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PubMed2000

Arm restlessness in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a neurologic disorder characterized principally by leg paresthesia and motor restlessness. Several clinical reports indicated that many patients with RLS also have arm paresthesia and restlessness. In the present study, the incidence of arm restlessness was assessed by questionnaire in 230 patients diagnosed with idiopathic RLS. Arm restlessness was reported by 48.7% of the patients. Patients with and without arm restlessness were compared with regard to clinical and polysomnographic parameters. No between-group differences were found for age at onset of RLS, duration of illness, gender, presence of a family history of RLS, sleep latency, total sleep time, sleep efficiency, and periodic leg movements index during sleep. However, arm restlessness was more frequent in patients with severe RLS. Interestingly, the polysomnographic data failed to differentiate the patients with arm restlessness from those without arm restlessness, except for sleep efficiency, which tended to be lower in patients with arm restlessness. In conclusion, the results of the present study are in agreement with clinical observations that a large proportion of patients with RLS have arm restlessness.

Adult↗
PubMed2002

Effects of pregnancy on mothers' sleep.

OBJECTIVES: To survey the effects of pregnancy on mothers' sleep. METHODS: Mothers were interviewed during and after pregnancy with a series of five questionnaires to assess alterations in their sleep. The first questionnaire covered the 3 months before becoming pregnant, the next three the trimesters of pregnancy and the last the 3 months after delivery. The study was carried out in a central hospital and the maternity care units in the nearby rural community. Altogether, 325 pregnant women completed all five questionnaires. RESULTS: The total amounts of reported sleep and of nocturnal sleep increased significantly during the first trimester of pregnancy, began to decrease thereafter and were shortest during the 3 months after pregnancy. During late pregnancy expectant mothers over 30 years of age reported less sleep than those under 30. During the whole pregnancy, but increasingly toward the end of pregnancy, sleep became more restless and fragmentary and its subjective quality worsened, due at least partly to increased restless legs and nightly awakenings increasing with advancing pregnancy. CONCLUSIONS: The subjective quality of sleep is disturbed as early as the first trimester of pregnancy, although total sleeping time increases. The amount of reported sleep begins to decrease in the second trimester. The frequency of reported sleep disturbances, such as restless legs syndrome and nocturnal awakenings, is maximum in the third trimester but is about normal within 3 months after delivery.

Journal Article↗
PubMed2001

[Excessive daytime sleepiness: etiology, differential diagnosis and diagnostic procedures].

This article gives an overview on frequent causes of excessive daytime sleepiness in clinical practice. Specifically, the insufficient sleep syndrome, sleep disordered breathing, narcolepsy, restless legs syndrome/periodic limb movements in sleep, and circadian disorders causing daytime sleepiness are discussed. Other possible causes including symptomatic daytime sleepiness associated with various medical conditions are mentioned. Different methods to determine daytime sleepiness are discussed in the final section.

Diagnosis, Differential↗
PubMed1997

The indications for polysomnography and related procedures.

This paper is a review of the literature on the use of polysomnography in the diagnosis of sleep disorders in the adult. It is based on a search of MEDLINE from January 1966 through April 1996. It has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association and provides the background for the accompanying ASDA Standards of Practice Committee's Parameters for the Practice of Sleep Medicine in North America. The diagnostic categories reviewed are: sleep-related breathing disorders; other respiratory disorders; narcolepsy; parasomnias and sleep-related epilepsy; restless legs syndrome and periodic limb movement disorders: insomnia; and circadian rhythm sleep disorders. Where appropriate, previously published practice parameters papers are cited and discussed. The relevant published peer-reviewed literature used as the basis for critical decisions was compiled into accompanying evidence tables and is analyzed in the text. In the section on the assessment of sleep apnea syndrome, options for estimating pretest probability to select high risk patients are also reviewed. Sleep-testing procedures other than standard polysomnography are also addressed (daytime polysomnography, split-night studies, oximetry, limited full respiratory recordings, and less-than-full respiratory recording) and treatment-related follow-up studies are discussed.

Adult↗
PubMed2002

Pergolide restores sleep maintenance but impairs sleep EEG synchronization in patients with restless legs syndrome.

