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Sample records for legs syndrome sleep

  1. Sleep disturbances in restless legs syndrome

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    Jović Jasmina

    2018-01-01

    Full Text Available Background/Aim. Resteless legs syndrome (RLS is chronical neurological disorder characterized by urge to move legs that is usually accompanied by unpleasant sensations in the lower extremities. Sleep disturbance is one of the main accompanying symptoms of RLS which exists in approximatelly 90% of patients. Impairment of sleep is related to daily sleepiness, depressive and anxiety disorders. The aim of this study was to detect frequency and characterisitics of sleep-related symptoms in patients with RLS, and its impairrment to daily sleepiness, fatique, anxiety and depression. Methods. We have examinated 94 patients with RLS. The diagnose of RLS was based on questionnaire with 4 specific questions according to the International Restless Legs Syndrome Study Group (IRLSSG criteria updated in 2003. Severity of symptoms was astimated with IRLSSG Rating Scale, depression and anxiety with Hamilton Depression Rating Scale (HDRS and Hamilton Anxiety Rating Scale (HARS and sleepiness with Epworth Sleepiness scale (ESS. We astimated sleep characteristics and disturbances with specific questionnaire. Results. In our study 79.9% of patients had sleep-related symptoms. Average sleep duration was 6.50 ± 1.42 hours, with average frequency of awakening 2.34 ± 1.69 times per night. Average ESS score was 5.12 ± 4.08 (0–17. Patients with more severe symptoms had higher degree of sleepiness (p = 0.005. Patients with higher symptoms frequency, significantly more often had sleep disturbance (p = 0.016, tiredness and daily sleepiness (p = 0.001. Daily sleepiness (ESS also significantly correlates with depression (p < 0.05 and anxiety (p = 0.012. Conclusion. Our results confirm that sleep disturbances are one of the key accompanying symptoms of RLS which cause daily sleepiness, tiredness, depression and anxiety. Therefore, their early recognition and appropriate treatment must be a priority in RLS patients.

  2. Restless legs syndrome and periodic leg movements of sleep.

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    Rye, David B; Trotti, Lynn Marie

    2012-11-01

    Women are more commonly affected than men by restless legs syndrome, and prevalence is highest amongst those of northern European heritage. The motor manifestations include nonvolitional myoclonus (periodic leg movements). Disinhibition of spinal sensorimotor circuits may underlie these primary features and can be affected by peripheral as well as supraspinal networks. Insufficient mobilizable iron stores increase expressivity in some individuals. The sensorimotor features are relieved by dopamine, especially dopamine agonists, gabapentin and its derivatives, and opioids. A diagnosis relies on recognition of key primary and supportive features, and treatments are generally well tolerated, efficacious, and life-changing. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy

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    Dunietz, Galit Levi; Lisabeth, Lynda D.; Shedden, Kerby; Shamim-Uzzaman, Q. Afifa; Bullough, Alexandra S.; Chames, Mark C.; Bowden, Marc F.; O'Brien, Louise M.

    2017-01-01

    Study Objectives: To estimate the association of restless legs syndrome (RLS) and its frequency with sleep-wake disturbances in pregnancy. Methods: A cohort of 1,563 women in their third trimester of pregnancy were recruited from prenatal clinics between March 2007 and December 2010. Demographic, pregnancy, and delivery data were extracted from medical records and sleep information was collected with questionnaires. To diagnose RLS, we used standardized criteria of RLS symptoms and frequency that were developed by the International Restless Legs Study Group. Logistic regression models were constructed to investigate the association of RLS and its frequency with sleep-wake disturbances (poor sleep quality, daytime sleepiness, poor daytime function) and delivery outcomes. Results: Overall 36% of the pregnant women had RLS, and half had moderate to severe symptoms. Compared to women without RLS, those with RLS were more likely to have poor sleep quality (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7–2.9), poor daytime function (OR 1.9, 95% CI 1.4–2.4), and excessive daytime sleepiness (OR 1.6, 95% CI 1.3–2.0). A dose-response relationship also was evident between RLS frequency and each of the sleep-wake disturbances. There was no evidence for any association between RLS and delivery outcomes. Conclusions: RLS is a significant contributor to poor sleep quality, daytime sleepiness, and poor daytime function, all common and often debilitating conditions in pregnancy. Obstetric health care providers should be aware of these associations and screen women for RLS. Commentary: A commentary on this article appears in this issue on page 857. Citation: Dunietz GL, Lisabeth LD, Shedden K, Shamim-Uzzaman A, Bullough AS, Chames MC, Bowden MF, O'Brien LM. Restless legs syndrome and sleep-wake disturbances in pregnancy. J Clin Sleep Med. 2017;13(7):863–870. PMID:28633715

  4. Short-interval leg movements during sleep entail greater cardiac activation than periodic leg movements during sleep in restless legs syndrome patients.

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    Ferri, Raffaele; Rundo, Francesco; Silvani, Alessandro; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Lanuzza, Bartolo; Ferini-Strambi, Luigi; Manconi, Mauro

    2017-10-01

    Periodic leg movements during sleep (PLMS) are sequences of ≥4 motor events with intermovement intervals (IMI) of 10-90 s. PLMS are a supportive diagnostic criterion for restless legs syndrome (RLS) and entail cardiac activation, particularly when associated with arousal. RLS patients also over-express short-interval leg movements during sleep (SILMS), which have IMI leg movements. We found that the duration of the R-R interval decrease with SILMS doublets was significantly longer than that with PLMS, whereas the maximal decrease in R-R interval was similar. Scoring SILMS in RLS patients may therefore be relevant from a cardiac autonomic perspective. © 2017 European Sleep Research Society.

  5. Leg movements during wakefulness in restless legs syndrome: time structure and relationships with periodic leg movements during sleep.

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    Ferri, Raffaele; Manconi, Mauro; Plazzi, Giuseppe; Bruni, Oliviero; Cosentino, Filomena I I; Ferini-Strambi, Luigi; Zucconi, Marco

    2012-05-01

    Approximately one third of patients with restless legs syndrome (RLS) also show periodic leg movements (PLM) during relaxed wake fulness (PLMW). In contrast with the large amount of data published on periodic leg movements during sleep (PLMS), PLMW have received less attention from the scientific community. The objective of this study was to evaluate the correlations/differences of time-structure and response to a dopamine-agonist between PLMW and PLMS in patients with RLS. Ninety idiopathic RLS patients and 28 controls were recruited. Subjects underwent clinical and neurophysiological evaluation, hematological screening, and one or two consecutive full-night polysomnographic studies. A subset of patients received 0.25mg of pramipexole or placebo before the second recording. Polysomnographic recordings were scored and LM activity was analyzed during sleep and during the epochs of wakefulness occurring during the first recording hour. RLS patients had higher LM activity during wakefulness than controls, but with a similar periodicity. Even if correlated, the ability of the PLMW index to predict the PLMS index decreased with increasing LM activity. Intermovement intervals during wakefulness showed one peak only at approximately 4s, gradually decreasing with increasing interval in both patients and controls. The effect of pramipexole was very limited and involved the small periodic portion of LM activity during wakefulness. PLMW index and PLMS index were correlated; however, the magnitude of this correlation was not sufficient to suggest that PLMW can be good predictors of PLMS. Short-interval LM activity during wakefulness and sleep might be linked to the severity of sleep disruption in RLS patients and the differences between their features obtained during wakefulness or sleep might be relevant for the diagnosis of sleep disturbances in RLS. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Immobilization tests and periodic leg movements in sleep for the diagnosis of restless leg syndrome.

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    Montplaisir, J; Boucher, S; Nicolas, A; Lesperance, P; Gosselin, A; Rompré, P; Lavigne, G

    1998-03-01

    Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left anterior tibialis muscles for an hour (Suggested Immobilization Test [SIT]); in the second test, the legs are immobilized in a stretcher (Forced Immobilization Test [FIT]). In the current study, the SIT and the FIT were compared in patients with RLS and normal control subjects matched for age and sex. More leg movements were seen in patients than in controls during immobilization tests, especially the SIT. These movements were periodic, occurring at a frequency of approximately one every 12 seconds. The SIT (index > 40) was found to discriminate between RLS and control subjects better than the FIT (index > 25). Patients were also recorded during two consecutive nights to measure periodic leg movements in sleep (PLMS). A SIT index greater than 40 and a PLMS index greater than 11 (highest PLMS index of 2 consecutive nights) were found to discriminate patients with RLS from control subjects with similar power. With each of these two measures, the clinical diagnosis was correctly predicted in 81% of patients and 81% of the control subjects. The SIT has several advantages over the measure of the PLMS index; it does not require an all-night polygraphic recording and can be administered several times a day to measure circadian fluctuation of motor restlessness.

  7. Impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, and quality of life.

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    Schindlbeck, Katharina A; Becker, Janek; Berger, Felix; Mehl, Arne; Rewitzer, Charlotte; Geffe, Sarah; Koch, Peter M; Preiß, Jan C; Siegmund, Britta; Maul, Jochen; Marzinzik, Frank

    2017-01-01

    Inflammatory bowel disease has been associated with neurological symptoms including restless legs syndrome. Here, we investigated the impact of restless legs syndrome in patients with inflammatory bowel disease on sleep, fatigue, mood, cognition, and quality of life. Two groups of inflammatory bowel disease patients, with and without restless legs syndrome, were prospectively evaluated for sleep disorders, fatigue, daytime sleepiness, depression, anxiety, and health-related quality of life. Furthermore, global cognitive function, executive function, attention, and concentration were assessed in both groups. Disease activity and duration of inflammatory bowel disease as well as current medication were assessed by interview. Inflammatory bowel disease patients with and without restless legs syndrome were matched for age, education, severity, and duration of their inflammatory bowel disease. Patients with inflammatory bowel disease and clinically relevant restless leg syndrome suffered significantly more frequent from sleep disturbances including sleep latency and duration, more fatigue, and worse health-related quality of life as compared to inflammatory bowel disease patients without restless legs syndrome. Affect and cognitive function including cognitive flexibility, attention, and concentration showed no significant differences among groups, indicating to be not related to restless legs syndrome. Sleep disorders including longer sleep latency, shorter sleep duration, and fatigue are characteristic symptoms of restless legs syndrome in inflammatory bowel disease patients, resulting in worse health-related quality of life. Therefore, clinicians treating patients with inflammatory bowel disease should be alert for restless legs syndrome.

  8. The Role of Periodic Limb Movements During Sleep in Restless Legs Syndrome: A Selective Update.

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    Fulda, Stephany

    2015-09-01

    Periodic leg movements during sleep (PLMS) are a highly active research topic and accumulating recent evidence has led to reevaluation of key aspects on the role of PLMS in restless legs syndrome (RLS). This article summarizes the recent developments in 3 areas: the relationship of PLMS to cortical arousals in patients with RLS, the differential effect of dopaminergic and non-dopaminergic treatment on PLMS, and the possible emergence of PLMS as a sleep-related cardiovascular risk factor. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Increased electroencephalographic high frequencies during the sleep onset period in patients with restless legs syndrome.

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    Ferri, Raffaele; Cosentino, Filomena I I; Manconi, Mauro; Rundo, Francesco; Bruni, Oliviero; Zucconi, Marco

    2014-08-01

    To analyze the electroencephalographic (EEG) spectral content in untreated patients with restless legs syndrome (RLS) during the sleep onset period (SOP) and during the quiet wakefulness preceding sleep, in order to test the hypothesis that a state of hyperarousal might be present during the SOP with RLS. Sleep Research Centre. Twenty-seven untreated consecutive patients with RLS (mean age = 53.6 y), 11 untreated consecutive patients with primary insomnia (mean age = 58.9 y), and 14 normal controls (mean age = 50.3 y). SOP was defined as the 10-min period centered with the occurrence of the first sleep spindle in the EEG, and then subdivided into SOP-1 (period of 5 min before the first spindle) and SOP-2 (period of 5 min following). Leg movements occurring during SOP were counted and used as a covariate in the statistical analysis. Also, one period of 1 min of artifact-free quiet wakefulness after lights off was identified. EEG spectral analysis was run during these periods using the C3/A2 or C4/A1 channel. Increased EEG alpha and beta bands and/or beta/delta ratio in RLS versus normal controls, during both wakefulness preceding sleep and SOP (both parts SOP-1 and SOP-2) were found, which were, however, smaller than the increases found in patients with insomnia. The results of this study support the hypothesis of the presence of a state of hyperarousal in restless legs syndrome (RLS) during the sleep onset period. Treatment for RLS might need to take these findings into consideration. Ferri R, Cosentino FI, Manconi M, Rundo F, Bruni O, Zucconi M. Increased electroencephalographic high frequencies during the sleep onset period in patients with restless legs syndrome.

