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PubMed1991

Sleep-disordered breathing in community-dwelling elderly.

These are the final results of a survey of sleep-disordered breathing, which examined objective and subjective information from a large randomly selected elderly sample. We randomly selected 427 elderly people aged 65 yr and over in the city of San Diego, California. Twenty-four percent had an apnea index, AI, greater than or equal to 5 and 62% had a respiratory disturbance index, RDI, greater than or equal to 10. Correlates of sleep-disordered breathing included high relative weight and reports of snoring, breathing cessation at night, nocturnal wandering or confusion, daytime sleepiness and depression. Body mass index, falling asleep at inappropriate times, male gender, no alcohol within 2 hr of bedtime and napping were the best predictors of sleep-disordered breathing. Despite statistical significance, all of the associations between interview variables and apnea indices were small. No combination of demographic variables and symptoms allowed highly reliable prediction of AI or RDI.

Aged↗

PubMed1991

Periodic limb movements in sleep in community-dwelling elderly.

The prevalence of periodic limb movements in sleep (PLMS) in a randomly selected elderly sample is reported. In San Diego, 427 elderly volunteers aged 65 yr and over were recorded in their homes. Forty-five percent had a myoclonus index, MI greater than or equal to 5. Correlates of PLMS included dissatisfaction with sleep, sleeping alone and reported kicking at night. Although statistically significant, the strengths of the associations between interview variables and myoclonus indices were all small. No combination of demographic variables and symptoms allowed highly reliable prediction of PLMS.

Aged↗

PubMedDate not supplied

[Arousal and motor activity during sleep].

OBJECTIVE: To describe different types of motor activity which occur during sleep in relation to episodes of arousal and sleep disorder. DEVELOPMENT: During sleep, normal motor activity should be distinguished from paroxystic episodes: parasomnias; abnormal movements such as nocturnal paroxystic dystonia, which is very similar to epilepsy of frontal origin; nocturnal epileptic crises and especially periodic movements of the limbs and the restless legs syndrome, which is related to it. Physiological cyclical fluctuations of sleep are common to all these conditions and due to cortico-subcortical changes in excitability. CONCLUSION: We review diagnostic, clinical and neurophysiological criteria and aspects of physiopathology and treatment.

Dystonia↗

PubMedDate not supplied

[Movement disorders and motor activity during sleep].

OBJECTIVE: To describe different types of motor activity and movement disorder which occur during sleep in relation to episodes of arousal and sleep disorder. DEVELOPMENT: During sleep, normal motor activity should be distinguished from paroxystic episodes: parasomnias; abnormal movements such as nocturnal paroxystic dystonia, which is very similar to epilepsy of frontal origin; nocturnal epileptic crises and especially periodic movements of the limbs and the restless legs syndrome, which is relates lo it. Physiological cyclical fluctuations of sleep are common to all these conditions and due to cortico-subcortical changes in excitability. CONCLUSION: We review diagnostic, clinical and neurophysiological criteria and aspects of physiopathology and treatment.

Adult↗

PubMed2000

Parasomnias. Managing bizarre sleep-related behavior disorders.

Sleep can be a troubling experience for persons plagued by nocturnal disorders known as parasomnias. While they are "asleep," such persons may be walking, screaming in terror, rearranging furniture, eating odd food concoctions, or wielding weapons. Or they may be unable to fall asleep because of the unpleasant sensations of restless legs syndrome. Although these disorders are indeed bizarre, effective treatments are available. In this article, Drs Schenck and Mahowald discuss the evaluation and treatment of parasomnias and provide illustrative patient vignettes from their extensive experience at a sleep disorders center.

Aged↗

PubMed2000

Update on nonapnea sleep disorders.

