Sleep disorders in anti-NMDAR encephalitis
Helena Ariño, Amaia Muñoz‐Lopetegi, Eugenia Martínez‐Hernández, Thaís Armangué, Mireia Rosa-Justícia, Domingo Escudero, Nuria Matos, Francesc Graus, Gisela Sugranyes, Josefina Castro‐Fornieles, Albert Compte, Josep Dalmau, Joan Santamaría
Abstract
<h3>Objective</h3> To describe the sleep disorders in anti–NMDA receptor encephalitis (anti-NMDARe). <h3>Methods</h3> 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. <h3>Results</h3> Eighteen patients (89% female, median age 26 years, interquartile range [IQR] 21–29 years) and 21 controls (81% female, median age 23 years, IQR 18–26 years) were included. In the acute stage, 16 (89%) patients reported insomnia and 2 hypersomnia; nightmares occurred in 7. After the acute stage, 14 (78%) had hypersomnia. At study admission (median 183 days after disease onset, IQR 110–242 days), 8 patients still had hypersomnia, 1 had insomnia, and 9 had normal sleep duration. Patients had more daytime sleepiness than controls (higher Barcelona Sleepiness Index, <i>p</i> = 0.02, and Epworth Sleepiness Score, <i>p</i> = 0.04). On V-PSG, sleep efficiency was similar in both groups, but patients more frequently had multiple and longer confusional arousals in non-REM (NREM) sleep (videos provided). In addition, 13 (72%) patients had cognitive deficits; 12 (67%) had psychological, social, or occupational disability; and 33% had depression or mania. Compared with controls, patients had a higher body mass index (median 23.5 [IQR 22.3–30.2] vs 20.5 [19.1–21.1] kg/m<sup>2</sup>; <i>p</i> = 0.007). Between disease onset and last follow-up, 14 (78%) patients developed hyperphagia, and 6 (33%) developed hypersexuality (2 requiring hospitalization), all associated with sleep dysfunction. <h3>Conclusions</h3> Sleep disturbances are frequent in anti-NMDARe. They show a temporal pattern (predominantly insomnia at onset; hypersomnia during recovery), are associated with behavioral and cognitive changes, and can occur with confusional arousals during NREM sleep.