  10. Restless legs syndrome.

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    Venkateshiah, Saiprakash B; Ioachimescu, Octavian C

    2015-07-01

    Restless legs syndrome is a common sensorimotor disorder characterized by an urge to move, and associated with uncomfortable sensations in the legs (limbs). Restless legs syndrome can lead to sleep-onset or sleep-maintenance insomnia, and occasionally excessive daytime sleepiness, all leading to significant morbidity. Brain iron deficiency and dopaminergic neurotransmission abnormalities play a central role in the pathogenesis of this disorder, along with other nondopaminergic systems, although the exact mechanisms are still. Intensive care unit patients are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, iron deficiency, and use of multiple medications that can antagonize dopamine. Published by Elsevier Inc.

  11. Pregabalin versus pramipexole: effects on sleep disturbance in restless legs syndrome.

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    Garcia-Borreguero, Diego; Patrick, Jeffrey; DuBrava, Sarah; Becker, Philip M; Lankford, Alan; Chen, Crystal; Miceli, Jeffrey; Knapp, Lloyd; Allen, Richard P

    2014-04-01

    To compare pregabalin versus placebo and pramipexole for reducing restless legs syndrome (RLS)-related sleep disturbance. Randomized, double-blinded, crossover trial. Twenty-three US sleep centers. Eighty-five individuals with moderate to severe idiopathic RLS and associated sleep disturbance. Participants were randomized across 6 treatment sequences comprising three 4-week periods on pregabalin 300 mg/day (n = 75), pramipexole 0.5 mg/day (n = 76), or placebo (n = 73). Polysomnography was conducted over 2 nights at the end of each period. Primary (wake after sleep onset [WASO], pregabalin vs placebo) and key secondary endpoints were analyzed for statistical significance, with descriptive statistics for other endpoints. Pregabalin improved sleep maintenance, demonstrated by reductions in WASO (-27.1 min vs placebo [P sleep onset (-2.7 vs placebo; -7.9 vs pramipexole [P sleep time (30.8 min vs placebo [P sleep duration (20.9 min vs placebo; 32.1 vs pramipexole [P periodic limb movement arousal index (PLMAI) with pregabalin was similar to pramipexole and greater than placebo (-3.7 PLMA/h [P sleep was less than for pramipexole. This study demonstrated improvements in objective and subjective measures of sleep maintenance and sleep architecture with pregabalin compared with placebo and pramipexole. Effects of pregabalin on periodic limb movement arousal index were comparable to pramipexole. ClinicalTrials.gov identifier, NCT00991276; http://clinicaltrials.gov/show/NCT00991276.

  12. Restless Legs Syndrome/Willis-Ekbom Disease Morbidity: Burden, Quality of Life, Cardiovascular Aspects, and Sleep.

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    Stevens, Mary Suzanne

    2015-09-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) has a significant negative effect on quality of life. The decreased quality of life is similar to that of other chronic diseases, such as diabetes type 2, depression, and osteoarthritis. RLS/WED disrupts sleep length, sleep quality, and daytime alertness. Sleep disruption can contribute to depression. RLS/WED has been associated with cardiovascular disease and high blood pressure, possibly because of increased sympathetic tone caused by periodic limb movements of sleep. RLS/WED is underdiagnosed, leading to chronic sleep disruption and daytime consequences. Patients with RLS/WED have decreased productivity at work, which potentially has far-reaching economic consequences. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Subjective sleep quality and suggested immobilization test in restless leg syndrome and periodic limb movement disorder.

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    Inoue, Yuichi; Nanba, Kazuyoshi; Honda, Yutaka; Takahashi, Yasuro; Arai, Heii

    2002-06-01

    The severity of restless leg syndrome (RLS) and/or periodic limb movement disorder (PLMD) was investigated by using a suggested immobilization test (SIT) and by measuring the influence of these disorders on the subjective sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI). Patients with RLS and those with both RLS and PLMD showed remarkably high values for PSQI and SIT, whereas patients with PLMD only showed normal values for PSQI. These findings suggest that there is only a small pathological significance for periodic limb movements, and demonstrate the efficacy of SIT and PSQI for evaluating the severity of these disorders.

  14. Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome.

    Directory of Open Access Journals (Sweden)

    Shih-Wei Lin

    Full Text Available STUDY OBJECTIVE: To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS. DESIGN: A prospective study. SETTING: Outpatients from one sleep disorders clinic in Taiwan. PARTICIPANTS: 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. INTERVENTIONS: After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. MEASUREMENTS AND RESULTS: A total of 1,185 participants were enrolled, and, of these, 131(11.1% fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9% patients had no comorbid condition and were diagnosed with primary RLS. CONCLUSIONS: Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS.

  15. Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

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    N.C.V. Moreira

    2008-10-01

    Full Text Available We have tested the hypothesis that restless leg syndrome (RLS is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS. The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27, quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6, excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10 and clinical disability by the Expanded Disability Status Scale (EDSS. Forty-four patients (32 women aged 14 to 64 years (43 ± 14 with disease from 0.4 to 23 years (6.7 ± 5.9 were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0. RLS was detected in 12 cases (27%. Patients with RLS presented greater disability (P = 0.01, poorer sleep (P = 0.02 and greater levels of fatigue (P = 0.03. Impaired sleep was present in 23 (52% and excessive daytime sleepiness in 3 cases (6.8%. Fatigue was present in 32 subjects (73% and was associated with clinical disability (P = 0.000 and sleep quality (P = 0.002. Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

  16. Evaluating daytime alertness in individuals with Restless Legs Syndrome (RLS) compared to sleep restricted controls.

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    Gamaldo, Charlene; Benbrook, Amy R; Allen, Richard P; Oguntimein, Oluwamurewa; Earley, Christopher J

    2009-01-01

    Restless Legs Syndrome (RLS) is a common sensorimotor disorder often associated with significant chronic sleep loss. Previous studies looking at the effects of sleep loss on daytime function in RLS individuals, using subjective reporting techniques have yielded mixed results. In this study we used more objective measures of alertness and compared RLS subjects who are off treatments and chronically sleep restricted to chronic sleep-restricted controls. The final sample consisted of 20 RLS subjects (10 male and 10 female) and 13 sleep-restricted controls (seven male and six female). Thirteen controls underwent a 14-day chronic partial sleep-restriction protocol in order to closely match the degree of chronic sleep loss reportedly experienced by untreated RLS patients. On the final day of the protocol each subject performed a morning and evening Suggested Immobilization Test (SIT) which served as a modified Maintenance of Wakefulness Test (MWT). RLS and control groups were compared for differences in alertness as measured objectively by the sleep latency on the morning and evening SITs. The RLS subjects had a longer sleep latency on the morning and evening SIT than controls (t=3.80, p=0.001, U=31.0, pRLS individuals still demonstrated a higher degree of objective alertness (p=0.023, p=0.006, Fisher's exact test). RLS subjects, despite having, if anything, greater sleep loss, displayed greater sustained alertness than sleep-restricted controls. Thus, the heightened degree of alertness demonstrated by RLS patients may be in contrast to the perceived impairment in mood, vigor, and vigilance commonly reported in previous studies.

  17. Sequence analysis of leg movements during sleep with different intervals (90 s) in restless legs syndrome.

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    Ferri, Raffaele; Rundo, Francesco; Silvani, Alessandro; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Cosentino, Filomena I I; Ferini-Strambi, Luigi; Manconi, Mauro

    2017-08-01

    The aim of this study was to define the time structure of leg movements during sleep occurring with an intermovement interval (onset-to-onset) shorter than 10 s in patients with restless legs syndrome and controls, and to compare it to the structure of movements with intervals of 10-90 s or >90 s. Polysomnographic recordings of 141 untreated patients and 68 age-matched normal controls were analysed. All movements were detected and classified into three categories, separated by intervals of 90 s. The number of movements included in each category was significantly higher in patients than in controls. The movements with an interval of >90 s occurred steadily during the night, whereas the hourly distribution of movements with intervals of 90 s. The time structure features of the three categories of movements considered in this study were found to be clearly different. This, together with previous observations on the differential effects of dopamine agonists on movements with different intervals, suggests that movements with intervals of 90 s are regulated by neurotransmitter mechanisms different from those modulating movements with an interval of 10-90 s. © 2017 European Sleep Research Society.

  18. An Evidence-based Analysis of the Association between Periodic Leg Movements during Sleep and Arousals in Restless Legs Syndrome.

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    Ferri, Raffaele; Rundo, Francesco; Zucconi, Marco; Manconi, Mauro; Bruni, Oliviero; Ferini-Strambi, Luigi; Fulda, Stephany

    2015-06-01

    To analyze statistically the association between periodic leg movements during sleep (PLMS) and arousals, in order to eventually support or challenge the current scoring rules and to further understand their reciprocal influence. Sleep research center. Twenty untreated consecutive patients with restless legs syndrome (RLS) (13 women and 7 males, mean age 60.9 y). In each recording, we selected all PLMS/arousal pairs that met the following inclusion criteria: (a) PLMS events that were separated from another PLMS event (preceding or following) by at least 10 s of EMG inactivity; (b) arousal events separated from another arousal event (preceding or following) by at least 10 s of stable EEG baseline activity; (c) PLMS/arousal pairs were then selected among events identified according to the previous two criteria, when PLMS and arousals were separated (offset-to-onset) by no more than 10 s, regardless of which was first. We selected a mean of 46.1 (SD 25.55) PLMS/arousal pairs per subject; in these pairs, average PLMS duration was 3.2 s (0.65) and average arousal duration was 6.5 s (0.92). Within these event pairs, the great majority (on average 98.4%, SD 3.88) was separated by less than 0.5 s (i.e., between the end of one event and the onset of the other, regardless of which was first). Arousal onsets preceded PLMS onset in 41.2% of pairs, while the opposite was true for the remaining 58.8% of pairs. A significant correlation between PLMS duration and arousal duration was also found (r = 0.447, P definition of the association between periodic leg movements during sleep (PLMS) and arousals. The tight time relationship between PLMS and arousals and their correlated durations seem to indicate that both events might be regulated by a complex mechanism, rather than being connected by a simple reciprocal cause/effect relationship. © 2015 Associated Professional Sleep Societies, LLC.

  19. Elevated C-reactive protein is associated with severe periodic leg movements of sleep in patients with restless legs syndrome.

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    Trotti, Lynn Marie; Rye, David B; De Staercke, Christine; Hooper, W Craig; Quyyumi, Arshed; Bliwise, Donald L

    2012-11-01

    Restless legs syndrome (RLS) is a common sleep disorder in which urges to move the legs are felt during rest, are felt at night, and are improved by leg movement. RLS has been implicated in the development of cardiovascular disease. Periodic leg movements (PLMs) may be a mediator of this relationship. We evaluated systemic inflammation and PLMs in RLS patients to further assess cardiovascular risk. 137 RLS patients had PLM measurements taken while unmedicated for RLS. Banked plasma was assayed for high sensitivity C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha). Mean (SD) PLM index was 19.3 (22.0). PLMs were unrelated to TNF-a and IL-6, but were modestly correlated with logCRP (r(129)=0.19, p=0.03). Those patients with at least 45PLMs/h had an odds ratio of 3.56 (95% CI 1.26-10.03, p=0.02, df=1) for having elevated CRP compared to those with fewer than 45PLMs/h. After adjustment for age, race, gender, diabetes, hypertension, hyperlipidemia, inflammatory disorders, CRP-lowering medications, and body mass index, the OR for those with ≥ 45PLMs/h was 8.60 (95% CI 1.23 to 60.17, p=0.03, df=10). PLMs are associated with increased inflammation, such that those RLS patients with at least 45PLMs/h had more than triple the odds of elevated CRP than those with fewer PLMs. Further investigation into PLMs and inflammation is warranted. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Prevalence and sleep related disorders of restless leg syndrome in hemodialysis patients.

