1
|
Xu W, Zhang X, Zhang B, Lu S, Huang W, Xu J, Liu Y, Zhao W, Yan Z, Yu Y, Qiu S, Wu B, Tang J. Clinical features and mechanisms of neck myoclonus in narcolepsy. Sleep Med 2024; 123:22-28. [PMID: 39226673 DOI: 10.1016/j.sleep.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/25/2024] [Accepted: 08/21/2024] [Indexed: 09/05/2024]
Abstract
STUDY OBJECTIVES The purpose of this study was to investigate the effects of neck myoclonus (NM) on sleep quality and daytime sleepiness in patients with narcolepsy (NT) and to further explore possible underlying mechanisms. METHODS We included 72 patients with narcolepsy type 1 (NT1), 34 patients with narcolepsy type 2 (NT2) and 33 healthy controls. Patients underwent questionnaires, lumbar puncture procedure, polysomnography, and multiple sleep latency test (MSLT). Healthy controls underwent polysomnography and questionnaires. Orexin-A levels in the cerebrospinal fluid (CSF) were analyzed by radioimmunoassay. Three catecholamines, including dopamine, norepinephrine and epinephrine, in the CSF were measured by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). RESULTS Both the NT1 and NT2 groups displayed a higher level of NM incidence rate and index compared to the control group in PSG. NT1 displayed greater MSLT REM--NM incidence rate and index than NT2. NM were often associated with arousal or awakening and body movements, which had a prominent influence on sleep quality in both narcoleptic patients and controls. There was a positive correlation between the NM index and the Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS) and Ullanlinna Narcolepsy Scale (UNS) scores in NT1 patients. In MSLT of NT1 patients, REM-NM index were positively correlated with the CSF dopamine levels, and there were elevated dopamine levels but reduced orexin-A levels in patients with REM-NM. CONCLUSION NM incidence rate and index were high in patients with narcolepsy, which had a huge effect on sleep quality and aggravated daytime sleepiness. NM should be considered pathological and viewed as a new sleep-related movement disorder. Orexin-A and dopamine may be involved in the development of NM.
Collapse
Affiliation(s)
- Wei Xu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766, Jingshi Road, Jinan, Shandong, 250014, People's Republic of China; Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Xiao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Baokun Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766, Jingshi Road, Jinan, Shandong, 250014, People's Republic of China
| | - Shanshan Lu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Weiwei Huang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Juanjuan Xu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Ying Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Wanyu Zhao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Zian Yan
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Yixin Yu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Shenghan Qiu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Bingyun Wu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China
| | - Jiyou Tang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, NO. 16766, Jingshi Road, Jinan, Shandong, 250014, People's Republic of China; Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, People's Republic of China.
| |
Collapse
|
2
|
Milane T, Hansen C, Correno MB, Chardon M, Barbieri FA, Bianchini E, Vuillerme N. Comparison of number of people with freezing of gait in Parkinson's disease with and without sleep disturbances: A systematic review. Sleep Med 2024; 121:32-41. [PMID: 38908269 DOI: 10.1016/j.sleep.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/08/2024] [Accepted: 06/04/2024] [Indexed: 06/24/2024]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder, involving motor and non-motor symptoms (NMS). Sleep disturbances (SD) are the second most common NMS in PD and include rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness and insomnia. Freezing of gait (FOG) is a gait impairment frequently reported in people with PD greatly hampering functional independence and quality of life. Presence of FOG has been associated with increased frequency and severity of NMS, including SD. Thus, the aim of this study was to systematically review the literature comparing the number of people with FOG in PD with (PD + SD) and without SD (PD-SD). By systematically searching PubMed and Web of Science databases to identify original peer-reviewed articles, 8 studies including 5251 people with PD (2025 PD + SD and 3226 PD-SD) met eligibility criteria and were included in the review. In 6 studies (4 studies investigating RBD, 2 studies investigating overall sleep quality), the group of PD + SD had higher prevalence of FOG compared with PD-SD. Although a limited number of studies, our findings suggest that PD + SD present more frequently FOG than PD-SD. More studies are required to investigate the possible mechanism underlying this association between FOG and sleep.
Collapse
Affiliation(s)
- Tracy Milane
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany.
| | - Mathias Baptiste Correno
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neurology, UKSH Campus Kiel, Kiel University, Arnold-Heller-Str. 3, Haus D, 24105, Kiel, Germany
| | - Matthias Chardon
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Fabio Augusto Barbieri
- São Paulo State University (UNESP), School of Sciences, Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), Bauru, Brazil
| | - Edoardo Bianchini
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, 00189, Rome, Italy
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000, Grenoble, France; LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38000, Grenoble, France; Institut Universitaire de France, 75005, Paris, France.
| |
Collapse
|
3
|
Chen Y, Xie WY, Xia D, Zhang MT, Sun YR, Duan WX, Shen Y, Wang F, Qu WM, Huang ZL, Liu CF. GBA-AAV mitigates sleep disruptions and motor deficits in mice with REM sleep behavior disorder. NPJ Parkinsons Dis 2024; 10:142. [PMID: 39095359 PMCID: PMC11297138 DOI: 10.1038/s41531-024-00756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
Sleep disturbances, including rapid eye movement sleep behavior disorder (RBD), excessive daytime sleepiness, and insomnia, are common non-motor manifestations of Parkinson's disease (PD). Little is known about the underlying mechanisms, partly due to the inability of current rodent models to adequately mimic the human PD sleep phenotype. Clinically, increasing studies have reported that variants of the glucocerebrosidase gene (GBA) increase the risk of PD. Here, we developed a mouse model characterized by sleep-wakefulness by injecting α-synuclein preformed fibronectin (PFF) into the sublaterodorsal tegmental nucleus (SLD) of GBA L444P mutant mice and investigated the role of the GBA L444P variant in the transition from rapid eye movement sleep behavior disorder to PD. Initially, we analyzed spectral correlates of REM and NREM sleep in GBA L444P mutant mice. Importantly, EEG power spectral analysis revealed that GBA L444P mutation mice exhibited reduced delta power during non-rapid eye movement (NREM) sleep and increased theta power (8.2-10 Hz) in active rapid eye movement (REM) sleep phases. Our study revealed that GBA L444P-mutant mice, after receiving PFF injections, exhibited increased sleep fragmentation, significant motor and cognitive dysfunctions, and loss of dopaminergic neurons in the substantia nigra. Furthermore, the over-expression of GBA-AAV partially improved these sleep disturbances and motor and cognitive impairments. In conclusion, we present the initial evidence that the GBA L444P mutant mouse serves as an essential tool in understanding the complex sleep disturbances associated with PD. This model further provides insights into potential therapeutic approaches, particularly concerning α-synuclein accumulation and its subsequent pathological consequences.
Collapse
Affiliation(s)
- Ying Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China
| | - Wei-Ye Xie
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China
| | - Dong Xia
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China
| | - Mu-Tian Zhang
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, 200032, Shanghai, China
| | - Yan-Rui Sun
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China
| | - Wen-Xiang Duan
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China
| | - Fen Wang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China
| | - Wei-Min Qu
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, 200032, Shanghai, China
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, 200032, Shanghai, China.
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, 215004, Suzhou, China.
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, 215123, Suzhou, Jiangsu, China.
- Department of Neurology, Xiongan Xuanwu Hospital, 071700, Xiongan, China.
| |
Collapse
|
4
|
Küçükali Cİ, Yılmaz V, Karadeniz D, Akyıldız UO, İlhan Algın D, Sarıtaş AŞ, Kısabay Ak A, Bican Demir A, Yılmaz H, Domaç FM, Elmalı AD, Hoş ÜD, Gözübatık-Çelik RG, Kabeloğlu V, Bilgin B, Tuncel Berktaş D, Türk BG, Delil Ş, Dilber C, Terzioğlu Öztürk S, Yeni SN, Özkara Ç, Aksu M, Tüzün E, Benbir Şenel G. Distinctive sleep complaints and polysomnographic findings in antibody subgroups of autoimmune limbic encephalitis. Neurol Sci 2024:10.1007/s10072-024-07652-z. [PMID: 38913197 DOI: 10.1007/s10072-024-07652-z] [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: 03/14/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Sleep disturbances are being increasingly recognized in association with autoimmune encephalitis (AIE). We investigated the prevalence of sleep-related symptoms and polysomnographic features of patients with AIE and the long-term outcomes in these patients in a multi-center, prospective study from Turkey. METHODS We prospectively evaluated patients with definite AIE in a common database including demographics, AIE-related and sleep-related symptomatology. Maximum and latest modified Rankin scores (mRS) and Liverpool Outcome Score (LOS) were noted. RESULTS Of 142 patients, 87 patients (61.3%) fulfilled the criteria for definite AIE (mean age, 46.8+18.8 years; 51.7% women; mean disease duration, 21.0+38.4 months). 78.9% of patients had at least one or more new onset or worsened sleep-related symptomatology: insomnia (55.3%), excessive daytime sleepiness (EDS, 28.0%), sleep apnea (18.7%), REM sleep behavior disorder (RBD, 17.3%), restless legs syndrome (10.7%) and oneiric stupor (9.3%). Sleep efficiency, N3 and REM sleep were decreased and N1 sleep was increased in patients with Ab[+] AIE. LOS points were highest in those with insomnia and sleep apnea, and lowest in those with EDS, RBD and oneiric stupor. RBD and sleep apnea were more common in anti-LG1 Ab[+] group than anti-NMDAR Ab[+] group. Index of periodic leg movements was highest in anti-LG1 Ab[+] group. Patients with EDS and oneiric stupor had more common memory problems. Maximum and latest mRS scores were positively correlated with EDS and oneiric stupor. EDS, RBD and oneiric stupor were negatively correlated with LOS points. CONCLUSION Our study emphasizes the presence and importance of early diagnosis of sleep disturbances in AIE in regard to their deteriorative influences on disease prognosis.
