The pupillogram and narcolepsy

Yoss, Robert E.; Moyer, Norma J.; Ogle, Kenneth N.

doi:10.1212/wnl.19.10.921

Cited by 89 publications

(18 citation statements)

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“…In narcolepsy and other dyssomnias, even non-pathological lack of night sleep, typical oscillations (so called fatigue waves) are seen immediately or after only a few minutes in darkness [36,70]. Additionally the pupil diameter decreases.…”

Section: Measurement Of Sleepinessmentioning

confidence: 99%

Neuro-ophthalmology of pupillary function - practical guidelines

Wilhelm

1998

Journal of Neurology

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An overview how to examine pupillary function and handle pupillary abnormalities is presented. The following issues are discussed: swinging flashlight test, clinical relevance of a relative afferent pupillary defect, anisocoria with normal light reaction, diagnosis and evaluation of Homer's syndrome, differential diagnosis of impaired light reaction, tonic pupil, third nerve palsy, supranuclear pupillary disorders, iris problems, systemic disease, measurement of sleepiness, and pupillography.

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Section: Measurement Of Sleepinessmentioning

confidence: 99%

Neuro-ophthalmology of pupillary function - practical guidelines

Wilhelm

1998

Journal of Neurology

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“…Pupillometry is a brief, non-invasive, physiologically based technique shown to concur with behavioral indicators of sleepiness in several populations (Lichstein et al, 1994; Wilhelm et al, 1998a, 2001, 2009; Wilhelm, 2008), including in narcolepsy, where its use dates back several decades (Yoss et al, 1969, 1970). The interpretation of pupillometry-derived measures of sleepiness is limited by a lack of normative data and a robust “single-best” measure.…”

Section: Introductionmentioning

confidence: 99%

Pupillometric Assessment of Sleepiness in Narcolepsy

et al. 2011

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Purpose: Excessive daytime sleepiness is highly prevalent in the general population, is the hallmark of narcolepsy, and is linked to significant morbidity. Clinical assessment of sleepiness remains challenging and the common objective multiple sleep latency test (MSLT) and subjective Epworth sleepiness scale (ESS) methods correlate poorly. We examined the relative utility of pupillary unrest index (PUI) as an objective measure of sleepiness in a group of unmedicated narcoleptics and healthy controls in a prospective, observational pilot study. Methods: Narcolepsy (n = 20; untreated for >2 weeks) and control (n = 56) participants were tested under the same experimental conditions; overnight polysomnography was performed on all participants, followed by a daytime testing protocol including: MSLT, PUI, sleepiness visual analog scale (VAS), ESS, and the psychomotor vigilance test (PVT). Results: The narcolepsy and control groups differed significantly on psychomotor performance and each measure of objective and subjective sleepiness, including PUI. Across the entire sample, PUI correlated significantly with objective (mean sleep latency, SL) and subjective (ESS and VAS) sleepiness, but none of the sleepiness measures correlated with performance (PVT). Among narcoleptics, VAS correlated with PVT measures. Within the control group, mean PUI was the only objective sleepiness measure that correlated with subjective sleepiness. Finally, in an ANCOVA model, SL and ESS were significantly predictive of PUI as measure of sleepiness. Conclusion: The role of PUI in quantifying and distinguishing sleepiness of narcolepsy from sleep-satiated healthy controls merits further investigation as it is a portable, brief, and objective test.

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“…A disturbance of the autonomic nervous system tANS) in narcolepsy has been suggested, based on abnormalities of pupil reactions [21], and ejaculatory [9] and cardiovascular function [16]. However, this evidence has been considered inconclusive [12].…”

Section: Introductionmentioning

confidence: 99%

Autonomic function in narcolepsy: power spectrum analysis of heart rate variability

et al. 1997

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Ten narcoleptic patients that had never been treated previously and ten healthy volunteers of comparable age underwent 48-h polygraphic recording to assess the effects of wakefulness and sleep on beat-to-beat heart rate variability by means of power spectrum analysis. The study revealed decreased power in the low frequencies (LF) during sleep (whereby an increase of the power in this band is associated with sympathetic activation) compared with wakefulness, with minimal values during stage 3-4 non-REM sleep and higher levels during REM sleep, both in patients and controls. Significantly reduced power in high frequencies (HF; mainly expression of parasympathetic control) and a significantly increased LF/HF ratio during wakefulness before sleep in narcoleptics compared with controls were found. Our study excludes a primary disturbance of cardiac autonomic nervous system in narcoleptics but suggests an altered circadian autonomic function in these patients.

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The pupillogram and narcolepsy

Cited by 89 publications

References 0 publications

Neuro-ophthalmology of pupillary function - practical guidelines

Neuro-ophthalmology of pupillary function - practical guidelines

Pupillometric Assessment of Sleepiness in Narcolepsy

Autonomic function in narcolepsy: power spectrum analysis of heart rate variability

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