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At least 217 records · Page 12Linked to original sources

PubMed2004

Sleep disorders and illness intrusiveness in patients on chronic dialysis.

BACKGROUND: The prevalence of sleep problems (insomnia, restless legs syndrome, periodic limb movements in sleep and sleep apnoea) has been shown to be high in patients with end-stage renal disease (ESRD) and might contribute to impaired quality of life in this population. METHODS: In a cross-sectional study using self-administered questionnaires, we examined the prevalence of sleep disorders and assessed their effect on different aspects of health-related quality of life in a sample of Hungarian patients on maintenance dialysis. RESULTS: Our data confirm that sleep problems are frequent in patients with ESRD; 65% of the patients reported symptoms of at least one specific sleep disorder; insomnia was the most common sleep complaint with 49%, the prevalence of sleep apnoea was 32% and the prevalence of restless legs syndrome was 15%. Co-morbidity, assessed by the End-Stage Renal Disease Severity Index, was shown to be an independent predictor of sleep disorders. Patients with sleep disorders reported higher illness intrusiveness and worse self-perceived health than those without sleep problems. The presence of sleep disorders was an independent predictor of illness intrusiveness, an important determinant of health-related quality of life. CONCLUSION: Sleep disorders are important determinants of illness intrusiveness and health-related quality of life in patients with ESRD. Sleep problems may be treated successfully; therefore, more attention should be paid to assessing these problems in this patient population.

Adult↗

PubMed2002

The role of cerebrospinal fluid hypocretin measurement in the diagnosis of narcolepsy and other hypersomnias.

CONTEXT: Narcolepsy, a neurological disorder affecting 1 in 2000 individuals, is associated with HLA-DQB1*0602 and low cerebrospinal fluid (CSF) hypocretin (orexin) levels. OBJECTIVES: To delineate the spectrum of the hypocretin deficiency syndrome and to establish CSF hypocretin-1 measurements as a diagnostic tool for narcolepsy. DESIGN: Diagnosis, HLA-DQ, clinical data, the multiple sleep latency test (MSLT), and CSF hypocretin-1 were studied in a case series of patients with sleep disorders from 1999 to 2002. Signal detection analysis was used to determine the CSF hypocretin-1 levels best predictive for International Classification of Sleep Disorders (ICSD)-defined narcolepsy (blinded criterion standard). Clinical and demographic features were compared in narcoleptic subjects with and without low CSF hypocretin-1 levels. SETTING: Sleep disorder and neurology clinics in the United States and Europe, with biological testing performed at Stanford University, Stanford, Calif. PARTICIPANTS: There were 274 patients with narcolepsy; hypersomnia; obstructive sleep apnea; restless legs syndrome; insomnia; and atypical hypersomnia cases such as familial cases, narcolepsy without cataplexy or without HLA-DQB1*0602, recurrent hypersomnias, and symptomatic cases (eg, Parkinson disease, depression, Prader-Willi syndrome, Niemann-Pick disease type C). The subject group also included 296 controls (healthy and with neurological disorders). INTERVENTION: Venopuncture for HLA typing, lumbar puncture for CSF analysis, primary diagnosis using the International Classification of Sleep Disorders, Stanford Sleep Inventory for evaluation of narcolepsy, and sleep recording studies. MAIN OUTCOME MEASURES: Diagnostic threshold for CSF hypocretin-1, HLA-DQB1*0602 positivity, and clinical and polysomnographic features. RESULTS: HLA-DQB1*0602 frequency was increased in narcolepsy with typical cataplexy (93% vs 17% in controls), narcolepsy without cataplexy (56%), and in essential hypersomnia (52%). Hypocretin-1 levels below 110 pg/mL were diagnostic for narcolepsy. Values above 200 pg/mL were considered normal. Most subjects with low levels were HLA-DQB1*0602-positive narcolepsy-cataplexy patients. These patients did not always have abnormal MSLT. Rare subjects without cataplexy, DQB1*0602, and/or with secondary narcolepsy had low levels. Ten subjects with hypersomnia had intermediate levels, 7 with narcolepsy (often HLA negative, of secondary nature, and/or with atypical cataplexy or no cataplexy), and 1 with periodic hypersomnia. Healthy controls and subjects with other sleep disorders all had normal levels. Neurological subjects had generally normal levels (n = 194). Intermediate (n = 30) and low (n = 3) levels were observed in various acute neuropathologic conditions. CONCLUSIONS: Narcolepsy-cataplexy with hypocretin deficiency is a genuine disease entity. Measuring CSF hypocretin-1 is a definitive diagnostic test, provided that it is interpreted within the clinical context. It may be most useful in cases with cataplexy and when the MSLT is difficult to interpret (ie, in subjects already treated with psychoactive drugs or with other concurrent sleep disorders).

