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Comparison Study of Polysomnographic Features in Multiple System Atrophy-cerebellar Types Combined with and without Rapid Eye Movement SleepBehaviorDisorder The brain stem is found to be impaired in multiple system atrophy-cerebellar types (MSA-C). Rapid eye movement (REM) sleepbehaviordisorder (RBD) is reported as a marker of progressive brain stem dysfunction. Few systematic studies about the sleep disturbances in MSA-C patients combined with or without RBD were reported. This study aimed (...) for MSA-C. The Student's t-test, Mann-Whitney U-test for continuous variables, and the Chi-square test for categorical variables were used in this study.MSA-C patients with RBD had younger visiting age (52.6 ± 7.4 vs. 56.7 ± 6.0 years, P = 0.046) and shorter duration of the disease (12.0 [12.0, 24.0] vs. 24.0 [14.0, 36.0] months, P = 0.009) than MSA-C patients without RBD. MSA-C with RBD had shorter REMsleep latency (111.7 ± 48.2 vs. 157.0 ± 68.8 min, P = 0.042), higher percentage of REMsleep (14.9
Mortality and Its Risk Factors in Patients with Rapid Eye Movement SleepBehaviorDisorder To determine the mortality and its risk factors in patients with rapid eye movement (REM) sleepbehaviordisorder (RBD).A total of 205 consecutive patients with video-polysomnography confirmed RBD (mean age = 66.4 ± 10.0 y, 78.5% males) were recruited. Medical records and death status were systematically reviewed in the computerized records of the health care system. Standardized mortality ratio (SMR (...) was significantly associated with age (hazard ratio [HR] = 1.05; 95% CI, 1.01-1.10), living alone (HR = 2.04; 95% CI, 1.39-2.99), chronic obstructive pulmonary disease (HR = 3.38; 95% CI, 1.21-9.46), cancer (HR = 10.09; 95% CI, 2.65-38.42), periodic limb movements during sleep (HR = 3.06; 95% CI, 1.50-6.24), and development of neurodegenerative diseases (HR = 2.84; 95% CI, 1.47-5.45) and dementia (HR = 2.66; 95% CI, 1.39-5.08).Patients with RBD have a higher mortality rate than the general population only
the Gria1 gene which codes for the GluA1 subunit of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor. Gria1-/- mice exhibit a phenotype relevant for neuropsychiatric disorders, including reduced synaptic plasticity and, at the behavioural level, attentional deficits leading to aberrant salience. In this study we report a striking reduction of EEG power density including the spindle-frequency range (10-15 Hz) during sleep in Gria1-/- mice. The reduction of spindle-activity in Gria1 (...) Absent sleep EEG spindle activity in GluA1 (Gria1) knockout mice: relevance to neuropsychiatric disordersSleep EEG spindles have been implicated in attention, sensory processing, synaptic plasticity and memory consolidation. In humans, deficits in sleep spindles have been reported in a wide range of neurological and psychiatric disorders, including schizophrenia. Genome-wide association studies have suggested a link between schizophrenia and genes associated with synaptic plasticity, including
A Review of Scales to Evaluate Sleep Disturbances in Movement Disorders Patients with movement disorders have a high prevalence of sleep disturbances that can be classified as (1) nocturnal sleep symptoms, such as insomnia, nocturia, restless legs syndrome (RLS), periodic limb movements (PLM), obstructive sleep apnea (OSA), and REMsleepbehaviordisorder; and (2) diurnal problems that include excessive daytime sleepiness (EDS) and sleep attacks. The objective of this review is to provide (...) Hopkins Restless Legs Severity Scale, the Restless Legs Syndrome-6 measure, a Pediatric RLS Severity Scale, and the Augmentation Severity Rating Scale (a scale to evaluate augmentation under treatment) and several instruments that assess impact on quality of sleep and health-related quality of life. To evaluate the presence of PLM, no clinical scales have been developed to date. As far as OSA, commonly used instruments such as the Sleep Apnea Scale of the SleepDisorders Questionnaire, the STOP-Bang
The Treatment of SleepDisorders in Parkinsonâ€™s Disease: From Research to Clinical Practice Sleepdisorders (SDs) are one of the most frequent non-motor symptoms of Parkinson's disease (PD), usually increasing in frequency over the course of the disease and disability progression. SDs include nocturnal and diurnal manifestations such as insomnia, REMsleepbehaviordisorder, and excessive daytime sleepiness. The causes of SDs in PD are numerous, including the neurodegeneration process itself (...) , which can disrupt the networks regulating the sleep-wake cycle and deplete a large number of cerebral amines possibly playing a role in the initiation and maintenance of sleep. Despite the significant prevalence of SDs in PD patients, few clinical trials on SDs treatment have been conducted. Our aim is to critically review the principal therapeutic options for the most common SDs in PD. The appropriate diagnosis and treatment of SDs in PD can lead to the consolidation of nocturnal sleep
