1
|
Gnarra O, van der Meer J, Warncke JD, Fregolente LG, Wenz E, Zub K, Nwachukwu U, Zhang Z, Khatami R, von Manitius S, Miano S, Acker J, Strub M, Riener R, Bassetti CLA, Schmidt MH. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study: feasibility of long-term monitoring with Fitbit smartwatches in central disorders of hypersomnolence and extraction of digital biomarkers in narcolepsy. Sleep 2024; 47:zsae083. [PMID: 38551123 DOI: 10.1093/sleep/zsae083] [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: 10/04/2023] [Revised: 03/11/2024] [Indexed: 09/10/2024] Open
Abstract
The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a multicenter research initiative to identify new biomarkers in central disorders of hypersomnolence (CDH). Whereas narcolepsy type 1 (NT1) is well characterized, other CDH disorders lack precise biomarkers. In SPHYNCS, we utilized Fitbit smartwatches to monitor physical activity, heart rate, and sleep parameters over 1 year. We examined the feasibility of long-term ambulatory monitoring using the wearable device. We then explored digital biomarkers differentiating patients with NT1 from healthy controls (HC). A total of 115 participants received a Fitbit smartwatch. Using a adherence metric to evaluate the usability of the wearable device, we found an overall adherence rate of 80% over 1 year. We calculated daily physical activity, heart rate, and sleep parameters from 2 weeks of greatest adherence to compare NT1 (n = 20) and HC (n = 9) participants. Compared to controls, NT1 patients demonstrated findings consistent with increased sleep fragmentation, including significantly greater wake-after-sleep onset (p = .007) and awakening index (p = .025), as well as standard deviation of time in bed (p = .044). Moreover, NT1 patients exhibited a significantly shorter REM latency (p = .019), and sleep latency (p = .001), as well as a lower peak heart rate (p = .008), heart rate standard deviation (p = .039) and high-intensity activity (p = .009) compared to HC. This ongoing study demonstrates the feasibility of long-term monitoring with wearable technology in patients with CDH and potentially identifies a digital biomarker profile for NT1. While further validation is needed in larger datasets, these data suggest that long-term wearable technology may play a future role in diagnosing and managing narcolepsy.
Collapse
Affiliation(s)
- Oriella Gnarra
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland
| | - Julia van der Meer
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Livia G Fregolente
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Elena Wenz
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Kseniia Zub
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uchendu Nwachukwu
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhongxing Zhang
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Ramin Khatami
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Sigrid von Manitius
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Silvia Miano
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Ospedale Civico, Lugano, Switzerland
| | - Jens Acker
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Ospedale Civico, Lugano, Switzerland
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | - Mathias Strub
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
- Zentrum für Schlafmedizin Basel, Basel, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland
- Zentrum für Schlafmedizin Basel, Basel, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
- Ohio Sleep Medicine Institute, Dublin, USA
| |
Collapse
|
2
|
Ben-Joseph RH, Saad R, Black J, Dabrowski EC, Taylor B, Gallucci S, Somers VK. Cardiovascular Burden of Narcolepsy Disease (CV-BOND): a real-world evidence study. Sleep 2023; 46:zsad161. [PMID: 37305967 PMCID: PMC10566243 DOI: 10.1093/sleep/zsad161] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
STUDY OBJECTIVES Narcolepsy is associated with cardiovascular risk factors; however, the risk of new-onset cardiovascular events in this population is unknown. This real-world study evaluated the excess risk of new-onset cardiovascular events in U.S. adults with narcolepsy. METHODS A retrospective cohort study using IBM MarketScan administrative claims data (2014-2019) was conducted. A narcolepsy cohort, comprising adults (≥18 years) with at least two outpatient claims containing a narcolepsy diagnosis, of which at least one was non-diagnostic, was matched to a non-narcolepsy control cohort (1:3) based on cohort entry date, age, sex, geographic region, and insurance type. The relative risk of new-onset cardiovascular events was estimated using a multivariable Cox proportional hazards model to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS The narcolepsy and matched non-narcolepsy control cohorts included 12 816 and 38 441 individuals, respectively. At baseline, cohort demographics were generally similar; however, patients with narcolepsy had more comorbidities. In adjusted analyses, the risk of new-onset cardiovascular events was higher in the narcolepsy cohort compared with the control cohort: any stroke (HR [95% CI], 1.71 [1.24, 2.34]); heart failure (1.35 [1.03, 1.76]); ischemic stroke (1.67 [1.19, 2.34]); major adverse cardiac event (1.45 [1.20, 1.74]); grouped instances of stroke, atrial fibrillation, or edema (1.48 [1.25, 1.74]); and cardiovascular disease (1.30 [1.08, 1.56]). CONCLUSION Individuals with narcolepsy are at increased risk of new-onset cardiovascular events compared with individuals without narcolepsy. Physicians should consider cardiovascular risk in patients with narcolepsy when weighing treatment options.
Collapse
Affiliation(s)
| | - Ragy Saad
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Jed Black
- Jazz Pharmaceuticals, Palo Alto, CA, USA
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | | | | | | | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
3
|
Sun Y, Tisdale RK, Yamashita A, Kilduff TS. Peripheral vs. core body temperature as hypocretin/orexin neurons degenerate: Exercise mitigates increased heat loss. Peptides 2023; 164:171002. [PMID: 36963505 PMCID: PMC10337601 DOI: 10.1016/j.peptides.2023.171002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/01/2023] [Accepted: 03/21/2023] [Indexed: 03/26/2023]
Abstract
Hypocretins/Orexins (Hcrt/Ox) are hypothalamic neuropeptides implicated in diverse functions, including body temperature regulation through modulation of sympathetic vasoconstrictor tone. In the current study, we measured subcutaneous (Tsc) and core (Tb) body temperature as well as activity in a conditional transgenic mouse strain that allows the inducible ablation of Hcrt/Ox-containing neurons by removal of doxycycline (DOX) from their diet (orexin-DTA mice). Measurements were made during a baseline, when mice were being maintained on food containing DOX, and over 42 days while the mice were fed normal chow which resulted in Hcrt/Ox neuron degeneration. The home cages of the orexin-DTA mice were equipped with running wheels that were either locked or unlocked. In the presence of a locked running wheel, Tsc progressively decreased on days 28 and 42 in the DOX(-) condition, primarily during the dark phase (the major active period for rodents). This nocturnal reduction in Tsc was mitigated when mice had access to unlocked running wheels. In contrast to Tsc, Tb was largely maintained until day 42 in the DOX(-) condition even when the running wheel was locked. Acute changes in both Tsc and Tb were observed preceding, during, and following cataplexy. Our results suggest that ablation of Hcrt/Ox-containing neurons results in elevated heat loss, likely through reduced sympathetic vasoconstrictor tone, and that exercise may have some therapeutic benefit to patients with narcolepsy, a disorder caused by Hcrt/Ox deficiency. Acute changes in body temperature may facilitate prediction of cataplexy onset and lead to interventions to mitigate its occurrence.
