title: Sleep structure: a new diagnostic tool for stage determination in sleeping sickness.
abstract: Human African trypanosomiasis (HAT), due to the transmission of Trypanosoma brucei (T. b.) gambiense and T. b. rhodesiense by tsetse flies, is re-emerging in inter-tropical Africa. It evolves from the hemolymphatic Stage I to the meningo-encephalitic Stage II. The latter is generally treated with melarsoprol, an arseniate provoking often a deadly encephalopathy. A precise determination of the HAT evolution stage is therefore crucial. Stage II patients show: (i) a deregulation of the 24-h distribution of the sleep-wake alternation; (ii) an alteration of the sleep structure, with frequent sleep onset rapid eye movement (REM) periods (SOREMPs). Gambian HAT was diagnosed in eight patients (four, Stage II; three, Stage I; one, "intermediate" case) at the trypanosomiasis clinic at Viana (Angola). Continuous 48-h polysomnography was recorded on Oxford Medilog 9000-II portable systems before and after treatment with melarsoprol (Stage II) or pentamidine (Stage I and "intermediate" stage). Sleep traces were visually analyzed in 20-s epochs using the PRANA software. Stage II patients showed the complete sleep-wake syndrome, partly reversed by melarsoprol 1 month later. Two Stage I patients did not experience any of these alterations. However, the "intermediate" and one Stage I patients exhibited sleep disruptions and/or SOREMPs, persistent after pentamidine treatment. Polysomnography may represent a diagnostic tool to distinguish the two stages of HAT. Especially, SOREMPs appear shortly after the central nervous system invasion by trypanosomes. The reversibility of the sleep-wake cycle and sleep structure alterations after appropriate treatment constitutes the basis of an evaluation of the healing process.
authors.affiliation: EA 3734 Neurobiologie des états de Vigilance, and IFR-19, Claude-Bernard-Lyon 1 University, 8 Avenue Rockefeller, 69373 Lyon Cédex 08, France. a.buguet@free.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Buguet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bisser
authors.forename: Théophile
authors.initials: T
authors.lastname: Josenando
authors.forename: Florian
authors.initials: F
authors.lastname: Chapotot
authors.forename: Raymond
authors.initials: R
authors.lastname: Cespuglio
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008549:Melarsoprol / Q000627:therapeutic use; D017286:Polysomnography; D012890:Sleep; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014347:Trypanosoma brucei gambiense / Q000254:growth & development*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D014344:Trypanocidal Agents; D008549:Melarsoprol