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Gnarra O, Calvello C, Schirinzi T, Beozzo F, De Masi C, Spanetta M, Fernandes M, Grillo P, Cerroni R, Pierantozzi M, Bassetti CLA, Mercuri NB, Stefani A, Liguori C. Exploring the Association Linking Head Position and Sleep Architecture to Motor Impairment in Parkinson's Disease: An Exploratory Study. J Pers Med 2023; 13:1591. [PMID: 38003906 PMCID: PMC10671918 DOI: 10.3390/jpm13111591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Patients with Parkinson's disease (PD) tend to sleep more frequently in the supine position and less often change head and body position during sleep. Besides sleep quality and continuity, head and body positions are crucial for glymphatic system (GS) activity. This pilot study evaluated sleep architecture and head position during each sleep stage in idiopathic PD patients without cognitive impairment, correlating sleep data to patients' motor and non-motor symptoms (NMS). All patients underwent the multi-night recordings, which were acquired using the Sleep Profiler headband. Sleep parameters, sleep time in each head position, and percentage of slow wave activity (SWA) in sleep, stage 3 of non-REM sleep (N3), and REM sleep in the supine position were extracted. Lastly, correlations with motor impairment and NMS were performed. Twenty PD patients (65.7 ± 8.6 y.o, ten women) were included. Sleep architecture did not change across the different nights of recording and showed the prevalence of sleep performed in the supine position. In addition, SWA and N3 were more frequently in the supine head position, and N3 in the supine decubitus correlated with REM sleep performed in the same position; this latter correlated with the disease duration (correlation coefficient = 0.48, p-value = 0.03) and motor impairment (correlation coefficient = 0.53, p-value = 0.02). These preliminary results demonstrated the importance of monitoring sleep in PD patients, supporting the need for preventive strategies in clinical practice for maintaining the lateral head position during the crucial sleep stages (SWA, N3, REM), essential for permitting the GS function and activity and ensuring brain health.
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Affiliation(s)
- Oriella Gnarra
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital of Bern, 3010 Bern, Switzerland; (O.G.); (C.L.A.B.)
- Sensory-Motor Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Carmen Calvello
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | - Francesca Beozzo
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
| | - Claudia De Masi
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | | | - Mariana Fernandes
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
| | - Piergiorgio Grillo
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | - Rocco Cerroni
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | - Mariangela Pierantozzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | - Claudio L. A. Bassetti
- Sleep-Wake-Epilepsy Center, Department of Neurology, University Hospital of Bern, 3010 Bern, Switzerland; (O.G.); (C.L.A.B.)
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
- Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Alessandro Stefani
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
- Parkinson’s Disease Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy; (C.D.M.); (P.G.); (R.C.)
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (C.C.); (T.S.); (F.B.); (M.P.); (N.B.M.); (A.S.)
- Neurology Unit, University Hospital of Rome “Tor Vergata”, 00133 Rome, Italy
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Baillieul S, Denis C, Barateau L, Arquizan C, Detante O, Pépin JL, Dauvilliers Y, Tamisier R. The multifaceted aspects of sleep and sleep-wake disorders following stroke. Rev Neurol (Paris) 2023; 179:782-792. [PMID: 37612191 DOI: 10.1016/j.neurol.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
Sleep-wake disorders (SWD) are acknowledged risk factors for both ischemic stroke and poor cardiovascular and functional outcome after stroke. SWD are frequent following stroke, with sleep apnea (SA) being the most frequent SWD affecting more than half of stroke survivors. While sleep disturbances and SWD are frequently reported in the acute phase, they may persist in the chronic phase after an ischemic stroke. Despite the frequency and risk associated with SWD following stroke, screening for SWD remains rare in the clinical setting, due to challenges in the assessment of post-stroke SWD, uncertainty regarding the optimal timing for their diagnosis, and a lack of clear treatment guidelines (i.e., when to treat and the optimal treatment strategy). However, little evidence support the feasibility of SWD treatment even in the acute phase of stroke and its favorable effect on long-term cardiovascular and functional outcomes. Thus, sleep health recommendations and SWD treatment should be systematically embedded in secondary stroke prevention strategy. We therefore propose that the management of SWD associated with stroke should rely on a multidisciplinary approach, with an integrated diagnostic, treatment, and follow-up strategy. The challenges in the field are to improve post-stroke SWD diagnosis, prognosis and treatment, through a better appraisal of their pathophysiology and temporal evolution.
