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Li SB, Damonte VM, Chen C, Wang GX, Kebschull JM, Yamaguchi H, Bian WJ, Purmann C, Pattni R, Urban AE, Mourrain P, Kauer JA, Scherrer G, de Lecea L. Hyperexcitable arousal circuits drive sleep instability during aging. Science 2022; 375:eabh3021. [PMID: 35201886 PMCID: PMC9107327 DOI: 10.1126/science.abh3021] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep quality declines with age; however, the underlying mechanisms remain elusive. We found that hyperexcitable hypocretin/orexin (Hcrt/OX) neurons drive sleep fragmentation during aging. In aged mice, Hcrt neurons exhibited more frequent neuronal activity epochs driving wake bouts, and optogenetic activation of Hcrt neurons elicited more prolonged wakefulness. Aged Hcrt neurons showed hyperexcitability with lower KCNQ2 expression and impaired M-current, mediated by KCNQ2/3 channels. Single-nucleus RNA-sequencing revealed adaptive changes to Hcrt neuron loss in the aging brain. Disruption of Kcnq2/3 genes in Hcrt neurons of young mice destabilized sleep, mimicking aging-associated sleep fragmentation, whereas the KCNQ-selective activator flupirtine hyperpolarized Hcrt neurons and rejuvenated sleep architecture in aged mice. Our findings demonstrate a mechanism underlying sleep instability during aging and a strategy to improve sleep continuity.
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Affiliation(s)
- Shi-Bin Li
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Valentina Martinez Damonte
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Chong Chen
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- UNC Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gordon X. Wang
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
| | | | - Hiroshi Yamaguchi
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Wen-Jie Bian
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Carolin Purmann
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Reenal Pattni
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Alexander Eckehart Urban
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Philippe Mourrain
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- INSERM 1024, Ecole Normale Supérieure, Paris, France
| | - Julie A. Kauer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
| | - Grégory Scherrer
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- UNC Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Luis de Lecea
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1201 Welch Road, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA 94305, USA
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Abstract
The circadian wake drive is a mathematic representation of the observed increased propensity to stay awake late in the day, peaking in the hours just before anticipated bed time. It has been called the "forbidden zone" due to the difficulty in initiating sleep during this time and is responsible for the problems initiating sleep when traveling eastward, for maintaining daytime sleep in shift workers, and for initiating sleep in some individuals with insomnia. Evidence culled from studies in individuals with narcolepsy, who lack production of hypocretin (orexin) neuropeptides, as well as a primate model of human wake consolidation and pharmacologic studies of hypocretin antagonists indicate that hypocretin-1 may be the physiologic instantiation of the circadian wake drive. This review will discuss the evidence in support of this hypothesis.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA 94304, United States.
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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Daida K, Ogaki K, Hayashida A, Ando M, Yokoyama K, Noda K, Kanbayashi T, Hattori N, Okuma Y. Somnolence Preceded the Development of a Subthalamic Lesion in Neuromyelitis Optica Spectrum Disorder. Intern Med 2020; 59:577-579. [PMID: 31611526 PMCID: PMC7056378 DOI: 10.2169/internalmedicine.2947-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 67-year-old woman with neuromyelitis optica spectrum disorder (NMOSD) developed severe somnolence. Ten days after admission, fluid-attenuated inversion-recovery magnetic resonance imaging (MRI) revealed hyperintense areas around the bilateral hypothalamus, which were not present on MRI at admission. The orexin level, which is decreased in idiopathic narcolepsy, was slightly decreased in her cerebrospinal fluid. Immunosuppressive treatment and methylphenidate markedly improved her somnolence. This case shows that NMOSD in the acute phase can cause somnolence in a patient without apparent lesions in the hypothalamus.
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Affiliation(s)
- Kensuke Daida
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
| | - Kotaro Ogaki
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Arisa Hayashida
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
| | - Maya Ando
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Kazuyuki Noda
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
| | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Yasuyuki Okuma
- Department of Neurology, Juntendo University Shizuoka Hospital, Japan
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Jeon S, Cho JW, Kim H, Evans AC, Hong SB, Joo EY. A five-year longitudinal study reveals progressive cortical thinning in narcolepsy and faster cortical thinning in relation to early-onset. Brain Imaging Behav 2020; 14:200-212. [PMID: 30392082 PMCID: PMC7938668 DOI: 10.1007/s11682-018-9981-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Narcolepsy with cataplexy is characterized by excessive daytime sleepiness, cataplexy, and other REM sleep phenomena. Previous MRI studies were cross-sectional in design and could not adequately address if disease progression leads the brain structural abnormalities in narcolepsy. Our analysis in patients using longitudinally collected brain MRIs (n = 17; 2 scans per patient; scan interval: 4.7 ± 1.9 years) revealed widespread progressive cortical thinning in bilateral dorsolateral frontal and fusiform cortices, right anterior cingulate (corrected p < 0.05). Cross-sectional analyses showed faster progressive cortical thinning in patients than controls (n = 83, one scan per subject available), which we confirmed significant in the analysis of a small-set of longitudinal control data (n = 10). The pattern of progressive thinning in patients was overlapped well with those found in structural and functional studies of narcolepsy. We also found a faster progression of cortical thinning and worse disease severity (decreased sleep efficiency, increased sleep latency and arousal index) over time in a subgroup of patients with earlier disease onset (n = 9, onset age: 15.9 ± 2.5 years old) compared to later disease onset (n = 8, 25.3 ± 4.9). The faster progressive cortical thinning and worse disease severity over time in the patients with early-onset suggest compelling evidence of disease progression existing in this phenotype of narcolepsy syndrome. Our result based on a small dataset, however, demands a more careful investigation of the underlying mechanism.
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Affiliation(s)
- Seun Jeon
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Jae Wook Cho
- Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hosung Kim
- Laboratory of Neuro Imaging, Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Alan C Evans
- McGill Centre for Integrative Neuroscience, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Annex 3rd F, #7, Gangnam-gu, Seoul, 06351, Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Annex 3rd F, #7, Gangnam-gu, Seoul, 06351, Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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Abstract
Hypertension is a major determinant of cardiovascular morbidity and mortality and is highly prevalent in the general population. While the relationship between sleep apnea and increased blood pressure has been well documented, less recognized is emerging evidence linking sleep-related movement disorders such as restless legs syndrome/periodic limb movements of sleep and sleep-related bruxism with blood pressure (BP) dysregulation and hypertension. There is also recent literature linking narcolepsy-cataplexy with elevated BP and altered pressor responses, and there are data suggesting abnormal BP control in rapid eye movement sleep behavior disorder. It is thought that neural circulatory mechanisms, sympathetic activation in particular, comprise the predominant mediator underlying elevated BP in these neurological sleep disorders. There is very limited evidence that treating these sleep disorders may be beneficial in lowering BP primarily because this question has received very little attention. In this review, we discuss the potential pathophysiologic mechanisms underlying elevated BP in restless legs syndrome/periodic limb movements of sleep, sleep-related bruxism, narcolepsy-cataplexy, and rapid eye movement sleep behavior disorder. We also examine the relationship between these sleep disorders and elevated BP and the impact of treatment of these conditions on BP control. Last, we discuss gaps in the literature evaluating the associations between these sleep disorders and elevated BP and identify areas for further research.
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Affiliation(s)
- Meghna P. Mansukhani
- Center for Sleep Medicine, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Naima Covassin
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
| | - Virend K. Somers
- Department of Cardiovascular Diseases, Mayo Clinic; Address: 200, First Street SW, Rochester, Minnesota
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Pizza F, Barateau L, Jaussent I, Vandi S, Antelmi E, Mignot E, Dauvilliers Y, Plazzi G. Validation of Multiple Sleep Latency Test for the diagnosis of pediatric narcolepsy type 1. Neurology 2019; 93:e1034-e1044. [PMID: 31405906 DOI: 10.1212/wnl.0000000000008094] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/21/2019] [Indexed: 01/07/2023] Open
Abstract
ObjectiveTo validate polysomnographic markers (sleep latency and sleep-onset REM periods [SOREMPs] at the Multiple Sleep Latency Test [MSLT] and nocturnal polysomnography [PSG]) for pediatric narcolepsy type 1 (NT1) against CSF hypocretin-1 (hcrt-1) deficiency and presence of cataplexy, as no criteria are currently validated in children.MethodsClinical, neurophysiologic, and, when available, biological data (HLA-DQB1*06:02 positivity, CSF hcrt-1 levels) of 357 consecutive children below 18 years of age evaluated for suspected narcolepsy were collected. Best MSLT cutoffs were obtained by receiver operating characteristic (ROC) curve analysis by contrasting among patients with available CSF hcrt-1 assay (n = 228) with vs without CSF hcrt-1 deficiency, and further validated in patients without available CSF hcrt-1 against cataplexy (n = 129).ResultsPatients with CSF hcrt-1 deficiency were best recognized using a mean MSLT sleep latency ≤8.2 minutes (area under the ROC curve of 0.985), or by at least 2 SOREMPs at the MSLT (area under the ROC curve of 0.975), or the combined PSG + MSLT (area under the ROC curve of 0.977). Although specificity and sensitivity of reference MSLT sleep latency ≤8 minutes and ≥2 SOREMPs (nocturnal SOREMP included) was 100% and 94.87%, the combination of MSLT sleep latency and SOREMP counts did not improve diagnostic accuracy. Age or sex also did not significantly influence these results in our pediatric population.ConclusionsAt least 2 SOREMPs or a mean sleep latency ≤8.2 minutes at the MSLT are valid and reliable markers for pediatric NT1 diagnosis, a result contrasting with adult NT1 criteria.Classification of evidenceThis study provides Class III evidence that for children with suspected narcolepsy, polysomnographic and MSLT markers accurately identify those with narcolepsy type 1.
