Disrupted Nighttime Sleep and Sleep Instability in Narcolepsy

Overview

Journal J Clin Sleep Med

Specialties Neurology
Psychiatry

Date 2021 Aug 31

PMID 34463249

Citations 18

Authors

Kiran Maski

Emmanuel Mignot

Giuseppe Plazzi

Yves Dauvilliers

Affiliations

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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. . 2022;18(1):289-304.

Citing Articles

The Lehigh Valley Health Network Narcolepsy Cohort: clinical and polysomnographic analysis of 304 cases.

Jiang R, Rochart R, Chu I, Duka S, Vendrame M J Clin Sleep Med. 2024; 21(3):479-491.

PMID: 39484812 PMC: 11874083. DOI: 10.5664/jcsm.11430.

Impaired sleep-dependent memory consolidation in pediatric narcolepsy type 1.

Maski K, Maski K, Heckler G, Heckler G, Worhach J, Worhach J Sleep. 2024; 48(2).

PMID: 39420719 PMC: 11807881. DOI: 10.1093/sleep/zsae238.

Characterizing disrupted nighttime sleep and associated functional outcomes in youth with narcolepsy type 1.

Heckler G, Worhach J, Wang G, Szilagyi K, Zhang B, Diniz Behn C J Clin Sleep Med. 2024; 21(2):355-363.

PMID: 39415540 PMC: 11789264. DOI: 10.5664/jcsm.11416.

Knowledge of Narcolepsy Among Physicians in Makkah Region, Saudi Arabia: A Cross-Sectional Study.

Almatrafi M, Zafer D, Alkhaldi R, Moglan T, Alkalash S Cureus. 2024; 16(8):e66052.

PMID: 39224746 PMC: 11367182. DOI: 10.7759/cureus.66052.

Orexin and Sleep Disturbances in Alpha-Synucleinopathies: a Systematic Review.

Raheel K, See Q, Munday V, Fakhroo B, Ivanenko O, Salvatelli M Curr Neurol Neurosci Rep. 2024; 24(9):389-412.

PMID: 39031323 PMC: 11349833. DOI: 10.1007/s11910-024-01359-6.

References

Mullington J, Broughton R . Scheduled naps in the management of daytime sleepiness in narcolepsy-cataplexy. Sleep. 1993; 16(5):444-56. DOI: 10.1093/sleep/16.5.444. View

Ohayon M, Black J, Lai C, Eller M, Guinta D, Bhattacharyya A . Increased mortality in narcolepsy. Sleep. 2014; 37(3):439-44. PMC: 3920308. DOI: 10.5665/sleep.3470. View

Morin C, Belleville G, Belanger L, Ivers H . The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011; 34(5):601-8. PMC: 3079939. DOI: 10.1093/sleep/34.5.601. View

Dauvilliers Y, Jaussent I, Krams B, Scholz S, Lado S, Levy P . Non-dipping blood pressure profile in narcolepsy with cataplexy. PLoS One. 2012; 7(6):e38977. PMC: 3387234. DOI: 10.1371/journal.pone.0038977. View

Filardi M, Pizza F, Antelmi E, Pillastrini P, Natale V, Plazzi G . Physical Activity and Sleep/Wake Behavior, Anthropometric, and Metabolic Profile in Pediatric Narcolepsy Type 1. Front Neurol. 2018; 9:707. PMC: 6117389. DOI: 10.3389/fneur.2018.00707. View

Buysse D, Ancoli-Israel S, Edinger J, Lichstein K, Morin C . Recommendations for a standard research assessment of insomnia. Sleep. 2006; 29(9):1155-73. DOI: 10.1093/sleep/29.9.1155. View

Thorpy M, Krieger A . Delayed diagnosis of narcolepsy: characterization and impact. Sleep Med. 2014; 15(5):502-7. DOI: 10.1016/j.sleep.2014.01.015. View

Mukai J, Uchida S, Miyazaki S, Nishihara K, Honda Y . Spectral analysis of all-night human sleep EEG in narcoleptic patients and normal subjects. J Sleep Res. 2003; 12(1):63-71. DOI: 10.1046/j.1365-2869.2003.00331.x. View

Fulcher B, Phillips A, Postnova S, Robinson P . A physiologically based model of orexinergic stabilization of sleep and wake. PLoS One. 2014; 9(3):e91982. PMC: 3961294. DOI: 10.1371/journal.pone.0091982. View

10.

Black J, Houghton W . Sodium oxybate improves excessive daytime sleepiness in narcolepsy. Sleep. 2006; 29(7):939-46. DOI: 10.1093/sleep/29.7.939. View

11.

Kansagra S, Walter R, Vaughn B . Nocturnal temazepam in the treatment of narcolepsy. J Clin Sleep Med. 2013; 9(5):499-500. PMC: 3629325. DOI: 10.5664/jcsm.2676. View

12.

Wolraich M, Hagan Jr J, Allan C, Chan E, Davison D, Earls M . Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019; 144(4). PMC: 7067282. DOI: 10.1542/peds.2019-2528. View

13.

Stephansen J, Olesen A, Olsen M, Ambati A, Leary E, Moore H . Neural network analysis of sleep stages enables efficient diagnosis of narcolepsy. Nat Commun. 2018; 9(1):5229. PMC: 6283836. DOI: 10.1038/s41467-018-07229-3. View

14.

Leger D, Gauriau C, Tonetti L, Lantin M, Filardi M, Philip P . Using actigraphy to assess sleep and wake rhythms of narcolepsy type 1 patients: a comparison with primary insomniacs and healthy controls. Sleep Med. 2018; 52:88-91. DOI: 10.1016/j.sleep.2018.07.024. View

15.

Black J, Pardi D, Hornfeldt C, Inhaber N . The nightly use of sodium oxybate is associated with a reduction in nocturnal sleep disruption: a double-blind, placebo-controlled study in patients with narcolepsy. J Clin Sleep Med. 2011; 6(6):596-602. PMC: 3014247. View

16.

Roth T, Dauvilliers Y, Mignot E, Montplaisir J, Paul J, Swick T . Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med. 2013; 9(9):955-65. PMC: 3746724. DOI: 10.5664/jcsm.3004. View

17.

Sorensen G, Knudsen S, Petersen E, Kempfner J, Gammeltoft S, Sorensen H . Attenuated heart rate response is associated with hypocretin deficiency in patients with narcolepsy. Sleep. 2013; 36(1):91-8. PMC: 3524548. DOI: 10.5665/sleep.2308. View

18.

Alakuijala A, Sarkanen T, Jokela T, Partinen M . Accuracy of Actigraphy Compared to Concomitant Ambulatory Polysomnography in Narcolepsy and Other Sleep Disorders. Front Neurol. 2021; 12:629709. PMC: 7969975. DOI: 10.3389/fneur.2021.629709. View

19.

Rogers A, Aldrich M . The effect of regularly scheduled naps on sleep attacks and excessive daytime sleepiness associated with narcolepsy. Nurs Res. 1993; 42(2):111-7. View

20.

Alakuijala A, Sarkanen T, Partinen M . Hypocretin-1 Levels Associate with Fragmented Sleep in Patients with Narcolepsy Type 1. Sleep. 2016; 39(5):1047-50. PMC: 4835302. DOI: 10.5665/sleep.5750. View