Adult↗

PubMed2004

Periodic limb movement disorder and restless legs syndrome in dialysis patients.

BACKGROUND: Sleep disturbances, in particular restless legs or limb movements, during the night are often reported by uremic patients. However, polysomnography (PSG) studies have never been carried out to confirm the actual occurrence of these disorders and the association with other objective and self-reported sleep-wake data. METHODS: Forty-eight participants were subjected to a 2-day PSG. These data on sleep including periodic limb movements, which are associated with restless legs, were correlated with clinical observations, quality of sleep-wake and life questionnaires, and with biochemical and neurographical measures. RESULTS: Restless legs syndrome (RLS) was observed in 58.3% of the patients and periodic limb movement disorder (PLMD) occurred in 70.8% of the patients. PLMD was revealed polysomnographically in almost 90% of the RLS patients. Patients with both PLMD and RLS had significantly poorer sleep quality than those with neither disorder or with PLMD alone, both in terms of self-reported data and the PSG. Quality of life was significantly worse in patients with RLS and PLMD compared to those patients with neither disorder. PLMD patients also tended to have a lower quality of life. All other metabolic measures and the results of a nerve conduction test were not correlated with RLS and/or PLMD. CONCLUSION: There was a high prevalence of severe RLS and PLMD in the present sample of uraemia patients. Nearly all RLS patients had severe PLMD. RLS (in combination with PLMD) in dialysis is associated with poor sleep quality, insomnia complaints, depression and emotional distress. Our results suggest that PLMD per se is also clinically relevant.

Female↗

PubMed1988

Treatment of restless legs syndrome and periodic movements during sleep with L-dopa: a double-blind, controlled study.

Six patients with restless legs syndrome (RLS) and periodic movements during sleep (PMS) received placebo or L-dopa in a double-blind study. We recorded patients for 36 consecutive hours in the sleep laboratory during a baseline investigation and at the end of each treatment period. Daily evening questionnaires and a suggested immobilization test (SIT) performed at bedtime on each recording night documented the effect of L-dopa in RLS. A nocturnal EMG recording of the anterior tibialis muscles revealed the effect of L-dopa on PMS. L-Dopa proved effective in treating both RLS and PMS. Although not present in every patient, leg movements recorded during the SIT exhibited a clear periodicity. These observations support the hypothesis that RLS and PMS are two manifestations of the same central sensorimotor disorder.

Benserazide↗

PubMed2002

Circadian aspects in the pathophysiology of the restless legs syndrome.

Several pieces of evidence suggest that a dopaminergic dysfunction might play a key role in the pathophysiology of restless legs syndrome (RLS), including the therapeutic effects of dopaminergic drugs and the results of several positron emission tomography and single photon emission computed tomography studies. However, RLS symptoms display a distinct circadian pattern, with an increase of both sensorial and motor symptoms in the evening and at night. Although the latter could also be caused by homeostatic mechanisms such as a linkage to the previous amount of wakefulness, several studies performed over the last few years under semiconstant, routine conditions have suggested the existence of a 'true' circadian mechanism modulating the severity of RLS symptoms across the day-night cycle. Thus, both periodic leg movements of sleep and restlessness show a maximal severity in timely coincidence with the falling phase of the core temperature circadian cycle. The present article reviews the evidence showing circadian oscillation of dopaminergic function and postulates that the amplitude of circadian rhythm of dopaminergic function is increased in RLS, with a hypofunction at night.

Journal Article↗

PubMed1984

A review of the clinical safety and tolerability of nomifensine.

The tolerability and safety of nomifensine in clinical practice are reviewed in the context of relevant topics for the second-generation antidepressants. Nomifensine is nonsedating and impairs neither psychomotor nor cognitive performance. It has minimal anticholinergic-like properties and is nontoxic to the heart and cardiovascular system at therapeutic dosage. It is nonepileptogenic. There are few relevant drug interactions, and overdose data to date show no serious sequelae resulting from the drug itself. Side effects include sleep disturbance, restlessness, and nausea; rare adverse reactions are in keeping with other antidepressants. Nomifensine's profile differentiates it from other commonly used antidepressants; the implications of this for treatment of both common depressions and specific at-risk patients are discussed.

