Sleep Disturbances in Patients with Disorders of the Nerve and Muscle Diseases

• Published in: Current sleep medicine reports 2019-06, Vol.5 (2), p.83-93
• Main Authors: Morales-Estrella, Jorge L., Aboussouan, Loutfi S.
• Format: Article
• Language: English
• Subjects: Acids; Age; Airway management; Amyotrophic lateral sclerosis; Body mass index; Cardiology; Diaphragm (Anatomy); Eye movements; Family Medicine; General Practice; Hypoventilation; Internal Medicine; Medicine; Medicine & Public Health; Movement disorders; Muscular dystrophy; Myasthenia gravis; Neurology; Neuromuscular diseases; Otorhinolaryngology; Poliomyelitis; Psychiatry; REM sleep; Respiratory failure; Restless legs syndrome; Section Editor; Sleep and Neurological Conditions (A Avidan; Sleep apnea; Sleep disorders; Spinal cord injuries; Steroids; Topical Collection on Sleep and Neurological Conditions; Weight control
• ISSN: 2198-6401; 2198-6401
• DOI: 10.1007/s40675-019-00140-3

Purpose of Review Recognize sleep disorders associated with neuromuscular diseases. Recent Findings Neuromuscular diseases can be associated with various sleep disorders. Diaphragmatic weakness, bulbar dysfunction, pharyngeal neuropathy, and central neurodegeneration cause sleep-disordered breathing. Spinal cord hyperexcitability, loss of inhibitory descending pathways, and neuropathy promote restless legs syndrome. Reduced cerebrospinal fluid (CSF) hypocretin, central dysfunction of sleep regulation, and degeneration of GABAergic intracortical circuits may contribute to central hypersomnia. Dysfunction of the nigrostriatal dopaminergic system, associated with neurodegenerative diseases and certain neuromuscular disorders, may be a common pathophysiologic mechanism responsible for the loss of rapid eye movement (REM) sleep muscle atonia and REM sleep behavior disorder (RBD). Summary Different neuromuscular disorder may be more susceptible to specific sleep disturbances. A low threshold needs to be maintained for the diagnosis and treatment of sleep disorders in neuromuscular diseases, due to their high prevalence, lack of symptom specificity, and presence even in minimally symptomatic patients. However, loss of REM atonia may be protective against sleep-disordered breathing. There are reasonable pathophysiologic mechanisms such as respiratory muscle weakness, upper airway obstruction, and central dysfunction that explain the link between sleep disorders and neuromuscular diseases