1044 Sleep Disturbances Are Prevalent In Autoimmune Encephalitis

Abstract

Abstract Autoimmune encephalitis (AE) is increasingly recognized as an important cause of subacute cognitive decline, seizures, and encephalopathy, with an ever broadening clinical phenotype. Sleep disturbances have been reported in patients with AE, including REM sleep behavior disorder, hypersomnia and fragmented sleep, and sleep-disordered breathing. There is a need to determine the prevalence of sleep pathology in patients with AE, and to clarify the relationship between specific autoantibodies and sleep symptomatology, with the potential to improve patient outcomes through diagnosis and management of comorbid sleep dysfunction. Clinical history and diagnostic data, including results of serum and CSF testing, EEG, and brain MRI, were retrospectively obtained from 25 consecutively-encountered patients with definite AE diagnosed at our tertiary care hospital. Polysomnography (PSG) was performed in a subset of patients, and raw data reviewed. Written informed consent was obtained from all patients or delegates, and study protocols were approved by our institution's human research protections office. Median age of this AE cohort was 52 years (range, 18-83) with intracellular autoantibodies (including ma and Hu autoantibodies) identified in 6/25 (24%) patients and cell-surface autoantibodies (including NMDAR and LGI1 autoantibodies) identified in the remainder (76%). New sleep complaints were reported in 18/25 (72%) of AE patients in this cohort, including dream enactment (24%, 6/25), insomnia (20%, 5/25), hypersomnia (16%, 4/25), other parasomnias (16%, 4/25), and sleep/ wake confusional states (8%, 2/25). PSG data showed poor sleep efficiency (55%) relative to healthy populations. Sleep disordered breathing was diagnosed in 32% (8/25). Sleep disturbances were prevalent in this retrospective cohort of AE patients, including dream enactment behavior, and poor sleep efficiency. This finding emphasizes the need to screen for sleep disorders in this population. Improved identification and treatment of sleep disorders may reduce morbidity associated with AE and affect long-term outcomes of these patients. Patient recruitment and data collection was supported through an American Brain Foundation Clinical Research Training Fellowship (GSD).