The Importance of Sleep for Successful Neurorehabilitation after Stroke.

Sleep has important clinical implications for neurorehabilitation after stroke. We aimed to systematically explore sleep (including naps) as an essential factor in the neurorehabilitation of patients after stroke. After titles and abstracts were screened, 49 full texts were reviewed, and 7 were included in this review. Data were extracted and assessed for quality and risk of bias. We looked at any neurorehabilitation setting, and compared sleep with no sleep and explored these factors in stroke patients versus healthy individuals. Rehabilitation is critical for many activities that may need to be learned or re-learned following stroke and for returning to everyday life. In this context, sleep is essential in neurorehabilitation and physical therapy practice as it supports neuroplasticity, memory, and learning. The available data suggest that sleep should be considered in the treatment plan for successfully targeted physiotherapy to optimize cognitive and motor learning. Physical therapists should advise about sleep hygiene and therapies to improve sleep, both quality and quantity.

Subjective and Objective Assessment of Hypersomnolence.

This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjective scales and objective tools and suggests situations where particular instruments may be appropriate.

Subjective and Objective Assessment of Hypersomnolence.

This article describes clinical approaches to assessing sleepiness. Subjective sleep scales are used in clinical settings but have significant limitations. Likewise, objective tools may have prohibitive expense, and practical administration considerations may prohibit regular use. Gold standard tests include the multiple sleep latency test and maintenance of wakefulness test. These studies are criticized for a variety of reasons but are useful in appropriate clinical context. New tools suggest novel ways to assess sleepiness and will likely be more prominent in clinical assessments over time. This article outlines subjective scales and objective tools and suggests situations where particular instruments may be appropriate.

Neurobiological aspects of sleep physiology.

Sleep is characterized by changes in neural firing and chemistry compared with wakefulness. Many neurologic diseases affect pathways that regulate control of sleep state and some primary sleep disorders have abnormalities of this circuitry. Nonrapid eye movement (NREM) and rapid eye movement (REM) sleep alternate in an approximately 90-minute cycle. Recent findings have expanded understanding of the control of sleep state, and will facilitate development of novel therapeutics to assist patients with a variety of disorders of sleep and wakefulness. Treatment of sleep and wake disorders can assist patients with a variety of neurologic problems.

Low CD40L levels and relative lymphopenia in narcoleptic patients.

Narcolepsy has been studied as a possible autoimmune disease for many years, and recent findings lend more credence to this belief. Although recent and important advances have been done, no study has analyzed the role of the CD40L in patients with narcolepsy. The purpose of this study was to assess CD40L levels, CD3, TCD4, TCD8, CD19, and CD56 lymphocytes, as well as levels of tumor necrosis factor-α and interleukin-6 in narcoleptic patients. We quantified the levels of CD40L, different types of lymphocytes, and levels of tumor necrosis factor-α and interleukin-6 in narcoleptic patients and control subjects. Narcoleptic patients had lower levels of CD40L. Total lymphocytes; CD3, and TCD4 were lower than in the control group. Our findings highlight the important role of CD40L in narcolepsy.