BACKGROUND: The treatment with the long-acting dopamine D1/D2 receptor agonist pergolide has been proven as very effective in lowering the frequency of periodic leg movements (PLM) in patients with restless legs syndrome (RLS). To further investigate the influence of this potent dopaminergic drug on the microstructure of rapid eye movement (REM) and non-REM sleep EEG we established a quantitative analysis of the EEG data. METHODS: The study group consisted of 15 patients with primary RLS (mean age 57.1+/-10.1 years) who were a subgroup of patients within a double-blind randomized crossover treatment study with pergolide versus placebo. The polysomnographic recordings were analyzed visually and submitted to a quantitative EEG analysis (fast Fourier transformation). RESULTS: The pergolide treatment induced a significant reduction of the spectral power in the delta range (0.78-3.9 Hz; P<0.05; t-test) during SWS, as well as a significant reduction of PLMs. In addition, we observed a decrease in the sigma EEG activity (12.1-14.8 Hz; P<0.03) during non-REM sleep and stage 2 sleep. The visual sleep scoring revealed a significant increase in stage 2 sleep (P<0.005), whereas wakefulness was markedly diminished (P<0.001). The REM sleep parameters including the EEG power spectrum remained unchanged. CONCLUSIONS: The treatment with pergolide markedly improved the sleep quality in RLS patients but did not restore SWS including the spectral power in the lower frequencies. Our results suggest that the dopamine agonist pergolide interferes with the subcortical mechanisms regulating the process of EEG synchronization during non-REM sleep.

Clinical Trial↗
PubMed1982

Effects of water beds on the sleep and motility of theophylline-treated preterm infants.

With evidence accumulating that the sleep of infants receiving theophylline is sharply reduced, this study tested whether water bed flotation could increase the sleep and attenuate the restlessness of preterm infants treated with theophylline for apnea. Seventeen preterm infants served as their own control, off and on gently oscillating water beds. The infants' sleep and motility were assessed on days 3 and 4 during the experimental and control conditions. While on the water bed, the infants had significantly more quiet and active sleep, shorter sleep latencies, fewer state changes, less restlessness during sleep, less waking activity, and fewer jittery and unsmooth movements. Reductions in wakefulness and state changes on the water bed were significantly greater, the longer the infants were receiving theophylline, but they were unrelated to theophylline levels which, for the group as a whole, were relatively low. Residual apnea was not reduced on the water bed. Although water bed flotation significantly improved the infants' sleep and motility, stable behaviour differences among the infants were observed across the experimental and control conditions.

Beds↗
PubMed1998

Sleep disturbance in spinocerebellar ataxias: is the SCA3 mutation a cause of restless legs syndrome?

OBJECTIVE: To identify and to characterize sleep disturbances in patients with hereditary ataxias. BACKGROUND: We observed restless legs syndrome (RLS) and impaired sleep as a frequent yet unrecognized symptom in spinocerebellar ataxia type 3 (SCA3). METHODS: A total of 89 patients with genetically defined subtypes of autosomal dominant cerebellar ataxias were investigated for sleep history and neurologic findings according to a standardized protocol. Nerve conduction studies were performed. Sleep was studied by overnight polysomnography in seven patients. RESULTS: RLS was present in 45% of SCA3 patients but is rare in other types of autosomal dominant cerebellar ataxias. RLS was a frequent but not the only cause of sleep impairment in SCA3. Impaired sleep in SCA3 is associated with older age, long-standing disease, and brainstem involvement. RLS tended to be more frequent in patients with clinical signs of polyneuropathy, but RLS was not restricted to patients with peripheral neuropathy. RLS was not observed in healthy members of SCA3 families. CONCLUSIONS: RLS is a frequent and treatable cause of disabling sleep disturbance in SCA3. This study provides evidence for the expanded CAG repeat in the SCA3 gene as a molecular factor causing RLS.

Adult↗
PubMed2006

Prevalence and correlates of restless legs syndrome symptoms in the Wisconsin Sleep Cohort.

