title: Stages of sleep pathology in spinocerebellar ataxia type 2 (SCA2).
abstract: BACKGROUND
  Autosomal dominant spinocerebellar ataxia type 2 (SCA2) bears clinical and neuropathologic similarities to sporadic multisystem atrophy (MSA) or Parkinson disease, in which sleep pathology is well documented. However, those clinical entities have a marked variability of the reported sleep disturbances, and their etiology is heterogeneous. In contrast, the study of SCA2 provides an opportunity to examine a molecularly homogeneous patient group, in which disease stages can be defined not only based on disease duration and ataxia scores, but also with regard to modulatory effects of mutation size.
  
  
  OBJECTIVE
  To examine the presence and progression of sleep pathology in SCA2.
  
  
  METHODS
  We analyzed eight patients with disease durations of 3 to 31 years, all with medium size SCA2 expansions (CAG 38 to 49), using clinical scores, sleep interviews, and video-polysomnography (VPSG) recordings.
  
  
  RESULTS
  Almost all patients reported good subjective sleep quality and negated incidents of REM behavior disorder (RBD). At early disease stages, however, REM without atonia in four patients' VPSG suggested subclinical RBD. This was accompanied by a consistent reduction of REM density. In three patients at later SCA2 stages, REM sleep was undetectable, whereas slow wave sleep (SWS) was markedly increased at the cost of light sleep. Periodic leg movements, apnea, or hypopnea were not prominent.
  
  
  CONCLUSIONS
  Progressive loss of dream recall in spinocerebellar ataxia type 2 was found and correlated with stages of REM more than non-REM pathology in video-polysomnography. These stages correspond to the progressive atrophy from the pons, nigrostriatal projection, and locus ceruleus to the thalamus.
authors.affiliation: Department of Neurology, J.W. Goethe-University, Frankfurt/Main, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Tuin
authors.forename: U
authors.initials: U
authors.lastname: Voss
authors.forename: J-S
authors.initials: JS
authors.lastname: Kang
authors.forename: K
authors.initials: K
authors.lastname: Kessler
authors.forename: U
authors.initials: U
authors.lastname: Rüb
authors.forename: D
authors.initials: D
authors.lastname: Nolte
authors.forename: H
authors.initials: H
authors.lastname: Lochmüller
authors.forename: S
authors.initials: S
authors.lastname: Tinschert
authors.forename: D
authors.initials: D
authors.lastname: Claus
authors.forename: K
authors.initials: K
authors.lastname: Krakow
authors.forename: B
authors.initials: B
authors.lastname: Pflug
authors.forename: H
authors.initials: H
authors.lastname: Steinmetz
authors.forename: G
authors.initials: G
authors.lastname: Auburger
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D017286:Polysomnography; D012894:Sleep Stages / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000150:complications / Q000235:genetics / Q000503:physiopathology*; D020754:Spinocerebellar Ataxias / Q000150:complications / Q000235:genetics / Q000503:physiopathology*