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PubMed2006

Sleep and wakefulness disturbances in Parkinson's disease.

Patients with Parkinson's disease experience prominent difficulties in maintaining sleep, painful night-time abnormal movements, and daytime sleepiness, sometimes culminating in sleep attacks. Recent insights into the pathophysiology of sleep disorders in PD points to a complex interaction between movement disorders, side-effects of dopamine agents and lesions in sleep-wake regulating systems. Treatment with dopamine agonists provides a twice higher risk of daytime sudden sleep episodes than levodopa, with no difference between ergotic and non ergotic compounds. Insomnia can be improved by a better control of night-time disability, restless legs syndrome and dystonia using subthalamic nucleus stimulation or night-time levodopa. A specific REM sleep disorder contributes to REM sleep behavior disorder and also to hallucinations (suggesting they could be awake dreams) and excessive daytime sleepiness. The management of sleep and alertness problems requires to analyze their potential causes, to monitor night-time and daytime sleep, and to subtly adjust psychotropic and dopaminergic treatment.

Hallucinations↗

PubMed2004

Sleep disturbances associated with periodic leg movements in chronic sarcoidosis.

BACKGROUND AND AIM OF THE WORK: Many sarcoidosis patients suffer from fatigue and sleep disturbances. Recently, it was demonstrated that obstructive sleep apnea (OSA) is rather common in sarcoidosis. Moreover, sheet intolerance and painful legs are frequently reported in sarcoidosis patients. These symptoms might interfere with sleep quality. METHODS: In order to determine the relationship between objective and subjective sleep disturbance full polysomnography, including leg EMG analysis, was performed in 46 chronic sarcoidosis patients indicating awakening unrefreshed in the morning. RESULTS: In 20 (44%) patients OSA activity [60% with PLM (n=12), 40% without (n = 8)] was demonstrated, while in 7 patients (15%) significant PLM without OSA were found. In 19 patients (42%) no OSA or PLM activity was present. Moreover restless legs (RLS) were reported by 52% of the patients (45% in OSA; 71% in PLM; 47% in others). Distribution of sleep stages and sleep fragmentation was comparable in all groups. In a healthy snoring control group (n = 102) a prevalence of PLM was found in 13.7% (17.8% in men; 3.4% in women), while RLS were only reported by 1.4% (men) and 6.9% (women). CONCLUSIONS: Sleep disturbance (OSA and/or PLM) and RLS were demonstrated in more than half of the studied sarcoidosis patients. A high prevalence of RLS or PLM (primary and secondary) has not been reported before in sarcoidosis. Further studies are needed to establish whether RLS, OSA and/or PLM might contribute to fatigue and whether fatigue complaints improve after treatment of RLS/PLM/OSA.

Adult↗

PubMedDate not supplied

Restless legs syndrome.

BACKGROUND: Restless legs syndrome is a common but not well-recognized central nervous system disorder that leads to insomnia and daytime distress. METHODS: A MEDLINE search of the recent English language literature was undertaken with review of appropriate articles and references. RESULTS: A growing body of work has added to an understanding of the epidemiology, diagnostic criteria, appropriate evaluation, and effective management of restless legs syndrome. CONCLUSIONS: Restless legs syndrome occurs in about 6% of the adult population, more so in the elderly. Affected patients experience uncomfortable sensations in the legs with inactivity, more pronounced late in the day and at bedtime, which are temporarily relieved by moving the limbs. Affected patients can suffer from insomnia, disrupted sleep, daytime fatigue, and difficulty with sedentary activities. Most cases are idiopathic, although secondary causes, such as iron deficiency, should be excluded. Dopaminergic agents are highly effective in treating restless legs syndrome, but side effects can be problematic. Alternative medications include benzodiazepines, opioids, gabapentin, and clonidine.

Humans↗

PubMed2006

Efficacy of cabergoline in restless legs syndrome: a placebo-controlled study with polysomnography (CATOR).

