REM sleep in narcolepsy

IF 11.2 1区 医学 Q1 CLINICAL NEUROLOGY
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Abstract

Narcolepsy is mainly associated with excessive daytime sleepiness, but the characteristic feature is abnormal rapid eye movement (REM) sleep phenomena. REM sleep disturbances can manifest as cataplexy (in narcolepsy type 1), sleep paralysis, sleep-related hallucinations, REM sleep behavior disorder, abnormal dreams, polysomnographic evidence of REM sleep disruption with sleep-onset REM periods, and fragmented REM sleep. Characterization of REM sleep and related symptoms facilitates the differentiation of narcolepsy from other central hypersomnolence disorders and aids in distinguishing between narcolepsy types 1 and 2. A circuit comprising regions within the brainstem, forebrain, and hypothalamus is involved in generating and regulating REM sleep, which is influenced by changes in monoamines, acetylcholine, and neuropeptides. REM sleep is associated with brainstem functions, including autonomic control, and REM sleep disturbances may be associated with increased cardiovascular risk. Medications used to treat narcolepsy (and REM-related symptoms of narcolepsy) include stimulants/wake-promoting agents, pitolisant, oxybates, and antidepressants; hypocretin agonists are a potential new class of therapeutics. The role of REM sleep disturbances in narcolepsy remains an area of active research in pathophysiology, symptom management, and treatment. This review summarizes the current understanding of the role of REM sleep and its dysfunction in narcolepsy.

嗜睡症的快速动眼期睡眠
嗜睡症主要与白天过度嗜睡有关,但其特征是快速眼动(REM)睡眠异常现象。快速眼动睡眠障碍可表现为惊厥(嗜睡症 1 型)、睡眠麻痹、与睡眠相关的幻觉、快速眼动睡眠行为障碍、异常梦境、多导睡眠图显示的快速眼动睡眠中断与睡眠期启动的快速眼动期,以及零碎的快速眼动睡眠。快速动眼期睡眠和相关症状的特征有助于区分嗜睡症和其他中枢性嗜睡症,并有助于区分嗜睡症 1 型和 2 型。由脑干、前脑和下丘脑组成的回路参与产生和调节快速动眼期睡眠,而快速动眼期睡眠受单胺类物质、乙酰胆碱和神经肽变化的影响。快速动眼期睡眠与脑干功能(包括自主神经控制)有关,快速动眼期睡眠障碍可能与心血管风险增加有关。用于治疗嗜睡症(以及嗜睡症的快速动眼期相关症状)的药物包括兴奋剂/促醒剂、眠尔通、羟苯乙酯和抗抑郁剂;视网膜下素激动剂是一类潜在的新疗法。快速动眼期睡眠障碍在嗜睡症中的作用仍然是病理生理学、症状管理和治疗方面一个活跃的研究领域。本综述总结了目前对快速动眼期睡眠及其功能障碍在嗜睡症中的作用的认识。
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来源期刊
Sleep Medicine Reviews
Sleep Medicine Reviews 医学-临床神经学
CiteScore
20.10
自引率
3.80%
发文量
107
期刊介绍: Sleep Medicine Reviews offers global coverage of sleep disorders, exploring their origins, diagnosis, treatment, and implications for related conditions at both individual and public health levels. Articles comprehensively review clinical information from peer-reviewed journals across various disciplines in sleep medicine, encompassing pulmonology, psychiatry, psychology, physiology, otolaryngology, pediatrics, geriatrics, cardiology, dentistry, nursing, neurology, and general medicine. The journal features narrative reviews, systematic reviews, and editorials addressing areas of controversy, debate, and future research within the field.
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