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low blood pressure. Narcolepsy, idiopathic hypersomnolence, chronic insomnia, restless legs syndrome, REMsleepbehaviordisorder or any other diagnosed or suspected sleepdisorder other than OSA that could affect the likelihood of apneas/hypopneas during a PSG. Periodic limb movement arousal index (PLMAI) > 10 on the screening/baseline PSG. Current use of diurnal or nocturnal supplemental oxygen Currently working night or rotating shifts Consumption of > 10 caffeinated beverages per day (...) ClinicalTrials.gov Identifier: Other Study ID Numbers: Ventus C020 First Posted: May 14, 2009 Last Update Posted: June 15, 2010 Last Verified: June 2010 Keywords provided by St. Luke's Hospital, Chesterfield, Missouri: SleepSleep Apnea, Obstructive OSA OSAH Additional relevant MeSH terms: Layout table for MeSH terms Apnea Sleep Apnea SyndromesSleep Apnea, Obstructive Respiration Disorders Respiratory Tract Diseases Signs and Symptoms, Respiratory Signs and Symptoms SleepDisorders, Intrinsic Dyssomnias Sleep
and DLB. The study also aims to look at the sleep patterns of caregivers of people with HD, PD and DLB. Condition or disease Intervention/treatment Phase Huntington's Disease Parkinson's Disease Dementia With Lewy Bodies SleepDisorders Circadian Dysregulation Drug: Ramelteon Drug: Placebo Not Applicable Detailed Description: Huntington's disease (HD) is a progressively degenerative brain disorder, which results in a loss of mental and physical abilities. It is genetically determined and people (...) to the patients and their caregivers' lives. In PD, sleep dysfunction occurs in approximately two thirds of patients. Sleep problems range from difficulty with sleep initiation, sleep fragmentation, disturbance of circadian rhythm, REMsleepbehaviordisorder (RBD), to excessive daytime sleepiness. Frequent nighttime awakening and sleep disruption are the most common sleep problems in PD. In DLB, REMsleepbehaviordisorder (RBD) occurs years to decades before the onset of dementia. Importantly, melatonin
percentile for age and gender Subject has any clinically significant or unstable medical illness/abnormality or chronic disease. Subject has a documented history of Bipolar I or II Disorder, major depression, conduct disorder, generalized anxiety disorder or any history of psychosis. Subject has periodic limb movement >5 times per hour, as demonstrated on Baseline PSG. Subject has sleepdisordered breathing, as demonstrated on Baseline PSG. Subject has another primary sleepdisorder, a secondary sleep (...) disorder, or any other known or suspected medical or psychiatric condition that has affected or may affect sleep Subject has a history of circadian rhythm disorder or will travel across ≥3 time zones more than once during the study. Subject has organic brain disease, or a history of febrile seizures. Subject is, in the opinion of the investigator, at suicidal or homicidal risk. Female subject who is pregnant or lactating or planning to become pregnant. Subject has taken any psychotropic medication
): Mya Schiess, The University of Texas Health Science Center, Houston Study Details Study Description Go to Brief Summary: Purpose - to validate a combination of biological and clinical markers in the rapid-eye-movement (REM) sleepbehaviordisorder (RBD) population as indicative of the pre-symptomatic stage of Parkinson's disease (PD). Procedures - All subjects (RBD diagnosis and controls) will have 1) a medical and neuro history and physical including videotape of movements, 2) neuropsychological (...) subjects who will be diagnosed. Subjects may be offered a repeat enrollment after 5 years. Condition or disease Rapid Eye Movement SleepBehaviorDisorder Detailed Description: Enrollment of PD and PS cohorts is complete. Currently enrolling only confirmed RBD and Controls. Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 240 participants Observational Model: Case-Control Time Perspective: Prospective Official Title: A Natural History Analysis
Nonviolent elaborate behaviors may also occur in REMsleepbehaviordisorder. To document unusual, nonviolent behaviors during REMsleepbehaviordisorder (RBD) and evaluate their frequency in Parkinson disease (PD).Most behaviors previously described during RBD mimic attacks, suggesting they proceed from archaic defense generators in the brainstem. Feeding, drinking, sexual behaviors, urination, and defecation have not been documented yet in RBD.We collected 24 cases of nonviolent behaviors (...) behaviors.Although they are less frequent than violent behaviors, nonviolent behaviors during REMsleepbehaviordisorder (RBD) fill a large spectrum including learned speeches and culture-specific behaviors, suggesting they proceed from the cortex activation. Sexual behaviors during RBD may expose patients and cosleepers to forensic consequences.