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    Chavoshi, Farzaneh; Einollahi, Behzad; Sadeghniat Haghighi, Khosro; Saraei, Maryam; Izadianmehr, Neda

    2015-03-01

    Despite being frequently described, Restless Leg Syndrome (RLS) in patients, who are on hemodialysis, is a common disease which, has not been well documented in Iran. The current study aimed to investigate the prevalence of RLS and its sleep disorders in Iranian patients on hemodialysis. In this multicenter cross sectional study, 397 consecutive patients on hemodialysis were evaluated by face-to-face interviews. RLS was diagnosed using the International RLS Study Group (IRLSS) criteria. In addition, three validated sleep disorder questionnaires (Insomnia Severity Index, Epworth sleepiness scale and Pittsburgh sleep quality index) were completed by the patients. One hundred-twenty-six patients with RLS (31.7%; mean age 57.6 ± 15.4 years) participated in the current study. RLS mostly occurs in females (P quality of sleep (Pittsburgh Sleep Quality Index > 5, P = 0.001), higher scores of Epworth Sleepiness Scale (P caffeine, and other associated comorbidities between the patients with and without RLS. In the current study, prevalence of RLS was near the weighted-mean prevalence of other studies (mean 30%, range 8%t-52%). This is not just racial variability and may attribute to narrow or wide definition of the disease, plus variations of the prevalence recording time, and sometimes not using the standard criteria or standard interview.

  1. Restless legs syndrome and periodic limb movements during sleep: diagnosis and treatment.

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    Karatas, Mehmet

    2007-09-01

    Restless legs syndrome (RLS) and periodic limb movements during sleep (PLMS) have been known for over 300 years, and they may be present in as many as 25% of patients who have sleep disorders. These patients generally present with insomnia. These disorders often remain undiagnosed for an average of 16 years and patients have seen an average of 13 physicians for their symptoms. Therefore, these disorders merit the attention and interest of the practitioner, so that such patients can be evaluated and treated without delay. The important features of these disorders are the following: (1) their recognition since 1685, (2) they may comprise up to 25% of all sleep disorders, (3) they require differentiation from many other disorders, and (4) effective treatment is available. Although it is believed that RLS and PLMS are 2 clinical manifestations of the same central nervous system dysfunction, they are generally discussed separately, as different nosological entities. RLS and PLMS are common neurologic disorders and increase in prevalence with aging. These disorders can be disabling conditions, causing sleep disturbance at night and excessive sleepiness during the day. Polysomnography and the suggested immobilization test are used to support the clinical diagnosis of RLS and PLMS. Although levodopa alleviates symptoms, rebound and augmentation occur frequently, limiting the long-term usefulness of this agent. The direct dopamine receptor agonists such as pergolide, pramipexole, ropinirole, and cabergoline have largely replaced levodopa as the most effective treatment for RLS and PLMS.

  2. Leg cramps and restless legs syndrome during pregnancy.

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    Hensley, Jennifer G

    2009-01-01

    Sleep disturbance during pregnancy can result in excessive daytime sleepiness, diminished daytime performance, inability to concentrate, irritability, and the potential for an increased length of labor and increased risk of operative birth. Sleep disturbance may be the result of a sleep disorder, such as leg cramps, a common yet benign disorder, or restless legs syndrome, a sensorimotor disorder. Both disrupt sleep, are distressing to the pregnant woman, and mimic one another and other serious disorders. During pregnancy, up to 30% of women can be affected by leg cramps, and up to 26% can be affected by restless legs syndrome.

  3. Remission of severe restless legs syndrome and periodic limb movements in sleep after bilateral excision of multiple foot neuromas: a case report

    Directory of Open Access Journals (Sweden)

    Lettau Ludwig A

    2010-09-01

    Full Text Available Abstract Introduction Restless legs syndrome is a sensorimotor neurological disorder characterized by an urge to move the legs in response to uncomfortable leg sensations. While asleep, 70 to 90 percent of patients with restless legs syndrome have periodic limb movements in sleep. Frequent periodic limb movements in sleep and related brain arousals as documented by polysomnography are associated with poorer quality of sleep and daytime fatigue. Restless legs syndrome in middle age is sometimes associated with neuropathic foot dysesthesias. The causes of restless legs syndrome and periodic limb movements in sleep are unknown, but the sensorimotor symptoms are hypothesized to originate in the central nervous system. We have previously determined that bilateral forefoot digital nerve impingement masses (neuromas may be a cause of both neuropathic foot dysesthesias and the leg restlessness of restless legs syndrome. To the best of our knowledge, this case is the first report of bilateral foot neuromas as a cause of periodic limb movements in sleep. Case presentation A 42-year-old Caucasian woman with severe restless legs syndrome and periodic limb movements in sleep and bilateral neuropathic foot dysesthesias was diagnosed as having neuromas in the second, third, and fourth metatarsal head interspaces of both feet. The third interspace neuromas represented regrowth (or 'stump' neuromas that had developed since bilateral third interspace neuroma excision five years earlier. Because intensive conservative treatments including repeated neuroma injections and various restless legs syndrome medications had failed, radical surgery was recommended. All six neuromas were excised. Leg restlessness, foot dysesthesias and subjective sleep quality improved immediately. Assessment after 18 days showed an 84 to 100 percent reduction of visual analog scale scores for specific dysesthesias and marked reductions of pre-operative scores of the Pittsburgh sleep

  4. Impact of Restless Legs Syndrome on the Sleep Quality in Chronic Obstructive Pulmonary Disease

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    Erdal İn

    2016-04-01

    Full Text Available Objective: It is well known that various sleep disorders are common in cases of chronic obstructive pulmonary disease (COPD. However, restless legs syndrome (RLS has not been extensively studied in these patients. The aim of the current study was to investigate the prevalence of RLS and its impact on sleep quality in patients with COPD. Methods: The study included a total of 50 patients with COPD with a mean age of 67.2±7.7 years; 39 (78% were male. The RLS diagnosis was made based on the questionnaire items standardized by the International RLS study group. Dyspnea severity (mMRC, quality of life (CAT, sleep quality [Pittsburgh sleep quality index (PSQI], and daytime sleepiness [Epworth sleepiness scale (ESS] were evaluated using certain specific questionnaires. The subjects were studied in two groups: RLS-positive and RLS-negative groups. Results: In the study population, RLS was detected in 17 (34% patients. It was found that the RLS-positive subjects had a longer disease duration (p=0.006, a higher hospital admission rate (p=0.008, and lower spirometric values (p=0.023 for FVC; p=0.001 for FEV1. The CAT score was significantly higher in the RLS-positive group (p=0.019. The RLS-positive group had higher PSQI and ESS scores (p<0.001 for both. There were negative correlations between PSQI, ESS scores, and spirometric measures (FVC and FEV1, whereas PSQI and ESS scores had positive correlations with disease duration, mMRC, and CAT scores. Conclusion: In our study, it was observed that RLS is a common condition in patients with COPD. As the duration and severity of COPD increases, RLS becomes more prevalent and sleep quality deteriorates.

  5. Restless Legs Syndrome & Depression: Effect Mediation by Disturbed Sleep and Periodic Limb Movements

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    Koo, Brian B; Blackwell, Terri; Lee, Hochang B.; Stone, Katie L.; Louis, Elan D.; Redline, Susan

    2016-01-01

    Objective To investigate association between restless legs syndrome (RLS) and depression and to what extent sleep disturbance, periodic limb movements during sleep (PLMS), and antidepressant medication mediate this relationship. Methods Conducted was cross-sectional analysis of Osteoporotic Fractures in Older Men (MrOS) Study data in 982 men assessed for RLS (International RLS Study Group scale [IRLSS]) and depression (Geriatric Depression Scale [GDS]), who underwent actigraphy (for sleep latency/efficiency) and polysomnography (for PLMS). Men were split into three groups: no RLS (n=815), mild RLS (IRLSS≤12, n=85), moderate-to-severe RLS (IRLSS>12, n=82). Depression was defined as GDS≥6. Logistic and linear regression assessed associations of RLS and depression or number depressive symptoms, respectively. Models were adjusted for age, site, race, education, BMI, personal habits, benzodiazepine/dopaminergic medication, physical activity, cardiovascular risk factors, and apnea-hypopnea index. Results Of 982 men, 167 (17.0%) had RLS. Depression was significantly associated with moderate-to-severe RLS after adjustment (vs. no RLS: OR [95% CI] 2.85 [1.23,6.64]). Further adjustment for potential mediators attenuated effect size modestly, most for sleep efficiency (OR 2.85 to 2.55). Compared to no RLS, moderate-to-severe RLS was associated with number of depressive symptoms after adjustment (adjusted means [95% CI]; no RLS: 1.14 [1.05,1.24] vs. IRLSS>12: 1.69 [1.32,2.11]). Further adjustment for potential mediators didn’t alter effect size. For men with PLMS index≥median, number of depressive symptoms significantly increased as RLS category became more severe. Conclusions Depression is more common as RLS severity worsens. The RLS-depression relationship is modestly explained by sleep disturbance and PLMS. PMID:27526989

  6. A Comparison of Glycemic Control, Sleep, Fatigue, and Depression in Type 2 Diabetes with and without Restless Legs Syndrome

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    Cuellar, Norma G.; Ratcliffe, Sarah J.

    2008-01-01

    Objective: The purpose of this pilot study was to determine how sleep quality, glycemic control, sleepiness, fatigue, and depression differ in persons with type 2 diabetes with and without restless legs syndrome (RLS). Research Designs/Methods: The design was a descriptive, case-control study of participants with type 2 diabetes with and without RLS at the University of Pennsylvania, Rodebaugh Diabetes Center. Thirty-nine participants (adults over 21 years of age who had been diagnosed with type 2 diabetes and had a HbA1c in the last 3 months) were stratified based on RLS diagnostic criteria. Exclusion criteria included severe hypoglycemia identified by seizures or coma related to hypoglycemia or known sleep disorder other than RLS. The primary outcome of sleep was measured by self-report sleep quality (Pittsburgh Sleep Quality Index) with secondary outcomes including HbA1c, sleepiness (Epworth Sleepiness Scale), fatigue (Fatigue Severity Scale), and depression (Center for Epidemiologic Studies-Depression Scale). Results: Participants with type 2 diabetes with RLS reported a significant difference in quality of sleep (p = .001), sleep latency (p = .04), sleep efficiency (p = .035), use of sleep medications (p < .001), and daytime dysfunction (p = .005). In the total group, higher HbA1c levels were positively correlated with sleepiness (p = .038). Global Pittsburgh Sleep Quality Index scores were positively correlated with fatigue (r = .58, p = .002) and depression (r = .74, p < .001). As well, fatigue and sleepiness were positively correlated (r = .36, p = .04). Conclusions: RLS is a significant sleep disorder that may have an impact on diabetes management and health outcomes. More research should be conducted on the impact of RLS in sleep to improve diabetic management. Citation: Cuellar NG; Ratcliffe SJ. A comparison of glycemic control, sleep, fatigue, and depression in type 2 diabetes with and without restless legs syndrome. J Clin Sleep Med 2008

  7. Restless legs syndrome: literature review

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    Emmanouil Symvoulakis

    Full Text Available Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.

  8. While Isolated Periodic Limb Movement Disorder Significantly Impacts Sleep Depth and Efficiency, Co-Morbid Restless Leg Syndrome Mainly Exacerbates Perceived Sleep Quality.

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    Hardy De Buisseret, Florent-Xavier; Mairesse, Olivier; Newell, Johan; Verbanck, Paul; Neu, Daniel

    2017-01-01

    Restless leg syndrome (RLS) and periodic limb movement (PLM) disorder (PLMD) can affect sleep quality and interfere with daytime functioning. Whether the co-morbidity of RLS further worsens daytime symptoms, sleep architecture and quality in patients with PLMs, is not yet fully clarified. Sleep (polysomnography) and daytime symptoms of 47 drug-free patients, assigned to isolated PLMD or co-morbid RLS subgroups, were compared to controls in a retrospective cohort-study (n = 501). Associations between perceived sleep quality, fatigue, sleepiness, mood and sleep variables were explored descriptively. Although co-morbid patients showed worsened sleep quality, both patient groups showed similar sleepiness and affective symptoms. While significantly differing from controls, patients presented similarly increased light sleep, decreased slow-wave sleep and lowered sleep efficiency. Altered sleep quality, fatigue and sleepiness were significantly correlated to decreased slow-wave sleep and sleep fragmentation. Affective symptoms, fatigue and perceived sleep quality also correlated to PLM index. Sleep structure and efficiency were similarly impacted in isolated PLMD and in co-morbid RLS. RLS mainly worsened perceived sleep quality. Given that systematic treatment for isolated PLMD is currently not recommended, such results may question whether no or different-from-RLS treatment strategies are compatible with optimal care. © 2017 S. Karger AG, Basel.

  9. Sleep disorders: A review of the interface between restless legs syndrome and iron metabolism

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    Paulo Daubian-Nosé

    2014-12-01

    Full Text Available Restless legs syndrome (RLS is characterized by unpleasant sensations mainly in the legs. 43% of RLS-associated conditions have also been associated with systemic iron deficiency. The objective of this study was to review in the literature the relationship between iron metabolism and RLS. With an initial search using the keywords combination “Iron Metabolism OR Iron Deficiency AND Restless Legs Syndrome,” 145 articles were screened, and 20 articles were selected. Few studies were found for this review in the period of 2001–2014, however, the correlation between RLS and iron was evident.

