1,721,636 research outputs found
Disrupted nighttime sleep and sleep instability in narcolepsy
No full textSTUDY OBJECTIVES: This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. METHODS: One hundred two peer-reviewed publications from a PubMed search were included. RESULTS: DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. CONCLUSIONS: DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research. CITATION: Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med. 2022;18(1):289-304
Diurnal and nocturnal sleep in narcolepsy with cataplexy
No full textNarcolepsy is an under-recognized disease, but classically reported as one of the most severe conditions of chronic hypersomnia. Excessive daytime sleepiness is usually the first symptom to appear in childhood or in young adulthood, occurring daily, often irresistible, with short duration, capable of restoring normal vigilance for one to several hours, and associated with dreaming. In contrast, disturbed nocturnal sleep is clearly underestimated in that condition and, even if not included in diagnostic criteria, this complaint may be considered as the fifth component in addition to the narcolepsy tetrad. The presence of poor sleep at night may represent a significant and severe symptom in patients, especially with the evolution process. The diagnosis of narcolepsy with cataplexy is essentially clinical, but requires, whenever possible, a nocturnal PSG recording followed by an MSLT showing short mean sleep latencies and the presence of sleep-onset REM (REM) periods. Typically, the nighttime sleep of narcoleptics is highly fragmented with several long awakenings that may be associated with dissociated sleep/wake states, abnormal movements or behaviours during REM or non-REM (NREM) sleep, periodic leg movements during wakefulness and sleep, and sleep-disorder breathing. All narcolepsy symptoms and associated conditions need to be considered in the management of the disorder, but daytime sleepiness in narcolepsy seems independent of the amount and quality of nighttime sleep. © 2010 Springer-Verlag New York
REM sleep behavior disorder in narcolepsy with cataplexy
No full textNarcolepsy with cataplexy (NC) is a chronic disease characterized by excessive daytime sleepiness, striking transitions from wakefulness into rapid eye movement (REM) sleep, typically associated with cataplexy and other phenomena due to the abnormal occurrence of REM sleep elements during wakefulness (sleep paralysis and hallucinations) and frequent sleep/wake transitions. Nocturnal sleep in NC is usually disturbed by a large cohort of phenomena: vivid frightening dreams, several nocturnal awakenings, REM sleep behavior disorder (RBD), periodic leg movement (PLM), obstructive sleep apnea (OSA), sleep-related eating disorders and other parasomnias. Several clinical and polysomnographic aspects seem to differentiate RBD in patients with narcolepsy from idiopathic or secondary RBD, suggesting the involvement of specific neurophysiological, neurochemical and neuropathological substrates. © 2010 Springer-Verlag New York
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