The underlying contribution of the central nervous system in OSA is not clear although, there is speculation that dysregulation of the autonomic nervous system is a factor. In TBI, abnormal central nervous system levels of orexin or hypocretin have been associated with CRSD. Patients with Alzheimer disease often have CRSD. Sleep dysfunction can occur in seizure disorders, especially if associated with frequent nocturnal seizures. Rapid eye movement behavior disorder (RBD) is common in Parkinson’s disease. Other neurological disorders are associated with sleep disorders. 8-9Ĭentral sleep apnea and other sleep disordered breathing (collectively SDB) has been reported in 25-60% of all SCI patients and up to 83% of cervical SCI patients. CRSD are seen in 20-40% of patients after stroke. CSA is less prevalent after stroke and has a greater probability of recovery over time when compared to OSA. The mechanisms are unclear as discussed below but attributed to positional sleep apnea, stroke-related upper airway tone changes, and untreated OSA preceding the stroke (1A). 8-9 Additionally, risk factors for OSA, such as obesity and cardiovascular disease, are also risk factors for stroke. The epidemiology data indicates stroke survivors are at an increased risk for OSA with an incidence of 50-70% of within the first 3 months following stroke. 7 Given the heterogeneous nature of TBI and the typically complex recovery, epidemiology about sleep disorders after TBI remains inconsistent. 5-6 There is no correlation between the severity of the TBI and the type or severity of sleep disorder. 2-4 In TBI studies, sleep disorders are reported in up to 70% of the population. Sleep disorders associated with TBI include OSA, CSA, hypersomnia, periodic limb movement disorder, and circadian rhythm sleep disorders (CRSD). Epidemiology including risk factors and primary prevention Alternatively, secondary factors such as weight gain, depression, anxiety, pain, and medications may cause or exacerbate an underlying sleep disorder. In some cases, the CNS injury may be the primary cause of sleep dysfunction. The etiology of sleep disorders is often complex and, in the setting of CNS injury, often multifactorial. For further classification of sleep disorders, please see the International Classification of Sleep Disorders – Third Edition 1. Common sleep disorders, such as obstructive sleep apnea (OSA) have been described as well as less common sleep disorders such as central sleep apnea (CSA). ![]() A multitude of sleep disorders have been described including disorders of sleep initiation, disorders of sleep maintenance, and disorders of excessive somnolence. Sleep disorders have been studied in traumatic brain injury (TBI), spinal cord injury (SCI), stroke, Parkinson’s disease, epilepsy, dementia, and other neurologic conditions. Sleep disorders are commonly seen after injuries to the central nervous system (CNS) and in neuro-degenerative disorders.
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