologna; IRCCS (F.P., S.V., G.P.), Istituto delle Scienze Neurologiche di Bologna; Department of Medicine and Surgery (C.F.), University of Parma; and Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Research institute-IRCCS, Troina, Italy.
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31
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August J, Maski K. Updates on Pediatric Sleep Disorders. CURRENT SLEEP MEDICINE REPORTS 2020. [DOI: 10.1007/s40675-020-00184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW The presentation of sleep issues in childhood differs from the presentation in adulthood and may be more subtle. Sleep issues may affect children differently than adults, and distinct treatment approaches are often used in children. RECENT FINDINGS Sodium oxybate was approved by the US Food and Drug Administration (FDA) in October 2018 for an expanded indication of treatment of sleepiness or cataplexy in patients with narcolepsy type 1 or narcolepsy type 2 aged 7 years or older, with side effect and safety profiles similar to those seen in adults. Restless sleep disorder is a recently proposed entity in which restless sleep, daytime sleepiness, and often iron deficiency are observed, but children do not meet the criteria for restless legs syndrome or periodic limb movement disorder. SUMMARY Children's sleep is discussed in this article, including normal sleep patterns and effects of insufficient sleep. Sleep disorders of childhood are reviewed, including insomnia, obstructive sleep apnea, restless legs syndrome, parasomnias, narcolepsy, and Kleine-Levin syndrome. Children with neurologic issues or neurodevelopmental disorders frequently have sleep disorders arising from an interaction of heterogeneous factors. Further attention to sleep may often be warranted through a polysomnogram or referral to a pediatric sleep specialist. Sleep disorders may cause indelible effects on children's cognitive functioning, general health, and well-being, and awareness of sleep disorders is imperative for neurologists who treat children.
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33
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Filardi M, Stefani A, Holzknecht E, Pizza F, Plazzi G, Högl B. Objective rest–activity cycle analysis by actigraphy identifies isolated rapid eye movement sleep behavior disorder. Eur J Neurol 2020; 27:1848-1855. [DOI: 10.1111/ene.14386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022]
Affiliation(s)
- M. Filardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
| | - A. Stefani
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - E. Holzknecht
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
| | - F. Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - G. Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM) University of Bologna Bologna Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy
| | - B. Högl
- Sleep Disorders Unit Department of Neurology Medical University of Innsbruck Innsbruck Austria
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34
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Abstract
PURPOSE OF REVIEW The complex nature of narcolepsy symptoms, along with the use of stimulants and anticataplectic medications, poses diagnostic difficulties in terms of underlying neuropsychiatric comorbidities. This study reviews recent evidence for the association between narcolepsy and neuropsychiatric disorders. We also critically analyze studies that have addressed the neuropsychiatric correlates of patients with narcolepsy, with a discussion of the possible pathophysiological mechanisms linking narcolepsy and neuropsychiatric disorders. RECENT FINDINGS Neuropsychiatric manifestations are common among patients with narcolepsy as narcolepsy and some neuropsychiatric disorders share common clinical features. This may create challenges in making the correct diagnosis, and hence result in a delay in starting appropriate treatment. Comorbid neuropsychiatric manifestations in patients with narcolepsy include depression, anxiety, psychosis, rapid eye movement (REM) sleep behavior disorder, and cognitive impairment. Although hypocretin deficiency has been proposed as a pathophysiological mechanism underlying both narcolepsy and neuropsychiatric disorders, further research is necessary to identify the exact mechanisms. Narcolepsy patients often manifest comorbid neuropsychiatric symptoms, which makes the diagnosis difficult. Therefore, it is essential to address neuropsychiatric symptoms in the clinical care of patients with narcolepsy.
