PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Restless sleep”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,063 records · Page 59Linked to original sources
PubMed2002

Restless legs syndrome: treatment with dopaminergic agents.

Restless legs syndrome (RLS) is a common neurologic disorder that affects 5 to 10% of the population and increases in prevalence with aging. The clinical hallmarks of RLS include dysesthesias or paresthesias in the legs and sometimes the arms, occurring primarily at rest, which are usually worse in the evening and are alleviated by movement. RLS can be a disabling disorder, causing sleep disturbance at night and excessive sleepiness during the day. Although treatment with levodopa alleviates symptoms, many RLS patients develop rebound (occurrence of symptoms during the night) or augmentation (occurrence of symptoms before levodopa dosing in the evening). Augmentation occurs in up to 82% of patients treated with levodopa, limiting the long-term usefulness of this agent. The direct dopamine receptor agonists are long-acting drugs often administered as a single dose at bedtime. Among these agents, pergolide, pramipexole, ropinirole, and cabergoline have all been shown to alleviate RLS symptoms in 70 to 100% of patients. The most common adverse effect is nausea. Augmentation, although it may be associated with chronic agonist use, is usually mild and responsive to additional dosing. The direct dopamine receptor agonists have largely replaced levodopa as the most effective treatment for RLS.

Clinical Trials as Topic↗
PubMed2005

Is restless legs syndrome underrecognized? Current management.

Restless legs syndrome (RLS) is a poorly understood sensory-motor neurological disorder whose prevalence in Caucasian populations ranges from 10% to 15%. The patient reports unpleasant sensations in the lower limbs with dysesthesia resulting in an urge to move the legs. The symptoms occur during periods of inactivity, increasing in the evening and at night. Moving the legs provides relief. In 80% of cases, polysomnography shows periodic leg movements during sleep. Patients with idiopathic RLS often report similar symptoms in family members. Secondary RLS may be due to medications, diabetes mellitus, renal failure, iron deficiency, neurological disorders, or rheumatoid arthritis. In secondary RLS, the management rests on treatment of the cause. Symptomatic treatment is warranted in patients with moderate-to-severe symptoms that adversely affect the quality of life. Dopaminergic agents are tried first. When they fail or induce adverse effects, weak opioids, benzodiazepines, anticonvulsants or, if needed, strong opioids, may be used.

Diagnosis, Differential↗
PubMed1999

An overview of levodopa in the management of restless legs syndrome in a dialysis population: pharmacokinetics, clinical trials, and complications of therapy.

OBJECTIVE: To review published literature investigating the efficacy and safety of levodopa in the management of restless legs syndrome (RLS), with emphasis on the hemodialysis population. DATA SOURCES: An English-language literature search using MEDLINE was conducted from 1966 to 1997 (key terms: restless legs syndrome, levodopa, hemodialysis). The bibliographies of all identified published articles were reviewed and cross-referenced to ensure that all possible references were identified. STUDY SELECTION AND DATA EXTRACTION: All identified human studies investigating the use of levodopa for the management of RLS in uremic and nonuremic patients were analyzed. RESULTS: The prevalence of RLS is 20-40% in patients with endstage renal disease (ESRD) and approximately 5% in the general population. Although the benefits of levodopa/(carbidopa/benserazide) in reducing the signs and symptoms of RLS are documented in nonuremic patients, evidence in patients with ESRD is less readily available. Three small (< 30 subjects) clinical trials in uremic patients provide preliminary evidence for the usefulness of levodopa/(carbidopa/benserazide) in this population. CONCLUSIONS: In general, the small amount of published literature supports the empirical use of levodopa/carbidopa as a safe and effective therapy to manage the distressing symptoms of RLS in a hemodialysis population. We also report personal observations over a 4-year period in our hemodialysis unit that support levodopa as an effective first-line therapy. We have averted suicidal ideation in two patients and frequently modified symptoms of severe sleep deprivation. The dose of levodopa/carbidopa must be individually titrated to each patient's symptomatology, and morning rebound and afternoon augmentation should be monitored.

Clinical Trials as Topic↗
PubMed1999

The evoked heart rate response to periodic leg movements of sleep.

