Near-total absence of REM sleep co-occurring with normal cognition: an update of the 1984 paper
Near-total absence of REM sleep co-occurring with normal cognition: an update of the 1984 paper
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DOI：
10.1016/j.sleep.2018.09.003
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发表时间：
2018-12-01
期刊：
影响因子：
4.8
通讯作者：
Nir, Yuval
中科院分区：
文献类型：
--
作者：
Magidov, Efrat;Hayat, Hanna;Nir, Yuval
背景：快速眼动睡眠 (REMS) 被认为对于支持健康和正常认知至关重要。然而，目前尚不清楚 REMS 的减少是否以及如何损害认知能力。由于脑桥病变导致 REMS 取消的患者的罕见病例研究仍然零星，并且缺乏对认知状态的正式评估。 1984 年，Lavie 及其同事描述了 Y.C. - 一名患有脑桥病变且几乎完全没有 REMS 的男性，但过着正常的生活。在此，我们在原始报告发布 30 年后开始重新评估此人的 REMS 状态，并正式评估他的认知能力。方法：进行四次整晚多导睡眠记录以评估睡眠结构。睡眠评分是根据美国睡眠医学会 (AASM) 指南进行的。进行了颅脑计算机断层扫描 (CT) 成像，以及正式的神经心理学测试来评估认知功能。结果：Y.C. REMS 睡眠时间平均为 4.5%，相当于其年龄正常值的 0.055 个百分点。此外，剩余的快速眼动睡眠期发作时间很短，仅发生在晚上结束时。 CT 成像显示脑桥、小脑和丘脑有损伤和金属碎片。神经心理学评估显示出平均到高平均的认知能力、正常的记忆力和运动困难，包括言语和左手运动障碍。结论：据我们所知，这是多年后重新评估因脑桥病变导致的 REMS 丧失的唯一病例。我们发现，在整个成年生活中，REMS 几乎完全消失，没有明显代偿的迹象，认知状态也正常。这些结果为有关 REMS 在支持认知方面的功能作用的持续争论提供了独特的视角。 (c) 2018 Elsevier B.V. 保留所有权利。
Background: REM sleep (REMS) is considered vital for supporting well-being and normal cognition. However, it remains unclear if and how decreases in REMS impair cognitive abilities. Rare case studies of patients with REMS abolishment due to pontine lesions remain sporadic, and formal evaluation of cognitive status is lacking. In 1984, Lavie and colleagues described the case of Y.C. - a man with a pontine lesion and near-total absence of REMS who led a normal life. Here, we set out to re-evaluate this individual's REMS status 30 years after the original report, and formally assess his cognitive abilities.Methods: Four whole-night polysomnographic sleep recordings were conducted to evaluate sleep architecture. Sleep scoring was performed according to the American Academy of Sleep Medicine (AASM) guidelines. Cranial Computed Tomography (CT) imaging was performed, as well as formal neuropsychological testing to evaluate cognitive functions.Results: Y.C. averaged 4.5% of sleep time in REMS, corresponding to the 0.055 percentile of normal values for his age. Furthermore, residual REMS episodes were short and only occurred towards the end of the night. CT imaging revealed damage and metallic fragments in pons, cerebellum, and thalamus. Neuropsychological evaluation demonstrated average to high-average cognitive skills, normal memory, and motor difficulties including speech and left hand dyspraxia.Conclusions: To our knowledge, this is the only case where REMS loss resulting from pontine lesion was re-evaluated after many years. We find a near-total absence of REMS with no signs of significant compensation throughout adult life, along with normal cognitive status. The results provide a unique perspective on the ongoing debate regarding the functional role of REMS in supporting cognition. (c) 2018 Elsevier B.V. All rights reserved.