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Barateau L, Chenini S, Lotierzo M, Rassu AL, Evangelista E, Lopez R, Gorce Dupuy A, Jaussent I, Dauvilliers Y. CSF and serum ferritin levels in narcolepsy type 1 comorbid with restless legs syndrome. Ann Clin Transl Neurol 2020; 7:924-931. [PMID: 32432412 PMCID: PMC7317640 DOI: 10.1002/acn3.51056] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate whether cerebrospinal fluid (CSF) and serum ferritin levels differ between patients with narcolepsy type 1 (NT1) comorbid with restless legs syndrome (RLS) or periodic leg movements during sleep (PLMS), and patients with NT1 or controls without comorbid RLS or PLMS. METHODS Sixty-six drug-free patients with NT1 (44 males, age 38.5 years [14-81]) were enrolled, including 20 with RLS, 18 with PLMS index ≥15/h (six with both RLS and PLMS). Thirty-eight drug-free patients (12 males, age 22.5 years [12-61]) referred for sleepiness complaint, but without central hypersomnia, RLS, PLMS were included as controls. Clinical, electrophysiological and biological (CSF/serum ferritin, orexin [ORX]) data were quantified. RESULTS NT1 patients with and without RLS did not differ for age, gender, and body mass index (BMI). No between-group differences were found for CSF ferritin, ORX, and serum ferritin levels. No CSF ferritin, ORX, and serum ferritin level differences were found between NT1 patients with and without PLMS, or with RLS or PLMS versus not. CSF-ferritin levels were not different between NT1 and controls in adjusted analyses. CSF-ferritin levels in the whole population correlated positively with age, serum-ferritin, BMI, negatively with ORX, but not with PLMS index. In NT1, CSF-ferritin levels correlated with age and serum-ferritin but not with PLMS. CONCLUSION The absence of CSF ferritin deficiency in NT1 with comorbid RLS or PLMS indicates normal brain iron levels in that condition. This result suggests that the frequent association between RLS, PLMS, and NT1 is not based on alterations in brain iron metabolism, a pathophysiological mechanism involved in primary RLS.
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Affiliation(s)
- Lucie Barateau
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
- National Reference Network for NarcolepsyCHU MontpellierMontpellierFrance
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
| | - Sofiene Chenini
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
| | - Manuela Lotierzo
- Department of BiochemistryMontpellier University HospitalMontpellierFrance
- PhyMedExpINSERM U1046CNRS UMR 9214University of MontpellierMontpellierFrance
| | - Anna Laura Rassu
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
| | - Elisa Evangelista
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
- National Reference Network for NarcolepsyCHU MontpellierMontpellierFrance
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
| | - Régis Lopez
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
- National Reference Network for NarcolepsyCHU MontpellierMontpellierFrance
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
| | - Anne‐Marie Gorce Dupuy
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
- Department of BiochemistryMontpellier University HospitalMontpellierFrance
| | - Isabelle Jaussent
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
| | - Yves Dauvilliers
- Sleep‐Wake Disorders UnitDepartment of NeurologyGui‐de‐Chauliac HospitalCHU MontpellierMontpellierFrance
- National Reference Network for NarcolepsyCHU MontpellierMontpellierFrance
- Neuropsychiatry: Epidemiological and Clinical ResearchINSERMUniversity MontpellierMontpellierFrance
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Silvestri R, Walters AS. Rhythmic movements in sleep disorders and in epileptic seizures during sleep. SLEEP SCIENCE AND PRACTICE 2020. [DOI: 10.1186/s41606-020-0042-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractRhythmic movements during sleep may occur in the context of physiological sleep-related motor activity or be part of sleep-related movement disorders such as bruxism, periodic limb movement disorder, restless legs syndrome, and sleep-related rhythmic movement disorder. They may also characterize some frontal or temporal nocturnal seizures of sleep-related hypermotor epilepsy, or be considered as part of NREM parasomnias, especially sleepwalking, sexsomnia or sleep-related eating disorder, or REM-related behaviors such as REM behavior disorder or complex movements associated with pediatric narcolepsy type I.In most cases rhythmic movements, especially when complex and long in duration, are related to different levels of arousal from sleep with recurrence of ancestral motor sequences promoted by central pattern generators in the brainstem, generally activated by the arousal process.A differential diagnosis between physiological events and pathological movement disorders, and between the latter and sleep-related epilepsy is critical to provide optimal treatment and an accurate prognosis. Specific treatment options for the aforementioned disorders are beyond the scope of this article.
