Sleep medicine最新文献

{"title":"Modulation mode of amygdala morphology and cognitive function under acute sleep deprivation in healthy male","authors":"Haoyuan Zhang ,&nbsp;Lili Xu ,&nbsp;Xiaohan Yi ,&nbsp;Xiangzi Zhang","doi":"10.1016/j.sleep.2025.01.008","DOIUrl":"10.1016/j.sleep.2025.01.008","url":null,"abstract":"<div><div>The amygdala plays a crucial role in various behavioral functions and psychiatric conditions, with its morphology showing alterations in sleep disorders. While the impact of chronic sleep disorders on amygdala morphology has been studied, the effects of acute sleep deprivation (ASD) remain largely unexplored. The present study aimed to investigate the modulation between amygdala sub-region volumes and spatial working memory (SWM) performance under ASD conditions. Twenty-eight healthy male participants underwent MRI scanning and performed SWM tasks before and after 24 h of ASD. Amygdala sub-region volumes were segmented into nine sub-regions, and Granger causality analysis was employed to examine the relationship between amygdala morphology and SWM performance. Results revealed significant decreases in SWM accuracy and increases in reaction time following ASD. Localized changes in amygdala sub-regions were observed, with increased left cortico-amygdaloid transition area (CAT) volume and decreased right paralaminar nucleus (PL) volume. Granger causality analysis uncovered a bidirectional modulation between centromedial and cortical-like nuclei, and a progressive involvement of amygdala sub-regions in modulating SWM performance as task difficulty increased. These findings demonstrate a complex interplay between sleep, amygdala morphology, and cognitive function, suggesting that the amygdala plays a crucial role in modulating cognitive performance under ASD conditions. The differential involvement of amygdala sub-regions across varying cognitive loads indicates a flexible and adaptive system attempting to maintain performance in the face of sleep loss.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 55-63"},"PeriodicalIF":3.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase angle between dim light melatonin onset and sleep timing during residential treatment prospectively predicts obsessive-compulsive symptoms","authors":"Jacob A. Nota ,&nbsp;Isabella H. Taylor ,&nbsp;Katherine Sharkey ,&nbsp;Meredith E. Coles","doi":"10.1016/j.sleep.2025.01.009","DOIUrl":"10.1016/j.sleep.2025.01.009","url":null,"abstract":"&lt;div&gt;&lt;div&gt;The relation between obsessive-compulsive disorder (OCD) and circadian rhythm disturbance has been increasingly acknowledged in recent years. While prior clinical studies have utilized patients’ self-reported sleep behaviors, there is a need to also explore the measurable, biological aspects of circadian rhythms. The current study has two aims: first, to describe the biological circadian rhythms of individuals with OCD seeking intensive residential treatment, including their relationship with self-reported measures of sleep and OCD symptoms; and second, to examine longitudinal associations between biological circadian rhythms and OCD symptom severity during the course of residential treatment. Adults receiving residential treatment for OCD (&lt;em&gt;n&lt;/em&gt; = 23) completed a procedure to measure their dim-light melatonin onset (DLMO) at admission, week two, week four, and discharge from treatment along with a battery of self-report assessments of OCD symptom severity and depression severity. Phase angle between DLMO and the midpoint of self-reported sleep was also calculated as a measure of the alignment between behavioral sleep-wake patterns and biological circadian rhythms at each time point. Cross-sectional correlations between these constructs were assessed and then cross-lagged panel models (CLPM) were fit to these data in order to examine the relation between 1) DLMO and OCD symptom severity across treatment and 2) phase angle of DLMO and midpoint of sleep and OCD symptom severity across treatment. Descriptive statistics indicate that sleep duration and timing were shifting closer toward general population averages across this period of treatment, perhaps due to newly supported bed and wake times in the treatment milieu. There were no significant cross-lagged paths between DLMO and OCD symptom severity during the first weeks of residential treatment. There was a significant cross-lagged path between DLMO phase angle from self-reported sleep midpoint and OCD symptom severity during the first weeks of residential