Q&A: Sleep disorders occur frequently in neurological disorders, but often go unrecognized

March includes several events dedicated to sleep health and wellness. This week marked Sleep Awareness Week, commemorated by the National Sleep Foundation in the 7 days after daylight savings time begins. March 19 is World Sleep Day.

World Sleep Day is an awareness event hosted by the World Sleep Society that originated with sleep health care providers gathering “to discuss and distribute sleep information across the world,” according to its website.

Raman Malhotra, MD, president-elect of the American Academy of Sleep Medicine board of directors and an associate professor of neurology at Washington University School of Medicine, spoke with Healio Neurology about the occurrence of sleep disorders in patients with neurological disorders.

Healio Neurology: Can you discuss the bidirectional relationship between sleep and neurological disorders?

Malhotra: The control and mechanisms for the process of sleep come from the brain, so any neurological disorder, such as a stroke, tumor or neurodegenerative condition, can involve and damage parts of the brain that control sleep and alertness. For this reason, patients with neurological disorders frequently report sleepiness, fatigue, insomnia and disrupted sleep to their neurologist. Further, disruption of sleep from any cause has been shown to increase the risk for, or cause earlier onset of, many neurological diseases such as stroke or neurodegenerative conditions. It is this interesting bidirectional relationship that makes it even more important for patients and their medical providers to better understand these connections.

Healio Neurology: Do some sleep disorders occur more frequently than others among patients with neurological disorders?

Malhotra: Different sleep disorders are seen more commonly in specific neurological disorders. REM sleep behavior disorder, or acting out dreams, is more commonly seen in patients with Parkinson’s disease or other synucleinopathies. REM sleep behavior disorder can sometimes be the first symptom of Parkinson’s disease, predated [by] other symptoms of the condition by over 10 years in many cases. Obstructive sleep apnea is seen more commonly in patients who had a stroke. Sleep-disordered breathing such as sleep apnea or hypoventilation are more common in patients with neuromuscular disorders that affect respiratory or upper airway musculature, such as myasthenia gravis or motor neuron disease. Narcolepsy has been seen at a higher rate in patients with myotonic dystrophy. Patients with MS are at risk for a variety of sleep disorders such as sleep apnea, restless legs syndrome and insomnia. Patients who have suffered traumatic brain injury are at higher risk for sleep apnea and narcolepsy.

Healio Neurology: Have there been any recent developments or research related to the treatment or management of sleep disorders among these patients?

Malhotra: There is ongoing research exploring wake-promoting agents to help combat severe excessive daytime sleepiness that is associated with various neurological conditions such as MS and TBI. Many of the same agents we use to help with sleepiness in narcolepsy are being researched in a variety of neurological disorders to test for efficacy and safety in these populations. Another exciting trial that has started is looking at the role treatment of sleep apnea may have in recovery from stroke and as secondary stroke prevention. There is growing evidence that sleep may play a critical role in recovery from mild TBI and concussion.

Healio Neurology: What unmet needs remain for these patients?

Malhotra: Unfortunately, most sleep disorders in patients go unrecognized and undiagnosed. It is important to emphasize to both patients and their providers that sleep is essential for health and may help in recovery from neurological disease. It is also important to screen for common sleep disorders such as insomnia and sleep apnea, as leaving these disorders untreated may increase risk for developing neurological disorders such as dementia, other neurodegenerative conditions and stroke.

Reference:

• World Sleep Day. World Sleep Day is March 19, 2021. Available at: https://worldsleepday.org/. Accessed March 19, 2021.