Sleep disorders in anti-NMDAR encephalitis

Neurology ◽  
2020 ◽  
Vol 95 (6) ◽  
pp. e671-e684 ◽  
Author(s):  
Helena Ariño ◽  
Amaia Muñoz-Lopetegi ◽  
Eugenia Martinez-Hernandez ◽  
Thaís Armangue ◽  
Mireia Rosa-Justicia ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Disease Onset ◽  
Nrem Sleep ◽  
Acute Stage ◽  
Cognitive Changes ◽  
Confusional Arousals ◽  
Nmda Receptor Encephalitis ◽  
Sleep Assessment ◽  
Normal Sleep

ObjectiveTo describe the sleep disorders in anti–NMDA receptor encephalitis (anti-NMDARe).MethodsPatients recovering from anti-NMDARe were invited to participate in a prospective observational single-center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment, and neuropsychological evaluation. Age- and sex-matched healthy participants served as controls.ResultsEighteen patients (89% female, median age 26 years, interquartile range [IQR] 21–29 years) and 21 controls (81% female, median age 23 years, IQR 18–26 years) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study admission (median 183 days after disease onset, IQR 110–242 days), 8 patients still had hypersomnia, 1 had insomnia, and 9 had normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p = 0.02, and Epworth Sleepiness Score, p = 0.04). On V-PSG, sleep efficiency was similar in both groups, but patients more frequently had multiple and longer confusional arousals in non-REM (NREM) sleep (videos provided). In addition, 13 (72%) patients had cognitive deficits; 12 (67%) had psychological, social, or occupational disability; and 33% had depression or mania. Compared with controls, patients had a higher body mass index (median 23.5 [IQR 22.3–30.2] vs 20.5 [19.1–21.1] kg/m2; p = 0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) developed hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction.ConclusionsSleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), are associated with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.

scholarly journals Sleep Disorders in Patients with Psoriatic Arthritis

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Mariana Castanho Risso
Keyword(s):  
Metabolic Syndrome ◽  
Psoriatic Arthritis ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Public Health Issue ◽  
Berlin Questionnaire ◽  
Sleep State ◽  
Simultaneous Control ◽  
Sleep Assessment

Sleep disorders are currently a major public health issue in Brazil, due to its high incidence and difficult diagnosis, identification of type and treatment.1 Rheumatic disorders have been associated with changes in sleep state, which cause reduction in quality of life, eventually reduced by the chronic inflammatory process of the primary disease.2–6 This study aimed to identify and describe the existence of sleep disturbances in patients with psoriatic arthritis, as well as to verify possible association of sleep disorders with metabolic syndrome and other parameters in these individuals. Thirty one patients with psoriatic arthritis from a Rheumatology Outpatient Clinic were analyzed. Three sleep assessment questionnaires were employed: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (EPW) and The Berlin Questionnaire (BQ). Sleep walking or talking were also inquired as a complementary scale. Sociodemographic variables and the presence of hypertension, obesity, diabetes, dyslipidemia and metabolic syndrome have also been investigated. On average, sleep disorders were found in 54.83% of the studied patients (64.5% from PSQI, 51.6% from EPW and 48.4% from Berlin) and around 70% of sleep disorders in patients with simultaneous diagnosis of metabolic syndrome and psoriatic arthritis. From these results, it is notable that sleep disorders are common in patients diagnosed with psoriatic arthritis. Thus, this pathology demands greater attention in clinical practice and search for ideal and complete therapy, in addition to simultaneous control of arthritis, sleep, hypertension, dyslipidemia and obesity.

scholarly journals Sleep-Based Interventions in Alzheimer’s Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory

2021 ◽  
Vol 14 (4) ◽  
pp. 383
Author(s):  
Susanna Cordone ◽  
Serena Scarpelli ◽  
Valentina Alfonsi ◽  
Luigi De De Gennaro ◽  
Maurizio Gorgoni
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Early Stage ◽  
Clinical Stage ◽  
Nrem Sleep ◽  
Behavioral Strategies ◽  
Healthy Elderly ◽  
Obstructive Sleep