treatment. Specifically, relatively shorter phase angle at admission was associated with less severe OCD symptoms at the second week of treatment; and relatively shorter phase angle at the second week of treatment was associated with more severe OCD symptoms at the fourth week of treatment. This study demonstrated the feasibility of measuring biological circadian rhythms in a residential treatment context and provided initial data demonstrating a longitudinal and dynamic relation between sleep, circadian rhythms, and OCD symptoms. Further study with larger samples is warranted. The non-linear pattern of relations across the course of this study also indicate that consideration of treatment processes and other factors not measured herein will strengthen future studies. Follow-up studies with residential treatment settings that continue salivary melatonin collection after treatment ends and patients return to their daily lives are ","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 73-80"},"PeriodicalIF":3.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Search filters for systematic reviews and meta-analyses in sleep medicine","authors":"Gabriel Natan Pires ,&nbsp;Erna S. Arnardóttir ,&nbsp;Jose M. Saavedra ,&nbsp;Sergio Tufik ,&nbsp;Walter T. McNicholas","doi":"10.1016/j.sleep.2024.12.032","DOIUrl":"10.1016/j.sleep.2024.12.032","url":null,"abstract":"<div><div>Systematic reviews and meta-analyses are increasingly common in sleep research, although the methodological quality level has been a matter of concern. Efforts towards methodological standardization are needed to ensure the reliability of sleep-related systematic reviews. The development of search strategies is a critical step in a systematic review, which often lead to methodological biases. Standardized search filters have been used to facilitate the development of search strategies. However, such filters have not been developed for sleep medicine. The current study aimed at developing a list of PubMed search filters related to sleep medicine, including specific search strategies for different sleep disorders and sleep conditions. First, a list of sleep disorders and conditions was created for which search filters would be developed. This included most conditions listed in the International Classification of Sleep Disorders – 3rd edition. Additional search filters were developed for proposed disorders not recognized as independent clinical entities, and for other sleep-related conditions. All search strategies were designed specifically for PubMed, by combining relevant MeSH terms and free terms. Nine fully independent and unrelated MeSH terms related to sleep were identified. In total, 91 search filters were developed, related to 71 different sleep-related conditions. With the current work, we aimed to provide a list of reliable search filters organized to cover the field in a broad manner, therefore being useful for different types of systematic reviews within sleep medicine, ranging from narrow-focused meta-analyses to broader scoping reviews, mapping reviews, and meta-epidemiological studies.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 100-119"},"PeriodicalIF":3.8,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143011757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare burden of narcolepsy in Japan: A retrospective analysis of health insurance claims from the Japan Medical Data Center","authors":"Hiroshi Kadotani ,&nbsp;Masahiro Matsuo ,&nbsp;Lucy Tran ,&nbsp;Victoria L. Parsons ,&nbsp;Andrew Maguire ,&nbsp;Somraj Ghosh ,&nbsp;Stephen Crawford ,&nbsp;Shreya Dave","doi":"10.1016/j.sleep.2025.01.003","DOIUrl":"10.1016/j.sleep.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Narcolepsy is a chronic disorder that requires lifelong management; however, few studies have evaluated disease burden of narcolepsy. We estimated the healthcare burden of narcolepsy in Japan using data from the Japan Medical Data Center health insurance claims database.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of clinical burden, healthcare resource utilization, and costs among incident narcolepsy cases and matched controls identified between January 1, 2014 and December 31, 2019.