Collapse
Affiliation(s)
- Yu Sun
- Biosciences Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA.
| | - Ryan K Tisdale
- Biosciences Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| | - Akira Yamashita
- Biosciences Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA; Department of Physiology, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima 890-8544, Japan
| | - Thomas S Kilduff
- Biosciences Division, SRI International, 333 Ravenswood Ave, Menlo Park, CA 94025, USA
| |
Collapse
|
4
|
Miglis MG. Autonomic Dysfunction in the Central Nervous System Hypersomnias. CURRENT SLEEP MEDICINE REPORTS 2023. [DOI: 10.1007/s40675-023-00247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
5
|
Wang Y, Sun Q, Tang Q, Zhang Y, Tang M, Wang D, Wang Z. Progress of autonomic disturbances in narcolepsy type 1. Front Neurol 2023; 14:1107632. [PMID: 36949858 PMCID: PMC10025459 DOI: 10.3389/fneur.2023.1107632] [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: 11/25/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
Narcolepsy type 1 is a kind of sleep disorder characterized by a specific loss of hypocretin neurons in the lateral hypothalamus and reduced levels of hypocretin-1 in the cerebrospinal fluid. Hypocretin deficiency is associated with autonomic disorders. This article summarizes the autonomic disorders and possible mechanisms associated with narcolepsy type 1. Patients with narcolepsy type 1 often have various systemic autonomic symptoms, including non-dipping blood pressure, reduced heart rate variability, dynamic cerebral autoregulation impairment, reduced gastric motility and emptying, sleep-related erectile dysfunction, skin temperature abnormalities, and blunted pupillary light reflex. Similar findings should strengthen the recognition and intervention of these disturbances in clinical practice. In addition to hypocretin deficiency, current evidence also indicates that pharmacological therapy (including psychostimulants and anti-cataplectic drugs) and comorbidities may contribute to the alterations of autonomic system observed in narcolepsy type 1.
Collapse
|
6
|
Bigalke JA, Shan Z, Carter JR. Orexin, Sleep, Sympathetic Neural Activity, and Cardiovascular Function. Hypertension 2022; 79:2643-2655. [PMID: 36148653 PMCID: PMC9649879 DOI: 10.1161/hypertensionaha.122.19796] [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] [Indexed: 11/04/2022]
Abstract
Inadequate sleep duration and quality are associated with reduced cardiovascular health and increased mortality. Experimental evidence points to the sympathetic nervous system as a key mediator in the observed relationship between poor sleep and cardiovascular dysfunction. However, brain mechanisms underpinning the impaired sympathetic function associated with poor sleep remain unclear. Recent evidence suggests the central orexin system, particularly orexins A and B and their receptors, have a key regulatory role for sleep in animal and human models. While orexin system activity has been observed to significantly impact sympathetic regulation in animals, the extension of these findings to humans has been difficult due to an inability to directly assess orexin system activity in humans. However, direct measures of sympathetic activity in populations with narcolepsy and chronic insomnia, 2 sleep disorders associated with deficient and excessive orexin neural activity, have allowed indirect assessment of the relationships between orexin, sleep, and sympathetic regulation. Further, the recent pharmaceutical development of dual orexin receptor antagonists for use in clinical insomnia populations offers an unprecedented opportunity to examine the mechanistic role of orexin in sleep and cardiovascular health in humans. The current review assesses the role of orexin in both sleep and sympathetic regulation from a translational perspective, spanning animal and human studies. The review concludes with future research directions necessary to fully elucidate the mechanistic role for orexin in sleep and sympathetic regulation in humans.
Collapse
Affiliation(s)
- Jeremy A. Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Department of Psychology, Montana State University, Bozeman, Montana
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Jason R. Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana
- Department of Psychology, Montana State University, Bozeman, Montana
| |
Collapse
|
7
|
Dhafar HO, BaHammam AS. Body Weight and Metabolic Rate Changes in Narcolepsy: Current Knowledge and Future Directions. Metabolites 2022; 12:1120. [PMID: 36422261 PMCID: PMC9693066 DOI: 10.3390/metabo12111120] [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: 10/23/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 08/26/2023] Open
Abstract
Narcolepsy is a known auto-immune disease that presents mainly in the teenage years with irresistible sleep attacks. Patients with narcolepsy, especially NT1, have been found to have a high prevalence of obesity and other metabolic derangements. This narrative review aimed to address the relationship between narcolepsy and changes in weight and metabolic rate, and discuss potential mechanisms for weight gain and metabolic changes and future research agendas on this topic. This article will provide a balanced, up-to-date critical review of the current literature, and delineate areas for future research, in order to understand the pathophysiological metabolic changes in narcolepsy. Articles using predefined keywords were searched for in PubMed and Google Scholar databases, with predefined inclusion and exclusion criteria. Compared to controls, patients with narcolepsy are more likely to be obese and have higher BMIs and waist circumferences. According to recent research, weight gain in narcolepsy patients may be higher during the disease's outset. The precise mechanisms causing this weight gain remains unknown. The available information, albeit limited, does not support differences in basal or resting metabolic rates between patients with narcolepsy and controls, other than during the time of disease onset. The evidence supporting the role of orexin in weight gain in humans with narcolepsy is still controversial, in the literature. Furthermore, the available data did not show any appreciable alterations in the levels of CSF melanin-concentrating hormone, plasma and CSF leptin, or serum growth hormone, in relation to weight gain. Other mechanisms have been proposed, including a reduction in sympathetic tone, hormonal changes, changes in eating behavior and physical activity, and genetic predisposition. The association between increased body mass index and narcolepsy is well-recognized; however, the relationship between narcolepsy and other metabolic measures, such as body fat/muscle distribution and metabolic rate independent of BMI, is not well documented, and the available evidence is inconsistent. Future longitudinal studies with larger sample sizes are needed to assess BMR in patients with narcolepsy under a standard protocol at the outset of narcolepsy, with regular follow-up.
Collapse
Affiliation(s)
- Hamza O. Dhafar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Family Medicine, Prince Mansour Military Hospital, Taif 26526, Saudi Arabia
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, P.O. Box 2454, Riyadh 11324, Saudi Arabia
| |
Collapse
|
8
|
Iwasaki A, Fujiwara K, Nakayama C, Sumi Y, Kano M, Nagamoto T, Kadotani H. R-R interval-based sleep apnea screening by a recurrent neural network in a large clinical polysomnography dataset. Clin Neurophysiol 2022; 139:80-89. [DOI: 10.1016/j.clinph.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/10/2022] [Accepted: 04/12/2022] [Indexed: 11/03/2022]
|
9
|
Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med 2022; 18:289-304. [PMID: 34463249 PMCID: PMC8807887 DOI: 10.5664/jcsm.9638] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management. METHODS One hundred two peer-reviewed publications from a PubMed search were included. RESULTS DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement in self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders. CONCLUSIONS DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research. CITATION Maski K, Mignot E, Plazzi G, Dauvilliers Y. Disrupted nighttime sleep and sleep instability in narcolepsy. J Clin Sleep Med. 2022;18(1):289-304.