Much of the attention in the field of sleep disorders focuses on the obstructive sleep apnea syndrome. However, for the pulmonary physician interested in a wider breadth of sleep knowledge, important and interesting developments have been witnessed in the area of nonapneic sleep disorders. Exciting new breakthroughs have illuminated the pathogenesis of narcolepsy and are expected to lead to new treatment options for narcoleptic patients. For the surprisingly common but poorly understood restless legs syndrome (RLS), an expanding armamentarium of medications aids the knowledgeable physician in caring for his or her patients. The physiology of circadian rhythms is better understood due to basic scientific advances. Finally, new drugs used to treat insomnia offer more flexible treatment options and an old and previously vilified drug may allow sleep specialists to better understand the mechanisms of sleep.

Animals↗

PubMed2001

Restless Legs Syndrome.

Restless Legs Syndrome (RLS) is a well-defined symptom complex and is frequently associated with sleep disturbance and a recognized family history. It occurs either as idiopathic RLS or in association with many medical, neurological or vascular disorders. The neurological examination and routine investigations in idiopathic RLS are normal. Polysomnography supports the diagnosis of RLS by documenting the associated sleep disturbances and periodic limb movements in sleep (PLMS). Although MRI studies disclose no intracerebral lesions, recent Positron Emission Tomography (PET) and single photon emission computed tomography (SPECT) studies point to some involvement of the basal and red nuclei and the cerebellum. No definitive etiology is known for this condition, but several pathophysiological mechanisms have been proposed. There is supportive evidence that RLS is a Central Nervous System (CNS) dysfunction, suggesting widespread involvement of the descending dopaminergic (DA) pathways, possibly originating in the diencephalon or upper brainstem. This is corroborated by the successful treatment of RLS with DA agents, sedatives, and neurotransmitters. However, RLS can also occur with spinal disorders and spinal cord lesions implying the existence of a spinal generator. The incidence of RLS in pregnancy is well known and its association with vascular disorders supports another mechanism in some patients. The primary treatment of RLS is largely symptomatic and quite effective with DA agents, DA agonists, opioids and other neurotransmitters. The treatment of RLS associated with various diseases is aimed at the correction of the underlying pathological or deficiency states. Antidepressant medications frequently precipitate or worsen the condition of RLS.

Adolescent↗

PubMed2004

Gender differences in sleep and sleep-disordered breathing.

Sleep and sleep disorders are different in several important ways between men and women. Because of pregnancy and menopause, women experience changes in sleep that may present as clinical problems. In clinical populations, women are more likely to present with insomnia than are men, although their sleep may be better preserved. The presentation of sleep apnea in women is distinct from that of men and is less likely to include a "classic" history of witnessed ap-nea or heavy snoring. More likely it presents with nonspecific symptoms, such as fatigue or mood disturbance. There are little data on the effects of different treatments for OSA between men and women. OHS is a syndrome that may be as common in women as in men. The role of hormones in its pathophysiology is not well-defined.

Female↗

PubMed1988

A double-blind randomized crossover trial of bromocriptine and placebo in restless legs syndrome.

A double-blind randomized crossover study of 7.5 mg bromocriptine at bedtime versus placebo was conducted in 30-day phases (with a 2-week washout period between phases) in 6 patients with idiopathic restless legs syndrome. Five patients experienced partial subjective improvement in restlessness and paresthesias on bromocriptine as opposed to placebo and expressed a desire to continue on the medication. On bromocriptine, the patients showed polysomnographically a mean decrease of 43% from control and a mean decrease of 57% from placebo in the number of periodic movements of sleep per hour of sleep (p less than 0.025). Two of 3 patients with abnormally decreased total sleep time and sleep efficiency showed an improvement in these measures on therapy. The dopamine agonist bromocriptine may be a useful therapy in some patients with restless legs syndrome.

Bromocriptine↗

PubMedDate not supplied

The restless legs syndrome: diagnosis and treatment.

Restless leg syndrome (RLS) is a common neurological disorder which can be accompanied with PLMS and can result in sleep disturbance. Greater understanding of pathophysiology of RLS in recent years has led to increased treatment options for this condition. A comprehensive clinical evaluation and appropriate management using combined nonpharmacologic and pharmacologic strategies can result in significant improvement in treatment outcomes in patients with RLS.