The multifactorial nature of Alzheimer’s disease (AD) has led scientific researchers to focus on the modifiable and treatable risk factors of AD. Sleep fits into this context, given the bidirectional relationship with AD confirmed by several studies over the last years. Sleep disorders appear at an early stage of AD and continue throughout the entire course of the pathology. Specifically, sleep abnormalities, such as more fragmented sleep, increase in time of awakenings, worsening of sleep quality and primary sleep disorders raise with the severity and progression of AD. Intervening on sleep, therefore, means acting both with prevention strategies in the pre-clinical phase and with treatments during the course of the disease. This review explores sleep disturbances in the different stages of AD, starting from the pre-clinical stage. Particular attention is given to the empirical evidence investigating obstructive sleep apnea (OSA) disorder and the mechanisms overlapping and sharing with AD. Next, we discuss sleep-based intervention strategies in the healthy elderly population, mild cognitive impairment (MCI) and AD patients. We mention interventions related to behavioral strategies, combination therapies, and bright light therapy, leaving extensive space for new and raising evidence on continuous positive air pressure (CPAP) treatment effectiveness. Finally, we clarify the role of NREM sleep across the AD trajectory and consider the most recent studies based on the promising results of NREM sleep enhancement, which use innovative experimental designs and techniques.

Neuroimaging in normal sleep and sleep disorders

2017 ◽  
Author(s):  
Pierre Maquet ◽  
Julien Fanielle
Keyword(s):  
Sleep Disorders ◽  
Temporal Resolution ◽  
Functional Neuroimaging ◽  
Brain Activity ◽  
Three Dimensional ◽  
Nrem Sleep ◽  
Brain Organization ◽  
Health And Disease ◽  
Normal Sleep ◽  
Electromagnetic Signals

Functional neuroimaging techniques include methods that probe various aspects of brain function and help derive models of brain organization in health and disease. These techniques can be grouped in two categories. Some are mainly based on electromagnetic signals (electroencephalography, magnetoencephalography), recording brain activity using a large number of sensors with exquisite temporal resolution (usually of the order of a kilohertz) but allowing only indirect characterization of three-dimensional brain activity by resorting to mathematical models. The second type includes different techniques (PET scan, SPECT, MRI, optical imaging) that typically assess metabolic or hemodynamic parameters, with millimeter spatial resolution and usually from the entire brain volume. However, temporal resolution is usually low because it is primarily driven by metabolic processes that unfold in several seconds or minutes. This chapter focuses on this second type, covering the contribution of brain imaging to understanding NREM sleep and REM sleep and also sleep disorders.

Decoding the Inter-relationship between Sleep Disorders and Alzheimer’s disease Pathogenesis

2020 ◽  
Vol 19 ◽  
Author(s):  
Zeba Mueed ◽  
Pankaj Kumar Rai ◽  
Mohammad A. Kamal ◽  
Nitesh Kumar Poddar
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Mammalian Target Of Rapamycin ◽  
Light Therapy ◽  
Paired Helical Filaments ◽  
Bidirectional Relationship ◽  
Causative Agents

Alzheimer’s disease (AD), characterized by abnormally phosphorylated tau, paired helical filaments (PHFs), neurofibrillary tangles (NFTs), deregulated mammalian target of rapamycin (mTOR), Aβ deposits, is a multifactorial disease with sleep disorders being one of the causative agents. Therefore, we have reviewed the literature and have tried to decode the existence of positive feedback, reciprocal and a bidirectional relationship allying between sleep disturbances and AD. Much light has been thrown on the role of tau pathology and amyloid pathology in sleep pathology and its association with AD pathology. We have also discussed the role of melatonin in regulating sleep disorders and AD. The neuroprotective action of melatonin via inhibiting tau hyperphosphorylation and Aβ deposition has also been pondered upon. Moreover, astrocytes involvement in aggravating AD has also been highlighted in this review. Several therapeutic approaches aimed at improving both sleep disorders and AD have been duly discussed such as administration of antidepressants and antihistamines, immunotherapy, metal chelators, melatonin supplementation, light therapy and physical activity. Despite consistent efforts, the complete etiology concerning sleep disorder and AD is still unclear. Therefore, further research is needed to unravel the mechanism involved and also to develop strategies that may help in obstructing AD in its preclinical stage.