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Affiliation(s)
- S Baillieul
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France.
| | - C Denis
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - C Arquizan
- Department of Neurology, Hôpital Gui-de-Chauliac, Montpellier, France; Inserm U1266, Paris, France
| | - O Detante
- Neurology Department, Grenoble Alpes University Hospital, Grenoble, France
| | - J-L Pépin
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy Rare Hypersomnias, Sleep Disorders Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| | - R Tamisier
- Université Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, 38000 Grenoble, France
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Gombolay G, Morris M, Loerinc L, Blackwell L, Howarth R. Sleep Characteristics in Pediatric Anti- N-methyl-d-aspartate (NMDA) Receptor Encephalitis: A Retrospective Cohort Study. J Child Neurol 2023; 38:298-306. [PMID: 37203168 PMCID: PMC10524468 DOI: 10.1177/08830738231173603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background: Rates of sleep problems in children with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis are unknown. Methods: We used a retrospective observational cohort database of children with a diagnosis of NMDA receptor encephalitis at a single freestanding institution. One-year outcomes were assessed with the pediatric modified Rankin Score (mRS), with 0 to 2 as good and 3 or greater as poor outcome. Results: Ninety-five percent (39/41) of children with NMDA receptor encephalitis had sleep dysfunction at onset; 34% (11/32) reported sleep problems at 1 year. Sleep problems at onset and propofol use were not associated with poor outcomes at 1 year. Poor sleep at 1 year correlated with mRS scores (range 2-5) at 1 year. Discussion: High rates of sleep dysfunction occur in children with NMDA receptor encephalitis. Persistent sleep problems at 1 year may correlate with outcomes as assessed by mRS at 1 year. Further studies comparing the relationship of poor sleep with outcomes in NMDA receptor encephalitis are needed.
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Affiliation(s)
- Grace Gombolay
- Department of Pediatric Neurology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
| | - Morgan Morris
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
| | - Leah Loerinc
- Emory University School of Medicine, Atlanta, GA, USA
| | - Laura Blackwell
- Emory University School of Medicine, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
- Department of Pediatric Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Robyn Howarth
- Department of Pediatric Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Study of Brain Circadian Rhythms in Patients with Chronic Disorders of Consciousness and Healthy Individuals Using Microwave Radiometry. Diagnostics (Basel) 2022; 12:diagnostics12081777. [PMID: 35892486 PMCID: PMC9331034 DOI: 10.3390/diagnostics12081777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
The study of circadian rhythms in the human body using temperature measurements is the most informative way to assess the viability of the body’s rhythm-organizing systems. Pathological processes can affect circadian rhythm dynamics in damaged organs. Severe brain damage that caused the development of disorders of consciousness (DOC) (strokes, traumatic brain injury) disrupts the activity of central oscillators, by directly damaging or destroying the periphery links, and the level of preservation of circadian rhythms and the dynamics of their recovery can be informative diagnostic criteria for patient’s condition assessment. This study examined 23 patients with DOC by using a non-invasive method for obtaining body and cerebral cortex temperature to compare with healthy controls. Measurements were made with a 4 h interval for 52 h beginning at 08:00 on day 1 and ending at 08:00 on day 3. The profile of patients with DOC showed complete disruption compared to healthy controls with rhythmic patterns. The results indicate that the mechanisms for maintaining brain circadian rhythms are different from general homeostasis regulation of the body. Use of microwave radio thermometry for the identification of rehabilitation potential in patients with DOC is a promising area of investigation.
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