Study Objectives:

This review aimed to summarize current knowledge about disrupted nighttime sleep (DNS) and sleep instability in narcolepsy, including self-reported and objective assessments, potential causes of sleep instability, health consequences and functional burden, and management.

Methods:

One hundred and two peer-reviewed publications from a PubMed search were included.

Results:

DNS is a key symptom of narcolepsy but has received less attention than excessive daytime sleepiness (EDS) and cataplexy. There has been a lack of clarity regarding the definition of DNS, as many sleep-related symptoms and conditions disrupt sleep quality in narcolepsy (eg, hallucinations, sleep paralysis, rapid eye movement sleep behavior disorder, nightmares, restless legs syndrome/periodic leg movements, nocturnal eating, sleep apnea, depression, anxiety). In addition, the intrinsic sleep instability of narcolepsy results in frequent spontaneous wakings and sleep stage transitions, contributing to DNS. Sleep instability likely emerges in the setting of orexin insufficiency/deficiency, but its exact pathophysiology remains unknown. DNS impairs quality of life among people with narcolepsy, and more research is needed to determine its contributions to cardiovascular risk. Multimodal treatment is appropriate for DNS management, including behavioral therapies, counseling on sleep hygiene, and/or medication. There is strong evidence showing improvement of self-reported sleep quality and objective sleep stability measures with sodium oxybate, but rigorous clinical trials with other pharmacotherapies are needed. Treatment may be complicated by comorbidities, concomitant medications, and mood disorders.

Conclusions:

DNS is a common symptom of narcolepsy deserving consideration in clinical care and future research.

中文翻译：

---

发作性睡病患者夜间睡眠中断和睡眠不稳定

学习目标：

本综述旨在总结目前关于发作性睡病患者夜间睡眠中断 (DNS) 和睡眠不稳定的知识，包括自我报告和客观评估、睡眠不稳定的潜在原因、健康后果和功能负担以及管理。

方法：

包括来自 PubMed 搜索的 102 篇同行评审出版物。

结果：

DNS 是发作性睡病的主要症状，但与白天过度嗜睡 (EDS) 和猝倒相比受到的关注较少。DNS 的定义缺乏明确性，因为许多睡眠相关症状和状况会扰乱发作性睡病的睡眠质量（例如，幻觉、睡眠麻痹、快速眼动睡眠行为障碍、噩梦、不安腿综合征/周期性腿部运动） 、夜间进食、睡眠呼吸暂停、抑郁、焦虑）。此外，发作性睡病的内在睡眠不稳定性导致频繁的自发觉醒和睡眠阶段转换，从而导致 DNS。在食欲素不足/缺乏的情况下可能会出现睡眠不稳定，但其确切的病理生理学仍然未知。DNS 会损害发作性睡病患者的生活质量，需要更多的研究来确定其对心血管风险的贡献。多模式治疗适用于 DNS 管理，包括行为疗法、睡眠卫生咨询和/或药物治疗。有强有力的证据表明羟丁酸钠可改善自我报告的睡眠质量和客观的睡眠稳定性指标，但需要与其他药物疗法进行严格的临床试验。治疗可能会因合并​​症、伴随药物和情绪障碍而复杂化。但需要与其他药物疗法进行严格的临床试验。治疗可能会因合并​​症、伴随药物和情绪障碍而复杂化。但需要与其他药物疗法进行严格的临床试验。治疗可能会因合并​​症、伴随药物和情绪障碍而复杂化。

结论：

DNS 是发作性睡病的常见症状，值得临床护理和未来研究考虑。