Sleep Disorders and Neurologic Diseases - 2nd Edition
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Sleep
Disorders
and
Neurologic
Diseases
SECOND EDITION
Edited by
Antonio Culebras
Community General Hospital and Upstate Medical University
Syracuse, New York, U.S.A.
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To my wife, Susan, and my daughters, Katerina and Andrea, who felt the
absences and enjoyed the successes with the same intensity that I did.
B Foreword
Sleep is the least understood third of our lives. From its prenatal inception to its
ultimate demise, basic questions persist at all stages. We know that sleep represents
an important phase in brain function, but we know much less about possible
circadian variability in the activity of pathophysiological processes affecting the
brain. For example, we have some idea about how sleep apnea may impact brain
function, but we have no clue, yet, whether so-called silent brain infarcts occur
predominantly in sleep and, if so, why and how.
Fortunately, interest, research, and overall activity in somnology is surging.
As this comprehensive book illustrates, a number of specialties are converging to
deal with the increasingly recognized problems associated with sleep disorders.
Neurosomnology emerges as a distinct subspecialty of neurology, with its
attendant professional organizations, certifications, and, eventually, formal
training programs.
A number of distinguished investigators and practitioners of sleep medicine
contributed to this volume. Although the basics of normal sleep development, func-
tion, and dysfunction receive their due, the emphasis remains decidedly clinical.
Not only neurologists, but pediatricians, internists, pulmonologists, endocrinolo-
gists, psychiatrists, and all those dealing with sleep disorders will find parts intrin-
sically interesting and applicable in practice. This book deserves a wide readership.
The readers and their patients will benefit.
Vladimir Hachinski, MD, FRCPC, DSc
Distinguished University Professor
Department of Clinical Neurological Sciences
Schulich School of Medicine and Dentistry
University of Western Ontario
London, Ontario, Canada
v
B Preface
Sleep is a function of the brain. However, the ultimate physiological function
of sleep remains enigmatic and unknown despite recent extensive research of this
ubiquitous and important brain activity. Sleep intervenes in functions of somatic
growth, regeneration, and memory. Sleep is important in medicine because it
modulates quality of life, while its disorders provoke family pathology, disturb
work routines, alter social activities, and, in general, affect the health of the
individual (1).
Sleep medicine is a unique specialty with input from diverse areas of the
medical sciences. Neurology, pulmonary, cardiology, pediatrics, psychiatry, otorhi-
nolaryngology, and even dental medicine have important contributions to make.
This diversity is the backbone of sleep medicine. But sleep medicine is branching
out and it is clear that sleep, being a function of the brain, suffers dysfunctions
that are distinctly neurological. Conditions such as epilepsy with expression only
in sleep, neuromuscular disorders masquerading as sleep apnea, parasomnias
mimicking seizure disorders, intrinsic hypersomnias with definite brain pathophys-
iology, sleep alterations in Parkinson’s disease, the risk of stroke in sleep, the
organic insomnias, the emerging autonomic dysfunctions of sleep, and so many
other unique neurological disturbances can only be evaluated, studied, diagnosed,
and managed with comfort by neurologists with special expertise in sleep dis-
orders. Non-neurological physicians with a title of “sleep specialist” may not
have sufficient training to tackle the above conditions, despite a sleep diploma or
certificate, and will value having immediate access to this important segment of
sleep medicine in the form of a book.
The subspecialty of neurosomnology will eventually emerge with strength
comparable to that of other subspecialties in neurology. The consequence is that
sleep centers may be compelled to add specialized neurosomnology, for which
they will need a neurosomnologist on staff. Eventually, clinical neurosomnology
will become a subspecialty of sleep medicine and neurology to incorporate all
that is new, unique, and only available in the neurology of sleep.
This book serves as a reference for those who practice sleep medicine and
encounter neurological pathology. The non-neurologist will value the special
information contained herein, and the neurologist will find updated clinical
science in their area of expertise. The chapters have a clinical orientation; pro-
cedural aspects and laboratory tests are not addressed, except where important
to enhance the understanding of clinical manifestations. Some topics are
covered in more than one chapter, not by accident but by design. This should
not be viewed as duplication but rather a way of presenting diverse views of
the same topic.
The authors are prestigious clinical neuroscientists with an international
name in the field of sleep medicine. They were invited to update work presented
in the first edition (2) or to collaborate with new information developed since
vii
viii Preface
this book was initially published only a few years ago. All collaborators have dili-
gently compiled their chapters despite multiple other obligations and should be
commended for their excellent work.
Antonio Culebras, MD
REFERENCES
1. Culebras A, ed. Clinical Handbook of Sleep Disorders. Boston: Butterworth-Heinemann
publishers, 1996.
2. Culebras A, ed. Sleep Disorders and Neurological Disease. First edition. New York: Marcel
Dekker, Inc publishers, 2000.
