b. OSAS 45 MRI 3 8 AHI 15/h OSAS 173 AHI 5/h 19 MRI 9 II movement disorders 1. Parkinson PD PD PD rapid eye movement sleep behavior disorder RBD

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1 * ****** Key Words : neurological disorder, sleep disturbance, cerebrovascular disease, Parkinson s disease, REM behavior disorder common Parkinson Parkinson disease PD I sleep apnea syndrome SAS Bassetti 3 39 polysomnography PSG obstructive SAS OSAS apnea hypopnea index AHI 10/h a. 71, body mass index 5 6,424 1,024 PSG 6 Yaggi OSAS AHI 5/h 325 AHI 5/h 3 88 OSAS Kaplan Meier OSAS Fig. 1 OSAS Sleep Disturbances in Neurological Disorders. Koichi HIRATA, Keisuke SUZUKI, Masayuki MIYAMOTO : Department of Neurology, Dokkyo Medical University 156

2 b. OSAS 45 MRI 3 8 AHI 15/h OSAS 173 AHI 5/h 19 MRI 9 II movement disorders 1. Parkinson PD PD PD rapid eye movement sleep behavior disorder RBD restless legs syndrome RLS Fig sleep benefit 11 PDLees PD PD 13 PD PD Fig. 1 Kaplan Meier estimates of the probability of event free survival among patients with obstructive sleep apnea syndrome and controls adapted from Yaggi HK et al, RBD RBD RBD 85% RBD RBD clonazepam mg 29 RBD PD Postuma PD 1 11 Lewy 4 Alzheimer % Fig. 3 PD Lewy 157

3 Fig. 2 Sleep disturbances in Parkinson s disease adapted from Suzuki K et al, RBD : rapid eye movement sleep behavior disorder, SAS : sleep apnea syndrome, RLS : restless legs syndrome, PLMS : periodic limb move ment during sleep Fig. 3 Kaplan Meier estimates of the cumulative incidence of neurodegenerative diseases in patients with idiopathic REM sleep behavior disorder adapted from Postuma RB et al, RBD MIBG RBD PD / 17 / RBD RBD PD Lewy 18 RBD PD RLS RLS periodic limb movement during sleep PLMS RLS PLMS PLM disorder PLMD 158

4 g/l 20 III 1. Alzheimer Alzheimer PSG sleep stage 1 K com plex P300 OSAS OSAS 50 OSAS P300 AHI 23 OSAS 24 OSAS OSAS 25 MR 26 functional MRI OSAS OSAS 27 COI 1 40 : , Parenti A, Macchi V, Snenghi R et al : Selective stroke of the solitary tract nuclei in two cases of central sleep apnoea. Clin Neuropathol 24 : , Bassetti C, Aldrich MS, Quint D : Sleep disordered breathing in patients with acute supra and infratentorial strokes. A prospective study of 39 patients. Stroke 28 : , Bassetti C, Aldrich MS : Sleep apnea in acute cerebrovascular diseases : final report on 128 patients. Sleep 22 : , Hu FB, Willett WC, Manson JE et al : Snoring and risk of car diovascular disease in women. J Am Coll Cardiol 35 : , Shahar E, Whitney CW, Redline S et al : Sleep disordered breathing and cardiovascular disease : cross sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163 : 19 25, Yaggi HK, Concato J, Kernan WN et al : Obstructive sleep ap nea as a risk factor for stroke and death. N Engl J Med 353 : , Davies CW, Crosby JH, Mullins RL et al : Case control study of cerebrovascular damage defined by magnetic resonance imag ing in patients with OSA and normal matched control subjects. Sleep 24 : , Nishibayashi M, Miyamoto M, Miyamoto T et al : Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions. J Clin Sleep Med 4 : , Suzuki K, Miyamoto M, Miyamoto T et al : Sleep disturbances associated with Parkinson s disease. In A Synopsis of Parkin son s Disease ed Abdul Qayyum Rana Intech, Rijeka, 2014, p Suzuki K, Okuma Y, Hattori N et al : Characteristics of sleep disturbances in Japanese patients with Parkinson s disease. A study using Parkinson s disease sleep scale. Mov Disord 22 : , Lees AJ, Blackburn NA, Campbell VL : The nighttime prob lems of Parkinson s disease. Clin Neuropharmacol 11 : , Suzuki K, Miyamoto M, Miyamoto T et al : Correlation be tween depressive symptoms and nocturnal disturbances in Japanese patients with Parkinson s disease. Parkinsonism Relat Disord 15 : 15 19, Suzuki K, Miyamoto T, Miyamoto M et al : Excessive daytime sleepiness and sleep episodes in Japanese patients with Par kinson's disease. J Neurol Sci 271 : 47 52, Schenck CH, Bundlie SR, Mahowald MW : Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially di agnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 46 : , Postuma RB, Gagnon JF, Vendette M et al : Quantifying the risk of neurodegenerative disease in idiopathic REM sleep be havior disorder. Neurology 72 : , Miyamoto T, Miyamoto M, Inoue Y et al : Reduced cardiac 123 I MIBG scintigraphy in idiopathic REM sleep behavior disorder. Neurology 67 : , Miyamoto T, Miyamoto M, Suzuki K et al : 123 I MIBG cardiac scintigraphy provides clues to the underlying neurodegenera 159

