1
|
Chin WC, Huang YS, Trevor Lam NY, Mak KY, Tang I, Wang CH, Lin C. Effects of modafinil on nocturnal sleep patterns in patients with narcolepsy: A cohort study. Sleep Med 2024; 119:95-102. [PMID: 38669836 DOI: 10.1016/j.sleep.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Patients with narcolepsy often experience disturbed nighttime sleep. Modafinil is commonly prescribed for hypersomnolence, but its impacts on nocturnal sleep remain unclear. This study uses actigraphy to examine the effect of modafinil on both hypersomnolence and nocturnal sleep patterns in patients with narcolepsy. METHODS Prior to treatment, 87 patients with narcolepsy wore an actigraphy for 7-14 days to assess their nighttime sleep. After evaluation, they received a daily dose of 200-400 mg of modafinil in the morning and wore an actigraphy again six months after initiating treatment. Questionnaires, including the Epworth-Sleepiness-Scale (ESS), the Visual-Analogue-for-Hypersomnolence (VAS), and the Short-Form-36-Health-Survey (SF-36), were used to evaluate hypersomnolence and quality of life both before and after treatment. Paired t-tests and independent samples t-tests were used for pre- and post-treatment comparisons and subgroup analysis. We used the Pearson's correlation test to measure the correlations between the sleep parameters of the actigraphy and data of the questionnaires. RESULTS Improvements in hypersomnolence were noted following modafinil treatment, and we observed no significant deterioration in nocturnal sleep parameters by the actigraphy. The total number of awakenings by actigraphy significantly decreased (p = 0.005), especially in females (p = 0.008), while sleep onset latency significantly increased in children/adolescents (p = 0.014). Correlations were found between the sleep parameters of the actigraphy and ESS, VAS, and SF-36 scores. CONCLUSION Modafinil treatment may not worsen nighttime sleep in patients with narcolepsy. However, it should be administered with care in children and adolescents.
Collapse
Affiliation(s)
- Wei-Chih Chin
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; College of Life Sciences and Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Shu Huang
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ngo Yan Trevor Lam
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Yu Mak
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - I Tang
- Division of Psychiatry and Sleep Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Huan Wang
- Department of Psychology, Zhejiang Normal University, Jinhua, China
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| |
Collapse
|
2
|
Dong P, Dai W, Su M, Wang S, Ma Y, Zhao T, Zheng F, Sun P. The potential role of the orexin system in premenstrual syndrome. Front Endocrinol (Lausanne) 2024; 14:1266806. [PMID: 38292774 PMCID: PMC10824941 DOI: 10.3389/fendo.2023.1266806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Premenstrual syndrome (PMS) occurs recurrently during the luteal phase of a woman's menstrual cycle and disappears after menstruation ends. It is characterized by abnormal changes in both the body and mood, and in certain cases, severe disruptions in daily life and even suicidal tendencies. Current drugs for treating PMS, such as selective serotonin reuptake inhibitors, do not yield satisfactory results. Orexin, a neuropeptide produced in the lateral hypothalamus, is garnering attention in the treatment of neurological disorders and is believed to modulate the symptoms of PMS. This paper reviews the advancements in research on sleep disturbances, mood changes, and cognitive impairment caused by PMS, and suggests potential pathways for orexin to address these symptoms. Furthermore, it delves into the role of orexin in the molecular mechanisms underlying PMS. Orexin regulates steroid hormones, and the cyclic fluctuations of estrogen and progesterone play a crucial role in the pathogenesis of PMS. Additionally, orexin also modulates the gamma-aminobutyric acid (GABA) system and the inflammatory response involved in coordinating the mechanism of PMS. Unraveling the role of orexin in the pathogenesis of PMS will not only aid in understanding the etiology of PMS but also hold implications for orexin as a novel target for treating PMS.
Collapse
Affiliation(s)
- Ping Dong
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Weibo Dai
- Department of Pharmacy, Zhongshan Hospital of Traditional Chinese Medicine, Zhong Shan, China
| | - Mengyue Su
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shukun Wang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuexiang Ma
- School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tingting Zhao
- College of Foreign Languages, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Feng Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Peng Sun
- Innovation Research Institute of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| |
Collapse
|
3
|
Kolmos MG, Arribas AP, Kornum BR, Justinussen JL. Experimental sickness reduces hypocretin receptor 1 expression in the lateral hypothalamus and ventral tegmental area of female mice. Eur J Neurosci 2023; 58:4002-4010. [PMID: 37818927 DOI: 10.1111/ejn.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
Recent studies have focused on how sickness behaviours, including lethargy, are coordinated in the brain in response to peripheral infections. Decreased hypocretin (orexin) signalling is associated with lethargy and previous research suggests that hypocretin signalling is downregulated during sickness. However, there are studies that find increases or no change in hypocretin signalling during sickness. It is further unknown whether hypocretin receptor expression changes during sickness. Using lipopolysaccharide (LPS) to induce sickness in female mice, we investigated how LPS-injection affects gene expression of hypocretin receptors and prepro-hypocretin as well as hypocretin-1 peptide concentrations in brain tissue. We found that hypocretin receptor 1 gene expression was downregulated during sickness in the lateral hypothalamus and ventral tegmental area, but not in the dorsal raphe nucleus or locus coeruleus. We found no changes in hypocretin receptor 2 expression. Using a gene expression calculation that accounts for primer efficiencies and multiple endogenous controls, we were unable to detect changes in prepro-hypocretin expression. Using radioimmunoassay, we found no change in hypocretin-1 peptide in rostral brain tissue. Our results indicate that hypocretin receptor expression can fluctuate during sickness, adding an additional level of complexity to understanding hypocretin signalling during sickness.
Collapse
Affiliation(s)
- Mie Gunni Kolmos
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alba Pérez Arribas
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Rahbek Kornum
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Lauren Justinussen
- Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Abe T. PERCLOS-based technologies for detecting drowsiness: current evidence and future directions. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad006. [PMID: 37193281 PMCID: PMC10108649 DOI: 10.1093/sleepadvances/zpad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/17/2023] [Indexed: 05/18/2023]
Abstract
Drowsiness associated with sleep loss and circadian misalignment is a risk factor for accidents and human error. The percentage of time that the eyes are more than 80% closed (PERCLOS) is one of the most validated indices used for the passive detection of drowsiness, which is increased with sleep deprivation, after partial sleep restriction, at nighttime, and by other drowsiness manipulations during vigilance tests, simulated driving, and on-road driving. However, some cases have been reported wherein PERCLOS was not affected by drowsiness manipulations, such as in moderate drowsiness conditions, in older adults, and during aviation-related tasks. Additionally, although PERCLOS is one of the most sensitive indices for detecting drowsiness-related performance impairments during the psychomotor vigilance test or behavioral maintenance of wakefulness test, no single index is currently available as an optimal marker for detecting drowsiness during driving or other real-world situations. Based on the current published evidence, this narrative review suggests that future studies should focus on: (1) standardization to minimize differences in the definition of PERCLOS between studies; (2) extensive validation using a single device that utilizes PERCLOS-based technology; (3) development and validation of technologies that integrate PERCLOS with other behavioral and/or physiological indices, because PERCLOS alone may not be sufficiently sensitive for detecting drowsiness caused by factors other than falling asleep, such as inattention or distraction; and (4) further validation studies and field trials targeting sleep disorders and trials in real-world environments. Through such studies, PERCLOS-based technology may contribute to preventing drowsiness-related accidents and human error.
Collapse
Affiliation(s)
- Takashi Abe
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| |
Collapse
|
5
|
Repeated measures of hypocretin-1 in Danish and Italian patients with narcolepsy and in controls. Sleep Med 2023; 101:213-220. [PMID: 36427467 DOI: 10.1016/j.sleep.2022.10.004] [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: 02/09/2022] [Revised: 09/15/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVES The assay currently used worldwide to measure cerebrospinal fluid hypocretin-1 (CSF-hcrt-1) for diagnosing narcolepsy uses a competitive radioimmunoassay with polyclonal anti-hcrt-1 antibodies. This assay detects multiple hypocretin-1 immunoreactive species in the CSF that are all derived from full-length hcrt-1. We aimed to revalidate CSF-hcrt-1 cut-offs for narcolepsy type 1 (NT1) diagnosis and to evaluate temporal changes in CSF-hcrt-1 levels in patients suspected of having central hypersomnia. METHOD We carried out a repeat lumbar puncture with a mean follow-up of 4.0 years, to measure CSF-hcrt-1 in patients suspected of having central hypersomnia in a follow-up study. Data from CSF samples of patients with NT1 and of controls without known hypersomnia, from the Italian-Stanford and Danish populations, were examined using a receiver-operating characteristic analysis. RESULTS The optimal CSF-hcrt-1 cut-offs for identifying NT1 were 129 pg/ml and 179 pg/ml for the Italian-Stanford and Danish populations, respectively. The sensitivity was 0.93-0.99 and the specificity was 1. Follow-up lumbar puncture measurements of CSF-hcrt-1 were obtained from 73 patients. 30 of 32 patients with low CSF-hcrt-1 levels continued to be categorized as low, with an unaltered diagnosis; two patients showed a marked increase in CSF-hcrt-1, attaining normal values at follow-up. One of these patients relapsed to low CSF-hcrt-1 after follow-up. All 41 patients with normal CSF-hcrt-1 at baseline had normal CSF-hcrt-1 at follow-up. CONCLUSION CSF-hcrt-1 measurement can provide an accurate test for diagnosing NT1, although it is important to validate the CSF-hcrt-1 cut-off for specific testing locations. Stable CSF-hcrt-1 levels support the already established prognosis of narcolepsy as permanent once the disorder has fully developed.
Collapse
|
6
|
Postiglione E, Barateau L, Pizza F, Lopez R, Antelmi E, Rassu AL, Vandi S, Chenini S, Mignot E, Dauvilliers Y, Plazzi G. Narcolepsy with intermediate cerebrospinal level of hypocretin-1. Sleep 2021; 45:6460454. [PMID: 34902030 DOI: 10.1093/sleep/zsab285] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To describe the phenotype of narcolepsy with intermediate cerebrospinal hypocretin-1 levels (CSF hcrt-1). METHODS From 1600 consecutive patients with narcolepsy from Bologna and Montpellier sleep centers we selected patients with intermediate CSF hcrt-1 levels (110-200 pg/ml). Clinical, neurophysiological and biological data were contrasted for the presence of cataplexy, HLA-DQB1*06:02, and median CSF hcrt-1 levels (149.34 pg/mL). RESULTS Forty-five (55% males, aged 35 ± 17 years) patients (2.8% of all cases) were included. Thirty-three (73%) were HLA-DQB1*06:02, 29 (64%) reported cataplexy (21, 72.4% with typical features), and 5 (11%) had presumed secondary etiology. Cataplexy was associated with other core narcolepsy symptoms, increased sleep onset REM periods, and nocturnal sleep disruption. Cataplexy and irrepressible daytime sleep were more frequent in HLA DQB1*06:02 positive patients. Lower CSF hcrt-1 levels were associated with hallucinations. CONCLUSION Narcolepsy with intermediate CSF hcrt-1 level is a rare condition with heterogeneous phenotype. HLA DQB1*06:02 and lower CSF hcrt-1 were associated with typical narcolepsy features, calling for future research to distinguish incomplete from secondary narcolepsy forms.