  10. Restless Legs Syndrome/Willis-Ekbom Disease and Periodic Limb Movements in Sleep in the Elderly with and without Dementia.

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    Figorilli, Michela; Puligheddu, Monica; Ferri, Raffaele

    2015-09-01

    There is great interest in the study of sleep in healthy and cognitively impaired elderly. Sleep disorders have been related to quality of aging. Sleep-related movements are a frequent cause of disordered sleep and daytime sleepiness. Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is often unrecognized in the elderly. This review explores RLS/WED in the elderly population. The elderly population may be subdivided into 3 groups: healthy, dependent, and frail. The RLS/WED could be a predictor for lower physical function; its burden on quality of life and health care-related costs, in the elderly, should be an important clinical and public health concern. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Prevalence and Characteristics of Periodic Limb Movements during Sleep in Korean Adult Patients with Restless Legs Syndrome

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    Shin, Jung-won; Koo, Yong Seo; Lee, Byeong Uk; Shin, Won Chul; Lee, Sang Kun; Cho, Yong Won; Jung, Ki-Young

    2016-01-01

    Study Objectives: The aim of this study was to investigate the prevalence and characteristics of periodic limb movements during sleep (PLMS) in Korean patients with restless legs syndrome (RLS). Methods: Unmedicated adult patients with idiopathic RLS (n = 354) who underwent polysomnography at three major sleep centers in tertiary hospitals were included. Characteristics of PLMS in RLS were analyzed using the time structure of polysomnographically recorded leg movements and periodicity indices (PIs). RLS severity and subjective sleep quality were assessed. Results: Out of 354 patients with idiopathic RLS (mean age: 52.9 ± 12.0 years), 150 patients (42.3%) had RLS with a PLMS index greater than 15 events/h, and 204 (57.9%) had a PLMS index greater than 5 events/h. The distribution of inter-LM intervals was bimodal, and high PIs (0.86 ± 0.10) were observed in patients with RLS and PLMS (PLMS index > 15 events/h). The PLMS index was positively correlated with age (r = 0.228; p 15 events/h. Conclusions: The prevalence of PLMS in Korean patients with RLS was lower than that observed in Western countries, but the characteristics of PLMS were not different. Ethnic differences and/or different genetic backgrounds may contribute to the varying prevalence of PLMS in RLS. Citation: Shin JW, Koo YS, Lee BU, Shin WC, Lee SK, Cho YW, Jung KY. Prevalence and characteristics of periodic limb movements during sleep in Korean adult patients with restless legs syndrome. J Clin Sleep Med 2016;12(8):1089–1097. PMID:27306390

  12. Associations of Incident Cardiovascular Events With Restless Legs Syndrome and Periodic Leg Movements of Sleep in Older Men, for the Outcomes of Sleep Disorders in Older Men Study (MrOS Sleep Study).

    Science.gov (United States)

    Winkelman, John W; Blackwell, Terri; Stone, Katie; Ancoli-Israel, Sonia; Redline, Susan

    2017-04-01

    Both restless legs syndrome (RLS) and periodic leg movements in sleep (PLMS) may be associated with incident cardiovascular disease (CVD). However, the individual contributions of these factors to adverse CVD outcomes are unknown. During the MrOS Sleep Study, 2823 men (mean age = 76.3 years) participated in a comprehensive sleep assessment from 2000 to 2002. RLS was identified by self-report of a physician diagnosis of RLS. A periodic limb movement of sleep index (PLMI) was derived from unattended in-home polysomnography. Incident cardiovascular events were centrally adjudicated during 8.7 ± 2.6 years of follow-up. The primary outcome was all-cause CVD; secondary outcomes included incident myocardial infarction (MI) and cerebrovascular disease. Cox proportional hazards regression models were adjusted for multiple covariates, including PLMI, to examine if there were independent associations of RLS and PLMI to the outcomes. Physician-diagnosed RLS was reported by 2.2% and a PLMI ≥ 15 was found in 59.6% of men. RLS was not associated with the composite CVD outcome. RLS was significantly associated with incident MI (Hazard ratio [HR] = 2.02, 95% CI, 1.04-3.91) even after adjustment for multiple covariates. Results were only modestly attenuated when PLMI was added to the model. PLMI also was found to predict incident MI (per SD increase in PLMI, HR = 1.14, 95% CI, 1.00-1.30, p = .05), and was materially unchanged after addition of RLS. The independent risk that RLS confers for MI suggests a role for non-PLMS factors such as sleep disturbance, shared genetic factors, or PLM-independent sympathetic hyperactivity. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  13. Leg Movement Activity during Sleep in School-Age Children and Adolescents: A Detailed Study in Normal Controls and Subjects with Restless Legs Syndrome and Narcolepsy Type 1.

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    Ferri, Raffaele; DelRosso, Lourdes M; Aricò, Debora; Zucconi, Marco; Ferini-Strambi, Luigi; Picchietti, Daniel L; Pizza, Fabio; Plazzi, Giuseppe; Manconi, Mauro; Bruni, Oliviero

    2018-01-22

    To evaluate leg movement activity during sleep (LMS) in normal school-age children and adolescents, to eventually establish age-specific periodic LMS (PLMS) index thresholds that support the diagnosis of restless legs syndrome (RLS) and to evaluate the utility of other LMS indices. Polysomnographic recordings from 61 controls, 46 children with RLS, and 44 children with narcolepsy type 1 (NT1) were analyzed for total leg movements (LMS), PLMS, and isolated leg movements (ISOLMS) duration and indices, separately for school-age children and adolescents. Moreover, intermovement interval (IMI) graphs and time-of-night distribution of LMS were analyzed and cut-off thresholds for PLMS index and total LMS index were assessed for the separation of RLS from controls. All indices tended to decrease from school-age children to adolescents in normal controls and in NT1, while in RLS, only PLMS index increased. All school-age children had a similar IMI distribution with a single peak at IMI 2-4s followed by gradual decline. In adolescents with RLS a second peak at IMI 10-50s, was seen. Time-of-night distribution of most indices decreased in RLS while most tended to increase in NT1. A PLMS index cutoff of 2/h best differentiated RLS from controls in school-age children (accuracy 70.0%) and in adolescents (accuracy 70.8%); however, most NT1 subjects also showed PLMS indices higher than this threshold. PLMS index alone does not reliably predict the diagnosis of RLS in children and adolescents. However, analyses of IMI distribution and time-of-night distribution provide additional elements to support a diagnosis of RLS. © Sleep Research Society 2018. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  14. Restless legs syndrome and central nervous system gamma-aminobutyric acid: preliminary associations with periodic limb movements in sleep and restless leg syndrome symptom severity.

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    Winkelman, John W; Schoerning, Laura; Platt, Sam; Jensen, J Eric

    2014-10-01

    Previous research has demonstrated abnormalities in glutamate and N-acetyl aspartate (NAA) in the thalamus in individuals with restless legs syndrome (RLS) compared with healthy matched controls. However, levels of these transmitters in other RLS-related brain areas and levels of the most common inhibitory neurotransmitter, gamma-aminobutyric acid (GABA), have not been assessed. This study examined GABA, glutamate, and NAA levels in the dorsal anterior cingulate cortex (ACC), thalamus and cerebellum with the use of proton magnetic resonance spectroscopy ((1)H-MRS) at 4 tesla (4 T) and Megapress difference-editing in 18 subjects with RLS and a matched control group without RLS. Actigraphy was performed on the nights before scans to assess periodic limb movements of sleep (PLMS). Levels of GABA, glutamate, and NAA were no different between RLS and control subjects in any of the three voxels of interest. However, GABA levels were positively correlated with both PLM indices and RLS severity in the thalamus and negatively with both of these measures in the cerebellum in RLS subjects. In addition, NAA levels were higher in the ACC in RLS than in controls. Our preliminary data suggest that known cerebellar-thalamic interactions may modulate the intensity of RLS sensory and motor symptoms. In addition, anterior cingulate cortex may be associated with the affective components of the painful symptoms in this disorder. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. A dose-ranging study of pramipexole for the symptomatic treatment of restless legs syndrome: polysomnographic evaluation of periodic leg movements and sleep disturbance.

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    Jama, Leni; Hirvonen, Kari; Partinen, Markku; Alakuijala, Anniina; Hublin, Christer; Tamminen, Ilkka; Koester, Juergen; Reess, Juergen

    2009-06-01

    To evaluate, both polysomnographically and by subjective scales, the efficacy and safety profile of pramipexole for restless legs syndrome (RLS) via a 3-week, double-blind, placebo-controlled, parallel-group, dose-ranging study. At baseline and after 3 weeks, periodic limb movements (PLM) and sleep parameters were assessed by polysomnography, and patients self-assessed their sleep disturbance and overall RLS severity using the international RLS study group rating scale (IRLS). Four pramipexole doses were evaluated: 0.125, 0.25, 0.50, and 0.75mg/d. Data from 107 patients were included in the intent-to-treat (ITT) analysis. For pramipexole recipients, the primary outcome measure, PLM per hour in bed asleep or awake (the PLM index, or PLMI), decreased by a median of -26.55 to -52.70 depending on dosage group, vs. -3.00 for placebo (p<0.01 or 0.001 for each group vs. placebo; Wilcoxon-Mann-Whitney test). Improvements in the secondary endpoints of PLM while asleep and while awake were also significantly superior for pramipexole. At 3 weeks, all pramipexole doses reduced the median for PLM while asleep to levels considered normal (<5PLM/h). Except for delta-sleep time and awakenings/arousals, sleep parameters remained unchanged or favored pramipexole. Median sleep latency was reduced by -5.00 to -11.75min in the pramipexole groups, vs. -2.00 for placebo (p<0.05 for all groups except 0.25mg/d). Median total sleep time increased by 25.75-66.75min, vs. 25.50 (p<0.05 for 0.50mg/d), and median time in stages 2-4/rapid eye movement (REM) sleep increased by 37.00-68.00min, vs. 26.75 (p<0.05 for 0.50mg/d). By subjective IRLS ratings, all pramipexole doses were significantly superior to placebo. Safety analysis demonstrated no dose-dependent increase in adverse events, and no drug-related increase in daytime somnolence was observed. Pramipexole is effective and well tolerated in RLS, most notably among objective measures, for reducing PLM and decreasing sleep latency. Although

  16. Restless legs syndrome

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    Ovallath S

    2012-10-01

    Full Text Available Sujith Ovallath, P DeepaJames Parkinson's Movement Disorder Research Centre, Kannur Medical College, Kerala, IndiaBackground: Restless legs syndrome (RLS is a common sleep-related disorder characterized by abnormal sensation and an urge to move the lower limbs. Symptoms occur at rest in the evening or at night, and they are alleviated by moving the affected extremity or by walking. Although the exact etiopathogenesis of RLS remains elusive, the rapid improvement of symptoms with dopaminergic agents suggests that dopaminergic system dysfunction may be a basic mechanism. Dopaminergic agents are the best-studied agents, and are considered first-line treatment of RLS.Objective: To review the diagnostic criteria, clinical features, etiopathogenesis, and the treatment options of RLS.Methods: The suggestions are based on evidence from studies published in peer-reviewed journals, or upon a comprehensive review of the medical literature.Results/conclusion: Extensive data are available for proving the link between the dopaminergic system and RLS. A possible genetic link also has been studied extensively. Dopamine agonists, especially pramipexole and ropinirole, are particularly useful in the treatment of RLS. Pharmacological treatment should however be limited to those patients who suffer from clinically relevant RLS with impaired sleep quality or quality of life.Keywords: dopamine, levodopa, pramipexole

  17. RESTLESS LEGS SYNDROME

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    Dmitriy Valer'evich Artem'ev

    2009-01-01

    Full Text Available The paper describes the epidemiology, etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, and treatment of restless legs syndrome. Recommendations are given how to choose therapeutic modalities and drugs in relation to different factors.

  18. Can't Curb the Urge to Move? Living with Restless Legs Syndrome

    Science.gov (United States)

    ... Sleep? Wise Choices Recognizing Restless Legs Restless legs syndrome brings all 4 of these characteristics: A strong urge to move your legs, often with unpleasant feelings like tingling, burning or throbbing in the legs. Symptoms that get better ... Legs Syndrome Fact Sheet What Is Restless Legs Syndrome? Brain ...