BACKGROUND AND PURPOSE: The aim of this study was to estimate the prevalence of restless legs syndrome (RLS) symptoms in the US adult population and to relate frequency of RLS symptoms to self-reported general health, depressive and anxiety symptoms, daytime sleepiness, and cardiovascular disease. PATIENTS AND METHODS: Data were obtained from a survey, conducted in 2002, of 2821 participants in the Wisconsin Sleep Cohort, a prospective community-based epidemiology study. Classification of RLS symptoms was based on the following four symptoms at the 2002 survey: 'repeated urge to move your legs' and 'strange and uncomfortable feelings in the legs', 'when sitting or lying down' which occur at least weekly, 'get better when you get up and start walking' and 'disrupt your sleep'. RESULTS: Prevalence of RLS symptoms occurring at least weekly was 10.6%, with no statistical difference between males (9.9%) and females (11.2%). Individuals with symptoms of RLS occurring at least weekly were older than those without such symptoms (P<0.02). Those with Daily RLS symptoms had statistically more frequent excessive daytime sleepiness, poorer self-reported general health, an elevation in depressive and anxiety symptoms, and an increased prevalence of cardiovascular disease compared to those with no RLS symptoms. All of these associations were stronger in subjects with Daily RLS symptoms than those with RLS symptoms 1-6 times per week. CONCLUSIONS: RLS symptoms are associated with multiple physical and psychological indices of impaired health. Longitudinal studies are required to determine whether RLS symptoms are causally related to excessive daytime sleepiness, poor general health, elevated depression and anxiety symptoms, and cardiovascular disease.

Adult↗
PubMed2006

Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD).

Sleep disorders are common in adults with attention deficit/hyperactivity disorder (ADHD). Two sleep questionnaires; the Brown ADD Scale, the Symptom-Checklist-90-R, and a self-developed symptom questionnaire were administered in this study. In a sample of 61 patients without comorbidity, current substance abuse and medication intake, sleep problems were reported more often than in healthy controls. A lack of being refreshed in the morning was very closely associated with ADHD symptomatology whereas insomnia was related to the presence of comorbidity and depressive symptoms. In the total sample (N = 120), medication intake (mainly stimulants) was not related to any of the sleep parameters. It seems important to screen adult patients with ADHD for the presence of sleep disorders, especially insomnia, restless legs syndrome, and sleep-related breathing disorders (the last in conjunction with the body mass index). Since primary sleep disorders are associated with cognitive impairment, one might expect that ADHD symptomatology may improve if comorbid sleep disorders are adequately treated in addition to the specific ADHD treatment.

Adolescent↗
PubMed2000

[Hypersomnia--etiology, clinic, diagnosis and therapy of excessive sleepiness].

Hypersomnia (excessive sleepiness) refers to an increased sleep propensity with a subjective craving for sleep, involuntary naps and "sleep attacks" during the day and/or prolonged nighttime sleep with sleep drunkeness. Excessive sleepiness should be separated from fatigue and lack of energy associated with a variety of medical and psychiatric diseases. Hypersomnia is reported by 2-5% of the adult population and can lead to poor work, accidents and neuropsychiatric disturbances. Sleep apnea syndrome (SAS), narcolepsy, chronic sleep deprivation (insufficiency), and restless legs/periodic limb movements in sleep syndrome (RLS/PLMS) represent the most common causes of hypersomnia. The diagnosis of these conditions can often be suspected on clinical grounds. However, an overnight polysomnography and a multiple sleep latency test are often additionally required for definite diagnosis. Treatment options include nasal CPAP for SAS, stimulants for narcolepsy, sleep prolongation for sleep insufficiency, and dopaminergic agents for RLS/PLMS.

Adult↗
PubMed2005

Antidepressants and sleep: a qualitative review of the literature.

