title: Manipulation of skin temperature improves nocturnal sleep in narcolepsy.
abstract: OBJECTIVE
  Besides excessive daytime sleepiness, disturbed nocturnal sleep is a major complaint of patients with narcolepsy. Previously, alterations in skin temperature regulation in narcoleptic patients have been shown to be related to increased sleepiness. This study tests the hypothesis that direct control of nocturnal skin temperature might be applied to improve the disturbed sleep of narcoleptic patients.
  
  
  METHODS
  Participants were eight patients (five males) diagnosed as having narcolepsy with cataplexy according to the ICSD-2 criteria, mean (SD) age 28.6 (6.4) years, range 18-35 years. During two nights, sleep was recorded polysomnographically while proximal and distal skin temperature were manipulated using a comfortable thermosuit that induced skin temperature to cycle slowly with an amplitude of only 0.4 degrees C within the comfortable range normally observed during sleep. Logistic regression was used to evaluate the effect of skin temperature manipulation on the probability of occurrence of different sleep stages and nocturnal wakefulness.
  
  
  RESULTS
  Proximal skin warming significantly suppressed wakefulness and enhanced slow wave sleep (SWS). In contrast, distal skin warming enhanced wakefulness and stage 1 sleep at the cost of SWS and REM sleep. The optimal combination of proximal skin warming and distal skin cooling led to a 160% increase in SWS, a 50% increase in REM sleep and a 68% decrease in wakefulness, compared with the least beneficial combination of proximal skin cooling and distal skin warming.
  
  
  CONCLUSIONS
  Subtle skin temperature manipulations under controlled conditions significantly improved the typical nocturnal sleep problems in narcolepsy.
authors.affiliation: Leiden University Medical Centre, Department of Neurology (K5Q), PO Box 9600, 2300 RC, Leiden, The Netherlands. r.fronczek@lumc.nl
authors.forename: R
authors.initials: R
authors.lastname: Fronczek
authors.forename: R J E M
authors.initials: RJ
authors.lastname: Raymann
authors.forename: S
authors.initials: S
authors.lastname: Overeem
authors.forename: N
authors.initials: N
authors.lastname: Romeijn
authors.forename: J G
authors.initials: JG
authors.lastname: van Dijk
authors.forename: G J
authors.initials: GJ
authors.lastname: Lammers
authors.forename: E J W
authors.initials: EJ
authors.lastname: Van Someren
mesh_terms: D000293:Adolescent; D000328:Adult; D001833:Body Temperature Regulation / Q000502:physiology*; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D009290:Narcolepsy / Q000175:diagnosis* / Q000628:therapy; D017286:Polysomnography / Q000379:methods; D012881:Skin Temperature; D012890:Sleep; D012893:Sleep Wake Disorders / Q000175:diagnosis; D013696:Temperature; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology