Sleep Neurology

August 2017, Volume 23, Issue 4
BROWSE ISSUES

Sleep Neurology

August 2017, Vol.23, No.4

Guest Editor:

Erik K. St. Louis, MD, MS, FAAN, FAASM

Editor-in-Chief:

Steven L. Lewis, MD, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
Brain Circuitry Controlling Sleep and Wakefulness
Horner, Richard L.; Peever, John H.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 955-972
doi: 10.1212/CON.0000000000000495
Diagnostic Approach and Investigation in Sleep Medicine
Silber, Michael H.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 973-988
doi: 10.1212/CON.0000000000000491
Narcolepsy and Other Central Hypersomnias
Dauvilliers, Yves; Barateau, Lucie
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 989-1004
doi: 10.1212/CON.0000000000000492
Restless Legs Syndrome and Sleep-Related Movement Disorders
Trotti, Lynn Marie
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1005-1016
doi: 10.1212/CON.0000000000000488
Rapid Eye Movement Sleep Behavior Disorder and Other Rapid Eye Movement Sleep Parasomnias
Ho¨gl, Birgit; Iranzo, Alex
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1017-1034
doi: 10.1212/CON.0000000000000489
Non–Rapid Eye Movement Sleep and Overlap Parasomnias
Irfan, Muna; Schenck, Carlos H.; Howell, Michael J.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1035-1050
doi: 10.1212/CON.0000000000000503
Circadian Rhythm Sleep-Wake Disorders
Pavlova, Milena
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1051-1063
doi: 10.1212/CON.0000000000000499
Chronic Insomnia Disorder
Avidan, Alon Y.; Neubauer, David N.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1064-1092
doi: 10.1212/01.CON.0000522244.13784.bf
Sleep-Disordered Breathing
Foldvary-Schaefer, Nancy R.; Waters, Tina E.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1093-1116
doi: 10.1212/01.CON.0000522245.13784.f6
Comorbid Sleep Disturbances in Neurologic Disorders
Ju, Yo-El S.; Videnovic, Aleksandar; Vaughn, Bradley V.
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1117-1131
doi: 10.1212/CON.0000000000000501
Sleep-Wake Disorders of Childhood
Kotagal, Suresh
CONTINUUM: Lifelong Learning in Neurology
August 2017 - Volume 23 - Issue 4, Sleep Neurology - p 1132-1150
doi: 10.1212/CON.0000000000000504
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology August 2017 - Volume 23 - Issue 4, Sleep Neurology -10.1212/01.CON.0000522238.75665.0b doi: 10.1212/01.CON.0000522238.75665.0b

Continuum: Lifelong Learning in Neurology—Sleep Neurology, Volume 23, Issue 4, August 2017

Issue Overview

Sleep Neurology 2017;23(4)

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Sleep Neurology issue, participants will be able to:

• Discuss the brain mechanisms that control sleep and wakefulness, and recognize how the breakdown of these mechanisms contributes to common disorders and disturbances of sleep

• Describe a clinical approach to the appropriate investigation and diagnosis of sleep disorders commonly seen by neurologists

• Recognize clinical features, recall the diagnostic criteria, discuss the latest advances in the understanding of the pathophysiology, and manage narcolepsy and other central hypersomnias

• Discuss the epidemiology, pathophysiology, and treatment of restless legs syndrome and other sleep-related movement disorders

• Diagnose and manage idiopathic and secondary rapid eye movement (REM) sleep behavior disorder, discuss the recent advances regarding idiopathic REM sleep behavior disorder as a primary feature of a synuclein disease, and recognize the typical features of sleep paralysis and nightmares

• Discuss the pathophysiologic basis of non-REM and overlap parasomnias, and appropriately diagnose and manage them in the clinical setting

• Describe the physiology of circadian rhythms and the relationships between circadian rhythms and neurologic disorders (including epilepsy and dementia), and diagnose the common circadian rhythm sleep-wake disorders, including delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, and irregular sleep-wake rhythm disorder

• Define insomnia, particularly as it presents in routine neurologic practice; recognize the evolution of insomnia and its pathophysiology; and use diagnostic tools and specific intervention techniques for insomnia, including behavioral approaches and pharmacologic options

• Discuss the prevalence, pathophysiology, diagnostic criteria, evaluation, and treatment of sleep-disordered breathing and its impact on medical and neurologic comorbidities

• Recognize sleep disturbances associated with common neurologic disorders, and describe the general approach to their management

• Discuss the diagnosis and management of childhood sleep-wake disorders

• Discuss strategies of shared medical decision making between the clinician and patient

• Recognize patients with neurologic disorders at increased risk for motor vehicle crashes and determine their fitness to drive

Core Competencies

This Continuum: Lifelong Learning in Neurology Sleep Neurology issue covers the following core competencies:

• Patient Care

• Medical Knowledge

• Practice-Based Learning and Improvement

• Interpersonal and Communication Skills

• Professionalism

• Systems-Based Practice

Disclosures

CONTRIBUTORS

Erik K. St. Louis, MD, MS, FAAN, FAASM, Guest Editor

Co-director, Mayo Center for Sleep Medicine; Associate Professor of Neurology; Consultant in Medicine and Neurology; Director, Sleep and Cognitive Neurophysiology Laboratory, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

aDr St. Louis serves on the editorial boards of Continuum and the Sleep and Chronobiology section of Frontiers in Neurology. Dr St. Louis has received personal compensation for serving as a consultant in clinical trial design for Axovant Sciences Ltd; for serving on the data safety monitoring board of Inspire Medical Systems, Inc; and has received research/grant support from Axovant Sciences Ltd; Mayo Clinic Center for Clinical and Translational Science; the Michael J. Fox Foundation; the National Institutes of Health/National Heart, Lung, and Blood Institute; and Sunovion Pharmaceuticals Inc. Dr St. Louis has received royalties from Wiley-Blackwell for the book, Epilepsy and the Interictal State: Co-morbidities and Quality of Life.

bDr St. Louis discusses the off-label use of clonazepam and melatonin for the treatment of rapid eye movement sleep behavior disorder.

Alon Y. Avidan, MD, MPH, FAAN

Professor, Vice Chair, Department of Neurology; Director, University of California Los Angeles Sleep Disorders Center, University of California Los Angeles, Los Angeles, California

aDr Avidan has received personal compensation for serving as a speaker for Arbor Pharmaceuticals and PERNIX Therapeutics and receives royalties from Elsevier and UpToDate, Inc.

bDr Avidan discusses the off-label use of various central nervous system–acting medications for insomnia, which include sedating antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone; the antipsychotic quetiapine; antihistamine compounds such as doxylamine; medications available over-the-counter marketed as sleep aids as single compounds or as a combination therapy with analgesics (acetaminophen or ibuprofen); and dietary supplement sleep aids such as chamomile, hops, kava kava, melatonin, passionflower, tart cherry juice, and valerian.

Lucie Barateau, MD

Neurologist, Sleep-Wake Disorders Center, National Reference Center for Narcolepsy and Idiopathic Hypersomnia, Gui de Chauliac Hospital, University of Montpellier, INSERM U1061, Montpellier, France

aDr Barateau has received reimbursement for travel expenses from Laidet Médical and has received personal compensation as a speaker for UCB SA.

bDr Barateau reports no disclosure.

Yves Dauvilliers, MD, PhD

Professor of Neurology and Physiology, Department of Neurology; Director of Sleep Lab; Coordinator, National Reference Center for Narcolepsy and Idiopathic Hypersomnia, Gui de Chauliac Hospital, University of Montpellier, INSERM U1061, Montpellier, France

aDr Dauvilliers has received personal compensation for speaking engagements and travel expenses, served as consultant for, and received research/grant support from Bioprojet Pharma, Flamel Technologies, Jazz Pharmaceuticals, Theranexus, and UCB SA. Dr Dauvilliers serves as specialty chief editor of the Sleep and Chronobiology section of Frontiers in Neurology.

bDr Dauvilliers reports no disclosure.

Mark Eric Dyken, MD, FAHA, FAASM, FANA

Professor of Neurology; Director of Sleep Disorders Program; Director of Clinical Neurophysiology Fellowship Program, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, Iowa

a,bDr Dyken reports no disclosures.

Waleed Hamed El-Feky, MD

Neurologist; Director, Texas Neurology, Sleep Disorders Center, Dallas, Texas

a,bDr El-Feky reports no disclosures.

David A. Evans, MBA

Chief Executive Officer, Texas Neurology, Dallas, Texas

a,bMr Evans reports no disclosures.

Nancy R. Foldvary-Schaefer, DO, MS

Professor of Medicine, Department of Neurology, Cleveland Clinic Lerner College of Medicine; Director, Cleveland Clinic Sleep Disorders Center, Cleveland, Ohio

aDr Foldvary-Schaefer has received personal compensation for serving on the speaker’s bureau of Jazz pharmaceuticals; receives research funding from Cleveland Medical Devices, Inc and UCB, Inc; and receives book royalties from Oxford University Press.

bDr Foldvary-Schaefer reports no disclosure.

