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Breakthrough symptoms during the daytime in patients with restless legs syndrome (Willis-Ekbom disease)
Tzonova D, Larrosa O, Calvo E, Granizo JJ, Williams AM, de la Llave Y, García-Borreguero D.
Sleep Research Institute, Madrid, Spain.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
It is often assumed that most patients with restless legs syndrome (RLS) only experience symptoms at night. However, previous studies have estimated the prevalence of daytime symptoms to be 10-60%. This study sought to investigate the prevalence and pattern of daytime symptoms in patients with moderate-to-severe RLS.METHODS:
Observational, cross-sectional investigation. A self-administered questionnaire was sent out, on a random basis, to 310 patients with RLS by the Spanish RLS patient support group. Only individuals with a confirmed diagnosis of RLS were included in the final survey.RESULTS:
In total, 224 individuals were included in the survey (response rate 72%). Over 55% of patients reported daytime crises on most (>3) days of the week, and 41% suffered daytime symptoms on a daily basis. These breakthrough crises were characterized by unexpected and sudden symptoms and were frequently precipitated by a reduction in daytime activity. The mean severity of these crises on a visual analogue scale (range 0-10) was 6.8 (standard deviation 2.1), and they had a major impact on quality of life. The prevalence of breakthrough crises was related to duration of illness but not to duration of treatment.CONCLUSION:
This study suggests that breakthrough crises are common in moderate-to-severe RLS and have a negative effect on quality of life. More studies are needed to investigate whether breakthrough crises reflect disease progression or, at least for those patients undergoing dopaminergic treatment, whether they represent an early indication of RLS augmentation.Copyright © 2011 Elsevier B.V. All rights reserved.
Tzonova D, Larrosa O, Calvo E, Granizo JJ, Williams AM, de la Llave Y, García-Borreguero D.
Sleep Research Institute, Madrid, Spain.
Sleep Med. 2012 Jan 24. [Epub ahead of print]
BACKGROUND:
It is often assumed that most patients with restless legs syndrome (RLS) only experience symptoms at night. However, previous studies have estimated the prevalence of daytime symptoms to be 10-60%. This study sought to investigate the prevalence and pattern of daytime symptoms in patients with moderate-to-severe RLS.METHODS:
Observational, cross-sectional investigation. A self-administered questionnaire was sent out, on a random basis, to 310 patients with RLS by the Spanish RLS patient support group. Only individuals with a confirmed diagnosis of RLS were included in the final survey.RESULTS:
In total, 224 individuals were included in the survey (response rate 72%). -
Obesity, diabetes and OSAS induce of sleep disorders: exercise as therapy
Alves ES, Lira FS, Santos RV, Tufik S, de Mello MT.
Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
Lipids Health Dis. 2011 Aug 23;10:148.
Abstract
Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations.
Alves ES, Lira FS, Santos RV, Tufik S, de Mello MT.
Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil.
Lipids Health Dis. 2011 Aug 23;10:148.
Abstract
Sleep is an integral part of good health. Sleep disorders and variations in sleep habits are associated with a low-grade inflammatory status, which may be either a cause or consequence of other conditions, including obesity, diabetes and cardiovascular disease. Several strategies are available to counteract these conditions including continuous positive airway pressure (CPAP), pharmacological and nutritional interventions, and even surgery. At present, our group is investigating the effect of chronic endurance exercise on sleep alterations. -
Does inadequate sleep play a role in vulnerability to obesity?
Knutson KL.
Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, 5841 S Maryland Ave MC 6076, Chicago, Illinois 60622. kknutson@medicine.bsd.uchicago.edu.