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Affiliation(s)
- Fabio Pizza
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Lucie Barateau
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Isabelle Jaussent
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Stefano Vandi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Elena Antelmi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA
| | - Yves Dauvilliers
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
| | - Giuseppe Plazzi
- From the Department of Biomedical and Neuromotor Sciences (DIBINEM) (F.P., S.V., E.A., G.P.), University of Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (F.P., S.V., E.A., G.P.), Italy; National Reference Centre for Orphan Diseases, Narcolepsy, Rare Hypersomnias, Sleep Disorders Center, Department of Neurology (L.B., Y.D.), Gui de Chauliac Hospital, Montpellier; Inserm, U1061 (L.B., I.J., Y.D.), Montpellier; University of Montpellier (L.B., I.J., Y.D.), France; and Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences (E.M.), Stanford University School of Medicine, Palo Alto, CA.
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Hoshino T, Sasanabe R, Mano M, Nomura A, Kato C, Sato M, Imai M, Murotani K, Guilleminault C, Shiomi T. Prevalence of Rapid Eye Movement-related Obstructive Sleep Apnea in Adult Narcolepsy. Intern Med 2019; 58:2151-2157. [PMID: 30996185 PMCID: PMC6709340 DOI: 10.2169/internalmedicine.2601-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The association between narcolepsy and rapid eye movement (REM)-related obstructive sleep apnea (OSA) has not been reported. This study aimed to examine the prevalence of REM-related OSA in narcolepsy patients. Methods From January 2013 to April 2018, 141 adult patients were diagnosed with narcolepsy using nocturnal polysomnography and the multiple sleep latency test. The prevalence of REM-related OSA in narcolepsy patients was retrospectively reviewed. Three criteria were used to determine REM-related OSA: Definition #1, an overall apnea-hypopnea index (AHI) ≥5 and AHI during REM (AHIREM)/AHI during non-rapid eye movement (NREM) (AHINREM) ≥2; Definition #2, an overall AHI ≥5 and AHIREM/AHINREM≥2 and AHINREM <15; and Definition #3, an overall AHI ≥5 and AHIREM/AHINREM≥2 and AHINREM <8 plus an REM sleep duration >10.5 minutes. Results Of the 141 narcolepsy patients, 26 were diagnosed with narcolepsy with cataplexy (NA-CA) and 115 with narcolepsy without cataplexy (NA w/o CA). Seventeen patients with NA-CA and 39 with NA w/o CA had OSA. According to Definition #1, the prevalence of REM-related OSA was 47.1% and 41.0%, respectively, in OSA patients with NA-CA and NA w/o CA; according to Definition #2, the respective prevalence was 47.1% and 38.5%, while that according to Definition #3 was 41.2% and 25.6%. No significant differences were found in the prevalence of REM-related OSA for each definition. Conclusion A high prevalence of REM-related OSA was confirmed in adult narcolepsy patients with OSA. Compared to previous reports, we noted a high frequency of REM-related OSA satisfying the relatively strict Definition #3. These results might reflect the pathophysiological characteristics of narcolepsy.
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Affiliation(s)
- Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Mamiko Mano
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Atsuhiko Nomura
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Chihiro Kato
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Masako Sato
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Masato Imai
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
| | - Kenta Murotani
- Center for Clinical Research, Aichi Medical University Hospital, Japan
| | | | - Toshiaki Shiomi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Japan
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10
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Srikanta JT, Kumar KMC. Narcolepsy - A Rare but under-recognized Problem in Children. Indian Pediatr 2019; 56:147. [PMID: 30819999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- J T Srikanta
- Institute of Pulmonology, Apollo Hospitals, Bengaluru, India.
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11
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Abstract
Narcolepsy is the most common neurological cause of chronic sleepiness. The discovery about 20 years ago that narcolepsy is caused by selective loss of the neurons producing orexins (also known as hypocretins) sparked great advances in the field. Here, we review the current understanding of how orexin neurons regulate sleep-wake behaviour and the consequences of the loss of orexin neurons. We also summarize the developing evidence that narcolepsy is an autoimmune disorder that may be caused by a T cell-mediated attack on the orexin neurons and explain how these new perspectives can inform better therapeutic approaches.
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Affiliation(s)
- Carrie E Mahoney
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Andrew Cogswell
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Igor J Koralnik
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas E Scammell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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12
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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.
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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
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13
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Schiappa C, Scarpelli S, D’Atri A, Gorgoni M, De Gennaro L. Narcolepsy and emotional experience: a review of the literature. Behav Brain Funct 2018; 14:19. [PMID: 30587203 PMCID: PMC6305999 DOI: 10.1186/s12993-018-0151-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Abstract
Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. This disease affects significantly the overall patient functioning, interfering with social, work, and affective life. Some symptoms of narcolepsy depend on emotional stimuli; for instance, cataplectic attacks can be triggered by emotional inputs such as laughing, joking, a pleasant surprise, and also anger. Neurophysiological and neurochemical findings suggest the involvement of emotional brain circuits in the physiopathology of cataplexy, which seems to depending on the dysfunctional interplay between the hypothalamus and the amygdala associated with an alteration of hypocretin levels. Furthermore, behavioral studies suggest an impairment of emotions processing in narcolepsy-cataplexy (NC), like a probable coping strategy to avoid or reduce the frequency of cataplexy attacks. Consistently, NC patients seem to use coping strategies even during their sleep, avoiding unpleasant mental sleep activity through lucid dreaming. Interestingly, NC patients, even during sleep, have a different emotional experience than healthy subjects, with more vivid, bizarre, and frightening dreams. Notwithstanding this evidence, the relationship between emotion and narcolepsy is poorly investigated. This review aims to provide a synthesis of behavioral, neurophysiological, and neurochemical evidence to discuss the complex relationship between NC and emotional experience and to direct future research.
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Affiliation(s)
- C. Schiappa
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - S. Scarpelli
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - A. D’Atri
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - M. Gorgoni
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, University of Rome “Sapienza”, Via dei Marsi, 78, 00185 Rome, Italy
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Stephansen JB, Olesen AN, Olsen M, Ambati A, Leary EB, Moore HE, Carrillo O, Lin L, Han F, Yan H, Sun YL, Dauvilliers Y, Scholz S, Barateau L, Hogl B, Stefani A, Hong SC, Kim TW, Pizza F, Plazzi G, Vandi S, Antelmi E, Perrin D, Kuna ST, Schweitzer PK, Kushida C, Peppard PE, Sorensen HBD, Jennum P, Mignot E. Neural network analysis of sleep stages enables efficient diagnosis of narcolepsy. Nat Commun 2018; 9:5229. [PMID: 30523329 PMCID: PMC6283836 DOI: 10.1038/s41467-018-07229-3] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/15/2018] [Indexed: 01/01/2023] Open
Abstract
Analysis of sleep for the diagnosis of sleep disorders such as Type-1 Narcolepsy (T1N) currently requires visual inspection of polysomnography records by trained scoring technicians. Here, we used neural networks in approximately 3,000 normal and abnormal sleep recordings to automate sleep stage scoring, producing a hypnodensity graph-a probability distribution conveying more information than classical hypnograms. Accuracy of sleep stage scoring was validated in 70 subjects assessed by six scorers. The best model performed better than any individual scorer (87% versus consensus). It also reliably scores sleep down to 5 s instead of 30 s scoring epochs. A T1N marker based on unusual sleep stage overlaps achieved a specificity of 96% and a sensitivity of 91%, validated in independent datasets. Addition of HLA-DQB1*06:02 typing increased specificity to 99%. Our method can reduce time spent in sleep clinics and automates T1N diagnosis. It also opens the possibility of diagnosing T1N using home sleep studies.
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Affiliation(s)
- Jens B Stephansen
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
- Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | - Alexander N Olesen
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
- Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, 2600, Denmark
| | - Mads Olsen
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
- Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, 2600, Denmark
| | - Aditya Ambati
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Eileen B Leary
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Hyatt E Moore
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Oscar Carrillo
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Ling Lin
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Fang Han
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Han Yan
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yun L Sun
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 34295, France
- INSERM, U1061, Université Montpellier 1, Montpellier, 34090, France
| | - Sabine Scholz
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 34295, France
- INSERM, U1061, Université Montpellier 1, Montpellier, 34090, France
| | - Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, 34295, France
- INSERM, U1061, Université Montpellier 1, Montpellier, 34090, France
| | - Birgit Hogl
- Department of Neurology, Innsbruck Medical University, Innsbruck, 6020, Austria
| | - Ambra Stefani
- Department of Neurology, Innsbruck Medical University, Innsbruck, 6020, Austria
| | - Seung Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Seoul, 16247, Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Seoul, 16247, Korea
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40123, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40123, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40123, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy
| | - Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, 40123, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, 40139, Italy
| | - Dimitri Perrin
- School of Electrical Engineering and Computer Science, Queensland University of Technology, Brisbane, 4001, Australia
| | - Samuel T Kuna
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Paula K Schweitzer
- Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield, 63017, MO, USA
| | - Clete Kushida
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA
| | - Paul E Peppard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, 53726, WI, USA
| | - Helge B D Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Rigshospitalet, Glostrup, 2600, Denmark
| | - Emmanuel Mignot
- Center for Sleep Science and Medicine, Stanford University, Stanford, 94304, CA, USA.