Birgit Högl, MD

Associate Professor of Neurology; Director, Sleep Laboratory and Sleep Disorders Outpatient Unit, Medical University of Innsbruck, Innsbruck, Austria

aDr Högl serves as associate editor of the Journal of Clinical Sleep Medicine and receives personal compensation for serving on the advisory board of Mundipharma and UCB. Dr Högl has received honoraria for lectures for Abbvie, Eli Lilly and Company, Janssen Cilag, Lundbeck, Mundipharma, Otsuka Pharmaceutical, and UCB, and as a consultant for Axovant and Benevolent Bio. Dr Högl receives royalties from Cambridge University Press and Springer.

bDr Högl discusses the unlabeled/investigational use of clonazepam and melatonin for the management of rapid eye movement sleep behavior disorder.

Richard L. Horner, PhD

Professor of Medicine and Physiology; Canada Research Chair, University of Toronto, Toronto, Ontario, Canada

aDr Horner has received personal compensation for serving as a consultant for Dairy Farmers of Canada and Viord Inc and receives royalties from BookBaby for his book, The Universal Pastime: Sleep and Rest Explained. Dr Horner has received grants from Canada Research Chair (950-229813), the Canadian Institutes of Health Research (MT-15563), and the National Sanitarium Association Innovative Research Program (00144051).

bDr Horner reports no disclosure.

Michael J. Howell, MD, FAAN

Associate Professor; Vice Chair of Education, Department of Neurology, University of Minnesota, Minneapolis, Minnesota

aDr Howell serves as an associate editor for MedLink.com and has received personal compensation for speaking engagements from the Sleep Performance Institute. Dr Howell receives royalties from UpToDate, Inc and research/grant support from the National Institutes of Health.

bDr Howell discusses the unlabeled/investigational use of benzodiazepines and melatonin for the treatment of parasomnias.

Alex Iranzo, MD

Neurologist, Hospital Clínic de Barcelona; Associate Professor, University of Medicine, Universidad de Barcelona, Barcelona, Spain

aDr Iranzo has received personal compensation for serving on the advisory board of and as a lecturer for Otsuka Pharmaceutical and UCB.

bDr Iranzo discusses the unlabeled/investigational use of clonazepam and melatonin for the management of rapid eye movement sleep behavior disorder.

Muna Irfan, MD

Assistant Professor, Department of Neurology, Hennepin County Medicine Center, University of Minnesota, Minneapolis, Minnesota

aDr Irfan reports no disclosure.

bDr Irfan discusses the unlabeled/investigational use of benzodiazepines and melatonin for the treatment of parasomnias.

Yo-El S. Ju, MD, MSCI

Assistant Professor of Neurology, Department of Neurology, Sleep Medicine Section, Washington University in St. Louis, St. Louis, Missouri

aDr Ju has received personal compensation for serving as a speaker and moderator for the American Academy of Neurology, as a speaker for the American Academy of Sleep Medicine and the World Association of Sleep Medicine, and as a consultant of C2N Diagnostics. Dr Ju has received research/grant support from the National Institutes of Health and as principal investigator of a study for Philips Respironics.

bDr Ju discusses the unlabeled/investigational use of trazodone to treat comorbid sleep disturbances in dementia.

Suresh Kotagal, MD, FAAN

Professor, Department of Neurology; Consultant in Neurology, Pediatrics, and Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

aDr Kotagal has received personal compensation as chair of the data safety monitoring board for INC Research, Inc and receives royalties from UpToDate, Inc.

bDr Kotagal reports no disclosure.

David N. Neubauer, MD

Associate Professor, Johns Hopkins University School of Medicine, Baltimore, Maryland

aDr Neubauer has received personal compensation for serving on the board of directors for the National Sleep Foundation, as a consultant for Purdue Pharma LP, and as a lecturer for the American Academy of Sleep Medicine, the American College of Chest Physicians, the Clayton Sleep Institute, the New Jersey Sleep Society, and the US Psychiatric and Mental Health Congress.

bDr Neubauer discusses the off-label use of various central nervous system–acting medications for insomnia, which include sedating antidepressants such as amitriptyline, doxepin, mirtazapine, and trazodone; the antipsychotic quetiapine; antihistamine compounds such as doxylamine; medications available over-the-counter marketed as sleep aids as single compounds or as a combination therapy with analgesics (acetaminophen or ibuprofen); and dietary supplement sleep aids such as chamomile, hops, kava kava, melatonin, passionflower, tart cherry juice, and valerian.

Milena Pavlova, MD, FAASM

Medical Director, Sleep Testing Center, Department of Neurology, Brigham and Women’s Faulkner Hospital; Assistant Professor, Harvard Medical School, Harvard University, Boston, Massachusetts

aDr Pavlova serves as associate editor of the Sleep and Chronobiology section of Frontiers in Neurology and receives research/grant support from Biomobie Inc and Lundbeck.

bDr Pavlova reports no disclosure.

