The aim of the present study was to examine gender and age-specific effects on subjective daytime sleepiness (as measured by the Epworth Sleepiness Scale), body weight and eating behaviour in patients with central disorders of hypersomnolence. Based on the European Narcolepsy Network database, we compared 1035 patients with narcolepsy type I and 505 patients with other central disorders of hypersomnolence ("narcoleptic borderland"), including narcolepsy type II (N = 308) and idiopathic hypersomnia (N = 174), using logistic regression and general linear models. In the entire study population, the Epworth Sleepiness Scale was higher in women (N = 735, mean age = 30 years, mean Epworth Sleepiness Scale = 16.6 ± SD 3.9) than in men (N = 805, mean age = 32 years, mean Epworth Sleepiness Scale = 15.8 ± SD 4.4). In women with narcolepsy type I (N = 475), both Epworth Sleepiness Scale and body mass index increased in parallel with age. In women of the narcoleptic borderland (N = 260), the Epworth Sleepiness Scale markedly peaked in their early 30s, while body mass index only started to rise at that age. This rise in body mass index following the Epworth Sleepiness Scale peak cannot be explained by sleepiness-induced uncontrolled eating, as self-reported uncontrolled eating was negatively associated with the Epworth Sleepiness Scale in this group. We propose that the narcoleptic borderland harbours a unique cluster of women in their fertile years with an unexplored aetiology requiring further investigation towards tailored interventions.
- MeSH
- Adult MeSH
- Body Mass Index * MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Narcolepsy * physiopathology MeSH
- Disorders of Excessive Somnolence * physiopathology epidemiology MeSH
- Sex Factors MeSH
- Feeding Behavior MeSH
- Body Weight MeSH
- Age Factors MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Sleep symptoms, including excessive sleepiness, are frequently reported by patients with functional motor disorders (FMD). We aimed to classify the comorbid sleep disorders in FMD, and to investigate the relationship between subjective sleepiness and objective measures of hypersomnia, comparing them with data from people with central hypersomnia. A total of 37 patients (mean [SD] age 46.4 [11.2] years) with clinically definite FMD, and 17 patients (mean [SD] age 41.1 [11.6] years) with central hypersomnia underwent structured medical and sleep history, neurological examination, polysomnography, multiple sleep latency test (MSLT), and questionnaires assessing sleepiness, fatigue, and depression. In all, 23 patients with FMD (62%) reported excessive daytime sleepiness. Evidence of specific sleep disorders was identified in our cohort, with 35% having restless legs syndrome; 49% obstructive sleep apnea; and 8% periodic limb movements in sleep; however, the presence of these disorders was not correlated with subjective sleepiness. Patients with FMD with self-reported sleepiness reported higher fatigue (p = 0.002), depression (p = 0.002), and had longer sleep latencies in the MSLT (p < 0.001) compared to the patients with central hypersomnia. No correlation was found between subjective and objective sleepiness in either group. Fatigue positively correlated with self-reported sleepiness in patients with FMD (p < 0.001). This study did not find objective correlates of increased sleepiness in patients with FMD. While sleep abnormalities were found to be common in FMD, they were not correlated with self-reports of excessive sleepiness. Positive correlations between self-reported sleepiness and fatigue support the current unified model of non-motor symptoms in FMD.
- MeSH
- Depression epidemiology physiopathology MeSH
- Adult MeSH
- Comorbidity * MeSH
- Middle Aged MeSH
- Humans MeSH
- Nocturnal Myoclonus Syndrome epidemiology physiopathology MeSH
- Polysomnography * MeSH
- Disorders of Excessive Somnolence * epidemiology physiopathology MeSH
- Sleep Wake Disorders epidemiology physiopathology MeSH
- Surveys and Questionnaires MeSH
- Sleepiness MeSH
- Sleep Latency physiology MeSH
- Restless Legs Syndrome physiopathology epidemiology MeSH
- Fatigue physiopathology epidemiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Little attention has been paid to the long-term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow-up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence.