Adult↗

PubMed2006

[Attention deficit-hyperactivity disorder and sleep disorders].

The attention deficit hyperactivity disorder (ADHD) is an heterogeneous, complex and common childhood disorder that causes significant impairment of child's functioning. This paper reviews the epidemiology, etiology, diagnosis, comorbidity, course and treatment of ADHD. Special attention is paid to sleep problems both because these 2 conditions frequently co-exist and because there is substantial evidence that ADHD psychopathology and sleep-wake regulation share common neurobiologic mechanisms. Moreover, there could be an overlap between symptoms of ADHD and certain sleep problems such as obstructive sleep apnea syndrome, restless leg syndrome and periodic limb movements of sleep. Children undergoing evaluation for ADHD should be systematically assessed for sleep disturbances because treatment of sleep disorders is often associated with improved symptomatology and decreased need for stimulants.

Attention Deficit Disorder with Hyperactivity↗

PubMed1997

Practice parameters for the indications for polysomnography and related procedures. Polysomnography Task Force, American Sleep Disorders Association Standards of Practice Committee.

These clinical guidelines, which have been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provide recommendations for the practice of sleep medicine in North America regarding the indications for polysomnography in the diagnosis of sleep disorders. Diagnostic categories that are considered include the following: sleep-related breathing disorders; neuromuscular disorders and sleep-related symptoms; chronic lung disease; narcolepsy; parasomnias; sleep-related epilepsy; restless legs syndrome; periodic limb movement disorder; depression with insomnia; and circadian rhythm sleep disorders. Whenever possible, conclusions are based on evidence from review of the literature. Where scientific data are absent, insufficient, or inconclusive, recommendations are based on consensus of opinion. The Standards of Practice Committee of the American Sleep Disorders Association appointed a task force to review the topic, the indications for polysomnography and related procedures. Based on the review and on consultation with specialists, the subsequent recommendations were developed by the Standards of Practice Committee and approved by the Board of Directors of the American Sleep Disorders Association. Polysomnography is routinely indicated for the diagnosis of sleep-related breathing disorders; for continuous positive airway pressure (CPAP) titration in patients with sleep-related breathing disorders; for documenting the presence of obstructive sleep apnea in patients prior to laser-assisted uvulopalatopharyngoplasty; for the assessment of treatment results in some cases; with a multiple sleep latency test in the evaluation of suspected narcolepsy; in evaluating sleep-related behaviors that are violent or otherwise potentially injurious to the patient or others; and in certain atypical or unusual parasomnias. Polysomnography may be indicated in patients with neuromuscular disorders and sleep-related symptoms; to assist in with the diagnosis of paroxysmal arousals or other sleep disruptions thought to be seizure-related; in a presumed parasomnia or sleep-related epilepsy that does not respond to conventional therapy; or when there is a strong clinical suspicion of periodic limb movement disorder. Polysomnography is not routinely indicated to diagnose chronic lung disease; in cases of typical, uncomplicated, and noninjurious parasomnias when the diagnosis is clearly delineated; for patients with epilepsy who have no specific complaints consistent with a sleep disorder; to diagnose or treat restless legs syndrome; for the diagnosis of circadian rhythm sleep disorders; or to establish a diagnosis of depression.

Circadian Rhythm↗

PubMed1989

Validity of the Center for Epidemiological Studies Depression Scale in arthritis populations.

Using data from 3 studies of patients with rheumatoid arthritis, we examined the extent to which responses to items in the Center for Epidemiological Studies Depression Scale (CES-D) are influenced by aspects of the disease process other than depression. Our findings suggested that 4 CES-D items (i.e., "I felt that everything I did was an effort," "I felt hopeful about the future," "My sleep was restless," and "I could not get going") may be influenced by aspects of the disease process and, thus, are not necessarily indicative of depression among persons with arthritis. The impact that these items have on the interpretation of CES-D scores was assessed in relation to 2 research issues: estimation of the prevalence and severity of depression in arthritis populations and identification of the determinants of depression among individuals with arthritis. Our results suggest that the original CES-D may overestimate the prevalence and severity of depression among patients with arthritis. The magnitude of this bias is modest, however. The results also suggest that in studies designed to identify the determinants of depression among individuals with arthritis, inclusion of the 4 items identified is unlikely to have any effect on study findings.

Adult↗

PubMed1997

Side effects of adjunct light therapy in patients with major depression.

