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Journal of Neurology
Published in: Journal of Neurology 4/2019

01-04-2019 | Insomnia | Original Communication

Sleep disturbances are common in patients with autoimmune encephalitis

Authors: Margaret S. Blattner, Gabriela S. de Bruin, Robert C. Bucelli, Gregory S. Day

Published in: Journal of Neurology | Issue 4/2019

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Abstract

Objectives

Autoimmune encephalitis (AE) is increasingly recognized as an important cause of subacute cognitive decline, seizures, and encephalopathy, with an ever-broadening clinical phenotype. Sleep disturbances are reported in AE patients, including rapid eye movement sleep behavior disorder, hypersomnia, fragmented sleep, and sleep-disordered breathing; however, the prevalence of sleep disturbances and contributions to outcomes in AE patients remain unknown. There is a need to determine the prevalence of sleep disturbances in AE patients, and to clarify the relationship between specific autoantibodies and disruptions in sleep.

Methods

Clinical history, results of serum and cerebrospinal fluid testing, electroencephalography, and neuroimaging were reviewed from 26 AE patients diagnosed and managed at our tertiary care hospital. Polysomnography was performed in patients with clinical indications, yielding data from 12 patients.

Results

The median age of AE patients was 53 years (range 18–83). Autoantibodies against intracellular antigens (including Ma and Hu autoantibodies) were identified in 6/26 (23%) patients, while autoantibodies against cell-surface neuronal antigens (including NMDAR and LGI1) were identified in 20/26 (77%) patients. New sleep complaints were reported by 19/26 (73%) AE patients, including gasping or snoring (9/19, 47%), dream enactment behavior (6/19, 32%), insomnia (5/19, 29%), hypersomnia (4/19, 21%), other parasomnias (4/19, 21%), and dream-wake confusional states (2/19, 11%). Dream enactment behaviors were particularly common in AE associated with LGI1 autoantibodies, reported in 4/7 (57%) patients. Polysomnography showed reduced total sleep time, stage 3 and rapid eye movement sleep, and prominent sleep fragmentation.

Conclusion

Sleep disturbances are common in AE, warranting active surveillance in affected patients. Improved identification and treatment of sleep disorders may reduce morbidity associated with AE and improve long-term outcomes.
Appendix
Available only for authorised users
Footnotes
1
Details available via the Mayo Clinic website: https://​www.​mayocliniclabs.​com/​test-catalog/​Overview.
 
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Metadata
Title
Sleep disturbances are common in patients with autoimmune encephalitis
Authors
Margaret S. Blattner
Gabriela S. de Bruin
Robert C. Bucelli
Gregory S. Day
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 4/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-019-09230-2

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