OBJECTIVE: To assess the efficacy and safety of the dopamine agonist cabergoline in the treatment of patients with idiopathic restless legs syndrome (CATOR study). METHODS: Patients with moderate to severe restless legs syndrome (RLS) were randomly assigned to cabergoline (single evening dose: 2 mg) or placebo and treated for 5 weeks in a double-blind, multicenter polysomnography (PSG) trial. The primary efficacy measures were the periodic leg movements during sleep arousal index (PLMS-AI) and sleep efficiency. These and further PSG variables were monitored by centrally evaluated PSG. Severity of RLS was assessed using the International RLS Study Group Severity Scale (IRLS), the RLS-6 scales, the Sleep Questionnaire Form A (SF-A; quality of sleep), and the Quality of Life for RLS questionnaire. RESULTS: Forty-three patients were treated and 40 patients were evaluated with PSG (age 56 +/- 10 years, 73% women). Cabergoline was superior to placebo in terms of the PLMS-AI (-17.7 +/- 16.4 vs -4.5 +/- 20.0 placebo; p = 0.0024), sleep efficiency (+6.2 +/- 13.9% vs +3.3 +/- 11.7%; p = 0.0443), PLMS index (p = 0.0014), PLM index (p = 0.0012), and total sleep time (p = 0.0443). Improvements in IRLS total score (-23.7 +/- 11.2 vs -7.9 +/- 11.0 placebo; p = 0.0002), RLS-6 severity scales during the night (p = 0.0010) and during the day (p = 0.0018), Clinical Global Impressions severity item (p = 0.0003), sleep quality (p = 0.0180), SF-A sleep quality (p = 0.0371), and QoL-RLS (p = 0.0247) were larger in patients treated with cabergoline compared with the placebo group. Adverse events were only mild and well-known side effects of dopamine agonists. CONCLUSION: Single-evening cabergoline is an efficacious and well-tolerated short-term therapy for sensorimotor symptoms of restless legs syndrome and associated sleep disturbances.

Adolescent↗

PubMed1991

Nonsteroidal antiinflammatory drug therapy in rheumatoid arthritis patients. Lack of association between clinical improvement and effects on sleep.

Thirteen patients with rheumatoid arthritis (mean +/- SD age 55.8 +/- 10.5 years) received 20 mg of tenoxicam daily for 90 days following a 3-7 day "washout" period and 4 days of placebo treatment. Clinical evaluations were conducted at the end of the washout period and at monthly intervals thereafter. All-night polysomnography was performed in a sleep laboratory during the last 2 days of placebo treatment and on days 13, 14, 89, and 90 of tenoxicam treatment. Although there was improvement in the patients' clinical condition, there were no treatment-related changes in any of the sleep parameters. Eight of the 13 patients, however, were found to have primary sleep disorders. Four had periodic leg movements during sleep, 3 had sleep apneas, and 1 had a combination of both disorders. The implications of these findings in the treatment of sleep disorders in patients with rheumatoid arthritis are discussed.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMedDate not supplied

[The use of chlorazepate dipotassium (Tranxene) in the states of restlessness and agitation].

Clorazepate dipotassium (Tranxene), benzodiazepine of retarded anxiety-relieving, sedative and sleep-inducing action was used in an open sample of 36 patients for fast control of anxiety and aggression in the course of schizophrenia, schizoaffective psychosis and other psychotic disorders. The intensity of aggressive behaviors was assessed as 6-7 items on the CGI scale. After intramuscular injection of clorazepate complementing the so-called basic treatment in the mean daily dose of 150 mg, several hours lasting sedative effect was achieved. No unfavourable interactions between the applied clorazepate (Tranxene) and the other medicines applied simultaneously (mostly neuroleptics and antidepressant drugs) were observed. Clorazepate (Tranxene) is an effective and safe drug giving fast and long-lasting sedation of the patients with low risk of interaction with other drugs or of side-effects.