Adjunct bright-light therapy has been suggested to augment antidepressant drug treatment in patients with non-seasonal major depression. Side effects of the combined therapy have not been investigated thus far. Therefore, somatic complaints and side effects of combined therapy were evaluated in 28 patients with major depression (DSM-III-R) randomly assigned to either trimipramine or trimipramine and serially applied adjunct bright-light therapy. Response rates were comparable in both treatment groups and rates of newly emergent side effects during treatment were generally low. The most prominent unfavourable side effects of adjunct bright-light therapy as compared with trimipramine monotherapy were aggravated sedation, persisting restlessness, emerging sleep disturbance and decreased appetite as well as the worsening of vertigo. Discriminant analysis revealed that the combination of trimipramine with bright light results in a different side effect profile compared with drug monotherapy.

Antidepressive Agents, Tricyclic↗

PubMed2005

Treatment of sleep disorders in elderly patients.

Sleep disorders are common among the elderly and are associated with diminished quality of life, increased risk for development of psychiatric disorders, inappropriate use of sleep aids, and decreased daytime functioning. The most common and important sleep disorders in the elderly include insomnia, obstructive sleep apnea syndrome, restless legs syndrome, rapid eye movement sleep behavior disorder, and the advanced sleep phase syndrome. In this article, we summarize the current treatment strategies for each of these sleep-related disorders. Before contemplating specific treatments, the authors recommend that more conservative and nonpharmacologic therapies be attempted first because the elderly are more likely to have medication side effects or complications related to surgery. Many sleep problems can be treated by simple sleep hygiene modifications that can be implemented and adopted easily. For others, therapies that specifically consider older adults may be required. For each of the sleep disorders we provide an updated discussion of therapies beginning with diet and lifestyle, pharmacologic treatment, interventional procedures, surgery, assistive devices, physical and speech therapy, exercise, and emerging therapies with specific considerations for older adults.

Journal Article↗

PubMed1984

Fragmentary pathological myoclonus in NREM sleep.

A 42-year-old patient is reported who presented with marked daytime sleepiness and in whom the only major nocturnal polysomnographic abnormality was intense fragmentary (partial) myoclonus occurring with equal frequency in all stages of NREM sleep associated with some degree of sleep fragmentation. The myoclonus was very brief (less than 150 msec duration), aperiodic and recurred in asynchronous and asymmetrical fashion over the legs, arms and face. It appears unrelated to the clinically similar physiological myoclonus of REM sleep. Other main sleep disorders such as periodic movements, restless leg syndrome, sleep apnea and narcolepsy-cataplexy were excluded by history and polysomnography.

Adult↗

PubMed2006

Generalised anxiety disorder.

Generalised anxiety disorder is a persistent and common disorder, in which the patient has unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations. This disorder is twice as common in women than it is in men. Generalised anxiety disorder is characterised by feelings of threat, restlessness, irritability, sleep disturbance, and tension, and symptoms such as palpitations, dry mouth, and sweating. These symptoms are recognised as part of the anxiety syndrome rather than independent complaints. The symptoms overlap greatly with those of other common mental disorders and we could regard the disorder as part of a spectrum of mood and related disorders rather than an independent disorder. Generalised anxiety disorder has a relapsing course, and intervention rarely results in complete resolution of symptoms, but in the short term and medium term, effective treatments include psychological therapies, such as cognitive behavioural therapy; self-help approaches based on cognitive behavioural therapy principles; and pharmacological treatments, mainly selective serotonin reuptake inhibitors.

Anti-Anxiety Agents↗

PubMed1997

Does organization matter? A multilevel analysis of the demand-control model applied to human services.

The demand-control model (DC model) in occupational epidemiology suggests that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. The objective of this study was empirical assessment of the model's tenet of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment. The study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizational units (level 2) with 8296 employees (level 1), a median of 18 employees per unit. 5730 persons (69.1%) completed the questionnaire. Listwise deletion of missing data left a net study base of 4756 individuals in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain index. Two such indices were calculated, one for quantitative demands and one for emotional demands. Individual attributes included age, gender, marital status, having children, social anchorage, and education. There were two dependent variables, self-assessed psychovegetative symptoms (worry, anxiousness, sadness, sleep difficulties, restlessness, and tension) and exhaustion (fatigue, feelings of being used up and overworked), both measured as summative indices. For psychovegetative health, a null model yielded 2.2% level 2 variance, unchanging when individual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, decreasing level 1 variance by 23% and level 2 variance by 62%. For exhaustion, level 2 variation was 8.3% in the null model and 1.6% in the final model, with strain variables. The strain variables utilized in the DC-model thus draw a substantial part of their variation from the organizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support.

