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PubMed2004

The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use.

Itch is a major symptom of skin disease and remains poorly studied. We have used limb-worn digital accelerometers, and infrared video of patients as a gold standard, on children with atopic dermatitis and control subjects in their own homes at night. Video analysis shows that nocturnal scratching and restlessness are more complex than we first thought, with many movements that potentially damage the skin not conforming to stereotypical scratch movements. Children with atopic dermatitis spent a mean of 46 minutes less time motionless or sleeping at night than control subjects (468 +/- 3 [SEM] vs 422 +/- 37 [SEM], P<.001). Children with atopic dermatitis showed 2 to 3 times as much scratching or restlessness activity as control subjects, with little overlap between groups (P<.01). Scratching and restlessness were highly correlated with each other (0.94, P<.01). Accelerometer scores were highly correlated with video results (rho>0.02, P<.01, for scratching, restlessness, and sleeping time). Individual limb scores were highly correlated with each other (rho approximately 0.87-0.98), suggesting that little information would be lost if only 1 limb was measured. There was little relation between parental assessment of scratch and objective measured scratch. Accelerometers provide a useful and practical way of assessing scratching at night in the patient's own home and could be used as an objective measure of disease activity both in clinical trials and in everyday clinical practice.

Behavior↗
PubMed2001

Prevalence of insomnia symptoms in patients with sleep-disordered breathing.

OBJECTIVE: To assess the prevalence of insomnia symptoms in patients with objectively diagnosed sleep-disordered breathing (SDB). DESIGN: Retrospective medical chart review of a representative sample of patients with SDB. SETTING: University sleep-disorders clinic and laboratory. PATIENTS: Two hundred thirty-one patients with SDB were selected from a pool of approximately 2,000 patients with sleep disorders. MEASUREMENTS: Data were extracted from intake questionnaires and polysomnographic studies. RESULTS: Of 231 patients with SDB diagnoses, 115 patients reported no insomnia complaints (SDB-only patients) and 116 patients reported clinically meaningful insomnia complaints (SDB-plus patients). Compared to SDB-only patients, SDB-plus patients reported significantly worse mean sleep characteristics consistent with insomnia, including sleep latency (17 min vs 65 min), total sleep time (7.2 h vs 5.6 h), and sleep efficiency (92% vs 75%). SDB-plus patients experienced significantly more psychiatric disorders, cognitive-emotional symptoms, and physical and mental symptoms that disrupted or prevented sleep. SDB-plus patients also reported greater use of sedative and psychotropic medications and had significantly more primary complaints of insomnia, restless legs or leg jerks, and poor sleep quality despite having relatively similar referral rates for sleep apnea or complaints of loud snoring. CONCLUSIONS: Problematic insomnia symptoms were reported by 50% of a representative sample of patients with objectively diagnosed SDB. Research is needed to determine the degree to which insomnia and related symptoms and behaviors interfere with SDB treatment.

Adult↗
PubMed2002

Prevalence of restless legs syndrome and periodic limb movement disorder in the general population.

BACKGROUND: Periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) are two sleep disorders characterized by abnormal leg movements and are responsible for deterioration in sleep quality. However, the prevalence of these disorders is not well known in the general population. This study aims to document the prevalence of RLS and PLMD in the general population and to identify factors associated with these conditions. METHODS: Cross-sectional studies were performed in the UK, Germany, Italy, Portugal and Spain. Overall, 18,980 subjects aged 15 to 100 years old representative of the general population of these five European countries underwent telephone interviews with the Sleep-EVAL system. A section of the questionnaire assessed leg symptoms during sleep. The diagnoses of PLMD and RLS were based on the minimal criteria provided by the International Classification of Sleep Disorders. RESULTS: The prevalence of PLMD was 3.9% and RLS was 5.5%. RLS and PLMD were higher in women than in men. The prevalence of RLS significantly increased with age. In multivariate models, being a woman, the presence of musculoskeletal disease, heart disease, obstructive sleep apnea syndrome, cataplexy, doing physical activities close to bedtime and the presence of a mental disorder were significantly associated with both disorders. Factors specific to PLMD were: being a shift or night worker, snoring, daily coffee intake, use of hypnotics and stress. Factors solely associated with RLS were: advanced age, obesity, hypertension, loud snoring, drinking at least three alcoholic beverages per day, smoking more than 20 cigarettes per day and use of SSRI. CONCLUSIONS: PLMD and RLS are prevalent in the general population. Both conditions are associated with several physical and mental disorders and may negatively impact sleep. Greater recognition of these sleep disorders is needed.