</div></div><div><h3>Results</h3><div>Of the 1317 incident cases; 889 (with 1778 controls) were analyzed for healthcare burden, 626 (with 1252 controls) for clinical journey, and 439 (no controls) for treatment patterns. The most common baseline comorbidity was non-narcolepsy sleep disorder (41.6 % cases vs 3.0 % controls), including insomnia (28.5 % vs 2.6 %) and sleep apnea (10.8 % vs 0.3 %; both <em>p</em> &lt; 0.001). The most common nonsleep disorder comorbidities were depression (35.0 % vs 2.6 %), anxiety (30.4 % vs 2.7 %), and headache/migraine (18.1 % vs 5.5 %; all <em>p</em> &lt; 0.001). Compared to controls, narcolepsy cases had more prescription claims in the year following index date (82.8 % vs 9.5 %; <em>p</em> &lt; 0.001), higher rates of outpatient (2291.8 vs 674.9 visits/100 person-years; <em>p</em> &lt; 0.001) and inpatient claims (56.8 vs 5.1/100 person-years; <em>p</em> &lt; 0.001), and longer hospital stays (mean 2.9 vs 0.5 days; <em>p</em> &lt; 0.001). Similarly, median HCRU costs were higher in cases than controls (total annual healthcare costs, $2531 vs $266; community pharmacy claims, $826 vs $47 per person; and outpatient claim costs, $1053 vs $188 per person year).</div></div><div><h3>Conclusions</h3><div>Narcolepsy carries a substantial comorbidity burden, a high rate of medication prescribing, and high healthcare resource use in Japan.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 64-72"},"PeriodicalIF":3.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loudness of snoring, not apnea-hypopnea index, is associated with hyperactivity behavior in snoring children and adolescents","authors":"Mireille Joseph,&nbsp;Mariem Lajili,&nbsp;Benjamin Dudoignon,&nbsp;Christophe Delclaux,&nbsp;Plamen Bokov","doi":"10.1016/j.sleep.2025.01.006","DOIUrl":"10.1016/j.sleep.2025.01.006","url":null,"abstract":"<div><h3>Study objectives</h3><div>It is unknown whether loudness of snoring or hypoxic burden are related to higher hyperactivity scores in habitually snoring children and whether this effect is impacted by the severity of sleep-disordered breathing (SDB). This study investigates the prevalence of hyperactivity in children with habitual snoring and the independent effects of loudness of snoring, as reported by the parents, hypoxic burden and obstructive sleep apnea syndrome's severity (OSAS) on hyperactivity, as measured by the Conners' Parent Rating Scale-Hyperactivity Index (CPRS-HI).</div></div><div><h3>Methods</h3><div>Children with habitual snoring aged 3–18 years were recruited for an overnight polysomnography reporting apnea-hypopnea index (AHI) and hypoxic burden, acoustic rhinometry, clinical examination and parental questionnaires assessing snoring loudness and CPRS-HI.</div></div><div><h3>Results</h3><div>The study analysis included 512 children (median (25th; 75th percentile) age, 10.6 (7.6; 13.4) years; 295 (58 %) males), of whom 358 (70 %) were overweight or obese and 179 (35 %) had an obstructive AHI &gt;3/h. Findings revealed that 36 % [95 % CI: 32%–41 %] of children exhibited increased hyperactivity/impulsivity, and 25 % [21%–29 %] showed emotional lability. Snoring loudness was significantly correlated with higher hyperactivity scores, particularly for hyperactivity/impulsivity, while hypoxic burden showed no significant association (rho_s = −0.09; p = 0.082). Multivariate analysis showed that the presence of very loud as compared to mildly quiet snoring was an independent predictor of hyperactivity symptoms, while an obstructive AHI &gt;3/h was associated with decreased hyperactivity scores.</div></div><div><h3>Conclusions</h3><div>These results suggest that the loudness of snoring, independent of OSAS severity, contributes to hyperactivity in children.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 43-48"},"PeriodicalIF":3.8,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in anti-insomnia medication utilization among pediatric patients in nine cities in China: A real-world study (2016–2023)","authors":"Ziheng Li ,&nbsp;Lipeng Xing ,&nbsp;Hailun Jiang ,&nbsp;Maochang Liu","doi":"10.1016/j.sleep.2025.01.004","DOIUrl":"10.1016/j.sleep.2025.01.004","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate prescription patterns of insomnia medications among Chinese children, assess the current status of drug treatment, and offer data to support the guidance of clinical prescribing practices.</div></div><div><h3>Methods</h3><div>This study analyzed pediatric prescriptions for insomnia medications from the China Hospital Prescription Analysis Cooperation Project database across nine cities between 2016 and 2023. The analysis focused on demographic characteristics, prescription trends, and frequency of medication use among pediatric insomnia patients. Patterns of combination therapy were also examined.