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Filardi M, Demir N, Pizza F, Vandi S, Antelmi E, Noce S, Bruni O, Plazzi G. Prevalence and neurophysiological correlates of sleep disordered breathing in pediatric type 1 narcolepsy. Sleep Med 2020; 65:8-12. [DOI: 10.1016/j.sleep.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
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REM sleep behavior disorder in narcolepsy: A secondary form or an intrinsic feature? Sleep Med Rev 2019; 50:101254. [PMID: 31931470 DOI: 10.1016/j.smrv.2019.101254] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 01/17/2023]
Abstract
Disrupted nighttime sleep is one of the pentad of symptoms defining Narcolepsy. REM sleep behavior disorder (RBD) largely contributes to night sleep disruption and narcolepsy is the most common cause of secondary RBD. However, RBD linked to narcolepsy (N-RBD) has been insufficiently characterized, leaving unsolved a number of issues. Indeed, it is still debated whether N-RBD is an intrinsic feature of narcolepsy, as indubitable for cataplexy, and therefore strictly linked to the cerebrospinal fluid hypocretin-1 (CSF hcrt-1) deficiency, or an associated feature, with a still unclear pathophysiology. The current review aims at rendering a comprehensive state-of-the-art of N-RBD, highlighting the open and unsettled topics. RBD reportedly affects 30-60% of patients with Narcolepsy type 1 (NT1), but it may be seen also in Narcolepsy type 2 (NT2). When compared to idiopathic/isolated RBD (iRBD), N-RBD has been reported to be characterized by less energetic and quieter episode, which however occur with the same probability in the first and the second part of the night and sometime even subcontinuously. N-RBD patients are generally younger than those with iRBD. N-RBD has been putatively linked to wake-sleep instability due to CSF hcrt-1 deficiency, but this latter by itself cannot explain completely the phenomenon as N-RBD has not been universally linked to low CSF hcrt-1 levels and it may be observed also in NT2. Therefore, other factors may probably play a role and further studies are needed to clarify this issue. In addition, therapeutic options have been poorly investigated.
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Ntafouli M, Galbiati A, Gazea M, Bassetti CLA, Bargiotas P. Update on nonpharmacological interventions in parasomnias. Postgrad Med 2019; 132:72-79. [PMID: 31760836 DOI: 10.1080/00325481.2019.1697119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parasomnias are abnormal behaviors that occur during sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction, and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Longterm pharmacological treatments are not always well tolerated and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various nonpharmacological techniques on different types of parasomnias and provide a glimpse into the future of nonpharmacological treatments in this field.
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Affiliation(s)
- Maria Ntafouli
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mary Gazea
- Centre for experimental Neurology, Dept. of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Biomedical Research (DBMR), Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Panagiotis Bargiotas
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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Antelmi E, Pizza F, Donadio V, Filardi M, Sosero YL, Incensi A, Vandi S, Moresco M, Ferri R, Marelli S, Ferini-Strambi L, Liguori R, Plazzi G. Biomarkers for REM sleep behavior disorder in idiopathic and narcoleptic patients. Ann Clin Transl Neurol 2019; 6:1872-1876. [PMID: 31386270 PMCID: PMC6764627 DOI: 10.1002/acn3.50833] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
To search for discriminating biomarkers, 30 patients with idiopathic rapid‐eye‐movements sleep behavior disorder (iRBD) were compared with 17 patients with RBD within narcolepsy type 1. Both groups underwent extensive examinations, including skin biopsy searching for phosphorylated α‐synuclein deposits and whole‐night video‐polysomnography. Skin biopsy was positive for phosphorylated α‐synuclein deposits in 86.7% of iRBD patients and in none of narcoleptic patients. The analysis of video‐polysomnographic motor events showed differences in their occurrence throughout the night in the two groups. iRBD and RBD due to narcolepsy do have different clinical and pathological findings, confirming a different pathophysiology.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Vincenzo Donadio
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Marco Filardi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Yuri L Sosero
