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Ruby P, Evangelista E, Bastuji H, Peter-Derex L. From physiological awakening to pathological sleep inertia: Neurophysiological and behavioural characteristics of the sleep-to-wake transition. Neurophysiol Clin 2024; 54:102934. [PMID: 38394921 DOI: 10.1016/j.neucli.2023.102934] [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: 09/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/25/2024] Open
Abstract
Sleep inertia refers to the transient physiological state of hypoarousal upon awakening, associated with various degrees of impaired neurobehavioral performance, confusion, a desire to return to sleep and often a negative emotional state. Scalp and intracranial electro-encephalography as well as functional imaging studies have provided evidence that the sleep inertia phenomenon is underpinned by an heterogenous cerebral state mixing local sleep and local wake patterns of activity, at the neuronal and network levels. Sleep inertia is modulated by homeostasis and circadian processes, sleep stage upon awakening, and individual factors; this translates into a huge variability in its intensity even under physiological conditions. In sleep disorders, especially in hypersomnolence disorders such as idiopathic hypersomnia, sleep inertia may be a daily, serious and long-lasting symptom leading to severe impairment. To date, few tools have been developed to assess sleep inertia in clinical practice. They include mainly questionnaires and behavioral tests such as the psychomotor vigilance task. Only one neurophysiological protocol has been evaluated in hypersomnia, the forced awakening test which is based on an event-related potentials paradigm upon awakening. This contrasts with the major functional consequences of sleep inertia and its potentially dangerous consequences in subjects required to perform safety-critical tasks soon after awakening. There is a great need to identify reproducible biomarkers correlated with sleep inertia-associated cognitive and behavioral impairment. These biomarkers will aim at better understanding and measuring sleep inertia in physiological and pathological conditions, as well as objectively evaluating wake-promoting treatments or non-pharmacological countermeasures to reduce this phenomenon.
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Affiliation(s)
- Perrine Ruby
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France
| | - Elisa Evangelista
- Sleep disorder Unit, Carémeau Hospital, Centre Hospitalo-universitaire de Nîmes, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Hélène Bastuji
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France
| | - Laure Peter-Derex
- Lyon Neuroscience Research Centre, INSERM U1028, CNRS UMR 5292, Lyon, France; Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France.
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Peter-Derex L, Micoulaud-Franchi JA, Lopez R, Barateau L. Evaluation of hypersomnolence: From symptoms to diagnosis, a multidimensional approach. Rev Neurol (Paris) 2023; 179:715-726. [PMID: 37563022 DOI: 10.1016/j.neurol.2023.07.004] [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: 07/02/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents.
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Affiliation(s)
- L Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Centre, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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