Consider the Impact of Sleep Dysfunction on Huntington's Disease Patients, Experts Say

A special issue of the Journal of Huntington's Disease has reviewed what is known about sleep and circadian rhythms in Huntington's disease (HD), and what is not known. Sleep disturbances in HD patients are an under-studied field, but there is growing evidence that sleep changes occur early in the clinical course of the disease. Treatment of sleep and circadian disturbances in HD is an unmet need, and intervention studies are needed to investigate the treatment of poor sleep associated with HD.

Getting a good night's sleep is crucial for everyone's well-being. However, for individuals with Huntington's disease (HD), sleep disturbances can have an even greater impact on their quality of life and disease outcomes. In a special issue of the Journal of Huntington's Disease, researchers delve into the current knowledge, as well as the unknowns, about sleep and circadian rhythms in HD.

Disrupted sleep not only affects our mood and energy levels but can also alter our metabolism and make us more susceptible to infections. While most of us recover from a bad night's sleep without lasting effects, it is a testament to the robust pathways and homeostatic mechanisms that our species has developed. However, emerging research suggests that abnormalities in sleep and circadian rhythms are associated with neurodegenerative diseases.

Jenny Morton, Ph.D., ScD, a professor of neurobiology at the University of Cambridge and the Guest Editor of this special issue, emphasizes the importance of good quality sleep and healthy diurnal rhythms in human health. She points out that we often take them for granted until they become disordered. The critical question for the HD field is whether chronically disturbed sleep and circadian rhythms have a greater impact on individuals with HD, whose brains are already vulnerable due to the disease.

It is still unclear whether sleep disorders precede the pathogenesis of HD or if they only appear as debilitating symptoms later on. However, the contributing authors of this special issue argue that sleep disturbances are an additional burden for HD patients and likely worsen disease outcomes.

Prof. Morton highlights that sleep and circadian dysfunction in HD patients are understudied and neglected fields. The lack of recognition of the problem is a significant barrier to progress. Sleep dysfunction in healthy individuals is taken seriously because it exacerbates cognitive symptoms and affects various aspects of daily life. These symptoms are also present in HD, but the impact of sleep dysfunction on HD patient symptoms is rarely considered.

Clinical and animal model studies provide growing evidence that sleep changes occur early in the course of HD. Sleep initiation and maintenance difficulties not only lead to decreased sleep efficiency but also progressively deteriorate sleep architecture. However, despite evidence of sleep and circadian abnormalities, they are often underreported by patients and underrecognized by health professionals. This lack of awareness may explain the scarcity of investigations into sleep in HD patients.

Treating sleep and circadian disturbances in HD is a significant unmet need. Well-designed intervention studies are necessary to address the poor sleep associated with HD. Noninvasive and low-cost circadian-based therapies, such as light therapy, show promise for managing sleep-wake disturbances in HD.

HD is a hereditary neurodegenerative condition that affects motor, cognitive, and psychiatric functions. As there is currently no treatment to slow or halt the disease's progression, current approaches focus on managing symptoms. Sleep dysfunction is a prevalent symptom in HD, but it is often overlooked in treatment approaches.

In a review titled "Sleep Dysfunction in Huntington's Disease: Impacts of Current Medications and Prospects for Treatment," researchers discuss the impact of commonly used medications on sleep and evaluate potential treatment approaches. Sleep disruption not only exacerbates cognitive and affective symptoms but may also directly affect neurodegenerative processes by inducing neuroinflammation or impairing glymphatic clearance of neurotoxic waste during slow wave sleep. Addressing sleep pathology in HD could potentially alleviate symptoms and modify disease progression, as seen in preclinical models of HD.

The role of sleep and circadian disorders in HD is underappreciated but critically important. This special issue aims to bridge the gaps in our knowledge and expand our understanding of how sleep dysfunction impacts individuals with HD, according to JHD co-Editor-in-Chief Leslie M. Thompson.

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