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Abstract
Objective To describe the sleep disorders in anti–NMDA receptor encephalitis (anti-NMDARe).
Methods Patients recovering from anti-NMDARe were invited to participate in a prospective observational single-center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment, and neuropsychological evaluation. Age- and sex-matched healthy participants served as controls.
Results Eighteen patients (89% female, median age 26 years, interquartile range [IQR] 21–29 years) and 21 controls (81% female, median age 23 years, IQR 18–26 years) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study admission (median 183 days after disease onset, IQR 110–242 days), 8 patients still had hypersomnia, 1 had insomnia, and 9 had normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p = 0.02, and Epworth Sleepiness Score, p = 0.04). On V-PSG, sleep efficiency was similar in both groups, but patients more frequently had multiple and longer confusional arousals in non-REM (NREM) sleep (videos provided). In addition, 13 (72%) patients had cognitive deficits; 12 (67%) had psychological, social, or occupational disability; and 33% had depression or mania. Compared with controls, patients had a higher body mass index (median 23.5 [IQR 22.3–30.2] vs 20.5 [19.1–21.1] kg/m2; p = 0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) developed hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction.
Conclusions Sleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), are associated with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.
Glossary
- BMI=
- body mass index;
- DSM=
- Diagnostic and Statistical Manual for Mental Disorders;
- EDS=
- excessive daytime sleepiness;
- HAM-D=
- Hamilton Rating Scale for Depression;
- IQR=
- interquartile range;
- KLS=
- Kleine-Levin syndrome;
- NMDAR=
- NMDA receptor;
- NREM=
- non-REM;
- PANSS=
- Positive and Negative Syndrome Scale;
- PSG=
- polysomnography;
- V-PSG=
- video-polysomnography;
- YMRS=
- Young Mania Rating Scale
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received September 24, 2019.
- Accepted in final form January 26, 2020.
- © 2020 American Academy of Neurology
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