Adult↗

PubMed2000

Concerns and expectations of parents with atopic infants.

The incidence of atopic diseases has rapidly increased in developed countries. The purpose of this study was to describe the problems that parents experience when atopic disease occurs in their children at an early age and what parents expect and get from health care professionals in the management of these problems. The parents of 81 high-risk atopic infants completed a questionnaire during the infant's first attendance at the Tampere University Hospital, Finland. The patients were treated by an intervention team comprising a pediatric nurse and two pediatricians consulting with dietician and a dermatologist to detect the infant's specific food allergies and to introduce and advise on appropriate diets at weaning. After a 9-month intervention period, the parents' perception of the intervention was evaluated by a second questionnaire. The skin prick test was positive to cow's milk in 30%, to egg in 26%, and to cereals in 19%, of infants during breast-feeding. Double-blind placebo-controlled cow's milk challenge was positive in 56% of infants. Upon introduction of a tolerated weaning diet, subjective symptoms and the extent and intensity of atopic eczema diminished as evidenced by lowered SCORAD scores, from 19.3 to 8.2 (F= 57.6, p < 0.0001; SCORAD scoring index combining extent, severity and subjective symptoms of atopic eczema). Ninety per cent of parents found the care of an atopic infant more demanding than that of a healthy child. This was because of the persistence of symptoms, such as atopic eczema and pruritus, and restlessness during sleep. For the management of these problems the parents advocated diagnostic evaluation and elimination of specific foods from the diet of the lactating mother. They expected from the intervention accurate diagnosis of food allergies, practical advice on elimination diets, alleviation of symptoms, and follow-up of growth and nutrition, and they considered the care provided by the intervention team to suffice in these aims. The present data support a comprehensive team approach to the care of atopic infants and their parents.

Adolescent↗

PubMed2003

The time course and significance of cannabis withdrawal.

Withdrawal symptoms following cessation of heavy cannabis (marijuana) use have been reported, yet their time course and clinical importance have not been established. A 50-day outpatient study assessed 18 marijuana users during a 5-day smoking-as-usual phase followed by a 45-day abstinence phase. Parallel assessment of 12 ex-users was obtained. A withdrawal pattern was observed for aggression, anger, anxiety, decreased appetite, decreased body weight, irritability, restlessness, shakiness, sleep problems, and stomach pain. Onset typically occurred between Days 1-3, peak effects between Days 2-6, and most effects lasted 4-14 days. The magnitude and time course of these effects appeared comparable to tobacco and other withdrawal syndromes. These effects likely contribute to the development of dependence and difficulty stopping use. Criteria for cannabis withdrawal are proposed.

Adult↗

PubMedDate not supplied

Pharmacologic management of integrative brain failure.

Integrative brain failure is often a comorbidity of critical illness, and although not uncommon, is perhaps the least understood of all the various organ failure phenomena. Factors that contribute to integrative brain failure include inadequate management of pain, stress, anxiety, and the several underlying mechanisms that create agitation in the intensive care unit patient. Delirium, a resultant organic mental syndrome, is reversible when promptly recognized and aggressively managed. The nurse who is astute in clinical assessments and skillful in the management of the environment of care can prevent and control states of anxiety, irritability, restlessness, and sleep disturbances that contribute to the development of delirium.

Adrenergic Antagonists↗

PubMed1988

Synthetic food colourings and 'hyperactivity': a double-blind crossover study.

Of 220 children referred for suspected 'hyperactivity', 55 were subjected to a 6 week trial of the Feingold diet. Forty (72.7%) demonstrated improved behaviour and 26 (47.3%) remained improved following liberalization of the diet over a period of 3-6 months. The parents of 14 children claimed that a particular cluster of behaviours was associated with the ingestion of foods containing synthetic colourings. A double-blind crossover study, employing a single-subject repeated measures design was conducted, using eight of these children. Subjects were maintained on a diet free from synthetic additives and were challenged daily for 18 weeks with either placebo (during lead-in and washout periods) or 50 mg of either tartrazine or carmoisine, each for 2 separate weeks. Two significant reactors were identified whose behavioural pattern featured extreme irritability, restlessness and sleep disturbance. One of the reactors did not have inattention as a feature. The findings raise the issue of whether the strict criteria for inclusion in studies concerned with 'hyperactivity' based on 'attention deficit disorder' may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.

Adolescent↗