Collapse
Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts,Address correspondence to: Kiran Maski, MD, MPH, Department of Neurology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02130; Phone: +01 857-218-5536; Fax: +01 617-730-0282;
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Redwood City, California
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy,IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France,University of Montpellier, INSERM Institute for Neurosciences Montpellier, Montpellier, France
| |
Collapse
|
10
|
Jennum PJ, Plazzi G, Silvani A, Surkin LA, Dauvilliers Y. Cardiovascular disorders in narcolepsy: Review of associations and determinants. Sleep Med Rev 2021; 58:101440. [PMID: 33582582 DOI: 10.1016/j.smrv.2021.101440] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Narcolepsy type 1 (NT1) is a lifelong disorder of sleep-wake dysregulation defined by clinical symptoms, neurophysiological findings, and low hypocretin levels. Besides a role in sleep, hypocretins are also involved in regulation of heart rate and blood pressure. This literature review examines data on the autonomic effects of hypocretin deficiency and evidence about how narcolepsy is associated with multiple cardiovascular risk factors and comorbidities, including cardiovascular disease. An important impact in NT1 is lack of nocturnal blood pressure dipping, which has been associated with mortality in the general population. Hypertension is also prevalent in NT1. Furthermore, disrupted nighttime sleep and excessive daytime sleepiness, which are characteristic of narcolepsy, may increase cardiovascular risk. Patients with narcolepsy also often present with other comorbidities (eg, obesity, diabetes, depression, other sleep disorders) that may contribute to increased cardiovascular risk. Management of multimorbidity in patients with narcolepsy should include regular assessment of cardiovascular health (including ambulatory blood pressure monitoring), mitigation of cardiovascular risk factors (eg, cessation of smoking and other lifestyle changes, sleep hygiene, and pharmacotherapy), and prescription of a regimen of narcolepsy medications that balances symptomatic benefits with cardiovascular safety.
Collapse
Affiliation(s)
- Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark.
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy; IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lee A Surkin
- Empire Sleep Medicine, New York, NY, United States
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM U1061, Montpellier, France
| |
Collapse
|
11
|
Orjatsalo M, Partinen E, Wallukat G, Alakuijala A, Partinen M. Activating autoantibodies against G protein-coupled receptors in narcolepsy type 1. Sleep Med 2020; 77:82-87. [PMID: 33341642 DOI: 10.1016/j.sleep.2020.11.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/26/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVES Narcolepsy type 1 is a rare hypersomnia of central origin, which is caused by loss of hypothalamic neurons that produce the neuropeptides hypocretin-1 and -2. Hypocretin-containing nerve terminals are found in areas known to play a central role in autonomic control and in pain signaling. Cholinergic M2 receptors are found in brain areas involved with the occurrence of hallucinations and cataplexy. In addition to classical symptoms of narcolepsy, the patients suffer frequently from autonomic dysfunction, chronic pain, and hypnagogic/hypnopompic hallucinations. We aimed to test whether narcolepsy type 1 patients have autoantibodies against autonomic β2 adrenergic receptor, M2 muscarinic receptors, or nociception receptors. METHODS We tested the serum of ten narcolepsy type 1 patients (five female) for activating β2 adrenergic receptor autoantibodies, M2 muscarinic receptor autoantibodies, and nociception receptor autoantibodies. RESULTS Ten of ten patients were positive for muscarinic M2 receptor autoantibodies (P < 0.001), 9/10 were positive for autoantibodies against nociception receptors (P < 0.001), and 5/10 were positive for β2 adrenergic receptor autoantibodies (P < 0.001). CONCLUSIONS Narcolepsy type 1 patients harbored activating autoantibodies against M2 muscarinic receptors, nociception receptors, and β2 adrenergic receptors. M2 receptor autoantibodies may be related to the occurrence of cataplexy and, moreover, hallucinations in narcolepsy since they are found in the same brain areas that are involved with these symptoms. The occurrence of nociception receptor autoantibodies strengthens the association between narcolepsy type 1 and pain. The connection between narcolepsy type 1, autonomic complaints, and the presumed cardiovascular morbidity might be associated with the occurrence of β2 adrenergic receptor autoantibodies. On the other hand, the presence of the autoantibodies may be secondary to the destruction of the hypocretin pathways.
Collapse
Affiliation(s)
- Maija Orjatsalo
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Finland; Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.
| | - Eemil Partinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Vitalmed Research Center, Helsinki Sleep Clinic, Valimotie 21, 00380, Helsinki, Finland
| | | | - Anniina Alakuijala
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Finland; Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Markku Partinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland; Vitalmed Research Center, Helsinki Sleep Clinic, Valimotie 21, 00380, Helsinki, Finland
| |
Collapse
|
12
|
DelRosso LM, Mogavero MP, Ferri R. Effect of Sleep Disorders on Blood Pressure and Hypertension in Children. Curr Hypertens Rep 2020; 22:88. [PMID: 32893326 DOI: 10.1007/s11906-020-01100-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW In this review, we aim to discuss the pathophysiologic basis of hypertension in sleep disorders and the current evidence in the medical literature linking sleep disorders and hypertension in children. RECENT FINDINGS The medical literature in adults is clear about the contribution of sleep disorders, poor sleep quality, and sleep deprivation to hypertension and increased cardiovascular risk. The literature on cardiovascular consequences of sleep disorders in children is not as robust, but there is some evidence of early cardiovascular changes in children with sleep deprivation and obstructive sleep apnea. Children with obstructive sleep apnea have increased sympathetic activation during sleep, blunted dipping, or elevated systolic or diastolic pressures. Although the literature on other sleep disorders such as narcolepsy and restless legs syndrome is scarce, there is evidence in adults and some recent supportive data in children.
Collapse
Affiliation(s)
- Lourdes M DelRosso
- Pediatric Pulmonary and Sleep Medicine, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Maria Paola Mogavero
- Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Via Salvatore Maugeri 4, 27100, Pavia, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
| |
Collapse
|
13
|
Barateau L, Chenini S, Evangelista E, Jaussent I, Lopez R, Dauvilliers Y. Clinical autonomic dysfunction in narcolepsy type 1. Sleep 2019; 42:5550322. [DOI: 10.1093/sleep/zsz187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
AbstractStudy Objectives(1) To compare the presence of autonomic symptoms using the validated SCOPA-AUT questionnaire in untreated patients with narcolepsy type 1 (NT1) to healthy controls, (2) to study the determinants of a high total SCOPA-AUT score in NT1, and (3) to evaluate the effect of drug intake on SCOPA-AUT results in NT1.MethodsThe SCOPA-AUT questionnaire that evaluates gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual dysfunction was completed by 92 consecutive drug-free adult NT1 patients (59 men, 39.1 ± 15.6 years old) and 109 healthy controls (63 men, 42.6 ± 18.2 years old). A subgroup of 59 NT1 patients completed the questionnaire a second time, under medication (delay between two evaluations: 1.28 ± 1.14 years).ResultsCompared to controls, NT1 patients were more frequently obese, had more dyslipidemia, with no difference for age and gender. The SCOPA-AUT score of NT1 was higher than in controls in crude and adjusted models. Patients experienced more problems than controls in all subdomains. A higher score in NT1 was associated with older age, longer disease duration, altered quality of life and more depressive symptoms, but not with orexin levels and disease severity. Among patients evaluated twice, the SCOPA-AUT score total did not differ according to treatment status, neither did each subdomain.ConclusionWe captured a frequent and large spectrum of clinical autonomic dysfunction in NT1, with impairment in all SCOPA-AUT domains, without key impact of medication intake. This assessment may allow physicians to screen and treat various symptoms, often not spontaneously reported but associated with poor quality of life.
