1 / 25

Sleep and neurology

AWAKE group meeting 11/05/2008 Eric Frenette MD FRCP(C) ‏ Neurologist and Sleep medicine Stanford Sleep Clinic. Sleep and neurology. Sleep and neurology. Sleep is a reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment

kiley
Download Presentation

Sleep and neurology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. AWAKE group meeting 11/05/2008 Eric Frenette MD FRCP(C)‏ Neurologist and Sleep medicine Stanford Sleep Clinic Sleep and neurology

  2. Sleep and neurology • Sleep is a reversible behavioral state of perceptual disengagement from and unresponsiveness to the environment Carskadon and Dement, Principles and practice of sleep medicine, 4th edition, Elsevier-Saunders, p. 13

  3. Sleep and neurology • We record sleep during an all-night sleep study, called polysomnography (PSG). • We analyze • Brain waves (EEG)‏ • Eye movements • Breathing (flow and effort)‏ • Muscle tone • Heart rhythm • Oxygen saturation • Leg movements

  4. Sleep and neurology • Normal sleep for an adult • Between 7-9 hours • 4-5 sleep cycles • Sleep cycle • Consists of NREM and REM sleep • 4 stages of NREM sleep (1-2-3-4) and then REM • More slow-wave sleep at beginning of the night (3-4)‏ • More REM sleep at the end of the night

  5. Sleep and neurology • STROKE • Defintion • Sudden brain dysfunction induced by a blood flow disruption • Strokes can be either ischemic (lack of blood flow) of hemorragic (blood vessel rupture)‏ • Anatomy • There are four major blood vessels supplying the brain: 2 carotids and 2 vertebral arteries. • The carotids supply the major part of the brain, while the vertebral arteries supply the brainstem, cerebellum and posterior part of the brain.

  6. Sleep and neurology • STROKE • Epidemiology • Prevalence of stroke is about 1% • 3rd cause of mortality and major cause of disability • Significant proportion of strokes occur during sleep • Obstructive sleep apnea (OSA) and ischemic stroke • Moderate to severe OSA increases risk of stroke by up to 2-3 folds compared to control groups • OSA is an independent risk factor for stroke • OSA is present in up to 60 % of patients in the post-stroke period and 50% at 3 months

  7. Sleep and neurology • STROKE • Treatment • Using CPAP reduces the markers of atherosclerosis in severe OSA • Take home message • OSA is a potentially reversible risk factor for stroke • Risk is significantly increased for moderate-severe OSA • Mild OSA?

  8. Sleep and neurology • EPILEPSY • Definition • Electrical brain dysfunction that manifests itself by seizures • Seizures can be simple, complex, generalized • Epidemiology • Prevalence is 1% of population • OSA is not, per se, a risk factor for epilepsy, although untreated OSA can affect seizure frequency.

  9. Sleep and neurology • EPILEPSY • Treatment • CPAP usage in patient with OSA and poorly controlled epilepsy reduces the number of seizures without the need of changing the antiepileptic drug regimen • How? • Reducing sleep fragmentation • Increasing blood oxygen saturation

  10. Sleep and neurology • EPILEPSY • Seizures frequently occur during sleep and may manifest themselves as: • Confusional arousal • Bizarre behavior • Sleep walking (wandering)‏ • All these manifestations can be mistaken for parasomnia, especially in children • Polysomnogram plus EEG monitoring might be required to make the distinction

  11. Sleep and neurology • EPILEPSY • Take home message • Undertreated OSA can exacerbate epilepsy (seizure frequency)‏ • Nightime manifestations of seizures may mimic parasomnias • PSG and EEG monitoring might be necessary to differentiate one from another

  12. Sleep and neurology • PARKINSON • Definition • Neurodegenarative disease caused by an overall reduction of dopamine production, particularly by the substantia nigra • Epidemiology • Affects 1 in 100 person above 70 yo • Clinical manifestations • Tremor (rest)‏ • Rigidity (cog-wheeling)‏ • Akinesia • Posture changes

  13. Sleep and neurology • PARKINSON • REM sleep behavior disorder • Sleep symptoms can be prominent particularly REM sleep behavior disorder, or RBD • RBD occurs in REM sleep and can be characterized by acting-out dreams, especially dreams with aggressive overtones. • Normally, in REM sleep, there is a loss of muscle tone except for the diaphragm and the eyes

  14. Sleep and neurology • PARKINSON • Diagnosis is made with the help of the clinical history (bed partner)‏ • In RBD, the muscle tone is increased in REM sleep, leading to muscle twitches and sometimes to the full blown syndrome • This can be documented with PSG • Treatment • Clonazepam is the drug of choice

  15. Sleep and neurology • MULTIPLE SCLEROSIS • Definition • Intermittent and recurrent affection of the central nervous system nerve sheaths, probably caused by an immune disorder, that creates neurological symptoms. • Epidemiology • Affects predominantly women • Peak age of onset between 20-40 yo. • Prevalence is 1 or 2 per 1000

  16. Sleep and neurology • MULTIPLE SCLEROSIS • Clinical manifestations • Loss of vision (optic neuritis)‏ • Balance problems (ataxia)‏ • Leg spasticity, sphincter problems, tingling (transverse myelitis)‏ • Fatigue is a common symptom, even in otherwise unaffected individuals • Sleep disruption common (insomnia, pain, leg movements)‏ • Treatment is symptomatic

  17. Sleep and neurology • NEUROMUSCULAR DISORDERS • Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig)‏ • Myotonic dystrophy (Steinert)‏ • Sleep disordered breathing common • Sleep related hypoventilation also seen with weakness of respiratory muscles • Bilevel a better choice than CPAP • Some report evidence of secondary narcolepsy (MD)‏

  18. Sleep and neurology • SUMMARY • Sleep disorders very common in neurological diseases • Patients with sleep disorders (OSA, RBD) at risk for neurological problems (stroke, Parkinson)‏ • Treating the sleep problem may help avoid the neurological consequences

More Related