Adolescent↗

PubMed1999

Periodic, profound peripheral vasoconstriction--a new marker of obstructive sleep apnea.

We report a novel approach to the determination of sleep apnea based on measuring the peripheral circulatory responses in a primary condition of disordered breathing. The apparatus is a finger plethysmograph coupled to a constant volume, variable pressure, pneumatic system. The plethysmograph's tip (measurement site) is composed of two parallel opposing longitudinal half thimbles, which is attached to a contiguous annular cuff. Each compartment consists of an internal membrane surrounded by an outer rigid wall. These provide a uniform pressure field and impart a two-point locking action preventing axial and longitudinal motion of the finger. Subdiastolic pressure is applied to prevent venous pooling, engorgement, and stasis, to inhibit retrograde venous shock wave propagation and partially unload arterial wall tension. The annular cuff extends the effective boundary of the pressure field beyond the measuring site. In 42 patients with Obstructive Sleep Apnea Syndrome (OSAS) profound, transient vasoconstriction and tachycardia usually of a periodic nature, were clearly seen with each apneic event, possibly related to transient arousal. Good agreement was found between standard total apnea-hypopnea scoring, 129.5+/-22.4 (Mean +/- SEM), and transient vasoconstriction and tachycardia events, 121.2+/-19.4 (R = .92, p<.0001). We conclude that the finger tip exemplifies the scope of peripheral vascular responsiveness due to its high density of alpha sympathetic innervation, and its high degree of blood flow rate lability. Given that elevated peripheral resistance and tightly linked transient heart rate elevation is a consistent part of the hemodynamic response to arousal and OSAS, we believe that pulsatile finger blood flow patterns can be clearly diagnostic of OSAS and other sleep-disordered breathing conditions.

Constriction, Pathologic↗

PubMed1999

Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder.

Fourteen consecutive children who were newly diagnosed with attention-deficit hyperactivity disorder (ADHD) and who had never been exposed to stimulants and 10 control children without ADHD underwent polysomnographic studies to quantify Periodic Limb Movements in Sleep (PLMS) and arousals. Parents commonly gave both false-negative and false-positive reports of PLMS in their children, and a sleep study was necessary to confirm their presence or absence. The prevalence of PLMS on polysomnography was higher in the children with ADHD than in the control subjects. Nine of 14 (64%) children with ADHD had PLMS at a rate of >5 per hour of sleep compared with none of the control children (p <0.0015). Three of 14 children with ADHD (21%) had PLMS at a rate of >20 per hour of sleep. Many of the PLMS in the children with ADHD were associated with arousals. Historical sleep times were less for children with ADHD. The children with ADHD who had PLMS chronically got 43 minutes less sleep at home than the control subjects (p = 0.0091). All nine children with ADHD who had a PLMS index of >5 per hour of sleep had a long-standing clinical history of sleep onset problems (>30 minutes) and/or maintenance problems (more than two full awakenings nightly) thus meeting the criteria for Periodic Limb Movement Disorder (PLMD). None of the control children had a clinical history of sleep onset or maintenance problems. The parents of the children with ADHD were more likely to have restless legs syndrome (RLS) than the parents of the control children. Twenty-five of 28 biologic parents of the children with ADHD and all of the biologic parents of the control children were reached for interview. Eight of twenty-five parents of the children with ADHD (32%) had symptoms of RLS as opposed to none of the control parents (p = 0.011). PLMS may directly lead to symptoms of ADHD through the mechanism of sleep disruption. Alternative explanations for the association between ADHD and RLS/PLMS are that they are genetically linked, they share a common dopaminergic deficit, or both.

