The characterisation of sleep and circadian rhythm in neuromyelitis optica

Abstract

Around a third of a human lifespan is spent in the essential life process of sleep. Disordered sleep is present in 15-35% of adults and is frequently underrecognized and underreported. Sleep disorders are associated with an elevated risk of hypertension, diabetes, obesity, depression, heart attack and stroke. The burden to health care associated with sleep disorders is significant and likely underestimated. Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing autoimmune disorder of the central nervous system characterised by devastating relapses which can result in blindness, disability, and death. Symptomatic narcolepsy is a core feature of the disease and though sleep disruption is common, it has not been systemically studied in large NMOSD cohorts. We present a literature review concerning sleep and circadian rhythm in NMOSD and offer a conceptual model of possible underlying pathophysiological mechanisms with suggestions for future research.

The Impact of Optic Nerve Disorders on Sleep Wake

“…Pain, fatigue and sphincter dysfunction are prevalent in NMOSD, and contribute to sleep fragmentation (811,812). Insomnia has been reported in 35% of patients with NMOSD, which may be aggravated by medication use such as agents for neuropathic pain, anticonvulsants, antidepressants and glucocorticoids, while disrupted circadian timing has also been described (810,813). Narcolepsy is a well-documented presentation of NMOSD, and hypersomnolence with low hypocretin levels has been reported, as has sudden onset of daytime sleepiness due to bilateral hypothalamic lesions (814)(815)(816)(817)(818).…”