Adolescent↗
PubMed2006

Quantification of electromyographic activity during sleep: a phasic electromyographic metric.

Recording of electromyographic (EMG) activity is considered essential for defining rapid eye movement (REM) sleep and for quantifying certain types of movements in sleep, such as periodic leg movements in sleep (PLMS). However, routine analyses of EMG activity beyond such purposes is performed rarely and quantified seldom, and normative data are lacking. In this study, the authors examined systematic application of a visual scoring system for short-duration (approximately 100-millisecond) phasic EMG activity recorded from five different muscle groups (submentalis, left/right anterior tibialis, left/right brachioradialis) recorded from two different age groups of normal subjects and a group of patients with Parkinson's disease. Quantification of this activity was labeled as a phasic electromyographic metric (PEM). PEM data were compiled separately by REM and non-REM sleep. Results indicated that PEM is a normal part of REM sleep in all muscle groups, more specifically constituting about 5% (SD = 3.1%) of 2.5-second intervals of REM sleep in the mentalis in healthy young adults. It occurs at higher rates in patients with Parkinson's disease, and its quantification in the legs may be influenced to some degree by the presence of PLMS. PEM may be a useful metric amenable to quantification with digital techniques. It may have particular relevance for the identification of neurodegenerative conditions in which disinhibition of midbrain dopaminergic pathways results in excessive motor discharge during sleep.

Adolescent↗
PubMed1991

Disorders of movement and behaviour during sleep.

OBJECTIVE: To outline recently described movement disorders during sleep which are common and poorly recognised. DATA SOURCES: Computer-based literature search up to July 1990 (with the index terms sleep disorders, sleep myoclonus, nocturnal myoclonus, periodic movements in sleep, REM behaviour disorder and parasomnias) supplemented by a manual search through the references of papers obtained by computer search and a manual search through contents of the following journals: Sleep, Sleep Research, Neurology and Brain. DATA SYNTHESIS AND CONCLUSION: There is a group of common and poorly recognised movement disorders during sleep. The patient usually presents complaining of disturbed sleep, daytime somnolence and abnormal nocturnal behaviour. These conditions are susceptible to precise diagnosis and effective treatment.

Epilepsy↗
PubMed2006

Sleep and wakefulness disturbances in Swiss pharmacy customers.

BACKGROUND AND OBJECTIVE: Sleep disturbances are prevalent but often overlooked or underestimated. We suspected that sleep disorders might be particularly common among pharmacy customers, and that they could benefit from counselling. Therefore, we described the prevalence and severity of symptoms associated with sleep and wakefulness disorders among Swiss pharmacy customers, and estimated the need for counselling and treatment. METHODS: In 804 Swiss pharmacies (49% of all community pharmacies) clients were invited to complete the Stanford Sleep Disorders Questionnaire (SDQ), and the Epworth Sleepiness Scale (EPW). The SDQ was designed to classify symptoms of sleep and wakefulness into the four most prevalent disorders: sleep apnoea syndrome (SAS), insomnia in psychiatric disorders (PSY), periodic leg movement disorders/restless legs (RLS) and narcolepsy (NAR). Data were entered into an internet-linked database for analysis by an expert system as a basis for immediate counselling by the pharmacist. RESULTS: Of 4901 participants, 3238 (66.1%) were female, and 1663 (33.9%) were male. The mean age (SD) of females and males was 52.4 (18.05), and 55.1 (17.10) years, respectively. The percentages of female and male individuals above cut-off of SDQ subscales were 11.4% and 19.8% for sleep apnoea, 40.9% and 38.7% for psychiatric sleep disorders, 59.3% and 46.8% for restless legs, and 10.4% and 9.4% for narcolepsy respectively. The prevalence of an Epworth Sleepiness Scale score >11 was 16.5% in females, and 23.9% in males. Reliability assessed by Cronbach's alpha was 0.65 to 0.78 for SDQ subscales, and for the Epworth score. CONCLUSIONS: Symptoms of sleep and wakefulness disorders among Swiss pharmacy customers were highly prevalent. The SDQ and the Epworth Sleepiness Scale score had a satisfactory reliability to be useful for identification of pharmacy customers who might benefit from information and counselling while visiting pharmacies. The internet-based system proved to be a helpful tool for the pharmacist when counselling his customers in terms of diagnostic classification and severity of symptoms associated with the sleeping and waking state.

Adult↗
PubMed1993

Daytime somnolence: therapeutic approaches.