Arousal↗

PubMed1997

Periodic limb movements during sleep are a frequent finding in patients with Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome (GTS) and restless legs syndrome (RLS) are two different neurological disorders with common features such as involuntary movements. In both disorders a disturbance of the dopaminergic system has been considered among other possible mechanisms. Since periodic leg movements (PLMS) during sleep are the predominant objective finding in RLS, the aim of this study was to investigate sleep parameters in GTS patients with particular emphasis on PLMS. Seven drug-free patients with GTS and seven age- and sex-matched healthy controls were studied polysomnographically, including superficial electromyogram (EMG) leads on all four extremities. A high number of PLMS were found in five of seven, and periodic arm movements in four of seven GTS patients. Total sleep time was significantly lower (P < 0.05) in the GTS patients than in the controls, which confirms earlier findings. The presence of PLMS in GTS might point towards evidence for a pathophysiological relationship between GTS and RLS, which, however, is not supported by the different responses to pharmacological treatments.

Adolescent↗

PubMed1991

[Personality markers of phobic patients and their change in psychotherapy. Descriptive results of a catamnestic project of the effectiveness of 6-9 week inpatient treatment].

The present paper is part on an extensive follow-up study aimed at the investigation of the effects of in-patient psychotherapy and at the durability of those effects. Using a psychoanalytic oriented personality-inventory (PSKB, Rudolf 1981) 85 phobic patients were examined at the beginning, at the end, and one year after a 6-8 week in-patient psychotherapy. Our results confirmed some of the generally described personality-characteristics in patients with phobia: the phobic symptoms are often accompanied by physical symptoms (sensation of dizziness, weakness sensation, palpitation, sleep disturbance, heavy sweating and breathlessness) and psychic symptoms (anxiousness, depression, restlessness, reduced self-awareness, pedantry, inhibition of aggressive impulses) which could be influenced by psychotherapy. Furthermore we depicted results which have not yet been published in literature.

Adult↗

PubMed1999

Is sleeping sickness a circadian disorder? The serotonergic hypothesis.

Patients with human African trypanosomiasis (HAT, sleeping sickness), due to the inoculation of Trypanosoma brucei gambiense or rhodesiense by the tsetse fly, are "sleepy by day and restless by night." The first 24 h polysomnographic recording (electroencephalogram [EEG], electromyogram [EMG], electrooculogram [EOG]), showing a disappearance of the 24 h rhythmicity of sleep and wakefulness, was performed in 1988. Thereafter, our team recorded 18 patients and 6 control volunteers at bed rest during 24 h sessions. Blood samples were taken hourly from 8 of the patients through a venous catheter and every 10 minutes from the remaining 10 patients. Plasma cortisol, prolactin, growth hormone (GH), melatonin, and plasma renin activity were analyzed. No disruptions of the circadian rhythms of sleep and wakefulness were described in the 6 healthy African subjects, and there also were no disturbances of 24 h hormone profiles. The patients experienced a dysregulation of the circadian rhythmicity of sleep and wakefulness that was proportional to the severity of the disease. Sleep onset rapid eye movement (REM) episodes were more frequent in the most severely sick patients, who also showed major disruptions in the 24 h plasma hormonal profiles, with intermediate profiles being observed at earlier stages of the sickness. However, the relationship between hormonal secretions and the states of vigilance persisted. Contrary to the other hormones, melatonin secretion remained undisturbed. These findings indicate that, at the stage of meningoencephalitis, HAT represents a dysregulation of the sleep-wake cycle and sleep structure, rather than a hypersomnia; this dysregulation is proportional to the degree of severity of the clinical and biological symptoms. It is accompanied by a circadian dysrhythmia of hormonal secretions, although the relationship between hormone pulses and sleep states is preserved. We therefore favor the involvement of the serotonergic raphe nuclei-suprachiasmatic nuclei liaison in the reversible disturbance of the circadian rhythms of the sleep-wake cycle and of hormonal secretions.

Animals↗

PubMed2003

Restless legs syndrome: diagnosis and treatment.