Am J Hum Biol. 2012 Jan 24. doi: 10.1002/ajhb.22219. [Epub ahead of print]
Abstract
The prevalence of obesity is increasing rapidly worldwide, which is cause for concern because obesity increases the risk of cardiovascular disease and diabetes, reduces life expectancy, and impairs quality of life. A better understanding of the risk factors for obesity is therefore a critical global health concern, and human biologists can play an important role in identifying these risk factors in various populations. The objective of this review is to present the evidence that inadequate sleep may be a novel risk factor associated with increased vulnerability to obesity and associated cardiometabolic disease. Experimental studies have found that short-term sleep restriction is associated with impaired glucose metabolism, dysregulation of appetite, and increased blood pressure. Observational studies have observed cross-sectional associations between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes, and prevalent hypertension. Some studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. A few prospective studies have found a significant increased risk of weight gain, incident diabetes, and incident hypertension associated with inadequate sleep. Given the potential link between inadequate sleep and obesity, a critical next step is to identify the social, cultural, and environmental determinants of sleep, which would help to identify vulnerable populations. Future human biology research should consider variation in sleep characteristics among different populations and determine whether the associations between sleep and obesity observed in Western populations persist elsewhere. © 2012 Wiley Periodicals, Inc.
Knutson KL.
Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago, 5841 S Maryland Ave MC 6076, Chicago, Illinois 60622. kknutson@medicine.bsd.uchicago.edu.
Am J Hum Biol. 2012 Jan 24. doi: 10.1002/ajhb.22219. [Epub ahead of print]
Abstract
The prevalence of obesity is increasing rapidly worldwide, which is cause for concern because obesity increases the risk of cardiovascular disease and diabetes, reduces life expectancy, and impairs quality of life. A better understanding of the risk factors for obesity is therefore a critical global health concern, and human biologists can play an important role in identifying these risk factors in various populations. The objective of this review is to present the evidence that inadequate sleep may be a novel risk factor associated with increased vulnerability to obesity and associated cardiometabolic disease. -
Excessive daytime sleepiness and vascular events: The Three City Study
Blachier M, Dauvilliers Y, Jaussent I, Helmer C, Ritchie K, Jouven X, Tzourio C, Amouyel P, Besset A, Ducimetiere P, Empana JP.
Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France.
Ann Neurol. 2011 Oct 31. doi: 10.1002/ana.22656. [Epub ahead of print]
OBJECTIVE:
We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events.METHODS:
The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged ≥65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale.RESULTS:
The mean age of the cohort was 73.7 years (standard deviation, 5.37), 63% were women, and 13.3% and 4.3% reported regular and frequent EDS, respectively. After a median follow-up period of 5.1 years, 372 subjects experienced a first event, either stroke (122 subjects) or a CHD event (250 subjects). The increased risk of CHD and stroke was confined to the group with frequent EDS, and was 1.73× as much as in the group that reported never having EDS (HR, 1.73; 95% confidence interval [CI], 1.15-2.60), after adjustment for confounding and mediating factors. This association was seen in those without hypertension but not in those with hypertension at baseline (p for interaction = 0.01). Moreover, the association with frequent EDS was statistically significant for stroke (HR, 2.10; 95% CI, 1.13-3.89) but not for CHD (HR, 1.51; 95% CI, 0.87-2.61).INTERPRETATION:
The current study suggests that frequent EDS is independently associated with future vascular events and stroke in particular in healthy community-dwelling elderly subjects. ANN NEUROL 2011.Copyright © 2011 American Neurological Association.
Blachier M, Dauvilliers Y, Jaussent I, Helmer C, Ritchie K, Jouven X, Tzourio C, Amouyel P, Besset A, Ducimetiere P, Empana JP.
Paris Cardiovascular Research Centre (PARCC), University Paris Descartes, Sorbonne Paris Cité, UMR-S970, Paris, France.
Ann Neurol. 2011 Oct 31. doi: 10.1002/ana.22656. [Epub ahead of print]
OBJECTIVE:
We assessed whether excessive daytime sleepiness (EDS) at baseline was associated with subsequent coronary heart disease (CHD) and stroke events.METHODS:
The Three City Study, a French population-based multicenter prospective study, included 7,007 subjects aged ≥65 years with no personal history of CHD, stroke, or dementia, and self-rated EDS as never, rare, regular, or frequent in response to a face-to-face questionnaire. Hazard ratios (HRs) for the first episode of stroke and CHD over 6 years were estimated using a Cox proportional hazards model with age as the time scale. -
Residual sleepiness in obstructive sleep apnoea: phenotype and related symptoms
Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I.