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Sara Marelli
- "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Centre, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Neurology - Sleep Disorders Centre, Milan, Italy
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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41
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Vandi S, Rodolfi S, Pizza F, Moresco M, Antelmi E, Ferri R, Mignot E, Plazzi G, Silvani A. Cardiovascular autonomic dysfunction, altered sleep architecture, and muscle overactivity during nocturnal sleep in pediatric patients with narcolepsy type 1. Sleep 2019; 42:5540159. [DOI: 10.1093/sleep/zsz169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/17/2019] [Indexed: 01/11/2023] Open
Abstract
AbstractStudy ObjectivesArterial blood pressure (ABP) decreases during sleep compared with wakefulness and this change is blunted in mouse models of and adult patients with narcolepsy type 1 (NT1). We tested whether: (1) pediatric patients with NT1 have similar cardiovascular autonomic abnormalities during nocturnal sleep; and (2) these abnormalities can be linked to hypocretin-1 cerebrospinal fluid concentration (CSF HCRT-1), sleep architecture, or muscle activity.MethodsLaboratory polysomnographic studies were performed in 27 consecutive drug-naïve NT1 children or adolescents and in 19 matched controls. Nocturnal sleep architecture and submentalis (SM), tibialis anterior (TA), and hand extensor (HE) electromyographic (EMG) activity were analyzed. Cardiovascular autonomic function was assessed through the analysis of pulse transit time (PTT) and heart period (HP).ResultsPTT showed reduced lengthening during total sleep and REM sleep compared with nocturnal wakefulness in NT1 patients than in controls, whereas HP did not. NT1 patients had altered sleep architecture, higher SM EMG during REM sleep, and higher TA and HE EMG during N1–N3 and REM sleep when compared with controls. PTT alterations found in NT1 patients were more severe in subjects with lower CSF HRCT-1, but did not cluster or correlate with sleep architecture alterations or muscle overactivity during sleep.ConclusionOur results suggest that pediatric NT1 patients close to disease onset have impaired capability to modulate ABP as a function of nocturnal wake–sleep transitions, possibly as a direct consequence of hypocretin neuron loss. The relevance of this finding for cardiovascular risk later in life remains to be determined.
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Affiliation(s)
- Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Sara Rodolfi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Monica Moresco
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute-IRCCS, Troina, Italy
| | - Emmanuel Mignot
- Centre for Narcolepsy, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Barateau L, Lopez R, Dauvilliers Y. Clinical neurophysiology of CNS hypersomnias. HANDBOOK OF CLINICAL NEUROLOGY 2019; 161:353-367. [PMID: 31307613 DOI: 10.1016/b978-0-444-64142-7.00060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Central nervous system hypersomnias (narcolepsy type 1 and type 2, idiopathic hypersomnia, and Kleine-Levin syndrome) are orphan sleep disorders in which the predominant symptom is excessive daytime sleepiness. The evaluation of sleepiness requires rigorous clinical and neurophysiologic approaches that may include the Epworth Sleepiness Scale, multiple sleep latency tests, and the maintenance of wakefulness test. However, to date, no gold standard measurement of excessive sleepiness exists, and there are no quantifiable biologic markers. The main pathophysiologic feature of central hypersomnias is thought to reflect a deficiency of arousal systems, rather than an overactivity of sleep systems or an imbalance between those systems. Impaired neurotransmission of hypocretin/orexin (neuropeptides of the lateral hypothalamus) is involved in the neurobiology of narcolepsy with cataplexy (NT1). NT1 is a well-characterized disorder, due to the destruction of hypocretin/orexin neurons by a probable autoimmune process. The biologic hallmarks of the other central hypersomnias remain unknown, and neurophysiologic biomarkers are still of major importance for the diagnosis and characterization of those disorders.
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Affiliation(s)
- Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France
| | - Régis Lopez
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Center, Hôpital Gui-de-Chauliac, Montpellier, France; National Reference Network for Narcolepsy, Montpellier, France.
