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Postgraduate Education Corner: CONTEMPORARY REVIEWS IN SLEEP MEDICINE |

Sleep-Related Problems in Neurologic DiseasesSleep Problems in Neurology

Mark Eric Dyken, MD; Adel K. Afifi, MD; Deborah C. Lin-Dyken, MD
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From the Department of Neurology, Division of Sleep Medicine (Dr Dyken) and the Department of Pediatrics, Division of Pediatric Neurology, Behavior, and Development (Drs Afifi and Lin-Dyken), University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA.

Correspondence to: Mark Eric Dyken, MD, Sleep Disorders Center, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242; e-mail: mark-dyken@uiowa.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(2):528-544. doi:10.1378/chest.11-0773
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There is a strong association between sleep-related problems and neurologic diseases. Neurologic diseases of the CNS can directly cause sleep problems when sleep-wake mechanisms associated with the ascending reticular activating system are involved. The major sleep disorders associated with neurologic problems are outlined in the International Classification of Sleep Disorders, 2nd edition, as hypersomnias of central origin, sleep-related breathing disorders, the insomnias, circadian rhythm sleep disorders, sleep-related movement disorders, parasomnias, and sleep-related epilepsy. In a patient with CNS disease and excessive sleepiness, sleep-related breathing disorders should be a first concern, given the known association between obstructive sleep apnea (OSA) and cerebrovascular disease and the potential confounding effects that OSA might have on an otherwise compromised ischemic CNS penumbra. A basic knowledge of the anatomy and physiology of the sleep-wake mechanisms provides a rationale for pharmacologic intervention. Nonpharmacologic treatments are also important, especially when sleep-related breathing disorders are a concern. In addition, as patients with neurologic diseases are often prone to the adverse effects of many medications, the specific treatment regimen for any given individual should always include good sleep hygiene practices that use cognitive behavioral therapy.

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