Collapse
Affiliation(s)
- Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Sofiene Chenini
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Elisa Evangelista
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Isabelle Jaussent
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| |
Collapse
|
14
|
Barateau L, Lopez R, Chenini S, Evangelista E, Benkiran M, Mariano-Goulart D, Jaussent I, Dauvilliers Y. Exploration of cardiac sympathetic adrenergic nerve activity in narcolepsy. Clin Neurophysiol 2019; 130:412-418. [DOI: 10.1016/j.clinph.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 12/18/2022]
|
15
|
Aslan S, Erbil N, Tezer FI. Heart Rate Variability During Nocturnal Sleep and Daytime Naps in Patients With Narcolepsy Type 1 and Type 2. J Clin Neurophysiol 2019; 36:104-111. [DOI: 10.1097/wnp.0000000000000544] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
16
|
Prolonged Waking and Recovery Sleep Affect the Serum MicroRNA Expression Profile in Humans. Clocks Sleep 2018; 1:75-86. [PMID: 33089155 PMCID: PMC7509676 DOI: 10.3390/clockssleep1010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/20/2018] [Indexed: 01/28/2023] Open
Abstract
MicroRNAs (miRNAs) are small, abundant, non-coding RNA fragments that regulate gene expression and silencing at the post-transcriptional level. The miRNAs each control various downstream targets and play established roles in different biological processes. Given that miRNAs were recently proposed to contribute to the molecular control of sleep-wake regulation in animal models and narcoleptic patients, we investigated the impact of acute sleep deprivation on blood miRNA expression in healthy adult men of two different age groups. Twenty-two young (mean age: 24 ± 3 years) and nine older (65 ± 1 years) volunteers completed a controlled in-lab study, consisting of 8 h baseline sleep, followed by 40 h of extended wakefulness, and a 10-h recovery sleep opportunity. At the same circadian time in all three conditions (at 4:23 p.m. ± 23 min), qPCR expression profiling of 86 miRNAs was performed in blood serum. Thirteen different miRNAs could be reliably quantified and were analyzed using mixed-model ANOVAs. It was found that miR-30c and miR-127 were reliably affected by previous sleep and wakefulness, such that expression of these miRNAs was upregulated after extended wakefulness and normalized after recovery sleep. Together with previous findings in narcolepsy patients, our preliminary data indicate that miR-30c and its target proteins may provide a biomarker of elevated sleep debt in humans.
Collapse
|
17
|
Antelmi E, Plazzi G, Pizza F, Vandi S, Aricò D, Ferri R. Impact of acute administration of sodium oxybate on heart rate variability in children with type 1 narcolepsy. Sleep Med 2018; 47:1-6. [PMID: 29880141 DOI: 10.1016/j.sleep.2018.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Currently, cardiovascular measurements in children affected with type 1 narcolepsy (NT1) have never been investigated, and neither have their modulation by the administration of sodium oxybate (SO). METHODS Twelve drug-naïve NT1 children (four males, eight females) with a mean age of 11 ± 3.16 years underwent a nocturnal polysomnography, at baseline and during the first night of SO administration. Data were contrasted with those recorded in 23 age-matched healthy controls. Heart rate variability (HRV) analysis was performed by analyzing the electrocardiogram signal for automatic detection of R waves with a computer program calculating a series of standard time-domain measures and obtaining spectral parameters, by means of a Fast-Fourier Transform. RESULTS In sleep stages N2 and N3, NT1 children showed increased power in the low-frequency (LF) and very-LF (VLF) ranges, when compared to controls. In addition, HRV (as measured by time domain parameters) during all sleep stages tended to be slightly higher in patients when compared to controls. Treatment with SO did not change significantly any parameter, but an overall trend to mildly decreased HRV that reached a significant value only during R sleep. CONCLUSIONS HRV during all sleep stages tended to be slightly higher in young patients when compared to controls, confirming the presence of a slight sympathovagal system imbalance even in NT1 children. SO tends to decrease these values especially during REM sleep and in that regard, further studies supporting these preliminary findings and considering the long-term effects of SO on heart rate parameters are warranted.
Collapse
Affiliation(s)
- Elena Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Stefano Vandi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Debora Aricò
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute IRCCS, Troina, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute IRCCS, Troina, Italy
| |
Collapse
|
18
|
Olesen AN, Cesari M, Christensen JAE, Sorensen HBD, Mignot E, Jennum P. A comparative study of methods for automatic detection of rapid eye movement abnormal muscular activity in narcolepsy. Sleep Med 2018. [DOI: 10.1016/j.sleep.2017.11.1141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Sieminski M, Chwojnicki K, Sarkanen T, Partinen M. The relationship between orexin levels and blood pressure changes in patients with narcolepsy. PLoS One 2017; 12:e0185975. [PMID: 29023559 PMCID: PMC5638315 DOI: 10.1371/journal.pone.0185975] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 09/24/2017] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVE Narcolepsy type 1 (NT1) is caused by a deficiency or absence of the neurotransmitter orexin. NT1 is also associated with a reduced nocturnal "dipping" of blood pressure (BP). The study objective was to analyze whether nocturnal BP values differed in patients depleted of orexin, versus those in whom production was preserved. METHODS We performed a retrospective analysis of the polysomnographic recordings, orexin levels, and BP values of patients with NT1. Data was collected from a total of 21 patients, divided into two groups as follows: those with a complete depletion of orexin (n = 11) (Group1), and those with a remaining, limited presence of orexin (n = 10) (Group 2). RESULTS The groups did not differ in terms of the clinical features of NT1 or sleep characteristics, with an exception of increased number of cataplexy episodes and increased percentage of sleep stage 2 in the Group 1. Daytime and nocturnal BP did not differ between the groups. Most patients, regardless of group, had a non-dipping blood pressure pattern, and no difference in dipping prevalence was observed between groups. The amplitude of the daytime to nighttime change in BP did not differ between the groups. CONCLUSIONS Non-dipping BP patterns are frequent among patients with narcolepsy type 1, but we saw no evidence that they depended on whether orexin levels were above or below the assay detection threshold. Therefore, our results do not support the hypothesis that in patients with narcolepsy type 1 residual orexin levels play a role in the control of nocturnal BP dipping.
