Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.
School of Medicine, Cardiff University, Cardiff, South Glamorgan, UK.
J Neurol Neurosurg Psychiatry. 2021 Jul;92(7):723-736. doi: 10.1136/jnnp-2020-325546. Epub 2021 Mar 19.
Sleep and circadian rhythm disturbances are central features of many movement disorders, exacerbating motor and non-motor symptoms and impairing quality of life. Understanding these disturbances to sleep is clinically important and may further our understanding of the underlying movement disorder. This review evaluates the current anatomical and neurochemical understanding of normal sleep and the recognised primary sleep disorders. In addition, we undertook a systematic review of the evidence for disruption to sleep across multiple movement disorders. Rapid eye movement sleep behaviour disorder has emerged as the most reliable prodromal biomarker for the alpha synucleinopathies, including Parkinson's disease and multiple system atrophy, often preceding motor symptom onset by several years. Abnormal sleep has also been described for many other movement disorders, but further evidence is needed to determine whether this is a primary or secondary phenotypic component of the underlying condition. Medication used in the treatment of motor symptoms also affects sleep and can aggravate or cause certain sleep disorders. Within the context of movement disorders, there is also some suggestion of a shared underlying mechanism for motor and sleep pathophysiology, with evidence implicating thalamic and brainstem structures and monoaminergic neurotransmission. This review highlights the need for an understanding of normal and abnormal sleep within the movement disorder clinic, an ability to screen for specific causes of poor sleep and to treat sleep disturbance to improve quality of life. Key sleep disorders also act as important biomarkers and have implications in diagnosis, prognosis and the development of future therapies.
睡眠和昼夜节律紊乱是许多运动障碍的核心特征，会加重运动和非运动症状，并降低生活质量。了解这些睡眠障碍对于临床非常重要，并且可能有助于我们深入了解潜在的运动障碍。本综述评估了正常睡眠的当前解剖学和神经化学理解，以及公认的原发性睡眠障碍。此外，我们对多种运动障碍的睡眠中断证据进行了系统回顾。快速眼动睡眠行为障碍已成为包括帕金森病和多系统萎缩在内的α-突触核蛋白病最可靠的前驱生物标志物，通常在运动症状出现前几年就出现。许多其他运动障碍也描述了异常睡眠，但还需要更多证据来确定这是潜在疾病的主要还是次要表型成分。用于治疗运动症状的药物也会影响睡眠，并可能加重或导致某些睡眠障碍。在运动障碍的背景下，运动和睡眠的病理生理学也存在潜在的共同机制，有证据表明涉及丘脑和脑干结构以及单胺能神经传递。本综述强调了在运动障碍诊所中了解正常和异常睡眠的必要性，能够筛查特定的睡眠不良原因，并治疗睡眠障碍以提高生活质量。关键的睡眠障碍也作为重要的生物标志物，对诊断、预后和未来治疗的发展具有重要意义。
