Table of Contents
Journal of Geriatrics
Volume 2015, Article ID 150927, 6 pages
Research Article

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

1Neurologische Klinik, Pfalzklinikum für Psychiatrie und Neurologie, Teaching Hospital, Medical Department, University of Mainz, 76889 Klingenmünster, Germany
2Klinik für Neurologie, Westpfalz-Klinikum, Teaching Hospital, Medical Departments, Universities of Mainz and Heidelberg/Mannheim, 67655 Kaiserslautern, Germany

Received 18 August 2015; Revised 9 November 2015; Accepted 11 November 2015

Academic Editor: Stephen D. Ginsberg

Copyright © 2015 Ralf Landwehr and Robert Liszka. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Patients with ischemic white matter lesions (WML) frequently report nonrestorative sleep or daytime sleepiness. However, subjective estimations of sleep and sleepiness can differ considerably from objective measures. The pupillographic sleepiness test (PST) could identify patients with sleep disorders requiring polysomnography (PSG) and further treatment. Methods. We performed a PST and a PSG of 35 nondemented patients with WML, who reported nonrestorative sleep or daytime sleepiness, and assessed the diagnostic value of the pupillary unrest index (PUI). Sleep parameters were compared to normative data. Results. The mean PUI of WML patients was normal (5.89 mm/min) and comparable to PUIs of patients with other neurological disorders. All 9 of the 35 WML patients (25.7%) who had a PUI above normal also had clinically relevant sleep disorders (5: sleep apnea, 7: periodic leg movements, and 4: insomnia). Six patients with a normal PUI had mild to moderate primary insomnia. Conclusion. PST and PSG parameters were physiological in most patients with WML. Age-related changes and affective and neuropsychological disorders might account for their sleep-related complaints. An elevated PUI in patients with WML seems to indicate comorbid sleep disorders that require further diagnostic evaluation and treatment (sleep apnea, insomnia with periodic leg movements, but not primary insomnia).