Collapse
Affiliation(s)
- Mariusz Sieminski
- Department of Adults’ Neurology, Medical University of Gdansk, Gdansk, Poland
- * E-mail:
| | - Kamil Chwojnicki
- Department of Adults’ Neurology, Medical University of Gdansk, Gdansk, Poland
| | | | | |
Collapse
|
20
|
The link between narcolepsy and autonomic cardiovascular dysfunction: a translational perspective. Clin Auton Res 2017; 28:545-555. [DOI: 10.1007/s10286-017-0473-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/25/2017] [Indexed: 01/09/2023]
|
21
|
Jennum P, Thorstensen EW, Pickering L, Ibsen R, Kjellberg J. Morbidity and mortality of middle-aged and elderly narcoleptics. Sleep Med 2017; 36:23-28. [PMID: 28735916 DOI: 10.1016/j.sleep.2017.03.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The objective of the study was to evaluate the morbidities and mortality in a national group of middle-aged and elderly narcolepsy patients before and after the first diagnosis of the condition. METHODS From the Danish National Patient Registry (NPR), 1174 patients (45.1% males) aged 20-59 years and 339 patients (44.8% males) aged 60+ who received a diagnosis of narcolepsy between 1998 and 2014 were compared, respectively, with 4716 and 1353 control citizens matched for age, gender and geography, who were randomly chosen from the Danish Civil Registration System Statistics. In the NPR, all morbidities are grouped into major WHO classes. RESULTS Middle-aged and elderly patients had more health contacts before and after their narcolepsy diagnosis with respect to several disease domains: infections, neoplasm, endocrine/metabolic diseases/diabetes, mental/psychiatric, neurological (including epilepsy), eye, cardiovascular (hypertension, ischemic heart disease), respiratory (upper-airway infections, sleep apnea), gastrointestinal, musculoskeletal (including discopathies) and skin diseases. Narcolepsy patients had lower reproductive rates. Furthermore, patients showed significantly more health contacts due to the evaluation and control contacts for disease and symptoms. Patients suffered from significantly more multiple diseases than did controls. The 17-year hazard ratio mortality rates were 1.35 (95% CI, 0.94-1.95, p = 0.106) among 20-59 year-olds, and 1.38 (1.12-1.69, p = 0.002) among those aged 60+ years. CONCLUSION There are higher rates of morbidity in several disease domains before and after a diagnosis of narcolepsy. Elderly narcolepsy patients have higher mortality rates.
Collapse
Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Eva Wiberg Thorstensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Line Pickering
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Ibsen
- Itracks, Klosterport 4E, 4, Aarhus, Denmark; Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark.
| | - Jakob Kjellberg
- Danish National Institute for Local and Regional Government Research, Copenhagen, Denmark.
| |
Collapse
|
22
|
|
23
|
Schrölkamp M, Jennum PJ, Gammeltoft S, Holm A, Kornum BR, Knudsen S. Normal Morning Melanin-Concentrating Hormone Levels and No Association with Rapid Eye Movement or Non-Rapid Eye Movement Sleep Parameters in Narcolepsy Type 1 and Type 2. J Clin Sleep Med 2017; 13:235-243. [PMID: 27855741 DOI: 10.5664/jcsm.6454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Other than hypocretin-1 (HCRT-1) deficiency in narcolepsy type 1 (NT1), the neurochemical imbalance of NT1 and narcolepsy type 2 (NT2) with normal HCRT-1 levels is largely unknown. The neuropeptide melanin-concentrating hormone (MCH) is mainly secreted during sleep and is involved in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep regulation. Hypocretin neurons reciprocally interact with MCH neurons. We hypothesized that altered MCH secretion contributes to the symptoms and sleep abnormalities of narcolepsy and that this is reflected in morning cerebrospinal fluid (CSF) MCH levels, in contrast to previously reported normal evening/afternoon levels. METHODS Lumbar CSF and plasma were collected from 07:00 to 10:00 from 57 patients with narcolepsy (subtypes: 47 NT1; 10 NT2) diagnosed according to International Classification of Sleep Disorders, Third Edition (ICSD-3) and 20 healthy controls. HCRT-1 and MCH levels were quantified by radioimmunoassay and correlated with clinical symptoms, polysomnography (PSG), and Multiple Sleep Latency Test (MSLT) parameters. RESULTS CSF and plasma MCH levels were not significantly different between narcolepsy patients regardless of ICSD-3 subtype, HCRT-1 levels, or compared to controls. CSF MCH and HCRT-1 levels were not significantly correlated. Multivariate regression models of CSF MCH levels, age, sex, and body mass index predicting clinical, PSG, and MSLT parameters did not reveal any significant associations to CSF MCH levels. CONCLUSIONS Our study shows that MCH levels in CSF collected in the morning are normal in narcolepsy and not associated with the clinical symptoms, REM sleep abnormalities, nor number of muscle movements during REM or NREM sleep of the patients. We conclude that morning lumbar CSF MCH measurement is not an informative diagnostic marker for narcolepsy.
Collapse
Affiliation(s)
- Maren Schrölkamp
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark.,FU-Berlin, Faculty Biology, Chemistry, Pharmacy, Takustr, Berlin, Germany
| | - Poul J Jennum
- Danish Center for Sleep Medicine, University of Copenhagen, Rigshospitalet, Glostrup, Denmark
| | - Steen Gammeltoft
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Anja Holm
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Birgitte R Kornum
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Danish Center for Sleep Medicine, University of Copenhagen, Rigshospitalet, Glostrup, Denmark.,Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias (NevSom), Oslo University Hospital, Ullevål, Norway
| |
Collapse
|
24
|
Abstract
Narcolepsy is a chronic sleep disorder that has a typical onset in adolescence and is characterized by excessive daytime sleepiness, which can have severe consequences for the patient. Problems faced by patients with narcolepsy include social stigma associated with this disease, difficulties in obtaining an education and keeping a job, a reduced quality of life and socioeconomic consequences. Two subtypes of narcolepsy have been described (narcolepsy type 1 and narcolepsy type 2), both of which have similar clinical profiles, except for the presence of cataplexy, which occurs only in patients with narcolepsy type 1. The pathogenesis of narcolepsy type 1 is hypothesized to be the autoimmune destruction of the hypocretin-producing neurons in the hypothalamus; this hypothesis is supported by immune-related genetic and environmental factors associated with the disease. However, direct evidence in support of the autoimmune hypothesis is currently unavailable. Diagnosis of narcolepsy encompasses clinical, electrophysiological and biological evaluations, but simpler and faster procedures are needed. Several medications are available for the symptomatic treatment of narcolepsy, all of which have quite good efficacy and safety profiles. However, to date, no treatment hinders or slows disease development. Improved diagnostic tools and increased understanding of the pathogenesis of narcolepsy type 1 are needed and might lead to therapeutic or even preventative interventions.
