Disrupted nighttime sleep and sleep instability in narcolepsy

被引:63
作者
Maski, Kiran [1 ]
Mignot, Emmanuel [2 ]
Plazzi, Giuseppe [3 ,4 ]
Dauvilliers, Yves [5 ,6 ]
机构
[1] Boston Childrens Hosp, Dept Neurol, 300 Longwood Ave, Boston, MA 02130 USA
[2] Stanford Ctr Sleep Sci & Med, Redwood City, CA USA
[3] Univ Modena & Reggio Emilia, Dept Biomed Metab & Neural Sci, Modena, Italy
[4] Ist Sci Neurol, IRCCS, Bologna, Italy
[5] Gui de Chauliac Hosp, Sleep & Wake Disorders Ctr, Dept Neurol, Natl Reference Network Narcolepsy, Montpellier, France
[6] Univ Montpellier, INSERM, Inst Neurosci Montpellier, Montpellier, France
来源
JOURNAL OF CLINICAL SLEEP MEDICINE | 2022年 / 18卷 / 01期
关键词
orexin/hypocretin; disrupted nighttime sleep; narcolepsy; polysomnography; sleep instability; EXCESSIVE DAYTIME SLEEPINESS; EYE-MOVEMENT SLEEP; NOCTURNAL SLEEP; SODIUM OXYBATE; REM-SLEEP; IDIOPATHIC HYPERSOMNIA; HYPOCRETIN DEFICIENCY; CHILDHOOD NARCOLEPSY; BEHAVIOR DISORDER; SCHEDULED NAPS;
D O I
10.5664/jcsm.9638
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. Methods: One hundred two peer-reviewed publications from a PubMed search were included. Results: DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. Conclusions: DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research.
引用
收藏
页码:289 / 304
页数:16
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