Excessive daytime somnolence is a major neurological problem involving about 4% of the general population. Its treatment is based on accurate etiological dissection. Sleep-disordered breathing is a major cause of EDS. Stimulant medication is helpful in many other instances.

Disorders of Excessive Somnolence↗
PubMed1991

Nocturnal bruxing events in subjects with sleep-disordered breathing and control subjects.

Nocturnal bruxing events were recorded during a single night of sleep for 12 subjects with sleep-disordered breathing and 12 age- and sex-matched controls. The results suggest that bruxing events are very common in both groups and are closely associated with sleep arousals. There were few differences in the number, duration, or type of bruxing events between these two groups. Bruxing events were common during stage 1, stage 2, and REM sleep, while they rarely occurred during stage 3 and 4 sleep. The average duration of bruxing events ranged from 3.82 to 6.68 seconds. There was a trend toward more bruxing events occurring while sleeping on the back than on the side.

Adult↗
PubMed2005

Event scoring in polysomnography: scoring arousals, respiratory events, and leg movements.

Polysomnographic events comprise a wide variety of phenomena,including episodes of apnea, episodes of hypopnea, leg movements, transient central nervous system arousals, and eye movements. The process of event scoring involves pattern recognition and provides a description of potentially pathophysiologic activity occurring during sleep. The rules for scoring sleep-related events continue to be developed. The rules are precise and must be followed with extreme care. When the polysomnogram is interpreted,the report must include a summary of event scoring and clinical correlation to the sleep complaint. Arousals, periodic limb movements, and respiratory events are significant because they represent pathophysiologies on which final diagnosis largely depends.

Arousal↗
PubMed1990

Validation of sleep observations in a nursing home.

Most of the studies on sleep patterns in elderly people have been performed on small samples in sleep laboratories and with the use of advanced technology. Such technology is generally unavailable either for research studies or clinical interventions with elderly people residing in the community. Additionally, the utility of the sleep laboratory in assessing sleep in the very demented patient is limited because of irregularities of electroencephalogram (EEG) patterns in this population. For these reasons, systematic sleep observations are presented as important tools in the assessment of sleep in the nursing home. Nursing homes have night-shift staff who are frequently not fully occupied and could be trained to perform sleep observations. The Observational Sleep Assessment Instrument (OSAI) documents the occurrence of sleep, as well as disruptions in sleep, breathing, snoring, myoclonic movements, and body restlessness. This study documented the validity of the OSAI by establishing interrater reliability and by correlating its results to those of a portable sleep monitor, namely, a four-channel ambulatory sleep respiratory monitor and a wrist activity monitor. Results show that the OSAI is a reliable and valid tool for examining sleep and sleep pathology in this population, and can become a useful screening tool for detecting sleep and breathing disorders.

Aged↗
PubMed1989

Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients.

Based on self-rating questionnaire evaluation of symptoms of major affective disorder, 67% of patients who presented to a major sleep disorders center reported an episode of depression within the previous 5 years, and 26% described themselves as depressed at presentation. Furthermore, patients with sleep apnea, narcolepsy, or sleep-related periodic leg movements all averaged high rates of self-reported depressive symptomatology, which suggests that sleep disorders should be considered in the differential diagnosis of affective disorders, and vice versa. Change scores on the Profile of Mood States were obtained for four subgroups of patients who were undergoing conventional treatment. Significant improvement in scores was observed in obstructive sleep apneics treated surgically and in patients with sleep-related periodic leg movements placed on clonazepam, but not in narcoleptics placed on a stimulant or in insomniacs with chronic use of sedative-hypnotic drugs who were withdrawn from sleep medications. Differential improvement in POMS scores after treatment for different sleep disorders could mean that the relationship to mood disturbance differs for different sleep disorders.

Adolescent↗
PubMed1997

Sleep changes after 4 consecutive days of venlafaxine administration in normal volunteers.

BACKGROUND: The purpose was to examine the effect of the antidepressant drug venlafaxine on sleep architecture and periodic leg movements of sleep (PLMS) in normal volunteers. METHOD: Eight normal volunteers were studied under laboratory sleep conditions as follows: 1 acclimatization night, 1 baseline night, and 4 consecutive nights of venlafaxine p.o. administration (75 mg during the first 2 nights and 150 mg the last 2 nights). RESULTS: Venlafaxine increased both wake time and sleep stage I. Sleep stages II and III were reduced. REM sleep time was reduced after the first venlafaxine dose, and, by the fourth night, REM sleep was completely suppressed in all volunteers. Six of the eight volunteers showed PLMS at a frequency above 25 per hour. CONCLUSION: Venlafaxine produces several sleep disturbances, which include abnormal leg movements.