Most antidepressants change sleep; in particular, they alter the physiological patterns of sleep stages recorded overnight with EEG and other physiological measures. These effects are greatest and most consistent on rapid eye movement (REM) sleep, and tend to be in the opposite direction to the sleep abnormalities found in major depression, but are usually of greater degree. Reductions in the amount of REM sleep and increases in REM sleep onset latency are seen after taking antidepressants, both in healthy volunteers and in depressed patients. Antidepressants that increase serotonin function by blocking reuptake or by inhibiting metabolism have the greatest effect on REM sleep. The decrease in amount of REM sleep appears to be greatest early in treatment, and gradually diminishes during long-term treatment, except after monoamine oxidase inhibitors when REM sleep is often absent for many months. Sleep initiation and maintenance are also affected by antidepressants, but the effects are much less consistent between drugs. Some antidepressants such as clomipramine and the selective serotonin receptor inhibitors (SSRIs), particularly fluoxetine, are sleep-disturbing early in treatment and some others such as amitriptyline and the newer serotonin 5-HT2-receptor antagonists are sleep promoting. However, these effects are fairly short-lived and there are very few significant differences between drugs after a few weeks of treatment. In general, the objectively measured sleep of depressed patients improves during 3-4 weeks of effective antidepressant treatment with most agents, as does their subjective impression of their sleep. Sleep improvement earlier in treatment may be an important clinical goal in some patients, perhaps when insomnia is particularly distressing, or to ensure compliance. In these patients, the choice of a safely used and effective antidepressant which improves sleep in short term is indicated. Patients with other sleep disorders such as restless legs syndrome and REM sleep behaviour disorder should be identified before choosing a treatment, as some antidepressants worsen these conditions. Conversely, there is evidence that some antidepressants may be useful in the treatment of sleep disorders such as night terrors.

Antidepressive Agents↗
PubMed2005

Sleep and psychiatry.

Psychiatric disorders constitute 15.4% of the disease burden in established market economies. Many psychiatric disorders are associated with sleep disturbances, and the relationship is often bidirectional. This paper reviews the prevalence of various psychiatric disorders, their clinical presentation, and their association with sleep disorders. Among the psychiatric disorders reviewed are affective disorders, psychosis, anxiety disorders (including posttraumatic stress disorder), substance abuse disorders, eating disorders, and attention deficit/hyperactivity disorders. The spectrum of associated sleep disorders includes insomnia, hypersomnia, nocturnal panic, sleep paralysis, hypnagogic hallucinations, restless legs/periodic limb movements of sleep, obstructive sleep apnea, and parasomnias. The effects on sleep of various psychotropic medications utilized to treat the above psychiatric disorders are summarized.

Humans↗
PubMed2006

Sleep and developmental disabilities: assessment, treatment, and outcome measures.

People with developmental disabilities sleep less and experience higher incidence of clinical sleep disorders than the general population. Exploring the neurophysiology linking sleep with daytime performance in patients with developmental disabilities is now possible using minimally sufficient sleep and sleep-sensitive behavioral assays. Although frequent sampling represents the primary difficulty, it is required to untangle coincident effects of sleep quality amidst circadian variation. Recent evidence finds high quality sleep promotes brain plasticity, improves health measures, and enriches quality of life. Sleep treatments for apnea, insomnia, restless limbs, and conditioned sleep-aversion are available, although not readily provided, for people with developmental disabilities. This population would gain both clinical and behavioral benefits as improved sleep-monitoring, behavioral testing, and sleep-treatment technology is adapted to their needs.

Brain↗
PubMed2003

Development of restless legs syndrome after dopaminergic treatment in a patient with periodic leg movements in sleep.

Periodic leg movements in sleep (PLMS) unrelated to restless legs syndrome (RLS) are a polysomnographic finding with a controversial clinical value. We describe a patient with isolated periodic leg movements in sleep (without any awake or sleep complaints), who developed severe diurnal RLS symptoms a few months after starting dopaminergic treatment, a phenomenon mimicking augmentation. The diurnal RLS symptoms disappeared after withdrawal of the dopaminergic drugs. Serum ferritin levels were relatively low (31-61 mcg/l; normal: 30-400 mcg/l). Since low levels of ferritin have been implicated in the genesis of RLS, and augmentation is a phenomenon associated with RLS, our findings here suggest that asymptomatic PLMS may have pathogenic mechanisms similar to RLS. Isolated PLMS and RLS could be, at least in some cases, different clinical forms of the same disorder. The conjunction of dopaminergic treatment with low ferritin levels may expose a patient with isolated PLMS to the development of RLS. Discontinuation of dopaminergic drugs in patients with isolated PLMS who develop RLS during the course of the treatment would be a reasonable recommendation.