Humans↗

PubMed2002

Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy.

OBJECTIVE: To determine if patients with nonarteritic ischemic optic neuropathy (NAION) have sleep apnea syndrome (SAS), an entity characterized by repetitive upper airway obstructions during sleep, inducing hypoxia and sleep disruption. METHODS: We recruited 17 patients with NAION and 17 age- and sex-matched controls from patients referred for treatment because of suspected restless legs syndrome. We performed overnight polysomnography and determined the respiratory disturbance index during night sleep, a value used to diagnose and grade SAS. We compared the proportions of patients with SAS among patients with NAION and matched controls using the chi(2) test. Additionally, we compared the proportions of patients with SAS among patients with NAION and a large SAS prevalence study using the binomial test. RESULTS: Twelve (71%) of 17 patients with NAION had SAS. According to the respiratory disturbance index, 4 patients (24%) had mild, 4 patients (24%) had moderate, and 4 patients (24%) had severe SAS. Only 3 (18%) of 17 controls had SAS (P =.005). In the 45- to 64-year age group, 4 (50%) of 8 patients with NAION had SAS; 51 (11.9%) of 430 of the random sample in the prevalence study had SAS (P =.005). In the group older than 64 years, 8 (89%) of 9 patients with NAION had SAS; 18 (24%) of 75 of the random sample in the prevalence study had SAS (P<.001). CONCLUSIONS: We found a high prevalence of SAS in patients with NAION, which supports previous case reports suggesting that such an association exists. This association may explain why approximately 75% of all patients with NAION discover visual loss on first awakening or when they first use vision critically after sleeping. Our findings indicate that SAS may play an important role in the pathogenesis of NAION.

Aged↗

PubMed2001

Clinical data on restless legs syndrome: a dose-finding study with cabergoline.

Current treatment options for restless legs syndrome (RLS), based on the American Academy of Sleep Medicine practice parameters, favor dopaminergic agents. The drug of first choice is levodopa, which is now licensed for RLS in two European countries. However, the short duration of action and augmentation of symptoms under therapy may limit the clinical use of levodopa, especially in severely affected patients. An open pilot study shows that the long-acting dopamine agonist cabergoline is a promising new tool in the treatment of RLS. Results of a double-blind, controlled trial are pending.

Adult↗

PubMed2004

The clinical neurophysiology of the restless legs syndrome and periodic limb movements. Part I: diagnosis, assessment, and characterization.

OBJECTIVE: The restless legs syndrome is a common sensorimotor disorder impacting on sleep which has been known for centuries, but only recently become recognized as a significant clinical and pathophysiological problem. The definition of RLS has evolved until certain key clinical features have been defined as diagnostic, while others are strongly associated: the urge to move is seen as primary. Epidemiology suggests ethnic variation with highest frequency in populations of European origin; family and genetic studies support a genetic basis to many idiopathic cases while links to secondary disorders usually involving low iron stores are also known. Abnormalities of brain iron transport and consequent dysfunction of the dopamine system are suspected sources of the disorder. METHODS: The literature was searched for all references relating clinical neurophysiologic investigations to the diagnosis, assessment, and characterization of RLS. RESULTS: RLS is defined clinically and diagnosed by medical history while its frequent concomitant, periodic limb movements (PLM), must be diagnosed by polysomnography or movement recording. Severity of RLS is generally assessed by subjective measures, but sleep recording and measurement of PLM frequency and association with sleep disruption are also used to measure severity. A provocative test, the suggested immobilization test, can also be used with both subjective and movement recording. RLS and PLM in RLS are both associated with the circadian cycle and are maximal early in the sleep period. PLM appear to be associated both with unstable EEG phases involving the cyclic alternating pattern and cyclical autonomic changes whose initiation may precede the muscle activity. CONCLUSIONS: While RLS remains a subjective disorder, neurophysiologic measures have been important, especially for assessment. Ambulatory methodologies may offer the most accurate and economical means of assessing motor activity as a key marker of RLS and of accurately measuring PLM from night to night. As the pathophysiology of RLS is better understood, more focused techniques may be developed to measure its presence and severity in individual patients.

