Sleep and cerebral degenerative disorders

Raman Malhotra MD (Dr. Malhotra, Co-Director of the SLUCare Sleep Disorders Center at Saint Louis University School of Medicine, has no relevant financial relationships to disclose.)
Alon Avidan MD MPH (Dr. Avidan of the University of California, Los Angeles, received honorariums from Arbor Pharmaceuticals and Pernix for speaking engagements.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released November 22, 1993; last updated May 11, 2016; expires May 11, 2019

This article includes discussion of sleep and cerebral degenerative disorders, sleep disorders associated with Alzheimer disease, sleep disorders associated with Parkinson disease, sleep disorders associated with progressive supranuclear palsy, sleep disorders associated with corticobasal degeneration, sleep disorders associated with multiple system atrophy, and sleep disorders associated with diffuse Lewy body disease. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Degenerative diseases of the central nervous system are a large and varied group of disorders that affect a range of neurologic function. Sleep disorders are commonly seen in patients with cerebral degenerative diseases. Much of this may be related to the underlying central nervous system damage to sleep regulatory centers of the brain. Research has shown that sleep disorders may serve as a biomarker to predict development of a future neurodegenerative disorder. Increasing new data has suggested that disrupted sleep may accelerate the degenerative process in conditions such as Alzheimer dementia and Parkinson disease. Prompt attention to and treatment of sleep symptoms can result in significant improvement in quality of life or possibly delay in progression of disease.

Key points

 

• Sleep disorders, such as insomnia, sleep apnea, restless legs syndrome, certain parasomnias, and circadian rhythm disorders, are disproportionally more common in patients with cerebral degenerative disorders than in the general population.

 

• Sleep disturbances in the setting of neurodegenerative disorders are sometimes secondary to localized damage to areas of the brain that control and regulate sleep and alertness.

 

• REM-sleep behavior disorder is a parasomnia frequently seen in patients with Parkinson disease and other synucleinopathies and can sometimes predate the motor and cognitive symptoms of the condition by several years or even decades. It is the first time that a sleep disorder can be used as a biomarker to predict a neurodegenerative disorder.

 

• Treatment of the underlying sleep disorder can not only help in improving quality of life, but may improve motor or cognitive symptoms of the underlying cerebral degenerative condition.

Historical note and terminology

The relationship between sleep disorders and neurodegenerative diseases has become increasingly more lucid as research into both areas has made significant progress. Indeed, a link between the 2 has been noted since the earliest descriptions of some neurodegenerative disorders. In the early 19th century, James Parkinson and his coworkers described clinical sleep abnormalities associated with extrapyramidal disorders (Pauletto et al 2004). Subsequently, a variety of sleep disorders have been found in tandem with diseases such as Parkinson disease, multiple system atrophy, diffuse Lewy body disease (DLBD), corticobasal degeneration, and others. However, the underlying sleep abnormalities were not extensively explored until relatively recently. In the latter half of the twentieth century, the advent of more sophisticated diagnostic techniques, such as polysomnography and improved EEG recordings, as well as the discovery of new treatments, allowed for major advances in the field (Pauletto et al 2004).

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