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16
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Scherrer KS, Relly C, Hackenberg A, Berger C, Paioni P. Case report: narcolepsy type 1 in an adolescent with HIV infection-coincidence or potential trigger? Medicine (Baltimore) 2018; 97:e11490. [PMID: 30045272 PMCID: PMC6078734 DOI: 10.1097/md.0000000000011490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Despite the acknowledged importance of environmental risk factors in the etiology of narcolepsy, there is little research on this topic. HIV as a trigger for narcolepsy has not been systematically investigated. PATIENT CONCERNS We describe a case of narcolepsy type 1 (NT1) in an adolescent with HIV infection presenting with increased daytime sleepiness and excessive weight gain. DIAGNOSES NT1 was diagnosed according to the criteria of the third edition of the International Classification of Sleep Disorders (ICSD-3). INTERVENTIONS Pharmacological treatment with methylphenidate. OUTCOMES Four months after initiation of methylphenidate therapy the increased daytime sleepiness improved and excessive weight gain stopped. LESSONS Diagnosis of NT1 can be challenging at disease onset and is often delayed, especially in the pediatric population, because symptoms usually evolve gradually. The case presented here raises the possibility that the HIV infection may play a role in the pathogenesis of NT1 serving as trigger for autoimmune-mediated destruction of hypocretin-secreting neurons.
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Affiliation(s)
- Karin Sofia Scherrer
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Churchill Hospital, Oxford, UK
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zürich, Zürich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center University Children's Hospital Zurich, Zürich, Switzerland
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17
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Abstract
PURPOSE OF REVIEW This article outlines the fundamental brain mechanisms that control sleep-wake patterns and reviews how pathologic changes in these control mechanisms contribute to common sleep disorders. RECENT FINDINGS Discrete but interconnected clusters of cells located within the brainstem and hypothalamus comprise the circuits that generate wakefulness, non-rapid eye movement (non-REM) sleep, and REM sleep. These clusters of cells use specific neurotransmitters, or collections of neurotransmitters, to inhibit or excite their respective sleep- and wake-promoting target sites. These excitatory and inhibitory connections modulate not only the presence of wakefulness or sleep, but also the levels of arousal within those states, including the depth of sleep, degree of vigilance, and motor activity. Dysfunction or degeneration of wake- and sleep-promoting circuits is associated with narcolepsy, REM sleep behavior disorder, and age-related sleep disturbances. SUMMARY Research has made significant headway in identifying the brain circuits that control wakefulness, non-REM, and REM sleep and has led to a deeper understanding of common sleep disorders and disturbances.
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18
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Walacik-Ufnal E, Piotrowska AJ, Wołyńczyk-Gmaj D, Januszko P, Gmaj B, Ufnal M, Kabat M, Wojnar M. Narcolepsy type 1 and hypersomnia associated with a psychiatric disorder show different slow wave activity dynamics. Acta Neurobiol Exp (Wars) 2018; 77:147-156. [PMID: 28691719 DOI: 10.21307/ane-2017-047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of the study was to compare electrophysiological parameters of night sleep in narcolepsy type 1 and hypersomnia associated with a psychiatric disorder. Fortyfour patients: 15 with narcolepsy type 1, 14 with hypersomnia associated with a psychiatric disorder and 15 age- and sex-matched controls participated in the study. The study subjects filled in the Athens Insomnia Scale (AIS) and the Beck Depression Inventory (BDI). The severity of daytime sleepiness was quantified subjectively using the Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS), and objectively using the Multiple Sleep Latency Test (MSLT). All subjects underwent polysomnography (PSG) on the two consecutive nights. The data from the second night was analysed. The slow wave activity (SWA, 1-4 Hz) was calculated for the three consecutive sleep cycles, and topographic delta power maps were plotted. In contrast to narcoleptics, psychiatric hypersomniacs had undisturbed nocturnal sleep, high sleep efficiency, normal non-rapid eye movement (NREM) and rapid eye movement (REM) sleep proportions, normal REM latency and sleep latencies on MSLT and PSG. The subjective and objective sleepiness was significantly higher in narcolepsy group than in psychiatric hypersomnia group. In all the study groups SWA was the most prominent in frontal areas, while the greatest between-group differences were found in the central areas. There were significant differences between the groups in SWA in the second NREM episode. The highest SWA was observed in the hypersomnia group, while the lowest in the narcolepsy group. Psychiatric hypersomniacs and controls did not differ in the SWA exponential decline over consecutive NREM episodes, whereas narcoleptics exhibited a steeper dissipation of sleep pressure from the first to the second NREM episode. In conclusion, narcolepsy type1 and hypersomnia associated with psychiatric disorder differ in the SWA dynamics. Narcoleptics presented with the altered dynamics of sleep homeostasis, whereas psychiatric hypersomniacs showed normal nocturnal sleep and normal sleep homeostasis.
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Affiliation(s)
| | - Anna Justyna Piotrowska
- Nowowiejski Hospital in Warsaw, Warsaw, Poland, and Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Wołyńczyk-Gmaj
- Nowowiejski Hospital in Warsaw, Warsaw, Poland, and Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland;
| | - Piotr Januszko
- Nowowiejski Hospital in Warsaw, Warsaw, Poland, and Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Bartłomiej Gmaj
- Nowowiejski Hospital in Warsaw, Warsaw, Poland, and Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Ufnal
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kabat
- Department of Hypertension, Institute of Cardiology, Warsaw, Poland
| | - Marcin Wojnar
- Nowowiejski Hospital in Warsaw, Warsaw, Poland, and Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
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19
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Kim P, During E, Miglis M. A Case of Narcolepsy Type 2 and Postural Tachycardia Syndrome Secondary to Lesions of the Thalamus and Amygdala. J Clin Sleep Med 2018; 14:479-481. [PMID: 29458703 PMCID: PMC5837851 DOI: 10.5664/jcsm.7006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT Although there are reports of narcolepsy type 1 caused by lesions of the central nervous system, there are far fewer reports of narcolepsy type 2 (NT2) caused by discrete brain lesions. We report a case of a patient in whom NT2 was diagnosed after a viral illness, and inflammatory lesions in the right thalamus and amygdala were found. In addition, symptoms of autonomic impairment developed and postural tachycardia syndrome was subsequently diagnosed in this patient. To our knowledge this is the first reported case of NT2 resulting from central nervous system lesions in these discrete locations, as well as the first reported case of postural tachycardia syndrome associated with narcolepsy.
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Affiliation(s)
- Paul Kim
- Department of Neurology & Neurological Sciences, Stanford University Medical Center, Palo Alto, California
| | - Emmanuel During
- Department of Neurology & Neurological Sciences, Stanford University Medical Center, Palo Alto, California
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, California
| | - Mitchell Miglis
- Department of Neurology & Neurological Sciences, Stanford University Medical Center, Palo Alto, California
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, California
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20
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Toyoda H, Honda Y, Tanaka S, Miyagawa T, Honda M, Honda K, Tokunaga K, Kodama T. Narcolepsy susceptibility gene CCR3 modulates sleep-wake patterns in mice. PLoS One 2017; 12:e0187888. [PMID: 29186205 PMCID: PMC5706730 DOI: 10.1371/journal.pone.0187888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022] Open
Abstract
Narcolepsy is caused by the loss of hypocretin (Hcrt) neurons and is associated with multiple genetic and environmental factors. Although abnormalities in immunity are suggested to be involved in the etiology of narcolepsy, no decisive mechanism has been established. We previously reported chemokine (C-C motif) receptor 3 (CCR3) as a novel susceptibility gene for narcolepsy. To understand the role of CCR3 in the development of narcolepsy, we investigated sleep-wake patterns of Ccr3 knockout (KO) mice. Ccr3 KO mice exhibited fragmented sleep patterns in the light phase, whereas the overall sleep structure in the dark phase did not differ between Ccr3 KO mice and wild-type (WT) littermates. Intraperitoneal injection of lipopolysaccharide (LPS) promoted wakefulness and suppressed both REM and NREM sleep in the light phase in both Ccr3 KO and WT mice. Conversely, LPS suppressed wakefulness and promoted NREM sleep in the dark phase in both genotypes. After LPS administration, the proportion of time spent in wakefulness was higher, and the proportion of time spent in NREM sleep was lower in Ccr3 KO compared to WT mice only in the light phase. LPS-induced changes in sleep patterns were larger in Ccr3 KO compared to WT mice. Furthermore, we quantified the number of Hcrt neurons and found that Ccr3 KO mice had fewer Hcrt neurons in the lateral hypothalamus compared to WT mice. We found abnormalities in sleep patterns in the resting phase and in the number of Hcrt neurons in Ccr3 KO mice. These observations suggest a role for CCR3 in sleep-wake regulation in narcolepsy patients.
