Disrupted Nighttime Sleep in Narcolepsy
1Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI; 2Sleep Unit, University Hospital, Gui de Chauliac, Montpellier, France; 3Stanford Center for Sleep Sciences, Stanford University, Palo Alto, CA; 4Center for Advanced Studies in Sleep Medicine, Hôpital de Sacré-Cœur de Montréal, Centre d'étude du sommeil, Montréal, Québec, Canada; 5Paul Scientific Communications, New York, NY; 6The Houston Sleep Center, University of Texas-Houston School of Medicine, Houston, TX; 7Sleep Disorders Center, Northwestern University, Chicago, IL
Characterize disrupted nighttime sleep (DNS) in narcolepsy, an important symptom of narcolepsy.
A panel of international narcolepsy experts was convened in 2011 to build a consensus characterization of DNS in patients with narcolepsy. A literature search of the Medline (1965 to date), Medline In-Process (latest weeks), Embase (1974 to date), Embase Alert (latest 8 weeks), and Biosis (1965 to date) databases was conducted using the following search terms: narcolepsy and disrupted nighttime sleep, disturbed nighttime sleep, fragmented sleep, consolidated sleep, sleep disruption, and narcolepsy questionnaire. The purpose of the literature search was to identify publications characterizing the nighttime sleep of patients with narcolepsy. The panel reviewed the literature. Nocturnal sleep can also be disturbed by REM sleep abnormalities such as vivid dreaming and REM sleep behavior disorder; however, these were not reviewed in the current paper, as we were evaluating for idiopathic sleep disturbances.
The literature reviewed provide a consistent characterization of nighttime sleep in patients with narcolepsy as fragmented, with reports of frequent, brief nightly awakenings with difficulties returning to sleep and associated reports of poor sleep quality. Polysomnographic studies consistently report frequent awakenings/arousals after sleep onset, more stage 1 (S1) sleep, and more frequent shifts to S1 sleep or wake from deeper stages of sleep. The consensus of the International Experts' Panel on Narcolepsy was that DNS can be distressing for patients with narcolepsy and that treatment of DNS warrants consideration.
Clinicians involved in the management of patients with narcolepsy should investigate patients' quality of nighttime sleep, give weight and consideration to patient reports of nighttime sleep experience, and consider DNS a target for treatment.
Roth T; Dauvilliers Y; Mignot E; Montplaisir J; Paul J; Swick T; Zee P. Disrupted nighttime sleep in narcolepsy. J Clin Sleep Med 2013;9(9):955-965.
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