SEARCHCROSS-SECTIONALpsychiatry, neurology

cross-sectional·psychiatry, neurology, sleep medicine, addiction medicine, neuropsychology·PMC10058993

Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff’s Syndrome: Relationship with Episodic Memory

Journal of Clinical Medicine · 13 authors, 7 centres

AI SUMMARY

POPULATION22 AUD patients (all men), 7 KS patients (all women), and 15 healthy controls (13 men)

INTERVENTIONPolysomnography (PSG) recording and neuropsychological assessment

COMPARISONAUD patients vs. KS patients vs. healthy controls

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TL;DR

This study compared sleep architecture in Alcohol Use Disorder (AUD) patients with and without Korsakoff's syndrome (KS) using polysomnography. Both groups showed high rates of sleep-disordered breathing and sleep fragmentation, but KS patients had a distinct reduction in REM sleep that correlated with their severe episodic memory deficits. The findings suggest that REM sleep alterations may contribute to the pathophysiology of alcohol-related memory disorders and highlight the need for systematic sleep assessment in these patients.

Full summary

3,218 CHARS

**Background:** Korsakoff's syndrome (KS) is a neurological complication of chronic alcohol use and thiamine deficiency characterized by severe episodic memory impairment. Up to 50% of Alcohol Use Disorder (AUD) patients without KS also present neuropsychological deficits. Sleep disturbances are common in AUD and may persist after withdrawal, but sleep architecture in KS patients has been poorly studied with mixed results. This study aimed to determine whether specific sleep parameters are impaired in KS compared to AUD patients and whether they relate to cognitive deficits.

**Methods:** Twenty-two AUD patients (all men, mean age 47.6±9.7 years, 10.81±3.80 days abstinent), seven KS patients (all women, mean age 56.1±4 years, all institutionalized >10 years except one at 18 months), and 15 healthy controls (13 men, mean age 48.3±11.3 years) underwent polysomnography using an ambulatory recording device. Sleep was scored in 30-second epochs per AASM criteria. Neuropsychological assessment included processing speed (TMT-A, Stroop naming), executive functions (backward span, Stroop interference, TMT-B minus A), short-term memory (forward span), and episodic memory (delayed free recall of FCSRT). Non-parametric Kruskal-Wallis ANOVAs and Mann-Whitney post-hoc tests were used. Spearman correlations examined relationships between sleep and cognition.

**Key Results:** KS patients slept longer than AUD (465±40.6 vs 376±65.7 min, p=0.002, r=0.77) and HC (p=0.007, r=0.71). Both AUD and KS patients had higher stage shift index (AUD vs HC: p=0.002, r=0.6; KS vs HC: p=0.01, r=0.68) and higher AHI (AUD: 26.2±14.9, KS: 29.5±21.6 vs HC: 9.4±4.3; both p<0.05) compared to HC. AUD patients had lower N3 sleep than HC (14.3±6.6% vs 21.2±7.2%, p=0.007, r=0.53), while KS patients did not differ from HC on N3. KS patients had lower REM sleep than both AUD (14.4±3.4% vs 23.2±4.9%, p=0.001, r=0.84) and HC (p=0.01, r=0.67). Episodic memory showed a graded deficit: HC > AUD > KS (HC: 0±1, AUD: -1.5±1.3, KS: -4.7±1.8; p<0.0001). In the pooled patient group, REM sleep proportion correlated positively with episodic memory performance (r=0.42, p=0.02), remaining significant after controlling for AHI (r=0.52, p=0.006). Subjective sleep complaints (PSQI) showed HC < KS < AUD (2.3±1.4 vs 4.6±2.1 vs 8.1±2.9, p<0.001).

**Clinical Implications:** This study demonstrates that both AUD and KS patients have high rates of sleep-disordered breathing (82% of AUD, 71% of KS with AHI≥15) that may go undetected due to lack of typical symptoms, particularly in women. The distinct REM sleep reduction in KS patients, correlating with episodic memory deficits, suggests REM sleep may contribute to the pathophysiology of alcohol-related amnesia. These findings support systematic screening for sleep disorders in AUD and KS patients using objective measures, as untreated sleep-disordered breathing may worsen cognitive and brain health outcomes. The relative preservation of slow-wave sleep in KS (vs AUD) may reflect recovery with prolonged abstinence. Limitations include small KS sample size, sex confound (all KS women, all AUD men), different recording environments, and psychotropic medication use in KS patients.

PICO

PPOPULATION

22 AUD patients (all men), 7 KS patients (all women), and 15 healthy controls (13 men)

IINTERVENTION

Polysomnography (PSG) recording and neuropsychological assessment

OOUTCOME

Sleep architecture parameters (sleep stages, AHI, sleep efficiency, etc.) and cognitive performance (episodic memory, executive functions, processing speed)

STUDY TYPE

cross-sectional

SPECIALTY

psychiatry

SUMMARISED BY

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FIDELITY CHECK

Not run

ORIGINAL PAPER

PMC10058993

Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff’s Syndrome: Relationship with Episodic Memory

Journal of Clinical Medicine

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ABSTRACT

Abstract Alcohol Use Disorder (AUD) results in sleep disturbances that may have deleterious impacts on cognition, especially on memory. However, little is known about the sleep architecture in patients with Korsakoff’s syndrome (KS). This study aims at characterizing sleep disturbances in KS compared to AUD without KS and at specifying the relationships with cognitive impairments. Twenty-nine AUD patients (22 without KS and 7 with KS) and 15 healthy controls underwent a neuropsychological assessment and a polysomnography. The severity of sleep-disordered breathing and sleep fragmentation was similar in AUD and KS patients compared to controls. Sleep architecture differed between both patient groups: the proportion of slow-wave sleep was reduced in AUD patients only, while a lower proportion of rapid-eye movement (REM) sleep was specifically observed in KS patients. The proportion of REM sleep correlated with the severity of episodic memory deficits when AUD and KS were examined together. These data provide evidence for both similarities and specificities regarding sleep alterations in AUD patients with and without KS. They also indicate that altered sleep architecture may contribute to the pathophysiology of alcohol-related memory disorders. Keywords: Korsakoff’s syndrome, alcohol use disorder, polysomnography, sleep, episodic memory

CITATION EXPORT

Alice Laniepce, Shailendra Segobin, Claire André et al.. Distinct Sleep Alterations in Alcohol Use Disorder Patients with and without Korsakoff’s Syndrome: Relationship with Episodic Memory. Journal of Clinical Medicine. (2023). https://doi.org/10.3390/jcm12062440

AUTHORS

13 · 7 CENTRES

Alice Laniepce, Shailendra Segobin, Claire André, Françoise Bertran, Céline Boudehent, Najlaa Lahbairi, Angéline Maillard, Alison Mary, Laurent Urso, François Vabret, Nicolas Cabé, Anne-Lise Pitel, Géraldine Rauchs

1Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, NIMH, 14000 Caen, France
2Normandie Univ, UNIROUEN, CRFDP (EA 7475), 76000 Rouen, France
3Normandie Univ, UNICAEN, INSERM, U1237, PhIND “Physiopathology and Imaging of Neurological Disorders”, Team NeuroPresage, Institut Blood and Brain @ Caen-Normandie, Cyceron, 14074 Caen, France
4Unité D’exploration et de Traitement des Troubles du Sommeil, CHU de Caen, 14000 Caen, France
5Addiction Department, CHU de Caen, 14000 Caen, France
6Addiction Department, Centre Hospitalier de Roubaix, 59100 Roubaix, France
7Institut Universitaire de France (IUF), 75231 Paris, France