Collapse
Affiliation(s)
- Cem İsmail Küçükali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye
| | - Vuslat Yılmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye
| | - Derya Karadeniz
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Utku Oğan Akyıldız
- Department of Neurology, Adnan Menderes University Medical Faculty, Aydın, Türkiye
| | - Demet İlhan Algın
- Department of Neurology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
| | | | - Ayşın Kısabay Ak
- Department of Neurology, Celal Bayar University Medical Faculty, Manisa, Türkiye
| | - Aylin Bican Demir
- Department of Neurology, Bursa Uludag University Medical Faculty, Bursa, Türkiye
| | - Hikmet Yılmaz
- Department of Neurology, Celal Bayar University Medical Faculty, Manisa, Türkiye
| | - Füsun Mayda Domaç
- Department of Neurology, Erenkoy Mental and Nervous Diseases Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Ayşe Deniz Elmalı
- Department of Neurology, Ministry of Health Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
| | - Ülkü Dübüş Hoş
- Department of Neurology, Ministry of Health Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
| | - R Gökçen Gözübatık-Çelik
- Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Türkiye
| | - Vasfiye Kabeloğlu
- Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Türkiye
| | - Bengisu Bilgin
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Türkiye
| | - Deniz Tuncel Berktaş
- Department of Neurology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Türkiye
| | - Bengi Gül Türk
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Şakir Delil
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Cengiz Dilber
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Türkiye
| | - Sedef Terzioğlu Öztürk
- Department of Pediatrics, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Türkiye
| | - S Naz Yeni
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Çiğdem Özkara
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Murat Aksu
- Department of Neurology, Acibadem University Atakent Hospital Medical Faculty, Istanbul, Türkiye
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Türkiye
| | - Gülçin Benbir Şenel
- Division of Clinical Neurophysiology, Department of Neurology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye.
| |
Collapse
|
5
|
Mao R, Cavelli ML, Findlay G, Driessen K, Peterson MJ, Marshall W, Tononi G, Cirelli C. Behavioral and cortical arousal from sleep, muscimol-induced coma, and anesthesia by direct optogenetic stimulation of cortical neurons. iScience 2024; 27:109919. [PMID: 38812551 PMCID: PMC11134913 DOI: 10.1016/j.isci.2024.109919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/28/2023] [Accepted: 05/03/2024] [Indexed: 05/31/2024] Open
Abstract
The cerebral cortex is widely considered part of the neural substrate of consciousness, but direct causal evidence is missing. Here, we tested in mice whether optogenetic activation of cortical neurons in posterior parietal cortex (PtA) or medial prefrontal cortex (mPFC) is sufficient for arousal from three behavioral states characterized by progressively deeper unresponsiveness: sleep, a coma-like state induced by muscimol injection in the midbrain, and deep sevoflurane-dexmedetomidine anesthesia. We find that cortical stimulation always awakens the mice from both NREM sleep and REM sleep, with PtA requiring weaker/shorter light pulses than mPFC. Moreover, in most cases light pulses produce both cortical activation (decrease in low frequencies) and behavioral arousal (recovery of the righting reflex) from brainstem coma, as well as cortical activation from anesthesia. These findings provide evidence that direct activation of cortical neurons is sufficient for behavioral and/or cortical arousal from sleep, brainstem coma, and anesthesia.
Collapse
Affiliation(s)
- Rong Mao
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Matias Lorenzo Cavelli
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Departamento de Fisiología de Facultad de Medicina, Universidad de la República, Montevideo 11800, Uruguay
| | - Graham Findlay
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Kort Driessen
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Michael J. Peterson
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - William Marshall
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
- Department of Mathematics and Statistics, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Chiara Cirelli
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| |
Collapse
|
6
|
Zhang H, Zhu Z, Ma WX, Kong LX, Yuan PC, Bu LF, Han J, Huang ZL, Wang YQ. The contribution of periaqueductal gray in the regulation of physiological and pathological behaviors. Front Neurosci 2024; 18:1380171. [PMID: 38650618 PMCID: PMC11034386 DOI: 10.3389/fnins.2024.1380171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
Periaqueductal gray (PAG), an integration center for neuronal signals, is located in the midbrain and regulates multiple physiological and pathological behaviors, including pain, defensive and aggressive behaviors, anxiety and depression, cardiovascular response, respiration, and sleep-wake behaviors. Due to the different neuroanatomical connections and functional characteristics of the four functional columns of PAG, different subregions of PAG synergistically regulate various instinctual behaviors. In the current review, we summarized the role and possible neurobiological mechanism of different subregions of PAG in the regulation of pain, defensive and aggressive behaviors, anxiety, and depression from the perspective of the up-down neuronal circuits of PAG. Furthermore, we proposed the potential clinical applications of PAG. Knowledge of these aspects will give us a better understanding of the key role of PAG in physiological and pathological behaviors and provide directions for future clinical treatments.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Zhe Zhu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Wei-Xiang Ma
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Ling-Xi Kong
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Ping-Chuan Yuan
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Li-Fang Bu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| | - Jun Han
- Anhui Provincial Engineering Laboratory for Screening and Re-evaluation of Active Compounds of Herbal Medicines in Southern Anhui, Anhui Provincial Engineering Research Center for Polysaccharide Drugs, Wannan Medical College, Wuhu, China
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Wang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Joint International Research Laboratory of Sleep, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Castelnovo A, Schraemli M, Schenck CH, Manconi M. The parasomnia defense in sleep-related homicide: A systematic review and a critical analysis of the medical literature. Sleep Med Rev 2024; 74:101898. [PMID: 38364685 DOI: 10.1016/j.smrv.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/18/2024]
Abstract
This review critically analyzes the forensic application of the Parasomnia Defense in homicidal incidents, drawing from medical literature on disorders of arousal (DOA) and rapid-eye-movement sleep behavior disorder (RBD). A systematic search of PubMed, Scopus, Embase, and Cochrane databases was conducted until October 16, 2022. We screened English-language articles in peer-reviewed journals discussing murders committed during sleep with a Parasomnia Defense. We followed PRISMA guidelines, extracting event details, diagnosis methods, factors influencing the acts, perpetrator behavior, timing, motives, concealment, mental experiences, victim demographics, and court verdicts. Three sleep experts evaluated each case. We selected ten homicides, four attempted homicides, and one homicide/attempted homicide that met inclusion/exclusion criteria. Most cases were suspected DOA as unanimously confirmed by experts. RBD cases were absent. Among aggressors, a minority reported dream-like experiences. Victims were primarily female family members killed in or near the bed by hands and/or with sharp objects. Objective sleep data and important crime scene details were often missing. Verdicts were ununiform. Homicides during DOA episodes, though rare, are documented, validating the Parasomnia Defense's use in forensics. RBD-related fatal aggression seems very uncommon. However, cases often lack diagnostic clarity. We propose updated guidelines to enhance future reporting and understanding of such incidents.
Collapse
Affiliation(s)
- Anna Castelnovo
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Matthias Schraemli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, Hennepin County Medical Center, And University of Minnesota Medical School, Minneapolis, MN, United States.
| | - Mauro Manconi
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| |
Collapse
|
8
|
Mogavero MP, Ferri R, Marelli S, Lanza G, Terzaghi M, Castelnuovo A, DelRosso LM, Schenck CH, Ferini‐Strambi L. Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches? CNS Neurosci Ther 2024; 30:e14569. [PMID: 38421131 PMCID: PMC10850928 DOI: 10.1111/cns.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/06/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024] Open
Abstract
AIMS Although clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained-release MLT, alone or in combination, and in a group of drug-free iRBD patients. METHODS A total of 96 patients were enrolled: 43 drug-free, 21 with CLO (0.5-2 mg), 20 with sustained-release MLT (1-4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected. RESULTS Although clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture. CONCLUSION These results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.
Collapse
Affiliation(s)
- Maria P. Mogavero
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Raffaele Ferri
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
| | - Sara Marelli
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | - Giuseppe Lanza
- Sleep Research Centre and Clinical Neurophysiology Research UnitOasi Research Institute – IRCCSTroinaItaly
- Department of Surgery and Medical‐Surgical SpecialtiesUniversity of CataniaCataniaItaly
| | - Michele Terzaghi
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly
- Unit of Sleep Medicine and EpilepsyIRCCS Mondino FoundationPaviaItaly
| | - Alessandra Castelnuovo
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| | | | - Carlos H. Schenck
- Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical CenterUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Luigi Ferini‐Strambi
- Vita‐Salute San Raffaele UniversityMilanItaly
- Sleep Disorders Center, Division of NeuroscienceSan Raffaele Scientific InstituteMilanItaly
| |
Collapse
|
9
|
Koyama Y. The role of orexinergic system in the regulation of cataplexy. Peptides 2023; 169:171080. [PMID: 37598758 DOI: 10.1016/j.peptides.2023.171080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 08/22/2023]
Abstract
Loss of orexin/hypocretin causes serious sleep disorder; narcolepsy. Cataplexy is the most striking symptom of narcolepsy, characterized by abrupt muscle paralysis induced by emotional stimuli, and has been considered pathological activation of REM sleep atonia system. Clinical treatments for cataplexy/narcolepsy and early pharmacological studies in narcoleptic dogs tell us about the involvement of monoaminergic and cholinergic systems in the control of cataplexy/narcolepsy. Muscle atonia may be induced by activation of REM sleep-atonia generating system in the brainstem. Emotional stimuli may be processed in the limbic systems including the amygdala, nucleus accumbens, and medial prefrontal cortex. It is now considered that orexin/hypocretin prevents cataplexy by modulating the activity of different points of cataplexy-inducing circuit, including monoaminergic/cholinergic systems, muscle atonia-generating systems, and emotion-related systems. This review will describe the recent advances in understanding the neural mechanisms controlling cataplexy, with a focus on the involvement of orexin/hypocretin system, and will discuss future experimental strategies that will lead to further understanding and treatment of this disease.
Collapse
Affiliation(s)
- Yoshimasa Koyama
- Faculty of Symbiotic Systems Science, Fukushima University, 1 Kanaya-gawa, Fukushima 960-1296, Japan..
| |
Collapse
|
10
|
Dodet P. REM behavior disorder: When Parkinson's disease meets Morpheus. Rev Neurol (Paris) 2023; 179:667-674. [PMID: 37598085 DOI: 10.1016/j.neurol.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia characterized by the absence of normal muscle atonia during REM sleep, resulting in excessive motor activity while dreaming. RBD can be classified as isolated which is the strongest clinical marker of prodromal synucleinopathy, or secondary, associated with other neurological diseases, mainly Parkinson's disease (PD) and dementia with Lewy bodies. The diagnosis of RBD must be systematically documented by a video polysomnography in the case of isolated RBD. PD associated with RBD may represent a distinct phenotype compared to PD without RBD, indicating a more severe and widespread synucleinopathy. Clinically, it is associated with poorer motor and cognitive performance, more severe non-motor symptoms, and faster disease progression. Imaging studies have revealed broader brain damage and significant alterations in cerebral metabolism and neurotransmission in PD patients with RBD. The management of RBD involves safety precautions and pharmacotherapy. Safety measures aim to minimize the risk of injury during RBD episodes and include creating a safe sleeping environment and separating the patient from their bed partner if necessary. Pharmacotherapy options include clonazepam and melatonin. Clonazepam must be cautiously prescribed in older patients due to potential side effects.
Collapse
Affiliation(s)
- P Dodet
- Service des Pathologies du Sommeil, Centre de Référence National des Narcolepsies et Hypersomnies rares, Assistance publique-Hôpitaux de Paris-Sorbonne (AP-HP-Sorbonne), Hôpital la Pitié-Salpêtrière, Paris, France; Paris Brain Institute (ICM), Sorbonne University, Inserm U1227, CNRS 7225, Paris, France.
| |
Collapse
|
11
|
Montini A, Iranzo A, Cortelli P, Gaig C, Muñoz-Lopetegi A, Provini F, Santamaria J. Scoring sleep in neurodegenerative diseases: A pilot study in the synucleinopathies. Sleep Med 2023; 110:268-286. [PMID: 37678074 DOI: 10.1016/j.sleep.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurodegenerative diseases often alter sleep architecture, complicating the application of the standard sleep scoring rules. There are no recommendations to overcome this problem. Our aim was to develop a scoring method that incorporates the stages previously applied in dementia with Lewy Bodies (DLB), anti-IgLON5 disease, and fatal insomnia, and to test it in patients with alpha-synucleinopathies. METHODS Video-polysomnographies (VPSG) of nine patients (DLB:3, Parkinson's disease (PD):3, and multiple system atrophy (MSA):3) selected for their difficulty in applying standard rules were scored independently by two authors, using additional Sleep/Wake stages. These included Abnormal Wake, Subwake, Undifferentiated NREM sleep (UNREM), Poorly structured N2 (P-S N2) and abnormal REM sleep including REM without atonia (RWA), REM without low-amplitude, mixed-frequency EEG activity (RWL) and REM without rapid eye movements (RWR). RESULTS Patients (4 females) had a median age of 74 (range 63-85). Six patients (all with PD or DLB) had abnormal EEG awake and Subwake stage. UNREM sleep was present in all patients, typically at sleep onset, and was the most common sleep stage in five. P-S N2 was recorded only in the three patients with MSA. Periods of normal and abnormal NREM coexisted in three patients. RWA was the predominant REM subtype, RWR occurred mainly in patients with MSA and RWL in those with DLB. Six patients had brief REM episodes into NREM sleep which we termed "Encapsulated RBD". CONCLUSION Our scoring system allows an accurate description of the complex sleep-wake changes in patients with alpha-synucleinopathies.