Collapse
Affiliation(s)
- Birgitte R Kornum
- Molecular Sleep Laboratory, Department of Clinical Biochemistry, Rigshospitalet, Forskerparken, Nordre Ringvej 69, 2600 Glostrup, Denmark.,Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Stine Knudsen
- Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Hanna M Ollila
- Department of Psychiatry and Behavioral Sciences, Center for Sleep Sciences, Stanford University, Stanford, California, USA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, AUSL di Bologna, Bologna, Italy
| | - Poul J Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Yves Dauvilliers
- Sleep Unit, Narcolepsy Reference Center, Department of Neurology, Gui de Chauliac Hospital, INSERM 1061, Montpellier, France
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
25
|
Partinen M. All children with narcolepsy type 1 should be encouraged to sleep regular naps during daytime. Sleep Med 2016; 24:145-146. [PMID: 27810180 DOI: 10.1016/j.sleep.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Markku Partinen
- Finnish Narcolepsy Research Center, Helsinki Sleep Clinic, Vitalmed Research Center, Department of Clinical Neurosciences, University of Helsinki, Valimotie 21, 00380 Helsinki, Finland.
| |
Collapse
|
26
|
Dergacheva O, Yamanaka A, Schwartz AR, Polotsky VY, Mendelowitz D. Direct projections from hypothalamic orexin neurons to brainstem cardiac vagal neurons. Neuroscience 2016; 339:47-53. [PMID: 27693474 DOI: 10.1016/j.neuroscience.2016.09.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/29/2022]
Abstract
Orexin neurons are known to augment the sympathetic control of cardiovascular function, however the role of orexin neurons in parasympathetic cardiac regulation remains unclear. To test the hypothesis that orexin neurons contribute to parasympathetic control we selectively expressed channelrhodopsin-2 (ChR2) in orexin neurons in orexin-Cre transgenic rats and examined postsynaptic currents in cardiac vagal neurons (CVNs) in the dorsal motor nucleus of the vagus (DMV). Simultaneous photostimulation and recording in ChR2-expressing orexin neurons in the lateral hypothalamus resulted in reliable action potential firing as well as large whole-cell currents suggesting a strong expression of ChR2 and reliable optogenetic excitation. Photostimulation of ChR2-expressing fibers in the DMV elicited short-latency (ranging from 3.2ms to 8.5ms) postsynaptic currents in 16 out of 44 CVNs tested. These responses were heterogeneous and included excitatory glutamatergic (63%) and inhibitory GABAergic (37%) postsynaptic currents. The results from this study suggest different sub-population of orexin neurons may exert diverse influences on brainstem CVNs and therefore may play distinct functional roles in parasympathetic control of the heart.
Collapse
Affiliation(s)
- Olga Dergacheva
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street, NW, Washington, DC 20037, USA.
| | - Akihiro Yamanaka
- Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Alan R Schwartz
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | | | - David Mendelowitz
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street, NW, Washington, DC 20037, USA
| |
Collapse
|
27
|
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: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
28
|
Calandra-Buonaura G, Provini F, Guaraldi P, Plazzi G, Cortelli P. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev 2016; 26:43-56. [DOI: 10.1016/j.smrv.2015.05.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/08/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
|
29
|
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: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
30
|
Black SW, Yamanaka A, Kilduff TS. Challenges in the development of therapeutics for narcolepsy. Prog Neurobiol 2015; 152:89-113. [PMID: 26721620 DOI: 10.1016/j.pneurobio.2015.12.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/14/2015] [Accepted: 12/04/2015] [Indexed: 01/19/2023]
Abstract
Narcolepsy is a neurological disorder that afflicts 1 in 2000 individuals and is characterized by excessive daytime sleepiness and cataplexy-a sudden loss of muscle tone triggered by positive emotions. Features of narcolepsy include dysregulation of arousal state boundaries as well as autonomic and metabolic disturbances. Disruption of neurotransmission through the hypocretin/orexin (Hcrt) system, usually by degeneration of the HCRT-producing neurons in the posterior hypothalamus, results in narcolepsy. The cause of Hcrt neurodegeneration is unknown but thought to be related to autoimmune processes. Current treatments for narcolepsy are symptomatic, including wake-promoting therapeutics that increase presynaptic dopamine release and anticataplectic agents that activate monoaminergic neurotransmission. Sodium oxybate is the only medication approved by the US Food and Drug Administration that alleviates both sleep/wake disturbances and cataplexy. Development of therapeutics for narcolepsy has been challenged by historical misunderstanding of the disease, its many disparate symptoms and, until recently, its unknown etiology. Animal models have been essential to elucidating the neuropathology underlying narcolepsy. These models have also aided understanding the neurobiology of the Hcrt system, mechanisms of cataplexy, and the pharmacology of narcolepsy medications. Transgenic rodent models will be critical in the development of novel therapeutics for the treatment of narcolepsy, particularly efforts directed to overcome challenges in the development of hypocretin replacement therapy.
Collapse
Affiliation(s)
- Sarah Wurts Black
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA 94025, USA
| | - Akihiro Yamanaka
- Research Institute of Environmental Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Thomas S Kilduff
- Center for Neuroscience, Biosciences Division, SRI International, Menlo Park, CA 94025, USA.
| |
Collapse
|
31
|
Jennum P, Stender-Petersen K, Rabøl R, Jørgensen NR, Chu PL, Madsbad S. The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes. Diabetes Care 2015; 38:2151-7. [PMID: 26407587 DOI: 10.2337/dc15-0907] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/23/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this trial was to investigate the impact of nocturnal hypoglycemia on sleep patterns (assessed by polysomnography) and counterregulatory hormones. RESEARCH DESIGN AND METHODS In this single-blinded, crossover trial, 26 subjects with type 2 diabetes attended two experimental night visits (one normoglycemic and one hypoglycemic) in randomized order. Plasma glucose (PG) levels were controlled by hyperinsulinemic glucose clamping. On the hypoglycemic night, hypoglycemia was induced after reaching sleep stage N2 by turning off glucose infusion until the PG target of 2.7-2.8 mmol/L was reached and maintained for 15 min. Thereafter, subjects were brought back to normoglycemia for the rest of the night. On the normoglycemic night, PG was maintained at 5.0-7.0 mmol/L throughout the night. RESULTS During the first 4 h of sleep (0-4 h; after reaching sleep stage N2), no difference between experimental nights was observed in the rate of electroencephalography-identified arousals or awakenings, but the rate of awakenings was 27% lower during 4-8 h and 20% lower during 0-8 h on the hypoglycemic night than on the normoglycemic night (both statistically significant). Total sleep time tended to be longer on the hypoglycemic night (observed means 366 vs. 349 min, P nonsignificant). Statistically significantly higher counterregulatory hormonal responses (adrenaline, growth hormone, and cortisol) to hypoglycemia were observed compared with normoglycemia. CONCLUSIONS Nocturnal hypoglycemia in patients with type 2 diabetes caused a decrease in awakening response in the 4-8-h period following the event. These findings underscore the risks associated with nocturnal hypoglycemia because nocturnal hypoglycemia potentially affects the patient's ability to wake up and respond with an adequate intake of carbohydrates.
Collapse
Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen University Hospital, Glostrup, Denmark
| | | | | | | | | | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| |
Collapse
|
32
|
Christensen JAE, Munk EGS, Peppard PE, Young T, Mignot E, Sorensen HBD, Jennum P. The diagnostic value of power spectra analysis of the sleep electroencephalography in narcoleptic patients. Sleep Med 2015; 16:1516-27. [PMID: 26611950 DOI: 10.1016/j.sleep.2015.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/30/2015] [Accepted: 09/07/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Manifestations of narcolepsy with cataplexy (NC) include disturbed nocturnal sleep - hereunder sleep-wake instability, decreased latency to rapid eye movement (REM) sleep, and dissociated REM sleep events. In this study, we characterized the electroencephalography (EEG) of various sleep stages in NC versus controls. METHODS EEG power spectral density (PSD) was computed in 136 NC patients and 510 sex- and age-matched controls. Features reflecting differences in PSD curves were computed. A Lasso-regularized regression model was used to find an optimal feature subset, which was validated on 19 NC patients and 708 non-NC patients from a sleep clinic. Reproducible features were analyzed using receiver operating characteristic (ROC) curves. RESULTS Thirteen features were selected based on the training dataset. Three were applicable in the validation dataset, indicating that NC patients show (1) increased alpha power in REM sleep, (2) decreased sigma power in wakefulness, and (3) decreased delta power in stage N1 versus wakefulness. Sensitivity of these features ranged from 4% to 10% with specificity around 98%, and it did not vary substantially with and without treatment. CONCLUSIONS EEG spectral analysis of REM sleep, wake, and differences between N1 and wakefulness contain diagnostic features of NC. These traits may represent sleepiness and dissociated REM sleep in patients with NC. However, the features are not sufficient for differentiating NC from controls, and further analysis is needed to completely evaluate the diagnostic potential of these features.