  19. Restless legs syndrome and periodic leg movements in patients with movement disorders: Specific considerations.

    Science.gov (United States)

    Högl, Birgit; Stefani, Ambra

    2017-05-01

    Restless legs syndrome is a frequent neurological disorder with potentially serious and highly distressing treatment complications. The role and potential implications of periodic leg movements during sleep range from being a genetic risk marker for restless legs syndrome to being a cardiovascular risk factor. The diagnosis of restless legs syndrome in patients with daytime movement disorders is challenging and restless legs syndrome needs to be differentiated from other sleep-related movement disorders. This article provides an update on the diagnosis of restless legs syndrome as an independent disorder and the role of periodic leg movements and reviews the association of restless legs syndrome with Parkinson's disease and other movement disorders. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  20. Restless legs syndrome mimicking S1 radiculopathy.

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    Zambelis, Th; Wolgamuth, B R; Papoutsi, S N; Economou, N T

    2016-01-01

    Α case of a chronic idiopathic form of a severe type of Restless Legs Syndrome (RLS), which developed during pregnancy and persisted after this, misdiagnosed for 34 years as radiculopathy S1, is reported. In spite of the thorough clinical and laboratory investigation, in addition to constant changes of the therapeutic approach, the diagnosis of S1 radiculopathy could not be confirmed, resulting in a chronic clinical course; the latter was characterized by relapses and remissions not attributed or linked in any way to the treatment (various types of). In fact, it was due to a routine workup in a sleep clinic, where the patient was referred because of a coincident chronic insomnia (Restless Legs Syndrome is a known and important cause of insomnia/chronic insomnia), which resulted in a proper diagnosis and treatment of this case. With the use of Restless Legs Syndrome appropriate treatment (Pramipexole 0.18 mg taken at bedtime, a dopaminergic agent and Level A recommended drug for Restless Legs Syndrome) an excellent response and immediate elimination of symptoms was achieved. Restless Legs Syndrome may present with a variety of symptoms (with the most prominent shortly being reported with the acronym URGE: Urge to move the legs usually associated with unpleasant leg sensations, Rest induces symptoms, Getting active brings relief, Evening and night deteriorate symptoms); given the fact that Restless Legs Syndrome presents with a great variety and heterogeneity of symptoms (mostly pain, dysesthesia and paresthesia), which may occur in several other diseases (the so called "RLS mimics"), proper diagnosis of Restless Legs Syndrome usually fails. Restless Legs Syndrome misinterpreted as S1 radiculopathy, to the best of our knowledge, has not been reported yet in the literature. Here, case history, clinical course and common RLS mimics are presented. Different forms of Restless Legs Syndrome manifestations, which are commonly -as in this case- misinterpreted due to their

  1. Excessive Daytime Sleepiness in Acute Ischemic Stroke: Association With Restless Legs Syndrome, Diabetes Mellitus, Obesity, and Sleep-Disordered Breathing.

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    Šiarnik, Pavel; Klobučníková, Katarína; Šurda, Pavol; Putala, Matúš; Šutovský, Stanislav; Kollár, Branislav; Turčáni, Peter

    2018-01-15

    Sleep disorders are frequent in stroke patients. The prevalence of sleep-disordered breathing (SDB), excessive daytime sleepiness (EDS), and restless legs syndrome (RLS) among stroke survivors is up to 91%, 72%, and 15%, respectively. Although the relationship between EDS and SDB is well described, there are insufficient data regarding the association of EDS with RLS. The aim of this study was to explore the association between EDS, SDB, and RLS in acute ischemic stroke. We enrolled 152 patients with acute ischemic stroke. Epworth Sleepiness Scale (ESS) was used to assess EDS. SDB was assessed using standard overnight polysomnography. All patients filled in a questionnaire focused on RLS. Clinical characteristics and medication were recorded on admission. EDS was present in 16 (10.5%), SDB in 90 (59.2%) and RLS in 23 patients (15.1%). EDS was significantly more frequent in patients with RLS in comparison with the patients without RLS (26.1% versus 7.8%, P = .008). ESS was significantly higher in the population with RLS compared to the population without RLS (7 [0-14] versus 3 [0-12], P = .032). We failed to find any significant difference in the frequency of EDS and values of ESS in the population with SDB compared to the population without SDB. Presence of RLS (beta = 0.209; P = .009), diabetes mellitus (beta = 0.193; P = .023), and body mass index (beta = 0.171; P = .042) were the only independent variables significantly associated with ESS in multiple linear regression analysis. Our results suggest a significant association of ESS with RLS, diabetes mellitus, and obesity in patients with acute ischemic stroke. © 2018 American Academy of Sleep Medicine

  2. Incident Cardiovascular Events and Death in Individuals With Restless Legs Syndrome or Periodic Limb Movements in Sleep: A Systematic Review.

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    Kendzerska, Tetyana; Kamra, Maneesha; Murray, Brian J; Boulos, Mark I

    2017-03-01

    To systematically review the current evidence examining restless legs syndrome (RLS) and periodic limb movements in sleep (PLMS) as prognostic factors for all-cause mortality and incident cardiovascular events (CVE) in longitudinal studies published in the adult population. All English language studies (from 1947 to 2016) found through Medline and Embase, as well as bibliographies of identified articles, were considered eligible. Quality was evaluated using published guidelines. Among 18 cohorts (reported in 13 manuscripts), 15 evaluated the association between RLS and incident CVE and/or all-cause mortality and 3 between PLMS and CVE and mortality. The follow-up periods ranged from 2 to 20 years. A significant relationship between RLS and CVE was reported in four cohorts with a greater risk suggested for severe RLS with longer duration and secondary forms of RLS. Although a significant association between RLS and all-cause mortality was reported in three cohorts, a meta-analysis we conducted of the four studies of highest quality found no association (pooled hazard ratio = 1.09, 95% confidence interval: 0.80-1.78). A positive association between PLMS and CVE and/or mortality was demonstrated in all included studies with a greater risk attributed to PLMS with arousals. The available evidence on RLS as a prognostic factor for incident CVE and all-cause mortality was limited and inconclusive; RLS duration, severity, and secondary manifestations may be important in understanding a possible relationship. Although very limited, the current evidence suggests that PLMS may be a prognostic factor for incident CVE and mortality. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  3. Symptom Severity of Restless Legs Syndrome Predicts Its Clinical Course.

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    Lee, Chung Suk; Kim, Tae; Lee, Sumin; Jeon, Hong Jun; Bang, Young Rong; Yoon, In-Young

    2016-04-01

    This study examines the clinical course of restless legs syndrome according to its severity and factors associated with the remission of restless legs syndrome symptoms. The remission or persistence of restless legs syndrome symptoms was investigated by considering patients with restless legs syndrome at the sleep clinic of Seoul National University Bundang Hospital. All subjects were observed for at least 18 months, and an incidence of remission was defined as having no restless legs syndrome symptoms for at least 1 year. Restless legs syndrome severity was evaluated by the International Restless Legs Syndrome Study Group Rating Scale. A total of 306 patients participated in this study. Over the observation periods of 4.1 ± 1.6 years, the cumulative incidence of remission is 32.5% (95% confidence interval [CI], 27.0-38.0) and decreased with baseline restless legs syndrome severity (P restless legs syndrome cases, respectively. Most cases of remission (82/96) were observed within 1 year, and the remission occurred sooner for mild restless legs syndrome. The hazard ratios of remission by Cox proportional hazards model were lower for moderate (0.556; 95% CI, 0.340-0.909) and severe to very severe (0.193; 95% CI, 0.108-0.343) restless legs syndrome than for mild restless legs syndrome. The remission incidence was lower for those patients who had a family history of restless legs syndrome and were older at restless legs syndrome diagnosis. Mild restless legs syndrome severity, no family history, and young age at restless legs syndrome diagnosis were significant predictors of restless legs syndrome remission. More than 80% of patients with severe restless legs syndrome showed a chronic clinical course. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Epilepsy and restless legs syndrome.

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    Geyer, James D; Geyer, Emery E; Fetterman, Zachary; Carney, Paul R

    2017-03-01

    Restless legs syndrome (RLS) is a common neurological movement disorder occurring in approximately 10% of the general population. The prevalence of moderately severe RLS is 2.7% overall (3.7% for women and 1.7% for men). Epilepsy is also a common neurological disorder with significant associated morbidity and impact on quality of life. We evaluated the severity and frequency of primary RLS in patients with localization-related temporal lobe epilepsy (TLE) and investigated the role of prodromal RLS symptoms as a warning sign and lateralizing indicator. All epilepsy patients seen in the outpatient clinic were screened for movement disorders from 2005 to 2015. Ninety-eight consecutive patients with localization-related TLE (50 right TLE and 48 left TLE) who met inclusion criteria were seen in the outpatient clinic. The control group consisted of 50 individuals with no history or immediate family history of epilepsy. Each patient was evaluated with the International Restless Legs Study Group (IRLSSG) questionnaire, NIH RLS diagnostic criteria, ferritin level, and comprehensive sleep screening including polysomnography. Furthermore, patients with obstructive sleep apnea or a definite cause of secondary restless legs syndrome such as low serum ferritin or serum iron levels were also excluded from the study. There was a significant association between the type of epilepsy and whether or not patients had RLS χ 2 (1)=10.17, prestlessness was typically described as moderately severe. The RLS symptoms were more common and somewhat more severe in the right TLE group than the left TLE group. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Klinefelter Syndrome With Leg Ulcers

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    Narendra G

    1999-01-01

    Full Text Available Leg ulcers are frequently caused by venous insufficiency, arterial insufficiency, neuropathy, or a combination of these factors. Klinefelter syndrome in association with chronic leg ulcers have been reported earlier. We report a case of Klinefelter syndrome with non- healing ulcer. The diagnosis of the Klinefelter syndrome was confirmed by karyotyping.

  6. Uremic restless legs syndrome (RLS) and sleep quality in patients with end-stage renal disease on hemodialysis: potential role of homocysteine and parathyroid hormone.

    Science.gov (United States)

    Gade, Katrin; Blaschke, Sabine; Rodenbeck, Andrea; Becker, Andreas; Anderson-Schmidt, Heike; Cohrs, Stefan

    2013-01-01

    The aetiology of uremic restless legs syndrome (RLS) remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis. Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos) and 26 non-affected (RLSneg) patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality. Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045). Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone. Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients. © 2013 S. Karger AG, Basel.

  7. Uremic Restless Legs Syndrome (RLS and Sleep Quality in Patients With End-Stage Renal Disease on Hemodialysis: Potential Role of Homocysteine and Parathyroid Hormone

    Directory of Open Access Journals (Sweden)

    Katrin Gade

    2013-10-01

    Full Text Available Background: The aetiology of uremic restless legs syndrome (RLS remains unclear. Our research investigated whether an elevated plasma concentration of the excitatory amino acid homocysteine might be associated with RLS occurrence in patients with chronic renal insufficiency on hemodialysis. Methods: Total plasma homocysteine as well as creatinine, urea, folate, parathyroid hormone, hemoglobin, iron, ferritin, phosphate, calcium, magnesium, and albumin levels were compared between 26 RLS-affected (RLSpos and 26 non-affected (RLSneg patients on chronic hemodialysis. We further compared subjective sleep quality between RLSpos and RLSneg patients using the Pittsburgh-Sleep-Quality-Index and investigated possible relationships between laboratory parameters and sleep quality. Results: Taking individual albumin concentrations into account, a significant positive correlation between total plasma homocysteine and RLS occurrence was observed (r= 0.246; p=0.045. Sleep quality was significantly more reduced in RLSpos compared to RLSneg patients and RLS severity correlated positively with impairment of sleep quality. Bad sleep quality in all patients was associated with higher concentrations of parathyroid hormone. Conclusion: Our results suggest a possible aetiological role of homocysteine in uremic RLS. They confirm that uremic RLS is an important factor causing sleep impairment in patients on hemodialysis. Higher parathyroid hormone levels might also be associated with bad sleep quality in these patients.

  8. Successful Treatment with Clonazepam and Pramipexole of a Patient with Sleep-Related Eating Disorder Associated with Restless Legs Syndrome: A Case Report

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    Nobuyuki Kobayashi

    2012-01-01

    Full Text Available Sleep-related eating disorder (SRED is characterized by recurrent episodes of involuntary eating during sleep period and is often associated with restless legs syndrome (RLS. Although pharmacotherapy is recommended for SRED patients, no drug have shown promising effects so far. The patient, a 48-year-old Japanese housewife, first visited our clinic and complained about nighttime eating. She had a history of hypertension, diabetes mellitus, sleep apnea syndrome, and depression. Insomnia appeared 10 years before the first visit and she often received hypnosedatives; at the same time, she developed nocturnal eating episodes. She had amnesia for these episodes, and she felt urge to move her legs while sleeping. The patient was diagnosed with SRED and RLS. Reduction in the doses of triazolam decreased her nighttime eating frequency, and her complete amnesia changed to vague recall of eating during night. Clonazepam 1.0 mg at bedtime decreased nocturnal eating frequency from 1 to 2 times per month, though sleepwalking remained. Administration of pramipexole 0.125 mg relieved all symptoms including SRED, RLS, and sleepwalking. This is the first paper to report that the combination of clonazepam and pramipexole therapy-reduced SRED episodes and RLS symptoms.