Complex dream-enacting behavior in sleepwalking. Currently, dream-enacting behaviors are viewed as occurring typically in association with a REM-sleepbehaviordisorder. In some cases, dream-like mentation is found also in non-REM parasomnia.We report a case of complex and dramatic sleepwalking behavior in a 26-year-old adult male who tied his 4-month-old daughter to the clothesline in the attic of his house.The explanation of this seemingly senseless behavior, which was related to psychosocial (...) stressors, was found in a detailed dream-like mentation that was reported by the patient. At the same time, an organic factor, namely, a worsening of the patient's asthma, was identified as the cause of an increased fragmentation of sleep.In some cases of non-REM parasomnia, detailed dream-like mentation may act as a bridge between psychosocial stressors and the specific parasomnic behavior.
targeting the premotor period are critical to elucidate both the onset and progression of premotor PD. Widespread data have demonstrated that dopaminergic imaging can detect PD subjects at the motor symptom threshold. Novel strategies combining dopaminergic imaging with known genetic mutations for PD or early clinical signs and PD-associated symptoms, such as olfactory loss and sleep disturbances like REMbehaviordisorder, have begun to be used to identify individuals at risk for PD before motor (...) Can we image premotor Parkinson disease? Pathology and imaging studies have shown that patients with Parkinson disease (PD) have a prolonged period of uncertain duration when vulnerable neuronal populations are degenerating, but typical motor symptoms have not yet developed. This provides both an opportunity-it may be best to test new medications and, ultimately, treat PD patients during this early phase of disease--and a challenge--how to find these premotor PD subjects? Imaging biomarkers
Idiopathic REMsleepbehaviordisorder in the transition to degenerative disease. Idiopathic REMsleepbehaviordisorder (RBD) predicts Parkinson's disease (PD) and dementia. However, the nature of the disease that emerges from RBD has not been fully characterized. Since 2004, we have been conducting a prospective study of idiopathic RBD patients, providing an opportunity to directly observe patients as they transitioned to a defined neurodegenerative syndrome. Patients with idiopathic RBD (...) underwent an extensive annual evaluation of motor function, olfaction, color vision, autonomic function, cognition and psychiatric symptoms. Neurodegenerative disease was defined according to standard criteria. We compared these measures in patients who had developed PD to those with dementia, all within the first year of developing disease. Of 67 patients, 6 developed PD and eleven developed dementia. Except for cognitive functioning, all tests of olfaction, color vision, autonomic function, depression
Restless legs syndrome, rapid eye movement sleepbehaviordisorder, and hypersomnia in patients with two parkin mutations. Parkin gene mutations cause a juvenile parkinsonism. Patients with these mutations may commonly exhibit REMsleepbehaviourdisorders, but other sleep problems (insomnia, sleepiness, restless legs syndrome) have not been studied. The aim of this study was to evaluate the sleep-wake phenotype in patients with two parkin mutations, compared with patients with idiopathic (...) group). Of the parkin patients, 45% had REMsleep without atonia, but only 9% had a definite REMsleepbehaviordisorder. All sleep measures were similar in the parkin and iPD groups. Two parkin siblings had a central hypersomnia, characterized by mean daytime sleep latencies of 3 min, no sleep onset REM periods, and normal nighttime sleep. Although the patients with two parkin mutations were young, their sleep phenotype paralleled the clinical and polygraphic sleep recording abnormalities reported
Midbrain hyperechogenicity in idiopathic REMsleepbehaviordisorder. Recent studies have reported an increased risk to develop Parkinson's disease (PD) in patients with idiopathic RBD (iRBD). Midbrain hyperechogenicity is a common transcranial sonography (TCS) finding in PD and has been suggested as a PD risk-marker in nonparkinsonian subjects. The objective of this study is to assess midbrain echogenicity by TCS in patients with iRBD and compare the findings with the healthy controls. TCS
