Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Psychiatry and Brain Research Institute, University of California, Los Angeles, CA, USA; Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Sleep Med Rev. 2024 Oct;77:101976. doi: 10.1016/j.smrv.2024.101976. Epub 2024 Aug 3.
Narcolepsy is mainly associated with excessive daytime sleepiness, but the characteristic feature is abnormal rapid eye movement (REM) sleep phenomena. REM sleep disturbances can manifest as cataplexy (in narcolepsy type 1), sleep paralysis, sleep-related hallucinations, REM sleep behavior disorder, abnormal dreams, polysomnographic evidence of REM sleep disruption with sleep-onset REM periods, and fragmented REM sleep. Characterization of REM sleep and related symptoms facilitates the differentiation of narcolepsy from other central hypersomnolence disorders and aids in distinguishing between narcolepsy types 1 and 2. A circuit comprising regions within the brainstem, forebrain, and hypothalamus is involved in generating and regulating REM sleep, which is influenced by changes in monoamines, acetylcholine, and neuropeptides. REM sleep is associated with brainstem functions, including autonomic control, and REM sleep disturbances may be associated with increased cardiovascular risk. Medications used to treat narcolepsy (and REM-related symptoms of narcolepsy) include stimulants/wake-promoting agents, pitolisant, oxybates, and antidepressants; hypocretin agonists are a potential new class of therapeutics. The role of REM sleep disturbances in narcolepsy remains an area of active research in pathophysiology, symptom management, and treatment. This review summarizes the current understanding of the role of REM sleep and its dysfunction in narcolepsy.
发作性睡病主要与日间过度嗜睡有关，但特征性表现为异常快速眼动（REM）睡眠现象。REM 睡眠障碍可表现为猝倒（在 1 型发作性睡病中）、睡眠瘫痪、睡眠相关幻觉、REM 睡眠行为障碍、异常梦境、多导睡眠图显示 REM 睡眠中断伴 REM 睡眠起始期、以及 REM 睡眠片段化。REM 睡眠及相关症状的特征有助于将发作性睡病与其他中枢性嗜睡障碍区分开来，并有助于区分 1 型和 2 型发作性睡病。一个包含脑桥、前脑和下丘脑内区域的回路参与了 REM 睡眠的产生和调节，其受单胺、乙酰胆碱和神经肽变化的影响。REM 睡眠与脑干功能有关，包括自主控制，REM 睡眠障碍可能与心血管风险增加有关。用于治疗发作性睡病（和 REM 相关症状）的药物包括兴奋剂/促醒剂、吡咯烷酮、羟丁酸钠和抗抑郁药；下丘脑分泌素激动剂是一类有潜力的新治疗药物。REM 睡眠障碍在发作性睡病中的作用仍然是生理病理学、症状管理和治疗领域的一个活跃研究领域。这篇综述总结了目前对 REM 睡眠及其在发作性睡病中的功能障碍的作用的理解。
