Rare Case of Late-Onset Narcolepsy Type 1

A 69-year-old male developed symptoms typical of the diagnosis of narcolepsy type 1 without any previous triggering events. First, daytime sleepiness occurred, soon followed by cataplexy. Nocturnal polysomnography revealed rapid eye movement (REM) sleep behavior disorder, a apnea-hypopnea index of 25.8 events/h, and no sleep-onset REM. Multiple Sleep Latency Test showed a mean sleep latency of 2.1 min and REM sleep in 3 tests. HLA DQB1*06:02 was positive and hypocretin-1 in cerebrospinal fluid unmeasurable. A treatment with 50 mg clomipramine controlled the cataplexy; excessive daytime sleepiness was sufficiently managed by repeated naps. The administration of 0.25 mg of clonazepam subjectively improved REM sleep behavior disorder. Bilevel Positive Airway Pressure improved the apnea-hypopnea index without important influence on sleepiness. Our unique case demonstrates that even elderly subjects can develop narcolepsy type 1.

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REM sleep behavior disorder in children with type 1 Narcolepsy treated with Sodium Oxybate

Neurology ◽

10.1212/wnl.0000000000011157 ◽

2020 ◽

pp. 10.1212/WNL.0000000000011157

Author(s):

Elena Antelmi ◽

Marco Filardi ◽

Fabio Pizza ◽

Stefano Vandi ◽

Monica Moresco ◽

...

Keyword(s):

Rem Sleep ◽

Sleep Stage ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Sodium Oxybate ◽

Direct Role ◽

Sleep Behavior ◽

Rem Sleep Without Atonia ◽

Nighttime Sleep

Objective:The aim was to study the effect of stable treatment with Sodium Oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1.Methods:Nineteen NT1 children and adolescents (nine females; mean age 12.5±2.7, mean disease duration: 3.4±1.6 years) underwent neurological investigations and video-polysomnography (v-PSG) at baseline and after three months of stable treatment with SO.v-PSG was independently analysed by two sleep experts, in order to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI).Results:Compared to baseline, RAI significantly improved (p< 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep stage architecture.Conclusions:RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep.

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A case of type 1 narcolepsy with REM sleep behavior disorder

Sleep Medicine ◽

10.1016/j.sleep.2017.11.712 ◽

2017 ◽

Vol 40 ◽

pp. e244

Author(s):

J. Oh ◽

Y. Um ◽

S. Hong

Keyword(s):

Rem Sleep ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Sleep Behavior

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P2-107: Anxiety and apathy are associated with probable REM sleep behavior disorder among cognitively normal elderly subjects: The Mayo Clinic study of aging

Alzheimer s & Dementia ◽

10.1016/j.jalz.2008.05.1181 ◽

2008 ◽

Vol 4 ◽

pp. T402-T402

Author(s):

Jennifer Molano ◽

Bradley Boeve ◽

Rosebud Roberts ◽

Yonas V. Geda ◽

David Knopman ◽

...

Keyword(s):

Rem Sleep ◽

Mayo Clinic ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Elderly Subjects ◽

Sleep Behavior ◽

Cognitively Normal ◽

Clinic Study

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Sleep quality, REM sleep behavior disorder and daytime sleepiness in adults with and without Parkinson's

Archivos de Neurociencias ◽

10.31157/archneurosciencesmex.v26i2.271 ◽

2021 ◽

Vol 26 (2) ◽

pp. 20-25

Author(s):

Andrea Díaz Pacheco ◽

Jesús Moo Estrella

Keyword(s):

Parkinson’S Disease ◽

Sleep Quality ◽

Rem Sleep ◽

Daytime Sleepiness ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Control Group ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Sleep Behavior

In Parkinson's disease (PD), poor sleep quality and sleep disorders are central part of the non-motor symptoms. The aim was to compare sleep quality (SQ), REM sleep behavior disorder (RBD) and excessive daytime sleepiness (EDS) among adults with and without Parkinson's disease (PD). A second objective was to know the relationship of SQ and RBD with EDS in patients with PD. Method. sixty adults (38 % women, mean age 66.7 ± 8.11 years), 50 % with PD diagnosis and 50 % healthy controls, Instruments: Epworth Sleepiness Scale, Sleep Quality Pittsburgh Index and REM Behavioral Disorder Sleep Questionnaire, which was designed for this study. Results. Differences were found in SQ (PD = 9.90 ±4.47 vs Control group = 7.23 ±4.71, t = 2.25, p = .028), and the percentage of cases with symptoms of RBD (PD = 30%, control group = 6.7%, ji2 = 5.455, p = .020). No differences were found in EDS (PD = 7.43 ± 5.46 vs Control group = 6.50 ± 5.28, t = .673, p = .504). According to the linear regression analysis, the increase in EDS was not associated with SQ, EDS was only associated with RBD. Conclusion, the PD group presents a poor sleep quality and a higher prevalence of RBD symptoms. EDS did not differ between adults with and without PD. However, RBD was associated with an increase in EDS in the PD group.

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Preliminary finding of a randomized, double-blind, placebo-controlled, crossover study to evaluate the safety and efficacy of 5-hydroxytryptophan on REM sleep behavior disorder in Parkinson’s disease

Sleep And Breathing ◽

10.1007/s11325-021-02417-w ◽

2021 ◽

Author(s):

Mario Meloni ◽

Michela Figorilli ◽

Manolo Carta ◽

Ludovica Tamburrino ◽

Antonino Cannas ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rem Sleep ◽

Rating Scale ◽

Sleep Onset ◽

Rem Sleep Behavior Disorder ◽

Behavior Disorder ◽

Double Blind ◽

Sleep Behavior ◽

Double Blind Placebo

Abstract Purpose Altered serotonergic neurotransmission may contribute to the non-motor features commonly associated with Parkinson’s disease (PD) such as sleep disorders. The 5-hydroxytryptophan (5-HTP) is the intermediate metabolite of l-tryptophan in the production of serotonin and melatonin. The purpose of this study was to compare the effects of 5-HTP to placebo on REM sleep behavior disorder (RBD) status in patients with PD. Methods A single-center, randomized, double-blind placebo-controlled crossover trial was performed in a selected population of 18 patients with PD and RBD. The patients received a placebo and 50 mg of 5-HTP daily in a crossover design over a period of 4 weeks. Results 5-HTP produced an increase in the total percentage of stage REM sleep without a related increase of RBD episodes, as well as a marginal, non-significant reduction in both arousal index and wake after sleep onset. The self-reported RBD frequency and clinical global impression (CGI) were improved during 5-HTP and placebo treatment in comparison to baseline. 5-HTP significantly improved our patients’ motor experiences of daily living as rated by the Unified Parkinson’s Disease Rating Scale (UPDRS) part II. Conclusions This study provides evidence that 5-HTP is safe and effective in improving sleep stability in PD, contributing to ameliorate patients’ global sleep quality. Larger studies with higher doses and longer treatment duration are needed to corroborate these preliminary findings.

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