Uncovering the Genetic Landscape for Multiple Sleep-Wake Traits Despite decades of research in defining sleep-wake properties in mammals, little is known about the nature or identity of genes that regulate sleep, a fundamental behaviour that in humans occupies about one-third of the entire lifespan. While genome-wide association studies in humans and quantitative trait loci (QTL) analyses in mice have identified candidate genes for an increasing number of complex traits and genetic diseases (...) or dark period while some loci had opposite effects on the trait during the light vs. dark. Analysis of a dataset for multiple sleep-wake traits led to previously undetected interactions (including the differential genetic control of number and duration of REM bouts), as well as possible shared genetic regulatory mechanisms for seemingly different unrelated sleep-wake traits (e.g., number of arousals and REM latency). Construction of a Bayesian network for sleep-wake traits and loci led
Disappearance of â€œphantom limbâ€ and amputated arm usage during dreaming in REMsleepbehaviourdisorder Limb amputation is followed, in approximately 90% of patients, by "phantom limb" sensations during wakefulness. When amputated patients dream, however, the phantom limb may be present all the time, part of the time, intermittently or not at all. Such dreaming experiences in amputees have usually been obtained only retrospectively in the morning and, moreover, dreaming is normally (...) associated with muscular atonia so the motor counterpart of the phantom limb experience cannot be observed directly. REMsleepbehaviourdisorder (RBD), in which muscle atonia is absent during REMsleep and patients act out their dreams, allows a more direct analysis of the "phantom limb" phenomena and their modifications during sleep.
Motor-Behavioral Episodes in REMSleepBehaviorDisorder and Phasic Events During REMSleep To investigate if sudden-onset motor-behavioral episodes in REMsleepbehaviordisorder (RBD) are associated with phasic events of REMsleep, and to explore the potential meaning of such an association.Observational review analysis.Tertiary sleep center.Twelve individuals (11 males; mean age 67.6 +/- 7.4 years) affected by idiopathic RBD, displaying a total of 978 motor-behavioral episodes during (...) variable (REMs, STWs, alpha bursts) was associated more with purposefullsemi-purposeful than with primitive movements (P<0.05).Motor-behavioral episodes in RBD were significantly more likely to occur in association with phasic than with tonic periods of REMsleep. The presence of REMs, alpha bursts and STWs was found to be more frequent in more complex episodes. We hypothesize that motor-behavioral episodes in RBD are likely to occur when the brain, during REMsleep, is in a state of increased
Excessive Muscle Activity Increases Over Time in Idiopathic REMSleepBehaviorDisorder Rapid eye movement (REM) sleepbehaviordisorder (RBD) is characterized by excessive electromyographic (EMG) activity due to dysfunction of the brainstem structures modulating REMsleep atonia. Patients with idiopathic RBD often develop a neurodegenerative disease, such as Parkinson disease, over the years, suggesting progression of an underlying pathologic process in the brainstem. It is unknown (...) if the excessive EMG activity in REMsleep changes over time in patients with idiopathic RBD.University hospital sleepdisorders center.Eleven patients with idiopathic RBD who were studied at baseline and after a mean follow-up of 5 years.NA.Eleven patients with idiopathic RBD underwent polysomnography (PSG) at the moment of the diagnosis of RBD (PSG1) and after a mean follow-up of 5 years (PSG2). Tonic EMG activity in PSG1 and PSG2 was blindly quantified and compared in the mentalis muscle during REMsleep
and withdrawal symptoms in recovering heroin addicts. Attention deficit-hyperactivity disorder (ADHD) . Insomnia . Premenstrual dysphoric disorder (PMDD) . Premenstrual syndrome (PMS) . Ramsey-Hunt syndrome . Other conditions . More evidence is needed to rate the effectiveness of 5-HTP for these uses. How does it work? 5-HTP works in the brain and central nervous system by increasing the production of the chemical serotonin. Serotonin can affect sleep, appetite, temperature, sexual behavior, and pain (...) is used for sleepdisorders such as insomnia, depression, anxiety, migraine and tension-type headaches, fibromyalgia, obesity, premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention deficit-hyperactivity disorder (ADHD), seizure disorder, and Parkinson's disease.. How effective is it? Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective
and is felt to be a unique disease entity. 1 Recurrent hypersomnia is a rare disorder characterized by re- current episodes of hypersomnia. 1 The Klein-Levin syndrome is the best characterized type and presents with associated behavior- al abnormalities including binge eating and hypersexuality. Hy- persomnia due to a medical condition refers to hypersomnia due to a co-existing medical condition in the absence of cataplexy. 1 Important subtypes of this diagnostic category include hypersom- nia secondary (...) an appropriate therapy. The ICSD-2 specifies necessary diagnostic tests and crite - ria for each disorder of hypersomnia of central origin. 1 Many other conditions produce such sleepiness and can mimic or coexist with a hypersomnia of central origin. These include sleepdisordered breathing syndromes, periodic limb movements, insufficient sleep, psychiatric disorders, medications, and circadian rhythm disorders. All need to be considered in the differential diagnosis as possibly causing or contributing
Version Page 6 of 28 June 2005 5.2. The aviation industry and pilot organisations have recognised that fatigue and sleep deprivation are important factors in lowering mental fitness leading to irrational behaviour and deterioration in performance and decision-making. This is greatest in tasks requiring self-generated arousal such as systems monitoring and may be unrecognised. 13 5.3. The catastrophic consequences of fatigue-related incidents in aviation have led to the establishment of fatigue (...) . Sleep is distinguished from unconsciousness Fatigue and Anaesthetists – Web Version Page 8 of 28 June 2005 and anaesthesia by a characteristic cycle of sleep phases with specific Electro encephalograph patterns and physiological changes. ? Natural sleep is divided into two distinctive states: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. ? It has been suggested that sleep might conserve energy by reducing core temperature slightly and lowering metabolic rate by 10% compared
Hospital, Oxford, UK S. P. L. Travis John Radcliffe Hospital, Oxford, UK Introduction ‘Acute severe colitis’ (formerly known as fulminant colitis) is a potentially life-threatening condition that constitutes a medical and surgical emergency. The majority of cases are due to ulcerative colitis (UC), although other causes such as Crohn’s colitis and pseudomembranous colitis (PMC) can result in a similar clinical picture. The condition is common; the prevalence is around 15% . As a very rough estimate (...) Position Statements: Management of Anal Fissure & Management of Acute Severe Colitis Colorectal Disease Position Statements: Management of Anal Fissure Management of Acute Severe ColitisContents Position Statements 1 The Management of Anal Fissure: ACPGBI Position Statement K. L. R. Cross, E. J. D. Massey, A. L. Fowler, J. R. T. Monson 8 The Management of Acute Severe Colitis: ACPGBI Position Statement S. R. Brown, N. Haboubi, J. Hampton, B. George, S. P. L. TravisPosition statement
Delayed blink reflex in dementia with Lewy bodies. Blink reflexes (BR) to electric stimuli of the supraorbital nerve were recorded in 26 patients with dementia with Lewy bodies (DLB), 26 patients with multiple system atrophy, 26 patients with Parkinson's disease, with or without REMsleepbehaviourdisorder (RBD), and in 20 patients with Alzheimer's disease and 20 with progressive supranuclear palsy without RBD, and compared with recordings in 30 healthy controls. BR were significantly delayed
particular combination of hallucinations, parkinsonism, or REMsleepbehavior disorder.Based on informant report, disturbed arousal and disorganized speech are specific aspects of fluctuations in dementia with Lewy bodies that reliably distinguish dementia with Lewy bodies from Alzheimer's disease and normal aging. (...) DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. To determine whether certain aspects of fluctuations reliably distinguish dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) and normal aging.Participants included 200 community-dwelling cognitively normal elderly persons, 70 DLB patients, and 70 AD patients with collateral informants. A 19-item questionnaire was administered to the informants that queried about symptoms of fluctuations