Elsevier

Neurologic Clinics

Volume 14, Issue 4, 1 November 1996, Pages 807-826
Neurologic Clinics

SLEEP AND DEGENERATIVE NEUROLOGIC DISORDERS

https://doi.org/10.1016/S0733-8619(05)70286-3Get rights and content

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GENERAL SLEEP COMPLAINTS

Insomnia and hypersomnia are the two major sleep complaints in neurodegenerative diseases. Other general sleep complaints include abnormal motor activity and behavior during sleep, breathing problems and snoring during sleep, and disturbances of normal sleep rhythm.

Complaints of insomnia may include difficulty in initiating sleep, repeated awakenings including early morning awakening, and insufficient or total lack of sleep.13 Excessive daytime sleepiness (EDS) or fatigue, anxiety,

Alzheimer's Disease

AD (or senile dementia of the Alzheimer's type) is the most common cerebral degenerative disorder that causes dementia. The condition usually begins in mid- or late life and is manifested by progressive intellectual deterioration associated with characteristic neuropathologic findings of senile plaques, neurofibrillary tangles, granulovacuolar degeneration, cerebral cortical atrophy, and neuronal loss in the nucleus basalis of Meynert. There are also alterations in the forebrain cholinergic as

PATHOGENETIC MECHANISMS

Pathogenetic mechanisms of sleep disturbances in neurodegenerative diseases include both direct and indirect mechanisms.15, 16 Direct structural alterations of the sleep–wake generating neurons in the brain stem and hypothalamus that change the balance between sleep and wakefulness may cause insomnia, hypersomnia, or circadian rhythm sleep disturbances. Insomnia may result from affection of the hypothalamic preoptic nuclei or the lower brain stem hypnogenic neurons in the region of the nucleus

Clinical Approach

Sleep complaints are common in degenerative diseases of the nervous system. For clinical assessment, the first step is a careful history of sleep complaints, including present and past sleep history, family history, drug and alcohol history, and medical and psychiatric histories. Sleep disturbances in neurodegenerative diseases include insomnia, hypersomnia, parasomnias, and circadian rhythm sleep disturbances. Their history also should address the question of sleep disturbances related to the

TREATMENT

Treatment of the underlying neurologic disease, if available, is the first step, as such treatment may improve the sleep disturbance. If such treatment is not available or does not resolve the problem, resolution of the condition may be difficult. Certain general principles should be applied (Table 1).2, 15, 32

The treatment of hypersomnia related to sleep-related breathing disorders may be divided into general measures, pharmacologic treatment, mechanical devices, and surgical treatment.15 The

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References (87)

  • J. Mouret

    Differences in sleep in patients with Parkinson's disease

    Electroencephalogr Clin Neurophysiol

    (1975)
  • M. Segawa et al.

    Long-term effects of l-dopa on hereditary progressive dystonia with marked diurnal fluctuation

  • E.G. Spokes et al.

    Multiple system atrophy with autonomic failure: Clinical, histological and neurochemical observations on 4 cases

    J Neurol Sci

    (1979)
  • M. Aldrich et al.

    Sleep abnormalities in progressive supranuclear palsy

    Ann Neurol

    (1989)
  • M.S. Aldrich

    Parkinsonism

  • M.C.P. Apps et al.

    Respiration and sleep in Parkinson's disease

    J Neurol Neurosurg Psychiatry

    (1985)
  • J.J. Askenasy

    Sleep in Parkinson's disease

    Acta Neurol Scand

    (1993)
  • R. Bannister et al.

    Degenerative disease of the nervous system associated with autonomic failure

    Brain

    (1972)
  • G. Barabas et al.

    Somnambulism in children with Tourette syndrome

    Dev Med Child Neurol

    (1984)
  • R.M. Benca et al.

    Sleep and psychiatric disorders: A meta-analysis

    Arch Gen Psychiatry

    (1992)
  • I.B. Black et al.

    Catecholamine enzymes in the degenerative neurological disease idiopathic orthostatic hypotension

    Science

    (1976)
  • D.L. Bliwise

    Dementia

  • D.L. Bliwise et al.

