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Idiaquez J, Casar JC, Arnardottir ES, August E, Santin J, Iturriaga R. Hyperhidrosis in sleep disorders - A narrative review of mechanisms and clinical significance. J Sleep Res 2023; 32:e13660. [PMID: 35706374 DOI: 10.1111/jsr.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/03/2023]
Abstract
Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs that affects patients' quality of life. It results from an excessive stimulation of eccrine sweat glands in the skin by the sympathetic nervous system. Hyperhidrosis may be primary or secondary to an underlying cause. Nocturnal hyperhidrosis is associated with different sleep disorders, such as obstructive sleep apnea, insomnia, restless legs syndrome/periodic limb movement during sleep and narcolepsy. The major cause of the hyperhidrosis is sympathetic overactivity and, in the case of narcolepsy type 1, orexin deficiency may also contribute. In this narrative review, we will provide an outline of the possible mechanisms underlying sudomotor dysfunction and the resulting nocturnal hyperhidrosis in these different sleep disorders and explore its clinical relevance.
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Affiliation(s)
- Juan Idiaquez
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Carlos Casar
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erna S Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.,Internal Medicine Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elias August
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.,Department of Engineering, School of Technology, Reykjavik University, Reykjavik, Iceland
| | - Julia Santin
- Departamento de Neurología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Iturriaga
- Laboratorio de Neurobiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
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Aldosari MS, Olaish AH, Nashwan SZ, Abulmeaty MMA, BaHammam AS. The effects of caffeine on drowsiness in patients with narcolepsy: a double-blind randomized controlled pilot study. Sleep Breath 2020; 24:1675-1684. [PMID: 32215834 DOI: 10.1007/s11325-020-02065-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The effects of caffeine on drowsiness and reaction time in patients with narcolepsy are unclear. We aimed to assess the effects of caffeine as add-on therapy in narcolepsy patients. METHODS A randomized, double-blind, placebo-control clinical pilot trial was conducted with a parallel, two-arm trial allocation ratio of 1:1. Participants attended two study visits 7 days apart. The drug was administered orally in a single opaque capsule containing 200 mg caffeine/placebo daily in the morning for 1 week. Sleepiness was assessed objectively using infrared reflectance oculography to measure the percentage of long eye closure (LEC%) and subjectively using two sleepiness scales, the Stanford Sleepiness Scale (SSS) and Karolinska Sleepiness Scale (KSS). Parameters were measured at baseline (BL) prior to taking the drug, after taking the first dose (FD), and after 1 week (WD) of daily caffeine. RESULTS Sixteen participants with narcolepsy were included. No significant differences between groups in baseline measurements were observed. LEC% was significantly decreased after the FD and WD compared with baseline levels (BL 1.4 ± 2.1 vs. FD 0.06 ± 0.0.6 and WD 0.03 ± 0.04). Significant improvements in alertness were observed using the KSS when comparing BL with FD and WD (6.3 ± 1.6, 4.9 ± 1.7, and 4.7 ± 1.7, respectively; p = 0.01). No changes in reaction time or SSS scores were noted. CONCLUSION Our findings suggest that a small dose of caffeine has positive effects on alertness in patients with narcolepsy. However, larger trials are required to confirm these findings. TRIAL REGISTRATION NO ClinicalTrial.gov NCT02832336.
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Affiliation(s)
- Mona S Aldosari
- Clinical Nutrition Department, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Awad H Olaish
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Samar Z Nashwan
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud M A Abulmeaty
- Clinical Nutrition Program, Community Health Sciences, King Saud University, Riyadh, Saudi Arabia. .,Obesity Management and Research Unit, Medical Physiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia. .,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in Saudi Arabia (08-MED511-02), Riyadh, Saudi Arabia.
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Abstract
Authors demonstrate that patients with narcolepsy type 1 (N1) have more tendency of eat salty snacks after satiety than health volunteers. A few mechanisms to explain the weight gain have been discussed in narcolepsy. The hypocretin-1 deficiency can influence the olfactory system. The olfactory system should be modulated through hypocretin-1 via connections from the hypothalamic to other brain regions. Likewise, hypocretin-1 can be synthesized locally in our olfactory mucosa with possible private role modulating the olfactory. In experimental studies, different kinds of smell influence the preference for type of diet. Olfactory and taste sensations help control of appetite and regulate the quantity and quality of foods that will be chosen. N1 patients have lower levels of hypocretin-1 and consequent inferior olfactory threshold, less olfactory discrimination, and these findings improved after nasal hypocretin-1 administration. It is possible that the hyposmia influenced the quality and quantity of food by narcoleptic patients. We suggest that a complementary analysis of olfactory function should be done concomitant with food preferences to compare narcoleptic patients with and without hypocretin-1 deficiency.
