Sleep and cerebral degenerative disorders

Introduction
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By Raman Malhotra MD and Alon Avidan MD MPH

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. Recent research has shown that sleep disorders may serve as a biomarker to predict development of a future neurodegenerative disorder. Other research has suggested that disrupted sleep may accelerate the degenerative process in conditions such as Alzheimer dementia. Prompt attention to and treatment of sleep symptoms can result in significant improvement in quality of life.

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 longer. 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.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors