Helena Ariño1, Amaia Muñoz-Lopetegi1,2, Eugenia Martinez-Hernandez1,2, Thaís Armangue1,3,4, Mireia Rosa-Justicia1, Domingo Escudero1,2, Nuria Matos2, Francesc Graus1, Gisela Sugranyes1,4, Josefina Castro-Fornieles1,4, Albert Compte1, Josep Dalmau5,2,6,7, Joan Santamaria5,2. 1. Clinical and experimental Neuroimmunology, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS). 2. Department of Neurology, Hospital Clinic, University of Barcelona, Barcelona (Spain). 3. Pediatric Neuroimmunology Unit, Sant Joan de Déu (SJD) Childrens' Hospital, University of Barcelona, Barcelona (Spain). 4. Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic, University of Barcelona, Barcelona (Spain). 5. Clinical and experimental Neuroimmunology, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS) jsantama@clinic.cat jdalmau@clinic.cat. 6. Department of Neurology, University of Pennsylvania, Philadelphia (USA). 7. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona (Spain).
Abstract
OBJECTIVE: To describe the sleep disorders in anti-NMDA receptor encephalitis (anti-NMDARe). METHODS: Patients recovering from anti-NMDARe were invited to participate in a prospective observational single center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment and neuropsychological evaluation. Age and sex-matched healthy participants served as controls. RESULTS: Eighteen patients (89% female, median age 26 years, IQR 21-29) and 21 controls (81% female, median age 23 years, IQR 18-26) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study-admission (median 183 days after disease onset, IQR 110-242) 8 patients still had hypersomnia, 1 insomnia, and 9 normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p=0.02, and Epworth Sleepiness Score, p=0.04). On V-PSG, sleep efficiency was similar in both groups, but patients had more frequently multiple and longer confusional arousals in NREM sleep (videos provided). Additionally, 13 (72%) patients had cognitive deficits, 12 (67%) psychological, social, or occupational disability, and 33% depression or mania. Compared with controls, patients had a higher body mass index (median, IQR: 23.5, 22.3-30.2 vs. 20.5, 19.1-21.1; p=0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction. CONCLUSIONS: Sleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), associate with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.
OBJECTIVE: To describe the sleep disorders in anti-NMDA receptor encephalitis (anti-NMDARe). METHODS:Patients recovering from anti-NMDARe were invited to participate in a prospective observational single center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment and neuropsychological evaluation. Age and sex-matched healthy participants served as controls. RESULTS: Eighteen patients (89% female, median age 26 years, IQR 21-29) and 21 controls (81% female, median age 23 years, IQR 18-26) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study-admission (median 183 days after disease onset, IQR 110-242) 8 patients still had hypersomnia, 1 insomnia, and 9 normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p=0.02, and Epworth Sleepiness Score, p=0.04). On V-PSG, sleep efficiency was similar in both groups, but patients had more frequently multiple and longer confusional arousals in NREM sleep (videos provided). Additionally, 13 (72%) patients had cognitive deficits, 12 (67%) psychological, social, or occupational disability, and 33% depression or mania. Compared with controls, patients had a higher body mass index (median, IQR: 23.5, 22.3-30.2 vs. 20.5, 19.1-21.1; p=0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction. CONCLUSIONS: Sleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), associate with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.