Article

Subjective and polysomnographic characteristics of patients diagnosed with narcolepsy.

Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan 48202.
General Hospital Psychiatry (Impact Factor: 2.9). 06/1990; 12(3):191-7. DOI: 10.1016/0163-8343(90)90078-Q
Source: PubMed

ABSTRACT In order to better characterize the subjective and polysomnographic findings in patients with narcolepsy, a follow-up questionnaire was mailed to all patients diagnosed with the disorder at the Henry Ford Hospital Sleep Disorders and Research Center. The questionnaire inquired regarding the present, previous, and change in status for the constellation of narcolepsy symptoms. Memory problems, problems of daytime function, and nocturnal sleep disturbance were included among the questions related to the symptomatic constellation. By definition, all patients were symptomatic of daytime sleepiness and were diagnosed with narcolepsy only if there were two or more rapid eye movement (REM) onsets documented on the polysomnographic evaluation. A high percentage of patients reported nocturnal sleep disturbance, which was one of the symptoms with the latest reported onset. Retrospective comparison of questionnaire responses to the clinical polysomnography revealed significantly more sleep maintenance difficulties in the group of patients reporting this symptom on the questionnaire. Patients with disturbed nocturnal sleep reported taking more naps during the day, although the Multiple Sleep Latency Test (MSLT) failed to show differences in sleep latency. Interestingly, this group of patients was found to have a significantly higher number of sleep onset REM episodes on the MSLT. Finally, the findings are discussed as they compare to studies that required the presence of cataplexy as part of their inclusion criteria.

