Case Report: Dysfunction of the Paraventricular Hypothalamic Nucleus Area Induces Hypersomnia in Patients

Abstract

BackgroundHypersomnia is a common and highly impairing symptom marked by pathological excessive sleepiness, which induces suboptimal functioning and poor quality of life. Hypersomnia can be both a primary (e.g., hypersomnolence disorder) and secondary (e.g., tumors, and head trauma) symptom of disorders. However, its underlying mechanisms remain largely unknown.Case PresentationWe report that three clinical cases with lesions around the paraventricular nucleus of the hypothalamus (PVH) area showed excessive daytime sleepiness and a prolonged nocturnal sleep lasting more than 20 h per day. Sleep architecture and subjective daytime sleepiness were examined by polysomnography. These cases were presented with stroke, myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders and neuromyelitis optical spectrum disorder (NMOSD), respectively. Magnetic resonance imaging (MRI) showed lesions around the PVH area in all these three patients. After treatment of their primary disorders, their excessive sleep decreased as the PVH area recovered.ConclusionOur findings suggest that the PVH may play an essential role in the occurrence of hypersomnia.

Role of the paraventricular nucleus of the hypothalamus in sleep–wake regulation

“…However, strong behavioral arousal is required in stressful situations, and PVH CRH neurons actively mediate stress-induced insomnia via the PVH CRH →LHHcrt pathway [8]. The above studies provide evidence to support the role for the PVH in controlling sleep–wake states from three aspects, as suggested from human clinical observations [29, 30] and animal experiments.…”

“…1(a) and (b)]. After treatment of primary disorders, these patients recovered with decreased sleep and PVH lesion areas, suggesting that the PVH plays an essential role in the occurrence of hypersomnia [29]. Notably, NREM sleep stage 2 was detected as the dominant stage for these three reported cases, and little REM sleep was observed [Fig.…”

“…Notably, NREM sleep stage 2 was detected as the dominant stage for these three reported cases, and little REM sleep was observed [Fig. 1(c)] [29], indicating disrupted sleep structures following lesions. Another clinical observation reported that there was a substantial loss (97%) of hypocretin-1 immunoreactive and CRH neurons (88%) in the PVH, along with markedly less CRH-positive fibers in the ME, in narcolepsy type 1 postmortem brains [30].…”

“…(a) – (c) are adapted with permission from Ref. [29] © 2022, Wang, Zhong, Jiang, Qu, Huang and Chen; (d) – (g) are adapted with permission from Ref. [12] with permission © 2021, Chen et al…”

Hypothalamic CRH Neurons Modulate Sevoflurane Anesthesia and The Post-anesthesia Stress Responses

“…There is increasing evidence supporting the 'shared circuits hypothesis' of GA and sleep, in which different GA drugs may exert hypnotic effect through a shared brain network with wake-sleep regulation 4 . The paraventricular nucleus of the hypothalamus (PVH) is one of the pivotal wake-promoting nuclei 5,6 , which has dense reciprocal connections with numerous neuroanatomical sites 6 that promote both wakefulness and emergence from inhaled GA, including the lateral septum (LS) 7 , paraventricular thalamus (PVT) 8,9 , and parabrachial nucleus (PB) [10][11][12][13][14] . The PVH mainly consists of glutamatergic neurons 15 .…”