[Neurophysiological examinations in narcolepsy]. / Badania neurofizjologiczne w narkolepsji.

BACKGROUND: Narcolepsy is a chronic hypersomnia of central origin, linked with dysfunction of hypocretin-containing neurons, localized in the lateral hypothalamus. Main symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis. Establishing the proper diagnosis is very important, because of the negative impact of narcolepsy on patients' functioning in social-life and the possibility of improvement of quality of life with adequate treatment. AIM OF THE STUDY: Present review describes clinical characteristics of narcolepsy, usefulness of neurophysiological tests in differential diagnosis of narcolepsy and assessing the efficacy of the treatment, as well as the application of novel biological methods in diagnosis of narcolepsy. METHODS AND RESULTS: According to diagnostic criteria of ICSD-2 the diagnosis of narcolepsy is based on the clinical features and diagnostic examinations and tests. Among them neurophysiological procedures, such as polysomnography (PSG) and Multiple Sleep Latency Test (MSLT) are still recommended as most useful in differential diagnosis of narcolepsy and other hypersomnias. In recent decades novel biochemical and genetic tools have been developed as diagnostic measures in narcolepsy, including the levels of hypocretin in cerebral spinal fluid and HLA DQB1*0602 typing. These both biological markers are strongly associated with the occurrence of cataplexy, therefore do not present considerable diagnostic value in narcolepsy without cataplexy. CONCLUSIONS: Neurophysiological procedures (MSLT) and biological markers are necessary in the diagnosis of narcolepsy with cataplexy and hypersomnia without cataplexy. Neurophysiological procedures are useful in monitoring of the treatment of hypersomnia also.

[Sleep quality and daytime sleepiness in schizophrenia spectrum disorders during antipsychotic treatment]. / Jakosc snu i sennosc w ciagu dnia w zaburzeniach psychotycznych z kregu schizofrenii w trakcie leczenia lekami przeciwpsychotycznymi.

AIM: Patients with schizophrenia frequently report disturbed sleep and excessive daytime sleepiness. In this study the sleep quality and daytime sleepiness of patients hospitalized due to psychotic disorders was assessed shortly before the discharge from the hospital. METHOD: 62 patients treated with antipsychotics (20 F/ 42 M, mean age 25.7 +/- 3.5) were examined. The patients performed a vigilance task (Mackworth clock test), clinical scales were used for the assessment of: sleep quality (Athens insomnia scale - AIS), daytime sleepiness (Epworth sleepiness scale - ESS), clinical global impression (CGI scale), drug side effects (UKU scale), psychopathology and depressive symptoms (PANSS and CDSS scales). RESULTS: Excessive daytime sleepiness (EDS) was reported in the UKU scale in 58% of the patients. This subjective sensation of EDS was not reflected in the results of the standardized methods for the assessment of EDS. In the ESS scale EDS was found in 20% of the patients. A disturbed vigilance was found in the vigilance task in 32% of the patients. CONCLUSION: Subjective feeling of EDS is common in patients treated with antipsychotics. The ESS scale allows to verify the patients' claims. EDS resulting from disturbed or shortened sleep, should be differentiated from sedation resulting from pharmacological treatment and fatigue that may be related to somatic or mental disorders.

REM sleep behaviour disorder in narcolepsy.

BACKGROUND AND PURPOSE: Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. The aim of the study was to evaluate the incidence of REM sleep behaviour disorder (RBD) in consecutive patients with narcolepsy referred to our sleep disorders centre. MATERIAL AND METHODS: Among patients examined because of hypersomnia, a diagnosis of narcolepsy was established in 30 patients (mean age 34.1 +/-13.6; 13 females, 17 males) on the basis of clinical features, polysomnography (PSG) and Multiple Sleep Latency Test. Polysomnographic analysis included assessment of muscle activity during REM sleep, recorded from chin and anterior tibialis muscles. Video recordings were reviewed for intense motor activity during REM periods, manifested as excessive, violent body movements (especially legs) and vocalization, reflecting dream-enacting behaviour. Questions about RBD symptoms were asked as a standard in all newly diagnosed patients and those reporting for follow-up visits. RESULTS: Symptomatic, polysomnographically documented RBD was found in three patients. In one of them RBD symptoms appeared during anticataplectic treatment with antidepressive medications. Disturbances of muscle tone regulation during REM sleep without clinical symptoms were found in polysomnography in a further four patients. Among patients reporting for follow-up visits, three subjects confirmed clinical symptoms corresponding to RBD of various severity. CONCLUSIONS: RBD occurs in narcolepsy more frequently than it was previously considered. Questions about symptoms of this disorder that may be injurious for the patient or patient's bed partner should be routinely asked during the clinical interview.

[The effectiveness of treatment with trazodone in patients with primary insomnia without and with prior history of hypnotics use]. / Skutecznosc trazodonu w leczeniu bezsennosci pierwotnej u pacjentów nieprzyjmujqcych leków nasennych i przyjmujqcych je w przeszlosci.

UNLABELLED: The treatment of primary insomnia frequently lasts longer than four weeks, the maximal time allowed for daily hypnotics use. Antidepressants are important alternative for long-term insomnia treatment. The aim of the study was compared the efficacy of trazodone in the treatment of patients with primary insomnia with and without prior history of hypnotics use. MATERIAL AND METHODS: 28 patients (9 M/19 F, mean age 55.9 +/- 11.8) were treated with trazodone, dose 25-150 mg/d, for three months. Before the start of the treatment the patients were observed for seven days without pharmacological treatment to exclude the hypnotics dependency. The Athens Insomnia Scale (AIS), the Sheehan Disability Scale (SDS), the Clinical Global Impression (CGI), the Leeds Sleep Questionnaire (LSEQ) were completed before (Day 0) and after each month of treatment (Day 30, 60, 90). Additionally the patients completed the sleep diaries and two actigraphic recordings for seven days were performed. RESULTS: The treatment with trazodone decreased the score in the AIS (13.5 +/- 2.4 vs. 6.3 +/- 4.3 points; p < 0.001), increased the sleep time (5.1 +/- 1.3 vs. 6.1 +/- 0.9 hours; p < 0.001) and decreased the sleep latency (82.0 +/- 69.2 vs. 45.9 +/- 41.2 minutes; p < 0.01) from sleep diaries. No significant differences were observed between the patients with and without prior history of hypnotics use. Significant improvement was observed also in all other used scales. Only the actigraphic recordings provided no significant changes during the trazodone treatment. CONCLUSION: Trazodone improves sleep quality and daytime functioning independently from prior history of hypnotics use.