STUDY OBJECTIVES: Periodic leg movements of sleep are currently subdivided based upon whether or not they are associated with EEG arousal. "Autonomic" arousals, characterized by elevations in heart rate and blood pressure without AASM-defined EEG changes, have been associated with daytime somnolence in experimental protocols. In this study, we will describe the heart rate response to periodic leg movements of sleep, both with and without associated arousals. DESIGN: Heart rate was averaged for each of the ten cardiac cycles before, and after, the onset of individual periodic leg movements occurring in non-REM sleep for eight patients with Periodic Limb Movement Disorder (PLMD). Records were blindly scored (without EKG data) to determine if AASM-defined EEG arousals occurred within two seconds of leg movement onset. Leg movements during wakefulness were performed by four non-patient controls as a control condition. SETTING: Sleep Disorders Center INTERVENTIONS: None MEASUREMENTS AND RESULTS: A significant rise in heart rate was observed following the onset of individual leg movements of sleep (N = 796), which was also significantly larger than that seen after waking leg movements (N = 275). Although heart rate elevation was 10%-40% higher when leg movements were associated with AASM-defined arousal, these differences did not reach statistical significance. CONCLUSIONS: Periodic leg movements of sleep are associated with cardiac acceleration, even in the absence of AASM-defined arousal. It appears premature to conclude that periodic leg movements of sleep not associated with visible EEG arousal are clinically insignificant.

Adult↗
PubMed2006

Restless legs syndrome: manifestations, treatment and dental implications.

BACKGROUND: The authors reviewed the clinical features, epidemiology, pathogenesis and risk factors, medical management, dental findings and dental management of patients with restless legs syndrome (RLS). TYPES OF STUDIES REVIEWED: The authors conducted a MEDLINE search for the years 2000 through 2004 using the key terms "restless legs syndrome," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected articles published in English in peer-reviewed journals for further review, and they gave preference to articles reporting randomized controlled trials. CONCLUSIONS: RLS is a neurological disorder that is characterized by unpleasant sensations in the legs that occur at rest, especially at bedtime. These symptoms cause an irresistible urge to get out of bed and move the legs to relieve the discomfort, thereby delaying sleep onset and resulting in fatigue and dysphoria the next day. CLINICAL IMPLICATIONS: The prevalence of dental disease may be extensive in patients with RLS because of diminished salivary flow resulting from the medications used to treat RLS. Patient education, saliva substitutes and anticaries agents are indicated. Special precautions must be taken when prescribing or administering sedative-hypnotic agents that are likely to have adverse reactions with the medications used to treat RLS.

Analgesics, Opioid↗
PubMed1984

Failure of IV atropine to abolish nasal irritation caused by chlormethiazole infusion in elderly patients undergoing spinal anaesthesia.

The efficacy of intravenous atropine in abolishing the nasal irritation of chlormethiazole was assessed. Forty elderly patients undergoing transurethral resection of prostate under spinal anaesthesia were studied. One ml of either atropine sulphate (0.6 mg) or normal saline was administered intravenously in a double-blind fashion 10 minutes prior to infusion of 0.8% chlormethiazole edisylate. A loading infusion of 5 ml X min-1 of the chlormethiazole solution was followed by a variable rate of infusion in order to maintain a predetermined state of sedation--i.e. where the patient lapsed into sleep but was easily awakened to obey commands. Sneezing was the commonest side-effect occurring in 45% and 70% of patients in atropine and saline groups respectively. This was not effectively abolished by IV atropine in incremental doses of 0.6 mg up to 1.8 mg. Because of the sneezing and restlessness, four patients in the atropine group required general anaesthesia to improve operating conditions. These side-effects of chlormethiazole may limit its use as a sedative for surgery in this elderly age group.

Aged↗
PubMed2006

The weight of evidence for ropinirole in restless legs syndrome.

Evidence-based guidelines consider dopaminergic therapy to be the mainstay of treatment for restless legs syndrome (RLS). l-dopa has been shown to reduce RLS symptoms, but subsequent augmentation of symptoms occurs in up to 73% of patients during continued treatment. The ergot-derived dopamine agonist pergolide has been shown to be effective in small, open or placebo-controlled studies, but there have been reports of pleuropulmonary or cardiac valvular disease with this ergoline agent. Amongst the non-ergoline dopamine agonists, pramipexole has been reported to reduce RLS symptoms, but robust trial data are limited. By contrast, the RLS clinical trial programme with ropinirole is the largest published to date. This programme includes 12-week randomized double-blind placebo-controlled studies and a 36-week maintenance-of-effect study. Data from the placebo-controlled studies show that ropinirole, 0.25-4.0 mg/day, produces rapid and significant reductions, compared with placebo, in the sensory and motor symptoms of RLS, and that these benefits are associated with significant improvements in sleep and quality of life. In addition, the maintenance study has shown that these benefits are maintained during longer-term treatment. Furthermore, ropinirole is generally well tolerated. Ropinirole thus represents a potential valuable approach to the management of RLS.

