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Schlafstörungen bei degenerativen Demenzen

Sleep disturbance in patients with degenerative dementias

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Zusammenfassung

Fragestellung

Patienten mit Demenz leiden neben ihrer kognitiven Störung an einer Störung des Schlaf-Wach-Rhythmus, wobei der Schlaf häufig fragmentiert und durch eine Reduktion der Schlaffizienz gekennzeichnet ist. Nur, in wenigen Studien wurden bisher eine polysomnographische Evaluation des Schlafs von Patienten mit Demenz vorgenommen. Ziel dieser Arbeit ist es, spezifische und unspezifische polysomnographische Veränderungen bei Patienten mit unterschiedlichen Demenzen zu charakterisieren.

Patienten und Methodik

Bisher konnten 21 Patienten vor Beginn einer Behandlung mit einem Antidementivum und ohne weitere psychotrope Medikation mit einer Polysomnographie im Rahmen der diagnostischen Abklärung einer Demenz untersucht werden. Alle Patienten erhielten vor der Durchführung der Polysomnographie eine ausführliche Untersuchung, die eine neurologische und psychiatrische Untersuchung, Laborwertbestimmung, EEG, CT oder MRT, Doppler-Untersuchung der zuführenden Hirngefäße, optional eine Lumbalpunktion, sowie eine ausführliche neuropsychologische Testung (CERAD-Testbatterie) umfasste. Nach den internationalen Standardkriterien wurde bei 14 Patienten eine DAT, bei 5 Patienten eine FTD diagnostiziert; bei 2 Patienten bestand der dringende Verdacht auf eine Lewy-Körperchen Demenz.

Ergebnisse

Bei allen Patienten wurde eine erhebliche Störung der Schlafkontinuität gefunden, die meist wesentlich stärker ausgeprägt war, als sie subjektiv von den Patienten wahrgenommen wurde. Der REM-Schlaf war bei Patienten mit DAT im Vergleich zu Patienten mit FTD signifikant reduziert. Zudem wurden vorwiegend bei Patienten mit DAT häufig schlafbezogene Atemstörungen (SBAS) und z. T. auch periodische Beinbewegungen (PLMS) im Schlaf beobachtet.

Schlussfolgerung

Die bisherigen Ergebnisse zeigen, dass Schlafstörungen bei Patienten mit Demenz häufig auftreten und vermutlich deutlich häufiger sind als bisher angenommen. Schlafstörungen, die mit Störungen der Schlafarchitektur und des REM-Schlafs verbunden sind sowie durch zusätzliche Faktoren wie SBAS und PLMS bedingt sind, können selbst eine Verschlechterung der kognitiven Leistungsfähigkeit bewirken und damit eine wichtige Rolle hinsichtlich des Verlaufs der dementiellen Erkrankung darstellen.

Summary

Question of the study

Besides their cognitive disorders, patients with dementia commonly present with a sleep-wake rhythm disturbance, sleep fragmentation, and sleep efficiency reduction. To date, very few studies have comparatively evaluated sleep disorders in different classes of dementia. The objective of our examination was to detect specific and unspecific polysomnographic changes in different dementia types.

Patients and methods

To date, 21 patients with a low to moderate grade of dementia have been examined. All patients received a thorough examination including routine neurologic and psychiatric examination, blood chemistry, CT/MRI, neuropsychologic evaluation, EEG and, when necessary, lumbar puncture, and Doppler/duplex. According to international standard criteria, 14 patients were classified with Alzheimer's disease (DAT), five with frontotemporal dementia (FTD), and two with dementia with Lewy bodies (DLB). Patients with vascular dementia were not included in our analysis due the heterogeneity of this particular type of dementia. After an adaptation night, a polysomnography was performed on all patients, who were free, of psychotropic medication before the beginning of therapy with antidementive medication.

Results

In all patients, a marked sleep continuity disruption was observed, which in most cases was not perceived by the patients. Moreover, in patients with DAT, a more accentuated REM sleep reduction in comparison to patients with FTD, was found. In addtion,. we detected a high amount of sleep-related breathing disorders (SRBD) and periodic leg movements with arousals (PLMS), predominantly in patients with DAT.

Conclusion

The prevalence of sleep disorders in patients with primary dementias is clearly higher than previously suspected. Sleep disturbances due to alteration of sleep architecture and REM sleep and due to additional factors such as SRBD and PLMS may be related to the deterioration of cognitive performance and thus can exert an important role in the expression and course of dementia.

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Authors and Affiliations

  1. Klinik für Neurologie der Universitätsklinik Marburg, Marburg, Deutschland

    Anja Haag & Andreas Becker

  2. Klinik für Neurochirurgie, Sektion Epileptologie, der Universitätsklinik Freiburg, Freiburg, Deutschland

    Rodrigo Rocamora

  3. Klinik für innere Medizin, Abt. Pneumologie, Universitätsklinik Marburg, Marburg, Deutschland

    Thomas Penzel

  4. Klinik für Neurologie, Universitätsklinik Bonn, Bonn, Deutschland

    Richard Dodel

  5. Department of Psychiatry and Psychotherapy, University Clinic Marburg, Rudolf Bultmann Str. 8, D-35039, Marburg

    Rodrigo Rocamora, Andreas Thum, Marco Giesler, Anja Haag, Jürgen-Christian Krieg & Ulrich Hemmeter MD PhD

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  1. Rodrigo Rocamora
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  2. Andreas Thum
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Rocamora, R., Thum, A., Giesler, M. et al. Schlafstörungen bei degenerativen Demenzen. Somnologie 9, 139–147 (2005). https://doi.org/10.1111/j.1439-054X.2005.00053.x

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  • DOI: https://doi.org/10.1111/j.1439-054X.2005.00053.x

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