Collapse
Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy.
| | - Alex Iranzo
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Carles Gaig
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Amaia Muñoz-Lopetegi
- Sleep Disorders Center, Neurology Service, Hospital Clínic de Barcelona, Barcelona, Spain; Clinical Neurophysiology Group, Institut D'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; CIBERNED CB06/05/0018-ISCIII, Spain.
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Joan Santamaria
- Emeritus Consultant and Researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS), Spain.
| |
Collapse
|
12
|
Eschbach E, Wang J. Sleep and critical illness: a review. Front Med (Lausanne) 2023; 10:1199685. [PMID: 37828946 PMCID: PMC10566646 DOI: 10.3389/fmed.2023.1199685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Critical illness and stays in the Intensive Care Unit (ICU) have significant impact on sleep. Poor sleep is common in this setting, can persist beyond acute critical illness, and is associated with increased morbidity and mortality. In the past 5 years, intensive care clinical practice guidelines have directed more focus on sleep and circadian disruption, spurring new initiatives to study and improve sleep complications in the critically ill. The global SARS-COV-2 (COVID-19) pandemic and dramatic spikes in patients requiring ICU level care also brought augmented levels of sleep disruption, the understanding of which continues to evolve. This review aims to summarize existing literature on sleep and critical illness and briefly discuss future directions in the field.
Collapse
Affiliation(s)
- Erin Eschbach
- Division of Pulmonary, Critical Care, and Sleep, Mount Sinai Hospital, New York, NY, United States
| | | |
Collapse
|
13
|
Lee DA, Lee HJ, Park KM. Cerebellar Volume Reduction in Patients with Isolated REM Sleep Behavior Disorder: Evidence of a Potential Role of the Cerebellum. Eur Neurol 2023; 86:341-347. [PMID: 37527632 DOI: 10.1159/000533297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION In this study, we aimed to investigate changes in the total cerebellar volume, subdivisions of the cerebellar volume, and intrinsic cerebellar network in patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) compared to healthy controls. METHODS We enrolled patients with newly diagnosed iRBD and healthy controls who had no structural lesions according to their brain MRI. All participants underwent three-dimensional T1-weighted imaging. We obtained the total cerebellar volume and subdivisions of the cerebellar volume using the ACAPULCO program and calculated the intrinsic cerebellar network using a BRAPH program based on the subdivisions of the cerebellar volume by applying a graph theory. We compared the cerebellar volumes and intrinsic cerebellar network between the patients with iRBD and healthy controls. RESULTS In total, we enrolled 43 patients with iRBD and 47 healthy controls. Total cerebellar volume in patients with iRBD was lower than that in the healthy controls (8.4637 vs. 9.0863%, p = 0.0001). There were significant differences in the subdivisions of cerebellar volume between the groups. The volumes of the right and left lobule VIIB in the patients with iRBD were lower than those in the healthy controls (right, 0.3495 vs. 0.4025%, p = 0.0009; left, 0.3561 vs. 0.4293%, p < 0.0001). However, the other cerebellar volumes, such as the corpus meullare and vermis, were not different between the groups. The intrinsic cerebellar network was not different between the patients with iRBD and healthy controls. CONCLUSION We found decreased total cerebellar volumes and subdivisions of the cerebellar volume, particularly in the right and left lobule VIIB, in patients with iRBD compared to healthy controls. The present results suggest that the cerebellum may play a potential role in the pathogenesis of iRBD.
Collapse
Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| |
Collapse
|
14
|
Nepozitek J, Varga Z, Dostalova S, Perinova P, Keller J, Robinson S, Ibarburu V, Prihodova I, Bezdicek O, Ruzicka E, Sonka K, Dusek P. Magnetic susceptibility changes in the brainstem reflect REM sleep without atonia severity in isolated REM sleep behavior disorder. NPJ Parkinsons Dis 2023; 9:112. [PMID: 37452075 PMCID: PMC10349141 DOI: 10.1038/s41531-023-00557-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
REM sleep without atonia (RWA) is the hallmark of isolated REM sleep behavior disorder (iRBD) and is caused by neurodegeneration of brainstem structures. Previously, quantitative susceptibility mapping (QSM) was shown to detect microstructural tissue changes in neurodegenerative diseases. The goal of the study was to compare brainstem magnetic susceptibility (MS) in iRBD and controls using the voxel-based QSM approach and to examine the association between brainstem MS and severity of RWA in iRBD. Sixty iRBD patients and 41 healthy controls were included in the study. Phasic, tonic, mixed RWA and SINBAR score was quantified. QSM maps were reconstructed with QSMbox software from a multi-gradient-echo sequence acquired at 3T MRI system and normalized using a custom T1 template. Voxel-based analysis with age and gender as covariates was performed using a two-sample t-test model for between-group comparison and using a linear regression model for association with the RWA parameters. Statistical maps were generated using threshold free cluster enhancement with p-value p < 0.05, corrected for family wise error. Compared to controls, the iRBD group had higher MS in bilateral substantia nigra (SN), red nucleus and the ventral tegmental area. MS positively correlated with iRBD duration in the right pedunculotegmental nucleus and white matter of caudal mesencephalic and pontine tegmentum and with phasic RWA in bilateral SN. QSM was able to detect MS abnormalities in several brainstem structures in iRBD. Association of MS levels in the brainstem with the intensity of RWA suggests that increased iron content in SN is related to RWA severity.
Collapse
Affiliation(s)
- Jiri Nepozitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Zsoka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Simona Dostalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Pavla Perinova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Keller
- Radiodiagnostic Department, Na Homolce Hospital, Prague, Czech Republic
| | - Simon Robinson
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Veronika Ibarburu
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iva Prihodova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Evzen Ruzicka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Karel Sonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Dusek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
15
|
Lee DA, Lee HJ, Park KM. Involvement of limbic structures in patients with isolated rapid eye movement sleep behavior disorder. Sleep Biol Rhythms 2023; 21:233-240. [PMID: 38469290 PMCID: PMC10899988 DOI: 10.1007/s41105-022-00440-2] [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: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate the alterations in limbic structure volumes and limbic covariance network in patients with isolated rapid eye movement (REM) sleep behavior disorder (iRBD) and to compare them with healthy controls. We retrospectively enrolled 35 patients with iRBD and 35 healthy controls who underwent three-dimensional T1-weighted brain MRI. Volumetric analysis of subcortical limbic structures, including the hippocampus, amygdala, thalamus, mammillary body, hypothalamus, basal forebrain, septal nuclei, fornix, and nucleus accumbens, was performed. Furthermore, the limbic covariance network was examined using graph theory based on the limbic structure volumes. Some of the limbic structure volumes differed significantly. The right amygdala and hypothalamus volumes were lower in the patients with iRBD than in the healthy controls (0.101% vs. 0.114%, p = 0.016, and 0.027% vs. 0.030%, p = 0.045, respectively). However, there were no significant differences in the limbic covariance network between the groups. This study demonstrated that the volumes of the right amygdala and hypothalamus are lower in patients with iRBD, even without cognitive impairments, than in healthy controls. However, there were no significant differences in the limbic covariance network between the groups. The involvements of the limbic structures could be related to the conversion to neurodegenerative diseases in patients with iRBD.
Collapse
Affiliation(s)
- D. A. Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108 Republic of Korea
| | - H. J. Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-gu, Busan Republic of Korea
| | - K. M. Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108 Republic of Korea
| |
Collapse
|
16
|
Functional roles of REM sleep. Neurosci Res 2022; 189:44-53. [PMID: 36572254 DOI: 10.1016/j.neures.2022.12.009] [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: 12/14/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Rapid eye movement (REM) sleep is an enigmatic and intriguing sleep state. REM sleep differs from non-REM sleep by its characteristic brain activity and from wakefulness by a reduced anti-gravity muscle tone. In addition to these key traits, diverse physiological phenomena appear across the whole body during REM sleep. However, it remains unclear whether these phenomena are the causes or the consequences of REM sleep. Experimental approaches using humans and animal models have gradually revealed the functional roles of REM sleep. Extensive efforts have been made to interpret the characteristic brain activity in the context of memory functions. Numerous physical and psychological functions of REM sleep have also been proposed. Moreover, REM sleep has been implicated in aspects of brain development. Here, we review the variety of functional roles of REM sleep, mainly as revealed by animal models. In addition, we discuss controversies regarding the functional roles of REM sleep.
Collapse
|
17
|
Wu Y, Yang YW, Gu SC, Zhang Y, Shi R, Wang CD, Yuan CX, Ye Q. The Importance of Early Identification for Parkinson's Disease Patients with Postural Instability and Gait Disturbance. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6701519. [PMID: 36438683 PMCID: PMC9699743 DOI: 10.1155/2022/6701519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2024]
Abstract
BACKGROUND More and more evidence-based medicine has proved that Parkinson's disease (PD) patients of tremor-dominant (TD) and postural instability and gait difficulty (PIGD) subtype express great individual differences and heterogeneity. Early identification of different subtypes may be an important way to delay disease progression and improve patients' prognosis. OBJECTIVE The study aimed to compare the spectrum of motor symptoms (MS) and nonmotor symptoms (NMS) between TD and PIGD dominant in the early and middle stages of PD, and determine predictive factors that are associated with different motor subtypes. METHODS 292 PD patients in this study were divided into TD-PD and PIGD-PD, and the clinical characteristics between different motor subtypes were compared based on scales related to sleep, mood, and autonomic function. Univariate and multivariate ordered logistic regression analyses were used to analyze the independent influencing factors of disease severity between different motor subtypes. Through the establishment of binary logistic regression model, the potential independent risk factors for distinguishing TD-PD and PIGD-PD were studied. RESULTS Compared with TD subtype, patients with PIGD subtype have longer course of disease, higher disease severity, and higher daily dosage of levodopa. The severity of nontremor motor symptoms in PIGD-PD is greater than that of TD subtype. Only PIGD score was independently associated with disease severity for the two motor subtypes. Meanwhile, high scores (LED, total UPDRS, PIGD score, gastrointestinal, thermoregulatory, RBDSQ) and low tremor scores were the potential independent risk factors for distinguishing PIGD-PD from TD-PD. CONCLUSION Specific nonmotor symptoms (RBD, gastrointestinal function and thermoregulation function) were associated with the PIGD subtype. Prompt detection and early treatment of NMSs related to the PIGD subtype based on the treatment of motor symptoms may improve patient outcomes.