Collapse
Affiliation(s)
- Emanuela Postiglione
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,National Reference Network for Narcolepsy, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,Institute for Neurosciences of Montpellier INM, INSERM, University of 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
| | - Régis Lopez
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,National Reference Network for Narcolepsy, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, France
| | - Elena Antelmi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anna-Laura Rassu
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sofiene Chenini
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,National Reference Network for Narcolepsy, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Stanford University Medical School, Palo Alto, California
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,National Reference Network for Narcolepsy, Gui-de-Chauliac Hospital, University Hospital Center, Montpellier, France.,Institute for Neurosciences of Montpellier INM, INSERM, University of Montpellier, France
| | - 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
| |
Collapse
|
7
|
Song J, Kim TW, Kim SM, Um YH, Jeong JH, Seo HJ, Oh JH, Hong SC. Nocturnal Sleep Onset Rapid Eye Movement Sleep Periods as a Predictor of the Severity of Narcolepsy in Korea. SLEEP MEDICINE RESEARCH 2020. [DOI: 10.17241/smr.2019.00444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Narcolepsy — clinical spectrum, aetiopathophysiology, diagnosis and treatment. Nat Rev Neurol 2019; 15:519-539. [DOI: 10.1038/s41582-019-0226-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 12/15/2022]
|
9
|
Abstract
The measurement of daytime sleepiness is important in the evaluation of patients with excessive sleepiness. The multiple sleep latency test (MSLT) is an objective test that measures the tendency to fall asleep under controlled conditions. It is based on the notion that sleep latency reflects underlying physiological sleepiness. The MSLT consists of four to five naps given 2h apart during the day, following a standardized procedure. The mean sleep latency from all naps is used as the measure of sleepiness. The test has been shown to be valid and reliable and is part of the diagnostic criteria for narcolepsy and idiopathic hypersomnia. However, the MSLT is affected by numerous variables including insufficient sleep, drugs, activity, and arousal level. Adherence to the established protocol is necessary to limit the effect of these extraneous factors on the MSLT. While the test is a valuable and widely used diagnostic tool for narcolepsy and idiopathic hypersomnia, the use of MSLT in other sleep disorders is not well established.
Collapse
Affiliation(s)
- Donna L Arand
- Kettering Medical Center and Wright State University Boonshoft School of Medicine, Dayton, OH, United States.
| | - Michael H Bonnet
- Kettering Medical Center and Wright State University Boonshoft School of Medicine, Dayton, OH, United States
| |
Collapse
|
10
|
Sturzenegger C, Baumann CR, Lammers GJ, Kallweit U, van der Zande WLM, Bassetti CL. Swiss Narcolepsy Scale. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2018. [DOI: 10.1177/2514183x18794175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Gerd J Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Sleep Wake Center SEIN Heemstede, Heemstede, The Netherlands
| | - Ulf Kallweit
- Department of Neurology, Bern University Hospital, Switzerland
| | | | - Claudio L Bassetti
- Department of Neurology, University Hospital, Zurich, Switzerland
- Department of Neurology, Bern University Hospital, Switzerland
| |
Collapse
|
11
|
Büchele F, Baumann CR, Poryazova R, Werth E, Valko PO. Remitting narcolepsy? Longitudinal observations in a hypocretin-deficient cohort. Sleep 2018; 41:5032742. [PMID: 29868885 DOI: 10.1093/sleep/zsy118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabian Büchele
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Elliott JE, De Luche SE, Churchill MJ, Moore C, Cohen AS, Meshul CK, Lim MM. Dietary therapy restores glutamatergic input to orexin/hypocretin neurons after traumatic brain injury in mice. Sleep 2018; 41:4791165. [PMID: 29315422 PMCID: PMC6454530 DOI: 10.1093/sleep/zsx212] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2017] [Indexed: 02/06/2023] Open
Abstract
Study Objectives In previous work, dietary branched-chain amino acid (BCAA) supplementation, precursors to de novo glutamate and γ-aminobutyric acid (GABA) synthesis, restored impaired sleep-wake regulation and orexin neuronal activity following traumatic brain injury (TBI) in mice. TBI was speculated to reduce orexin neuronal activity through decreased regional excitatory (glutamate) and/or increased inhibitory (GABA) input. Therefore, we hypothesized that TBI would decrease synaptic glutamate and/or increase synaptic GABA in nerve terminals contacting orexin neurons, and BCAA supplementation would restore TBI-induced changes in synaptic glutamate and/or GABA. Methods Brain tissue was processed for orexin pre-embed diaminobenzidine labeling and glutamate or GABA postembed immunogold labeling. The density of glutamate and GABA immunogold within presynaptic nerve terminals contacting orexin-positive lateral hypothalamic neurons was quantified using electron microscopy in three groups of mice (n = 8 per group): Sham/noninjured controls, TBI without BCAA supplementation, and TBI with BCAA supplementation (given for 5 days, 48 hr post-TBI). Glutamate and GABA were also quantified within the cortical penumbral region (layer VIb) adjacent to the TBI lesion. Results In the hypothalamus and cortex, TBI decreased relative glutamate density in presynaptic terminals making axodendritic contacts. However, BCAA supplementation only restored relative glutamate density within presynaptic terminals contacting orexin-positive hypothalamic neurons. BCAA supplementation did not change relative glutamate density in presynaptic terminals making axosomatic contacts, or relative GABA density in presynaptic terminals making axosomatic or axodendritic contacts, within either the hypothalamus or cortex. Conclusions These results suggest TBI compromises orexin neuron function via decreased glutamate density and highlight BCAA supplementation as a potential therapy to restore glutamate density to orexin neurons.
Collapse
Affiliation(s)
- Jonathan E Elliott
- VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health and Science University, Portland, OR
| | | | | | - Cindy Moore
- VA Portland Health Care System, Portland, OR
| | - Akiva S Cohen
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology, Joseph Stokes Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Charles K Meshul
- VA Portland Health Care System, Portland, OR
- Department of Behavioral Neuroscience and Pathology, Oregon Health and Science University, Portland, OR
| | - Miranda M Lim
- VA Portland Health Care System, Portland, OR
- Department of Neurology, Oregon Health and Science University, Portland, OR
- Department of Medicine and Behavioral Neuroscience, Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR
| |
Collapse
|
13
|
Taddei RN, Werth E, Poryazova R, Baumann CR, Valko PO. Diagnostic delay in narcolepsy type 1: combining the patients' and the doctors' perspectives. J Sleep Res 2016; 25:709-715. [DOI: 10.1111/jsr.12420] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/25/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Raquel N. Taddei
- Department of Neurology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Esther Werth
- Department of Neurology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Rositsa Poryazova
- Department of Neurology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Christian R. Baumann
- Department of Neurology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Philipp O. Valko
- Department of Neurology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| |
Collapse
|
14
|
Sarkanen T, Alakuijala A, Partinen M. Clinical course of H1N1-vaccine-related narcolepsy. Sleep Med 2016; 19:17-22. [DOI: 10.1016/j.sleep.2015.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/16/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
|
15
|
Vyazovskiy VV, Delogu A. NREM and REM Sleep: Complementary Roles in Recovery after Wakefulness. Neuroscientist 2014; 20:203-19. [PMID: 24598308 DOI: 10.1177/1073858413518152] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The overall function of sleep is hypothesized to provide "recovery" after preceding waking activities, thereby ensuring optimal functioning during subsequent wakefulness. However, the functional significance of the temporal dynamics of sleep, manifested in the slow homeostatic process and the alternation between non-rapid eye movement (NREM) and REM sleep remains unclear. We propose that NREM and REM sleep have distinct and complementary contributions to the overall function of sleep. Specifically, we suggest that cortical slow oscillations, occurring within specific functionally interconnected neuronal networks during NREM sleep, enable information processing, synaptic plasticity, and prophylactic cellular maintenance ("recovery process"). In turn, periodic excursions into an activated brain state-REM sleep-appear to be ideally placed to perform "selection" of brain networks, which have benefited from the process of "recovery," based on their offline performance. Such two-stage modus operandi of the sleep process would ensure that its functions are fulfilled according to the current need and in the shortest time possible. Our hypothesis accounts for the overall architecture of normal sleep and opens up new perspectives for understanding pathological conditions associated with abnormal sleep patterns.