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Affiliation(s)
- Hiromi Toyoda
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- * E-mail:
| | - Yoshiko Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Susumu Tanaka
- Department of Anatomy and Cell Science, Kansai Medical University, Hirakata, Japan
| | - Taku Miyagawa
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Makoto Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Seiwa Hospital, Institute of Neuropsychiatry, Tokyo, Japan
| | - Kazuki Honda
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tohru Kodama
- Sleep Disorders Project, Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Sieminski M, Chwojnicki K, Sarkanen T, Partinen M. The relationship between orexin levels and blood pressure changes in patients with narcolepsy. PLoS One 2017; 12:e0185975. [PMID: 29023559 PMCID: PMC5638315 DOI: 10.1371/journal.pone.0185975] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 09/24/2017] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVE Narcolepsy type 1 (NT1) is caused by a deficiency or absence of the neurotransmitter orexin. NT1 is also associated with a reduced nocturnal "dipping" of blood pressure (BP). The study objective was to analyze whether nocturnal BP values differed in patients depleted of orexin, versus those in whom production was preserved. METHODS We performed a retrospective analysis of the polysomnographic recordings, orexin levels, and BP values of patients with NT1. Data was collected from a total of 21 patients, divided into two groups as follows: those with a complete depletion of orexin (n = 11) (Group1), and those with a remaining, limited presence of orexin (n = 10) (Group 2). RESULTS The groups did not differ in terms of the clinical features of NT1 or sleep characteristics, with an exception of increased number of cataplexy episodes and increased percentage of sleep stage 2 in the Group 1. Daytime and nocturnal BP did not differ between the groups. Most patients, regardless of group, had a non-dipping blood pressure pattern, and no difference in dipping prevalence was observed between groups. The amplitude of the daytime to nighttime change in BP did not differ between the groups. CONCLUSIONS Non-dipping BP patterns are frequent among patients with narcolepsy type 1, but we saw no evidence that they depended on whether orexin levels were above or below the assay detection threshold. Therefore, our results do not support the hypothesis that in patients with narcolepsy type 1 residual orexin levels play a role in the control of nocturnal BP dipping.
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Affiliation(s)
- Mariusz Sieminski
- Department of Adults’ Neurology, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | - Kamil Chwojnicki
- Department of Adults’ Neurology, Medical University of Gdansk, Gdansk, Poland
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Affiliation(s)
- Jun Zhang
- Department of Neurology, Peking University People's Hospital, 11, Xi Zhi Men Nan Da Jie, Xi Chen Qu, Beijing 100044, China
| | - Fang Han
- Department of Respiratory Medicine, Peking University People's Hospital, 11, Xi Zhi Men Nan Da Jie, Xi Chen Qu, Beijing 100044, China.
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Liu M, Blanco-Centurion C, Shiromani PJ. Rewiring brain circuits to block cataplexy in murine models of narcolepsy. Curr Opin Neurobiol 2017; 44:110-115. [PMID: 28445807 PMCID: PMC5511086 DOI: 10.1016/j.conb.2017.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/14/2017] [Accepted: 03/31/2017] [Indexed: 12/31/2022]
Abstract
Narcolepsy was first identified almost 130 years ago, but it was only 15 years ago that it was identified as a neurodegenerative disease linked to a loss of orexin neurons in the brain. It is unclear what causes the orexin neurons to die, but our strategy has been to place the gene for orexin into surrogate neurons in the validated mouse models of narcolepsy, and test whether it can block narcolepsy symptoms, such as cataplexy. In both the orexin knockout and the orexin-ataxin-3 mouse models of narcolepsy we have found that cataplexy can be blocked if the surrogate neurons are part of the circuit responsible for cataplexy. We have also determined that the orexin gene can be inserted into surrogate neurons in the amygdala to block emotion-induced cataplexy. Through the use of optogenetics we anticipate that it will be possible to preemptively block cataplexy.
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Affiliation(s)
- Meng Liu
- Ralph H. Johnson VA and Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Carlos Blanco-Centurion
- Ralph H. Johnson VA and Medical University of South Carolina, Charleston, SC 29425, United States
| | - Priyattam J Shiromani
- Ralph H. Johnson VA and Medical University of South Carolina, Charleston, SC 29425, United States
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van der Heide A, Werth E, Donjacour CE, Reijntjes RH, Lammers GJ, Van Someren EJ, Baumann CR, Fronczek R. Core Body and Skin Temperature in Type 1 Narcolepsy in Daily Life; Effects of Sodium Oxybate and Prediction of Sleep Attacks. Sleep 2016; 39:1941-1949. [PMID: 27568803 PMCID: PMC5070748 DOI: 10.5665/sleep.6220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/12/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Previous laboratory studies in narcolepsy patients showed altered core body and skin temperatures, which are hypothesised to be related to a disturbed sleep wake regulation. In this ambulatory study we assessed temperature profiles in normal daily life, and whether sleep attacks are heralded by changes in skin temperature. Furthermore, the effects of three months of treatment with sodium oxybate (SXB) were investigated. METHODS Twenty-five narcolepsy patients and 15 healthy controls were included. Core body, proximal and distal skin temperatures, and sleep-wake state were measured simultaneously for 24 hours in ambulatory patients. This procedure was repeated in 16 narcolepsy patients after at least 3 months of stable treatment with SXB. RESULTS Increases in distal skin temperature and distal-to-proximal temperature gradient (DPG) strongly predicted daytime sleep attacks (P < 0.001). As compared to controls, patients had a higher proximal and distal skin temperature in the morning, and a lower distal skin temperature during the night (all P < 0.05). Furthermore, they had a higher core body temperature during the first part of the night (P < 0.05), which SXB decreased (F = 4.99, df = 1, P = 0.03) to a level similar to controls. SXB did not affect skin temperature. CONCLUSIONS This ambulatory study demonstrates that daytime sleep attacks were preceded by clear changes in distal skin temperature and DPG. Furthermore, changes in core body and skin temperature in narcolepsy, previously only studied in laboratory settings, were partially confirmed. Treatment with SXB resulted in a normalisation of the core body temperature profile. Future studies should explore whether predictive temperature changes can be used to signal or even prevent sleep attacks.
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Affiliation(s)
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, Switzerland
| | - Claire E.H.M. Donjacour
- Leiden University Medical Centre, Leiden, The Netherlands
- SleepWake Centre SEIN, Zwolle, The Netherlands
| | | | - Gert Jan Lammers
- Leiden University Medical Centre, Leiden, The Netherlands
- SleepWake Centre SEIN, Heemstede, The Netherlands
| | - Eus J.W. Van Someren
- Department Sleep & Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry GGZ inGeest, Centre for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Centre, Amsterdam, The Netherlands
| | | | - Rolf Fronczek
- Leiden University Medical Centre, Leiden, The Netherlands
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Walker JM, James NT, Campbell H, Wilson SH, Churchill S, Weaver LK. Sleep assessments for a mild traumatic brain injury trial in a military population. Undersea Hyperb Med 2016; 43:549-566. [PMID: 28768073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Baseline sleep characteristics were explored for 71 U.S. military service members with mild traumatic brain injury (mTBI) enrolled in a post-concussive syndrome clinical trial. The Pittsburgh Sleep Quality Index (PSQI), sleep diary, several disorder-specific questionnaires, actigraphy and polysomnographic nap were collected. Almost all (97%) reported ongoing sleep problems. The mean global PSQI score was 13.5 (SD=3.8) and 87% met insomnia criteria. Sleep maintenance efficiency was 79.1% for PSQI, 82.7% for sleep diary and 90.5% for actigraphy; total sleep time was 288, 302 and 400 minutes, respectively. There was no correlation between actigraphy and subjective questionnaires. Overall, 70% met hypersomnia conditions, 70% were at high risk for obstructive sleep apnea (OSA), 32% were symptomatic for restless legs syndrome, and 6% reported cataplexy. Nearly half (44%) reported coexisting insomnia, hypersomnia and high OSA risk. Participants with post-traumatic stress disorder (PTSD) had higher PSQI scores and increased OSA risk. Older participants and those with higher aggression, anxiety or depression also had increased OSA risk. The results confirm poor sleep quality in mTBI with insomnia, hypersomnia, and OSA risk higher than previously reported, and imply sleep disorders in mTBI may be underdiagnosed or exacerbated by comorbid PTSD.
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Affiliation(s)
- James M Walker
- PSG Professional Services, Inc, Farmington, Utah U.S
- Lovelace Biomedical Research, Albuquerque, New Mexico U.S
| | | | | | | | - Susan Churchill
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Lindell K Weaver
- Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah, and Intermountain LDS Hospital, Salt Lake City, Utah U.S
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah U.S
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Dauvilliers Y, Lopez R. [NARCOLEPSY WITH CATAPLEXY: TYPE 1 NARCOLEPSY]. Rev Prat 2016; 66:671-676. [PMID: 27538328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Narcolepsy with cataplexy or narcolepsy type 1 in a rare, disabling sleep disorder, with a prevalence of 20 to 30 per 100,000. Its onset peaks in the second decade. The main features are excessive daytime sleepiness and cataplexy or sudden less of muscle tone triggered by emotional situations. Other less consistent symptoms include hypnagogic hallucinations, sleep paralysis, disturbed nighttime sleep, and weight gain. Narcolepsy with cataplexy remains a clinical diagnosis but nighttime and daytime polysomnography (multiple sleep latency tests) are useful to document mean sleep latency below 8 min and at least two sleep-onset REM periods. HLA typing shows an association with HLA DQB1*0602 in more than 92% of cases but was not included in the new diagnostic criteria. In contrast, a low hypocretin-1/orexin-A levels (values below 110 pg/mL) in the cerebrospinal fluid was highly specific for narcolepsy with cataplexy and was included in the recent diagnostic criteria for narcolepsy. The deficiency of the hypocretin system is well-established in human narcoleptics with a reduction of cerebrospinal fluid hypocretin levels in relation with an early loss of hypocretin neurons. The cause of human narcolepsy remains unknown, however an autoimmune process in most probable acting on a highly genetic background with environmental factors such as streptococcal infections, and H1N1 AS03-adjuvanted vaccine named Pandemrix.