Adult↗
PubMed1993

[Parasomnias].

Parasomnias are frequent. They usually represent either the exaggeration of a physiological phenomenon (e.g. sleep starts) or a non-disturbing, idiopathic and usually benign sleep disorder (e.g. sleep talking and bruxism), which need only counseling and improvement of sleep hygiene. However, occasionally parasomnias are of clinical relevance. They can cause insomnia or hypersomnia (e.g. 'myoclonus nocturnus'), psychosocial stress (e.g. sleep-related enuresis and sleep walking) and injuries to oneself and others (e.g. REM-parasomnia). Finally, they can be symptomatic of neurological and medical disorders (e.g. sleep paralysis and 'myoclonus nocturnus'). In these cases special investigations including video-polysomnography can establish a correct diagnosis and allow a specific treatment.

Bruxism↗
PubMed1995

[Poorly understood sleep disorders in depression].

Although the clinical symptoms of severe depression are easily recognized, this is not always the case in minimal forms or in certain masked depressions. Failure to respond to appropriate treatment may then be taken to indicate the possible existence of specific and organic sleep disorders with clinical symptoms similar to those of depressive illness. Sleep disorders mainly comprise sleep apnea and periodic movement of the lower limbs. Diagnosis can only be confirmed by EPS before a specific treatment is selected : correct diagnosis of the disorder is essential, particularly for sleep apnea, since standard drug therapy for depression and anxiety disorders often includes benzodiazepines, which, through the depressant effect they exert on the respiratory centers, only worsen symptoms.

Depressive Disorder↗
PubMed2007

Diagnostic indicators of restless legs syndrome in primary care consultations: the DESYR study.

The objective of this study is to determine whether spontaneous complaints about sleep or the legs could be used as potential indicators of restless legs syndrome (RLS) in primary care. A total of 351 general practitioners participated in the study. In a first historical patient identification phase, all patients with spontaneous complaints of sleep or leg symptoms over the previous year were identified. A control group without such complaints was identified. In a second prospective data collection phase, those who consulted a participating physician were interviewed to assess consensus diagnostic criteria of RLS. Severity was assessed with the International Restless Legs Syndrome Study Group severity rating scale. Of 1,405,823 patients consulting during the historical phase, a leg complaint was reported in 61,685 and a sleep complaint in 40,568. A total of 1,432 consulted during the prospective phase. A diagnosis of RLS was assigned to 42.6% of patients with leg complaints, 35.5% of those with sleep complaints, 54.9% of those with both complaints, and 12.9% of those with no complaints. Median RLS severity scores were 18.8 to 20.4. A total of 63.7% of patients were prescribed a venotonic, 43.7% a hypnotic, and 41.5% an anxiolytic. Complaints of sleep or leg symptoms are frequently associated with a diagnosis of RLS, and their presence should alert the physician to the possibility of a differential diagnosis of RLS.

Adult↗
PubMed2003

Sleep disorders.

Humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.

Adult↗
PubMed2003

Acute double-blind, placebo-controlled sleep laboratory and clinical follow-up studies with a combination treatment of rr-L-dopa and sr-L-dopa in restless legs syndrome.

In a double-blind, placebo-controlled randomized crossover trial, the acute efficacy of a combination treatment of 100 mg regular-release (rr) and 100 mg sustained-release (sr) L-dopa/benserazide in RLS was investigated by means of sleep laboratory methods, with a subsequent open clinical follow-up for 4 weeks. 21 RLS patients classified according to ICSD and IRLSSG criteria were included; 18 completed the study. Objective sleep quality was determined by polysomnography (PSG) in 3 subsequent nights (adaptation/screening, placebo and drug night), subjective sleep and awakening quality was evaluated by rating scales, objective awakening quality by psychometric tests. Clinical follow-up consisted of daily ratings of subjective sleep and awakening quality (SSA) and VAS for RLS symptomatology ratings, completion of the RLS (IRLSSG) Scale weekly and the Zung Depression (SDS) and Anxiety (SAS) Scale, Quality of Life Index, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale before and after therapy. Acute L-dopa/benserazide significantly (p < 0.001) and markedly (75%) decreased the target variable PLM/h of sleep as well as all other RLS/PLM variables, but failed to improve objective sleep efficiency and subjective sleep quality in comparison to placebo. After 4 weeks of therapy, however, subjective sleep and awakening quality also improved significantly. While RLS/PLM measures showed an immediate significant and marked response to the combination therapy subjective sleep quality only improved after chronic treatment.

Adult↗