Dopamine Agonists↗
PubMed2006

Ropinirole in the treatment of patients with restless legs syndrome: a US-based randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: To assess the efficacy, safety, and tolerability of the dopamine agonist ropinirole in the treatment of patients with moderate to severe primary restless legs syndrome (RLS). PATIENTS AND METHODS: This multicenter, 12-week, double-blind, placebo-controlled, flexible-dose study enrolled US patients and was conducted between September 2003 and May 2004. Patients were randomized to ropinirole or placebo, 0.25-4.0 mg as needed and tolerated, once daily, 1 to 3 hours before bedtime. The primary end point was mean change from baseline to week 12 in International Restless Legs Scale (IRLS) total score. Key secondary efficacy measures included the Clinical Global Impression-Improvement scale. RESULTS: A total of 381 patients were enrolled; 164 (87.7%) of 187 patients randomized to ropinirole and 167 (86.1%) of 194 randomized to placebo completed the study. Significant treatment differences favoring ropinirole, compared with placebo, were observed for change in IRLS total score at week 12 (adjusted mean treatment difference, -3.7; 95% confidence interval, -5.4 to -2.0; P < .001) and for all 3 key secondary end points: mean change from baseline in IRLS total score at week 1 and proportion of patients who were much/very much improved on the Clinical Global Impression Improvement scale at weeks 1 and 12. Ropinirole was associated with significantly greater Improvements in subjective measures of sleep disturbance, quantity, and adequacy; quality of life; and anxiety. Although treatment differences favoring ropinirole in daytime somnolence were observed, they were not statistically significant (P = .10). Ropinirole was generally well tolerated, with an adverse-event profile consistent with other dopamine agonists. CONCLUSION: This study confirms that ropinirole improves RLS symptoms and subjective measures of sleep, quality of life, and anxiety and that it is generally well tolerated.

Adolescent↗
PubMed2006

Restless legs syndrome and periodic limb movements.

The history, clinical aspects, and treatment of restless legs syndrome (RLS), a heterogeneous distressing sensorimotor disorder, and periodic limb movements (PLMs) that are the typical motor accompaniment of the syndrome, are described. A positive family history, a positive response to dopaminergic treatment, and the presence of PLM while awake or asleep are supportive criteria for the diagnosis of the disorder. RLS and PLM occur more frequently at the beginning of night and exponentially decline across sleep cycles, suggesting circadian influences. Altered circadian rhythmicity in dopamine metabolism and enhanced circadian variations in dopaminergic functions have been reported in the disorder. Dysfunction or atrophy of A11 cells from the diencephalic-spinal dopamine A11 system has been suggested to explain the efficacy of dopaminergic drugs in relieving RLS symptoms and the circadian rhythmicity of RLS. Studies support the hypothesis that the A11 dopaminergic neurons and spinal pathways may be more involved in the pathophysiology of RLS than the nigrostriatal system. Neurophysiological evidence indicates that the involuntary movements in RLS may be of spinal or propriospinal origin. Despite these findings, however, the pathogenic mechanisms underlying the peculiar sensory and motor manifestations of RLS remain unexplained. Among the current treatment options offered for the treatment of RLS, dopaminergic agents have provided the best evidence for efficacy in symptom relief.

Circadian Rhythm↗
PubMed2003

Restless legs syndrome in hemodialysis patients in India: a case controlled study.

OBJECTIVE: To assess the prevalence of restless legs syndrome (RLS) in Indian patients on hemodialysis as compared to controls. METHODS: One hundred and twenty-one consecutive hemodialysis patients and 99 controls were evaluated using a standard predesigned questionnaire. The control group comprised completely normal healthy adults who were being evaluated as renal donors. Nerve conduction studies were done in those patients diagnosed with RLS. RESULTS: RLS was present in eight hemodialysis patients (6.6%) and none of the controls. Patients (87.5%) with RLS had delayed sleep onset. Nerve conduction showed evidence of sensori-motor neuropathy in five patients and a normal study in one patient. When we compared the patients with RLS to those without RLS, there was no significant difference in their age, duration of hemodialysis, hemoglobin, blood urea, creatinine, serum ferritin or use of erythropoeitin. CONCLUSIONS: The prevalence of RLS was 6.6% in patients on hemodialysis; and 0% in controls, which is much lower than that reported from the West.

Adult↗
PubMed1999

Restless Legs Syndrome.