scholarly journals A systematic review and meta-analysis of prevalence of insomnia in the third trimester of pregnancy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nader Salari ◽  
Niloofar Darvishi ◽  
Behnam Khaledi-Paveh ◽  
Aliakbar Vaisi-Raygani ◽  
Rostam Jalali ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Physical And Mental Health ◽  
Third Trimester ◽  
Cross Sectional ◽  
The Third ◽  
Physical Problems ◽  
Meta Regression Analysis

Abstract Background Sleep disorders, which are among the foremost important medical care issues, are prevalent in pregnancy. The present study is a meta-analysis of the prevalence of insomnia in the third trimester of pregnancy. This study aims to systematically review the overall prevalence of insomnia in the third trimester of pregnancy through conducting a meta-analysis. Method The literature used in this meta-analysis for the topic discussed above were obtained through searching several databases, including SID, MagIran, IranDoc, Scopus, Embase, Web of Science (WoS), PubMed Science Direct and Google Scholar databases without time limitation until December 2020. Articles developed based on cross-sectional studies were included in the study. The heterogeneity of studies was investigated using the I2 index. Also, the possible effects of heterogeneity in the studied studies are investigated using meta-regression analysis. Result In 10 articles and 8798 participants aged between11–40, the overall prevalence of insomnia in the third trimester of pregnancy based on meta-analysis was 42.4% (95% CI: 32.9–52.5%). It was reported that as the sample size increases, the prevalence of insomnia in the third trimester of pregnancy increases. Conversely, as the year of research increases, the prevalence of insomnia in the third trimester of pregnancy decreases. Both of these differences were statistically significant (P < 0.05). Conclusion Insomnia was highly prevalent in the last trimester of pregnancy. Sleep disorders are neglected among pregnant women, and they are considered natural. While sleep disturbances can cause mental and physical problems in pregnant women, they can consequently cause problems for the fetus. As a result, maintaining the physical and mental health of pregnant mothers is very important. It is thus recommended that in addition to having regular visits during pregnancy, pregnant women should also be continuously monitored for sleep-related disorders.

The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals, Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units

2021 ◽  
Vol 80 ◽  
pp. 279-285
Author(s):  
Giuseppe Loddo ◽  
Giusy La Fauci ◽  
Luca Vignatelli ◽  
Corrado Zenesini ◽  
Rosalia Cilea ◽  
...  
Keyword(s):  
Sleep Disorders ◽  
Screening Tool ◽  
Effective Screening ◽  
Confusional Arousals ◽  
Sleep Terrors

scholarly journals Sleep Disturbance, Sleep Disorders and Co-Morbidities in the Care of the Older Person

2021 ◽  
Vol 9 (2) ◽  
pp. 31
Author(s):  
Christine E. Mc Carthy
Keyword(s):  
Sleep Disturbance ◽  
Sleep Disorders ◽  
Older Patients ◽  
Disease Risk ◽  
Medication Management ◽  
Sleep Complaints ◽  
Co Morbidity ◽  
Sleep Assessment ◽  
Form Part

Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson’s disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.

NORMAL SLEEP AND SLEEP DISORDERS

1995 ◽  
Vol 7 (2) ◽  
pp. 181-194
Author(s):  
G. Vernon Pegram ◽  
Ed Lucas
Keyword(s):  
Sleep Disorders ◽  
Normal Sleep

Sleep Disorders

2015 ◽  
Author(s):  
Sudhansu Chokroverty
Keyword(s):  
Sleep Apnea ◽  
Sleep Disorders ◽  
Eye Movement ◽  
Rem Sleep ◽  
Sleep Apnea Syndrome ◽  
Nrem Sleep ◽  
Rapid Eye Movement ◽  
Circadian Rhythm Sleep Disorders ◽  
Apnea Syndrome ◽  
Sleep Mechanism