Collapse
Affiliation(s)
- You Wu
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai 200032, China
| | - Yi-Wen Yang
- School of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai 201203, China
| | - Si-Chun Gu
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai 200032, China
| | - Yu Zhang
- Department of Neurology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 665 Kongjiang Road, Shanghai 200092, China
| | - Rong Shi
- Department of Emergency, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Shanghai 201203, China
| | - Chang-De Wang
- Department of Neurology, Shanghai TCM-integrated Hospital, Shanghai University of Traditional Chinese Medicine, 230 Baoding Road, Shanghai 200082, China
| | - Can-Xing Yuan
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai 200032, China
| | - Qing Ye
- Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai 200032, China
| |
Collapse
|
18
|
Parrino L, Halasz P, Szucs A, Thomas RJ, Azzi N, Rausa F, Pizzarotti S, Zilioli A, Misirocchi F, Mutti C. Sleep medicine: Practice, challenges and new frontiers. Front Neurol 2022; 13:966659. [PMID: 36313516 PMCID: PMC9616008 DOI: 10.3389/fneur.2022.966659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep medicine is an ambitious cross-disciplinary challenge, requiring the mutual integration between complementary specialists in order to build a solid framework. Although knowledge in the sleep field is growing impressively thanks to technical and brain imaging support and through detailed clinic-epidemiologic observations, several topics are still dominated by outdated paradigms. In this review we explore the main novelties and gaps in the field of sleep medicine, assess the commonest sleep disturbances, provide advices for routine clinical practice and offer alternative insights and perspectives on the future of sleep research.
Collapse
Affiliation(s)
- Liborio Parrino
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- *Correspondence: Liborio Parrino
| | - Peter Halasz
- Szentagothai János School of Ph.D Studies, Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Anna Szucs
- Department of Behavioral Sciences, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Robert J. Thomas
- Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Nicoletta Azzi
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Francesco Rausa
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Silvia Pizzarotti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
| | - Alessandro Zilioli
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Francesco Misirocchi
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| | - Carlotta Mutti
- Department of General and Specialized Medicine, Sleep Disorders Center, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Unit of Neurology, University of Parma, Parma, Italy
| |
Collapse
|
19
|
Ahnaou A, Whim D. REM sleep behavior and olfactory dysfunction: improving the utility and translation of animal models in the search for neuroprotective therapies for Parkinson's disease. Neurosci Biobehav Rev 2022; 143:104897. [PMID: 36183864 DOI: 10.1016/j.neubiorev.2022.104897] [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: 05/14/2021] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
Parkinson's disease (PD) is a heterogeneous neurodegenerative disease that belongs to the family of synucleiopathies, varying in age, symptoms and progression. Hallmark of the disease is the accumulation of misfolded α-synuclein protein (α-Syn) in neuronal and non-neuronal brain cells. In past decades, diagnosis and treatment of PD has focused on motor deficits, which for the clinical endpoint, have contributed to the prevalence of deficits in the nigrostriatal dopaminergic system and animal models related to motor behavior to study disease. However, clinical trials have failed to translate results from animal models into effective treatments. PD as a multisystem disorder therefore requires additional assessment of motor and non-motor symptoms. Braak's staging revealed early α-Syn pathology in pontine brainstem and olfactory circuits controlling rapid eye movement sleep behavior disorder (RBD) and olfaction, respectively. Recent converging evidence from multicenter clinical studies supports that RBD is the most important risk factor for prodromal PD and the conduct of neuroprotective therapeutic trials in RBD-enriched cohorts has been recommended. Animal models of RBD and olfaction dysfunction can aid to fill the gap in translational research.
Collapse
Affiliation(s)
- A Ahnaou
- Department of Neuroscience, Janssen Research & Development, a Division of Janssen Pharmaceutica NV. Turnhoutseweg 30, B-2340 Beerse, Belgium.
| | - Drinkenburg Whim
- Department of Neuroscience, Janssen Research & Development, a Division of Janssen Pharmaceutica NV. Turnhoutseweg 30, B-2340 Beerse, Belgium
| |
Collapse
|
20
|
Potter LE, Burgess CR. The melanin-concentrating hormone system as a target for the treatment of sleep disorders. Front Neurosci 2022; 16:952275. [PMID: 36177357 PMCID: PMC9513178 DOI: 10.3389/fnins.2022.952275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Given the widespread prevalence of sleep disorders and their impacts on health, it is critical that researchers continue to identify and evaluate novel avenues of treatment. Recently the melanin-concentrating hormone (MCH) system has attracted commercial and scientific interest as a potential target of pharmacotherapy for sleep disorders. This interest emerges from basic scientific research demonstrating a role for MCH in regulating sleep, and particularly REM sleep. In addition to this role in sleep regulation, the MCH system and the MCH receptor 1 (MCHR1) have been implicated in a wide variety of other physiological functions and behaviors, including feeding/metabolism, reward, anxiety, depression, and learning. The basic research literature on sleep and the MCH system, and the history of MCH drug development, provide cause for both skepticism and cautious optimism about the prospects of MCH-targeting drugs in sleep disorders. Extensive efforts have focused on developing MCHR1 antagonists for use in obesity, however, few of these drugs have advanced to clinical trials, and none have gained regulatory approval. Additional basic research will be needed to fully characterize the MCH system’s role in sleep regulation, for example, to fully differentiate between MCH-neuron and peptide/receptor-mediated functions. Additionally, a number of issues relating to drug design will continue to pose a practical challenge for novel pharmacotherapies targeting the MCH system.
Collapse
Affiliation(s)
- Liam E. Potter
- Department of Molecular and Integrative Physiology, Michigan Medicine, Ann Arbor, MI, United States
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Liam E. Potter,
| | - Christian R. Burgess
- Department of Molecular and Integrative Physiology, Michigan Medicine, Ann Arbor, MI, United States
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI, United States
- Christian R. Burgess,
| |
Collapse
|
21
|
Leng B, Sun H, Li M, Zhao J, Liu X, Yao R, Shen T, Li Z, Zhang J. Blood neuroexosomal excitatory amino acid transporter-2 is associated with cognitive decline in Parkinson’s disease with RBD. Front Aging Neurosci 2022; 14:952368. [PMID: 36081890 PMCID: PMC9445359 DOI: 10.3389/fnagi.2022.952368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Rapid eye movement (REM) sleep behavior disorder (RBD) predicts cognitive decline in Parkinson’s disease (PD) patients without dementia. However, underlying mechanisms remain unknown. Accumulating studies suggest glutamatergic system dysregulation is associated. Objective To examine the effect of RBD on the rate of cognitive decline in PD patients and investigate whether plasma levels of the neuroexosomal vesicular glutamate transporter-1 (VGLUT-1) and excitatory amino acid transporter-2 (EAAT-2) are altered in PD patients with RBD. Methods This study included 157 newly diagnosed cognitive normal PD patients and 70 healthy controls (HCs). Based on one-night polysomnography recordings, the PD subjects were divided into PD with and without RBD (PD-RBD and PD-nRBD) groups. All participants received a complete clinical and neuropsychological evaluation at baseline. Plasma levels of neuroexosomal VGLUT-1 and EAAT-2 were measured by ELISA kits. After a 3-year follow-up, we evaluated baseline plasma levels of neuroexosomal glutamate transporters in each group as a predictor of cognitive decline using MoCA score changes over 3 years in regression models. Results Plasma levels of neuron-derived exosomal EAAT-2 and VGLUT-1 were significantly lower in PD patients than in HCs. Plasma levels of neuroexosomal EAAT-2 were significantly lower in PD-RBD than PD-nRBD group at baseline. At the 3-year follow-up, PD-RBD patients presented greater cognitive decline. Lower baseline blood neuroexosomal EAAT-2 predicted cognitive decline over 3 years in PD-RBD patients (β = 0.064, P = 0.003). Conclusion These findings indicate that blood neuroexosomal EAAT-2 is associated with cognitive decline in PD with RBD.
Collapse
|
22
|
Wang Y, Deboer T. Long-Term Effect of a Single Dose of Caffeine on Sleep, the Sleep EEG and Neuronal Activity in the Peduncular Part of the Lateral Hypothalamus under Constant Dark Conditions. Clocks Sleep 2022; 4:260-276. [PMID: 35735603 PMCID: PMC9222093 DOI: 10.3390/clockssleep4020023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Caffeine is a central nervous system stimulant that influences both the sleep–wake cycle and the circadian clock and is known to influence neuronal activity in the lateral hypothalamus, an important area involved in sleep–wake regulation. Light is a strong zeitgeber and it is known to interact with the effect of caffeine on the sleep–wake cycle. We therefore wanted to investigate the long-term effects of a single dose of caffeine under constant dark conditions. Methods: We performed long-term (2 days) electroencephalogram (EEG)/electromyogram recordings combined with multi-unit neuronal activity recordings in the peduncular part of the lateral hypothalamus (PLH) under constant darkness in Brown Norway rats, and investigated the effect of a single caffeine treatment (15 mg/kg) or saline control given 1 h after the onset of the endogenous rest phase. Results: After a reduction in sleep and an increase in waking and activity in the first hours after administration, also on the second recording day after caffeine administration, rapid eye movement (REM) sleep was still reduced. Analysis of the EEG showed that power density in the theta range during waking and REM sleep was increased for at least two days. Neuronal activity in PLH was also increased for two days after the treatment, particularly during non-rapid eye movement sleep. Conclusion: Surprisingly, the data reveal long-term effects of a single dose of caffeine on vigilance states, EEG, and neuronal activity in the PLH. The absence of a light–dark cycle may have enabled the expression of these long-term changes. It therefore may be that caffeine, or its metabolites, have a stronger and longer lasting influence, particularly on the expression of REM sleep, than acknowledged until now.
Collapse
|
23
|
Liu Y, Zhang J, Chau SW, Man Yu MW, Chan NY, Chan JW, Li SX, Huang B, Wang J, Feng H, Zhou L, Mok V, Wing YK. Evolution of Prodromal REM Sleep Behavior Disorder to Neurodegeneration: A Retrospective, Longitudinal Case-control Study. Neurology 2022; 99:e627-e637. [PMID: 35550550 DOI: 10.1212/wnl.0000000000200707] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals with a history of recurrent dream-enactment behaviors, but with subthreshold REM sleep without atonia levels for REM sleep behavior disorder (RBD) diagnosis, are currently classified to have prodromal RBD (pRBD). However, the REM sleep elevated EMG diagnostic cut-off, progression trajectory, and long-term neurodegenerative outcome of pRBD are not well understood. This study aimed to delineate the evolution of REM sleep EMG levels, determine the EMG cut-off score for diagnosing pRBD, and examine the risk for neurodegenerative diseases of pRBD. METHODS This retrospective longitudinal case-control study recruited pRBD patients and age, sex, and follow-up duration matched controls who were free of neurodegenerative disease at baseline in the Sleep Assessment Unit, the Chinese University of Hong Kong from 1997 to 2018. Patients and controls underwent clinical and video-polysomnography assessments at baseline and follow-up(s). REM sleep EMG activity level on mentalis and anterior tibialis (AT) muscles on video-polysomnography at each visit was scored. The diagnosis of neurodegenerative diseases was confirmed by a neurologist. RESULTS 44 patients (67.4 ± 8.2 years old, 6 females) and 44 controls were recruited. The combined REM sleep EMG level on mentalis and AT muscles of pRBD patients significantly increased during 8.2 ± 3.3 years of follow-up (from 19.3 ± 9.7% to 47.3 ± 27.4% with estimated annual increase of 3.9%), yielding 29 pRBD patients (66%) meeting the full-blown RBD diagnostic criteria. Baseline REM sleep mentalis and AT muscles EMG activity of patients who developed full-blown RBD could favourably differentiate pRBD from controls (6.3% for mentalis 'any' and 9.1% for combination of mentalis 'any' and bilateral AT muscles phasic EMG with AUC of 0.88 [0.78-0.98] and 0.97 [0.92-1.00] respectively). pRBD patients had a higher risk for neurodegenerative diseases (9 developed Parkinson's disease and 3 developed dementia with Lewy bodies) when compared to controls (5 developed Alzheimer's disease, adjusted hazard ratio = 2.95, 95% CI = 1.02-8.54). CONCLUSIONS pRBD has a predictive progression in both pathophysiology and neurodegenerative outcome. This finding has significant implications to the nosological status of pRBD, the current REM sleep-related EMG diagnostic criteria, spectrum concept of RBD and future neuroprotective intervention. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EMG activity during REM sleep predicts the development of prodromal REM sleep behavior disorder.