Sleep Disorders Unit, UMR 975, National Reference Centre for Narcolepsy and Hypersomnia, Paris, France.
Eur Respir J. 2011 Jul;38(1):98-105. Epub 2011 Mar 15.
Abstract
The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean ± sd score 16.4 ± 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). Compared with patients without RES, the patients with RES had more fatigue, lower stage N3 percentages, more periodic leg movements (without arousals), lower mean sleep latencies and longer daytime sleep periods. Most neuropsychological dimensions (morning headaches, memory complaints, spatial memory, inattention, apathy, depression, anxiety and lack of self-confidence) were not different between patients with and without RES, but gradually altered from controls to apnoeic patients without and then with RES. RES in apnoeic patients differs markedly from sleepiness in central hypersomnia. The association between RES, periodic leg movements, apathy and depressive mood parallels the post-hypoxic lesions in noradrenaline, dopamine and serotonin systems in animals exposed to intermittent hypoxia.
Vernet C, Redolfi S, Attali V, Konofal E, Brion A, Frija-Orvoen E, Pottier M, Similowski T, Arnulf I.
Sleep Disorders Unit, UMR 975, National Reference Centre for Narcolepsy and Hypersomnia, Paris, France.
Eur Respir J. 2011 Jul;38(1):98-105. Epub 2011 Mar 15.
Abstract
The characteristics of residual excessive sleepiness (RES), defined by an Epworth score >10 in adequately treated apnoeic patients, are unknown. 40 apnoeic patients, with (n = 20) and without (n = 20) RES, and 20 healthy controls underwent clinical interviews, cognitive and biological tests, polysomnography, a multiple sleep latency test, and 24-h sleep monitoring. The marked subjective sleepiness in the RES group (mean ± sd score 16.4 ± 3) contrasted with moderately abnormal objective measures of sleepiness (90% of patients with RES had daytime sleep latencies >8 min). -
Effects of 8 weeks of CPAP on abdominal adiposity in obstructive sleep apnoea.
Sivam S, Phillips CL, Trenell MI, Yee BJ, Liu PY, Wong KK, Grunstein RR.
Woolcock Institute of Medical Research, PO Box M77, Missenden Road, NSW 2050, Australia.
Eur Respir J. 2012 Jan 20. [Epub ahead of print]
Abstract
To investigate the effect of Continuous Positive Airway Pressure treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea.Patients received both therapeutic and sham CPAP in random order for 2 months each with an intervening one month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms.38 eligible patients were randomly assigned to a treatment order with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28.6 cm(3), p=0.49) and visceral adipose tissue (-16.8 cm(3), p=0.59), intra-hepatic lipid (-0.2(% ), p=0.21) and fasting glucose measurements (-0.1 mmol·L(-1), p=0.46) between treatment modalities. Alkaline phosphatase decreased (-3.1 U·L(-1), p=0.02) while on therapeutic CPAP compared with sham CPAP but other liver enzymes including aspartate aminotransferase (0.3 U·L(-1), p=0.82), alanine aminotransferase (1.34 U·L(-1), p=0.59) and gamma-glutamyltransferase (-2.3 U·L(-1), p=0.33) remained unchanged.In this first randomized sham controlled trial, there was no change in adipose tissue distribution after 8 weeks of therapeutic CPAP compared with 8 weeks of sham CPAP. Longer duration of CPAP use may be necessary to demonstrate a difference.
Sivam S, Phillips CL, Trenell MI, Yee BJ, Liu PY, Wong KK, Grunstein RR.
Woolcock Institute of Medical Research, PO Box M77, Missenden Road, NSW 2050, Australia.
