Sleep disorders in children and adolescents.
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Adolescent↗
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Results for “Restless sleep”
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Chronic use of triazolam in patients with periodic leg movements, fragmented sleep and daytime sleepiness.
Many studies have shown a relationship between fragmented nocturnal sleep and daytime sleepiness. In the current study, 9 patients, aged 55-79, with fragmented nocturnal sleep secondary to periodic leg movements and objective daytime sleepiness, as verified by Multiple Sleep Latency Test (MSLT), had 12 weeks of treatment with 0.125 mg of triazolam following 2 screening nights and 2 placebo baseline nights; 2 final placebo nights were placed 5 nights following the last medication night. The medication increased total sleep time and sleep efficiency throughout the administration period, as compared to average placebo values; total leg movements were not changed. Generally, daytime performance, as measured by a vigilance task, and objective alertness, as measured by MSLT, were improved following the use of triazolam. No adverse reactions or significant side effects were noted. It was concluded that 0.125 mg triazolam, when used for up to 3 months, could improve sleep and daytime function in older patients with periodic leg movements, fragmented sleep, and daytime sleepiness.
Aged↗
Double-blind evaluation of clonazepam on periodic leg movements in sleep.
Treatment with clonazepam was studied in a group of 20 patients suffering from periodic movements in sleep, in a double-blind parallel group design. Eleven complained of excessive daytime sleepiness, and nine complained of insomnia. Ten patients received clonazepam, and 10 received placebo, over a period of 1 month. Clonazepam (0.5-2 mg per night) proved to be an effective treatment of periodic movements in sleep. Polysomnographic recordings demonstrated a significant decrease in the number of leg movements and a significant improvement in sleep parameters in the clonazepam group as compared with placebo. Subjective responses to treatment corroborated the sleep laboratory findings.
Clonazepam↗
Ropinirole in the treatment of restless legs syndrome.
Ropinirole is an original nonergoline dopamine agonist indicated for the treatment of Parkinson's disease. However, recent developments in the study of restless legs syndrome have demonstrated another role for this drug. The symptoms of restless legs syndrome are responsive to dopaminergic agents such as ropinirole. The dosage of ropinirole needed to treat the symptoms of restless legs syndrome appears to be much smaller than what is necessary for Parkinson's disease therapy. The liver is primarily responsible for the metabolism of ropinirole, which has an elimination half-life of approximately 6 h. Ropinirole is generally well tolerated, with no serious adverse effects. Clinical studies have indicated that ropinirole can effectively reduce the motor symptoms of restless legs syndrome and improve overall sleep quality.
Dopamine Agonists↗
Insomnia in the geriatric patient.
Insomnia in the geriatric patient is unique and complex, requiring a comprehensive and careful evaluation. Insomnia is the most common sleep complaint reported by persons > 60 years. It is defined as the inability to initiate or maintain sleep, and the etiology can be multifactorial. Insomnia in the geriatric patient may be due to a primary sleep disorder, such as obstructive sleep apnea, periodic limb movements in sleep, circadian rhythm disorders, or restless legs syndrome, or it may be secondary to underlying medical or psychiatric conditions, medication effects, or psychosocial factors. When insomnia becomes chronic, it may exacerbate medical and psychiatric illnesses. Insomnia can lead to excessive daytime sleepiness, which may result in disturbed intellect, impaired cognition, confusion, psychomotor retardation, or increased risk of injury, any of which can compromise the patient's quality of life and create social and economic burdens for caregivers. This article discusses the recommended diagnostic and treatment approaches that may be used by the clinician in treating the geriatric patient. Case studies are presented to illustrate diagnoses of insomnia and therapeutic interventions.
Age Factors↗
Sleep related breathing disorder: is it sleep apnea syndrome?
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Disorders of Excessive Somnolence↗
Getting a good night's sleep with kidney disease.
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Humans↗
Evaluating the quality of life of patients with restless legs syndrome.
BACKGROUND: The primary morbidities of restless legs syndrome (RLS) involve sleep loss, extreme discomfort, and disruption of normal activities. Although the condition is not life-threatening, assessing the disease burden and the impact of RLS on quality of life (QOL) is critical for evaluating treatment benefits. OBJECTIVE: The purpose of this study was to assess the impact of RLS on QOL. METHODS: In this subanalysis of a specific validation study, the SF-36 (Medical Outcomes Study 36-Item Short Form health survey) was administered to 85 patients with primary RLS who had been referred to a sleep-medicine clinic. The scores were compared with published norms for the general population (N = 2474). RESULTS: The majority (63.5%) of RLS patients were women; the mean (SD) age was 62.4 (14.0) years; 67.1% of patients experienced RLS symptoms almost daily. The RLS group, particularly patients with more severe RLS, reported significant deficits (10-40 points on 100-points scales) in physical functioning, bodily pain, role functioning, mental health, general health, and vitality compared with the general population. The RLS sample had significantly lower scores (worse QOL) on all 8 scales of the SF-36 compared with patients with hypertension (P<0.01); compared with patients with other cardiovascular conditions (ie, congestive heart failure, myocardial infarction within the past year, and angina), the RLS group had lower scores on 6 of the 8 scales. RLS patients had lower scores on 7 of 8 scales compared with diabetes patients, and on 4 of 8 scales compared with osteoarthritis patients. CONCLUSIONS: Comparison of the SF-36 scores of patients with RLS and the normative general population suggests that the disorder has a significant impact on patient QOL.