Dopamine Agents↗
PubMed2006

Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll.

PURPOSES: The purpose of this analysis was to investigate the prevalence and correlates of restless legs syndrome (RLS) symptoms in the 2005 National Sleep Foundation (NSF) Sleep in America 2005 Poll. The NSF poll is an annual telephone interview of a random, representative sample of US adults. METHODS: The NSF 2005 poll included 1,506 adults. Their mean age was 49 years, and 775 were women. RESULTS: Symptoms of RLS that included unpleasant feelings in the legs for at least a few nights a week, which were worse at night, were reported by 9.7% of individuals in this poll, including 8% of men and 11% of women. Those from the northeast United States were much less likely to be at risk than those from other regions of the country (p < 0.05). Those who were unemployed (p < 0.05) or smoked daily (p < 0.5) were more likely to be at risk for RLS, as were those with hypertension, arthritis, gastroesophageal reflux disease, depression, anxiety, and diabetes (p < 0.05 for all). Adults who were at risk for RLS appeared to also be at increased risk for sleep apnea and insomnia (p < 0.05), and were more likely to stay up longer than they planned, to take longer than 30 min to fall asleep, to drive when drowsy, and to report daytime fatigue than those who were not at risk (p < 0.05 for all). They were also more likely to report being late to work, missing work, making errors at work, and missing social events because of sleepiness than other respondents in the poll (p < 0.05 for all). CONCLUSIONS: RLS is significantly associated with medical and psychiatric conditions, other sleep disorders, unfavorable lifestyle behaviors, and adverse effects on daytime function. Chest physicians who practice sleep medicine need to be able to identify and manage RLS, which is prevalent and is associated with considerable morbidity.

Adult↗
PubMed2002

Subjective sleep quality and suggested immobilization test in restless leg syndrome and periodic limb movement disorder.

The severity of restless leg syndrome (RLS) and/or periodic limb movement disorder (PLMD) was investigated by using a suggested immobilization test (SIT) and by measuring the influence of these disorders on the subjective sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI). Patients with RLS and those with both RLS and PLMD showed remarkably high values for PSQI and SIT, whereas patients with PLMD only showed normal values for PSQI. These findings suggest that there is only a small pathological significance for periodic limb movements, and demonstrate the efficacy of SIT and PSQI for evaluating the severity of these disorders.

Electromyography↗
PubMedDate not supplied

[Restless legs syndrome and periodic limb movements in sleep: clinical features, epidemiology, diagnosis].

In this review article we summarise the clinical features, epidemiology and differential diagnosis of the Restless Legs Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS). RLS and PLMS belong to the most common causes which disturb sleep, and the RLS prevalence in the general population is estimated to range from 5 to 15%. The RLS is encountered in 10-20% of patients presenting with a problem of initiating and maintaining sleep, and in over 10% of patients with excessive daytime sleepiness. The RLS is characterised by unpleasant sensations felt deep in the legs, usually between the ankle and knee, but occasionally involving also the upper limbs or the trunk, and occurring at rest, especially at bedtime. The paresthesias are accompanied by motor restlessness and by an urge to move the limb, which results in a temporary relief of the symptoms. In virtually all of the sleeping RLS patients PLMS are observed. These are stereotyped, periodic jerking movements of a non-epileptic origin consisting in an extension of the big toe and dorsiflexion of the ankle with an occasional flexion of the knee and hip. PLMS are accompanied by usually short awakenings or transient arousals as demonstrated by sleep LEG resulting in sleep disruption. In establishing the diagnosis of RLS/PLMS idiopathic and secondary forms should be distinguished, and in particular, a number of other conditions (e.g. uremia or iron-deficiency) need to be ruled out. The clinical diagnosis of the RLS is based on the criteria of The International Restless Legs Syndrome Study Group, and the most useful laboratory support is gained from all-night polysomnography and high-resolution actography.

Electroencephalography↗