Collapse
Affiliation(s)
| | - Alessio Delogu
- Department of Neuroscience, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
16
|
Andlauer O, Moore H, Jouhier L, Drake C, Peppard PE, Han F, Hong SC, Poli F, Plazzi G, O'Hara R, Haffen E, Roth T, Young T, Mignot E. Nocturnal rapid eye movement sleep latency for identifying patients with narcolepsy/hypocretin deficiency. JAMA Neurol 2013; 70:891-902. [PMID: 23649748 DOI: 10.1001/jamaneurol.2013.1589] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Narcolepsy, a disorder associated with HLA-DQB1*06:02 and caused by hypocretin (orexin) deficiency, is diagnosed using the Multiple Sleep Latency Test (MSLT) following nocturnal polysomnography (NPSG). In many patients, a short rapid eye movement sleep latency (REML) during the NPSG is also observed but not used diagnostically. OBJECTIVE To determine diagnostic accuracy and clinical utility of nocturnal REML measures in narcolepsy/hypocretin deficiency. DESIGN, SETTING, AND PARTICIPANTS Observational study using receiver operating characteristic curves for NPSG REML and MSLT findings (sleep studies performed between May 1976 and September 2011 at university medical centers in the United States, China, Korea, and Europe) to determine optimal diagnostic cutoffs for narcolepsy/hypocretin deficiency compared with different samples: controls, patients with other sleep disorders, patients with other hypersomnias, and patients with narcolepsy with normal hypocretin levels. Increasingly stringent comparisons were made. In a first comparison, 516 age- and sex-matched patients with narcolepsy/hypocretin deficiency were selected from 1749 patients and compared with 516 controls. In a second comparison, 749 successive patients undergoing sleep evaluation for any sleep disorders (low pretest probability for narcolepsy) were compared within groups by final diagnosis of narcolepsy/hypocretin deficiency. In the third comparison, 254 patients with a high pretest probability of having narcolepsy were compared within group by their final diagnosis. Finally, 118 patients with narcolepsy/hypocretin deficiency were compared with 118 age- and sex-matched patients with a diagnosis of narcolepsy but with normal hypocretin levels. MAIN OUTCOME AND MEASURES Sensitivity and specificity of NPSG REML and MSLT as diagnostic tests for narcolepsy/hypocretin deficiency. This diagnosis was defined as narcolepsy associated with cataplexy plus HLA-DQB1*06:02 positivity (no cerebrospinal fluid hypocretin-1 results available) or narcolepsy with documented low (≤ 110 pg/mL) cerebrospinal fluid hypocretin-1 level. RESULTS Short REML (≤15 minutes) during NPSG was highly specific (99.2% [95% CI, 98.5%-100.0%] of 516 and 99.6% [95% CI, 99.1%-100.0%] of 735) but not sensitive (50.6% [95% CI, 46.3%-54.9%] of 516 and 35.7% [95% CI, 10.6%-60.8%] of 14) for patients with narcolepsy/hypocretin deficiency vs population-based controls or all patients with sleep disorders undergoing a nocturnal sleep study (area under the curve, 0.799 [95% CI, 0.771-0.826] and 0.704 [95% CI, 0.524-0.907], respectively). In patients with central hypersomnia and thus a high pretest probability for narcolepsy, short REML remained highly specific (95.4% [95% CI, 90.4%-98.3%] of 132) and similarly sensitive (57.4% [95% CI, 48.1%-66.3%] of 122) for narcolepsy/hypocretin deficiency (area under the curve, 0.765 [95% CI, 0.707-0.831]). Positive predictive value in this high pretest probability sample was 92.1% (95% CI, 83.6%-97.0%). CONCLUSIONS AND RELEVANCE Among patients being evaluated for possible narcolepsy, short REML (≤15 minutes) at NPSG had high specificity and positive predictive value and may be considered diagnostic without the use of an MSLT; absence of short REML, however, requires a subsequent MSLT.
Collapse
Affiliation(s)
- Olivier Andlauer
- Center for Sleep Sciences and Medicine and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Various brain imaging techniques have been used to study narcolepsy with cataplexy. Anatomical data with magnetic resonance imaging have characterized specific alterations in grey and white matter and their potential implications on disease severity. Functional neuroimaging studies have described changes in brain perfusion or glucose metabolism during resting wakefulness, as well as brain responses to emotional stimulation in narcoleptic patients. These different imaging modalities provide evidence for structural and functional abnormalities compatible with a deficit in the hypocretinergic system. They also indicate the involvement of other neural structures, such as the amygdala, nucleus accumbens, midbrain, thalamus, hippocampus, and fronto-temporal cortical areas. This article reviews the contribution of neuroimaging to the pathophysiology of narcolepsy with cataplexy, focusing on the most recent developments.
