Sleep disturbances are common in patients with autoimmune encephalitis

Abstract

Objectives: Autoimmune encephalitis (AE) is increasingly recognized as an important cause of subacute cognitive decline, seizures, and encephalopathy, with an ever-broadening clinical phenotype. Sleep disturbances are reported in AE patients, including rapid eye movement sleep behavior disorder, hypersomnia, fragmented sleep, and sleep-disordered breathing; however, the prevalence of sleep disturbances and contributions to outcomes in AE patients remain unknown. There is a need to determine the prevalence of sleep disturbances in AE patients, and to clarify the relationship between specific autoantibodies and disruptions in sleep. Methods: Clinical history, results of serum and cerebrospinal fluid testing, electroencephalography, and neuroimaging were reviewed from 26 AE patients diagnosed and managed at our tertiary care hospital. Polysomnography was performed in patients with clinical indications, yielding data from 12 patients. Results: The median age of AE patients was 53 years (range, 18-83). Autoantibodies against intracellular antigens (including Ma and Hu autoantibodies) were identified in 6/26 (23%) patients, while autoantibodies against cell-surface neuronal antigens (including NMDAR and LGI1) were identified in 20/26 (77%) patients. New sleep complaints were reported by 19/26 (73%) AE patients, including gasping or snoring (9/19, 47%), dream enactment behavior (6/19, 32%), insomnia (5/19, 29%), hypersomnia (4/19, 21%), other parasomnias (4/19, 21%), and dream-wake confusional states (2/19, 11%). Dream enactment behaviors were particularly common in AE associated with LGI1 autoantibodies, reported in 4/7 (57%) patients.

Sleep Disorders in Leucine-Rich Glioma-Inactivated Protein 1 and Contactin Protein-Like 2 Antibody-Associated Diseases

“…PSGs in patients with LGI1-Ab encephalitis demonstrated a decrease in TST, sleep efficiency, and the percentages of REM and N3 sleep stages but a marked increase in LMS index. Consistent with previous reports (8,11,26), we found that RBD and PLMS were more common in LGI1-Ab encephalitis than in Caspr2-Ab diseases. LGI1-Ab encephalitis is characterized by limbic system involvements.…”

“…Sleep disorders are prominent manifestations of Morvan's syndrome and also commonly seen in LGI1-Ab encephalitis. These clinical features include insomnia, rapid eye movement (REM) sleep behavior disorder (RBD), periodic limb movements in sleep (PLMS), hypersomnia, agrypnia excitata, and obstructive sleep apnea syndrome (OSAS) ( 11 – 13 ). However, the spectrum of sleep manifestations in LGI1-Ab and Caspr2-Ab diseases has not been systematically studied.…”

Fatigue, Sleep, and Autoimmune and Related Disorders

“…Evidence also suggests that the sleep disorder narcolepsy has an autoimmune origin (179). Individuals with autoimmune disease often report disturbed sleep (180–185). In a mouse model of systemic lupus erythematosus, it was reported that an increased disturbances in sleep corresponded with the progression of the disease including increased sleep fragmentation and impaired sleep-stage transitions (186).…”

A Patient With Anti-LGI-1 Limbic Encephalitis Diagnosed as Conversion Disorder

“…A subset, classified as limbic encephalitis, is mediated by antibodies that target limbic structures. Common symptoms include mood changes; sleep disturbances, including dream enactment; seizures; and subacute short-term memory loss (3,4). Impaired stage III sleep contributes to memory loss and decreased attention.…”

“…Typical symptomatology of LGI-1 limbic encephalitis includes psychiatric symptoms, confusion, hyponatremia, REM sleep disorder, and faciobrachial dystonic seizures (FBDS). Treating sleep symptoms has shown to improve overall mortality rates (4). FBDS are pathognomonic and described as a rapid jerking of one side of the face or upper extremity and may precede other symptoms.…”