  9. Genetic aspects of restless legs syndrome

    OpenAIRE

    Dhawan, V; Ali, M; Chaudhuri, K R

    2006-01-01

    Restless legs syndrome (RLS), also known as Ekbom syndrome, is a common movement disorder with sensorimotor symptoms occurring during sleep and quiet wakefulness. The underlying cause for RLS is unknown but genetic influences play a strong part in the pathogenesis of RLS, particularly when the condition starts at a young age. This review explores the genetic basis of RLS and related phenotypic variations. Recently, three loci showing vulnerability to RLS have been described in French‐Canadian...

  10. Effect of Renal Transplantation in Restless Legs Syndrome.

    Science.gov (United States)

    Kahvecioglu, Serdar; Yildiz, Demet; Buyukkoyuncu, Nilufer; Celik, Huseyin; Tufan, Fatih; Kılıç, Ahmet Kasım; Gul, Bulent; Yildiz, Abdulmecid

    2016-02-01

    Restless legs syndrome is a disorder in which patients have irresistible urge to move legs during rest. Restless legs syndrome seems to be common in end-stage renal disease. After a successful renal transplant, symptoms ameliorate with renal function improvement and restless legs syndrome is seen less in this population. Here, we aimed to investigate restless legs syndrome frequency and associated factors in renal transplant patients. In a cross-sectional study with 193 patients (116 hemodialysis patients, 45 transplant patients, and 32 controls), the presence of restless legs syndrome was assessed using the Restless Legs Syndrome Questionnaire. Medical history, demographic, and laboratory data were collected from the patients' medical records. Patients were questioned about the presence of restless legs syndrome using the Restless Legs Syndrome Questionnaire. Patients were evaluated with Beck Depression Scale for depression and Pittsburgh tests for sleep disturbances. While the rate of restless legs syndrome was similar between transplants and controls, it was significantly greater in hemodialysis patients. Hemodialysis patients and controls had similar depression scores that were higher compared with transplant patients. Pittsburgh score was similar in transplant patients and controls and significantly increased in the hemodialysis patients. The rate of insomnia was significantly higher in the hemodialysis patients compared with the other 2 groups. Logistic regression analysis revealed independent correlates of restless legs syndrome as insomnia, Beck depression score, and being on hemodialysis. Linear regression analysis showed that independent correlates of higher Pittsburgh score were higher depression score, higher age, and presence of restless legs syndrome. The prevalence of restless legs syndrome is significantly lower in transplant patients than it is in patients on maintenance dialysis. In renal transplant patients, restless legs syndrome frequency was

  11. Restless Legs Syndrome in Iranian People With Type 2 Diabetes Mellitus: The Role in Quality of Life and Quality of Sleep.

    Science.gov (United States)

    Modarresnia, Leila; Golgiri, Fatemeh; Madani, Nahid Hashemi; Emami, Zahra; Tanha, Kiarash

    2018-02-15

    To investigate the prevalence of restless legs syndrome (RLS) in patients with type 2 diabetes mellitus (T2DM) and explore its role in quality of life (QoL) and quality of sleep of these patients. This is a cross-sectional study performed on 210 Iranian people with T2DM. The diagnosis of RLS was established based on the essential diagnostic criteria for RLS recommended by the National Institutes of Health. Sleep quality and QoL were assessed in all participants using Pittsburgh Sleep Quality Index and EuroQol five-dimension questionnaire, respectively. Regression models were used for final analysis of data. The prevalence of RLS was 19.5%; of whom 38.1% had poor quality of sleep. Male sex, being single, body mass index (BMI), and RLS were associated with poor quality of sleep. Patients with RLS were almost three times as likely as the patients without RLS to have poor sleep quality. Moreover, being female, BMI value, level of glycosylated hemoglobine (HbA1C), and RLS were associated with lower QoL. RLS lowers the score of QoL even more than BMI and HbA1C. In addition, the QoL and sleep quality of this population of patients with diabetes have not been affected by the severity of RLS as well as presence or absence of neuropathy. RLS has an independent and significant role in sleep quality and QoL in the patients with diabetes. Neuropathy with RLS does not confer any additive burden on QoL and sleep quality of this population of patients with diabetes. © 2018 American Academy of Sleep Medicine

  12. Night-to-night variability of periodic leg movements during sleep in restless legs syndrome and periodic limb movement disorder: comparison between the periodicity index and the PLMS index.

    Science.gov (United States)

    Ferri, Raffaele; Fulda, Stephany; Manconi, Mauro; Högl, Birgit; Ehrmann, Laura; Ferini-Strambi, Luigi; Zucconi, Marco

    2013-03-01

    The number of periodic leg movements during sleep (PLMS index) shows high night-to-night variability, requiring multiple nights for its reliable estimation. It is currently not known if this is also the case for the degree of periodicity of leg movements, quantified by the Periodicity index. To compare night-to-night variability of PLMS and Periodicity indices in patients with restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). Eighteen idiopathic RLS patients and 9 PLMD patients were recruited. Subjects underwent two consecutive full night polysomnographic studies. Polysomnographic recordings were scored and leg movement activity analyzed during sleep for the computation of the PLMS and Periodicity indices. In both patient groups, the Periodicity index showed a significantly lower degree of variability than that of PLMS index, being >6.5 times lower in RLS patients and 2 times lower in PLMD patients. These data support the use of the Periodicity index in the evaluation of PLMS in RLS and PLMD and indicate that this parameter seems to be more stable than the widely used PLMS index which has higher night-to-night variability. Copyright © 2012 Elsevier B.V. All rights reserved.

  13. Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)

    Science.gov (United States)

    ... the syndrome. Risk factors include the following: A sedentary lifestyle Smoking Obesity Many people with narcolepsy or rapid eye movement (REM) behavior disorder move their legs periodically during sleep. Both ...

  14. Association between serum hepcidin level and restless legs syndrome.

    Science.gov (United States)

    Dauvilliers, Yves; Chenini, Sofiene; Vialaret, Jérôme; Delaby, Constance; Guiraud, Lily; Gabelle, Audrey; Lopez, Regis; Hirtz, Christophe; Jaussent, Isabelle; Lehmann, Sylvain

    2018-02-08

    To better understand the role of iron homeostasis dysregulation in restless legs syndrome, we compared serum hepcidin and ferritin levels in drug-free patients with primary restless legs syndrome and healthy controls and studied the relationship between hepcidin level and restless legs syndrome severity. One hundred and eight drug-free patients with primary restless legs syndrome (65 women; median age, 61.5 years) and 45 controls (28 women; median age, 53.9 years) were enrolled. Inclusion criteria were: normal ferritin level (>50 ng/mL) and absence of iron disorders, chronic renal or liver failure, and inflammatory or neurological diseases. Each subject underwent a thorough clinical examination and a polysomnography assessment. Serum hepcidin-25 was quantified using a validated mass spectrometry method. Restless legs syndrome severity was evaluated according to the International Restless Legs Syndrome Study Group. Despite no group difference between normal ferritin levels and demographic features, serum hepcidin level and hepcidin/ferritin ratio were higher in patients than in controls. Hepcidin level and hepcidin/ferritin ratio, but not ferritin level, were positively correlated with periodic leg movements during sleep and wakefulness in the whole sample. Hepcidin level seem to be associated with restless legs syndrome severity in a complex U-shaped relationship, without relationship with age at restless legs syndrome onset, positive family history, sleep and depressive symptoms, genetic background, and polysomnographic measurements. No relationship was found between ferritin level and restless legs syndrome severity. In drug-free patients with primary restless legs syndrome, hepcidin level is higher than in controls and may be associated with restless legs syndrome clinical severity. This result emphasizes the complex peripheral iron metabolism deregulation in restless legs syndrome, opening potential perspectives for a personalized approach with a hepcidin

  15. Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients

    Science.gov (United States)

    Scherer, Jennifer S.; Combs, Sara A.; Brennan, Frank

    2017-01-01

    Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additional areas of further study needed to improve symptom management in dialysis patients. PMID:27693261

  16. Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients

    OpenAIRE

    Scherer, Jennifer S.; Combs, Sara A.; Brennan, Frank

    2016-01-01

    Maintenance dialysis patients experience a high burden of physical and emotional symptoms that directly affect their quality of life and health care utilization. In this review, we specifically highlight common troublesome symptoms affecting dialysis patients: insomnia, restless legs syndrome, and uremic pruritus. Epidemiology, pathophysiology, and evidence-based current treatment are reviewed with the goal of providing a guide for diagnosis and treatment. Finally, we identify multiple additi...

  17. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson's Disease.

    Science.gov (United States)

    Suzuki, Keisuke; Miyamoto, Masayuki; Miyamoto, Tomoyuki; Hirata, Koichi

    2015-01-01

    Sleep disturbances are important nonmotor symptoms in Parkinson's disease (PD) that are associated with a negative impact on quality of life. Restless legs syndrome (RLS), which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR), which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  18. The Molecular Genetics of Restless Legs Syndrome.

    Science.gov (United States)

    Rye, David B

    2015-09-01

    Restless legs syndrome (RLS) is a common sensorimotor trait defined by symptoms that interfere with sleep onset and maintenance in a clinically meaningful way. Nonvolitional myoclonus while awake and asleep is a sign of the disorder and an informative endophenotype. The genetic contributions to RLS/periodic leg movements are substantial, are among the most robust defined to date for a common disease, and account for much of the variance in disease expressivity. The disorder is polygenic, as revealed by recent genome-wide association studies. Experimental studies are revealing mechanistic details of how these common variants might influence RLS expressivity. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Validation of the post sleep questionnaire for assessing subjects with restless legs syndrome: results from two double-blind, multicenter, placebo-controlled clinical trials

    Directory of Open Access Journals (Sweden)

    Bharmal Murtuza

    2011-04-01

    Full Text Available Abstract Background Because of the subjective nature of Restless Legs Syndrome (RLS symptoms and the impact of these symptoms on sleep, patient-reported outcomes (PROs play a prominent role as study endpoints in clinical trials investigating RLS treatments. The objective of this study was to validate a new measure, the Post Sleep Questionnaire (PSQ, to assess sleep dysfunction in subjects with moderate-to-severe RLS symptoms. Methods Pooled data were analyzed from two 12-week, randomized, placebo-controlled trials of gabapentin enacarbil (N = 540. At baseline and Week 12, subjects completed the PSQ and other validated health surveys: IRLS Rating Scale, Clinical Global Impression of Improvement (CGI-I, Profile of Mood States (POMS, Medical Outcomes Study Scale-Sleep (MOS-Sleep, and RLS-Quality of Life (RLSQoL. Pooled data were used post hoc to examine the convergent, divergent, known-group validity and the responsiveness of the PSQ. Results Convergent validity was demonstrated by significant correlations between baseline PSQ items and total scores of IRLS, POMS, RLSQoL, and the MOS-Sleep Scale (p ≤ 0.007 each. Divergent validity was demonstrated through the lack of significant correlations between PSQ items and demographic characteristics. Correlations (p Conclusions Although these analyses were potentially limited by the use of clinical trial data and not prospective data from a study conducted solely for validation purposes, the PSQ demonstrated robust psychometric properties and is a valid instrument for assessing sleep and sleep improvements in subjects with moderate-to-severe RLS symptoms. Trial Registration This study analyzed data from two registered trials, NCT00298623 and NCT00365352.