</div></div><div><h3>Results</h3><div>The number of children receiving insomnia medications increased substantially from 228 in 2016 to 1166 in 2023, representing an approximate 409 % increase. A growing proportion of patients were aged 12–14 years, with female patients outnumbering males by a ratio of 1.50: 1. There was an increased representation of patients from psychiatry and neurology departments. Regarding medication choices, benzodiazepines (BZDs) remained the most commonly prescribed class, though their use showed a declining trend. Similarly, non-benzodiazepine receptor agonists (nBZRAs) demonstrated a downward trend (<em>P</em> &gt; 0.05), while antidepressant prescriptions significantly increased (<em>P</em> &lt; 0.05). The most commonly prescribed medications within each class were alprazolam, zolpidem, trazodone, sertraline, and quetiapine. A significant proportion of patients (37.25 %) received combination therapy, with benzodiazepine receptor agonists (BZRAs) plus antidepressants being the most common combination.</div></div><div><h3>Conclusions</h3><div>The utilization of pharmacological interventions for pediatric insomnia in China has risen markedly in recent years. Despite growing concerns about adverse effects, BZDs continue to be the primary therapeutic choice. The increasing prevalence of combination therapy suggests a trend toward more individualized treatment approaches. These findings underscore the importance of careful monitoring and rational prescribing practices in pediatric insomnia management.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 28-35"},"PeriodicalIF":3.8,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No match, more sleep: Greater weekend catch-up sleep in youth soccer players on free weekends","authors":"João Barreira ,&nbsp;João Brito ,&nbsp;Fábio Y. Nakamura ,&nbsp;Pedro Figueiredo","doi":"10.1016/j.sleep.2025.01.002","DOIUrl":"10.1016/j.sleep.2025.01.002","url":null,"abstract":"<div><div>This study aimed to compare young soccer players' week and weekend sleep behaviors in two different microcycle types: with and without an official match (no sporting commitments). Twenty-three youth male players (mean ± SD; age: 17.2 ± 0.6 years) from the same U19 soccer team had their sleep objectively monitored for eight weeks. Questionnaires for subjective sleep quality, sleepiness, and to identify individual chronotype were completed at the beginning of the study. External training and match loads were monitored using global positioning systems. Overall, all players slept less than 8 h throughout the study and 16 slept less than 7 h. On weekdays, total sleep time (TST) was reduced (390 ± 60 min). A significant (p &lt; 0.05) main effect of the microcycle type, night of the week, and an interaction between the two were observed for TST, bedtime, and wake-up time, indicating that weekend sleep adjustments were dependent on whether a match was played or not. Specifically, weekends without a match showed higher TST (+34 min, p &lt; 0.001), and later bed and wake-up times (+48 min, p &lt; 0.001; and +1.06 h, p &lt; 0.001; respectively) compared with weekends that included a match. While players seem to try to compensate their week sleep debt when possible, sleep adjustments were more predominant on weekends without a match, despite still relatively short sleep durations observed.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 36-42"},"PeriodicalIF":3.8,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative evaluation of dynamic glymphatic activity in insomnia: A contrast-enhanced synthetic MRI study","authors":"Ruifang Xiong ,&nbsp;Jie Feng ,&nbsp;Hanting Zhu ,&nbsp;Chengyi Li ,&nbsp;Pengxin Hu ,&nbsp;Yu Zou ,&nbsp;Mingyu Zhou ,&nbsp;Ye Wang ,&nbsp;Xiaoping Tang","doi":"10.1016/j.sleep.2024.12.038","DOIUrl":"10.1016/j.sleep.2024.12.038","url":null,"abstract":"<div><h3>Background</h3><div>Sleep is associated with glymphatic circulation activity; however, there is no direct imaging modality to validate glymphatic circulation disorders in patients with insomnia. Therefore, this study aimed to explore the relationship between insomnia disorder (ID) and the glymphatic system. Dynamic synthetic magnetic resonance imaging (syMRI) was performed.</div></div><div><h3>Methods</h3><div>Thirty-two patients with insomnia and ten healthy volunteers were prospectively recruited from the Second Affiliated Medical Hospital of Nanchang University, China. All subjects underwent syMRI at baseline (0 h), 0.5 h, 1 h, 1.5 h, 12 h, and 3 d after enhancement. The MAGiC post-processing workstation was used to measure T1 signal changes in different brain regions, peak ΔT1, and slopes at different time periods. All patients with insomnia underwent polysomnography (PSG) and were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Repeated measures analysis of variance, Bonferroni multiple comparison, Shapiro-Wilk test, <em>t</em>-test, and Pearson or Spearman correlation analysis were used.