Collapse
Affiliation(s)
- Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Steven Wh Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Mandy Wai Man Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Bei Huang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Jing Wang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Hongliang Feng
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li Zhou
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Vincent Mok
- Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Wo Institute of Innovative Medicine, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| |
Collapse
|
24
|
Motor and non-motor circuit disturbances in early Parkinson disease: which happens first? Nat Rev Neurosci 2022; 23:115-128. [PMID: 34907352 DOI: 10.1038/s41583-021-00542-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
For the last two decades, pathogenic concepts in Parkinson disease (PD) have revolved around the toxicity and spread of α-synuclein. Thus, α-synuclein would follow caudo-rostral propagation from the periphery to the central nervous system, first producing non-motor manifestations (such as constipation, sleep disorders and hyposmia), and subsequently impinging upon the mesencephalon to account for the cardinal motor features before reaching the neocortex as the disease evolves towards dementia. This model is the prevailing theory of the principal neurobiological mechanism of disease. Here, we scrutinize the temporal evolution of motor and non-motor manifestations in PD and suggest that, even though the postulated bottom-up mechanisms are likely to be involved, early involvement of the nigrostriatal system is a key and prominent pathophysiological mechanism. Upcoming studies of detailed clinical manifestations with newer neuroimaging techniques will allow us to more closely define, in vivo, the role of α-synuclein aggregates with respect to neuronal loss during the onset and progression of PD.
Collapse
|
25
|
Van Den Berge N, Ulusoy A. Animal models of brain-first and body-first Parkinson's disease. Neurobiol Dis 2022; 163:105599. [DOI: 10.1016/j.nbd.2021.105599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022] Open
|
26
|
Neurophysiological Aspects of REM Sleep Behavior Disorder (RBD): A Narrative Review. Brain Sci 2021. [PMID: 34942893 DOI: 10.3390/brainsci11121588.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
REM sleep without atonia (RSWA) is the polysomnographic (PSG) hallmark of rapid eye movement (REM) sleep behavior disorder (RBD), a feature essential for the diagnosis of this condition. Several additional neurophysiological aspects of this complex disorder have also recently been investigated in depth, which constitute the focus of this narrative review, together with RSWA. First, we describe the complex neural network underlying REM sleep and its muscle atonia, focusing on the disordered mechanisms leading to RSWA. RSWA is then described in terms of its polysomnographic features, and the methods (visual and automatic) currently available for its scoring and quantification are exposed and discussed. Subsequently, more recent and advanced neurophysiological features of RBD are described, such as electroencephalography during wakefulness and sleep, transcranial magnetic stimulation, and vestibular evoked myogenic potentials. The role of the assessment of neurophysiological features in the study of RBD is then carefully discussed, highlighting their usefulness and sensitivity in detecting neurodegeneration in the early or prodromal stages of RBD, as well as their relationship with other proposed biomarkers for the diagnosis, prognosis, and monitoring of this condition. Finally, a future research agenda is proposed to help clarify the many still unclear aspects of RBD.
Collapse
|
27
|
Figorilli M, Lanza G, Congiu P, Lecca R, Casaglia E, Mogavero MP, Puligheddu M, Ferri R. Neurophysiological Aspects of REM Sleep Behavior Disorder (RBD): A Narrative Review. Brain Sci 2021; 11:brainsci11121588. [PMID: 34942893 PMCID: PMC8699681 DOI: 10.3390/brainsci11121588] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023] Open
Abstract
REM sleep without atonia (RSWA) is the polysomnographic (PSG) hallmark of rapid eye movement (REM) sleep behavior disorder (RBD), a feature essential for the diagnosis of this condition. Several additional neurophysiological aspects of this complex disorder have also recently been investigated in depth, which constitute the focus of this narrative review, together with RSWA. First, we describe the complex neural network underlying REM sleep and its muscle atonia, focusing on the disordered mechanisms leading to RSWA. RSWA is then described in terms of its polysomnographic features, and the methods (visual and automatic) currently available for its scoring and quantification are exposed and discussed. Subsequently, more recent and advanced neurophysiological features of RBD are described, such as electroencephalography during wakefulness and sleep, transcranial magnetic stimulation, and vestibular evoked myogenic potentials. The role of the assessment of neurophysiological features in the study of RBD is then carefully discussed, highlighting their usefulness and sensitivity in detecting neurodegeneration in the early or prodromal stages of RBD, as well as their relationship with other proposed biomarkers for the diagnosis, prognosis, and monitoring of this condition. Finally, a future research agenda is proposed to help clarify the many still unclear aspects of RBD.
Collapse
Affiliation(s)
- Michela Figorilli
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Giuseppe Lanza
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
| | - Patrizia Congiu
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Rosamaria Lecca
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Elisa Casaglia
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Maria P. Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, 27100 Pavia, Italy;
| | - Monica Puligheddu
- Neurology Unit, Department of Medical Sciences and Public Health, University of Cagliari and AOU Cagliari, Monserrato, 09042 Cagliari, Italy; (M.F.); (P.C.); (R.L.); (E.C.); (M.P.)
- Sleep Disorders Center, Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E., SS 554 Bivio Sestu, Monserrato, 09042 Cagliari, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
- Correspondence: ; Tel.: +39-0935-936111
| |
Collapse
|
28
|
Galbiati A, Carli G, Fasiello E, Casoni F, Zucconi M, De Gennaro L, Perani D, Ferini-Strambi L. Exploring the functional role and neural correlates of K-complexes in isolated rapid eye movement sleep behavior disorder. Cortex 2021; 145:105-114. [PMID: 34710676 DOI: 10.1016/j.cortex.2021.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 02/05/2023]
Abstract
Underlying neural mechanisms and cognitive implications of non-Rapid Eye Movement (NREM) sleep in isolated Rapid Eye Movement (REM) sleep behavior disorder (iRBD) are not yet fully elucidated. This study aims to evaluate brain metabolic connectivity of the anterior default mode network (ADMN) underlying a waveform that is an hallmark of NREM sleep, namely K-complex (KC) and their implication for neuropsychological functioning in iRBD patients. Combining polysomnographic and multivariate molecular imaging (FDG-PET) approaches may provide crucial insights regarding KCs role in the prodromal stages of synucleinopathies. We applied a seed-based interregional correlation analysis on FDG-PET data. iRBD patients with cognitive decline displayed a reduced KC density (KCd) in comparison to patients without cognitive impairments. KCd showed a significant positive correlation with global cognitive functioning, specifically with visuo-spatial and executive performances, two cognitive domains known to be relevant in predicting conversion into neurodegenerative disorders. Increased KCd was associated with a more preserved ADMN connectivity. Our study underlines the importance of NREM sleep in prodromal stages of synucleinopathies, and future investigations might clarify its role in iRBD.
Collapse
Affiliation(s)
- Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.
| | - Giulia Carli
- "Vita-Salute" San Raffaele University, Milan, Italy; In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Daniela Perani
- "Vita-Salute" San Raffaele University, Milan, Italy; In vivo Human Molecular and Structural Neuroimaging Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy; IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| |
Collapse
|
29
|
Seifinejad A, Vassalli A, Tafti M. Neurobiology of cataplexy. Sleep Med Rev 2021; 60:101546. [PMID: 34607185 DOI: 10.1016/j.smrv.2021.101546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022]
Abstract
Cataplexy is the pathognomonic and the most striking symptom of narcolepsy. It has originally been, and still is now, widely considered as an abnormal manifestation of rapid eye movement (REM) sleep during wakefulness due to the typical muscle atonia. The neurocircuits of cataplexy, originally confined to the brainstem as those of REM sleep atonia, now include the hypothalamus, dorsal raphe (DR), amygdala and frontal cortex, and its neurochemistry originally focused on catecholamines and acetylcholine now extend to hypocretin (HCRT) and other neuromodulators. Here, we review the neuroanatomy and neurochemistry of cataplexy and propose that cataplexy is a distinct brain state that, despite similarities with REM sleep, involves cataplexy-specific features.
Collapse
Affiliation(s)
- Ali Seifinejad
- Department of Biomedical Sciences, Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Anne Vassalli
- Department of Biomedical Sciences, Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Mehdi Tafti
- Department of Biomedical Sciences, Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland.
| |
Collapse
|
30
|
Abstract
TOPIC Sleep in the intensive care unit can be poorly consolidated and highly fragmented. This review examines the neurobiology of normal and abnormal sleep, with a focus on the changes that occur in the intensive care unit environment. CLINICAL RELEVANCE Patients in the intensive care unit demonstrate a lack of rapid-eye-movement sleep and an inability to effectively transition from light to deep stages of sleep. These abnormalities can adversely affect hemodynamic parameters and physiological and psychological outcomes. PURPOSE To describe the brain mechanisms and electroencephalographic characteristics of wakefulness and the different stages of sleep. This review also describes how sleep can be altered by hospitalization in the intensive care unit and how nurses can design interventions that improve sleep and outcomes. CONTENT COVERED The review examines sleep mechanisms, including brain electrical activity, regulatory centers in the brain, and circadian and diurnal patterns of sleep and hemodynamic function. Nursing interventions for specific patient risk factors in the intensive care unit are proposed.
Collapse
Affiliation(s)
- Anne M Fink
- Anne M. Fink is an assistant professor in the Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
31
|
Simor P, Szalárdy O, Gombos F, Ujma PP, Jordán Z, Halász L, Erőss L, Fabó D, Bódizs R. REM Sleep Microstates in the Human Anterior Thalamus. J Neurosci 2021; 41:5677-5686. [PMID: 33863786 PMCID: PMC8244978 DOI: 10.1523/jneurosci.1899-20.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/24/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
Rapid eye movement (REM) sleep is an elusive neural state that is associated with a variety of functions from physiological regulatory mechanisms to complex cognitive processing. REM periods consist of the alternation of phasic and tonic REM microstates that differ in spontaneous and evoked neural activity. Although previous studies indicate, that cortical and thalamocortical activity differs across phasic and tonic microstates, the characterization of neural activity, particularly in subcortical structures that are critical in the initiation and maintenance of REM sleep is still limited in humans. Here, we examined electric activity patterns of the anterior nuclei of the thalamus as well as their functional connectivity with scalp EEG recordings during REM microstates and wakefulness in a group of epilepsy patients (N = 12, 7 females). Anterothalamic local field potentials (LFPs) showed increased high-α and β frequency power in tonic compared with phasic REM, emerging as an intermediate state between phasic REM and wakefulness. Moreover, we observed increased thalamocortical synchronization in phasic compared with tonic REM sleep, especially in the slow and fast frequency ranges. Wake-like activity in tonic REM sleep may index the regulation of arousal and vigilance facilitating environmental alertness. On the other hand, increased thalamocortical synchronization may reflect the intrinsic activity of frontolimbic networks supporting emotional and memory processes during phasic REM sleep. In sum, our findings highlight that the heterogeneity of phasic and tonic REM sleep is not limited to cortical activity, but is also manifested by anterothalamic LFPs and thalamocortical synchronization.SIGNIFICANCE STATEMENT REM sleep is a heterogeneous sleep state that features the alternation of two microstates, phasic and tonic rapid eye movement (REM). These states differ in sensory processing, awakening thresholds, and cortical activity. Nevertheless, the characterization of these microstates, particularly in subcortical structures is still limited in humans. We had the unique opportunity to examine electric activity patterns of the anterior nuclei of the thalamus (ANTs) as well as their functional connectivity with scalp EEG recordings during REM microstates and wakefulness. Our findings show that the heterogeneity of phasic and tonic REM sleep is not limited to cortical activity, but is also manifested in the level of the thalamus and thalamocortical networks.
