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Sleep: In-Focus

 

Excessive Daytime Sleepiness Associated with Migraine

A new study has confirmed the link between excessive daytime sleepiness (EDS) and migraine. Investigating the prevalence and impact of EDS in a population-based sample in Korea, investigators used the Epworth Sleepiness Scale (ESS) to evaluate 2,695 patients. Among this group, 5.3 percent and 11.6 percent were classified as having migraine and EDS, respectively. Importantly, the prevalence of EDS was nearly 20 percent in participants with migraine and non-migraine headache compared to non-headache controls. Additionally, the investigators noted that migraineurs with EDS had higher scores on the Visual Analogue Scale (VAS) for headache intensity and Headache Impact Test-6 compared to migraineurs without EDS.

—J Headache Pain. 2016 Dec; 17(1): 62

Parkinson’s Disease Linked to Poorer Sleep, Heightened Anxiety

By the Numbers

The percentage of individuals with dystonia who had excessive daytime sleepiness in a new study. Investigators assessed fatigue and sleep disturbances in 91 patients with dystonia who presented to a botulinum toxin clinic. They found that excessive daytime sleepiness and nocturnal sleep disturbances—the latter seen in 26 percent of patients—correlated significantly with health-related quality of life. However, the authors observed that these effects were not seen for daytime sleepiness when controlled for depression.

—Int J Neurosci. 2016 Oct; 126(10): 928-35

Integrative treatment approaches that address pain in patients with Parkinson’s disease (PD) may be warranted to improve anxiety and sleep quality, according to new findings. In a cross-sectional case-control study, PD patients with pain showed significantly higher anxiety and poorer sleep quality than PD patients without pain. The investigators also noted that PD patients with pain were more likely to report akathisic, tension, and sharp pain compared to controls with pain, but these three pain characteristics did not correlate with each other. However, they noted that there were no differences in depression, anxiety, or sleep between PD patients with akathisic, tension, and sharp pain and those without.

—J Neurol Sci. 2016 Oct 15; 369: 212-5.

REM Sleep Behavior Disorder May Occur in Alzheimer’s but Does Not Impact Sleep Architecture of Patients

Rapid eye movement (REM) sleep behavior disorder (RBD) can occur in patients with AD, though it does not change the sleep architecture of AD patients, according to a new study. Out of 105 clinically probable AD patients, investigators identified 15 with suspected RBD who then underwent a video-polysomnography (vPSG) examination. They found that one of the patients performed repeated touching of the head and the face with his hands and flailed his arms, while three patients exhibited hand twisting, exploring, prominent limb kicking, and jerking. The fifth patient exhibited all of the characteristics of RBD. Of the five patients, one patient took the acetylcholinesterase inhibitor drug donepezil. Additionally, the patients with AD plus RBD demonstrated increases in both tonic and phasic electromyography activity during REM sleep, but sleep architecture did not differ between the AD plus RBD and AD-alone groups.

—Aging Clin Exp Res. 2016 Oct; 28(5): 951-7.

Sleep Disordered Breathing and Sleep Disturbances Increase Stroke Risk

Sleep-disordered breathing (SDB) and sleep-wake disturbances (SWD) appear to increase the risk of stroke and affect both short- and long-term stroke recovery and outcome. In a review of sleep studies, investigators offered insights on risk factors as well and therapeutic options for patients with these disorders. Suggesting that SDB is an independent risk factor for stroke, the authors suggested that sleep studies in TIA and stroke patients may be appropriate, due to the high prevalence of SDB (Class IIb, level of evidence B).

They also recommended continuous positive airway pressure for the treatment of obstructive SDB, given the strength of the increasing evidence in support of a positive effect on outcome (Class IIb, level of evidence B). The article also offered a discussion in therapeutics options, specifically highlighting the utility of oxygen, biphasic positive airway pressure, and adaptive servoventilation in patients with central SDB. Looking at recent trends, the authors noted that reduced and increased sleep duration, as well as hypersomnia, insomnia, and restless legs syndrome (RLS) appear to increase stroke risk and that some experimental studies found that SWD may in addition impair neuroplasticity processes and functional stroke recovery. n

—Neurology. 2016 Sep 27; 87(13): 1407-16.

Neuroinflammatory Agents May Benefit Patients with IRBD

Anti-inflammatory agents could possibly delay progression to a manifest synucleinopathy in patients with idiopathic REM sleep behaviour disorder (IRBD). In a study presented last month at the World Parkinson Congress in Portland, OR, researchers evaluated the in vivo occurrence of neuroinflammation in the brains of patients with idiopathic REM sleep behavior disorder (IRBD) and its temporal relationship with striatal dopamine dysfunction using PET. Patients showed significantly reduced 18F- DOPA tracer uptake compared to control subjects in the putamen bilaterally and similar uptake in the caudate and substantia nigra (SN)s. 11C-PK11195 tracer uptake was significantly increased in the left SN and slightly increased in the right SN. Patients with more severe reductions in putamen 18F-DOPA uptake had significantly higher putamen 11C- PK11195 binding. Also, there was a positive correlation between 11C-PK11195 tracer uptake in the SN and the ipsilateral posterior part of the putamen. The investigators concluded that microglial activation occurs in the SN and in the putamen in IRBD.

 

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About Practical Neurology

Launched in January 2002, Practical Neurology strives to enhance quality of care and improve the daily operation of neurology practices. Each month, our experts explain the real-world significance of recent advances in neurologic science and offer step-by-step advice on how to overcome the clinical and business challenges neurologists face. Our straightforward, how-to articles give neurologists tools they can put into practice right away.

 
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