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Autonomic Dysfunction in Sleep Disorders

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Autonomic Disorders in Clinical Practice

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Abstract

The autonomic nervous system (ANS) main function is the maintenance of body homeostasis and the promotion of adaptation against external changes. Sleep state deeply differs from waking state in terms of metabolic needs, motor activity, and environmental interaction. As a direct consequence, ANS plays a role of utmost importance during: a) the passage between wakefulness and sleep; b) the maintenance of sleep and its architecture (i.e., sleep phases and cycles); and c) the awakening. The subtle balance between sympathetic and parasympathetic activity dynamically changes during all these phases, in order to regulate cardiovascular function, body temperature, neuroendocrine system, and awareness. The functional association between ANS and sleep is sustained also by strict anatomical relationships between ANS and sleep structures, in particular in the hypothalamus and brainstem. All these assumptions account for the fact that sleep disorders may be associated with autonomic dysfunction.

The main sleep disorders associated with autonomic dysfunction are insomnia, obstructive sleep apnoea (OSA), narcolepsy, REM behaviour disorder, restless legs syndrome, and the rare idiopathic hypersomnia. With the partial exception of OSA, the supposed pathological mechanisms underlying the ANS involvement are often controversial, but result in a common final consequence, that is a sustained imbalance between sympathetic and parasympathetic activity. When sleep disorders persist, the cardiovascular alterations during sleep (i.e., heart rate and blood pressure increase, arrhythmias, blunted day-to-night blood pressure dipping) may also occur during daytime, resulting in increased cardiovascular diseases and stroke risk.

Taken together, this evidence suggests that the prevention, diagnosis, and treatment of sleep disorders and the prompt evaluation and characterisation of the associated ANS involvement may be of paramount importance in reducing morbidity and mortality due to cardiovascular and cerebrovascular diseases.

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Authors and Affiliations

  1. ‘Rita Levi Montalcini’ Department of Neuroscience, University of Torino, Turin, Italy

    Marco Bozzali & Alberto Romagnolo

  2. SC Neurologia 2U, AOU City of Health and Science, Turin, Italy

    Marco Bozzali & Alberto Romagnolo

  3. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Raffaele Manni & Michele Terzaghi

  4. Unit of Sleep Medicine and Epilepsy, IRCCS Istituto Mondino Foundation, Pavia, Italy

    Michele Terzaghi

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  1. Marco Bozzali
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  2. Raffaele Manni
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  3. Alberto Romagnolo
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  4. Michele Terzaghi
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Correspondence to Marco Bozzali .

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Editors and Affiliations

  1. Emergency Neurology, Fondazione Istituto Neurologico Nazionale Mondino, Pavia, Italy

    Giuseppe Micieli

  2. Dept. of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany

    Max Hilz

  3. Neurology, Operative Director IRCCS ISNB, University of Bologna, Bologna, Italy

    Pietro Cortelli

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Bozzali, M., Manni, R., Romagnolo, A., Terzaghi, M. (2023). Autonomic Dysfunction in Sleep Disorders. In: Micieli, G., Hilz, M., Cortelli, P. (eds) Autonomic Disorders in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-43036-7_9

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