Collapse
Affiliation(s)
- Thien Thanh Dang-Vu
- Department of Exercise Science, Concordia University, 7141 Sherbrooke St W, Room SP 165.27, Montréal, Québec, H4B 1R6, Canada.
| |
Collapse
|
18
|
Çoban A, Bilgiç B, Lohmann E, Küçükali Cİ, Benbir G, Karadeniz D, Hanagasi HA, Tüzün E, Gürvit H. Reduced orexin-A levels in frontotemporal dementia: possible association with sleep disturbance. Am J Alzheimers Dis Other Demen 2013; 28:606-11. [PMID: 23813609 PMCID: PMC10852656 DOI: 10.1177/1533317513494453] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances including excessive daytime sleepiness (EDS) are encountered in frontotemporal dementia (FTD). To investigate the relationship between the plasma orexin-A levels and sleep disturbance patterns, we measured the plasma orexin-A levels and performed sleep studies in patients with FTD. The orexin-A levels were measured in 10 consecutive patients with FTD and controls by enzyme-linked immunosorbent assay. Nocturnal polysomnography (PSG) and Multiple Sleep Latency Test (MSLT) were performed in 2 patients with FTD. The orexin-A levels were significantly lower in patients with FTD compared to controls. The PSG revealed increased rapid eye movement (REM) latency in patients, whether or not they reported EDS. Mean sleep latency in MSLT was less than 10 minutes in both the patients, being shorter in patient without EDS, but none of them had REM sleep onset. Some patients with FTD may develop narcolepsy-like involuntary sleep attacks, even without complaining of EDS. Involvement of hypothalamus and a subsequent alteration in the orexin levels might be one of the determining factors in this sleep disturbance.
Collapse
Affiliation(s)
- Arzu Çoban
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Machaalani R, Hunt NJ, Waters KA. Effects of changes in energy homeostasis and exposure of noxious insults on the expression of orexin (hypocretin) and its receptors in the brain. Brain Res 2013; 1526:102-22. [PMID: 23830852 DOI: 10.1016/j.brainres.2013.06.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 12/23/2022]
Abstract
This review summarizes data regarding the brain expression of the orexin (hypocretin) system including: prepro-orexin (PPO), orexin A (OxA), orexin B (OxB) and the two orexin receptors 1 and 2 (OxR1, OxR2). Clinical data is limited to OxA and OxB in cerebral spinal fluid and serum/plasma, thus necessitating the development of animal models to undertake mechanistic studies. We focus on changes in animal models that were either exposed to a regime of altered sleep, metabolic energy homeostasis, exposed to drugs and noxious insults. Many more expressional studies are available for PPO, OxA and OxB levels, compared to studies of the receptors. Interestingly, the direction and pattern of change for PPO, OxA and OxB is inconsistent amongst studies, whereas for the receptors, there tends to be increased expression for both OxR1 and OxR2 after alterations in energy homeostasis, and an increased expression after noxious insults or exposure to some drugs. The clinical implications of these results from animal models are discussed in light of the findings from human studies, and future research directions are suggested to fill knowledge gaps with regard to the orexin system, particularly during early brain development.
Collapse
Affiliation(s)
- Rita Machaalani
- Department of Medicine, Blackburn Building, DO6, University of Sydney, NSW 2006, Australia.
| | | | | |
Collapse
|
20
|
Dauvilliers Y, Delallée N, Jaussent I, Scholz S, Bayard S, Croyal M, Schwartz JC, Robert P. Normal cerebrospinal fluid histamine and tele-methylhistamine levels in hypersomnia conditions. Sleep 2012; 35:1359-66. [PMID: 23024434 DOI: 10.5665/sleep.2114] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To determine the activity of cerebral histaminergic system evaluated by CSF levels of histamine (HA) and tele-methylhistamine (t-MHA), its major metabolite, and their relationships with hypocretin-1 levels in a large population of patients with hypersomnia and neurological conditions. DESIGN sensitive liquid chromatographic-electrospray/tandem mass spectrometric assay was developed for the simultaneous quantification of CSF HA and t-MHA. SETTING ata were collected and CSF hypocretin-1 levels were measured using radioimmunoassay at the Sleep Disorders Center, Montpellier, France. CSF HA and t-MHA were measured in Bioprojet-Biotech, France PARTICIPANTS One hundred fourteen unrelated patients with a suspicion of central hypersomnia underwent one night of polysomnography followed by the multiple sleep latency test. Sleep disorders were diagnosed clinically and using sleep studies: narcolepsy-cataplexy NC (n = 56), narcolepsy without cataplexy NwC (n = 27), idiopathic hypersomnia IH (n = 11), secondary narcolepsy (n = 3), and unspecified hypersomnia Uns EDS (n = 17). Fifty neurological patients without daytime sleepiness were included as controls. MEASUREMENTS AND RESULTS No between-hypersomnia group differences were found for CSF HA levels (median 708.62 pM extreme range [55.92-3335.50] in NC; 781.34 [174.08-4391.50] in NwC; 489.42 [177.45-906.70] in IH, and 1155.40 [134.80-2736.59] in Uns EDS) or for t-MHA levels. No association was found between CSF HA, t-MHA, or HA + t-MHA, sleepiness, treatment intake, and frequency of cataplexy. A slight negative correlation was found between age and HA levels. Further adjustment for the age revealed no significant HA levels difference between hypersomnia patients and controls. CONCLUSION CSF histamine and tele-methylhistamine did not significantly differ between patients with narcolepsy-cataplexy and other etiologies of non-hypocretin-1 deficient central hypersomnias; these measurements, therefore, are not useful in assessing the etiology or severity of centrally mediated hypersomnia.
Collapse
Affiliation(s)
- Yves Dauvilliers
- Sleep Unit, Department of Neurology, Gui de Chauliac Hospital, CHU Montpellier, National Reference Network for Orphan Diseases-Narcolepsy, Hypersomnia, Kleine-Levin Syndrome, France.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Andlauer O, Moore H, Hong SC, Dauvilliers Y, Kanbayashi T, Nishino S, Han F, Silber MH, Rico T, Einen M, Kornum BR, Jennum P, Knudsen S, Nevsimalova S, Poli F, Plazzi G, Mignot E. Predictors of hypocretin (orexin) deficiency in narcolepsy without cataplexy. Sleep 2012; 35:1247-55F. [PMID: 22942503 DOI: 10.5665/sleep.2080] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To compare clinical, electrophysiologic, and biologic data in narcolepsy without cataplexy with low (≤ 110 pg/ml), intermediate (110-200 pg/ml), and normal (> 200 pg/ml) concentrations of cerebrospinal fluid (CSF) hypocretin-1. SETTING University-based sleep clinics and laboratories. PATIENTS Narcolepsy without cataplexy (n = 171) and control patients (n = 170), all with available CSF hypocretin-1. DESIGN AND INTERVENTIONS Retrospective comparison and receiver operating characteristics curve analysis. Patients were also recontacted to evaluate if they developed cataplexy by survival curve analysis. MEASUREMENTS AND RESULTS The optimal cutoff of CSF hypocretin-1 for narcolepsy without cataplexy diagnosis was 200 pg/ml rather than 110 pg/ml (sensitivity 33%, specificity 99%). Forty-one patients (24%), all HLA DQB1*06:02 positive, had low concentrations (≤ 110 pg/ml) of CSF hypocretin-1. Patients with low concentrations of hypocretin-1 only differed subjectively from other groups by a higher Epworth Sleepiness Scale score and more frequent sleep paralysis. Compared with patients with normal hypocretin-1 concentration (n = 117, 68%), those with low hypocretin-1 concentration had higher HLA DQB1*06:02 frequencies, were more frequently non-Caucasians (notably African Americans), with lower age of onset, and longer duration of illness. They also had more frequently short rapid-eye movement (REM) sleep latency (≤ 15 min) during polysomnography (64% versus 23%), and shorter sleep latencies (2.7 ± 0.3 versus 4.4 ± 0.2 min) and more sleep-onset REM periods (3.6 ± 0.1 versus 2.9 ± 0.1 min) during the Multiple Sleep Latency Test (MSLT). Patients with intermediate concentrations of CSF hypocretin-1 (n = 13, 8%) had intermediate HLA DQB1*06:02 and polysomnography results, suggesting heterogeneity. Of the 127 patients we were able to recontact, survival analysis showed that almost half (48%) with low concentration of CSF hypocretin-1 had developed typical cataplexy at 26 yr after onset, whereas only 2% had done so when CSF hypocretin-1 concentration was normal. Almost all patients (87%) still complained of daytime sleepiness independent of hypocretin status. CONCLUSION Objective (HLA typing, MSLT, and sleep studies) more than subjective (sleepiness and sleep paralysis) features predicted low concentration of CSF hypocretin-1 in patients with narcolepsy without cataplexy.
Collapse
Affiliation(s)
- Olivier Andlauer
- Center for Sleep Sciences and Medicine, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
WIENECKE MIRIAM, WERTH ESTHER, PORYAZOVA ROSITSA, BAUMANN-VOGEL HEIDE, BASSETTI CLAUDIOL, WELLER MICHAEL, WALDVOGEL DANIEL, STORCH ALEXANDER, BAUMANN CHRISTIANR. Progressive dopamine and hypocretin deficiencies in Parkinson’s disease: is there an impact on sleep and wakefulness? J Sleep Res 2012; 21:710-7. [DOI: 10.1111/j.1365-2869.2012.01027.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
23
|
Dang-Vu TT. Structural changes in the narcoleptic brain and their possible relevance for clinical severity. Sleep Med 2012; 13:775-6. [PMID: 22633057 DOI: 10.1016/j.sleep.2012.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
|
24
|
Adeghate E. Orexins: tissue localization, functions, and its relation to insulin secretion and diabetes mellitus. VITAMINS AND HORMONES 2012; 89:111-33. [PMID: 22640611 DOI: 10.1016/b978-0-12-394623-2.00007-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Orexins play a role in many biological functions include sleep, feeding, and energy balance. They also regulate circadian rhythms and the way that we feel pain. Orexins have been identified in a variety of tissues including the cerebrospinal fluid, blood, hypothalamus, spinal cord, sensory ganglion, enteric nervous system, pituitary, adrenal, salivary and lacrimal glands, testis, vestibular gland, and skin. Orexins play a role in a variety of biological functions including arousal, sleeping, food and fluid intake, pain, memory, perception of odor, and sexual activity. Orexins have also been implicated in the regulation of glucose metabolism. The expression of orexin is induced by hypoglycemia, low food, pregnancy, and hemodialysis. In contrast, factors that inhibit the expression of orexins include obstructive sleep apnea, aging, depression, obesity, traumatic brain injury, and inflammatory molecules such as liposaccharide. In conclusion, orexins are widely distributed and involved in a large variety of biological activities.
Collapse
Affiliation(s)
- Ernest Adeghate
- Department of Anatomy, Faculty of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| |
Collapse
|
25
|
Wing YK, Chen L, Lam SP, Li AM, Tang NL, Ng MH, Cheng SH, Ho CK, Mok V, Leung HW, Lau A, Chan MHM, Chan HS, Chan PS. Familial aggregation of narcolepsy. Sleep Med 2011; 12:947-51. [PMID: 22036600 DOI: 10.1016/j.sleep.2011.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/12/2011] [Accepted: 05/04/2011] [Indexed: 10/15/2022]
|
26
|
Melanin concentrating hormone in central hypersomnia. Sleep Med 2011; 12:768-72. [DOI: 10.1016/j.sleep.2011.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 03/15/2011] [Accepted: 04/23/2011] [Indexed: 11/18/2022]
|
27
|
Nakamura M, Kanbayashi T, Sugiura T, Inoue Y. Relationship between clinical characteristics of narcolepsy and CSF orexin-A levels. J Sleep Res 2011; 20:45-9. [PMID: 20642748 DOI: 10.1111/j.1365-2869.2010.00870.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although an abnormally low cerebrospinal fluid (CSF)-orexin level is well known to be a specific finding in narcoleptic patients, the relationships between the severity of the core symptoms of narcolepsy [i.e. daytime sleepiness and increased rapid eye movement (REM) propensity], as well as levels of obesity, and CSF-orexin levels have not been well elucidated. The aim of this study was to examine the relationship between these characteristic symptoms of narcolepsy and CSF-orexin level. Fifty-three patients with narcolepsy with cataplexy (NA/CA) and 17 without cataplexy (NA w/o CA) were enrolled. Sleep latency and sleep onset REM latency were measured using the multiple sleep latency test (MSLT). Multiple linear regression analysis was used to determine factors associated with both mean sleep latency and mean sleep onset REM latency on MSLT, with %body mass index (BMI), gender, onset age, length of excessive daytime sleepiness (EDS) morbidity, diagnostic subgroup and CSF-orexin levels being used as independent variables. The NA/CA group included a significantly higher number of patients with undetectable CSF-orexin levels and shorter sleep onset and rapid eye movement (SOREM) latency, as well as a higher %BMI, versus NA w/o CA. Multiple linear regression analysis revealed that sleep latency was associated significantly with CSF-orexin levels and gender. With regard to sleep onset REM latency and %BMI, only CSF-orexin levels appeared to be a significantly associated factor. In narcoleptic patients, the severity of both excessive daytime sleepiness and increased REM propensity, as well as the level of obesity, could be associated with CSF-orexin deficiency, rather than with subcategories of the disorder.
