ABSTRACT
The review article enlightens contemporary concept about a role of sleep in cellular energy metabolism, neuroplasticity and glymphatic clearance of waste products. Many researches have demonstrated that prolonged wakefulness is an energetic and a neurophysiologic issue for the brain. The article provides description of biochemical processes that are responsive for energy restoration in sleep, particularly the role of ATP, adenosine and glycogen. Energy metabolism substrates depletion leads to endoplasmic reticulum stress and unfolded protein response. At the same time the conductance of synapses increases that worsens energetic problems. Level of the glymphatic clearance during wakefulness is substantially lower in comparison with sleep, and waste products are not removed fast enough.
Subject(s)
Brain , Sleep , Humans , Brain/physiology , Sleep/physiology , Energy Metabolism/physiology , WakefulnessABSTRACT
OBJECTIVE: To determine the predictive role of periodic limb movements in sleep (PLMS) in cerebral small vessel disease (cSVD) progression rate. MATERIAL AND METHODS: Fifty patients with cSVD, aged 60-75 y.o., were enrolled. The study protocol included MRI assessment of white matter hyperintensities (WMH), nocturnal actigraphy and cognitive assessment. Depending on the PLMS, the main (PLM index ≥15) and the control (PLM index <15) groups were formed. The second visit was carried out in one year follow-up period, the examination consisted of brain MRI and cognitive assessment under the same protocol. ANCOVA was performed to determine if PLMS influence the degree of MRI- and neuropsychological changes. RESULTS: A significant effect of PLMS on the increase in the volume of WMH was revealed, both in the form of an increase in the index by more than 15 movements per hour (p=0.03), and quantitatively in the form of a connection with the index value (p=0.048). The influence of PLMS on the progression of cognitive dysfunction has not been found, however, it has been shown that the presence of PLMS is associated with lesions in the deep white matter (r=0.42, p<0.0001), and the results of neuropsychological tests are associated with lesions in the periventricular and juxtacortical WMH (p < 0.05 for each test). CONCLUSION: PLMS predict WMH progression in cSVD.
Subject(s)
Cerebral Small Vessel Diseases , Nocturnal Myoclonus Syndrome , Humans , Nocturnal Myoclonus Syndrome/complications , Nocturnal Myoclonus Syndrome/diagnosis , Prospective Studies , Movement , Sleep , Cerebral Small Vessel Diseases/complications , Cerebral Small Vessel Diseases/diagnostic imagingABSTRACT
OBJECTIVE: To search for the association between white matter deterioration extend as well as related cognitive dysfunction and periodic limb movements in sleep (PLMS) in patients with cerebral small vessel disease (cSVD). MATERIAL AND METHODS: Thirty-four subjects with cSVD were enrolled (12 men, 22 women, average age 66.9 y.o.). The study protocol includes nocturnal actigraphy, cardiorespiratory monitoring, cognitive assessment and brain MRI. Two groups were formed depending on PLMS index. The patients of the main group had PLMS index equal or more than 15 movements per hour, and the controls had PLMS index less than 15. RESULTS AND CONCLUSION: The significant differences between groups are shown in the executive functioning (p=0.0025 for the Frontal Assessment battery, p=0.036 for TMT-B, p=0.009 for TMT-A) and in the volume of juxtacortical white matter hyperintensities (WMH) (p=0.009). The positive correlation of PLMS features with total and periventricular volume of WMH and the negative correlation of PLMS features with cognitive performance are found as well.
