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Cyclic alternating pattern in narcolepsy patients and healthy controls after partial and total sleep deprivation

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Rositsa Poryazova^a, Esther Werth^a, Liborio Parrino^b, Mario Giovanni Terzano^b and Claudio L. Bassetti^{a, c, ,}

^a Department of Neurology, University Hospital Zurich, Switzerland
^b Department of Neurology, University Hospital Parma, Italy
^c Neurocenter (EOC) of Southern Switzerland, Neurology Department, Ospedale Civico, Via Tesserete 46, 6903 Lugano, Switzerland

Accepted 24 February 2011. 

Available online 31 March 2011.

Abstract

Objective

To investigate the regulation NREM sleep at baseline and in morning recovery sleep after partial and total sleep deprivation (SD) in narcolepsy–cataplexy (NC) using cyclic alternating pattern (CAP).

Methods

Daytime sleep under either increased (no sleep in the previous night) or decreased sleep pressure (allowing 4 h of sleep, 23:00–3:00 h) was recorded in ten drug-free, HLA-positive, hypocretin deficient NC patients and ten age, gender and body mass index matched healthy controls. Baseline sleep was also recorded and used for comparison purposes. CAP parameters were scored and analyzed for each subject.

Results

Narcolepsy patients had significantly lower CAP rate, CAP index, CAP time, number of CAP cycles, A1 index and number of A1 cycles in comparison to healthy controls at baseline as well as after partial and total SD. In both narcolepsy patients and healthy control subjects there was a significant decrease in these parameters after partial and total SD but the changes followed a similar pattern.

Conclusion

The persistence of baseline differences in CAP parameters between narcolepsy patients and healthy controls and their similar behavior after partial and total SD suggests similar homeostatic NREM sleep regulation but on a different level.

Significance

CAP analysis demonstrates that NREM sleep homeostasis although altered, is functional in narcolepsy patients.

Highlights

► Cyclic alternating pattern (CAP) rates are lower in narcolepsy patients in comparison to healthy controls. ► CAP rates decrease in both narcolepsy patients and healthy controls during morning recovery sleep after partial and total sleep deprivation. ► Our findings suggest that NREM sleep homeostasis although altered, is functional in narcolepsy patients.

Keywords: Narcolepsy; Sleep microstructure; Sleep deprivation; Cyclic alternating pattern (CAP); Sleep homeostasis

References

Fig. 1. Graphical representation of the dynamics in CAP parameters at baseline and after partial and total SD during morning recovery sleep. A, CAP rate, %; B, CAP index/h; C, CAP time, min; D, CAP number of cycles; E, A1 number of cycles; F, A1 index/h; G, A2 number of cycles; H, A2 index/h; I, A3 number of cycles; J, A3 index/h. The error indicators represent SEM.

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Table 1. Demographic and clinical characteristics of the 10 patients with NC and the 10 control subjects. Data is presented as mean ± SEM.
BMI refers to body mass index; ESS, Epworth Sleepiness Scale; UNS, Ullanlinna Narcolepsy Scale; SNS, Swiss Narcolepsy Scale; SCQ, Stanford Cataplexy Questionnaire.

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Table 2. Sleep parameters in the NC patients and the controls, mean ± SEM.
TTA, total time analyzed; TST, total sleep time; SL, sleep latency; REM-SL, REM sleep latency; SE, sleep efficiency; SWS, slow wave sleep; AHI, apnea/hypopnea index; PLMSI, periodic limb movements in sleep index; SD, sleep deprivation.

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Table 3. Full rANOVA table. Data is presented as mean ± SEM.

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The study was performed at the Department of Neurology, University Hospital Zurich. The CAP analysis was performed at the Department of Neurology, University Hospital Parma.

Corresponding author at: Neurocenter (EOC) of Southern Switzerland, Neurology Department, Ospedale Civico, Via Tesserete 46, 6903 Lugano, Switzerland. Tel.: +41 91 811 6658; fax: +41 91 811 6915.