Eur Respir J. 2012 Jan 20. [Epub ahead of print]
Abstract
To investigate the effect of Continuous Positive Airway Pressure treatment on regional adipose tissue distribution in patients with moderate or severe obstructive sleep apnoea.Patients received both therapeutic and sham CPAP in random order for 2 months each with an intervening one month washout. Abdominal subcutaneous, visceral and liver fat were quantified using magnetic resonance imaging (MRI) and spectroscopy (MRS). Liver enzymes and plasma glucose were also determined. Measurements were obtained at baseline and at the end of both treatment arms.38 eligible patients were randomly assigned to a treatment order with 27 patients having complete MRI/MRS data. No significant difference was observed in subcutaneous (-28. -
Efficacy of a behavioral self-help treatment with or without therapist guidance for co-morbid and primary insomnia - a randomize
Jernelov S, Lekander M, Blom K, Rydh S, Ljotsson B, Axelsson J, Kaldo V.
BMC Psychiatry. 2012 Jan 22;12(1):5. [Epub ahead of print]
BACKGROUND:
Cognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.METHODS:
Volunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression). Parallel randomized (block-randomization, n>21) controlled "open label" trial; three groups - bibliotherapy with (n=44) and without (n=45) therapist support, and waiting list control (n=44). Assessments before and after treatment, and at three-month follow-up. Intervention was six weeks of bibliotherapeutic self-help, with established cognitive behavioral methods including sleep restriction, stimulus control, and cognitive restructuring. Therapist support was a 15-minute structured telephone call scheduled weekly. Main outcome measures were sleep diary data, and the Insomnia Severity Index.RESULTS:
Intention-to-treat analyses of 133 participants showed significant improvements in both self-help groups from pre to post treatment compared to waiting list. For example, treatment with and without support gave shorter sleep onset latency (improvement minutes [95% Confidence Interval], 35.4 [24.2 to 46.6], and 20.6 [10.6 to 30.6] respectively), and support gave a higher remission rate (defined as ISI score below 8; 61.4%), than bibliotherapy alone (24.4%, p's<.001). Improvements were not seen in the control group (sleep onset latency 4.6 minutes shorter [-1.5 to 10.7], and remission rate 2.3%). Self-help groups maintained gains at three-month follow-up.CONCLUSIONS:
Participants receiving self-help for insomnia benefited markedly. Self-help, especially if therapist-supported, has considerable potential to be as effective as individual treatment at lower cost, also for individuals with co-morbid problems. Trial registration ClinicalTrials.gov, NCT01105052.
Jernelov S, Lekander M, Blom K, Rydh S, Ljotsson B, Axelsson J, Kaldo V.
BMC Psychiatry. 2012 Jan 22;12(1):5. [Epub ahead of print]
BACKGROUND:
Cognitive behavioral therapy is treatment of choice for insomnia, but availability is scarce. Self-help can increase availability at low cost, but evidence for its efficacy is limited, especially for the typical insomnia patient with co-morbid problems. We hypothesized that a cognitive behaviorally based self-help book is effective to treat insomnia in individuals, also with co-morbid problems, and that the effect is enhanced by adding brief therapist telephone support.METHODS:
Volunteer sample; 133 media-recruited adults with insomnia. History of sleep difficulties (mean [SD]) 11.8 [12.0] years. 92.5% had co-morbid problems (e.g. allergy, pain, and depression). -
Chronic insomnia
Morin CM, Benca R.
Université Laval, Québec City, QC, Canada.
Lancet. 2012 Jan 19. [Epub ahead of print]Abstract
Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce.
Morin CM, Benca R.
Université Laval, Québec City, QC, Canada.
Lancet. 2012 Jan 19. [Epub ahead of print]Abstract
Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. -
Driver sleepiness-Comparisons between young and older men during a monotonous afternoon simulated drive
Filtness AJ, Reyner LA, Horne JA.
Sleep Research Centre, Loughborough University, Leicestershire LE11 3TU, UK(1); Accident Research Centre, Injury Research Institute, Monash University, Clayton 3188, Australia(2).