, Rapid eye movement (REM) sleepbehaviordisorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted.The mean age of the patients was 80.92±4.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered 'yes' to at least (...) An under-diagnosed geriatric syndrome: sleepdisorders among older adults Sleepdisorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic.Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale
Investigating rapid eye movement sleep without atonia in Parkinson's disease using the rapid eye movement sleepbehaviordisorder screening questionnaire. Rapid eye movement (REM) sleepbehaviordisorder (RBD) is frequently observed in patients with Parkinson's disease (PD). Accurate diagnosis is essential for managing this condition. Furthermore, the emergence of idiopathic RBD in later life can represent a premotor feature, heralding the development of PD. Reliable, accurate methods (...) for identifying RBD may offer a window for early intervention. This study sought to identify whether the RBD screening questionnaire (RBDSQ) and three questionnaires focused on dream enactment were able to correctly identify patients with REM without atonia (RWA), the neurophysiological hallmark of RBD. Forty-six patients with PD underwent neurological and sleep assessment in addition to completing the RBDSQ, the RBD single question (RBD1Q), and the Mayo Sleep Questionnaire (MSQ). The REM atonia index
specialist is essential to evaluate and treat less common sleep problems associated with mTBI, such as sleep-related breathing disorder (e.g., obstructive sleep apnea), circadian rhythm shift, restless leg syndrome, periodic limb movement disorder, and REMsleepbehaviourdisorder. Some benefits of melatonin have been documented for insomnia, daytime alertness, or circadian rhythm difficulties after mTBI, 2,16,23 however recent guidelines for the treatment of insomnia 24 do not encourage use of melatonin (...) A B C Updated Evidence 7.5 B It is recommended to treat sleep-wake disturbances in patients with concussion/mTBI. Treatment of sleepdisorders may help with: Mood Anxiety Pain Fatigue Cognitive Problems 7.6 C All patients with persistent sleep-wake complaints should be placed on a program of sleep hygiene. Behavioural interventions for sleep (e.g., cognitive-behavioral therapy techniques, mindfulness-based therapies) should also be considered. See Appendix for a sleep hygiene program and Appendix
practice guideline is to 1)reviewthe evidence of the impact of weight-loss interventions on OSA severity, quality of life, and associated comorbidities and 2) provide speci?c recommendations for weight management in adult patients with OSA who are overweight or obese, as de?ned as a body mass index (BMI) greater than or equal to 25 kg/m 2 .A panel of sleep and pulmonary physicians, weight management experts, and behavioral scientists developed seven therapy-related questions, reviewed the relevant (...) with OSA with a BMI greaterthanorequalto27kg/m 2 ,whose weight has not improved despite participating in a comprehensive weight- loss lifestyle program, and who have AMERICAN THORACIC SOCIETY DOCUMENTS American Thoracic Society Documents e71 no contraindications including no active cardiovascular disease, we suggest an evaluation for antiobesity pharmacotherapy (conditional recommendation, very low certainty in the estimated effects). 3. For patients with OSA with a BMI greaterthanorequalto35kg/m 2
,” “conditional,” or “good” practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. Results: The Pain , Agitation/ Sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered (...) prioritized question list remained without recommendation. Conclusions: We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain , Agitation/ sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain , Agitation