With suitable pharmacotherapy, patients with any degree of restless legs syndrome (RLS) should be able to obtain substantial relief of symptoms. The best therapeutic success is attained when the physician tailors therapy to the patient's specific symptoms and can flexibly try a variety of agents, if needed. Therapy should be reserved for those in whom RLS cannot be managed with just sleep hygiene and related practices. It should not be withheld, however, if a patient reasonably believes that his or her quality of life is being impaired by RLS. The optimal initial approach to RLS in the general patient is usually the use of a dopaminergic agent: low-dose levodopa in milder cases, a dopamine agonist in more severe ones. Patients whose problems are primarily sleep related can initially be treated with a benzodiazepine. Patients who have symptoms primarily while awake can initially be treated with a dopaminergic agent or an opioid. Patients whose RLS discomfort is truly painful can initially be treated with gabapentin. Combination therapy with two or three agents from different classes can be useful as well. Determination of iron status is the most important initial laboratory evaluation in patients with RLS. Iron supplementation should be used as indicated. In the future, delivery modes other than oral administration of medications may be of significant benefit, especially in more severe cases.

Journal Article↗
PubMed1993

Acute exogenic psychosis following oral ingestion of 2 mg lormetazepam in an eleven-year-old boy.

After oral ingestion of 2 mg lormetazepam given by his mother, an 11-year-old boy suffered from severe adverse effects. Main symptoms were disorientation, restlessness, amnesia, anxiety, hostility, and rage reactions. Paranoid ideations and impaired perception were concluded from strange reactions and remarks of the child. Symptoms are similar to the van der Kroef syndrome described after the use of rapidly eliminated high-potency benzodiazepines. This case demonstrates drug abuse on the part of parents wishing to induce sleep in their children.

Adolescent↗
PubMed1995

Evidence of peripheral axonal neuropathy in primary restless legs syndrome.

Restless legs syndrome (RLS) is a well-defined clinical entity characterized by an unpleasant creeping sensation arising in the legs with an irresistible need to move them. The trouble is more pronounced when the affected people lie in a prolonged rest position and try to fall asleep. It is known that RLS may be consequent to systemic disorders and to diseases affecting the central or peripheral nervous system. The International Classification of Sleep Disorders states that peripheral neuropathy should be ruled out by medical history and clinical grounds before diagnosing primary RLS (pRLS). The present study extended peripheral nerve investigation in eight consecutive pRLS patients with normal neurological examination results and showed that all patients exhibited two or more electrical, psychophysiological, and/or morphological features of peripheral axonal neuropathy. Morphometric analysis of sural nerve showed a significant reduction in myelinated fiber density and g ratio (axon diameter/fiber diameter) in the pRLS group compared with eight control biopsy specimens. These results suggest that axonal neuropathy is often present in patients with RLS. A comprehensive peripheral nerve investigation should be considered in RLS patients.

Adult↗
PubMed2004

Circadian effects of dopaminergic treatment in restless legs syndrome.

BACKGROUND AND PURPOSE: Although an essential diagnostic feature of restless legs syndrome (RLS) is the presence of circadian symptom variations, with an increase in the evening or at night, the mechanisms underlying this time-bound variation remain unknown. Since dopaminergic mechanisms seem to play a central role in the pathophysiology of RLS, it is likely that circadian variations in the dopaminergic system or factors affecting it cause the nightly increase. The reverse is also possible; dopaminergic medication might affect melatonin function, a key element of the circadian system. The present study investigated the effects of dopaminergic medication on melatonin secretion in RLS. PATIENTS AND METHODS: Eight previously untreated patients diagnosed with idiopathic RLS underwent a three-week, open-labeled treatment with 400 mg L-DOPA (+100 mg CarbiDOPA). Dim Light Melatonin Onset (DLMO), a marker of circadian phase, was determined before and after treatment. RESULTS: Compared to baseline, earlier DLMO was found in L-DOPA treated patients (21:00+/-1:20 vs. 18:50+/-0:55; P < 0.05). Anticipation of DLMO was more marked in the subgroup of patients showing augmentation. A positive correlation was observed between change of DLMO, sleep latency and time of onset of symptoms following treatment with L-DOPA. CONCLUSIONS: Our results suggest that L-DOPA may exert chronobiotic effects in RLS.

Adult↗
PubMed2004

Effective cabergoline treatment in idiopathic restless legs syndrome.