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    ABSTRACT: The diagnosis of narcolepsy without documented cataplexy is based on the observation of two or more sleep-onset REM periods (SOREMPs) during the Multiple Sleep Latency Test (MSLT). We report on the prevalence and correlates of SOREMPs in the community-based Wisconsin Sleep Cohort Study. MSLTs were conducted following nocturnal polysomnography (NPSG) and daily sleep diaries in 289 males and 267 females (age 35-70, 97% Caucasians). Multiple SOREMPs were observed in 13.1% of males and 5.6% of females. An MSLT mean sleep latency < or =8 min and > or =2 SOREMPs (diagnostic of narcolepsy) was observed in 5.9% (males) and 1.1% (females), all without cataplexy. Because of significant sex interactions, analyses were stratified by sex. Increased prevalence of HLA-DQB1*0602, a marker of narcolepsy, was observed in males but not in females with > or =2 SOREMPs. Males with multiple SOREMPs compared with those with no SOREMPs had shorter rapid eye movement (REM) latency during NPSG, were sleepier on the MSLT and reported increased sleepiness, hypnagogic hallucinations and cataplexy-like symptoms, suggesting a narcolepsy-like phenotype. In males only, the occurrence of SOREMPs increased with shift work and some indirect markers of sleep restriction, such as shorter sleep a day before NPSG. SOREMPs were unrelated to age, body mass index, depression (Zung Scale), anxiety (State-Trait Anxiety Scale) and the number of apnea and hypopnea events per hour of sleep (AHI), but were associated with decreased mean lowest oxygen saturation in males. Finally, we found that both males and females with SOREMPs reported taking more antidepressants, but those were of the types known not to suppress REM sleep. These results suggest a high prevalence of narcolepsy without cataplexy, as defined by the International Classification of Sleep Disorders, and/or a large number of false-positives for the MSLT.
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    ABSTRACT: Die bisherigen Daten zur Schlafwahrnehmung sind heterogen, rudimentär und entbehren einer metaanalytischen Ordnung. Insomniepatienten unterschätzen bekanntermaßen ihren Schlaf. Über das Schlafwahrnehmungsverhalten anderer Gruppen von Schlafgestörten ist kaum etwas bekannt. Dabei sind insbesondere die Angaben von hypersomnischen Gruppen wichtig für die klinische Einschätzung ihrer Einschlafneigung am Tage, zum Beispiel beim Autofahren. Wie schätzen hypersomnische Patienten ihren Schlaf ein? Unterscheiden sie sich von Insomniepatienten? Wie lassen sich Unterschiede erklären? Vier diagnostische Gruppen: 35 Gesunde, 40 Insomniepatienten, 36 Hypersomniepatienten und 22 Narkolepsiepatienten wurden hinsichtlich ihrer Schlaferinnerung, der Schlafeinschätzung und der Schlafbeurteilung untersucht. Die methodischen Grundlagen bildeten der Mehrfach-Schlaf-Latenz-Test30 mit fünf standardisierten 30-minütigen polysomnographischen Registrierzeiten an einem Tag und die vorangegangene nächtliche Polysomnographie. Die subjektiven Daten wurden jeweils im Anschluss an die Polysomnographie mittels eines eigenen Schlaffragebogens erhoben. Die Insomniepatienten zeigen beim MSLT30 die schlechteste Erinnerung an Schlaf mit nur der Hälfte der objektiven Schlafereignisse. Die hypersomnischen Gruppen können den registrierten Schlaf überwiegend erinnern. In den Schlafeinschätzungsparametern am Tag unterscheiden sich die Stichproben nur geringfügig. Die Schlaflatenzen werden überschätzt. Insgesamt ist die Schlafeinschätzung schlechter, wenn Schlafstadium 1 zum objektiven Schlaf dazugezählt wird. In der Nachtableitung zeigen sich Diagnosegruppenunterschiede: Im Gegensatz zu den hypersomnischen Gruppen zeigen die Insomniepatienten eine deutliche Unterschätzung des Schlafes. Hypersomniepatienten überschätzen zwar ebenfalls die Schaflatenz, unterschätzen jedoch die nächtliche Wachzeit. Die Narkolepsiepatienten können ihren Schlaf nicht einschätzen, signifikante Korrelationen zwischen den objektiven und den subjektiven Schlafdaten fehlen. Eine Schlafwahrnehmungsverzerrung im Sinne einer systematischen Unterschätzung des Schlafes zeigen nur die Insomniepatienten, was als Hauptergebnis dieser Arbeit gewertet wird. Diese Unterschätzung wird mit einer Insomnietypisch ängstlichen Erwartungshaltung gegenüber dem Schlaf erklärt. Die Schlafwahrnehmungsverzerrung der Insomniepatienten ist somit ein Teil deren Psychopathologie. Bei Hypersomniepatienten ist vor allem morgens die Einschätzung des Tagschlafes schlecht. Dies sollte im klinischen Umgang mit ihnen berücksichtigt werden. Narkolepsiepatienten können den objektiven Schlaf zwar erinnern, aber nicht einschätzen. Besonders bei der letzteren Gruppe ergibt sich noch erheblicher Forschungsbedarf. Objective and Methods: It is well known that insomniacs underestimate their sleep. There is little information about the perception of sleep in patients with other sleep disorders, such as hypersomnia or narcolepsy. Subjective and objective sleep parameters of patients with psychophysiological insomnia (N= 40), primary hypersomnia (N= 36), narcolepsy (N= 22) and a group of normals (N= 35) were compared. Data were obtained from an all-night polysomnography and a subsequent Multiple Sleep Latency Test (MSLT30). Immediately after each test period, subjects were asked, whether they had slept at all and about their subjective sleep latency, sleep duration and time awake after sleep onset. Results: Comparison of subjective and objective parameters of the MSLT30 showed little differences between the four groups. The estimation of night sleep revealed differences between the diagnostic groups. Insomnia patients underestimated sleep time and overestimated wake after sleep onset. Hypersomnia patients also overestimated sleep latency but underestimated wake after sleep onset. Patients with narcolepsy showed no correlations between subjective and objective sleep parameters. Conclusion: Insomniac patients consistently underestimate their sleep, while this is not true for patients with narcolepsy or hypersomnia. Psychopathological aspects of a disturbed sleep perception are discussed.
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    ABSTRACT: There are methodological difficulties in assessing cognitive function in narcolepsy, but despite these it appears that there is a defect in maintenance of attention, which is more significant than the problems with memory. The subject’s perception of memory loss is however greater than what can be demonstrated objectively. There may also be a generalised executive dysfunction unrelated to attention and memory deficits. Anxiety and depression are common, particularly in younger subjects. Psychosis is usually drug-induced, particularly by amphetamines. The realistic dreams and hypnagogic hallucinations should be distinguished from schizophrenia and REM sleep behaviour disorder. There is considerable functional impairment due to the symptoms of narcolepsy with reduced quality of life, particularly in the domains of vitality and physical roles. Changes with age are probably important, but there are only few differences between the genders. Education, performance at work, social and recreational activities are all impaired by narcolepsy, but attention to lifestyle aspects and treatment with modern drugs, particularly modafinil and sodium oxybate, can improve functional capacity.