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Affiliation(s)
- Giselle de Martin Truzzi
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil
| | - Renata Carvalho Cremaschi
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia - São Paulo - São Paulo - Brazil
| | - Fernando Morgadinho Coelho
- Universidade Federal de São Paulo, Departamento de Psicobiologia - São Paulo - São Paulo - Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia - São Paulo - São Paulo - Brazil
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Sforza E, Roche F, Barthélémy JC, Pichot V. Diurnal and nocturnal cardiovascular variability and heart rate arousal response in idiopathic hypersomnia. Sleep Med 2016; 24:131-136. [PMID: 27810179 DOI: 10.1016/j.sleep.2016.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Autonomic nervous system dysfunction has been described in narcolepsy with cataplexy affecting sympathetic functions. In this study we analyzed whether altered diurnal and nocturnal cardiovascular control is present in idiopathic hypersomnia (IH). METHODS Fourteen drug-free patients aged 26.2 ± 7 years and 14 age-matched controls were examined. Clinical data, 24-h polysomnography, heart rate (HR) variability, and the HR response to spontaneous arousal were available. RESULTS Sleep macrostructure was comparable between controls and patients, with the latter having significantly longer sleep time, a higher number of sleep cycles (p < 0.0001), and low sleep efficiency (p < 0.01). The HR variability indices did not differ between groups, except for the rise of high frequency (HF) and HFnu in patients (p < 0.05) associated with blunted sympathetic indices (p < 0.01). These parasympathetic alterations were present for light, slow wave, and rapid eye-movement sleep and persisted for all sleep cycles. Compared to controls, the HR arousal response was significantly higher (p < 0.01) in patients starting before the arousal onset and persisting into the post-arousal period. CONCLUSIONS In IH patients a dysfunction of the parasympathetic activity during awake and sleep and an altered autonomic response to arousals are present. These findings suggest an impaired parasympathetic function that may explain some vegetative symptoms present in this type of central hypersomnia.
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Affiliation(s)
- Emilia Sforza
- Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.
| | - Frédéric Roche
- Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France
| | - Jean Claude Barthélémy
- Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France
| | - Vincent Pichot
- Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France
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Wang JY, Han F, Dong SX, Li J, An P, Zhang XZ, Chang Y, Zhao L, Zhang XL, Liu YN, Yan H, Li QH, Hu Y, Lv CJ, Gao ZC, Strohl KP. Cerebrospinal Fluid Orexin A Levels and Autonomic Function in Kleine-Levin Syndrome. Sleep 2016; 39:855-60. [PMID: 26943469 DOI: 10.5665/sleep.5642] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. METHODS From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS. Cerebrospinal fluid orexin A levels and diurnal blood pressure were measured in relapse versus remission in a subgroup of patients. RESULTS Presenting symptoms included relapsing or remitting excessive sleepiness-associated parallel complaints of cognitive changes (82%), eating disorders (84%); depression (45%); irritability (36%); hypersexuality (18%); and compulsions (11%). Episodes were 8.2 ± 3.3 days in duration. In relapse, diurnal values for blood pressure and heart rate were lower (P < 0.001). In a subgroup (n = 34), cerebrospinal fluid orexin A levels were ∼31% lower in a relapse versus remission (215.7 ± 81.5 versus 319.2 ± 95.92 pg/ml, P < 0.001); in three patients a pattern of lower levels during subsequent relapses was documented. CONCLUSIONS There are lower orexin A levels in the symptomatic phase than in remission and a fall and rise in blood pressure and heart rate, suggesting a role for orexin dysregulation in KLS pathophysiology.
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Affiliation(s)
- Jing Yu Wang
- Binzhou Medical University Hospital, Shandong Province, China
| | - Fang Han
- Binzhou Medical University Hospital, Shandong Province, China.,Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Song X Dong
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Pei An
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xiao Zhe Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yuan Chang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xue Li Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Ya Nan Liu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Han Yan
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Qing Hua Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yan Hu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Chang Jun Lv
- Binzhou Medical University Hospital, Shandong Province, China
| | - Zhan Cheng Gao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, OH
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van der Meijden WP, Fronczek R, Reijntjes RHAM, Corssmit EPM, Biermasz NR, Lammers GJ, van Dijk JG, Thijs RD. Time- and state-dependent analysis of autonomic control in narcolepsy: higher heart rate with normal heart rate variability independent of sleep fragmentation. J Sleep Res 2014; 24:206-14. [DOI: 10.1111/jsr.12253] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 09/21/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Wisse P. van der Meijden
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- Department of Sleep and Cognition; Netherlands Institute for Neuroscience; Royal Netherlands Academy of Arts and Sciences; Amsterdam The Netherlands
| | - Rolf Fronczek
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | | | - Eleonora P. M. Corssmit
- Department of Endocrinology and Metabolic Diseases; Leiden University Medical Center; Leiden The Netherlands
| | - Nienke R. Biermasz
- Department of Endocrinology and Metabolic Diseases; Leiden University Medical Center; Leiden The Netherlands
| | - Gert Jan. Lammers
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- Sleep Wake Center SEIN; Heemstede The Netherlands
| | - J. Gert van Dijk
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
| | - Roland D. Thijs
- Department of Neurology; Leiden University Medical Center; Leiden The Netherlands
- SEIN - Stichting Epilepsie Instellingen Nederland; Heemstede The Netherlands
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Silvani A, Bastianini S, Berteotti C, Cenacchi G, Leone O, Lo Martire V, Papa V, Zoccoli G. Sleep and cardiovascular phenotype in middle-aged hypocretin-deficient narcoleptic mice. J Sleep Res 2013; 23:98-106. [DOI: 10.1111/jsr.12081] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/15/2013] [Indexed: 01/02/2023]
Affiliation(s)
- Alessandro Silvani
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Stefano Bastianini
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Chiara Berteotti
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Giovanna Cenacchi
- Pathology Unit; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Ornella Leone
- Pathology Unit; S. Orsola-Malpighi Hospital; Bologna Italy
| | - Viviana Lo Martire
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Valentina Papa
- Pathology Unit; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Giovanna Zoccoli
- PRISM Laboratory; Department of Biomedical and Neuromotor Sciences; Alma Mater Studiorum; Università di Bologna; Bologna Italy
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