Biol Psychol. 2012 Jan 18. [Epub ahead of print]
Abstract
Young men figure prominently in sleep-related road crashes. Non-driving studies show them to be particularly vulnerable to sleep loss, compared with older men. We assessed the effect of a normal night's sleep vs. prior sleep restricted to 5h, in a counterbalanced design, on prolonged (2h) afternoon simulated driving in 20 younger (av. 23y) and 19 older (av. 67y) healthy men. Driving was monitored for sleepiness related lane deviations, EEGs were recorded continuously and subjective ratings of sleepiness taken every 200s. Following normal sleep there were no differences between groups for any measure. After sleep restriction younger drivers showed significantly more sleepiness-related deviations and greater 4-11Hz EEG power, indicative of sleepiness. There was a near significant increase in subjective sleepiness. Correlations between the EEG and subjective measures were highly significant for both groups, indicating good self-insight into increasing sleepiness. We confirm the greater vulnerability of younger drivers to sleep loss under prolonged afternoon driving.
Filtness AJ, Reyner LA, Horne JA.
Sleep Research Centre, Loughborough University, Leicestershire LE11 3TU, UK(1); Accident Research Centre, Injury Research Institute, Monash University, Clayton 3188, Australia(2).
Biol Psychol. 2012 Jan 18. [Epub ahead of print]
Abstract
Young men figure prominently in sleep-related road crashes. Non-driving studies show them to be particularly vulnerable to sleep loss, compared with older men. We assessed the effect of a normal night's sleep vs. prior sleep restricted to 5h, in a counterbalanced design, on prolonged (2h) afternoon simulated driving in 20 younger (av. 23y) and 19 older (av. 67y) healthy men. Driving was monitored for sleepiness related lane deviations, EEGs were recorded continuously and subjective ratings of sleepiness taken every 200s. Following normal sleep there were no differences between groups for any measure. -
Sleep-Disordered Breathing in Neurodegenerative Diseases
Gaig C, Iranzo A.
Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic and Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain, cgaig@clinic.ub.es.
Curr Neurol Neurosci Rep. 2012 Jan 18. [Epub ahead of print]
Abstract
Sleep disorders are common in neurodegenerative diseases such as Parkinson's disease (PD), multiple system atrophy (MSA), amyotrophic lateral sclerosis (ALS), hereditary ataxias, and Alzheimer's disease (AD). Type, frequency, and severity of sleep disturbances vary depending on each of these diseases. Cell loss of the brainstem nuclei that modulates respiration, and dysfunction of bulbar and diaphragmatic muscles increase the risk for sleep-disordered breathing (SDB) in MSA and ALS. The most relevant SDB in MSA is stridor, whereas in ALS nocturnal hypoventilation due to diaphragmatic weakness is the most common sleep breathing abnormality. Stridor and nocturnal hypoventilation are associated with reduced survival in MSA and ALS. In contrast, sleep apnea seems not to be more prevalent in PD than in the general population. In some PD patients, however, coincidental obstructive sleep apnea (OSA) can be the cause of excessive daytime sleepiness (EDS). SDB can also occur in some hereditary ataxias, such as stridor in spinocerebellar ataxia type 3 (Machado-Joseph disease). The presence of concomitant OSA in patients with AD can have deleterious effects on nocturnal sleep, may result in EDS, and might aggravate the cognitive deficits inherent to the disease. However, whether OSA is more frequent in patients with AD than in the general population is uncertain. Recognition of SDB in neurodegenerative disease is important because they are associated with significant morbidity and potential effective treatments are available.
Gaig C, Iranzo A.
Neurology Service, Multidisciplinary Sleep Unit, Hospital Clínic and Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain, cgaig@clinic.ub.es.
Curr Neurol Neurosci Rep. 2012 Jan 18. [Epub ahead of print]
Abstract
Sleep disorders are common in neurodegenerative diseases such as Parkinson's disease (PD), multiple system atrophy (MSA), amyotrophic lateral sclerosis (ALS), hereditary ataxias, and Alzheimer's disease (AD). Type, frequency, and severity of sleep disturbances vary depending on each of these diseases. Cell loss of the brainstem nuclei that modulates respiration, and dysfunction of bulbar and diaphragmatic muscles increase the risk for sleep-disordered breathing (SDB) in MSA and ALS.
