Sleep Disorders and Circadian Disruption in Huntington’s Disease

Abstract

Sleep and circadian alterations are common in patients with Huntington’s disease (HD). Understanding the pathophysiology of these alterations and their association with disease progression and morbidity can guide HD management. We provide a narrative review of the clinical and basic-science studies centered on sleep and circadian function on HD. Sleep/wake disturbances among HD patients share many similarities with other neurodegenerative diseases. Overall, HD patients and animal models of the disease present with sleep changes early in the clinical course of the disease, including difficulties with sleep initiation and maintenance leading to decreased sleep efficiency, and progressive deterioration of normal sleep architecture. Despite this, sleep alterations remain frequently under-reported by patients and under-recognized by health professionals. The degree of sleep and circadian alterations has not consistently shown to be CAG dose-dependent. Evidence based treatment recommendations are insufficient due to lack of well-designed intervention trials. Approaches aimed at improving circadian entrainment, such as including light therapy, and time-restricted feeding have demonstrated a potential to delay symptom progression in some basic HD investigations. Larger study cohorts, comprehensive assessment of sleep and circadian function, and reproducibility of findings are needed in future in order to better understand sleep and circadian function in HD and to develop effective treatments.

Sleep and circadian rhythm dysfunctions in movement disorders beyond Parkinson's disease and atypical parkinsonisms

“…Latency to the first REM sleep episode was also prolonged. Additionally, sleep microarchitecture may also be affected in manifest Huntington's disease, characterized by elevated sleep spindle density and a reduction in theta power during Non-REM and REM sleep [42,44 ▪ ].…”

Sleep and Circadian Rhythm Dysfunction in Animal Models of Huntington’s Disease

“…Sleep disorders seen in HD may arise from either dysfunction of the pathways that regulate sleep and wake or from circadian dysfunction, since the sleep/wake cycle is a circadian-driven behavior. The evidence for sleep and circadian dysfunction in people with HD is reviewed in this special issue by Saade-Lemus and Videnovic [1] (for other reviews, see [2][3][4][5]).…”

“…Summary of selected animal models of Huntington's disease NHP, non-human primate; EEG, electroencephalogram; BAC, bacterial artificial chromosome; YAC, yeast artificial chromosome; ?, possibly. For further references see 1. Farshim PP, Bates GP.…”