Sleep Disorders In Anti-NMDAR Encephalitis (1605)

Objective: To describe the sleep disorders in anti-NMDA receptor encephalitis (anti-NMDARe)

Background: Patients with anti-NMDARe often have sleep problems. The severity and complexity of the accompanying neuropsychiatric symptoms, mask these sleep disorders, complicate their assessment, and explain the lack of prior studies

Design/Methods: Patients recovering from anti-NMDARe were invited to participate in a prospective observational single center study including comprehensive clinical, video-polysomnography (V-PSG) sleep assessment and neuropsychological evaluation. Age and sex-matched healthy participants served as controls

Results: Eighteen patients (89% female, median age 26 years, IQR 21–29) and 21 controls (81% female, median age 23 years, IQR 18–26) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia (1 rapidly changed to insomnia). After the acute stage, 14 (78%) had hypersomnia. At study-admission (median 183 days after disease-onset, IQR 110–242) 8 patients still had hypersomnia, 1 insomnia, and 9 normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, p=0.02, and Epworth Sleepiness Score, p=0.04), but a similar perception of sleep quality. On V-PSG, sleep efficiency was similar in both groups although patients had more frequently multiple and longer confusional arousals in NREM sleep (p=0.03). Additionally, 13 (72%) patients had cognitive deficits, 12 (67%) psychological, social, or occupational disability, and 33% depression or mania. Between disease-onset and the last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction. At study-admission, patients had a higher body mass index compared with controls (median, IQR: 23.5, 22.3–30.2 vs. 20.5, 19.1–21.1; p=0.007)

Conclusions: Sleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), associate with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.

Disclosure: Dr. Ariño has nothing to disclose. Dr. Munoz-Lopetegi has nothing to disclose. Dr. Martinez-Hernandez has nothing to disclose. Dr. Armangue has received research support from Mutua Madrilena Foundation. Dr. Santamaria has nothing to disclose. Dr. Dalmau has received personal compensation in an editorial capacity for Editor: Neurology, Neuroimmunology, Neuroinflammation; and UpToDate. Dr. Dalmau has received royalty, license fees, or contractual rights payments from Euroimmune. Dr. Dalmau has received research support from Sage therapeutics.