Collapse
Affiliation(s)
- Masaki Nakamura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | | | | | | |
Collapse
|
28
|
Constantinescu CS, Niepel G, Patterson M, Judd A, Braitch M, Fahey AJ, Harikrishnan S, Edwards LJ, Tench CR, Bennett GW, Ghatei M. Orexin A (hypocretin-1) levels are not reduced while cocaine/amphetamine regulated transcript levels are increased in the cerebrospinal fluid of patients with multiple sclerosis: no correlation with fatigue and sleepiness. J Neurol Sci 2011; 307:127-31. [PMID: 21605873 DOI: 10.1016/j.jns.2011.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 04/21/2011] [Accepted: 04/25/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fatigue and sleep disturbance are common features of multiple sclerosis (MS). Our objectives were to determine cerebrospinal fluid levels of orexin A (hypocretin-1), a hypothalamic peptide involved in sleep, in patients with MS, and correlate them with fatigue, sleepiness, and levels of cocaine and amphetamine regulated transcript (CART) another neuropeptide regulating metabolism with wider nervous system distribution. METHODS Consecutive patients with MS (n=34), other inflammatory (n=24) or non-inflammatory (n=42) neurological diseases, undergoing lumbar puncture were investigated. Orexin and CART were measured by RIA by investigators unaware of the patients' diagnosis. RESULTS Orexin A was slightly decreased in the cerebrospinal fluid of patients with inflammatory disease. There was no evidence of orexin A deficiency in MS, although there was a non-significant trend toward a decrease compared to non-inflammatory neurological diseases (p=0.06). CART levels were increased in MS compared to the non-inflammatory disease group (p=0.03). There were no significant correlations between CSF levels of orexin A and CART, fatigue, and hypersomnolence. CONCLUSIONS Cerebrospinal fluid orexin A is decreased in CNS inflammatory diseases other than MS, where it shows a trend toward reduction, but does not correlate significantly with CART or with measures of fatigue and hypersomnolence.
Collapse
Affiliation(s)
- Cris S Constantinescu
- Division of Clinical Neurology, School of Clinical Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Bassetti CL, Baumann CR, Dauvilliers Y, Croyal M, Robert P, Schwartz JC. Cerebrospinal fluid histamine levels are decreased in patients with narcolepsy and excessive daytime sleepiness of other origin. J Sleep Res 2010; 19:620-3. [PMID: 20846244 DOI: 10.1111/j.1365-2869.2010.00819.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Claudio L Bassetti
- Neurocenter (EOC) of Southern Switzerland, Ospedale Civico, Via Tesserete, Lugano, Switzerland.
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVES In the absence of socio-economical consequences of hypersomnia this study addresses the factual indirect and direct costs. METHODS Two thousand two hundred and eight patients with a hypersomnia diagnosis from 1998 to 2005 were identified in the Danish national patient registry (NPR), each compared with 4 age and gender adjusted, randomly chosen citizens selected from the Civil Registration System Statistics. The health cost was decomposed in direct and indirect yearly costs, including labor supply and social transfer payments. Direct costs included frequencies and costs of discharges and outpatient use by cost weights according to diagnosis related groups and specific outpatient prices based on data from The Danish Ministry of Health. The use of and costs of drugs was based on data from the Danish Medicines Agency. The frequencies and costs from primary sectors were based on data from The National Health Security. Indirect costs were based on income data from the coherent social statistics (CSS). RESULTS Patients with hypersomnia presented significant higher health related contact rate, expenses and medication use. No differences were identified in employment and income. The yearly sum of direct and indirect costs were yearly euro3402 vs. euro1212 in controls (P < 0.001), corresponding to a yearly excess costs euro2190. The patients presented higher transfer income, total euro889. CONCLUSION Hypersomnia patient present higher health and medication uses, and social transfer income and thus represent a significant socio-economical burden.
Collapse
|
31
|
Knudsen S, Jennum PJ, Alving J, Sheikh SP, Gammeltoft S. Validation of the ICSD-2 criteria for CSF hypocretin-1 measurements in the diagnosis of narcolepsy in the Danish population. Sleep 2010; 33:169-76. [PMID: 20175400 DOI: 10.1093/sleep/33.2.169] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES The International Classification of Sleep Disorders (ICSD-2) criteria for low CSF hypocretin-1 levels (CSF hcrt-1) still need validation as a diagnostic tool for narcolepsy in different populations because inter-assay variability and different definitions of hypocretin deficiency complicate direct comparisons of study results. DESIGN AND PARTICIPANTS Interviews, polysomnography, multiple sleep latency test, HLA-typing, and CSF hcrt-1 measurements in Danish patients with narcolepsy with cataplexy (NC) and narcolepsy without cataplexy (NwC), CSF hcrt-1 measurements in other hypersomnias, neurological and normal controls. Comparisons of hypocretin deficiency and frequency of HLA-DQB1*0602-positivity in the Danish and eligible NC and NwC populations (included via MEDLINE search), by (re)calculation of study results using the ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean). MEASUREMENTS AND RESULTS In Danes, low CSF hcrt-1 was present in 40/46 NC, 3/14 NwC and 0/106 controls (P < 0.0001). Thirty-nine of 41 NC and 4/13 NwC patients were HLA-DQB1*0602-positive (P < 0.01). Hypocretin-deficient NC patients had higher frequency of cataplexy, shorter mean sleep latency, more sleep onset REM periods (P < 0.05) and more awakenings (NS) than did NC patients with normal CSF hcrt-1. Across populations, low CSF hcrt-1 and HLA-DQB1*0602-positivity characterized the majority of NC (80% to 100%, P = 0.53; 80% to 100%, P = 0.11) but a minority of NwC patients (11% to 29%, P = 0.75; 29% to 89%, P = 0.043). CONCLUSION The study provides evidence that hypocretin deficiency causes a more severe NC phenotype. The ICSD-2 criterion for low CSF hcrt-1 (< 30% of normal mean) is valid for diagnosing NC, but not NwC. HLA-typing should precede CSF hcrt-1 measurements because hypocretin deficiency is rare in HLA-DQB1*0602-negative patients.
