Sleep-wake stability in narcolepsy patients with normal, low and unmeasurable hypocretin levels

TY - JOUR

T1 - Sleep-wake stability in narcolepsy patients with normal, low and unmeasurable hypocretin levels

AU - Hansen, Mathias Hvidtfelt

AU - Kornum, Birgitte Rahbek

AU - Jennum, Poul

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - OBJECTIVE: To compare diurnal and nocturnal electrophysiological data from narcolepsy patients with undetectable (<20 pg/mL), low (20-110 pg/mL) and normal (>110 pg/mL) cerebrospinal fluid (CSF) hypocretin-1 levels.PATIENTS/METHODS: A total of 109 narcolepsy patients and 37 controls were studied; all had available CSF hypocretin-1 measurements. The sleep laboratory studies were conducted between 2008 and 2014. The study retrospectively examined measurements of sleep stage transitions in diurnal and nocturnal continuous polysomnography. The percentage distribution of time awake and rapid eye movement (REM) sleep, and the occurrence of sleep onset REM (SOREM) in the nocturnal polysomnography were also measured.RESULTS: Participants with undetectable hypocretin-1 levels had significantly higher frequencies of transitions than controls and those with normal hypocretin-1 levels. Participants with low hypocretin-1 levels showed more transitions than controls and, in some cases, also more than those with normal hypocretin-1. Participants with normal hypocretin-1 failed to show any significant difference from the controls, except in the overall diurnal transitions.CONCLUSION: Undetectable hypocretin-1 levels in particular, but also low hypocretin-1 levels, were associated with a less stable phenotype featuring more sleep state transitions and SOREM episodes. In addition, there was a distinction between nocturnal and diurnal REM sleep in hypocretin-deficient participants, expressed as increased diurnal REM sleep, which was not reflected in nocturnal sleep.

AB - OBJECTIVE: To compare diurnal and nocturnal electrophysiological data from narcolepsy patients with undetectable (<20 pg/mL), low (20-110 pg/mL) and normal (>110 pg/mL) cerebrospinal fluid (CSF) hypocretin-1 levels.PATIENTS/METHODS: A total of 109 narcolepsy patients and 37 controls were studied; all had available CSF hypocretin-1 measurements. The sleep laboratory studies were conducted between 2008 and 2014. The study retrospectively examined measurements of sleep stage transitions in diurnal and nocturnal continuous polysomnography. The percentage distribution of time awake and rapid eye movement (REM) sleep, and the occurrence of sleep onset REM (SOREM) in the nocturnal polysomnography were also measured.RESULTS: Participants with undetectable hypocretin-1 levels had significantly higher frequencies of transitions than controls and those with normal hypocretin-1 levels. Participants with low hypocretin-1 levels showed more transitions than controls and, in some cases, also more than those with normal hypocretin-1. Participants with normal hypocretin-1 failed to show any significant difference from the controls, except in the overall diurnal transitions.CONCLUSION: Undetectable hypocretin-1 levels in particular, but also low hypocretin-1 levels, were associated with a less stable phenotype featuring more sleep state transitions and SOREM episodes. In addition, there was a distinction between nocturnal and diurnal REM sleep in hypocretin-deficient participants, expressed as increased diurnal REM sleep, which was not reflected in nocturnal sleep.

KW - Adult

KW - Brain/physiopathology

KW - Electroencephalography

KW - Female

KW - Humans

KW - Male

KW - Narcolepsy/physiopathology

KW - Orexins/cerebrospinal fluid

KW - Polysomnography

KW - Retrospective Studies

KW - Sleep/physiology

KW - Spinal Puncture

KW - Time Factors

KW - Wakefulness/physiology

U2 - 10.1016/j.sleep.2017.01.021

DO - 10.1016/j.sleep.2017.01.021

M3 - Journal article

C2 - 28522076

SN - 1389-9457

VL - 34

SP - 1

EP - 6

JO - Sleep Medicine

JF - Sleep Medicine

ER -