Risk factors for neurodegeneration in idiopathic rapid eye movement sleepbehaviordisorder: A multicenter study. To assess whether risk factors for Parkinson disease and dementia with Lewy bodies increase rate of defined neurodegenerative disease in idiopathic rapid eye movement (REM) sleepbehaviordisorder (RBD).Twelve centers administered a detailed questionnaire assessing risk factors for neurodegenerative synucleinopathy to patients with idiopathic RBD. Variables included demographics (...) , lifestyle factors, pesticide exposures, occupation, comorbid conditions, medication use, family history, and autonomic/motor symptoms. After 4 years of follow-up, patients were assessed for dementia or parkinsonism. Disease risk was assessed with Kaplan-Meier analysis, and epidemiologic variables were compared between convertors and those still idiopathic using logistic regression.Of 305 patients, follow-up information was available for 279, of whom 93 (33.3%) developed defined neurodegenerative disease
Slow oscillating transcranial direct current stimulation during non-rapid eye movement sleep improves behavioral inhibition in attention-deficit/hyperactivity disorder. Behavioral inhibition, which is a later-developing executive function (EF) and anatomically located in prefrontal areas, is impaired in attention-deficit and hyperactivity disorder (ADHD). While optimal EFs have been shown to depend on efficient sleep in healthy subjects, the impact of sleep problems, frequently reported in ADHD (...) stimulation (so-tDCS, frequency = 0.75 Hz) during non-REMsleep, we aimed to improve daytime behavioral inhibition in children with ADHD.Fourteen boys (10-14 years) diagnosed with ADHD were included. In a randomized, double-blind, cross-over design, patients received so-tDCS either in the first or in the second experimental sleep night. Inhibition control was assessed with a visuomotor go/no-go task. Intrinsic alertness was assessed with a simple stimulus response task. To control for visuomotor
Insulinoma Masquerading as Rapid Eye Movement SleepBehaviorDisorder: Case Series and Literature Review. Insulinoma is a rare endocrine tumor that can cause a wide variety of symptoms, including abnormal nocturnal behavior. We report on 3 patients with insulinoma who presented with abnormal nocturnal behavior and injury during sleep, which simulated rapid eye movement (REM) sleepbehaviordisorder (RBD). In case 1, the fasting glucose level was 15 mg/dL, and insulin levels were elevated (15 (...) ineffective. Polysomnography showed no evidence of REMsleep without atonia in any of the 3 patients. No patient remembered any events that occurred during sleep. When a patient manifests abnormal behavior during the night and early morning, glucose monitoring should be performed, especially during the night and early morning. Clinicians should be aware that although insulinomas are rare, they can mimic parasomnias, such as RBD.
Increased REMsleep without atonia in Parkinson disease with freezing of gait. The objective of this cross-sectional study was to test the hypothesis that patients with Parkinson disease (PD) and freezing of gait (PD+FOG) would demonstrate sleep disturbances comparable to those seen in patients with REMsleepbehaviordisorder (RBD) and these changes would be significantly different from those in PD patients without FOG (PD-FOG) and age-matched controls.We conducted overnight polysomnography (...) studies in 4 groups of subjects: RBD, PD-FOG, PD+FOG, and controls. Tonic and phasic muscle activity during REMsleep were quantified using EMG recordings from the chin, compared among study groups, and correlated with disease metrics.There were no significant differences in measures of disease severity, duration, or dopaminergic medications between the PD+FOG and PD-FOG groups. Tonic muscle activity was increased significantly (p < 0.007) in the RBD and PD+FOG groups compared to the PD-FOG
REM Theta Activity Enhances Inhibitory Control in Typically Developing Children but not Children with ADHD Symptoms Sleep disturbances impair cognitive functioning in typically developing populations. Children with attention-deficit/hyperactivity disorder (ADHD), a disorder characterized by impaired inhibitory control and attention, commonly experience sleep disturbances. Whether inhibitory impairments are related to sleep deficits in children with ADHD is unknown. Children with ADHD (n = 18; M (...) in children with ADHD compared to typically developing children, it was functionally insignificant. Neither inhibitory control nor sustained attention was improved following overnight sleep in children with ADHD symptoms, and neither of these behaviors was associated with REM theta activity in this group. Taken together, these results indicate that elevated REM theta activity may be functionally related to ADHD symptomology, possibly reflecting delayed cortical maturation.
