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Abstract
IntroductionExcessive daytime sleepiness is a commonly reported problem in dementia with Lewy bodies (DLB). We examined the relationship between nighttime sleep continuity and the propensity to fall asleep during the day in clinically probable DLB compared to Alzheimer’s disease (AD) dementia.MethodsA full-night polysomnography was carried out in 61 participants with DLB and 26 with AD dementia. Among this group, 32 participants with DLB and 18 with AD dementia underwent a daytime Multiple Sleep Latency Test (MSLT). Neuropathologic examinations of 20 participants with DLB were carried out.ResultsAlthough nighttime sleep efficiency did not differentiate diagnostic groups, the mean MSLT initial sleep latency was significantly shorter in participants with DLB than in those with AD dementia (mean 6.4 ± 5 minutes vs 11 ± 5 minutes, P <0.01). In the DLB group, 81% fell asleep within 10 minutes compared to 39% of the AD dementia group (P <0.01), and 56% in the DLB group fell asleep within 5 minutes compared to 17% in the AD dementia group (P <0.01). Daytime sleepiness in AD dementia was associated with greater dementia severity, but mean MSLT latency in DLB was not related to dementia severity, sleep efficiency the night before, or to visual hallucinations, fluctuations, parkinsonism or rapid eye movement sleep behavior disorder. These data suggest that abnormal daytime sleepiness is a unique feature of DLB that does not depend on nighttime sleep fragmentation or the presence of the four cardinal DLB features. Of the 20 DLB participants who underwent autopsy, those with transitional Lewy body disease (brainstem and limbic) did not differ from those with added cortical pathology (diffuse Lewy body disease) in dementia severity, DLB core features or sleep variables.ConclusionsDaytime sleepiness is more likely to occur in persons with DLB than in those with AD dementia. Daytime sleepiness in DLB may be attributed to disrupted brainstem and limbic sleep–wake physiology, and further work is needed to better understand the underlying mechanisms.
Highlights
Excessive daytime sleepiness is a commonly reported problem in dementia with Lewy bodies (DLB)
The DLB group had higher self-reported depression scores compared to the Alzheimer’s disease (AD) dementia group, though there was no difference in informant report of depression between groups using the Neuropsychiatric Inventory Questionnaire–Short Form (NPI-Q)
There was no difference in demographics, dementia severity, number or duration of core DLB features between patients who participated in the Multiple Sleep Latency Test (MSLT) compared to those who opted out
Summary
Excessive daytime sleepiness is a commonly reported problem in dementia with Lewy bodies (DLB). Daytime somnolence is commonly reported in patients with dementia with Lewy bodies (DLB) [1,2,3], and it is a major stressor for caregivers [4]. When daytime sleepiness is subjectively and objectively found in AD dementia, it is typically related to greater dementia severity [5,6]. Sleep fragmentation due to respiratory and movement-related arousals can occur in DLB and Parkinson’s disease [9,10,11,12], but it is not known if these nocturnal arousals are sufficient to interfere with daytime alertness
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