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NEUROLOGY 1980;30:113
© 1980 American Academy of Neurology

Adrenergic hyperactivity and cardiac abnormality in primary disorders of sleep

Robert W. Clark, M. D., Harisios Boudoulas, M.D., Stephen F. Schaal, M. D. and Helmut S. Schmidt, M. D.

Ohio State University Sleep Disorders Evaluation Center and the Division of Neurology (Department of Medicine) and Department of Psychiatry (Drs. Clark and Schmidt), and the Division of Cardiology (Department of Medicine) (Drs. Boudoulas and schaal), the Ohio State University College of Medicine, Columbus.

Symptoms suggesting autonomic instability and increased adrenergic effect were identified in 53 patients with primary disorders of impaired wakefulness. Urine and plasma catecholamine concentrations were significantly increased in patients with sleep apnea. Excessive increases in heart rate during isoproterenol infusions suggested adrenergic hyperresponsiveness as an alternative explanation for symptoms of catecholamine excess in some individuals. Twenty-two patients demonstrated mitral valve prolapse (MVP), implicating primary neurologic disturbances as potential factors in the fatigue and lassitude often associated with MVP. The catecholamine abnormalities may explain some of the difficulties frequently encountered in using stimulants to treat sleep disorders.

Address correspondence and reprint requests to Dr. Clark, Ohio State University Sleep Disorders Evaluation Center, 473 West 12th Avenue, Columbus, OH 43210.

Accepted for publication July 11, 1979.

This investigation was supported in part by Clinical Research Center Grant No. RR 34, National Institutes of Health, Bethesda, MD.




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