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Rogers JP, Pollak TA, Blackman G, David AS. Catatonia and the immune system: a review. Lancet Psychiatry 2019; 6:620-630. [PMID: 31196793 PMCID: PMC7185541 DOI: 10.1016/s2215-0366(19)30190-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 12/13/2022]
Abstract
Catatonia is a psychomotor disorder featuring stupor, posturing, and echophenomena. This Series paper examines the evidence for immune dysregulation in catatonia. Activation of the innate immune system is associated with mutism, withdrawal, and psychomotor retardation, which constitute the neurovegetative features of catatonia. Evidence is sparse and conflicting for acute-phase activation in catatonia, and whether this feature is secondary to immobility is unclear. Various viral, bacterial, and parasitic infections have been associated with catatonia, but it is primarily linked to CNS infections. The most common cause of autoimmune catatonia is N-methyl-D-aspartate receptor (NMDAR) encephalitis, which can account for the full spectrum of catatonic features. Autoimmunity appears to cause catatonia less by systemic inflammation than by the downstream effects of specific actions on extracellular antigens. The specific association with NMDAR encephalitis supports a hypothesis of glutamatergic hypofunction in catatonia.
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Affiliation(s)
- Jonathan P Rogers
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, UK.
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, UK
| | - Graham Blackman
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
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Vignatelli L, Antelmi E, Ceretelli I, Bellini M, Carta C, Cortelli P, Ferini-Strambi L, Ferri R, Guerrini R, Ingravallo F, Marchiani V, Mari F, Pieroni G, Pizza F, Verga MC, Verrillo E, Taruscio D, Plazzi G. Red Flags for early referral of people with symptoms suggestive of narcolepsy: a report from a national multidisciplinary panel. Neurol Sci 2018; 40:447-456. [PMID: 30539345 PMCID: PMC6433801 DOI: 10.1007/s10072-018-3666-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Narcolepsy is a lifelong disease, manifesting with excessive daytime sleepiness and cataplexy, arising between childhood and young adulthood. The diagnosis is typically made after a long delay that burdens the disease severity. The aim of the project, promoted by the "Associazione Italiana Narcolettici e Ipersonni" is to develop Red Flags to detect symptoms for early referral, targeting non-sleep medicine specialists, general practitioners, and pediatricians. MATERIALS AND METHODS A multidisciplinary panel, including patients, public institutions, and representatives of national scientific societies of specialties possibly involved in the diagnostic process of suspected narcolepsy, was convened. The project was accomplished in three phases. Phase 1: Sleep experts shaped clinical pictures of narcolepsy in pediatric and adult patients. On the basis of these pictures, Red Flags were drafted. Phase 2: Representatives of the scientific societies and patients filled in a form to identify barriers to the diagnosis of narcolepsy. Phase 3: The panel produced suggestions for the implementation of Red Flags. RESULTS Red Flags were produced representing three clinical pictures of narcolepsy in pediatric patients ((1) usual sleep symptoms, (2) unusual sleep symptoms, (3) endocrinological signs) and two in adult patients ((1) usual sleep symptoms, (2) unusual sleep symptoms). Inadequate knowledge of symptoms at onset by medical doctors turned out to be the main reported barrier to diagnosis. CONCLUSIONS This report will hopefully enhance knowledge and awareness of narcolepsy among non-specialists in sleep medicine in order to reduce the diagnostic delay that burdens patients in Italy. Similar initiatives could be promoted across Europe.