  20. Gabapentin enacarbil in subjects with moderate to severe primary restless legs syndrome with and without severe sleep disturbance: an integrated analysis of subjective and novel sleep endpoints from two studies

    Directory of Open Access Journals (Sweden)

    Bogan RK

    2013-05-01

    Full Text Available Richard K Bogan,1 Aaron Ellenbogen,2 Philip M Becker,3 Clete Kushida,4 Eric Ball,5 William G Ondo,6 Christine K Caivano,7 Sarah Kavanagh71SleepMed, Columbia, SC, 2Quest Research Institute, Farmington Hills, MI, 3Sleep Medicine Associates of Texas, Dallas, TX, 4Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Center for Human Sleep Research, Stanford, CA, 5Walla Walla Clinic, Walla Walla, WA, 6University of Texas Health Science Center, Houston, TX, 7Global Regulatory Affairs (CKC* and Neurosciences MDC (SK, GlaxoSmithKline, Research Triangle Park, NC, USA*Development Sciences department at the time of the analysisPurpose: The aim of the study reported here was assessment of subjective and novel sleep endpoints, according to sleep disturbance severity at baseline, in adult subjects with moderate to severe primary restless legs syndrome (RLS treated with gabapentin enacarbil (GEn 1200 mg or placebo.Methods: Integrated analysis of two 12-week randomized trials in subjects with RLS was undertaken. Sleep outcomes from the Medical Outcomes Study (MOS Sleep Scale and the Post Sleep Questionnaire were evaluated. Novel sleep endpoints derived from the 24-Hour RLS Symptom Diary were compared with similar endpoints derived from the Pittsburgh Sleep Diary (PghSD. Subjects were divided into two subgroups based on their level of sleep disturbance (responses to item 4 of the International Restless Legs Scale at baseline. Data were analyzed using a last observation carried forward approach.Results: The modified intent-to-treat population comprised 427 subjects (GEn 1200 mg, n = 223; placebo, n = 204. GEn significantly improved all MOS Sleep Scale domain scores from baseline compared with placebo (P < 0.05 in both subgroups. Compared with placebo, GEn-treated subjects with very severe to severe sleep disturbance reported higher overall sleep quality, fewer nighttime awakenings, and fewer hours awake per night due to RLS

  1. Effects of Exercise Training on Restless Legs Syndrome, Depression, Sleep Quality, and Fatigue Among Hemodialysis Patients: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Song, Yuan-Yuan; Hu, Ru-Jun; Diao, Yong-Shu; Chen, Lin; Jiang, Xiao-Lian

    2018-04-01

    Hemodialysis (HD) patients experience a heavy symptom burden that leads to a decreased quality of life. Pharmacological treatment is effective but costly and has adverse effects. Exercise is a promising approach for symptom management, but the effect of exercise on restless legs syndrome (RLS), depression, sleep quality, and fatigue in HD patients is still uncertain. This meta-analysis was conducted to identify whether exercise training is beneficial in the treatment of the symptoms of RLS, depression, poor sleep quality, and fatigue in patients receiving HD. A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials, and Web of Science was conducted to identify randomized controlled trials (RCTs) comparing exercise training with routine care on RLS, depression, sleep quality, and fatigue among HD patients. Quality assessment was conducted using the Cochrane risk of bias tool, and RevMan 5.3 was used to analyze the data. Fifteen RCTs that met our inclusion criteria were included. The pooled effect size showed that exercise training was effective on RLS (P sleep quality were not performed owing to the sensitivity analysis results. Exercise training may help HD patients to reduce the severity of RLS, depression, and fatigue. More high-quality RCTs with larger samples and comparative RCTs focused on different exercise regimens are needed. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  2. Sleep improvement for restless legs syndrome patients. Part IV: meta-analysis comparison of effect sizes of vibratory stimulation sham pads and placebo pills

    Directory of Open Access Journals (Sweden)

    Burbank F

    2014-02-01

    Full Text Available Fred Burbank Salt Creek International Women's Health Foundation, San Clemente, CA, USA Purpose: To determine whether sham pads used as controls in randomized clinical trials of vibratory stimulation to treat patients with sleep loss associated with restless legs syndrome perform differently than placebo pills used in comparable restless legs syndrome drug trials. Patients and methods: Sham pad effect sizes from 66 control patients in two randomized clinical trials of vibratory stimulation were compared with placebo responses from 1,024 control patients in 12 randomized clinical drug trials reporting subjective sleep measurement scales. Control patient responses were measured as the standardized difference in means corrected for correlation between beginning and ending scores and for small sample sizes. Results: For parallel randomized clinical trials, sham effects in vibratory stimulation trials were not significantly different from placebo effects in drug trials (0.37 and 0.31, respectively, Qbetween subgroups =0.25, PQ≥0.62. Placebo effect sizes were significantly smaller in crossover drug trials than sham effect sizes in parallel vibratory stimulation trials (0.07 versus 0.37, respectively, Qbetween subgroups =4.59, PQ≤0.03 and placebo effect sizes in parallel drug trials (0.07 versus 0.31, respectively, Qbetween subgroups =5.50, PQ≤0.02. Conclusion: For subjective sleep loss assessments in parallel trials, sham pads in vibratory stimulation trials performed similarly to placebo pills in drug trials. Trial design (parallel versus crossover had a large influence on control effect sizes. Placebo pills in crossover drug trials had significantly smaller effect sizes than sham pads in parallel vibratory stimulation trials or placebo pills in parallel drug trials. Keywords: sham effect, placebo effect, trial design, crossover study, parallel study, counterstimulation

  3. Restless legs syndrome in migraine patients : prevalence and severity

    NARCIS (Netherlands)

    van Oosterhout, W P J; van Someren, E J W; Louter, M A; Schoonman, G G; Lammers, G J; Rijsman, R M; Ferrari, M D; Terwindt, G M

    BACKGROUND AND PURPOSE: Our aim was to study not only the prevalence but more importantly the severity and the correlation between sleep quality and restless legs syndrome (RLS) in a large population of well-defined migraine patients as poor sleep presumably triggers migraine attacks. METHODS: In a

  4. Restless Legs Syndrome Foundation

    Science.gov (United States)

    ... just like my grandfather. With treatment I can sleep again. I avoid triggers and my grades are back on track!” Joseph Rochester, Minnesota “When I told my folks I had RLS, first they laughed and then they said it was just in my head. I couldn’t sleep or work until I began to get treatment. ...

  5. Restless Legs Syndrome Among the Elderly

    Directory of Open Access Journals (Sweden)

    Pei-Hao Chen

    2009-12-01

    Full Text Available Restless legs syndrome is a sleep and movement disorder that affects 5–15% of the general population, with an increased prevalence among the elderly population. It not only affects quality of life but also increases risk of mortality among older adults. The diagnosis is based on clinical symptoms of the patient by four minimal essential criteria. Restless legs syndrome can be divided into primary or secondary causes. Examination should be performed to rule out potentially treatable illnesses, such as iron deficiency, renal failure or peripheral neuropathy, especially among elderly patients. The initial approach to restless legs syndrome should be nonpharmacologic management, such as good sleep hygiene, regular exercise, cognitive behavioral therapy and avoidance of certain aggravating drugs. An algorithm based on scientific evidence and expert opinion was developed for guidance of treatment. Combination or change of medication can be applied to resistant or difficult cases. Since elderly patients are prone to treatment-related side effects, the best strategy is to start medication cautiously and at the lowest recommended dosage.

  6. Frequent periodic leg movement during sleep is an unrecognized risk factor for progression of atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Mahek Mirza

    Full Text Available Sleep apnea has been recognized as a factor predisposing to atrial fibrillation recurrence and progression. The effect of other sleep-disturbing conditions on atrial fibrillation progression is not known. We sought to determine whether frequent periodic leg movement during sleep is a risk factor for progression of atrial fibrillation. In this retrospective study, patients with atrial fibrillation and a clinical suspicion of restless legs syndrome who were referred for polysomnography were divided into two groups based on severity of periodic leg movement during sleep: frequent (periodic movement index >35/h and infrequent (≤35/h. Progression of atrial fibrillation to persistent or permanent forms between the two groups was compared using Wilcoxon rank-sum test, chi-square tests and logistic regression analysis. Of 373 patients with atrial fibrillation (77% paroxysmal, 23% persistent, 108 (29% progressed to persistent or permanent atrial fibrillation during follow-up (median, 33 months; interquartile range, 16-50. Compared to patients with infrequent periodic leg movement during sleep (n=168, patients with frequent periodic leg movement during sleep (n=205 had a higher rate of atrial fibrillation progression (23% vs. 34%; p=0.01. Patients with frequent periodic leg movement during sleep were older and predominantly male; however, there were no significant differences at baseline in clinical factors that promote atrial fibrillation progression between both groups. On multivariate analysis, independent predictors of atrial fibrillation progression were persistent atrial fibrillation at baseline, female gender, hypertension and frequent periodic leg movement during sleep. In patients with frequent periodic leg movement during sleep, dopaminergic therapy for control of leg movements in patients with restless legs syndrome reduced risk of atrial fibrillation progression. Frequent leg movement during sleep in patients with restless legs syndrome is

  7. Sleep apnea in patients reporting insomnia or restless legs symptoms.

    Science.gov (United States)

    Bianchi, M T; Goparaju, B; Moro, M

    2016-01-01

    Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles. We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire. More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk. Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Impact of Restless Legs Syndrome on Cardiovascular Autonomic Control.

    Science.gov (United States)

    Bertisch, Suzanne M; Muresan, Cristen; Schoerning, Laura; Winkelman, John W; Taylor, J Andrew

    2016-03-01

    To examine whether patients with restless legs syndrome demonstrate specific alterations in cardiovascular autonomic control. Patients with moderate-severe restless legs syndrome (n = 20, 80% female) and controls (n = 20) matched for age, sex, body mass index, and free of hypertension and cardiovascular disease were enrolled. We assessed cardiovagal baroreflex gain via the modified Oxford technique, sympathetically mediated vascular responses to isometric exercise to fatigue, bradycardiac response to Valsalva maneuver, and respiratory sinus arrhythmia during paced breathing. Standard electrocardiography, beat-by-beat arterial pressure, respiration, and popliteal blood flow velocity were recorded continuously. Resting blood pressure and heart rate were similar between groups. However, baroreflex gain averaged 14.3 ± 1.4 msec/mm Hg in restless legs syndrome and was lower than in controls (22.6 ± 3.5 msec/mm Hg, P = 0.04). Hemodynamic responses to isometric exercise were similar between groups, though participants with restless legs syndrome had lower leg blood flow (P leg vascular resistance (P restless legs syndrome demonstrate compromised cardiovagal control, specific to the arterial baroreflex, with greater peripheral vascular resistance, potentially due to heightened sympathetic outflow. These autonomic alterations may directly relate to the higher prevalence of cardiovascular disease in restless legs syndrome. © 2016 Associated Professional Sleep Societies, LLC.

  9. Is There an Association between Restless Legs Syndrome and Urticaria?

    Science.gov (United States)

    Tuna, Serpil; Alan, Sevil; Samancı, Nehir; Karakaş, Ayşe Akman

    2016-05-01

    Restless legs syndrome (RLS) is a disease characterized by the urge to move the legs and sleep disturbances. Similarly, chronic spontaneous urticaria (CSU) is a dermatological disease characterized by pruritus and sleep disorders. In this study, we aimed to determine the prevalence and severity of RLS in patients with chronic spontaneous urticaria (CSU) and to compare the quality of sleep of patients with and without RLS in the CSU group using the Pittsburgh Sleep Quality Index. A total of 130 patients with CSU and 100 healthy controls were included in this study. The frequency of RLS, frequency of sleep disturbances, and average score of RLS in patients with CSU were statistically significantly higher than control groups (respectively P = 0.008, P = 0.009, P = 0.004). Subjective sleep quality, sleep latency and habitual sleep efficiency scores in patients with RLS were statistically significantly higher than patients without RLS (respectively P = 0.016, P = 0.007, P = 0.035). We claimed that pruritus of urticaria may decrease the quality of sleep in patients with RLS and it may trigger and worsen the restless legs syndrome. Furthermore, RLS and CSU may share a common etiology.

  10. Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder

    Directory of Open Access Journals (Sweden)

    Corrado Garbazza

    2018-05-01

    Full Text Available Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD compared to healthy controls.Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI and the periodic leg movement during sleep arousal index (PLMSAI. Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires.Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL, a longer duration of the periodic leg movements during sleep (PLMS in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients.Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS or periodic limb movement disorder (PLMD. The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.

  11. Irregular sleep-wake syndrome

    Science.gov (United States)

    Sleep-wake syndrome - irregular; Circadian rhythm sleep disorder - irregular sleep-wake type ... have sleep disturbances on occasion. But if this type of irregular sleep-wake pattern occurs regularly and without cause, see your provider.

  12. Effects of rotigotine on clinical symptoms, quality of life and sleep hygiene adequacy in hemodialysis-associated restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Vicent Esteve

    2018-01-01

    Conclusions: RLS showed a considerable prevalence in our HD unit. Rotigotine improved clinical symptoms, quality of life and sleep hygiene in RLS patients on HD and was found to be a safe drug with minimal side effects and total therapeutic compliance. Nevertheless, future studies should be performed to confirm the benefits of rotigotine in RLS patients on hemodialysis.

