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sleep disorder

Etiology: 1) disturbances of the sleep-wake cycle a) travel across time zones b) shift work c) advanced sleep phase d) exposure to outdoor artificial light at night disrupts circadian rhythms [26] e) pharmaceutical agents 2) insomnia (disorders of initiating or maintaining sleep) a) transient or short-term - acute psychologic stress - bereavement - anxiety - pharmaceutical agents* - acute physical illness - menopause & hot flashes in menopausal women [5,10] - dyspepsia [6] b) long-term - psychiatric disorders - systemic illness - alcohol or substance abuse - chronic pain - gastroesophageal reflux disease (GERD) 3) hypersomnia (excessive daytime somnolence) a) sleep apnea b) narcolepsy/cataplexy c) depression d) alcohol or drug-induced e) systemic illness f) head injury 4) parasomnias (partial arousal with episodic movement) a) sleepwalking (somnambulism) b) nightmares & night terrors c) periodic leg movements during sleep d) restless legs syndrome e) sleep-related enuresis f) nocturnal seizures g) sleep-related cluster headaches h) sleep palsies i) bruxism j) REM behavior disorder * pharmacologic agents: 1) anorexic agents 2) levodopa 3) monoamine oxidase (MAO) inhibitors 4) sympathomimetics Epidemiology: 1) 1/7 of Americans are affected by a sleep disorder [4] a) difficulty falling asleep (37%) - prevalence > women than men - prevalence increases with age in men (65-85 years of age) b) nighttime awakening (29%) - no sex difference - prevalence increases with age (65-85 years of age) c) early morning awakening (19%) d) daytime sleepiness (19%) 2) common in patients with Parkinson's disease Pathology: - sleep disturbance in middle-aged adults is associated with amyloid burden in at least 8 areas of the brain determined by 11C Pittsburgh compound B [16] - excessive daytime sleepiness associated with accumulation of beta-amyloid in the cingulate gyrus & precuneus regions [18] - 3 wake-promoting CNS nuclei, noradrenergic locus coeruleus, orexinergic lateral hypothalamic area & histaminergic tuberomammillary nucleus are associated with mt-tau pathology [25] - Alzheimer's disease (AD) with excessive sleep & progressive supranuclear palsy (PSP) with excessive arousal represent opposite poles of the sleep disorder spectrum [25] - mt-tau pathology is seen in both AD & PSP [25] - both short & long sleep durations are associated with worse outcomes for older adults, including greater brain beta-amyloid burden, greater symptoms of depression, higher body mass index, & cognitive decline [23] Special laboratory: - see sleep study a) polysomnography with multiple sleep latency test (gold standard) b) bilateral anterior tibialis EMG for restless legs syndrome c) actigraphy may be useful for assessment of sleep disorders d) overnight pulse oximetry is useful for rule-out OSA in low-risk patients [1] * has not been validated as a screening tool for OSA Complications: 1) use of hypnotics in older individuals increases risk of falls & fractures 2) insomnia & self-medication to improve sleep are associated with increased mortality 3) sleep deprivation associated with hypertension & obesity 4) sleep disturbance or poor quality of sleep associated with poor health-related quality of life, depression & increased mortality in the elderly [8] 5) poor quality sleep associated with increased risk for suicide in the elderly [15] 6) may play a role in restless legs syndrome 7) sleep disturbance is common in patients with dementia [29] - most likely associated with Lewy body dementia (49%) [29] - less likely associated with Alzheimer's disease (24%) [16,29], frontotemporal dementia (32%), vascular dementia (35%) [29] 8) sleep disruption is common in hospitalized patients & is a risk factor for delirium [20] 9) impaired sleep is associated with a higher rate of future beta-amyloid accumulation [21] - slow-wave activity & sleep efficiency both forecast an increase in beta-amyloid accumulation [21] 10) sleep disorders associated with 3-fold increase in risk of stroke [28] - obstructive sleep apnea specifically cited 11) exposure to outdoor artificial light at night disrupts circadian rhythms & might be a risk factor for diabetes mellitus 12) insufficient sleep associated with medical errors [22] 13) sleep irregularity, especially sleep duration irregularity, is associated measures of subclinical atherosclerosis [27] Management: 1) exposure to bright lights a) exposure in the morning shortens onset of onset of sleep at night b) exposure in the evening delays onset of onset of sleep at night c) exposure to light during sleep impairs cardiometabolic function [24] 2) it is easier to lengthen a sleep cycle than to shorten it a) traveling from west to east takes one day per time zone to adjust b) traveling from east to west takes less time c) melatonin 5 mg PO QHS at the point of destination for jet lag 3) tasimelteon for sleep-wake disorder in the blind [7]

Interactions

disease interactions

Related

age-associated changes in sleep bruxism enuresis International classification of sleep disorders Kleine-Levin syndrome nightmare

Specific

advanced sleep-phase syndrome; familial advanced sleep-phase syndrome (FASPS) asleep at the wheel (drowsy driving) fibromyalgia syndrome (fibromyositis, fibrositis) hypersomnia (hypersomnolence, excessive sleepiness) hypnic jerk; hypnagogic jerk; sleep start; sleep twitch; night start in-hospital sleep disruption insomnia irregular sleep/wake rhythm disorder narcolepsy parasomnia shift work sleep disorder sleep attack sleep deprivation; insufficient sleep syndrome sleep disordered breathing (SDB) sleep disorders in the elderly sleep fragmentation sleep paralysis sleep-related hypoventilation syndrome sleep-related movement disorder

General

sign/symptom disease/disorder primarily affecting brain

References

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