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Lamb F, Ploner A, Fink K, Maeurer M, Bergman P, Piehl F, Weibel D, Sparén P, Dahlström LA. No Evidence for Disease History as a Risk Factor for Narcolepsy after A(H1N1)pdm09 Vaccination. PLoS One 2016; 11:e0154296. [PMID: 27120092 PMCID: PMC4847913 DOI: 10.1371/journal.pone.0154296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy. METHODS Case-control study in Sweden. Cases included persons referred for a Multiple Sleep Latency Test between 2009 and 2010, identified through diagnostic sleep centres and confirmed through independent review of medical charts. Controls, selected from the total population register, were matched to cases on age, gender, MSLT-referral date and county of residence. Disease history (prescriptions and diagnoses) and vaccination history was collected through telephone interviews and population-based healthcare registers. Conditional logistic regression was used to investigate disease history before A(H1N1)pdm09 vaccination as a risk-factor for narcolepsy. RESULTS In total, 72 narcolepsy cases and 251 controls were included (range 3-69 years mean19-years). Risk of narcolepsy was increased in individuals with a disease history of nervous system disorders (OR range = 3.6-8.8) and mental and behavioural disorders (OR = 3.8, 95% CI 1.6-8.8) before referral. In a second analysis of vaccinated individuals only, nearly all initial associations were no longer statistically significant and effect sizes were smaller (OR range = 1.3-2.6). A significant effect for antibiotics (OR = 0.4, 95% CI 0.2-0.8) and a marginally significant effect for nervous system disorders was observed. In a third case-only analysis, comparing cases referred before vaccination to those referred after; prescriptions for nervous system disorders (OR = 26.0 95% CI 4.0-170.2) and ADHD (OR = 35.3 95% CI 3.4-369.9) were statistically significant during the vaccination period, suggesting initial associations were due to confounding by indication. CONCLUSION The findings of this study do not support disease history before A(H1N1)pdm09 vaccination as a risk factor for narcolepsy.
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Affiliation(s)
- Favelle Lamb
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markus Maeurer
- CAST (Centre for allogenic stem cell transplantation), Karolinska Hospital, Stockholm, Sweden
- Division of Therapeutic Immunology (TIM), LabMed Karolinska Institutet, Stockholm, Sweden
| | - Peter Bergman
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Weibel
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lisen Arnheim Dahlström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Christensen JAE, Carrillo O, Leary EB, Peppard PE, Young T, Sorensen HBD, Jennum P, Mignot E. Sleep-stage transitions during polysomnographic recordings as diagnostic features of type 1 narcolepsy. Sleep Med 2015; 16:1558-66. [PMID: 26299470 PMCID: PMC8066516 DOI: 10.1016/j.sleep.2015.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/30/2015] [Accepted: 06/18/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Type 1 narcolepsy/hypocretin deficiency is characterized by excessive daytime sleepiness, sleep fragmentation, and cataplexy. Short rapid eye movement (REM) latency (≤15 min) during nocturnal polysomnography (PSG) or during naps of the multiple sleep latency test (MSLT) defines a sleep-onset REM sleep period (SOREMP), a diagnostic hallmark. We hypothesized that abnormal sleep transitions other than SOREMPs can be identified in type 1 narcolepsy. METHODS Sleep-stage transitions (one to 10 epochs to one to five epochs of any other stage) and bout length features (one to 10 epochs) were extracted from PSGs. The first 15 min of sleep were excluded when a nocturnal SOREMP was recorded. F(0.1) measures and receiver operating characteristic curves were used to identify specific (≥98%) features. A data set of 136 patients and 510 sex- and age-matched controls was used for the training. A data set of 19 cases and 708 sleep-clinic patients was used for the validation. RESULTS (1) ≥5 transitions from ≥5 epochs of stage N1 or W to ≥2 epochs of REM sleep, (2) ≥22 transitions from ≥3 epochs of stage N2 or N3 to ≥2 epochs of N1 or W, and (3) ≥16 bouts of ≥6 epochs of N1 or W were found to be highly specific (≥98%). Sensitivity ranged from 16% to 30%, and it did not vary substantially with and without medication or a nocturnal SOREMP. In patients taking antidepressants, nocturnal SOREMPs occurred much less frequently (16% vs. 36%, p < 0.001). CONCLUSIONS Increased sleep-stage transitions notably from ≥2.5 min of W/N1 into REM are specifically diagnostic for narcolepsy independent of a nocturnal SOREMP.
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Affiliation(s)
- Julie Anja Engelhard Christensen
- Department of Electrical Engineering, Technical University of Denmark, Orsteds Plads 349, DK-2800 Kongens Lyngby, Denmark; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive, Palo Alto, CA 94304, USA
| | - Oscar Carrillo
- Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive, Palo Alto, CA 94304, USA
| | - Eileen B Leary
- Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive, Palo Alto, CA 94304, USA
| | - Paul E Peppard
- School of Medicine and Public Health, Health Sciences Learning Center, University of Wisconsin, 750 Highland Ave., Madison, WI 53705, USA
| | - Terry Young
- School of Medicine and Public Health, Health Sciences Learning Center, University of Wisconsin, 750 Highland Ave., Madison, WI 53705, USA
| | - Helge Bjarrup Dissing Sorensen
- Department of Electrical Engineering, Technical University of Denmark, Orsteds Plads 349, DK-2800 Kongens Lyngby, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; Center for Healthy Aging, University of Copenhagen, Norregade 10, DK-1017 Copenhagen, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Drive, Palo Alto, CA 94304, USA.
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Mensen A, Poryazova R, Huegli G, Baumann CR, Schwartz S, Khatami R. The Roles of Dopamine and Hypocretin in Reward: A Electroencephalographic Study. PLoS One 2015; 10:e0142432. [PMID: 26599765 PMCID: PMC4658140 DOI: 10.1371/journal.pone.0142432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 10/21/2015] [Indexed: 11/19/2022] Open
Abstract
The proper functioning of the mesolimbic reward system is largely dependent on the neurotransmitter dopamine. Recent evidence suggests that the hypocretin system has significant projections to this reward system. We examined the distinct effects of reduced dopamine or reduced hypocretin levels on reward activity in patients with Parkinson’s disease, dopamine deficient, as well as patients with narcolepsy-cataplexy, hypocretin depleted, and healthy controls. Participants performed a simple game-like task while high-density electroencephalography was recorded. Topography and timing of event-related potentials for both reward cue, and reward feedback was examined across the entire dataset. While response to reward cue was similar in all groups, two distinct time points were found to distinguish patients and controls for reward feedback. Around 160ms both patient groups had reduced ERP amplitude compared to controls. Later at 250ms, both patient groups also showed a clear event-related potential (ERP), which was absent in controls. The initial differences show that both patient groups show a similar, blunted response to reward delivery. The second potential corresponds to the classic feedback-related negativity (FRN) potential which relies on dopamine activity and reflects reward prediction-error signaling. In particular the mismatch between predicted reward and reward subsequently received was significantly higher in PD compared to NC, independent of reward magnitude and valence. The intermediate FRN response in NC highlights the contribution of hypocretin in reward processing, yet also shows that this is not as detrimental to the reward system as in Parkinson’s. Furthermore, the inability to generate accurate predictions in NC may explain why hypocretin deficiency mediates cataplexy triggered by both positive and negative emotions.
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Affiliation(s)
- Armand Mensen
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, 8006 Zurich, Switzerland
| | - Gordana Huegli
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
| | | | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, 1211 Geneva, Switzerland
| | - Ramin Khatami
- Department of Sleep Medicine, Clinic Barmelweid, 5017 Aargau, Switzerland
- * E-mail:
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Sasai-Sakuma T, Kinoshita A, Inoue Y. Polysomnographic Assessment of Sleep Comorbidities in Drug-Naïve Narcolepsy-Spectrum Disorders--A Japanese Cross-Sectional Study. PLoS One 2015; 10:e0136988. [PMID: 26322978 PMCID: PMC4556112 DOI: 10.1371/journal.pone.0136988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/11/2015] [Indexed: 01/01/2023] Open
Abstract
This is a large cross-sectional study which aimed to investigate comorbidity rate, degree of sleep-related breathing disorder, polysomnigraphically diagnosible rapid eye movement sleep behavior disorder/rapid eye movement sleep without atonia and periodic limb movements during sleep in Japanese drug-naïve patients with narcolepsy-spectrum disorders. A total of 158 consecutive drug naïve patients with narcolepsy with cataplexy, 295 patients with narcolepsy without cataplexy and 395 patients with idiopathic hypersomnia without long sleep time were enrolled. From retrospectively analyzed data of nocturnal polysomnography and multiple sleep latency test, higher rates of periodic limb movements during sleep (> = 15 h-1) (10.2%) and polysomnographically diagnosable rapid eye movement sleep behavior disorder (1.9%) were found in patients with narcolepsy with cataplexy. They had more severe periodic limb movements during sleep especially during rapid eye movement sleep and higher percentages of rapid eye movement sleep without atonia than the other two patient groups. In the present large sample study, Japanese drug naïve patients with narcolepsy with cataplexy showed the highest comorbidity rates of periodic limb movements during sleep, polysomnographically diagnosable rapid eye movement sleep behavior disorder and rapid eye movement sleep without atonia among those with the other narcolepsy-spectrum disorders; the rates were lower than those for Western patients.