Collapse
Affiliation(s)
- Péter Simor
- Institute of Psychology, ELTE, Eötvös Loránd University, Budapest 1064, Hungary
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- UR2NF, Neuropsychology and Functional Neuroimaging Research Unit at CRCN, Center for Research in Cognition and Neurosciences and UNI-ULB Neurosciences Institute, Université Libre de Bruxelles, Brussels 1050, Belgium
| | - Orsolya Szalárdy
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest 1117, Hungary
| | - Ferenc Gombos
- MTA-PPKE, Hungarian Academy of Sciences, Pázmány Péter Catholic University, Adolescent Development Research Group, Budapest 1088, Hungary
| | - Péter Przemyslaw Ujma
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Zsófia Jordán
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - László Halász
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Loránd Erőss
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Dániel Fabó
- National Institute of Clinical Neurosciences, Budapest 1145, Hungary
| | - Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Budapest 1089, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest 1117, Hungary
| |
Collapse
|
32
|
Wang YQ, Liu WY, Li L, Qu WM, Huang ZL. Neural circuitry underlying REM sleep: A review of the literature and current concepts. Prog Neurobiol 2021; 204:102106. [PMID: 34144122 DOI: 10.1016/j.pneurobio.2021.102106] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/25/2021] [Accepted: 06/09/2021] [Indexed: 01/09/2023]
Abstract
As one of the fundamental sleep states, rapid eye movement (REM) sleep is believed to be associated with dreaming and is characterized by low-voltage, fast electroencephalographic activity and loss of muscle tone. However, the mechanisms of REM sleep generation have remained unclear despite decades of research. Several models of REM sleep have been established, including a reciprocal interaction model, limit-cycle model, flip-flop model, and a model involving γ-aminobutyric acid, glutamate, and aminergic/orexin/melanin-concentrating hormone neurons. In the present review, we discuss these models and summarize two typical disorders related to REM sleep, namely REM sleep behavior disorder and narcolepsy. REM sleep behavior disorder is a sleep muscle-tone-related disorder and can be treated with clonazepam and melatonin. Narcolepsy, with core symptoms of excessive daytime sleepiness and cataplexy, is strongly connected with orexin in early adulthood.
Collapse
Affiliation(s)
- Yi-Qun Wang
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Wen-Ying Liu
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Lei Li
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Wei-Min Qu
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Zhi-Li Huang
- Department of Pharmacology, School of Basic Medical Sciences and State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
33
|
Howell MJ. Rapid Eye Movement Sleep Behavior Disorder and Other Rapid Eye Movement Parasomnias. ACTA ACUST UNITED AC 2021; 26:929-945. [PMID: 32756229 DOI: 10.1212/con.0000000000000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW The discovery of rapid eye movement (REM) sleep and, in particular, REM sleep behavior disorder (RBD) have brought elusive nightmarish experiences to scientific scrutiny. This article summarizes a century of sleep research to examine the maladies of dreaming, their pathophysiologic significance, and management. RECENT FINDINGS Under healthy physiologic conditions, REM sleep is characterized by vivid mentation combined with skeletal muscle paralysis. The loss of REM sleep atonia in RBD results in vivid, potentially injurious dream enactment to patients and bed partners. RBD is common, affecting at least 1% of the population and is primarily caused by α-synuclein pathology of REM sleep-related brainstem neurons. The majority of patients with RBD ultimately develop a neurodegenerative syndrome such as Parkinson disease, dementia with Lewy bodies, or multiple system atrophy. Among patients with Parkinson disease, RBD predicts an aggressive disease course with rapid cognitive, motor, and autonomic decline. RBD is diagnosed by the presence of dream enactment episodes (either recorded or clinically recalled) and physiologic evidence of REM sleep without atonia demonstrated on polysomnography. Bedroom safety is of paramount importance in the management of RBD while pharmacokinetic options include melatonin or clonazepam. SUMMARY The injurious dream enactment of RBD is common and treatable. It is a syndrome of α-synuclein pathology with most patients ultimately developing Parkinson disease, dementia with Lewy bodies, or a related disorder.
Collapse
|
34
|
Sunwoo JS, Cha KS, Byun JI, Jun JS, Kim TJ, Shin JW, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Kim HJ, Schenck CH, Jung KY. Nonrapid eye movement sleep electroencephalographic oscillations in idiopathic rapid eye movement sleep behavior disorder: a study of sleep spindles and slow oscillations. Sleep 2021; 44:5896006. [PMID: 32827438 DOI: 10.1093/sleep/zsaa160] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/18/2020] [Indexed: 12/29/2022] Open
Abstract
STUDY OBJECTIVES We investigated electroencephalographic (EEG) slow oscillations (SOs), sleep spindles (SSs), and their temporal coordination during nonrapid eye movement (NREM) sleep in patients with idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). METHODS We analyzed 16 patients with video-polysomnography-confirmed iRBD (age, 65.4 ± 6.6 years; male, 87.5%) and 10 controls (age, 62.3 ± 7.5 years; male, 70%). SSs and SOs were automatically detected during stage N2 and N3. We analyzed their characteristics, including density, frequency, duration, and amplitude. We additionally identified SO-locked spindles and examined their phase distribution and phase locking with the corresponding SO. For inter-group comparisons, we used the independent samples t-test or Wilcoxon rank-sum test, as appropriate. RESULTS The SOs of iRBD patients had significantly lower amplitude, longer duration (p = 0.005 for both), and shallower slope (p < 0.001) than those of controls. The SS power of iRBD patients was significantly lower than that of controls (p = 0.002), although spindle density did not differ significantly. Furthermore, SO-locked spindles of iRBD patients prematurely occurred during the down-to-up-state transition of SOs, whereas those of controls occurred at the up-state peak of SOs (p = 0.009). The phase of SO-locked spindles showed a positive correlation with delayed recall subscores (p = 0.005) but not with tonic or phasic electromyography activity during REM sleep. CONCLUSIONS In this study, we found abnormal EEG oscillations during NREM sleep in patients with iRBD. The impaired temporal coupling between SOs and SSs may reflect early neurodegenerative changes in iRBD.
Collapse
Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea
| | - Kwang Su Cha
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jin-Sun Jun
- Department of Neurology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, South Korea
| | - Jung-Won Shin
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Protein Metabolism and Dementia Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center and Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
35
|
Panagiotou M, Michel S, Meijer JH, Deboer T. The aging brain: sleep, the circadian clock and exercise. Biochem Pharmacol 2021; 191:114563. [PMID: 33857490 DOI: 10.1016/j.bcp.2021.114563] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022]
Abstract
Aging is a multifactorial process likely stemming from damage accumulation and/or a decline in maintenance and repair mechanisms in the organisms that eventually determine their lifespan. In our review, we focus on the morphological and functional alterations that the aging brain undergoes affecting sleep and the circadian clock in both human and rodent models. Although both species share mammalian features, differences have been identified on several experimental levels, which we outline in this review. Additionally, we delineate some challenges on the preferred analysis and we suggest that a uniform route is followed so that findings can be smoothly compared. We conclude by discussing potential interventions and highlight the influence of physical exercise as a beneficial lifestyle intervention, and its effect on healthy aging and longevity. We emphasize that even moderate age-matched exercise is able to ameliorate several aging characteristics as far as sleep and circadian rhythms are concerned, independent of the species studied.
Collapse
Affiliation(s)
- M Panagiotou
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, The Netherlands.
| | - S Michel
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - J H Meijer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| | - T Deboer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, The Netherlands
| |
Collapse
|
36
|
Zhang Y, Ren R, Yang L, Zhang H, Shi Y, Sanford LD, Tang X. Polysomnographic nighttime features of narcolepsy: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101488. [PMID: 33934047 DOI: 10.1016/j.smrv.2021.101488] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/27/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies have been conducted to explore nighttime sleep features in narcolepsy, but their relationship to narcolepsy is still imperfectly understood. We conducted a systematic review of the literature exploring polysomnographic differences between narcolepsy patients and healthy controls (HCs) in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO. 108 studies were identified for this review, 105 of which were used for meta-analysis. Meta-analyses revealed significant reductions in sleep latency, sleep efficiency, slow wave sleep percentage, rapid eye movement sleep (REM) latency, cyclic alternating pattern rate, and increases in total sleep time, wake time after sleep onset (WASO), awakening numbers (AWN) per hour, stage shift (SS) per hour, N1 percentage, apnea hypopnea index, and periodic limb movement index in narcolepsy patients compared with HCs. Furthermore, narcolepsy type 1 patients showed more disturbed nighttime sleep compared with narcolepsy type 2 patients. Children and adolescent narcolepsy patients show increased WASO, AWN, and SS compared with adult patients. Macro- and micro-structurally, our study suggests that narcolepsy patients have poor nighttime sleep. Sex, age, body mass index, disease duration, disease type, medication status, and adaptation night are demographic, clinical and methodological factors that contribute to heterogeneity between studies.
Collapse
Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Haipeng Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Shi
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
37
|
Sunwoo JS. Narcolepsy, autoimmunity, and influenza A H1N1 vaccination. ENCEPHALITIS 2021; 1:31-35. [PMID: 37469760 PMCID: PMC10295885 DOI: 10.47936/encephalitis.2021.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 07/21/2023] Open
Abstract
Narcolepsy is a rare neurological disorder characterized by excessive daytime sleepiness (EDS) with or without cataplexy. A main pathophysiology of narcolepsy is hypocretin deficiency in the central nervous system resulting from a selective loss of hypocretin neurons in the lateral hypothalamus. To date, the pathogenesis of hypocretin neuron loss in narcolepsy is the most commonly accepted autoimmune hypothesis which is supported by genetic risk factors for narcolepsy such as HLA‑DQB1*06:02 allele and T-cell receptor alpha polymorphisms. Other evidence supporting the immune-mediated mechanisms include the presence of anti-Tribbles homolog 2 (TRIB2) and anti-streptococcal antibodies in patients with narcolepsy, seasonal patterns of narcolepsy onset, and increased incidence of narcolepsy after the H1N1 pandemic influenza A infections and vaccinations. Among several types of vaccines, the AS03-adjuvanted vaccine Pandemrix (GlaxoSmithKline) was the only vaccine found to increase the risk of narcolepsy. However, the comprehensive results of several epidemiological studies indicate the adjuvant AS03 alone cannot cause the disease. The genetic predisposition, environmental triggers, molecular mimicry of specific H1N1 antigens, and bystander immune activation caused by the adjuvant AS03 may have combined to contribute to autoimmunity against hypocretin neurons and development of narcolepsy.
