Autonomic dysfunction in sleep disorders

Pietro Cortelli MD PhD (Dr. Cortelli of the University of Bologna has no relevant financial relationships to disclose.)
Giovanna Calandra-Buonaura MD PhD (Dr. Calandra-Buonaura of the University of Bologna has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released July 21, 2003; last updated July 12, 2015; expires July 12, 2018

This article includes discussion of autonomic dysfunction in sleep disorders, autonomic dysfunction in congenital central alveolar hypoventilation syndrome (congenital central hypoventilation syndrome, Ondine curse), autonomic dysfunction in fatal familial insomnia, autonomic dysfunction in narcolepsy type 1 (narcolepsy with cataplexy), autonomic dysfunction in obstructive sleep apnea, autonomic dysfunction in REM sleep behavior disorder. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Sleep and the autonomic nervous system are closely related from an anatomical, physiological, and neurochemical point of view. In this article, the authors describe the clinically relevant dysfunctions of cardiovascular and respiratory autonomic control caused by or associated with sleep disorders. In particular, the authors discuss the association between sleep-wake cycle derangement and autonomic sympathetic over-activity in fatal familial insomnia; the autonomic dysfunctions and the genetic discoveries in congenital central alveolar hypoventilation syndrome; the abnormalities of cardiovascular autonomic control in obstructive sleep apnea and narcolepsy type 1; and the relationship among REM sleep behavior disorder, cardiovascular autonomic dysfunction, and neurodegenerative disease. The autonomic dysfunction, particularly when involving cardiovascular or respiratory control, has a negative impact on prognosis of the associated sleep disorder and may represent a risk factor for the development of other chronic diseases or for life-threatening events. A prompt diagnosis of these autonomic dysfunctions is, therefore, of crucial importance to choose the proper therapeutic approach and treat the risk factors that could severely influence the prognosis.

Key points

 

• Sleep and the autonomic nervous system are closely related from an anatomical, physiological, and neurochemical point of view.

 

• Sleep disorders may cause or be associated with clinically relevant autonomic dysfunctions.

 

• Fatal familial insomnia, congenital central alveolar hypoventilation syndrome, obstructive sleep apnea, narcolepsy type 1, and REM sleep behavior disorder are associated with clinically relevant autonomic dysfunctions involving cardiovascular and respiratory control.

 

• Dysfunctions of cardiovascular and respiratory autonomic control have a significantly negative impact on prognosis of the associated sleep disorder and may represent a risk factor for the development of other chronic diseases or for life-threatening events.

Historical note and terminology

The autonomic nervous system controls vital involuntary body functions, such as circulation, respiration, thermoregulation, neuroendocrine secretion, and gastrointestinal and genitourinary functions, through several interconnected areas of the central nervous system belonging to the central autonomic network and two efferent pathways: the sympathetic and parasympathetic nervous systems (Table 1). These efferent systems are composed of preganglionic neurons in the brainstem and spinal cord and postganglionic neurons that form synapses with the target organs (Benarroch 1997). There is an intimate relationship between the autonomic nervous system and sleep from an anatomical, physiological, and neurochemical point of view. However, in the past it was commonly assumed that autonomic regulation remained unchanged across behavioral states and the concept of a state-dependent regulation of the autonomic nervous system has been addressed only recently. Coccagna and colleagues first understood the importance of recording autonomic parameters during sleep in clinical medicine and described the dramatic changes in systemic and pulmonary blood pressure associated with apneas and renewal of breathing in patients with obstructive sleep apnea (Coccagna et al 1972; Lugaresi et al 1972). Because the discovery that an abnormal blood pressure behavior during sleep is an important risk factor for cerebrovascular and cardiovascular disease, many studies have evaluated changes in autonomic nervous system activity associated with sleep disorders (Calandra-Buonaura et al 2016).

Table 1. Main Effects of the Sympathetic and Parasympathetic Control on the Target Organs

Organ

Sympathetic control

Parasympathetic control

Pupil

Dilation

Constriction

Blood Vessel (arterioles)

Constriction

none

Lung

Bronchodilation

Bronchodilation

 

Increase rate

Decrease rate

Heart

Increase myocardial contractility

Decrease myocardial contractility

Gastrointestinal tract

Decrease motility

Increase motility

Kidney

Decrease output

none

Bladder

Relax detrusor

Relax sphincter

 

Contract sphincter

Contract detrusor

Penis

Ejaculation

Erection

Sweat gland

Secretion

Palmar sweating

Piloerection

Increase

none

Lacrimal gland

Slight secretion

Secretion

Parotid gland

Slight secretion

Secretion

Submandibular gland

Slight secretion

Secretion

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