Excessive daytime sleepiness and the pathophysiology of narcolepsy-cataplexy: a laboratory perspective

The main disabling symptom of narcolepsy-cataplexy is shown to be the unrelenting excessive daytime sleepiness (EDS) based upon controlled studies of socioeconomic effects and the poor response to treatment. Objective performance deficits mainly involve tests of ability to sustain performance on rep...

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Bibliographic Details
Published in:Sleep (New York, N.Y.) N.Y.), 1986-01, Vol.9 (1 Pt 2), p.205-215
Main Authors: Broughton, R, Valley, V, Aguirre, M, Roberts, J, Suwalski, W, Dunham, W
Format: Article
Language:English
Subjects:
Cataplexy - physiopathology
Electroencephalography
Evoked Potentials
Humans
Monitoring, Physiologic
Narcolepsy - diagnosis
Narcolepsy - physiopathology
Periodicity
Sleep - physiology
Sleep Stages - physiology
Socioeconomic Factors
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Summary:The main disabling symptom of narcolepsy-cataplexy is shown to be the unrelenting excessive daytime sleepiness (EDS) based upon controlled studies of socioeconomic effects and the poor response to treatment. Objective performance deficits mainly involve tests of ability to sustain performance on repetitive boring tasks and are reversible by improved alertness. Physiologically, EDS is seen to represent relatively slow waxing and waning of alertness rather than punctate microsleeps. Evidence is provided for complex cerebral evoked potentials (P300, contingent negative variation) being very sensitive EDS measures comparable to the multiple sleep latency test (MSLT). EDS appears to have qualitatively somewhat different forms mainly reflecting pressure for REM sleep (REM sleepiness) or pressure for NREM sleep (NREM sleepiness), which have different effects on cerebral evoked potentials as well as subjective and objective (MSLT) differences. It is argued that in pathophysiological terms narcolepsy may best be considered a disease of state boundary control.
ISSN:0161-8105
1550-9109
DOI:10.1093/sleep/9.1.205