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Affiliation(s)
- Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Department of Life Sciences and Bio-informatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
| | - Akihiko Kinoshita
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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Kuhn A, Brodbeck V, Tagliazucchi E, Morzelewski A, von Wegner F, Laufs H. Narcoleptic Patients Show Fragmented EEG-Microstructure During Early NREM Sleep. Brain Topogr 2015; 28:619-635. [PMID: 25168255 DOI: 10.1007/s10548-014-0387-1/figures/8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 07/20/2014] [Indexed: 05/25/2023]
Abstract
Narcolepsy is a chronic disorder of the sleep-wake cycle with pathological shifts between sleep stages. These abrupt shifts are induced by a sleep-regulating flip-flop mechanism which is destabilized in narcolepsy without obvious alterations in EEG oscillations. Here, we focus on the question whether the pathology of narcolepsy is reflected in EEG microstate patterns. 30 channel awake and NREM sleep EEGs of 12 narcoleptic patients and 32 healthy subjects were analyzed. Fitting back the dominant amplitude topography maps into the EEG led to a temporal sequence of maps. Mean microstate duration, ratio total time (RTT), global explained variance (GEV) and transition probability of each map were compared between both groups. Nine patients reached N1, 5 N2 and only 4 N3. All healthy subjects reached at least N2, 19 also N3. Four dominant maps could be found during wakefulness and all NREM- sleep stages in healthy subjects. During N3, narcolepsy patients showed an additional fifth map. The mean microstate duration was significantly shorter in narcoleptic patients than controls, most prominent in deep sleep. Single maps' GEV and RTT were also altered in narcolepsy. Being aware of the limitation of our low sample size, narcolepsy patients showed wake-like features during sleep as reflected in shorter microstate durations. These microstructural EEG alterations might reflect the intrusion of brain states characteristic of wakefulness into sleep and an instability of the sleep-regulating flip-flop mechanism resulting not only in pathological switches between REM- and NREM-sleep but also within NREM sleep itself, which may lead to a microstructural fragmentation of the EEG.
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Affiliation(s)
- Alena Kuhn
- Department of Neurology and Brain Imaging Center, Goethe University, Frankfurt am Main, Germany,
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Tanaka H. [Multiple sleep latency test, maintenance of wakefulness test and suggestive immobilization test]. Nihon Rinsho 2015; 73:971-979. [PMID: 26065128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In clinical practice, assessment usually involves self-report; however, objective measures are available. The multiple sleep latency test(MSLT) is performed during the main period of wakefulness and is designed to determine a patient's propensity to fall asleep. To be valid, the MSLT should be performed the day after nocturnal polysomnography (PSG). It is the standard test for the assessment of objective sleepiness and diagnosis of narcolepsy, that is a mean sleep latency equal to or under 8 minutes and equal to or greater than two sleep onset REM periods (SOREMPs). As opposed to the MSLT, the maintenance of wakefulness test (MWT) is designed to test the patient's ability to stay awake. The MWT is a 40-minutes protocol consisting of four trials separated by 2-hour intervals and is performed in much the same way as the MSLT. The MWT may be indicated in assessment of individuals in whom the inability to remain awake constitutes a safety issue, or in patients with narcolepsy or idiopathic hypersomnia to assess response to treatment with medications. There is little evidence linking mean sleep latency on the MWT with risk of accidents in real world circumstances. The suggestive immobilization test(SIT) was designed during which sensor and motor symptoms of restless legs syndrome are quantified during a period of immobility taking place in the evening before PSG. The patient is instructed to avoid moving voluntary for the entire duration of the test, which is designed to last 1 hour. The subjective leg discomfort evaluation and periodic leg movement by surface electromyograms from right and left anterior tibialis support diagnosis for restless legs syndrome. Many factors, such as clinical setting, pretest condition or aging effects etc. can alter the findings of the test and considerable clinical judgment is needed to avoid an error in interpretation. Above those three sleep-wake related tests provide us useful information.
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Affiliation(s)
- Yves Dauvilliers
- 1 Centre de Référence Nationale Maladie Rare - Narcolepsie et Hypersomnie Idiopathique, Département de Neurologie, Hôpital Gui-de-Chauliac, Inserm U1061, Montpellier, France
| | - Philippe Peigneux
- 2 UR2NF - Neuropsychology and Functional Neuroimaging Research Unit at CRCN - Centre de Recherche Cognition et Neurosciences and UNI - ULB Neurosciences Institute, Université Libre de Bruxelles, Belgium
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Susta M, Papezova H, Petranek S, Sonka K. Brain activation sequences. Neuro Endocrinol Lett 2015; 36:758-766. [PMID: 26921576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Reported brain abnormalities in anatomy and function in psychiatric and neurological patients led to a project based on qualitative electroencephalography examination and analysis in an attempt to find specific brain derived pattern--or sequence of brain locations involved in processing various stimuli--both visual and auditory. METHODS Specialized software called Brain Activation Sequences was built according to our team member specifications (M.S.). The software utilizes event related potentials recorded during cognitive/emotion processing in participants (healthy controls, neurological patients and psychiatric patients) to calculate the sequence of brain areas using nonlinear and linear algorithms. RESULTS Results show significant differences in activation patterns between patients and healthy controls as well as significant similarities within the groups of patients and controls in both performed testing experiments.
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Affiliation(s)
- Marek Susta
- St. Elisabeth University, Bratislava, Slovakia
| | - Hana Papezova
- Psychiatric Clinic, Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Czech Republic
| | - Svojmil Petranek
- Department of Neurology, Faculty Hospital Bulovka, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Busková J, Kemlink D, Ibarburu V, Nevsímalová S, Sonka K. Antidepressants substantially affect basic REM sleep characteristics in narcolepsy-cataplexy patients. Neuro Endocrinol Lett 2015; 36:430-433. [PMID: 26707042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Antidepressants substantially affect REM sleep characteristics and trigger manifestations of REM sleep behavior disorder (RBD) in the general, non-narcoleptic, population. Antidepressants are also frequently administrated in an attempt to suppress cataplexy. We investigated the role of antidepressants in the development of RBD in narcolepsy with cataplexy (NC) patients. PATIENTS/METHODS Seventy-five patients diagnosed with NC were assessed by a structured interview (focused on RBD manifestations and the use of antidepressants) and night video-polysomnography followed by the multiple sleep latency test. RESULTS Of all 75 NC patients (36 male, 39 female; mean age 46.1±18.5 years), 34 cases had a history of antidepressant use (45.3%; 18 male, 16 female). In this antidepressant-positive group, 13 patients suffered from RBD (38.2%). Among antidepressant-naïve patients, only 5 subjects (12.2%) were diagnosed with RBD. Polysomnographic data showed significantly increased REM latency (p<0.01) and reduced percentage of REM sleep (p<0.01) in the antidepressant-positive group, as well as more periodic limb movements during sleep (p=0.01). CONCLUSIONS NC patients with a history of antidepressant use showed a three-fold higher occurrence of RBD in comparison to antidepressant-naïve patients.
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Affiliation(s)
- Jitka Busková
- Department of Neurology and Center for Clinical Neurosciences, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Center for Clinical Neurosciences, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Veronika Ibarburu
- Department of Neurology and Center for Clinical Neurosciences, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Sona Nevsímalová
- Department of Neurology and Center for Clinical Neurosciences, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center for Clinical Neurosciences, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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NARCOLEPSY. The Body Systems Training Room (BSTR) is the fourth of ANMF's CPD training room for nurses and midwives. Aust Nurs Midwifery J 2014; 22:26-8. [PMID: 29220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
Although narcolepsy was first described in the late nineteenth century in Germany and France, much of the research on this disorder has been conducted at Stanford University, starting with Drs. William C. Dement and Christian Guilleminault in the 1970s. The prevalence of narcolepsy was established, and a canine model discovered. Following the finding in Japan that almost all patients with narcolepsy carry a specific HLA subtype, HLA-DR2, Hugh Mac Devitt, F. Carl Grumet, and Larry Steinman initiated immunological studies, but results were generally negative. Using the narcoleptic canines, Dr. Nishino and I established that stimulants increased wakefulness by stimulating dopaminergic transmission while antidepressants suppress cataplexy via adrenergic reuptake inhibition. A linkage study was initiated with Dr. Grumet in 1988, and after 10 years of work, the canine narcolepsy gene was cloned by in 1999 and identified as the hypocretin (orexin) receptor 2. In 1992, studying African Americans, we also found that DQ0602 rather than DR2 was a better marker for narcolepsy across all ethnic groups. In 2000, Dr. Nishino and I, in collaboration with Dr. Lammers in the Netherlands, found that hypocretin 1 levels in the cerebrospinal fluid (CSF) were undetectable in most cases, establishing hypocretin deficiency as the cause of narcolepsy. Pursuing this research, our and Dr. Siegel's group, examining postmortem brains, found that the decreased CSF hypocretin 1 was secondary to the loss the 70,000 neurons producing hypocretin in the hypothalamus. This finding revived the autoimmune hypothesis but attempts at demonstrating immune targeting of hypocretin cells failed until 2013. At this date, Dr. Elisabeth Mellins and I discovered that narcolepsy is characterized by the presence of autoreactive CD4(+) T cells to hypocretin fragments when presented by DQ0602. Following reports that narcolepsy cases were triggered by vaccinations and infections against influenza A 2009 pH1N1, a new pandemic strain that erupted in 2009, our groups also established that a small epitope of pH1N1 resembles hypocretin and is likely involved in molecular mimicry. Although much remains to be done, these achievements, establishing hypocretin deficiency as the cause of narcolepsy, demonstrating its autoimmune basis, and showing molecular mimicry between hypocretin and sequences derived from a pandemic strain of influenza, are likely to remain classics in human immunology.
