Sleeping with and Without Norepinephrine: Effects of Metoclopramide and D,L-Threo-3,4-Dihydroxyphenylserine on Sleep in Dopamine Beta-Hydroxylase Deficiency

Abstract

Sleep characteristics are presented for two female patients (aged 21 and 31 years) with central and peripheral dopamine beta-hydroxylase (DBH) deficiency. This deficiency results in the absence of norepinephrine, epinephrine, and their metabolites in plasma, urine, and cerebrospinal fluid, while concentrations of dopamine are increased. The sleep pattern of these patients was studied when they were untreated, after blockade of central dopamine receptors with metoclopramide, and after restoring norepinephrine production with D,L-threo-3,4-dihydroxyphenylserine (DOPS). When the patients were untreated sleep duration was normal, with tendencies of a decreased amount of rapid eye movement (REM) sleep, presence of alpha-delta sleep, and an increased amount of slow-wave sleep. The amount of REM sleep varied between 18 and 21% of sleep period time. Administration of metoclopramide resulted in a slight reduction of REM sleep to 16-17%, whereas wakefulness after sleep onset increased. During treatment with DOPS, an increase in the amount of REM sleep was observed in both patients to an average amount of 27%. These data indicate that in patients with DBH deficiency norepinephrine is not essential for the development of a normal sleep/wake pattern but may have a facilitatory role in the generation of REM sleep.