Circadian Rhythm↗

PubMed1999

Disappearance of rhythmic involuntary movements during sleep in a case of olivopontocerebellar atrophy.

We report on a 54-year-old woman with an 8 or so year history of olivopontocerebellar atrophy associated with the rhythmic involuntary movements of the left upper and lower limbs, and cervical region. Surface electromyogram of the left upper limb revealed rhythmicity (about 3 Hz) and reciprocity between antagonistic muscles, which disappeared on polysomnography at all sleep stages including rapid eye movement sleep without atonia. These were characterized by the co-existence of rhythmic skeletal myoclonus and parkinsonian tremor. These findings suggest that a disturbance of the striatonigral system as well as the dentato-rubro-olivary circuit may be involved in these movements. It also seems that their fate is dependent on the level of wakefulness and that the ascending reticular activating system also plays a role in the development of these movements.

Cerebellar Nuclei↗

PubMedDate not supplied

L-tryptophan in neuropsychiatric disorders: a review.

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.

Dopamine↗

PubMed2006

Recommendations and supporting evidence in guidelines for referral of patients to sleep laboratories.

At the request of Canadian health ministries, we reviewed recommendations in guidelines prepared by professional bodies on the referral of individuals to sleep laboratories. Searching electronic databases and the Internet, we found 37 guidelines that covered 18 applications of sleep laboratory investigation including obstructive sleep apnea, other respiratory disorders, obstructive sleep apnea and other conditions in children, sudden infant death syndrome, treatment for snoring, insomnia, depression with insomnia, narcolepsy, restless legs syndrome/periodic limb movement disorder, parasomnias and circadian rhythm disorders. We identified recommendations on referral of patients for sleep studies and assessed the quality and relevance of evidence cited in support of these. Of 81 recommendations, 46 were supported by evidence from primary investigations. Only six cases cited evidence from well-conducted, prospective controlled studies. Evidence was highly relevant in 18 cases, of some relevance in 22 and of little or no relevance in six. No evidence was provided in support of 31 recommendations, and in four cases the guideline had identified an absence of available evidence. Although the publications from professional bodies that were reviewed contain much detailed information, evidence supporting many recommendations is limited. There is a need for further, good quality, studies of many sleep laboratory applications.

Adult↗

PubMed1995

[Treatment of idiopathic and uremic restless legs syndrome with L-dopa--a double-blind cross-over study].

In a randomized, controlled and double-blind cross-over trial with L-Dopa and placebo we evaluated the effects of a single bedtime dose of L-Dopa 100 to 200 mg on sleep quality and frequency of periodic leg movements (PLM) in 17 patients with idiopathic and in 11 patients with uremic restless legs syndrome (RLS) by polysomnography, actigraphy, and subjective ratings. Treatment with L-Dopa showed significant reduction of the number of periodic leg movements and the PLM-index most pronounced during the first 4 hours of bedtime. Subjective evaluation confirmed improvement of sleep quality. L-Dopa proved to be effective in idiopathic and uremic RLS without any severe side effects.

Administration, Oral↗

PubMed2006

Restless leg syndrome manifested by iron deficiency from chronic hemoptysis in cystic fibrosis.

Restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) are considered to be a continuum of a neurological sleep disorder associated with abnormal iron metabolism or deficiency. I describe a case of RLS and PLMD in a cystic fibrosis patient with iron deficiency from chronic hemoptysis. This is the first case that reports RLS and PLMD manifesting from iron deficiency caused by chronic hemoptysis in advanced cystic fibrosis lung disease.

Adult↗