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Affiliation(s)
- Emmanuel J M Mignot
- Stanford University Center for Sleep Sciences, 3165 Porter Drive, #2178, Palo Alto, CA, 94304, USA,
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Arias-Carrión O, Murillo-Rodríguez E. Effects of hypocretin/orexin cell transplantation on narcoleptic-like sleep behavior in rats. PLoS One 2014; 9:e95342. [PMID: 24736646 PMCID: PMC3988205 DOI: 10.1371/journal.pone.0095342] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 03/25/2014] [Indexed: 11/22/2022] Open
Abstract
The sleep disorder narcolepsy is now considered a neurodegenerative disease because there is a massive loss of neurons containing the neuropeptide hypocretin/orexin (HCRT). In consequence, narcoleptic patients have very low cerebrospinal fluid (CSF) levels of HCRT. Studies in animal models of narcolepsy have shown the neurophysiological role of the HCRT system in the development of this disease. For example, the injection of the neurotoxin named hypocretin-2-saporin (HCRT2/SAP) into the lateral hypothalamus (LH) destroys the HCRT neurons, therefore diminishes the contents of HCRT in the CSF and induces narcoleptic-like behavior in rats. Transplants of various cell types have been used to induce recovery in a variety of neurodegenerative animal models. In models such as Parkinson's disease, cell survival has been shown to be small but satisfactory. Similarly, cell transplantation could be employed to implant grafts of HCRT cells into the LH or even other brain regions to treat narcolepsy. Here, we report for the first time that transplantation of HCRT neurons into the LH of HCRT2/SAP-lesioned rats diminishes narcoleptic-like sleep behavior. Therefore, cell transplantation may provide an effective method to treat narcolepsy.
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Affiliation(s)
- Oscar Arias-Carrión
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Dr. Manuel Gea González, Mexico City, Mexico
- Unidad de Trastornos del Movimiento y Sueño (TMS), Hospital General Ajusco Medio, Mexico City, Mexico
- * E-mail: (OAC); (EMR)
| | - Eric Murillo-Rodríguez
- Laboratorio de Neurociencias Moleculares e Integrativas, Escuela de Medicina, División Ciencias de la Salud, Universidad Anáhuac Mayab, Mérida, Yucatán, Mexico
- * E-mail: (OAC); (EMR)
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Fulcher BD, Phillips AJK, Postnova S, Robinson PA. A physiologically based model of orexinergic stabilization of sleep and wake. PLoS One 2014; 9:e91982. [PMID: 24651580 PMCID: PMC3961294 DOI: 10.1371/journal.pone.0091982] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/15/2014] [Indexed: 01/09/2023] Open
Abstract
The orexinergic neurons of the lateral hypothalamus (Orx) are essential for regulating sleep-wake dynamics, and their loss causes narcolepsy, a disorder characterized by severe instability of sleep and wake states. However, the mechanisms through which Orx stabilize sleep and wake are not well understood. In this work, an explanation of the stabilizing effects of Orx is presented using a quantitative model of important physiological connections between Orx and the sleep-wake switch. In addition to Orx and the sleep-wake switch, which is composed of mutually inhibitory wake-active monoaminergic neurons in brainstem and hypothalamus (MA) and the sleep-active ventrolateral preoptic neurons of the hypothalamus (VLPO), the model also includes the circadian and homeostatic sleep drives. It is shown that Orx stabilizes prolonged waking episodes via its excitatory input to MA and by relaying a circadian input to MA, thus sustaining MA firing activity during the circadian day. During sleep, both Orx and MA are inhibited by the VLPO, and the subsequent reduction in Orx input to the MA indirectly stabilizes sustained sleep episodes. Simulating a loss of Orx, the model produces dynamics resembling narcolepsy, including frequent transitions between states, reduced waking arousal levels, and a normal daily amount of total sleep. The model predicts a change in sleep timing with differences in orexin levels, with higher orexin levels delaying the normal sleep episode, suggesting that individual differences in Orx signaling may contribute to chronotype. Dynamics resembling sleep inertia also emerge from the model as a gradual sleep-to-wake transition on a timescale that varies with that of Orx dynamics. The quantitative, physiologically based model developed in this work thus provides a new explanation of how Orx stabilizes prolonged episodes of sleep and wake, and makes a range of experimentally testable predictions, including a role for Orx in chronotype and sleep inertia.
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Affiliation(s)
- Ben D. Fulcher
- School of Physics, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Andrew J. K. Phillips
- Division of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Svetlana Postnova
- School of Physics, The University of Sydney, Sydney, New South Wales, Australia
- Center for Integrated Research and Understanding of Sleep, The University of Sydney, Sydney, New South Wales, Australia
- Brain Dynamics Center, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter A. Robinson
- School of Physics, The University of Sydney, Sydney, New South Wales, Australia
- Center for Integrated Research and Understanding of Sleep, The University of Sydney, Sydney, New South Wales, Australia
- Brain Dynamics Center, The University of Sydney, Sydney, New South Wales, Australia
- Cooperative Research Center for Alertness, Safety and Productivity, The University of Sydney, Sydney, New South Wales, Australia
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Gow M. Narcolepsy goes to school: the three Rs for school nurses. NASN Sch Nurse 2014; 29:99-101. [PMID: 24707660 DOI: 10.1177/1942602x13510744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sleep disorder narcolepsy most often first appears in the teen years. It can dash the dreams of optimistic, intelligent students. It can make some students the target of nasty jokes and bullying, leaving them depressed and socially isolated. It can challenge children's self-esteem, and lowered self-esteem may last a lifetime. Typically, children with narcolepsy gain weight and have no interest in participating in anything. Many constantly feel extreme tiredness, and they may experience cataplexy. School nurses and teachers can help if they know the symptoms and practice the 3 Rs of narcolepsy: Recognize the symptoms of narcolepsy; Respect that narcolepsy is a lifelong, serious sleep disorder that needs treatment; and Refer students who exhibit symptoms to medical professionals. The 3 Rs will help students living with this lifelong disorder to get a fair shake in life's academic, social, and career arenas.
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Mediavilla C, Risco S. [Orexin: clinical and therapeutic implications]. Rev Neurol 2014; 58:117-124. [PMID: 24469938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION. Recent research has reported the existence of a new class of neuropeptides, called orexins or hypocretins, which are produced by a small group of neurons in the hypothalamus and whose actions are mediated by two types of receptors: OX1R and OX2R. More specifically, the orexinergic neurons have been located exclusively in cells in the lateral, dorsomedial and perifornical areas of the hypothalamus. Despite this highly specific anatomical origin, the orexinergic neurons are projected widely into a number of brainstem, cortical and limbic regions. DEVELOPMENT. This fuzzy pattern of distribution of the orexinergic fibres would be indicating the involvement of this peptidic system in a wide range of functions; indeed, it has been related with the mechanisms that enable regulation of the sleep-wake cycle, the ingestion of food and drink, and some particular types of learning, such as learning certain preferences regarding tastes. It has also been suggested that upsets in the functioning of the orexinergic system would explain the appearance of certain clinical disorders like narcolepsy, obesity or addiction to drug of abuse. CONCLUSIONS. Further research will help to determine the functioning of orexinergic neurons and the interaction between the systems that regulate emotion, energetic homeostasis and the reward mechanisms, on the one hand, and the systems that regulate the sleep-wake cycle on the other. That knowledge would almost certainly make it possible to develop new drugs that, by acting upon the orexinergic system, would be effective in the treatment of sleep disorders such as insomnia or narcolepsy, eating disorders or drug addiction.
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Abstract
STUDY OBJECTIVES Many cognitive factors contribute to unintentional pedestrian injury, including reaction time, impulsivity, risk-taking, attention, and decision-making. These same factors are negatively influenced by excessive daytime sleepiness (EDS), which may place children with EDS at greater risk for pedestrian injury. DESIGN PARTICIPANTS AND METHODS Using a case-control design, 33 children age 8 to 16 y with EDS from an established diagnosis of narcolepsy or idiopathic hypersomnia (IHS) engaged in a virtual reality pedestrian environment while unmedicated. Thirty-three healthy children matched by age, race, sex, and household income served as controls. RESULTS Children with EDS were riskier pedestrians than healthy children. They were twice as likely to be struck by a virtual vehicle in the virtual pedestrian environment than healthy controls. Attentional skills of looking at oncoming traffic were not impaired among children with EDS, but decision-making for when to cross the street safely was significantly impaired. CONCLUSIONS Results suggest excessive daytime sleepiness (EDS) from the clinical sleep disorders known as the hypersomnias of central origin may have significant consequences on children's daytime functioning in a critical domain of personal safety, pedestrian skills. Cognitive processes involved in safe pedestrian crossings may be impaired in children with EDS. In the pedestrian simulation, children with EDS appeared to show a pattern consistent with inattentional blindness, in that they "looked but did not process" information in their pedestrian environment. Results highlight the need for heightened awareness of potentially irreversible consequences of untreated sleep disorders and identify a possible target for pediatric injury prevention.
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Affiliation(s)
| | | | - David C. Schwebel
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL
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Depierreux-Lahaye F, Fanielle J, Martin-Lecomte M, Hans G, Maquet P, Poirrier R. [Narcolepsy-cataplexy today]. Rev Med Liege 2014; 69:72-81. [PMID: 24683827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diagnostic criteria and pathophysiology of narcolepsy-cataplexy have evolved considerably over the last 10 years. The main cause, already mentioned in a previous paper, in the Revue Médicale de Liège (65), in 2002, is based, in human beings, on a destruction of specific cells located in the lateral and posterior part of the hypothalamus (the perifornical nuclei, containing some 70,000 neurons), producing peptides which stimulate the central nervous system; they are called hypocretins or orexins. The role of autoimmunity in their disappearance becomes more evident. The treatment is simplified, but remains symptomatic. It is mainly based on Sodium Oxybate or Gamma-Hydroxybutyrate, syrup, prescribed for the night. The authors report on their own experience in this regard and on future therapeutics more targeted towards the cause of the disease.
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Mensen A, Poryazova R, Schwartz S, Khatami R. Humor as a reward mechanism: event-related potentials in the healthy and diseased brain. PLoS One 2014; 9:e85978. [PMID: 24489683 PMCID: PMC3906016 DOI: 10.1371/journal.pone.0085978] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/03/2013] [Indexed: 12/04/2022] Open
Abstract
Humor processing involves distinct processing stages including incongruity detection, emotional response, and engagement of mesolimbic reward regions. Dysfunctional reward processing and clinical symptoms in response to humor have been previously described in both hypocretin deficient narcolepsy-cataplexy (NC) and in idiopathic Parkinson disease (PD). For NC patients, humor is the strongest trigger for cataplexy, a transient loss of muscle tone, whereas dopamine-deficient PD-patients show blunted emotional responses to humor. To better understand the role of reward system and the various contributions of hypocretinergic and dopaminergic mechanisms to different stages of humor processing we examined the electrophysiological response to humorous and neutral pictures when given as reward feedback in PD, NC and healthy controls. Humor compared to neutral feedback demonstrated modulation of early ERP amplitudes likely corresponding to visual processing stages, with no group differences. At 270 ms post-feedback, conditions showed topographical and amplitudinal differences for frontal and left posterior electrodes, in that humor feedback was absent in PD patients but increased in NC patients. We suggest that this effect relates to a relatively early affective response, reminiscent of increased amygdala response reported in NC patients. Later ERP differences, corresponding to the late positive potential, revealed a lack of sustained activation in PD, likely due to altered dopamine regulation in reward structures in these patients. This research provides new insights into the temporal dynamics and underlying mechanisms of humor detection and appreciation in health and disease.
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Affiliation(s)
- Armand Mensen
- Department of Sleep Medicine, Clinic Barmelweid, Barmelweid, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, University of Geneva, Geneva, Switzerland
| | - Ramin Khatami
- Department of Sleep Medicine, Clinic Barmelweid, Barmelweid, Switzerland
- * E-mail:
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Donadio V, Liguori R, Vandi S, Giannoccaro MP, Pizza F, Leta V, Plazzi G. Sympathetic and cardiovascular changes during sleep in narcolepsy with cataplexy patients. Sleep Med 2014; 15:315-21. [PMID: 24503475 DOI: 10.1016/j.sleep.2013.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Neural mechanisms underlying sleep-onset rapid eye movement (REM) periods (SOREMPs) in narcolepsy and the role of hypocretin in driving sympathetic changes during sleep are misunderstood. We aimed to characterize autonomic changes during sleep in narcolepsy with cataplexy (NC) patients to clarify the nature of SOREMP events and the effect of hypocretin deficiency on sympathetic activity during sleep. METHODS We observed 13 hypocretin-deficient NC patients and five healthy controls who underwent nocturnal video-polysomnography (v-PSG) with blood pressure (BP) recording, heart rate (HR), skin sympathetic activity (SSA), and muscle sympathetic nerve activity (MSNA) from the peroneal nerve by microneurography. RESULTS Compared to wake, control participants displayed a progressive significant decrease of BP and sympathetic activities during nonrapid eye movement (NREM) sleep and an increase of autonomic activity during REM sleep, as expected. NC patients showed: (1) a decrease of sympathetic activities during SOREMP comparable to NREM sleep stage 1 (N1) but in contrast to the increased activity typical of REM sleep; and (2) physiologic sympathetic change during the following sleep stages with a progressive decrease during NREM sleep stage 2 (N2) and NREM sleep stage 3 (N3) and a clear increase in REM sleep, though BP did not show the physiologic decrease during sleep (nondipper pattern). CONCLUSIONS SOREMPs in NC patients lack the sympathetic activation occurring during physiologic REM sleep, thus suggesting a dissociated REM sleep condition. In addition, our data indicated that hypocretin plays a limited role in the regulation of sympathetic changes during sleep.
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Affiliation(s)
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy
| | - Stefano Vandi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy
| | - Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy
| | - Valentina Leta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy
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Abstract
Sodium oxybate (Xyrem), also known as gamma-hydroxybutyric acid, is the only therapeutic specifically approved in the USA for the treatment of cataplexy in narcolepsy. The US FDA has recently expanded its indication to include excessive daytime sleepiness associated with narcolepsy. In contrast to the antidepressants and stimulants commonly used to treat the disorder, sodium oxybate is the only compound that addresses both sets of symptoms and, when used properly, is less likely to lead to the development of tolerance and other undesirable side effects. In this review, the results of clinical trials and the place of sodium oxybate in narcolepsy treatment are discussed.
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Affiliation(s)
- Martin B Scharf
- The Center for Research in Sleep Disorders, 1275 Kemper Road Cincinnati, OH 45246-3901, USA.
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Hasegawa E, Yanagisawa M, Sakurai T, Mieda M. Orexin neurons suppress narcolepsy via 2 distinct efferent pathways. J Clin Invest 2014; 124:604-16. [PMID: 24382351 DOI: 10.1172/jci71017] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/15/2013] [Indexed: 11/17/2022] Open
Abstract
The loss of orexin neurons in humans is associated with the sleep disorder narcolepsy, which is characterized by excessive daytime sleepiness and cataplexy. Mice lacking orexin peptides, orexin neurons, or orexin receptors recapitulate human narcolepsy phenotypes, further highlighting a critical role for orexin signaling in the maintenance of wakefulness. Despite the known role of orexin neurons in narcolepsy, the precise neural mechanisms downstream of these neurons remain unknown. We found that targeted restoration of orexin receptor expression in the dorsal raphe (DR) and in the locus coeruleus (LC) of mice lacking orexin receptors inhibited cataplexy-like episodes and pathological fragmentation of wakefulness (i.e., sleepiness), respectively. The suppression of cataplexy-like episodes correlated with the number of serotonergic neurons restored with orexin receptor expression in the DR, while the consolidation of fragmented wakefulness correlated with the number of noradrenergic neurons restored in the LC. Furthermore, pharmacogenetic activation of these neurons using designer receptor exclusively activated by designer drug (DREADD) technology ameliorated narcolepsy in mice lacking orexin neurons. These results suggest that DR serotonergic and LC noradrenergic neurons play differential roles in orexin neuron-dependent regulation of sleep/wakefulness and highlight a pharmacogenetic approach for the amelioration of narcolepsy.
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Abstract
STUDY OBJECTIVES Characterize disrupted nighttime sleep (DNS) in narcolepsy, an important symptom of narcolepsy. METHODS A panel of international narcolepsy experts was convened in 2011 to build a consensus characterization of DNS in patients with narcolepsy. A literature search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. The panel reviewed the literature. Nocturnal sleep can also be disturbed by REM sleep abnormalities such as vivid dreaming and REM sleep behavior disorder; however, these were not reviewed in the current paper, as we were evaluating for idiopathic sleep disturbances. RESULTS The literature reviewed provide a consistent characterization of nighttime sleep in patients with narcolepsy as fragmented, with reports of frequent, brief nightly awakenings with difficulties returning to sleep and associated reports of poor sleep quality. Polysomnographic studies consistently report frequent awakenings/arousals after sleep onset, more stage 1 (S1) sleep, and more frequent shifts to S1 sleep or wake from deeper stages of sleep. The consensus of the International Experts' Panel on Narcolepsy was that DNS can be distressing for patients with narcolepsy and that treatment of DNS warrants consideration. CONCLUSIONS Clinicians involved in the management of patients with narcolepsy should investigate patients' quality of nighttime sleep, give weight and consideration to patient reports of nighttime sleep experience, and consider DNS a target for treatment.
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Affiliation(s)
- Thomas Roth
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI 48202, USA.
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