Adult↗
Pathological yawning (chasm) associated with periodic leg movements in sleep: cure by levodopa.
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Adult↗
Cognitive deficits associated with restless legs syndrome (RLS).
BACKGROUND AND PURPOSE: Restless legs syndrome produces significant chronic sleep loss, which despite not causing expected profound sleepiness, might nonetheless produce cognitive deficits similar to those seen with acute sleep deprivation, i.e. involving mostly pre-frontal cortical (PFC) functioning. PATIENTS AND METHODS: Sixteen patients off RLS treatment for at least 2 weeks and 15 age- and gender-matched control subjects had polysomnograms (PSGs) on two consecutive nights. Cognitive tests were given in the morning after the second night. Six cognitive tests were used: two Verbal Fluency tests and the Trail Making tests were selected to be particularly sensitive to PFC function and sleep loss. Porteus Mazes and the Stroop Test were selected to reflect more general frontal and executive function. The Colored Progressive Matrices were used to assess general cognitive skills. RESULTS: RLS patients compared to controls showed significant (P<0.05) and sizeable (20-40%) deficits on two of the three PFC tests and marginally non-significant deficit (P<0.1) on the third. The other three tests showed no significant differences. CONCLUSIONS: The results indicate that RLS patients show cognitive deficits similar to that reported for one night of sleep loss.
Aged↗
Sleep disorders presenting as common pediatric problems.
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Adolescent↗
Time-dependent variation in cerebral and autonomic activity during periodic leg movements in sleep: implications for arousal mechanisms.
OBJECTIVES: A hierarchy in arousal response has been proposed for spontaneous arousal by analyzing the temporal changes in heart rate (HR) and electroencephalographic (EEG) activity. To address the question as to whether the same continuum may be proposed in sleep disorders, we performed temporal spectral EEG and HR analyses during periodic leg movements (PLM) associated or not with microarousal (MA). METHODS: Data were obtained in 12 patients with restless leg syndrome and/or PLM syndrome. PLMs were classified into 3 types including PLM associated with MA, PLM without MA, and PLM associated with delta or K-complex bursts. HR and EEG spectral analyses were done for 10s before and 10s after the PLM onset. RESULTS: Each type of PLM was associated with a typical EEG and autonomic pattern consisting of an increase in HR and delta band activity before the PLM, regardless of the presence or absence of MA. Thereafter, a rise in delta, alpha and beta(2) activity was noted associated with tachycardia. This was greater when MA or bursts of slow wave activity were present. In the period following the PLM, HR, delta and alpha power showed a long-lasting decrease with values significantly below the baseline. CONCLUSIONS: From these data, we can conclude that: (1) cardiac and cerebral changes occur in association with PLM even when MA cannot be detected; (2) the combined increase in delta activity and HR before the onset of PLM suggests that these changes are part of the arousal response during PLM; (3) the graded arousal response during PLM confirms that the human arousal response involves a progression of central nervous system activation from brainstem to cortical level.
Adult↗
Parasomnias including the restless legs syndrome.
The three states of mammalian being, W, REM sleep, and NREM sleep, are not mutually exclusive, and may occur simultaneously, oscillate rapidly, or appear in dissociated or incomplete form to produce primary sleep parasomnias. In addition, dysfunctions of a wide variety of organ systems may take adwide variety of organ systems may take advantage of the sleeping state to declare themselves, resulting in secondary sleep parasomnias. Contrary to popular opinion, the majority of the often bizarre and frightening experiences are not the manifestation of underlying psychological or psychiatric conditions. There is an interesting interaction between sleep-disordered breathing and parasominas. Formal study in an experienced sleep disorders center will usually reveal a diagnosable and treatable condition that explains the spells. Continued study of unusual sleep-related events undoubtedly will reveal more fascinating conditions, expanding our knowledge of sleep physiology, and strengthening the bonds between clinicians and basic-science sleep researchers.
Adult↗
Space motion sickness medications: interference with biomedical parameters.
