title: Sympathetic and cardiovascular changes during sleep in narcolepsy with cataplexy patients.
abstract: OBJECTIVE
  Neural mechanisms underlying sleep-onset rapid eye movement (REM) periods (SOREMPs) in narcolepsy and the role of hypocretin in driving sympathetic changes during sleep are misunderstood. We aimed to characterize autonomic changes during sleep in narcolepsy with cataplexy (NC) patients to clarify the nature of SOREMP events and the effect of hypocretin deficiency on sympathetic activity during sleep.
  
  
  METHODS
  We observed 13 hypocretin-deficient NC patients and five healthy controls who underwent nocturnal video-polysomnography (v-PSG) with blood pressure (BP) recording, heart rate (HR), skin sympathetic activity (SSA), and muscle sympathetic nerve activity (MSNA) from the peroneal nerve by microneurography.
  
  
  RESULTS
  Compared to wake, control participants displayed a progressive significant decrease of BP and sympathetic activities during nonrapid eye movement (NREM) sleep and an increase of autonomic activity during REM sleep, as expected. NC patients showed: (1) a decrease of sympathetic activities during SOREMP comparable to NREM sleep stage 1 (N1) but in contrast to the increased activity typical of REM sleep; and (2) physiologic sympathetic change during the following sleep stages with a progressive decrease during NREM sleep stage 2 (N2) and NREM sleep stage 3 (N3) and a clear increase in REM sleep, though BP did not show the physiologic decrease during sleep (nondipper pattern).
  
  
  CONCLUSIONS
  SOREMPs in NC patients lack the sympathetic activation occurring during physiologic REM sleep, thus suggesting a dissociated REM sleep condition. In addition, our data indicated that hypocretin plays a limited role in the regulation of sympathetic changes during sleep.
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy. Electronic address: vincenzo.donadio@unibo.it.
authors: Vincenzo
authors: V
authors: Donadio
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy.
authors: Rocco
authors: R
authors: Liguori
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy.
authors: Stefano
authors: S
authors: Vandi
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy.
authors: Maria Pia
authors: MP
authors: Giannoccaro
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy.
authors: Fabio
authors: F
authors: Pizza
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy.
authors: Valentina
authors: V
authors: Leta
authors: IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy; Dipartimento di Scienze Biomediche e NeuroMotorie, Università di Bologna, Italy.
authors: Giuseppe
authors: G
authors: Plazzi
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002319:Cardiovascular System / Q000503:physiopathology*; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009290:Narcolepsy / Q000503:physiopathology*; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D012895:Sleep, REM / Q000502:physiology; D013564:Sympathetic Nervous System / Q000503:physiopathology*; D055815:Young Adult
keywords: Microneurography; Muscle sympathetic nerve activity; Narcolepsy with cataplexy; SOREMPs; Skin sympathetic activity; Sleep