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. 2017 Nov 1;40(11):zsx154.
doi: 10.1093/sleep/zsx154.

Sleepless Night and Day, the Plight of Progressive Supranuclear Palsy

Christine M Walsh  1 , Leslie Ruoff  2 , Kathleen Walker  1 , Alaisa Emery  1   2 , Jonathan Varbel  2 , Elissaios Karageorgiou  1   3 , Phi N Luong  1 , Irida Mance  1 , Hilary W Heuer  1 , Adam L Boxer  1 , Lea T Grinberg  1   4 , Joel H Kramer  1   5 , Bruce L Miller  1 , Thomas C Neylan  2   5
Affiliations

Sleepless Night and Day, the Plight of Progressive Supranuclear Palsy

Christine M Walsh et al. Sleep. .

Abstract

Objectives: To elucidate the unique sleep and waking characteristics in progressive supranuclear palsy (PSP), a neurodegenerative disease associated with motor deficits and dementia that largely affects the brainstem and thalamic regions.

Methods: A total of 20 PSP and 16 healthy older adult controls participated in this study. The participants underwent an overnight polysomnography and multiple sleep latency test (MSLT) the following day. Prior to the MSLT last trial, they were asked to complete the Stanford Sleepiness Scale. Data were assessed for measures of latency to sleep onset, sleep duration, waking, and sleep staging during the night. Mean sleep latency, a measure of daytime sleepiness, sleep onset rapid eye movement (REM) periods, and microsleeps were studied with the MSLT. Spectral analysis of wake electroencephalogram (EEG) was performed for 30-second periods at the start of each MSLT trial.

Results: PSP took significantly longer time to fall asleep (p < .001), slept less during the night (p ≤ .001), and had more wake after sleep onset than controls (p ≤ .001). PSP had less N2 sleep (p < .05) and N3 sleep (p < .05), and REM sleep (p < .001) than controls. During the MSLT, PSP took significantly longer to fall asleep (p < .001), did not have microsleeps when they remained awake throughout the assessment periods, but were subjectively sleepier than controls (p < .05). Gamma power was increased during wake EEG in PSP (p < .01).

Conclusions: Sleep/waking regulation and REM sleep regulation are disrupted in PSP, leading to profound sleep deprivation without recuperation. Our findings suggest a diminished homeostatic sleep drive in PSP. This hyperaroused state is unique and is a severely disabling feature of PSP.

Keywords: homeostatic sleep drive; hyperarousal; multiple sleep latency test; neurodegenerative disease; spectral analysis.

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Figures

Figure 1
Figure 1
PSP have difficulty sleeping during the night. The number of minutes it took both healthy older adult controls (Con) and PSP to fall asleep (blue), total sleep time (green) and wake during the sleep period time (orange) is shown in minutes. **p ≤ .01, ***p ≤ .001.
Figure 2
Figure 2
Percent time in sleep and wake during the sleep period time. The time of each sleep stage (N1, N2, N3, and REM) and waking (Wake) is shown as a percent of the sleep period time (time of the start of the first sleep stage to the end of the last sleep stage). Data are shown as the mean for Con (blue) and PSP (red). *p < .05, ***p ≤ .001.
Figure 3
Figure 3
Average latency to sleep during the MSLT. The average time to fall asleep across the MSLT trials is shown in minutes for each individual of both the Con (blue) and PSP (red) groups. ***p < .001.
Figure 4
Figure 4
Spectral analysis of frontal channels during wake EEG. Power within each energy bandwidth of interest is shown as mean ± SEM for both Con (blue) and PSP (red). **p < .01, ***p < .001.
See this image and copyright information in PMC

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