Abstract

Sleep dysfunction is highly prevalent across the spectrum of neurodegenerative conditions and is a key determinant of quality of life for both patients and their families. Mounting recent evidence also suggests that such dysfunction exacerbates cognitive and affective clinical features of neurodegeneration, as well as disease progression through acceleration of pathogenic processes. Effective assessment and treatment of sleep dysfunction in neurodegeneration is therefore of paramount importance; yet robust therapeutic guidelines are lacking, owing in part to a historical paucity of effective treatments and trials. Here, we review the common sleep abnormalities evident in neurodegenerative disease states and evaluate the latest evidence for traditional and emerging interventions, both pharmacological and nonpharmacological. Interventions considered include conservative measures, targeted treatments of specific clinical sleep pathologies, established sedating and alerting agents, melatonin, and orexin antagonists, as well as bright light therapy, behavioral measures, and slow-wave sleep augmentation techniques. We conclude by providing a suggested framework for treatment based on contemporary evidence and highlight areas that may emerge as major therapeutic advances in the near future.

摘要

睡眠功能障碍在各种神经退行性疾病中非常普遍，是患者及其家人生活质量的关键决定因素。最近越来越多的证据还表明，这种功能障碍会加剧神经变性的认知和情感临床特征，以及通过加速致病过程而加剧疾病进展。因此，有效评估和治疗神经退行性疾病中的睡眠功能障碍至关重要；然而，由于历史上缺乏有效的治疗和试验，因此缺乏强有力的治疗指南。在这里，我们回顾了神经退行性疾病状态下常见的睡眠异常，并评估了传统和新兴干预措施（包括药物和非药物）的最新证据。考虑的干预措施包括保守措施、针对特定临床睡眠病理的针对性治疗、既定的镇静和警觉剂、褪黑激素和食欲素拮抗剂，以及强光疗法、行为措施和慢波睡眠增强技术。最后，我们根据当代证据提供了一个建议的治疗框架，并强调了在不久的将来可能出现的主要治疗进展的领域。