The possibility that drugs administered to Skylab 3 (SL-3) and 4 (SL-4) crewmen for space motion sickness may have interfered with their biomedical evaluation in space was investigated. Healthy volunteers received combinations of Scopolamine/Dexedrine for four days in regimens similar to those used in these missions. Urine samples, heart rate, body temperature, mood and performance were analyzed for drug-related changes. Twenty-four hour urine samples were analyzed by the same procedures as those used to analyze the flight samples. Hormone concentrations determined included cortisol, epinephrine, norepinephrine, aldosterone and antidiuretic hormone (ADH). In addition, volume, specific gravity, osmolarity, sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), chloride (Cl), inorganic phosphate, uric acid and creatinine were measured. Performance was not affected by the Scopolamine/Dexedrine. The drug combination increased daily mean heart rate (HR) significantly in all the subjects and daily mean rectal temperature (RT) in some of the subjects. A 2-4 hr phase shift in the HR circadian rhythm was also observed which indicates that internal circadian synchrony was disturbed by the drugs. Psychological and subjective evaluation indicated that the subjects could usually identify which days they were given the drugs by an increase in tension and anxiety, decreased patience, restlessness, decreased appetite, difficulty in sleeping and feelings of increased heart rate and body temperature. Urinary electrolytes were not changed significantly by the drug, but marked and significant changes occurred in urine volume and hormone excretion patterns. Scopolamine/Dexedrine caused consistent elevations in urinary cortisol and epinephrine and a transient elevation in ADH. Norepinephrine excretion was decreased, but there was no significant change in aldosterone excretion or in 24 hr urine volume. A comparison of these findings with the first four days of inflight data from the SL-3 and SL-4 missions leads to the conclusion that the dramatic increases in aldosterone excretion during the first three days of spaceflight probably can be directly attributed to weightlessness, whereas the antimotion sickness medication could have substantially contributed to the early increased excretion of epinephrine and cortisol during these missions.
Adult↗
Restless legs syndrome triggered by heart surgery.
This report presents the case of a 9-year-old child with a familial history of restless legs syndrome who began to complain of restless legs syndrome symptoms after heart surgery. Hypotheses on the potential interactions between genetic and environmental factors in the development of her restless legs syndrome are discussed. Increasing evidence supports reduced brain iron in the pathophysiology of idiopathic restless legs syndrome. It is possible that the child inherited a compromised brain and peripheral iron regulation, which predisposed her to restless legs syndrome. The interaction between her dysfunctional iron management and her intraoperatory blood loss may have led to a significant decrease in brain iron, triggering restless legs syndrome symptoms. Other factors, such as immobilization and sleep deprivation after surgery, may have contributed to trigger the restless legs syndrome symptoms. If confirmed by further evidence, this patient suggests the need to carefully monitor for restless legs syndrome symptoms in young surgical patients who present with a familial history of restless legs syndrome.
Child↗
[Lorcainide in stable ventricular extrasystole. A double-blind study with 48-hour continuous ECG recording].
In a randomized double-blind cross-over trial, the effectiveness of lorcainide at a dosage of three times 100 mg/d by mouth was compared with that of a placebo for the treatment of subjectively disturbing stable ventricular extrasystoles (VES), using 48-hour continuous ECG monitoring. In 11 of 20 patients there was a regression in the VES rate to under 5%, in other 3 patients to under 50% of the initial values. Continuing the treatment, good therapeutic effect was still demonstrable 14 and 28 days later. However, only three patients had no side-effects. The others had sleep disturbances, hot flushes, sweating, restlessness, anxiety, dizziness, hallucinations and gastrointestinal symptoms. Lorcainide thus has a good anti-arrhythmic effect but, because of its side-effects, it should be used only in special circumstances.
Adult↗
Evaluation of the ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder.
In light of ongoing considerations for DSM-IV, the 18 ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder were evaluated. The interrater reliability and endorsement rates of each symptom were calculated from interview-based ratings of generalized anxiety disorder patients at four sites (total N = 204). Interrater reliability analyses indicated high agreement for the majority of the 18 symptoms. Regarding the frequency of symptom endorsement, significant Spearman correlations (range = .69 to .94) revealed marked consistency in the rates of symptom endorsement across the four sites. A list of "satisfactory" symptoms was generated from those meeting certain reliability and endorsement criteria. Seven symptoms were identified: irritability, restlessness, muscle tension, difficulty concentrating, sleep difficulties, feeling keyed up, and easy fatigability. Interestingly, all of the above belong to either the motor tension or vigilance and scanning clusters of the DSM-III-R associated symptom ratings. In contrast, symptoms belonging to the autonomic hyperactivity cluster were endorsed infrequently at all sites. Although additional research is needed (e.g., examination of the symptoms' discriminant validity), these findings essentially support revising the associated symptom criterion of generalized anxiety disorder in accord with option E3 in the DSM-IV Options Book.
Adult↗