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Affiliation(s)
- L Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - E Antelmi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - I Ceretelli
- Associazione Italiana Narcolettici e Ipersonni (AIN), Florence, Italy
| | - M Bellini
- Azienda USL Toscana centro Sedi di Prato, Prato, Italy
| | - C Carta
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - P Cortelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - L Ferini-Strambi
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - R Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Research Institute - IRCCS, Troina, Italy
| | - R Guerrini
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - F Ingravallo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - V Marchiani
- Child Neuropsychiatric Unit, Polyclinic S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - F Mari
- Pediatric Neurology, Neurogenetics and Neurobiology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - G Pieroni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - F Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy
| | - M C Verga
- Primary Care Pediatrics, ASL Salerno, Vietri sul Mare, SA, Italy
| | - E Verrillo
- Sleep and Long Term Ventilation Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Academic Department of Pediatrics (DPUO) Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - D Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
- Department of Biomedical and Neuromotor Sciences, University of Bologna, via Ugo Foscolo n 7, 40123, Bologna, Italy.
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45
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Dauvilliers Y, Schenck CH, Postuma RB, Iranzo A, Luppi PH, Plazzi G, Montplaisir J, Boeve B. REM sleep behaviour disorder. Nat Rev Dis Primers 2018; 4:19. [PMID: 30166532 DOI: 10.1038/s41572-018-0016-5] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia that is characterized by loss of muscle atonia during REM sleep (known as REM sleep without atonia, or RSWA) and abnormal behaviours occurring during REM sleep, often as dream enactments that can cause injury. RBD is categorized as either idiopathic RBD or symptomatic (also known as secondary) RBD; the latter is associated with antidepressant use or with neurological diseases, especially α-synucleinopathies (such as Parkinson disease, dementia with Lewy bodies and multiple system atrophy) but also narcolepsy type 1. A clinical history of dream enactment or complex motor behaviours together with the presence of muscle activity during REM sleep confirmed by video polysomnography are mandatory for a definite RBD diagnosis. Management involves clonazepam and/or melatonin and counselling and aims to suppress unpleasant dreams and behaviours and improve bedpartner quality of life. RSWA and RBD are now recognized as manifestations of an α-synucleinopathy; most older adults with idiopathic RBD will eventually develop an overt neurodegenerative syndrome. In the future, studies will likely evaluate neuroprotective therapies in patients with idiopathic RBD to prevent or delay α-synucleinopathy-related motor and cognitive decline.
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Affiliation(s)
- Yves Dauvilliers
- Centre National de Référence Narcolepsie Hypersomnies, Unité des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-de-Chauliac Montpellier, Montpellier, France. .,INSERM, U1061, Montpellier, France, Université Montpellier, Montpellier, France.
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, and Departments of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ronald B Postuma
- Department of Neurology, Montreal General Hospital, Montreal, Quebec, Canada
| | - Alex Iranzo
- Neurology Service, Multidisciplinary Sleep Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain
| | - Pierre-Herve Luppi
- UMR 5292 CNRS/U1028 INSERM, Center of Research in Neuroscience of Lyon (CRNL), SLEEP Team, Université Claude Bernard Lyon I, Faculté de Médecine RTH Laennec, Lyon, France
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Québec, Canada and Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Quebec, Canada
| | - Bradley Boeve
- Department of Neurology and Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
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Plazzi G, Clawges HM, Owens JA. Clinical Characteristics and Burden of Illness in Pediatric Patients with Narcolepsy. Pediatr Neurol 2018; 85:21-32. [PMID: 30190179 DOI: 10.1016/j.pediatrneurol.2018.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Narcolepsy is a chronic and lifelong neurologic disorder with onset commonly occurring in childhood or adolescence, and affecting approximately 0.025% to 0.05% of the general population. The primary symptom is excessive daytime sleepiness, which is accompanied by cataplexy in 70% of patients. Other common symptoms include sleep paralysis, hallucinations upon falling asleep or waking, and disrupted nocturnal sleep. Narcolepsy is associated with a considerable burden of illness (BOI), which has been well characterized in adults, and is exacerbated by delays in symptom recognition, diagnosis, and intervention. METHODS This review describes the specific characteristics and BOI of pediatric narcolepsy, using a wide range of published research data. RESULTS Pediatric narcolepsy presents distinct challenges in diagnosis and management. Narcolepsy symptoms often initially manifest differently in children and adolescents versus adults, which may pose diagnostic dilemmas. Children often respond to sleepiness with irritability, hyperactivity, and poor attention, which may be misinterpreted as misbehavior or neurocognitive sequelae of other conditions. Pediatric cataplexy symptoms may include subtle and unusual facial expressions or choreic-like movements, which are not observed in adults. Insufficient sleep and circadian rhythm disorders presenting with excessive daytime sleepiness are common in adolescents, potentially confounding narcolepsy diagnosis. Pediatric narcolepsy is also associated with comorbidities including rapid weight gain, precocious puberty, and attention deficit hyperactivity disorder, and increased risk for deficits in social functioning, depression, and anxiety. School performance is also typically impaired, requiring special education services. CONCLUSIONS Thus, the discrete BOI of pediatric narcolepsy underscores the need for prompt and accurate diagnosis, and appropriate treatment of this disorder.