AIM: To describe clinical, biochemical and electrophysiological profile in Indian patients with Restless Legs Syndrome. MATERIAL AND METHODS: A total of 84 patients with sleep disorders were evaluated. Eight patients were diagnosed to have RLS. All underwent series of hematological, biochemical investigations and electrophysiological studies. Severity was assessed before and after specific treatment RESULTS: Eight patients presenting with clinical features of RLS formed the study group. The mean age was 51.6 +/- 13.8 years. The male : female ratio was 7:1. Six cases were primary and two were of secondary type of RLS. Seven patients reported significant improvement in symptoms after treatment CONCLUSION: RLS can be diagnosed purely on clinical criteria; and appropriate treatment results in significant relief. Thus, the recognition of this entity is essential.

Adult↗

PubMed1983

Age-related sleep-wake disorders at a sleep disorder center.

The specific sleep disorders of 97 patients 61-81 years old were compared with those of 264 middle-aged (41-60 years old) and 202 young (20-40 years old) patients. Sleep disorder diagnoses were made according to the Diagnostic Classification of the Association of Sleep Disorders Centers based on evaluations consisting of mental and physical examinations and all-night sleep recordings. Most young and middle-aged patients complained of excessive daytime sleepiness; the elderly complained of insomnia as often as excessive daytime sleepiness. The evaluations revealed objective findings in 93 per cent of the elderly, but only 77 per cent of younger patients. Nocturnal myoclonus or restless leg syndrome was the diagnosed cause of 23 per cent of elderly patients' sleep-wake problems, but only 11 per cent of middle-aged and 4 per cent of young patients had this problem. Respiratory disorders of sleep were found in 27 per cent of elderly, 35 per cent of middle-aged, and 20 per cent of young patients. Elderly patients (6 per cent) had psychiatric disorders diagnosed as the causes for their problems less frequently than did younger patients (22 per cent).

Adult↗

PubMed2004

Prevalence of obstructive sleep apnoea and periodic limb movement in 45 subjects with heart transplantation.

BACKGROUND: Obesity, a major risk factor for obstructive sleep apnoea, is common after cardiac transplantation. Case reports have shown development of obstructive sleep apnoea in cardiac transplantation recipients. The present study represents the first systematic evaluation of sleep disorders after cardiac transplantation. OBJECTIVE: To determine the prevalence and clinical impact of sleep disorders in a cohort of cardiac transplant recipients. METHODS: This was a cross-sectional study at the Veterans Affairs Medical Center. Forty-five of 60 eligible subjects agreed to take part in the study. Polysomnography, sleep and health survey questionnaires, and laboratory tests were recorded. RESULTS: Thirty-six percent had obstructive sleep apnoea-hypopnoea with an index of 15 or more per hour. The average apnoea-hypopnoea index was about 50+/-27 (SD) per hour. Sleep apnoea resulted in arterial oxyhaemoglobin desaturation, excessive arousals, unrefreshing sleep, excessive daytime sleepiness, poor health-related quality of life, and hypertension (all P values <0.05). Weight gain since transplantation was significantly greater in recipients with obstructive sleep apnoea than those without. Thirty-three percent of patients had periodic limb movement with an index of >?15/hour and an average of 55+/-43/hour. Forty-five percent of these patients had restless legs syndrome. CONCLUSION: Thirty-six percent of cardiac transplant recipients have moderate to severe obstructive sleep apnoea. Sleep apnoea results in disrupted sleep, desaturation and impaired quality of life. Polysomnography should be routinely considered in the ongoing management of most cardiac transplant recipients. Treatment of obstructive sleep apnoea may improve quality of life and other outcomes of cardiac transplantation.

Cohort Studies↗

PubMed2002

Is there a subpopulation of children with growing pains who really have Restless Legs Syndrome? A review of the literature.