OBJECTIVE: To assess the efficacy and safety of the dopamine agonist cabergoline (CAB) in patients with restless legs syndrome (RLS). METHODS: Patients with moderate to severe RLS were randomized into four groups receiving placebo, 0.5 mg, 1 mg, or 2 mg CAB once daily in a double-blind, placebo-controlled, multicenter dose-finding trial followed by an open long-term extension trial of 47 weeks. Efficacy was assessed with the RLS-6 scales and International RLS Study Group severity scale (IRLS). RESULTS: A total of 85 patients (age 56 +/- 10 years, 71% females) were treated. Severity of RLS-6 scale symptoms during the night (the primary endpoint) was markedly improved by all CAB doses compared to placebo (placebo: -1.4 +/- 3.1, 0.5 mg CAB: -4.2 +/- 3.0 [p = 0.0082], 1.0 mg CAB: -4.0 +/- 2.9 [p = 0.0040], 2.0 mg CAB: -4.8 +/- 3.7 [p = 0.0026]). Similar results were found for the RLS severity at bedtime and during the day, IRLS, and satisfaction with sleep. A stable, clinically relevant improvement was achieved in all efficacy measures (severity during the night: change between last assessment and baseline: -5.6 +/- 2.5, rate of remission: 71.2%) throughout 1 year with a mean CAB dose of 2.2 mg per day. During long-term treatment, 6 of 66 treated patients were affected (n = 2) or possibly affected (n = 4) by mild augmentation. Under CAB therapy up to 1 year, 11 of 85 patients discontinued treatment due to a drug-related adverse event. CONCLUSIONS: Cabergoline is an efficacious and well-tolerated option for the treatment of restless legs symptoms during the night and the day.

Aged↗
PubMed2005

Circadian variation of the effects of immobility on symptoms of restless legs syndrome.

STUDY OBJECTIVES: It is now well established that symptoms of restless legs syndrome (RLS) are worsened by immobility and that their severity fluctuates according to a circadian pattern with a maximum occurring in the late evening or during the night. However, no study has ever attempted to dissociate these two effects. The objective of this study was to evaluate the nycthemeral variations in the effects of duration of immobility on symptoms of RLS. DESIGN: A 28-hour modified constant routine protocol. SETTING: Sleep Disorders Center, Montreal Sacré-Coeur Hospital. PARTICIPANTS: Seven patients with primary RLS (3 men, 4 women; mean age: 43.9 years) and seven controls matched for age (42.4 years) and gender. INTERVENTION: None. MEASUREMENTS AND RESULTS: A 40-minute Suggested Immobilization Test (SIT) was repeated every 2 hours during the 28-hour protocol in order to quantify both subjective leg discomfort and periodic leg movements (PLM). Regarding leg discomfort, a two-way ANOVA performed on patients' data revealed a significant interaction (p = 0.037) between Time within the SIT and Time of day. Simple effect analyses performed to decompose the interaction showed that the increase in leg discomfort with duration of immobility was found only on SIT 7, 8, 9, 10 and 12, which corresponds to the period between 21:20 and 08:00. In addition, in patients, a significant circadian variation (p < 0.01) was found for the 28-hour profiles of leg discomfort progression during the SIT. No interaction or Time within the SIT effect was found for controls. CONCLUSIONS: These results show that worsening of RLS symptoms by immobility is closely linked to their intrinsic circadian variation.

Adult↗
PubMed2005

Postoperative delirium.

Delirium is a global impairment of upper brain functions caused by an organic substrate. It is frequently observed in the postoperative period, particularly in elderly people. Vascular and orthopedic surgery and long-duration surgery are associated with a higher incidence of postoperative delirium. When it occurs, postoperative delirium makes patient management much more difficult, increases costs, and, above all, causes severe discomfort to the patient. Delirium is also associated with higher postoperative mortality and morbidity, and with delayed functional recovery, but it is still unclear whether worse prognosis is directly caused by delirium or results from the neurological damage of which delirium is simply a symptom. Drug therapy should be part of a complex approach to prevent and treat this complication. Neuroleptics like haloperidol and droperidol, and benzodiazepines are usually employed in order to control symptoms like agitation, restlessness, and altered perceptions. Atypical neuroleptics, like risperidone, have not yet been studied in postoperative delirium, although some case reports in which they were successfully used have been published. Physiostigmine is effective in delirium caused by anticholinergic syndrome; vitamins may be useful in alcoholics; melatonin use has been suggested in order to prevent and treat delirium by normalizing sleep-wake cycle alterations. Environmental interventions are often costless and may be very useful to prevent and treat postoperative delirium in patients at risk.

Anti-Anxiety Agents↗