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Affiliation(s)
- Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Heather M Clawges
- Department of Pediatrics, Sleep Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, WestVirginia
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, Massachusetts
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Cardiac Sympathetic Activity differentiates Idiopathic and Symptomatic Rapid Eye Movement Sleep Behaviour Disorder. Sci Rep 2018; 8:7304. [PMID: 29740055 PMCID: PMC5940783 DOI: 10.1038/s41598-018-25547-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/03/2018] [Indexed: 12/20/2022] Open
Abstract
The pathophysiology of rapid eye movement sleep behavior disorder (RBD) associated with narcolepsy type 1 (NT1) is still poorly understood, potentially distinct from idiopathic RBD (iRBD), but may share affected common pathways. We investigated whether MIBG cardiac uptake differs between iRBD and NT1 comorbid with RBD. Thirty-four patients with NT1-RBD and 15 patients with iRBD underwent MIBG cardiac scintigraphy. MIBG uptake was measured by calculating the early and delayed heart to mediastinum (H/M) ratios. A delayed H/M ratio lower than 1.46 was considered abnormal based on a population of 78 subjects without neurological or cardiac diseases. Patients with iRBD were older, had an older RBD onset age and higher REM sleep phasic and tonic muscular activities than NT1-RBD. Lower delayed and early H/M ratios were associated with iRBD, but not with NT1-RBD, in crude and adjusted associations. The delayed H/M ratio differed between iRBD and controls, after adjustment, but not between patients with NT1-RBD and controls. In conclusion, the MIBG cardiac uptake difference between NT1-RBD and iRBD supports the hypothesis of different processes involved in RBD pathogenesis, providing for the first time a cardiac biomarker to differentiate those disorders.
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Antelmi E, Plazzi G, Pizza F, Vandi S, Aricò D, Ferri R. Impact of acute administration of sodium oxybate on heart rate variability in children with type 1 narcolepsy. Sleep Med 2018; 47:1-6. [PMID: 29880141 DOI: 10.1016/j.sleep.2018.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Currently, cardiovascular measurements in children affected with type 1 narcolepsy (NT1) have never been investigated, and neither have their modulation by the administration of sodium oxybate (SO). METHODS Twelve drug-naïve NT1 children (four males, eight females) with a mean age of 11 ± 3.16 years underwent a nocturnal polysomnography, at baseline and during the first night of SO administration. Data were contrasted with those recorded in 23 age-matched healthy controls. Heart rate variability (HRV) analysis was performed by analyzing the electrocardiogram signal for automatic detection of R waves with a computer program calculating a series of standard time-domain measures and obtaining spectral parameters, by means of a Fast-Fourier Transform. RESULTS In sleep stages N2 and N3, NT1 children showed increased power in the low-frequency (LF) and very-LF (VLF) ranges, when compared to controls. In addition, HRV (as measured by time domain parameters) during all sleep stages tended to be slightly higher in patients when compared to controls. Treatment with SO did not change significantly any parameter, but an overall trend to mildly decreased HRV that reached a significant value only during R sleep. CONCLUSIONS HRV during all sleep stages tended to be slightly higher in young patients when compared to controls, confirming the presence of a slight sympathovagal system imbalance even in NT1 children. SO tends to decrease these values especially during REM sleep and in that regard, further studies supporting these preliminary findings and considering the long-term effects of SO on heart rate parameters are warranted.