Collapse
Affiliation(s)
- Julie Anja Engelhard Christensen
- Department of Electrical Engineering, Technical University of Denmark, KongensLyngby, Denmark; Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark; Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA
| | - Emil Gammelmark Schreiner Munk
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark; Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA
| | - Paul E Peppard
- University of Wisconsin, School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, USA
| | - Terry Young
- University of Wisconsin, School of Medicine and Public Health, Health Sciences Learning Center, Madison, WI, USA
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Science, Stanford University, Palo Alto, CA, USA.
| | | | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Glostrup Hospital, Glostrup, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
33
|
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: 2.1] [Reference Citation Analysis] [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
| |
Collapse
|
34
|
Klein G, Burghaus L, Vaillant M, Pieri V, Fink GR, Diederich N. Dysautonomia in narcolepsy: evidence by questionnaire assessment. J Clin Neurol 2014; 10:314-9. [PMID: 25324880 PMCID: PMC4198712 DOI: 10.3988/jcn.2014.10.4.314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/24/2022] Open
Abstract
Background and Purpose Excessive daytime sleepiness and sudden sleep attacks are the main features of narcolepsy, but rapid-eye-movement sleep behavior disorder (RBD), hyposmia, and depression can also occur. The latter symptoms are nonmotor features in idiopathic Parkinson's disease (IPD). In the present study, IPD-proven diagnostic tools were tested to determine whether they are also applicable in the assessment of narcolepsy. Methods This was a case-control study comparing 15 patients with narcolepsy (PN) and 15 control subjects (CS) using the Scales for Outcomes in Parkinson's Autonomic Test (SCOPA-AUT), Parkinson's Disease Nonmotor Symptoms (PDNMS), University of Pennsylvania Smell Test, Farnsworth-Munsell 100 Hue test, Beck Depression Inventory, and the RBD screening questionnaire. Results Both the PN and CS exhibited mild hyposmia and no deficits in visual tests. Frequent dysautonomia in all domains except sexuality was found for the PN. The total SCOPA-AUT score was higher for the PN (18.47±10.08, mean±SD) than for the CS (4.40±3.09), as was the PDNMS score (10.53±4.78 and 1.80±2.31, respectively). RBD was present in 87% of the PN and 0% of the CS. The PN were more depressed than the CS. The differences between the PN and CS for all of these variables were statistically significant (all p<0.05). Conclusions The results of this study provide evidence for the presence of dysautonomia and confirm the comorbidities of depression and RBD in narcolepsy patients. The spectrum, which is comparable to the nonmotor complex in IPD, suggests wide-ranging, clinically detectable dysfunction beyond the narcoleptic core syndrome.
Collapse
Affiliation(s)
- Gilles Klein
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Internal Medicine, Brothers of Charity Hospital, Trier, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Michel Vaillant
- Competences Center for Methodology and Statistics, CRP Santé, Strassen, Luxembourg
| | - Vannina Pieri
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Cologne, Germany. ; Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Nico Diederich
- Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg. ; Department of Neurology, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
35
|
Holm A, Bang-Berthelsen CH, Knudsen S, Kornum BR, Modvig S, Jennum P, Gammeltoft S. miRNA profiles in plasma from patients with sleep disorders reveal dysregulation of miRNAs in narcolepsy and other central hypersomnias. Sleep 2014; 37:1525-33. [PMID: 25142559 DOI: 10.5665/sleep.4004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES MicroRNAs (miRNAs) have been implicated in the pathogenesis of human diseases including neurological disorders. The aim is to address the involvement of miRNAs in the pathophysiology of central hypersomnias including autoimmune narcolepsy with cataplexy and hypocretin deficiency (type 1 narcolepsy), narcolepsy without cataplexy (type 2 narcolepsy), and idiopathic hypersomnia. DESIGN We conducted high-throughput analysis of miRNA in plasma from three groups of patients-with type 1 narcolepsy, type 2 narcolepsy, and idiopathic hypersomnia, respectively-in comparison with healthy controls using quantitative real-time polymerase chain reaction (qPCR) panels. SETTING University hospital based sleep clinic and research laboratories. PATIENTS Twelve patients with type 1 narcolepsy, 12 patients with type 2 narcolepsy, 12 patients with idiopathic hypersomnia, and 12 healthy controls. MEASUREMENTS AND RESULTS By analyzing miRNA in plasma with qPCR we identified 50, 24, and 6 miRNAs that were different in patients with type 1 narcolepsy, type 2 narcolepsy, and idiopathic hypersomnia, respectively, compared with healthy controls. Twenty miRNA candidates who fulfilled the criteria of at least two-fold difference and p-value < 0.05 were selected to validate the miRNA changes in an independent cohort of patients. Four miRNAs differed significantly between type 1 narcolepsy patients and healthy controls. Levels of miR-30c, let-7f, and miR-26a were higher, whereas the level of miR-130a was lower in type 1 narcolepsy than healthy controls. The miRNA differences were not specific for type 1 narcolepsy, since the levels of the four miRNAs were also altered in patients with type 2 narcolepsy and idiopathic hypersomnia compared with healthy controls. CONCLUSION The levels of four miRNAs differed in plasma from patients with type 1 narcolepsy, type 2 narcolepsy and idiopathic hypersomnia suggesting that alterations of miRNAs may be involved in the pathophysiology of central hypersomnias.
Collapse
|
36
|
Pereira D, Lopes E, da Silva Behrens NSC, de Almeida Fonseca H, Sguillar DA, de Araújo Lima TF, Pradella-Hallinan M, Castro J, Tufik S, Santos Coelho FM. Prevalence of periodical leg movements in patients with narcolepsy in an outpatient facility in São Paulo. ACTA ACUST UNITED AC 2014; 7:69-71. [PMID: 26483906 PMCID: PMC4521645 DOI: 10.1016/j.slsci.2014.07.018] [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: 07/24/2013] [Accepted: 03/10/2014] [Indexed: 11/21/2022]
Abstract
Studies have pointed out that approximately 50–60% of narcolepsy patients may demonstrate higher prevalence of periodical leg movements. However, we highlight that the prevalence studies and the effects of periodical leg movements in patients with narcolepsy are limited and with conflicting results. The objective of this study was that of describing and discussing the prevalence of periodical leg movements in patients with narcolepsy in the outpatient facility of diurnal excessive sleepiness of the Federal University of São Paulo, Brazil. We revised 59 files of patients with the clinical and electrophysiological diagnosis of narcolepsy according to the American Academy of Sleep Medicine. Of these 59 cases of patients with narcolepsy, 12 (20.3%) demonstrated periodical leg movements. Thirty five patients (59.3%) had history of cataplexy and 38 patients (64.4%) had the presence of the allele HLA-DQB1⁎0602. There was a higher prevalence of periodical leg movements in patients with cataplexy (p<0.0001) and in patients with the presence of the allele HLA-DQB1⁎0602 (p<0.0001). Our study characterized the higher prevalence of periodical leg movement in patients with narcolepsy, mainly in patients with cataplexy and with the presence of the allele HLA-DQB1⁎0602.
