ABSTRACT
Resumen Los pacientes con Esclerosis múltiples tienen mayor tasa de trastornos del sueño que la población general. Los trastornos del sueño más prevalentes son: somnolencia diurna, insomnio, síndrome de piernas inquietas, trastornos respiratorios del sueño y narcolepsia. Los principales factores involucrados en la calidad del sueño en estos pacientes son la nicturia, dolor inespecífico, depresión, efectos colaterales de las terapias, ubicación de las lesiones y severidad de la enfermedad. La presencia de estos trastornos contribuyen de forma significativa a la reducción en la calidad de vida y funcionalidad diurna. A pesar de su alta frecuencia, está demostrado que los trastornos del sueño en estos pacientes son subdiagnosticados. Esta revisión, busca hacer un repaso de los trastornos del sueño más frecuentes en pacientes con esclerosis múltiple, su fisiopatología y clínica.
Sleep disorders occur in multiple sclerosis patients at higher frequency than the general population. Among sleep disorders; daytime sleepiness, insomnia, restless legs syndrome, sleep disordered breathing and narcolepsy have all been reported to be more frequent in multiple sclerosis patients. Factors that influence the quality of sleep in this population include pain, nycturia, depression, medication effects, location of lesions, and disease severity. Sleep disorders have the potential to negatively impact overall health and quality of life in these patients. Sleep disorders in multiple sclerosis patients are known to be clinically underdiagnosed. High suspicion of this condition is pivotal to prompt diagnosis and treatment. The aim of this paper is to review pathophysiology and clinical aspect of the most frequent sleep disorders in multiples sclerosis patients.
Subject(s)
Humans , Quality of Life , Sleep Wake Disorders , Multiple Sclerosis , Respiration Disorders , Restless Legs Syndrome , Sleep Apnea SyndromesABSTRACT
The risk of sudden unexpected death in patients with epilepsy (SUDEP), is 20 to 25 times greater than in the general population. This increased risk is seen specially in refractory epilepsy, with an incidence of 9:1,000 patients-years. Risk factors have been established based on retrospective studies, finding that the frequency of seizures, specially generalized tonic clonic seizures, is the most important one. The physiopathological mechanism of SUDEP is not yet fully understood. Autonomic system abnormalities, as well as cardiac and respiratory changes have been found. The finding of new molecular biomarkers to identify patients with increased risk should be a priority. Treatment is based in the management of risk factors, although clear recommendations are hard to establish given the low level of evidence.