5 tive disorder in idiopathic REM sleep behavior disorder. Sleep 31 : , Miyamoto T, Miyamoto M, Iwanami M et al : Odor identifica tion test as an indicator of idiopathic REM sleep behavior dis order. Mov Disord 24 : , Oertel WH, Trenkwalder C, Zucconi M et al : State of the art in restless legs syndrome therapy : practice recommendations for treating restless legs syndrome. Mov Disord 22 Suppl 18 : S , Petit D, Gagnon JF, Fantini ML et al : Sleep and quantitative EEG in neurodegenerative disorders. J Psychosom Res 56 : , Dauvilliers Y : Insomnia in patients with neurodegenerative conditions. Sleep Med 8 Suppl 4 : S27 34, : , Beebe DW, Groesz L, Wells C et al : The neuropsychological ef fects of obstructive sleep apnea : a meta analysis of norm ref erenced and case controlled data. Sleep 26 : , Gale SD, Hopkins RO : Effects of hypoxia on the brain : neu roimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. J Int Neu ropsychol Soc 10 : 60 71, Alchanatis M, Deligiorgis N, Zias N et al : Frontal brain lobe impairment in obstructive sleep apnoea : a proton MR spec troscopy study. Eur Respir J 24 : , Macey KE, Macey PM, Woo MA et al : Inspiratory loading elic its aberrant fmri signal changes in obstructive sleep apnea. Respir Physiol Neurobiol 151 : 44 60, 2006 Sleep Disturbances in Neurological Disorders Koichi HIRATA, Keisuke SUZUKI, Masayuki, MIYAMOTO Department of Neurology, Dokkyo Medical University Sleep disturbances are common in neurological disor ders, and are caused by lesions involving the regulatory center of sleep and wakefulness and neurological symp toms interfering with sleep as well as co existence of sleep apnea syndrome, restless legs syndrome, rapid eye move ment sleep behavior disorder and circadian rhythm sleep disorder. Sleep disturbances detrimentally affect quality of life of patients; however, they are often overlooked and un derestimated. Therefore, adequate evaluation of sleep dis turbance is imperative in improving quality of life of pa tients with neurological disorders. In this review, we summarize sleep disturbances seen in neurological disor ders. 160

REM Rapid Eye Movement REM Zzz Non-REM

Sleep and sleep-related disorders in the elderly 20051027 REM Rapid Eye Movement REM Zzz Non-REM 90 180 270 360 90 How old is the elderly in sleep? 40 In: Primer of Polysomnography Circadian rhythm 24