</div></div><div><h3>Results</h3><div>The main effect of T1 values for the cerebral white matter, cerebral gray matter, putamen, thalamus, and cerebellar white matter at different measurement times were significant in all subjects (all p &lt; 0.05). The T1 values of the insula gray matter at 0.5 h were statistically different between the insomnia group and the control group (1231.76 ± 9.42 vs. 1272.95 ± 16.86 ms; p = 0.005), and the T1 values of the hippocampal gray matter at 3 d were different between the two groups (1198.24 ± 9.01 vs. 1234.55 ± 16.12 ms; p = 0.025). The time-varying curves of the T1 values in the cerebral gray matter and putamen were statistically different between the two groups (p = 0.009, 0.026). The cerebellar gray matter slope (1–1.5 h) and thalamic slope (1–1.5 h) were statistically different between the two groups [-113 (−188.5, −28) vs. 4.739 (−2.07, 7.98); 52 (−10, 119.75) vs. −19.25 (−120, 31.50]; p = 0.048, 0.017).</div></div><div><h3>Conclusion</h3><div>Reduced clearance of the gadolinium-based contrast agent by the gray matter and deep nuclei indicates the presence of glymphatic system impairment in insomnia.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 16-23"},"PeriodicalIF":3.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endorsement of: “Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper” by the World Sleep Society","authors":"F. Provini ,&nbsp;B. Högl ,&nbsp;A. Iranzo ,&nbsp;C. Kushida ,&nbsp;J.-Y. Lee ,&nbsp;G. Shukla ,&nbsp;A. Stefani ,&nbsp;Y.K. Wing ,&nbsp;R. Malkani ,&nbsp;the Governing Council of the World Sleep Society","doi":"10.1016/j.sleep.2025.01.001","DOIUrl":"10.1016/j.sleep.2025.01.001","url":null,"abstract":"","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 49-54"},"PeriodicalIF":3.8,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal familial insomnia: A new case description with response to thoracic sympathetic nerve thermocoagulation and stellate ganglion block","authors":"Yanan Chen ,&nbsp;Ying Li ,&nbsp;Yao Zhou ,&nbsp;Ting Zhao ,&nbsp;Na Wang ,&nbsp;Lei Sun ,&nbsp;Jiuyan Han ,&nbsp;Zhe Ren ,&nbsp;Bin Wang ,&nbsp;Xiong Han","doi":"10.1016/j.sleep.2024.12.034","DOIUrl":"10.1016/j.sleep.2024.12.034","url":null,"abstract":"<div><div>Fatal familial insomnia (FFI) is a rare autosomal dominant neurodegenerative disorder characterized by rapidly progressive dementia, severe sleep disturbances, and autonomic dysfunction. The clinical manifestations of FFI can exhibit substantial variations, making it crucial to rule out other conditions, such as autoimmune encephalitis and Creutzfeldt-Jakob disease, during early diagnosis. In this study, we describe the case of a 58-year-old man who experienced persistent insomnia, autonomic symptoms, gait instability, and rapidly progressive dementia. Polysomnography revealed considerable alterations brain positron emission tomography/computed tomography showed no significant abnormal changes and cerebrospinal fluid analysis indicated a slight elevation in protein levels. Results of tests for autoimmune encephalitis antibodies were negative. The presence of the prion protein gene D178N mutation was confirmed through genetic testing and in conjunction with the patient's clinical manifestations, a diagnosis of FFI was established. Owing to severe autonomic neuropathy and intractable hyponatremia resulting from excessive sweating, therapeutic interventions, including thoracic sympathetic nerve thermocoagulation and stellate ganglion block, were attempted. These treatments initially led to symptomatic improvements, such as reduced sweating and amelioration of hyponatremia; however, sweating persisted, albeit to a lesser extent. Despite these interventions, the patient's condition deteriorated, leading to death 16 months after symptom onset owing to progressive agrypnia excitata, worsening dementia, and gait instability. This case underscores the current lack of effective treatments for FFI and highlights the urgent need for further research on this debilitating disorder.</div></div>","PeriodicalId":21874,"journal":{"name":"Sleep medicine","volume":"127 ","pages":"Pages 24-27"},"PeriodicalIF":3.8,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}