Collapse
Affiliation(s)
- Danielle Pereira
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Eduardo Lopes
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Nilce Sanny Costa da Silva Behrens
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Ear, Nose and Throat Clinic, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil
| | - Hassana de Almeida Fonseca
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of General Practice, Federal University of Rio de Janeiro, Brazil
| | - Danilo Anunciatto Sguillar
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Taís Figueiredo de Araújo Lima
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Marcia Pradella-Hallinan
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Juliana Castro
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Sergio Tufik
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil
| | - Fernando Morgadinho Santos Coelho
- Outpatient Facility of Diurnal Excessive Sleepiness, Department of Psychobiology, Federal University of São Paulo, Brazil ; Department of Neurology and Neurosurgery, Federal University of São Paulo, Brazil
| |
Collapse
|
37
|
Carrive P. Orexin, orexin receptor antagonists and central cardiovascular control. Front Neurosci 2013; 7:257. [PMID: 24415993 PMCID: PMC3874580 DOI: 10.3389/fnins.2013.00257] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/09/2013] [Indexed: 01/08/2023] Open
Abstract
Orexin makes an important contribution to the regulation of cardiovascular function. When injected centrally under anesthesia, orexin increases blood pressure, heart rate and sympathetic nerve activity. This is consistent with the location of orexin neurons in the hypothalamus and the distribution of orexin terminals in the central autonomic network. Thus, the two orexin receptors, Ox1R and Ox2R, which have partly overlapping distributions in the brain, are expressed in the sympathetic preganglionic neurons (SPN) of the thoracic cord as well as in regions such as the pressor area of the rostral ventrolateral medulla (RVLM). Both Ox1R and Ox2R appear to contribute to the cardiovascular effects of orexin, although Ox1R is probably more important. Blockade of orexin receptors reduces the cardiovascular response to certain stressors, especially psychogenic stressors such as novelty, aggressive conspecifics and induced panic. Blockade of orexin receptors also reduces basal blood pressure and heart rate in spontaneous hypertensive rats, a model of essential hypertension. Thus, there is a link between psychogenic stress, orexin and elevated blood pressure. The use of dual orexin receptor antagonists (DORAs) and selective orexin receptor antagonists (SORAs) may be beneficial in the treatment of certain forms of hypertension.
Collapse
Affiliation(s)
- Pascal Carrive
- Blood Pressure, Brain and Behavior Laboratory, School of Medical Sciences, University of New South Wales Sydney, NSW, Australia
| |
Collapse
|
38
|
Abstract
There is increasing evidence that cardiovascular control during sleep is relevant for cardiovascular risk. This evidence warrants increased experimental efforts to understand the physiological mechanisms of such control. This review summarizes current knowledge on autonomic features of sleep states [non-rapid-eye-movement sleep (NREMS) and rapid-eye-movement sleep (REMS)] and proposes some testable hypotheses concerning the underlying neural circuits. The physiological reduction of blood pressure (BP) during the night (BP dipping phenomenon) is mainly caused by generalized cardiovascular deactivation and baroreflex resetting during NREMS, which, in turn, are primarily a consequence of central autonomic commands. Central commands during NREMS may involve the hypothalamic ventrolateral preoptic area, central thermoregulatory and central baroreflex pathways, and command neurons in the pons and midbrain. During REMS, opposing changes in vascular resistance in different regional beds have the net effect of increasing BP compared with that of NREMS. In addition, there are transient increases in BP and baroreflex suppression associated with bursts of brain and skeletal muscle activity during REMS. These effects are also primarily a consequence of central autonomic commands, which may involve the midbrain periaqueductal gray, the sublaterodorsal and peduncular pontine nuclei, and the vestibular and raphe obscurus medullary nuclei. A key role in permitting physiological changes in BP during sleep may be played by orexin peptides released by hypothalamic neurons, which target the postulated neural pathways of central autonomic commands during NREMS and REMS. Experimental verification of these hypotheses may help reveal which central neural pathways and mechanisms are most essential for sleep-related changes in cardiovascular function.
Collapse
Affiliation(s)
- Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy; and
| | | |
Collapse
|
39
|
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: 2.0] [Reference Citation Analysis] [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
| |
Collapse
|
40
|
Abstract
STUDY OBJECTIVES Narcolepsy is characterized by instability of sleep-wake, tonus, and rapid eye movement (REM) sleep regulation. It is associated with severe hypothalamic hypocretin deficiency, especially in patients with cataplexy (loss of tonus). As the hypocretin neurons coordinate and stabilize the brain's sleep-wake pattern, tonus, and REM flip-flop neuronal centers in animal models, we set out to determine whether hypocretin deficiency and/or cataplexy predicts the unstable sleep-wake and REM sleep pattern of the human phenotype. DESIGN We measured the frequency of transitions in patients with narcolepsy between sleep-wake states and to/from REM and NREM sleep stages. Patients were subdivided by the presence of +/- cataplexy and +/- hypocretin-1 deficiency. SETTING Sleep laboratory studies conducted from 2001-2011. PATIENTS In total 63 narcolepsy patients were included in the study. Cataplexy was present in 43 of 63 patients and hypocretin-1 deficiency was present in 37 of 57 patients. MEASUREMENTS AND RESULTS Hypocretin-deficient patients with narcolepsy had a significantly higher frequency of sleep-wake transitions (P = 0.014) and of transitions to/from REM sleep (P = 0.044) than patients with normal levels of hypocretin-1. Patients with cataplexy had a significantly higher frequency of sleep-wake transitions (P = 0.002) than those without cataplexy. A multivariate analysis showed that transitions to/from REM sleep were predicted mainly by hypocretin-1 deficiency (P = 0.011), whereas sleep-wake transitions were predicted mainly by cataplexy (P = 0.001). CONCLUSIONS In human narcolepsy, hypocretin deficiency and cataplexy are both associated with signs of destabilized sleep-wake and REM sleep control, indicating that the disorder may serve as a human model for the sleep-wake and REM sleep flip-flop switches.
Collapse
Affiliation(s)
- Gertrud Laura Sorensen
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark
| | | | | |
Collapse
|
41
|
Fronczek R, Thijs RD. Autonomic alterations in narcolepsy-contrasting results in mice and men. Sleep 2013; 36:9-10. [PMID: 23288964 DOI: 10.5665/sleep.2286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|