Nightmares in narcolepsy: underinvestigated symptom?

Piško, Juraj; Pastorek, Lukáš; Bušková, Jitka; Šonka, Karel; Nevšímalová, Soňa

doi:10.1016/j.sleep.2014.03.006

Cited by 41 publications

(25 citation statements)

References 33 publications

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“…We have previously studied the epidemiological correlates of nightmares extensively. These and other epidemiological studies have shown that both sleep problems and severe sleep disorders, such as insomnia and narcolepsy, are associated with nightmares, there being a strong association with insomnia, fatigue and sleep terrors [4][5][6][7] . Furthermore, we have previously shown a familial aggregation between nightmares and psychiatric disorders 3 .…”

Section: Introductionmentioning

confidence: 68%

Nightmares share strong genetic risk with sleep and psychiatric disorders

Ollila

Sinnott-Armstrong

Kantojärvi

et al. 2019

Preprint

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Nightmares are vivid, extended and extremely dysphoric dreams that awaken the dreamer. Twin studies indicate that nightmare frequency has a heritability between 36 and 51% providing evidence for genetic factors underlying predisposition to nightmares. Furthermore, while crosssectional epidemiological findings suggest that heavy alcohol usage, traumatic experiences and psychiatric diseases associate with nightmares, the causal relationships between these conditions and nightmares have remained unknown. To examine the biological mechanisms behind nightmares, we performed a genome-wide association study in 28,596 individuals from Finland and the United States. We identified individual genetic variants that predispose to nightmares near MYOF (rs701873, p=2.18e-8) and PTPRJ (rs11039471,p=3.7e-8), a gene previously associated with sleep duration. We found a strong genetic correlation between the frequency of nightmares and traits related to personality and psychiatric disorders; neuroticism (rg=0.59, p=8e-7), post-traumatic stress disorder (PTSD) (rg=0.58, p=0.004) as well as major depressive disorder (rg=0.68, p=7e-4), and sleep traits; and daytime sleepiness (rg=0.62, p=1e-6) and insomnia (rg=0.50, p=1.87e-5). Analysis of directionality using mendelian randomization showed a significant effect from feelings of fed-up (p=0.001), nervous (p=0.004) and miserableness (p=0.0045) to nightmares with no evidence of pleiotropy and no evidence of nightmares predisposing to psychiatric or psychological problems. Our findings suggest that nightmares are caused by unique genetic risk factors, and here we identify the first individual genetic associations. In addition, a substantial effect on nightmares is conveyed through underlying psychological and sleep problems, with psychological problems being causal for nightmares.

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Section: Introductionmentioning

confidence: 68%

Nightmares share strong genetic risk with sleep and psychiatric disorders

Ollila

Sinnott-Armstrong

Kantojärvi

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…70 Moreover, hallucinations may be confused with other parasomnias frequently occurring in childhood, such as night terrors, nightmares, confusional arousals, or may even be misdiagnosed. 71 In different studies the prevalence of hypnagogic hallucinations in childhood NT1 varies significantly, ranging from 39 to 62.5% 31,41 (►Table 1).…”

Section: Clinical Phenotypementioning

confidence: 99%

Narcolepsy during Childhood: An Update

et al. 2015

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Narcolepsy type 1 (NT1) is a rare central disorder of hypersomnolence characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, hallucinations, and fragmented nocturnal sleep usually arising in adolescence or young adulthood. Recently, the childhood NT1 diagnoses have increased for improved disease awareness and for several cases occurring after the H1N1 pandemic influenza or vaccination. As in adults, the occurrence of NT1 in individuals with a genetic predisposition of the immune system (e.g., human leukocyte antigen, HLA-DQB1*0602) together with the role of environmental triggers (e.g., H1N1 influenza virus, streptococcus β hemolyticus) further supports the autoimmune pathogenesis. Children with NT1 close to disease onset show a peculiar cataplexy phenotype characterized by persistent hypotonia with prominent facial involvement (cataplectic facies) and by a complex mosaic of hyperkinetic movement abnormalities that increase during emotional stimulation. This phenotype progressively vanishes along the disease course leading to the typical picture of cataplexy (i.e., muscle weakness exclusively evoked by strong emotions). This possibly explains in part the misdiagnoses and diagnostic delay. Childhood NT1 also shows behavioral abnormalities and psychiatric disorders, encompassing depressive feelings, hyperactive/aggressive behavior, up to psychotic features. The association with obesity and precocious puberty strikingly suggests that NT1 arising in prepubertal children may reflect a wide hypothalamic derangement secondary to hypocretin neuronal loss. The complexity of the childhood NT1 phenotype claims a multidisciplinary assessment and management, taking behavioral and endocrinological features into account. NT1 indeed is a lifelong disorder with a devastating impact on quality of life, especially when arising across developmental age, and targeted school programs, medicolegal and psychological supports are essential for patients care. Controlled studies are mandatory to assess safety and efficacy of the current symptomatic off-label medications on which also relies the treatment for children with NT1, and hopefully future pathogenetic evidences will pave the way to better disease prevention and therapies to modify the disease course.

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“…The symptoms of sleep paralysis and hypnagogic/hypnopompic hallucinations are not as prevalent as the other symptoms, but aid in making the diagnosis and can have a substantial impact on the patient when they do occur. Other sleep symptoms, although not included in the pentad, include frequent vivid, bizarre, and delusional dreams as well as nightmares [20][21][22]. Symptoms of REM behavior disorder (RBD) may also be present in up to 36% of narcolepsy patients, but these may not be a primary complaint and RBD may more likely be recognized during polysomnography [23,24].…”

Section: Introductionmentioning

confidence: 99%

Clinical and practical considerations in the pharmacologic management of narcolepsy

Thorpy¹,

Dauvilliers²

2015

Sleep Medicine

109

110

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Despite published treatment recommendations and the availability of approved and off-label pharmacologic therapies for narcolepsy, the clinical management of this incurable, chronic neurologic disorder remains challenging. While treatment is generally symptomatically driven, decisions regarding which drug(s) to use need to take into account a variety of factors that may affect adherence, efficacy, and tolerability. Type 1 narcolepsy (predominantly excessive daytime sleepiness with cataplexy) or type 2 narcolepsy (excessive daytime sleepiness without cataplexy) may drive treatment decisions, with consideration given either to a single drug that targets multiple symptoms or to multiple drugs that each treat a specific symptom. Other drug-related characteristics that affect drug choice are dosing regimens, tolerability, and potential drug-drug interactions. Additionally, the patient should be an active participant in treatment decisions, and the main symptomatic complaints, treatment goals, psychosocial setting, and use of lifestyle substances (ie, alcohol, nicotine, caffeine, and cannabis) need to be discussed with respect to treatment decisions. Although there is a lack of narcolepsy-specific instruments for monitoring therapeutic effects, clinically relevant subjective and objective measures of daytime sleepiness (eg, Epworth Sleepiness Scale and Maintenance of Wakefulness Test) can be used to provide guidance on whether treatment goals are being met. These considerations are discussed with the objective of providing clinically relevant recommendations for making treatment decisions that can enhance the effective management of patients with narcolepsy.

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Nightmares in narcolepsy: underinvestigated symptom?

Cited by 41 publications

References 33 publications

Nightmares share strong genetic risk with sleep and psychiatric disorders

Nightmares share strong genetic risk with sleep and psychiatric disorders

Narcolepsy during Childhood: An Update

Clinical and practical considerations in the pharmacologic management of narcolepsy

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