Collapse
Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
38
|
Christensen JAE, Jennum PJ, Fagerlund B, Baandrup L. Association of neurocognitive functioning with sleep stage dissociation and REM sleep instability in medicated patients with schizophrenia. J Psychiatr Res 2021; 136:198-203. [PMID: 33610947 DOI: 10.1016/j.jpsychires.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/22/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
Many patients with schizophrenia present with impaired cognitive functioning and sleep disturbances. Dissociated stages of sleep represent instability within distinct sleep regulatory cerebral networks. Previous studies found increased rates of rapid eye movement (REM) sleep abnormalities in patients with schizophrenia and a positive association with psychopathology. In this study, we examined if sleep stage dissociation and REM sleep instability was associated with neurocognitive functioning in a sample of medicated patients with schizophrenia. The analyses were performed on 31 baseline polysomnographic recordings as well as baseline data on neurocognitive performance. Regression models were built with the cognitive composite score as primary dependent variable and measures of sleep stage dissociation, including REM sleep without atonia (RSWA), REM sleep without eye movements, non-REM sleep with eye movements, REM sleep percentage in REM periods and REM sleep stability as independent variables. Analyses were adjusted for age, gender, total antipsychotic dose, total benzodiazepine dose, and symptom severity. After correction for multiple testing, we found that the neurocognitive composite score was inversely associated with the degree of RSWA. Exploratory analyses with the cognitive sub scores as dependent variables showed that RSWA was associated with cognitive performance across several sub domains. Dissociated sleep stages, specifically the RSWA feature, might represent a new treatment target for improving cognitive impairment in patients with schizophrenia.
Collapse
Affiliation(s)
- Julie Anja Engelhard Christensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark; Department of Health Technology, Technical University of Denmark, Denmark
| | - Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet Glostrup, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Birgitte Fagerlund
- Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Denmark; Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Glostrup, Denmark; Mental Health Center Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
39
|
Shen Y, Yu WB, Shen B, Dong H, Zhao J, Tang YL, Fan Y, Yang YF, Sun YM, Luo SS, Chen C, Liu FT, Wu JJ, Xiao BG, Yu H, Koprich JB, Huang ZL, Wang J. Propagated α-synucleinopathy recapitulates REM sleep behaviour disorder followed by parkinsonian phenotypes in mice. Brain 2021; 143:3374-3392. [PMID: 33170925 DOI: 10.1093/brain/awaa283] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/18/2020] [Accepted: 07/12/2020] [Indexed: 11/14/2022] Open
Abstract
Idiopathic rapid eye movement sleep behaviour disorder (RBD) is now recognized as an early manifestation of α-synucleinopathies. Increasing experimental studies demonstrate that manipulative lesion or inactivation of the neurons within the sublaterodorsal tegmental nucleus (also known as the subcoeruleus nucleus in humans) can induce RBD-like behaviours in animals. As current RBD animal models are not established on the basis of α-synucleinopathy, they do not represent the pathological substrate of idiopathic RBD and thus cannot model the phenoconversion to Parkinson's disease. The purpose of this study was therefore to establish an α-synucleinopathy-based RBD animal model with the potential to convert to parkinsonian disorder. To this end, we first determined the functional neuroanatomical location of the sublaterodorsal tegmental nucleus in wild-type C57BL/6J mice and then validated its function by recapitulating RBD-like behaviours based on this determined nucleus. Next, we injected preformed α-synuclein fibrils into the sublaterodorsal tegmental nucleus and performed regular polysomnographic recordings and parkinsonian behavioural and histopathological studies in these mice. As a result, we recapitulated RBD-like behaviours in the mice and further showed that the α-synucleinopathy and neuron degeneration identified within the sublaterodorsal tegmental nucleus acted as the neuropathological substrates. Subsequent parkinsonian behavioural studies indicated that the α-synucleinopathy-based RBD mouse model were not stationary, but could further progress to display parkinsonian locomotor dysfunction, depression-like disorder, olfactory dysfunction and gastrointestinal dysmotility. Corresponding to that, we determined α-synuclein pathology in the substantia nigra pars compacta, olfactory bulb, enteral neuroplexus and dorsal motor nucleus of vagus nerve, which could underlie the parkinsonian manifestations in mice. In conclusion, we established a novel α-synucleinopathy-based RBD mouse model and further demonstrated the phenoconversion of RBD to Parkinson's disease in this animal model.
Collapse
Affiliation(s)
- Yan Shen
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen-Bo Yu
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bo Shen
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Hui Dong
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Jue Zhao
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Lin Tang
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yun Fan
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan-Fei Yang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Yi-Min Sun
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Su-Shan Luo
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Chen
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng-Tao Liu
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Jun Wu
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bao-Guo Xiao
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Huan Yu
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - James B Koprich
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
- Krembil Institute, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Zhi-Li Huang
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Jian Wang
- Department of Neurology and National Research Center for Aging and Medicine, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
40
|
Aygün D, Ertaş Fİ, Gündüz A, Benbir Şenel G, Karadeniz D, Kızıltan M. The role of pedunculopontine nucleus in isolated REM sleep behavior disorder and REM sleep without atonia. Parkinsonism Relat Disord 2021; 84:68-73. [PMID: 33571873 DOI: 10.1016/j.parkreldis.2021.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to analyze the functions of pedunculopontine nucleus (PPN) in isolated REM sleep behavior disorder (iRBD) and REM sleep without atonia (RSWA) to investigate the role of PPN in dream-enacting motor behaviors in RBD. We evaluated the activity of PPN through the prepulse modulation (PPM) together with other brainstem reflexes to investigate the differences in changes at brainstem. METHODS We included nine patients with isolated RSWA and 10 patients with iRBD. For diagnosis, all patients underwent polysomnography. None of the patients had parkinsonism or dementia. We also included 17 healthy participants with similar age and sex. Blink reflex (BR), PPM of BR, recovery excitability of BR, and auditory startle reflex (ASR) were recorded in all participants. RESULTS There was a prepulse inhibition deficit in iRBD and RSWA groups compared to healthy subjects. The BR-R2 recovery at 200 ms interval was also higher in patients with iRBD and RSWA. In ASR recordings, the response probabilities were higher in the RBD group compared to RSWA and control groups. CONCLUSION The PPM was abnormal in both iRBD and RSWA whereas ASR was enhanced in iRBD. We suggest that there are certain similarities and differences in the pathophysiologies of iRBD and RSWA.
Collapse
Affiliation(s)
- Demet Aygün
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey
| | - F İnci Ertaş
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey
| | - Ayşegül Gündüz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey.
| | - Gülçin Benbir Şenel
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey
| | - Derya Karadeniz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey
| | - Meral Kızıltan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Division of Clinical Electroneurophysiology, Istanbul, Turkey
| |
Collapse
|
41
|
Video-polysomnographic findings after acute COVID-19: REM sleep without atonia as sign of CNS pathology? Sleep Med 2021; 80:92-95. [PMID: 33588262 PMCID: PMC7985859 DOI: 10.1016/j.sleep.2021.01.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 01/25/2023]
Abstract
Objective Sleep complaints are frequent after acute COVID-19. Aim of this study was to videopolysomnographically evaluate sleep and sleep disorders after SARS-Cov2 infection. Methods Patients with suspected sleep disorders after acute COVID-19 underwent video-polysomnography (v-PSG) at the Sleep Disorders Clinic, Department of Neurology, Medical University Innsbruck. V-PSG was conducted 4.2 (SD = 1.3) months after diagnosis of SARS-CoV-2 infection. Results Eleven patients [nine men, age 52.5 (SD = 11.7) years; BMI 29 (SD = 5.2) kg/m2] were included. At 60 days follow-up after diagnosis, persisting breathing complaints were present in 7/11 (64%) patients. After v-PSG four patients (36%) were diagnosed with obstructive sleep apnea (OSA). Respiratory frequency during sleep was normal and no tachypnea, thoracoabdominal asynchrony, or periodic deep sighing were detected. Four patients (36%) showed REM sleep without atonia (RWA), and two additional patients showed an RWA index within the highest range of normality. Conclusion We report videopolysomnographic findings in a series of eleven patients after acute COVID-19. A major finding of this study was the presence of isolated RWA, a recognized prodromal stage of RBD, in more than one third of the patients. Future videopolysomnographic investigations including quantification of RWA in patients after COVID-19 will give more insights into a possible acute or post-infectious CNS pathology related to the SARS-CoV-2 infection.
Collapse
|
42
|
Nobleza CMN, Siddiqui M, Shah PV, Balani P, Lopez AR, Khan S. The Relationship of Rapid Eye Movement Sleep Behavior Disorder and Freezing of Gait in Parkinson's Disease. Cureus 2020; 12:e12385. [PMID: 33532150 PMCID: PMC7846434 DOI: 10.7759/cureus.12385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rapid eye movement sleep behavior disorder (RBD) contributes to injury due to the alteration of the expected atonia during rapid eye movement (REM) sleep. It occurs before the overt signs of Parkinson's disease (PD). The co-expression of PD and RBD is characterized by non-tremor predominant subtype and higher incidence of freezing. Freezing of gait (FOG) is a debilitating symptom seen in PD patients that lead to falls. While this phenomenon is understood poorly, the involvement of the pedunculopontine nucleus (PPN) and the neural circuits that control locomotion and gait have been examined. This network has also the same control for REM sleep and arousal. The close relationship between PD and RBD and FOG's consequences has led us to explore the relationship between RBD and PD with FOG. This review provides an overview of the neural connections that control gait, locomotion, and REM sleep. The neural changes were seen in PD with FOG and RBD, and sensory and motor changes observed in these two diseases. The functional neuroanatomy that controls REM sleep, arousal, and locomotion overlap significantly with multiple neural circuits affected in RBD and PD with FOG. Visual perception dysfunction and motor symptoms that primarily affect gait initiation are common to both patients with RBD and FOG in PD, leading to freezing episodes. Prospective studies should be conducted to elucidate the relationship of RBD and PD with FOG subtype and find innovative treatment approaches and diagnostic tools for PD with FOG.
Collapse
Affiliation(s)
- Chelsea Mae N Nobleza
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mariah Siddiqui
- Neurology, St. George's University, True Blue, GRD.,Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Parth V Shah
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Prachi Balani
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Angel R Lopez
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
43
|
Thieux M, Zhang M, Marcastel A, Herbillon V, Guignard-Perret A, Seugnet L, Lin JS, Guyon A, Plancoulaine S, Franco P. Intellectual Abilities of Children with Narcolepsy. J Clin Med 2020; 9:jcm9124075. [PMID: 33348677 PMCID: PMC7766444 DOI: 10.3390/jcm9124075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
High cognitive functioning could be a protective factor for school difficulties, behavioral and mood impairments in children with narcolepsy. To investigate this factor, we studied the intellectual abilities of 74 children with narcolepsy (43 boys, 11.7 years old at diagnosis, 91% of cataplexies, 64% obese, 100% HLA positive for DR-DQB1*06:02). All children underwent a one-night polysomnography followed by Multiple Sleep Latency Tests, an evaluation of intelligence quotient (IQ), and filled standardized questionnaires. Thirty-eight percent had high potentialities (HP defined by IQ > 130) and 48% had school difficulties. Using non-parametric tests, we found that HP children reported less difficulties at school and tended to have less impulsivity, conduct, and learning disorders than those without HP. They also tended to be less obese and had less desaturation. Using a multivariate regression analysis, we found an association between the REM sleep percentage and the IQ. REM sleep could be involved in the dynamic changes contributing to the equilibrium of intellectual functioning. This study highlights that despite their frequent school difficulties, narcolepsy per se is unlikely to be a cause of intellectual disability in children. Prompt diagnosis and management of comorbidities such as obesity and obstructive sleep apnea (OSA) could improve cognitive and school performances in these children.