    Disruptive nocturnal behavior in Parkinson's disease and Alzheimer's disease

    J Geriatr Psychiatry Neurol

    (1995)
  • I.J. Butler et al.

    Biogenic amine metabolism in Tourette syndrome

    Ann Neurol

    (1979)
  • S. Chokroverty

    Sleep and breathing in neurological disorders

  • S. Chokroverty

    The spectrum of ventilatory disturbances in movement disorders

  • S. Chokroverty et al.

    Autonomic dysfunction and sleep apnea in olivopontocerebellar degeneration

    Arch Neurol

    (1984)
  • S. Chokroverty et al.

    Periodic respiration in erect posture in Shy-Drager syndrome

    J Neurol Neurosurg Psychiatry

    (1978)
  • C.L. Comella et al.

    Parkinson's disease patients with and without REM behavior disorder (RBD): A polysomnographic and clinical comparison

    Neurology

    (1993)
  • J.A. Dempsey et al.

    Hormones and neurochemicals in the regulation of breathing

  • J. Efthimiou et al.

    Sleep apnea in idiopathic and postencephalitic parkinsonism

  • T. Erkinjuntti et al.

    Sleep apnea in multi-infarct dementia and Alzheimer's disease

    Sleep

    (1987)
  • S.A. Factor et al.

    Sleep disorders and sleep effect in Parkinson's disease

    Mov Disord

    (1990)
  • D.R. Fish et al.

    The effect of sleep on the dyskinetic movements of Parkinson's disease, Gilles de la Tourette syndrome, Huntington's disease, and torsion dystonia

    Arch Neurol

    (1991)
  • P.C. Gay et al.

    Effect of alterations in pulmonary function and sleep variables on survival in patients with amyotrophic lateral sclerosis

    Mayo Clin Proc

    (1991)
  • D.G. Glaze et al.

    Sleep in Gilles de la Tourette syndrome: Disorder of arousal

    Neurology

    (1983)
  • P. Hansotia et al.

    Sleep disturbances and severity of Huntington's disease

    Neurology

    (1985)
  • R.J. Hardie et al.

    Respiration and sleep in Parkinson's disease

    J Neurol Neurosurg Psychiatry

    (1986)
  • B.V. Hilten et al.

    Sleep disruption in Parkinson's disease: Assessment by continuous activity monitoring

    Arch Neurol

    (1994)
  • C.C. Hoch et al.

    Sleep disordered breathing in normal and pathologic aging

    J Clin Psychiatry

    (1986)
  • O. Hornykiewicz et al.

    Brain neurotransmitters in dystonia musculorum deformans

    N Engl J Med

    (1986)
  • A. Hovestadt et al.

    Pulmonary function in Parkinson's disease

    J Neurol Neurosurg Psychiatr

    (1989)
  • W.R. Jankel et al.

    Polysomnographic findings in dystonia musculorum deformans

    Sleep

    (1983)
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      These findings are in contrast to a recently published PSG supported study on 62 PD patients [17], where the gender-dependence of slow wave sleep expression was not seen. However, Diederich and coworkers, as well as other previous study groups [28,29] demonstrated surprisingly high overall amounts of slow wave sleep with 14 to 19 % which contradict findings in other PD cohorts [10,11,30] and in healthy elderly males as well [25]. Whether this difference in the amount of slow wave sleep is due to methodological differences, the selection bias of subjectively sleep disordered patients, the larger number of patients investigated in our cohort, their slightly older mean age, longer disease duration, or increased disease severity needs to be clarified in further studies.

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    Address reprint requests to Sudhansu Chokroverty, MD, Department of Neurology, Cronin 4, St. Vincent's Hospital and Medical Center, 153 West 11th Street, New York, NY 10011

    *

    From the Department of Neurology and Division of Neurophysiology, St. Vincent's Hospital and Medical Center, New York, New York; the Department of Neurology, Veterans Affairs Medical Center, Lyons, New Jersey; Department of Neurology, Robert Wood Johnson Medical School, New Brunswick, New Jersey; and New York Medical College, New York, New York

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