- MeSH
- Adult MeSH
- Idiopathic Hypersomnia * diagnosis epidemiology drug therapy MeSH
- Comorbidity MeSH
- Middle Aged MeSH
- Humans MeSH
- Narcolepsy * diagnosis epidemiology MeSH
- Disorders of Excessive Somnolence * diagnosis epidemiology complications MeSH
- Attention MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
STUDY OBJECTIVES: Microbial antigens can elicit an immune response leading to the production of autoantibodies cross-reacting with autoantigens. Still, their clinical significance in human sera in the context of brain diseases is unclear. Therefore, assessment of natural autoantibodies reacting with their neuropeptides may elucidate the autoimmune etiology of central hypersomnias. The study aims to determine whether serum autoantibody levels differ in patients with different types of central hypersomnias (narcolepsy type 1 and 2, NT1 and NT2; idiopathic hypersomnia, IH) and healthy controls and if the differences could suggest the participation of autoantibodies in disease pathogenesis. METHODS: Sera from 91 patients with NT1, 27 with NT2, 46 with IH, and 50 healthy controls were examined for autoantibodies against assorted neuropeptides. Participants were screened using questionnaires related to sleep disorders, quality of life, and mental health conditions. In addition, serum biochemical parameters and biomarkers of microbial penetration through the intestinal wall were determined. RESULTS: A higher prevalence of autoantibodies against neuropeptides was observed only for alpha-melanocytes-stimulating hormone (α-MSH) and neuropeptide glutamic acid-isoleucine (NEI), which differed slightly among diagnoses. Patients with both types of narcolepsy exhibited signs of microbial translocation through the gut barrier. According to the questionnaires, patients diagnosed with NT2 or IH had subjectively worse life quality than patients with NT1. Patients displayed significantly lower levels of bilirubin and creatinine and slightly higher alkaline phosphatase values than healthy controls. CONCLUSIONS: Overall, serum anti-neuronal antibodies prevalence is rare, suggesting that their participation in the pathophysiology of concerned sleep disorders is insignificant. Moreover, their levels vary slightly between diagnoses indicating no major diagnostic significance.
- MeSH
- Autoantibodies MeSH
- Quality of Life MeSH
- Humans MeSH
- Narcolepsy * epidemiology MeSH
- Neuropeptides * MeSH
- Disorders of Excessive Somnolence * epidemiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND OBJECTIVES: Recent studies fueled doubts as to whether all currently defined central disorders of hypersomnolence are stable entities, especially narcolepsy type 2 and idiopathic hypersomnia. New reliable biomarkers are needed, and the question arises of whether current diagnostic criteria of hypersomnolence disorders should be reassessed. The main aim of this data-driven observational study was to see whether data-driven algorithms would segregate narcolepsy type 1 and identify more reliable subgrouping of individuals without cataplexy with new clinical biomarkers. METHODS: We used agglomerative hierarchical clustering, an unsupervised machine learning algorithm, to identify distinct hypersomnolence clusters in the large-scale European Narcolepsy Network database. We included 97 variables, covering all aspects of central hypersomnolence disorders such as symptoms, demographics, objective and subjective sleep measures, and laboratory biomarkers. We specifically focused on subgrouping of patients without cataplexy. The number of clusters was chosen to be the minimal number for which patients without cataplexy were put in distinct groups. RESULTS: We included 1,078 unmedicated adolescents and adults. Seven clusters were identified, of which 4 clusters included predominantly individuals with cataplexy. The 2 most distinct clusters consisted of 158 and 157 patients, were dominated by those without cataplexy, and among other variables, significantly differed in presence of sleep drunkenness, subjective difficulty awakening, and weekend-week sleep length difference. Patients formally diagnosed as having narcolepsy type 2 and idiopathic hypersomnia were evenly mixed in these 2 clusters. DISCUSSION: Using a data-driven approach in the largest study on central disorders of hypersomnolence to date, our study identified distinct patient subgroups within the central disorders of hypersomnolence population. Our results contest inclusion of sleep-onset REM periods in diagnostic criteria for people without cataplexy and provide promising new variables for reliable diagnostic categories that better resemble different patient phenotypes. Cluster-guided classification will result in a more solid hypersomnolence classification system that is less vulnerable to instability of single features.