Symptoms of Restless Legs Syndrome (RLS) can begin in childhood and persist into adulthood. To our knowledge, no one has done a systematic review of the literature to determine if the descriptions of 'growing pains' are consistent with the diagnosis of childhood RLS. Our group and that of Ekbom have noted that childhood onset RLS can be misdiagnosed as 'growing pains'. We therefore reviewed the work of seven groups of authors that addressed 'growing pains' as an isolated phenomenon in order to determine whether the descriptions of 'growing pains' were consistent with the clinical features of RLS. We found no consistent pattern in the descriptions even when articular pain was excluded. Thus, it is unlikely that all patients with 'growing pains' have RLS and it is likely that 'growing pains' is a heterogeneous disorder. The aforementioned authors were not looking for features unique to RLS and descriptions of the complete symptom complex of RLS are usually lacking. Further complicating the data are problems with methodology, e.g. in some studies small children and their parents were asked to retrospectively recall remote and infrequent events, and in other studies, articular pain was not adequately ruled out. Inconsistent with the hypothesis that RLS and 'growing pains' are the same are the high association of 'growing pains' with migraine headaches and abdominal pain. However, from this background emerge subsets of patients with 'growing pains' that are described as having one, some, or all of the following features consistent with the diagnosis of RLS: symptoms that are primarily in the legs, the patients rub their legs to get relief of the discomfort, the symptoms are worse at night, sleep disturbance is present and the discomfort is sometimes accompanied by motor restlessness A non-painful form of 'growing pains' has even been described. Ekbom and Brenning, a contemporary of Ekom, directly addressed the relationship between 'growing pains' and RLS. Ekbom felt that 'growing pains' and RLS were probably different since 'growing pains' disappear after childhood and one of his patients described her childhood 'growing pains' as being different from the sensory discomfort of her adult onset RLS. However, Brenning showed that RLS-like features in adulthood and a previous history of 'growing pains' in childhood occurred far more frequently in the parents of children with 'growing pains' than in control parents. More work needs to be done on the potential relationship between 'growing pains' and RLS.

Journal Article↗

PubMed1999

Treatment of periodic leg movement disorder and restless leg syndrome with talipexole.

In order to investigate the bedtime dose of talipexole, a D2 and alpha2 stimulant, on patients with periodic leg movement disorder (PLMD) and restless leg syndrome (RLS), we made a comparison of polysomnographic findings and subjective symptom ratings before and during 4 weeks of the treatment on five cases with RLS and PLMD. A significant decrease in both the frequencies of periodic leg movements and subjective symptom ratings and significant improvement of sleep composition were recognized during the treatment. We speculate that the combination of the agonistic action of D2 and alpha2 receptor with the drug might not only suppress PLMD and RLS but also improve sleep quality.

Azepines↗

PubMed1995

Toward a better definition of the restless legs syndrome. The International Restless Legs Syndrome Study Group.

A large International Restless Legs Syndrome (RLS) Study Group has been formed. As its first task, the group has taken upon itself the role of defining the clinical features of the RLS. As minimal criteria for diagnosis, the group proposes the following four features: (a) desire to move the extremities, often associated with paresthesias/dysesthesias; (b) motor restlessness; (c) worsening of symptoms at rest with at least temporary relief by activity, and (d) worsening of symptoms in the evening or night. Other features commonly seen in RLS include sleep disturbance, periodic limb movements in sleep and similar involuntary movements while awake, a normal neurological examination in the idiopathic form, a tendency for the symptoms to be worse in middle to older age, and, in some cases, a family history suggestive of an autosomal dominant mode of inheritance.

Age of Onset↗

PubMed1997

Restless legs syndrome in home healthcare.

Restless legs syndrome affects millions, but most healthcare providers don't know it exists. Its sleep-deprived victims are plagued by indescribable crawling sensations in their legs that occur at night and that are only relieved by moving the legs. Many home healthcare clients, already challenged by their primary illness, are also affected by the persistent symptoms of Restless Legs Syndrome. It is important that home care nurses learn about Restless Legs Syndrome-what it is, how to assess it, and what can be done about it.

Community Health Nursing↗