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Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Debora Aricò
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute IRCCS, Troina, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute IRCCS, Troina, Italy
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49
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Bin-Hasan S, Videnovic A, Maski K. Nocturnal REM Sleep Without Atonia Is a Diagnostic Biomarker of Pediatric Narcolepsy. J Clin Sleep Med 2018; 14:245-252. [PMID: 29351827 DOI: 10.5664/jcsm.6944] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/17/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Compare nocturnal REM sleep without atonia (nRWA) and REM sleep behavior disorder (RBD) between pediatric patients with and without narcolepsy and determine if the nRWA index is a valid diagnostic biomarker for narcolepsy. METHODS Retrospective cohort study of children ages 6 to 18 years who completed a nocturnal polysomnogram (PSG) and Multiple Sleep Latency Test (MSLT). Our study sample included 11 patients with narcolepsy type 1 (NT1), 6 with narcolepsy type 2 (NT2), 12 with idiopathic hypersomnia (IH), and 11 with subjective hypersomnia (sHS). We compared group nRWA indices (epochs of RWA/total stage R sleep epochs) from the nocturnal PSGs and analyzed nRWA index receiver operating curve (ROC) statistics for narcolepsy diagnosis. RESULTS The median nRWA index of patients with NT1 was 15 to 30 times higher compared to sHS and IH (Ps < .005) but similar to that of the NT2 group (P = .46). RBD was present in 25% of patients with narcolepsy (NT1 and NT2). In comparing those with and without narcolepsy, the nRWA index area under the curve was 0.87 (0.6), 95% confidence interval (CI) = 0.75 to 0.99, P < .001. The threshold of having ≥ 1% of stage R sleep epochs with nRWA yielded a sensitivity of 88.2%, 95% CI = 63.6-98.5 and specificity of 60.9%, 95% CI = 38.5 to 80.3 for diagnosis of narcolepsy. In contrast, a threshold of ≥ 8% yielded a specificity of 95.7%, 95% CI = 78.1 to 99.9 and sensitivity of 52.9%, 95% CI = 27.8 to 77. CONCLUSIONS The nRWA index is a very good diagnostic biomarker of pediatric narcolepsy. Depending on the clinical cutoffs utilized, this biomarker can identify more children/adolescents with narcolepsy using just the PSG or reduce false-positive diagnostic results.
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Affiliation(s)
- Saadoun Bin-Hasan
- University of Toronto, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aleksandar Videnovic
- Harvard Medical School, Boston, Massachusetts.,Movement Disorders Unit and Division of Sleep Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kiran Maski
- Harvard Medical School, Boston, Massachusetts.,Boston Children's Hospital, Boston, Massachusetts
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Gundrum K, Chelimsky TC, Norins NA, Simpson P, Nugent M, Chelimsky G. Pediatric sleep and autonomic complaints. SAGE Open Med 2017; 5:2050312117740295. [PMID: 29163944 PMCID: PMC5692136 DOI: 10.1177/2050312117740295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/04/2017] [Indexed: 11/27/2022] Open
Abstract
Objectives: Little is known about the relationship between autonomic dysfunction and sleep disturbances. This study aimed to identify patterns of sleep disturbances and autonomic dysfunction in children. Methods: A retrospective chart review of 14 children who underwent sleep and autonomic testing was performed. Subjects were divided into three groups based on sudomotor Composite Autonomic Severity Score Scale score and postural tachycardia syndrome criteria. Sleep quality, sleep architecture, and number of comorbidities were analyzed. Results: There were no statistically significant differences between groups in measures of sleep quality, sleep architecture, and number of comorbidities. Conclusion: Patients with postural tachycardia syndrome and autonomic dysfunction experience multiple sleep-related complaints. The low power of our study did not allow firm conclusions, but there is no pattern to these abnormalities.
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Affiliation(s)
| | | | - Nan A Norins
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Gisela Chelimsky
- Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Pediatric Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA
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