Pillai Jagan A, Leverenz James B
Lou Ruvo Center for Brain Health, Neurological Institute, and Department of Neurology, Cleveland Clinic, Cleveland, OH.
Lou Ruvo Center for Brain Health, Neurological Institute, and Department of Neurology, Cleveland Clinic, Cleveland, OH.
Chest. 2017 Jun;151(6):1375-1386. doi: 10.1016/j.chest.2017.01.002. Epub 2017 Jan 10.
Sleep abnormalities are clearly recognized as a distinct clinical symptom of concern in neurodegenerative disorders. Appropriate management of sleep-related symptoms has a positive impact on quality of life in patients with neurodegenerative disorders. This review provides an overview of mechanisms that are currently being considered that tie sleep with neurodegeneration. It appraises the literature regarding specific sleep changes seen in common neurodegenerative diseases, with a focus on Alzheimer disease and synucleinopathies (ie, Parkinson disease, dementia with Lewy bodies, multiple system atrophy), that have been better studied. Sleep changes may also serve as markers to identify patients in the preclinical stage of some neurodegenerative disorders. A hypothetical model is postulated founded on the conjecture that specific sleep abnormalities, when noted to increase in severity beyond that expected for age, could be a surrogate marker reflecting pathophysiological processes related to neurodegenerative disorders. This provides a clinical strategy for screening patients in the preclinical stages of neurodegenerative disorders to enable therapeutic trials to establish the efficacy of neuroprotective agents to prevent or delay the development of symptoms and functional decline. It is unclear if sleep disturbance directly impacts neurodegenerative processes or is a secondary outcome of neurodegeneration; this is an active area of research. The clinical importance of recognizing and managing sleep changes in neurodegenerative disorders is beyond doubt.
睡眠异常已被明确视为神经退行性疾病中一种值得关注的独特临床症状。对与睡眠相关症状的恰当管理，对神经退行性疾病患者的生活质量有积极影响。本综述概述了目前正在探讨的将睡眠与神经退行性变联系起来的机制。它评估了有关常见神经退行性疾病中特定睡眠变化的文献，重点关注研究较多的阿尔茨海默病和突触核蛋白病（即帕金森病、路易体痴呆、多系统萎缩）。睡眠变化也可能作为识别某些神经退行性疾病临床前期患者的标志物。基于这样的推测提出了一个假设模型：当特定睡眠异常的严重程度超过预期年龄水平时，可能是反映与神经退行性疾病相关病理生理过程的替代标志物。这为筛查神经退行性疾病临床前期患者提供了一种临床策略，以便进行治疗试验来确定神经保护剂预防或延缓症状发展和功能衰退的疗效。目前尚不清楚睡眠障碍是直接影响神经退行性过程，还是神经退行性变的次要结果；这是一个活跃的研究领域。认识和管理神经退行性疾病中的睡眠变化的临床重要性毋庸置疑。