John H. Peever, PhD

Professor, University of Toronto, Toronto, Ontario, Canada

aDr Peever has received grant support from the Canadian Institutes of Health Research.

bDr Peever reports no disclosure.

Michael Rubin, MD, MA

Assistant Professor of Neurology and Neurotherapeutics, Assistant Professor of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas

a,bDr Rubin reports no disclosures.

Carlos H. Schenck, MD

Professor, Department of Neurology, Hennepin County Medicine Center, University of Minnesota, Minneapolis, Minnesota

aDr Schenck has received personal compensation as a consultant for Sunovion Pharmaceuticals, Inc.

bDr Schenck discusses the unlabeled/investigational use of benzodiazepines and melatonin for the treatment of parasomnias.

Michael H. Silber, MBChB, FAAN

Professor of Neurology, Mayo Clinic College of Medicine and Science; Consultant Neurologist, Mayo Clinic Center for Sleep Medicine in Minnesota, Rochester, Minnesota

aDr Silber receives royalties from Oakstone Publishing and UpToDate, Inc.

bDr Silber reports no disclosure.

Jon Tippin, MD, FAAN, FAASM

Clinical Professor of Neurology, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa

aDr Tippin received research/grant support from the National Institutes of Health/National Heart, Lung, and Blood Institute (R01 HL091917-01A2).

bDr Tippin reports no disclosure.

Lynn Marie Trotti, MD, MSc

Associate Professor of Neurology; Associate Director, Sleep Medicine Fellowship, Emory University School of Medicine, Atlanta, Georgia

aDr Trotti serves on the editorial board of the Journal of Clinical Sleep Medicine and has received personal compensation as a speaker for the American Academy of Neurology, Associated Professional Sleep Societies, Movement Disorder Society, New Jersey Sleep Society, New York University, Ohio State University, and Southern Sleep Society. Dr Trotti has received research/grant support from the National Institute of Neurological Disorders and Stroke and the National Institutes of Health (K23 NS083748).

bDr Trotti discusses the unlabeled/investigational use of benzodiazepines, botulinum toxin, clonazepam, and clonidine for the treatment of bruxism; of clonazepam for the treatment of hypnic myoclonus and rhythmic movement disorder; of carbamazepine, carisoprodol, diltiazem, gabapentin, lamotrigine, magnesium, oxcarbazepine, quinine, and verapamil for the treatment of leg cramps; of clonazepam and topiramate for the treatment of propriospinal myoclonus; and of gabapentin, iron (including ferric carboxymaltose), opioids, and pregabalin for the treatment of restless legs syndrome.

Bradley V. Vaughn, MD, FAAN, FAASM

Professor of Neurology, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, North Carolina

aDr Vaughn has received personal compensation as a speaker for the American Academy of Neurology, American Academy of Sleep Medicine, and Medical Education Resources and receives royalties from Medlink Neurobase and UpToDate, Inc. Dr Vaughn has received personal compensation for serving as chair of the sleep medicine examination committee of the American Board of Internal Medicine.

bDr Vaughn reports no disclosure.

Aleksandar Videnovic, MD, MSc, FAAN, FAASM

Associate Professor of Neurology, Harvard Medical School, Harvard University; Director, Program on Sleep, Circadian Biology and Neurodegeneration, Massachusetts General Hospital, Boston, Massachusetts

aDr Videnovic serves on the editorial board of Parkinsonism & Related Disorders and has received personal compensation for serving as chair of the data and safety monitoring board of Acorda Therapeutics and for serving on the data and safety monitoring board of Wilson Therapeutics. Dr Videnovic has received research grants from the National Institute of Neurological Disorders and Stroke and receives royalties from Springer International Publishing AG.

bDr Videnovic reports no disclosure.

Tina E. Waters, MD

Neurologist, Sleep Disorders Center; Clinical Assistant Professor, Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio

aDr Waters receives research funding as principal investigator for a study for the Inspire Upper Airway Stimulation therapy system through Inspire Medical Systems, Inc.

bDr Waters reports no disclosure.

Ronnie Bergen, MD

Assistant Professor of Clinical Neurology, University of Arizona; Staff Neurologist, Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona

a,b Dr Bergen reports no disclosures.

James W. M. Owens Jr, MD, PhD

Associate Professor of Neurology and Adjunct Associate Professor of Pediatrics, University of Washington, Seattle, Washington

aDr Owens receives personal compensation for medicolegal record review and royalties from UpToDate, Inc.

bDr Owens reports no disclosure.

a Relationship Disclosure

b Unlabeled Use of Products/Investigational Use Disclosure

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive CME and self-assessment offerings, including a self-assessment pretest, multiple-choice questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

Copyright © 2017 by the American Academy of Neurology.