Recent research has generated an enormous fund of knowledge about the neurobiology of sleep and wakefulness. Sleeping and waking brain circuits can now be studied by sophisticated neuroimaging techniques that map different areas of the brain during different sleep states and stages. Although the exact biologic functions of sleep are not known, sleep is essential, and sleep deprivation leads to impaired attention and decreased performance. Sleep is also believed to have restorative, conservative, adaptive, thermoregulatory, and consolidative functions. This review discusses the physiology of sleep, including its two independent states, rapid eye movement (REM) and non–rapid eye movement (NREM) sleep, as well as functional neuroanatomy, physiologic changes during sleep, and circadian rhythms. The classification and diagnosis of sleep disorders are discussed generally. The diagnosis and treatment of the following disorders are described: obstructive sleep apnea syndrome, narcolepsy-cataplexy sydrome, idiopathic hypersomnia, restless legs syndrome (RLS) and periodic limb movements in sleep, circadian rhythm sleep disorders, insomnias, nocturnal frontal lobe epilepsy, and parasomnias. Sleep-related movement disorders and the relationship between sleep and psychiatric disorders are also discussed. Tables describe behavioral and physiologic characteristics of states of awareness, the international classification of sleep disorders, common sleep complaints, comorbid insomnia disorders, causes of excessive daytime somnolence, laboratory tests to assess sleep disorders, essential diagnostic criteria for RLS and Willis-Ekbom disease, and drug therapy for insomnia. Figures include polysomnographic recording showing wakefulness in an adult; stage 1, 2, and 3 NREM sleep in an adult; REM sleep in an adult; a patient with sleep apnea syndrome; a patient with Cheyne-Stokes breathing; a patient with RLS; and a patient with dream-enacting behavior; schematic sagittal section of the brainstem of the cat; schematic diagram of the McCarley-Hobson model of REM sleep mechanism; the Lu-Saper “flip-flop” model; the Luppi model to explain REM sleep mechanism; and a wrist actigraph from a man with bipolar disorder. This review contains 14 highly rendered figures, 8 tables, 115 references, and 5 MCQs.

Features of modern approaches to the diagnosis and treatment of insomnia

2020 ◽  
pp. 56-66
Author(s):  
Dmitry Fedorovich Khritinin ◽  
M. A. Sumarokova ◽  
E. P. Schukina
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Secondary Prevention ◽  
Sleep Disorders ◽  
Sleep Disturbances ◽  
Behavioral Therapy ◽  
Mental Illnesses ◽  
Cognitive Behavioral ◽  
Relaxation Techniques ◽  
Primary And Secondary Prevention ◽  
Prevention And Treatment

Currently, insomnia is not only a medical, but also a social as well as an economic problem. Sleep disorders increase the risk of somatic, neurological and mental illnesses. The shift schedule has a significant impact on the employee’s health, increasing the risk of developing such disorders as metabolic syndrome, arterial hypertension and other. As a result of sleep disturbances, lipid peroxidation processes may intensify, which can lead to the disorders described above. Therefore, the prevention and treatment of sleep disorders is an important aspect of chronic diseases diagnostics. In our opinion, it is crucial to study possible sleep disorders for their timely correction. The article discusses the features of drug and non-drug treatment of sleep disorders, as well as approaches to the primary and secondary prevention of insomnia. It is recommended to begin the treatment of sleep disorders with cognitive-behavioral therapy. Cognitive-behavioral therapy for insomnia typically includes psycho-education, training in relaxation techniques, stimulation limitation method, sleep limitation therapy, and cognitive therapy. When developing recreational activities for employees with a shift work schedule, attention should be paid to work and rest regimes, prevention of fatigue and obesity, and the sleep disorders treatment. Training in sleep hygiene and improving its compliance in the target groups is regarded as a method of non-pharmacological treatment of sleep disorders and a means of primary and secondary prevention of insomnia. In our opinion, further research on the features of the prevention and treatment of insomnia in various population groups is needed. Effective primary and secondary prevention of sleep disorders will reduce the risks of developing neurological, somatic and mental diseases and significantly improve the quality of life.

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