B Contents
Foreword Vladimir Hachinski . . . . v
Preface . . . . vii
Contributors . . . . xiii
PART I: INTRODUCTION
1. Concept of Sleep Medicine and of Neurosomnology 1
Antonio Culebras
PART II: INFANCY AND DEVELOPMENT
2. Disorders of Development and Maturation of Sleep 7
Stephen H. Sheldon
3. Sleep Disorders Associated with Mental Retardation 27
Michael J. Rack
PART III: INSOMNIA AND CIRCADIAN DYSRHYTHMIAS
4. Insomnia in Neurology 39
Federica Provini, Carolina Lombardi, and Elio Lugaresi
5. Delayed Sleep Phase Disorder and Other Circadian
Rhythm Sleep Disorders 53
Baruch El-Ad
PART IV: NARCOLEPSY AND OTHER HYPERSOMNIAS
6. Narcolepsy 83
Claudio L. Bassetti
7. Secondary Narcolepsy 117
Thomas E. Scammell
8. Hypocretin—Hypothalamic System 135
Christian R. Baumann and Claudio L. Bassetti
9. Idiopathic Hypersomnia and Recurrent Hypersomnia 143
Douglas B. Kirsch and Ronald D. Chervin
ix
x Contents
PART V: MOTOR DISORDERS OF SLEEP
10. Motor Disorders of Sleep: Periodic, Aperiodic, and
Rhythmic Motor Disorders 157
Roberto Vetrugno and Pasquale Montagna
11. Restless Legs Syndrome 171
Renata Egatz, Belen Cabrero, and Diego Garcia-Borreguero
12. Periodic Leg Movements of Sleep 193
Diego Garcia-Borreguero, Oscar Larrosa, and Renata Egatz
13. Sleep in Parkinson’s Disease 205
Robert L. Rodnitzky
PART VI: EPILEPSY AND PARASOMNIAS
14. Epilepsy and Sleep 229
Bradley V. Vaughn and O’Neill F. D’Cruz
15. Somnambulism, Somniloquy, and Sleep Terrors 255
Rosalia Silvestri
16. Rapid Eye Movement Sleep Behavior Disorder 263
Mark W. Mahowald and Carlos H. Schenck
PART VII: SLEEP APNEAS
17. Obstructive and Nonobstructive Sleep Apnea: The Neurological
Perspective 277
Gulcin Benbir and Christian Guilleminault
18. Sleep Apnea and Stroke 301
Antonio Culebras
PART VIII: NEURODEGENERATIVE DISORDERS
19. Sleep Disturbances in Dementia and Other Neurodegenerative
Disorders 315
Alon Y. Avidan
20. Autonomic Dysfunctions in Sleep Disorders 337
Pietro Cortelli and Carolina Lombardi
PART IX: MISCELLANEOUS NEUROLOGIC DISORDERS
21. Headache Disorders and Sleep 349
Antonio Culebras
Contents xi
22. Sleep in Traumatic Brain Injury and Other Acquired Central
Nervous System Conditions 361
Mark W. Mahowald
23. Sleep Disorders Associated with Multiple Sclerosis 381
Antonio Culebras
24. Sleep Disorders and Neuromuscular Disorders 387
Antonio Culebras
PART X: PHARMACOLOGY
25. Stimulant-Dependent and Hypnotic-Dependent Sleep
Disorders 405
Harold R. Smith
Index . . . . 421
B Contributors
Alon Y. Avidan Sleep Disorders Center, Department of Neurology, UCLA,
Los Angeles, California, U.S.A.
Claudio L. Bassetti Department of Neurology, University Hospital, Zurich,
Switzerland
Christian R. Baumann Department of Neurology, University Hospital, Zurich,
Switzerland
Gulcin Benbir Stanford University Sleep Medicine Program, Stanford,
California, U.S.A.
Belen Cabrero Sleep Research Institute, Madrid, Spain
Ronald D. Chervin Department of Neurology, Sleep Disorders Center, University
of Michigan Health System, Ann Arbor, Michigan, U.S.A.
Pietro Cortelli Center for Sleep Disorders, Department of Neurological Sciences,
University of Bologna, Bologna, Italy
Antonio Culebras The Sleep Center, Community General Hospital, and
Department of Neurology, Upstate Medical University, Syracuse, New York, U.S.A.
O’Neill F. D’Cruz Division of Child Neurology, Department of Neurology,
University of North Carolina School of Medicine, Chapel Hill, North Carolina,
U.S.A.
Renata Egatz Sleep Research Institute, Madrid, Spain
Baruch El-Ad Sleep Medicine Center, Technion – Israel Institute of Technology,
Tel Aviv, Israel
Diego Garcia-Borreguero Sleep Research Institute, Madrid, Spain
Christian Guilleminault Stanford University Sleep Medicine Program, Stanford,
California, U.S.A.
Douglas B. Kirsch Division of Sleep Medicine, Harvard Medical School, and
Department of Neurology, University of Michigan, University of Michigan
Hospital, Ann Arbor, Michigan, U.S.A.
Oscar Larrosa Sleep Research Institute, Madrid, Spain
Carolina Lombardi Department of Clinical Medicine, University of Milano-
Bicocca, and Physiology and Hypertension Center, S. Luca Hospital, IRCCS, Istituto
Auxologico Italiano, Milan, Italy
xiii