Family history of idiopathic REMbehaviordisorder: A multicenter case-control study. To compare the frequency of proxy-reported REMsleepbehaviordisorder (RBD) among relatives of patients with polysomnogram-diagnosed idiopathic RBD (iRBD) in comparison to controls using a large multicenter clinic-based cohort.A total of 316 patients with polysomnography-confirmed iRBD were recruited from 12 RBD study group centers, along with 316 controls matched on sex and age group. All subjects completed (...) a self-administered questionnaire that collected proxy-reported information on family history of tremor, gait trouble, balance trouble, Parkinson disease, memory loss, and Alzheimer disease. The questionnaire also included a single question that asked about possible symptoms of RBD among first-degree relatives (siblings, parents, and children).A positive family history of dream enactment was reported in 13.8% of iRBD cases compared to 4.8% of controls (odds ratio [OR] = 3.9, 95% confidence interval
Heartbeat Evoked Potentials During Sleep and Daytime Behavior in Children with SleepDisordered Breathing. Event-related brain potentials allow probing of cortical information processing, but when evoked with externally induced stimuli may disrupt sleep homeostasis and do not provide insight into intrinsic cortical information processing. To investigate if cortical processing of intrinsic information in children with sleep-disordered breathing (SDB) is different from healthy children and, if so (...) , whether it resolves with treatment, we used heartbeat as a source of interoceptive event-related brain potentials.To investigate heartbeat evoked potentials (HEP) during sleep in healthy children and in children with SDB before and after treatment and to explore if there are any associations between HEP and daytime behavioral deficits in children with SDB.Heartbeat-aligned EEG was assessed for presence of HEP within stage 2, slow-wave sleep, and REMsleep in 40 children with primarily mild to moderate
scoring, and there are no accepted rules for quantifying itspresence orseverity.However,scoringof respiratory effort–related arousals (RERAs), a subtle form of recurrent upper airway obstruction where ?ow-limited events are followed by EEG microarousals, is accepted by the American Academy of Sleep Medicine (4). RERAs that are associated with daytime impairment de?ne upper airway resistance syndrome (UARS) (5). As an increasing number of ambulatory sleep studies without EEG are being performed (...) . Montserrat and colleagues (6) have demonstrated that the nasal pressure air?ow signal correlates well with pneumotachographic ?ow. Thus, the standardized visual detection of IFL from a nasal cannula pressure signal could enhance the evaluation of sleep-disordered breathing in situations where a low AHI fails to capture suspected risk for health outcomes. The overarching goal of this workshop was to develop an approach to standardizing visual analysis of IFL in the clinical setting, which can be applied
in a multicentre study, including 436 patients with PD and 401 age-matched controls. PD-related sleep problems (PD-SP), excessive daytime sleepiness (EDS) and probable REMsleepbehaviourdisorder (pRBD) were evaluated using the PD sleep scale (PDSS)-2, Epworth Sleepiness Scale (ESS) and RBD screening questionnaire-Japanese version (RBDSQ-J), respectively.PD-SP (PDSS-2 ≥18; 35.1% vs 7.0%), EDS (ESS ≥10; 37.8% vs 15.5%) and pRBD (RBDSQ-J ≥5; 35.1% vs 7.7%) were more common in patients with PD than in controls (...) . The prevalence of restless legs syndrome did not differ between patients with PD and controls (3.4% vs 2.7%). After adjusting for age, sex, disease duration and Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) part III score, the PIGD group had higher PDSS-2 and ESS scores than the TD group. The RBDSQ-J scores did not differ among the TD, intermediate and PIGD groups. A stepwise regression model predicting the MDS-UPDRS part II score identified the Hoehn and Yahr stage, followed by the number