Collapse
Affiliation(s)
- Marine Thieux
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Min Zhang
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Agathe Marcastel
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Vania Herbillon
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Anne Guignard-Perret
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
| | - Laurent Seugnet
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Jian-Sheng Lin
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | - Aurore Guyon
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
| | | | - Patricia Franco
- Pediatric Sleep Unit, Department of Pediatric Clinical Epileptology, Sleep Disorders and Functional Neurology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69500 Lyon, France; (M.T.); (A.M.); (V.H.); (A.G.-P.); (A.G.)
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, 69500 Lyon, France; (M.Z.); (L.S.); (J.-S.L.)
- Correspondence: ; Tel./Fax: +33-4-27-85-60-52
| |
Collapse
|
44
|
Baldelli L, Provini F. Differentiating Oneiric Stupor in Agrypnia Excitata From Dreaming Disorders. Front Neurol 2020; 11:565694. [PMID: 33281702 PMCID: PMC7688744 DOI: 10.3389/fneur.2020.565694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/01/2020] [Indexed: 12/22/2022] Open
Abstract
Oneiric Stupor (OS) in Agrypnia Excitata represents a peculiar condition characterized by the recurrence of stereotyped gestures such as mimicking daily-life activities associated with the reporting of a dream mentation consisting in a single oneiric scene. It arises in the context of a completely disorganized sleep structure lacking any physiological cyclic organization, thus, going beyond the concept of abnormal dream. However, a proper differential diagnosis of OS, in the complex world of the “disorders of dreaming” can become quite challenging. The aim of this review is to provide useful clinical and videopolygraphic data on OS to differentiate it from other dreaming disorders. Each entity will be clinically evaluated among the areas of dream mentation and abnormal sleep behaviors and its polygraphic features will be analyzed and distinguished from OS.
Collapse
Affiliation(s)
- Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| |
Collapse
|
45
|
Schwenkgrub J, Harrell ER, Bathellier B, Bouvier J. Deep imaging in the brainstem reveals functional heterogeneity in V2a neurons controlling locomotion. SCIENCE ADVANCES 2020; 6:6/49/eabc6309. [PMID: 33277252 PMCID: PMC7821901 DOI: 10.1126/sciadv.abc6309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/20/2020] [Indexed: 05/28/2023]
Abstract
V2a neurons are a genetically defined cell class that forms a major excitatory descending pathway from the brainstem reticular formation to the spinal cord. Their activation has been linked to the termination of locomotor activity based on broad optogenetic manipulations. However, because of the difficulties involved in accessing brainstem structures for in vivo cell type-specific recordings, V2a neuron function has never been directly observed during natural behaviors. Here, we imaged the activity of V2a neurons using micro-endoscopy in freely moving mice. We find that as many as half of the V2a neurons are excited at locomotion arrest and with low reliability. Other V2a neurons are inhibited at locomotor arrests and/or activated during other behaviors such as locomotion initiation or stationary grooming. Our results establish that V2a neurons not only drive stops as suggested by bulk optogenetics but also are stratified into subpopulations that likely contribute to diverse motor patterns.
Collapse
Affiliation(s)
- Joanna Schwenkgrub
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190 Gif-sur-Yvette, France
- Institut Pasteur, INSERM, Institut de l'Audition, 63 rue de Charenton, F-75012 Paris, France
| | - Evan R Harrell
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190 Gif-sur-Yvette, France
- Institut Pasteur, INSERM, Institut de l'Audition, 63 rue de Charenton, F-75012 Paris, France
| | - Brice Bathellier
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190 Gif-sur-Yvette, France.
- Institut Pasteur, INSERM, Institut de l'Audition, 63 rue de Charenton, F-75012 Paris, France
| | - Julien Bouvier
- Université Paris-Saclay, CNRS, Institut des Neurosciences Paris-Saclay, 91190 Gif-sur-Yvette, France.
| |
Collapse
|
46
|
Bandaru SS, Khanday MA, Ibrahim N, Naganuma F, Vetrivelan R. Sleep-Wake Control by Melanin-Concentrating Hormone (MCH) Neurons: a Review of Recent Findings. Curr Neurol Neurosci Rep 2020; 20:55. [PMID: 33006677 DOI: 10.1007/s11910-020-01075-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW Melanin-concentrating hormone (MCH)-expressing neurons located in the lateral hypothalamus are considered as an integral component of sleep-wake circuitry. However, the precise role of MCH neurons in sleep-wake regulation has remained unclear, despite several years of research employing a wide range of techniques. We review recent data on this aspect, which are mostly inconsistent, and propose a novel role for MCH neurons in sleep regulation. RECENT FINDINGS While almost all studies using "gain-of-function" approaches show an increase in rapid eye movement sleep (or paradoxical sleep; PS), loss-of-function approaches have not shown reductions in PS. Similarly, the reported changes in wakefulness or non-rapid eye movement sleep (slow-wave sleep; SWS) with manipulation of the MCH system using conditional genetic methods are inconsistent. Currently available data do not support a role for MCH neurons in spontaneous sleep-wake but imply a crucial role for them in orchestrating sleep-wake responses to changes in external and internal environments.
Collapse
Affiliation(s)
- Sathyajit S Bandaru
- Department of Neurology, Beth Israel Deaconess Medical Center, 3 Blackfan Circle, Center for Life Science # 711, Boston, MA, USA
| | - Mudasir A Khanday
- Department of Neurology, Beth Israel Deaconess Medical Center, 3 Blackfan Circle, Center for Life Science # 711, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Nazifa Ibrahim
- Department of Neurology, Beth Israel Deaconess Medical Center, 3 Blackfan Circle, Center for Life Science # 711, Boston, MA, USA.,Department of Public Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Fumito Naganuma
- Department of Neurology, Beth Israel Deaconess Medical Center, 3 Blackfan Circle, Center for Life Science # 711, Boston, MA, USA.,Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ramalingam Vetrivelan
- Department of Neurology, Beth Israel Deaconess Medical Center, 3 Blackfan Circle, Center for Life Science # 711, Boston, MA, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
47
|
Simor P, van der Wijk G, Nobili L, Peigneux P. The microstructure of REM sleep: Why phasic and tonic? Sleep Med Rev 2020; 52:101305. [DOI: 10.1016/j.smrv.2020.101305] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022]
|
48
|
Feng H, Wen SY, Qiao QC, Pang YJ, Wang SY, Li HY, Cai J, Zhang KX, Chen J, Hu ZA, Luo FL, Wang GZ, Yang N, Zhang J. Orexin signaling modulates synchronized excitation in the sublaterodorsal tegmental nucleus to stabilize REM sleep. Nat Commun 2020; 11:3661. [PMID: 32694504 PMCID: PMC7374574 DOI: 10.1038/s41467-020-17401-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/24/2020] [Indexed: 11/30/2022] Open
Abstract
The relationship between orexin/hypocretin and rapid eye movement (REM) sleep remains elusive. Here, we find that a proportion of orexin neurons project to the sublaterodorsal tegmental nucleus (SLD) and exhibit REM sleep-related activation. In SLD, orexin directly excites orexin receptor-positive neurons (occupying ~3/4 of total-population) and increases gap junction conductance among neurons. Their interaction spreads the orexin-elicited partial-excitation to activate SLD network globally. Besides, the activated SLD network exhibits increased probability of synchronized firings. This synchronized excitation promotes the correspondence between SLD and its downstream target to enhance SLD output. Using optogenetics and fiber-photometry, we consequently find that orexin-enhanced SLD output prolongs REM sleep episodes through consolidating brain state activation/muscle tone inhibition. After chemogenetic silencing of SLD orexin signaling, a ~17% reduction of REM sleep amounts and disruptions of REM sleep muscle atonia are observed. These findings reveal a stabilization role of orexin in REM sleep. Orexin signaling is provided by diffusely distributed fibers and involved in different brain circuits that orchestrate sleep and wakefulness states. Here, the authors show that a proportion of orexin neurons project to the sublaterodorsal tegmental nucleus and exhibit rapid eye movement (REM) sleep-related actions.
Collapse
Affiliation(s)
- Hui Feng
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Si-Yi Wen
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Qi-Cheng Qiao
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Yu-Jie Pang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Sheng-Yun Wang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Hao-Yi Li
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Jiao Cai
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Kai-Xuan Zhang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Jing Chen
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Zhi-An Hu
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Fen-Lan Luo
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Guan-Zhong Wang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China
| | - Nian Yang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China.
| | - Jun Zhang
- Department of Physiology, Third Military Medical University, 400038, Chongqing, P.R. China.
| |
Collapse
|
49
|
Zhang Y, Ren R, Yang L, Sanford LD, Tang X. Polysomnographically measured sleep changes in idiopathic REM sleep behavior disorder: A systematic review and meta-analysis. Sleep Med Rev 2020; 54:101362. [PMID: 32739826 DOI: 10.1016/j.smrv.2020.101362] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
Abstract
Polysomnographic studies conducted to explore sleep changes in idiopathic rapid eye movement sleep behavior disorder (iRBD) have not established clear relationships between sleep disturbances and iRBD. To explore the polysomnographic differences between iRBD patients and healthy controls and their associated factors, an electronic literature search was conducted in EMBASE, MEDLINE, All EBM databases, CINAHL, and PsycINFO inception to December 2019.34 studies were identified for systematic review, 33 of which were used for meta-analysis. Meta-analyses revealed significant reductions in total sleep time (SMD = -0.212, 95%CI: -0.378 to -0.046), sleep efficiency (SMD = -0.194, 95%CI: -0.369 to -0.018), apnea hypopnea index (SMD = -0.440, 95%CI: -0.780 to -0.101), and increases in sleep latency (SMD = 0.340, 95%CI: 0.074 to 0.606), and slow wave sleep (SMD = 0.294, 95%CI: 0.064 to 0.523) in iRBD patients compared with controls. Furthermore, electroencephalogram frequency components during REM sleep were altered in iRBD patients compared with controls; however, the specific changes could not be determined. Our findings suggest that polysomnographic sleep is abnormal in iRBD patients. Further studies are needed on underlying mechanisms and associations with neurodegenerative diseases.
Collapse
Affiliation(s)
- Ye Zhang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Yang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Larry D Sanford
- Sleep Research Laboratory, Center for Integrative Neuroscience and Inflammatory Diseases, Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
50
|
Abstract
PURPOSE OF REVIEW Narcolepsy is a central disorder of hypersomnolence with symptoms of excessive daytime sleepiness, sleep paralysis, and cataplexy. Cataplexy is the sudden loss of muscle tone in either the face, neck, trunk, and/or limbs, leading to a loss of voluntary muscle control. This article reviews recent research on the clinical characteristics of cataplexy. RECENT FINDINGS Longitudinal research in adults suggests that there may be a remission of cataplectic severity after symptom stabilization. First-line treatment options for cataplexy include sodium oxybate and pitolisant, with many drugs such as AXS-12, FT218, and JZP258 under investigation. Patients with cataplexy reported greater limitations of daily activities such as driving and exercise compared to patients without cataplexy. Cataplexy remains a challenge for children and adults with narcolepsy and can interfere with daily activities. There is no cure for narcolepsy, but cataplexy can be well-managed with current and promising new treatment options on the horizon.
Collapse
|