- MeSH
- Idiopathic Hypersomnia * diagnosis MeSH
- Cataplexy * diagnosis MeSH
- Humans MeSH
- Adolescent MeSH
- Narcolepsy * diagnosis drug therapy MeSH
- Disorders of Excessive Somnolence * diagnosis epidemiology MeSH
- Cluster Analysis MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
INTRODUCTION: Idiopathic hypersomnia (IH) is a rare orphan disease characterized by excessive daytime sleepiness, frequently accompanied by prolonged nocturnal sleep and difficulties awakening, termed sleep inertia or sleep drunkenness. Severe sleepiness usually causes a greater handicap than manifestations of narcolepsy. METHODS: Forty-three IH patients (17 male, mean age 42.8 ± SD 12.2 years, range 20-67), diagnosed in the past 20 years according to ICSD-2 or ICSD-3 criteria were invited for clinical examination to evaluate the course, manifestations and severity of the disease, as well as clinical comorbidities. The patients completed a set of questionnaires scoring sleepiness, sleep inertia, fatigue, depression, anxiety, circadian preference, and quality of life. RESULTS: IH patients were divided according to the duration of nocturnal sleep at the time of their diagnosis into two cohorts: (1) with normal sleep duration (n = 25, 58.1%) and (2) with long sleep duration (n = 18, 41.9%). The mean duration of ad libitum sleep per 22 h in the second cohort was 732.0 ± 115.4 min (range 603-1100), and women markedly prevailed (n = 14, 77.8%). Age at disease onset was younger in the group with long sleep duration (21.2 ± 11.4 years versus 28.1 ± 13.6 years, p = 0.028), their MSLT latency was longer (7.2 ± 3.7 min versus 5.1 ± 1.7 min, p = 0.005), a history of sleep inertia prevailed (p = 0.005), and daily naps were mostly non-refreshing (p = 0.014). Additionally, questionnaires in the group with long sleep duration showed more severe sleep inertia (p = 0.007), fatigue (p = 0.004), and a tendency towards evening chronotype (p = 0.001). CONCLUSIONS: IH patients with long sleep duration differ clinically as well as by objective measures at the time of diagnosis and in long-term follow up from IH patients without long 24-h sleep time. In our opinion they represent an independent clinical entity to be considered in the revised ICSD-3 criteria.
- MeSH
- Adult MeSH
- Idiopathic Hypersomnia * diagnosis MeSH
- Quality of Life MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Narcolepsy * MeSH
- Polysomnography MeSH
- Disorders of Excessive Somnolence * diagnosis epidemiology etiology MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Antidepressive Agents adverse effects therapeutic use MeSH
- Hypnotics and Sedatives adverse effects therapeutic use MeSH
- Humans MeSH
- Night Eating Syndrome epidemiology complications MeSH
- Obesity epidemiology etiology MeSH
- Polysomnography MeSH
- Disorders of Excessive Somnolence epidemiology complications MeSH
- Sleep Disorders, Intrinsic epidemiology complications MeSH
- Risk Factors MeSH
- Sleep Deprivation diagnostic imaging complications MeSH
- Sleep Apnea Syndromes epidemiology complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Parkinsonova choroba (PCh) patrí spolu s demenciou s Lewyho telieskami (DLB) a multisystémovou atrofiou (MSA) k patologicky definovanej skupine ochorení – synukleinopatiam. Zdieľajú nielen spoločný patologický mechanizmus vzniku, ale aj niektoré klinické príznaky. Medzi časté patria aj poruchy spánku a bdenia, ktoré ďalej zhoršujú kvalitu života postihnutých pacientov, ale zvyšujú aj celkovú morbiditu a mortalitu.
Parkinson's disease (PD), along with dementia with Lewy bodies (DLB) and multisystem atrophy (MSA), belongs to a pathologically defined group of diseases – synucleinopathies. They share not only a common pathological mechanism of origin, but also some clinical signs. Also frequent are sleep-wake disorders that further impair the quality of life of those affected as well as increase the overall morbidity and mortality.
- MeSH
- Lewy Body Disease complications MeSH
- Humans MeSH
- Multiple System Atrophy complications MeSH
- Parkinson Disease * complications MeSH
- REM Sleep Behavior Disorder etiology drug therapy MeSH
- Sleep Initiation and Maintenance Disorders * epidemiology etiology therapy MeSH
- Disorders of Excessive Somnolence * epidemiology etiology therapy MeSH
- Respiratory Sounds MeSH
- Restless Legs Syndrome etiology drug therapy MeSH
- Sleep Apnea Syndromes epidemiology etiology MeSH
- Check Tag
- Humans MeSH
Nadměrná denní spavost (EDS) je významný klinický symptom s mnoha důsledky pro jednotlivce a celou společnost. Většina případů EDS u zdravých lidí souvisí se zkrácením nočního spánku. U nemocných a starších lidí je EDS způsobena většinou fragmentací nočního spánku a malou skupinu nemocných tvoří centrální hypersomnie. Článek popisuje měření tendence usnout, epidemiologii EDS a její následky včetně zkušeností ve zdravotnictví. Letmo je zmíněna léčba.
Excessive daytime sleepiness (EDS) is an important clinical symptom with many obnoxious consequences both on individual and society levels. EDS in healthy people in most of cases results from night sleep shortage while in ill and elderly people is EDS caused by fragmentation of nocturnal sleep and just a small group is formed by patients suffering from central hypersomnias. This paper describes measurement of a tendency to fall asleep, EDS epidemiology and its after-effects including common clinical practice. Brief overview of treatment procedures is also included.