Collapse
Affiliation(s)
- Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark.
| | | | | | | | | |
Collapse
|
32
|
Ponz A, Khatami R, Poryazova R, Werth E, Boesiger P, Bassetti CL, Schwartz S. Abnormal activity in reward brain circuits in human narcolepsy with cataplexy. Ann Neurol 2010; 67:190-200. [PMID: 20225193 DOI: 10.1002/ana.21825] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aurélie Ponz
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | | | | | | | | | | | | |
Collapse
|
33
|
Jennum P, Knudsen S, Kjellberg J. The economic consequences of narcolepsy. J Clin Sleep Med 2009; 5:240-5. [PMID: 19960645 PMCID: PMC2699169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Narcolepsy is a chronic neurodegenerative disorder with a typical onset in childhood or early adulthood. Narcolepsy may have serious negative effects on health-, social-, education-, and work-related issues for people with narcolepsy and for their families. The disease may, thus, present a significant socioeconomic burden, but no studies to date have addressed the indirect and direct costs of narcolepsy. METHODS Using records from the Danish National Patient Registry (1998-2005), we identified 459 Danish patients with the diagnosis of narcolepsy. Using a ratio of 1 patient record to 4 control subjects' records, we then compared the information of patients with narcolepsy with that of 1836 records from age- and sex-matched, randomly chosen citizens in the Danish Civil Registration System Statistics. We calculated the annual direct and indirect health costs, including labor supply and social transfer payments (which include income derived from state coffers, such as subsistence allowances, pensions, social security, social assistance, public personal support for education, etc.). Direct costs included frequencies and costs of hospitalizations and weighted outpatient use, according to diagnosis-related groups, and specific outpatient costs based on data from The Danish Ministry of Health. The use of and costs of drugs were based on data from the Danish Medicines Agency. The frequencies and costs from primary sectors were based on data from The National Health Security. Indirect costs were based on income data derived from data from the Coherent Social Statistics. RESULTS Patients with narcolepsy had significantly higher rates of health-related contact and medication use and higher expenses, as compared with control subjects. They also had higher unemployment rates. The income level of patients with narcolepsy who were employed was lower than that of employed control subjects. The annual total direct and indirect costs were euro 11,654 (euro = Eurodollars) for patients with narcolepsy and euro 1430 for control subjects (p < 0.001), corresponding to an annual mean excess health-related cost of euro 10,223 for each patient with narcolepsy. In addition, the patients with narcolepsy received an annual social transfer income of euro 2588. CONCLUSION The study confirms that narcolepsy has major socioeconomic consequences for the individual patient and for society. Early diagnosis and treatment could potentially reduce disease burden, which would have a significant socioeconomic impact.
Collapse
Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
| | | | | |
Collapse
|
34
|
Deisenhammer F, Egg R, Giovannoni G, Hemmer B, Petzold A, Sellebjerg F, Teunissen C, Tumani H. EFNS guidelines on disease-specific CSF investigations. Eur J Neurol 2009; 16:760-70. [DOI: 10.1111/j.1468-1331.2009.02595.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
35
|
Martínez-Rodríguez JE, Iranzo A, Casamitjana R, Graus F, Santamaria J. [Comparative analysis of patients with narcolepsy-cataplexy, narcolepsy without cataplexy and idiopathic hypersomnia]. Med Clin (Barc) 2007; 128:361-4. [PMID: 17386240 DOI: 10.1157/13099970] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the distribution of clinical, electrophysiological and biological variables, and their relationship with the CSF hypocretin-1 levels, in patients with central hypersomnias diagnosed as narcolepsy-cataplexy (NC), narcolepsy without cataplexy (NnC) and idiopathic hypersomnia (IH) based on the ICSD-2 criteria. PATIENTS AND METHOD We performed in all patients a clinical interview, a nocturnal polysomnogram and a multiple sleep latency test (MSLT), HLA analysis and measurement of CSF Hcrt-1 levels (low < or = 110 pg/mL). RESULTS Out of 51 patients, 31 were classified as NC, 11 as NnC and 8 as IH. 34 patients (66.7%) had low CSF Hcrt-1 levels (29 NC, 3 NnC and 1 IH). In the NC group, 96.1% were HLA DQB1*0602 positive and 91% had low CSF Hcrt-1 levels. The most frequent variables found in NC patients and in those with a low CSF Hcrt-1 levels were cataplexy, fragmented nocturnal sleep, short refreshing naps, automatic behavior, HLA DQB1*0602, and, in the MSLT, a short mean sleep latency, a higher number of REM sleep episodes and a short mean latency of REM sleep episodes. A long nocturnal sleep time and morning sleep drunkenness, 2 variables used in the ICSD-2 for the diagnosis of IH, were not different among the three groups of hypersomnias. CONCLUSIONS Central hypersomnias have a superposition of several clinical, electrophysiological and biological variables that makes sometimes difficult the differential diagnosis. The measurement of CSF Hcrt-1 levels may help in the diagnosis of those patients with unclear clinical or electrophysiological forms.
Collapse
Affiliation(s)
- José E Martínez-Rodríguez
- Servicio de Neurología, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España
| | | | | | | | | |
Collapse
|
36
|
|