The effects of isolated brainstem lesions on human REM sleep

Clinical and electrophysiologic data support the role of multiple brainstem structures responsible for sleep architecture. To determine if patients with isolated brainstem lesions have detectable abnormalities of sleep architecture with polysomnography (PSG).

The objective of this study is to determine if patients with isolated brainstem lesions defined by magnetic resonance imaging (MRI), and without sleep complaints, underwent PSG. The data was compared to age-matched controls. Eight patients met inclusion criteria. Of the eight locations, one was midbrain, two were pontomesencephalic, four were pontine and one was pontomedullary.

Four of the eight patients had a decreased percentage of Rapid Eye Movement (REM) sleep. The abnormal studies occurred in patients with a right paramedian pontine infarct, a left pontomedullary cavernous hemangioma (CH), a left pontine CH, and a right pontomesencephalic CH. REM sleep, as a percentage of total bed time, was 8.7, 12.3, 14.8, and 16.7%, respectively.

These findings concur with non-human data that depict pontine structures as the major generators of REM sleep.