  13. Restless legs syndrome in migraine patients: prevalence and severity.

    Science.gov (United States)

    van Oosterhout, W P J; van Someren, E J W; Louter, M A; Schoonman, G G; Lammers, G J; Rijsman, R M; Ferrari, M D; Terwindt, G M

    2016-06-01

    Our aim was to study not only the prevalence but more importantly the severity and the correlation between sleep quality and restless legs syndrome (RLS) in a large population of well-defined migraine patients as poor sleep presumably triggers migraine attacks. In a large cross-sectional and observational study, data on migraine and RLS were collected from 2385 migraine patients (according to the International Classification of Headache Disorders ICHD-IIIb) and 332 non-headache controls. RLS severity (International RLS Study Group severity scale) and sleep quality (Pittsburgh Sleep Quality Index) were assessed. Risk factors for RLS and RLS severity were calculated using multivariable-adjusted regression models. Restless legs syndrome prevalence in migraine was higher than in controls (16.9% vs. 8.7%; multivariable-adjusted odds ratio 1.83; 95% confidence interval 1.18-2.86; P = 0.008) and more severe (adjusted severity score 14.5 ± 0.5 vs. 12.0 ± 1.1; P = 0.036). Poor sleepers were overrepresented amongst migraineurs (50.1% vs. 25.6%; P Restless legs syndrome is not only twice as prevalent but also more severe in migraine patients, and associated with decreased sleep quality. © 2016 EAN.

  14. Gabapentin Enacarbil: Pharmacotherapy of Restless Legs Syndrome

    Directory of Open Access Journals (Sweden)

    Ruth Jones

    2010-01-01

    Full Text Available Restless Legs Syndrome (RLS is a prevalent sleep-associated movement disorder greatly affecting patients’ quality of life (QoL. Several drugs can be used to control this condition although the first-line dopamine agents often cause adverse effects. Non-dopaminergic drugs such as oral gabapentin (GBP have been more recently advocated. Despite ameliorating RLS symptoms, GBP's pharmacokinetic limitations restrict its overall effectiveness. A novel specifically designed prodrug, gabapentin enacarbil (GE, has demonstrated successful RLS alleviation with a superior pharmacokinetic profile. This review aims to examine the efficacy and tolerability of both GBP and GE as pharmacotherapy for RLS. Despite some heterogeneity and limitations across research methodologies, GE appears to be a potential RLS therapy superior to GBP and other dopaminergic agents.

  15. Restless Legs Syndrome in Pediatric Patients With Nephrotic Syndrome

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    Victoria Cheung BA

    2015-05-01

    Full Text Available Background. Restless legs syndrome (RLS is a sleep disorder characterized by an urge to move or the presence of unpleasant sensations in the extremities. The prevalence of RLS is higher in children and adults with chronic kidney disease and in adults with glomerular disease. Objective. To determine the prevalence of RLS in children with nephrotic syndrome. Methods. We studied 50 children with nephrotic syndrome and 22 controls. The following surveys were administered: Pediatric Emory RLS questionnaire, Pediatric Daytime Sleepiness Scale, and Pediatric Sleep Questionnaire. Results. Children with nephrotic syndrome were 9.0 ± 4.4 years old, 27 were male, and 27 were in remission. The prevalence of RLS was similar in the nephrotic syndrome cases and controls, whether or not indeterminate cases were considered positive: 14.0% versus 13.6% including indeterminate cases, and 8.0% versus 9.1% excluding indeterminate cases. Conclusion. RLS is not more common in children with glomerular disease compared to healthy controls.

  16. Restless Legs Syndrome in a Nigerian Elderly Population

    Science.gov (United States)

    Fawale, Michael B.; Ismaila, Isiaka Alani; Mustapha, Adekunle F.; Komolafe, Morenikeji A.; Adedeji, Tewogbade A.

    2016-01-01

    Study Objectives: The prevalence of restless legs syndrome (RLS) is highest in the elderly in Caucasian populations; the prevalence of RLS in elderly Africans is not known. This study aimed at determining the frequency and associations of RLS in a Nigerian elderly population. Methods: The study population comprised of 633 consecutive elderly individuals aged 65–105 years attending the general outpatient clinic of the State Hospital, Ilesa, for minor complaints and routine check-up. The diagnosis of RLS was made using the 2003 minimal criteria of the International Restless Legs Syndrome Study Group. Relevant sociodemographic and clinical data, including sleep duration, were also obtained. Results: Restless legs syndrome was found in 3.5% of the study population with a male-female ratio of 2:1. There was no significant age (p = 0.427) or gender (p = 0.178) influence on the prevalence of RLS except in the 75- to 84-year age group where there was significant male preponderance (p = 0.044). A strong independent association between RLS and sleep duration (OR, 3.229; 95% CI, 1.283–8.486; p = 0.013) and past history of head injury (OR, 4.691; 95% CI, 1.750–12.577; p = 0.002) was found. Conclusions: Our finding support previous reports of a possible lower prevalence of RLS in Africans. Restless legs syndrome independently increases the odds of habitual sleep curtailment in elderly individuals. Head injury may be a risk factor for future RLS; this requires further investigation as indirect evidence for a possible link between RLS and traumatic brain injury exists. Citation: Fawale MB, Ismaila IA, Mustapha AF, Komolafe MA, Adedeji TA. Restless legs syndrome in a Nigerian elderly population. J Clin Sleep Med 2016;12(7):965–972. PMID:27070251

  17. Differentiating nocturnal leg cramps and restless legs syndrome.

    Science.gov (United States)

    Rana, Abdul Qayyum; Khan, Fatima; Mosabbir, Abdullah; Ondo, William

    2014-07-01

    Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.

  18. Restless legs syndrome in patients on hemodialysis

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    Saleh Mohammad Yaser Salman

    2011-01-01

    Full Text Available Restless legs syndrome (RLS is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn-drome Study Group (IRLSSG. Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa-tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD, the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.

  19. Two pedigrees with restless legs syndrome in Brazil

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    A.M. Esteves

    2008-02-01

    Full Text Available Numerous studies have suggested a substantial genetic contribution in the etiology of the primary form of restless legs syndrome (RLS and periodic leg movements (PLM. We describe the symptoms, the sleep profiles and physiological parameters of two families in which several members present RLS/PLM. The proband of family 1 is a 70-year-old woman and the proband of family 2 is a 57-year-old woman; both have exhibited the symptoms since the age of 20 years. All patients in both families were diagnosed with RLS according to the criteria of the International RLS Study Group. Polysomnographic recordings were performed to quantify and to describe PLM during sleep. Sleep parameters showed decreased sleep efficiency, increased sleep latency in the arousal index and the presence of PLM in all subjects. One of the families showed an exact profile of dominant inheritance with anticipation of age at onset. In the other family, the founders were blood relatives and there was no affected member in the third generation suggesting a recessive mode of inheritance. RLS/PLM is a prevalent sleep disorder affecting about 5 to 15% of the population and one that substantially impairs healthy sleep patterns. Efforts to understand the underlying pathophysiology will contribute to improve the sleep and life quality of these patients.

  20. Primary headaches in restless legs syndrome patients

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    Ravi Gupta

    2012-01-01

    Full Text Available Earlier studies conducted among migraineurs have shown an association between migraine and restless legs syndrome (RLS. We chose RLS patients and looked for migraine to exclude sample bias. Materials and Methods: 99 consecutive subjects of idiopathic RLS were recruited from the sleep clinic during four months period. Physician diagnosis of headache and depressive disorder was made with the help of ICHD-2 and DSM-IV-TR criteria, respectively. Sleep history was gathered. Severity of RLS and insomnia was measured using IRLS (Hindi version and insomnia severity index Hindi version, respectively. Chi-square test, one way ANOVA and t-test were applied to find out the significance. Results: Primary headache was seen in 51.5% cases of RLS. Migraine was reported by 44.4% subjects and other types of ′primary headaches′ were reported by 7.1% subjects. Subjects were divided into- RLS; RLS with migraine and RLS with other headache. Females outnumbered in migraine subgroup (χ2 =16.46, P<0.001. Prevalence of depression (χ2 =3.12, P=0.21 and family history of RLS (χ2 =2.65, P=0.26 were not different among groups. Severity of RLS (P=0.22 or insomnia (P=0.43 were also similar. Conclusion: Migraine is frequently found in RLS patients in clinic based samples. Females with RLS are prone to develop migraine. Depression and severity of RLS or insomnia do not affect development of headache.

  1. Restless legs syndrome in patients on dialysis

    International Nuclear Information System (INIS)

    AlJahdali, Hamdan H; AlQadhi, Waleed A; Khogeer, Haithm A; AlHejaili, Fayez F; Al Sayyari, Abdullah A; AlGhamdi, Saeed M

    2009-01-01

    Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 + - 17.2 years and mean duration on dialysis 40.4 + - 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and

  2. Restless legs syndrome in patients on dialysis

    Directory of Open Access Journals (Sweden)

    Al-Jahdali Hamdan

    2009-01-01

    Full Text Available Restless legs syndrome (RLS is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG. This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH, Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC, Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG′s RLS Questionnaire (RLSQ. Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 ± 17.2 years and mean duration on dialysis 40.4 ± 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM, coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively. Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS (P= < 0.001 and 0.001, respectively. Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis

  3. Not only limbs in atypical restless legs syndrome.

    Science.gov (United States)

    Turrini, Alessandra; Raggi, Alberto; Calandra-Buonaura, Giovanna; Martinelli, Paolo; Ferri, Raffaele; Provini, Federica

    2018-04-01

    Restless legs syndrome (RLS) typically affects the limbs, but the involvement of other body parts has also been reported. In this essay, we critically review all literature reports of atypical RLS cases with unusual localizations. Applying the updated diagnostic criteria of the International restless legs syndrome study group (IRLSSG), which also consider symptoms localized outside of the lower limbs, a few of these atypical cases reported in the previous literature resulted in a definitive diagnosis of RLS. We also discuss the relationship between RLS and burning mouth syndrome (BMS) or restless genital syndrome (RGS). We conclude clinical sleep specialists should be aware of unusual RLS localizations because they respond to the usual treatment for RLS. All the IRLSSG diagnostic criteria should be applied in every suspected case, in order to establish a correct diagnosis of this disabling but treatable condition. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. The biopsychosocial effects of restless legs syndrome (RLS)

    OpenAIRE

    Becker, Philip M

    2006-01-01

    The symptoms of restless legs syndrome (RLS) are associated with reductions in patients? quality of life (QoL) and mental heath. Sleep disturbance, which is often the most troublesome symptom of RLS, may have a negative impact on patients? daytime cognitive abilities. Research has established a relationship between the symptoms of RLS and mood symptoms, but causality is unclear. Some studies have indicated that the symptoms of RLS precede those of depression or anxiety, and others relate the ...

  5. Restless Legs Syndrome in a Nigerian Elderly Population.

    Science.gov (United States)

    Fawale, Michael B; Ismail, Ishaq Alani; Mustapha, Adekunle F; Komolafe, Morenikeji A; Adedeji, Tewogbade A

    2016-07-15

    The prevalence of restless legs syndrome (RLS) is highest in the elderly in Caucasian populations; the prevalence of RLS in elderly Africans is not known. This study aimed at determining the frequency and associations of RLS in a Nigerian elderly population. The study population comprised of 633 consecutive elderly individuals aged 65-105 years attending the general outpatient clinic of the State Hospital, Ilesa, for minor complaints and routine check-up. The diagnosis of RLS was made using the 2003 minimal criteria of the International Restless Legs Syndrome Study Group. Relevant sociodemographic and clinical data, including sleep duration, were also obtained. Restless legs syndrome was found in 3.5% of the study population with a male-female ratio of 2:1. There was no significant age (p = 0.427) or gender (p = 0.178) influence on the prevalence of RLS except in the 75- to 84-year age group where there was significant male preponderance (p = 0.044). A strong independent association between RLS and sleep duration (OR, 3.229; 95% CI, 1.283-8.486; p = 0.013) and past history of head injury (OR, 4.691; 95% CI, 1.750-12.577; p = 0.002) was found. Our finding support previous reports of a possible lower prevalence of RLS in Africans. Restless legs syndrome independently increases the odds of habitual sleep curtailment in elderly individuals. Head injury may be a risk factor for future RLS; this requires further investigation as indirect evidence for a possible link between RLS and traumatic brain injury exists. © 2016 American Academy of Sleep Medicine.

  6. Motor hyperactivity of the iron-deficient rat - an animal model of restless legs syndrome.

    Science.gov (United States)

    Lai, Yuan-Yang; Cheng, Yu-Hsuan; Hsieh, Kung-Chiao; Nguyen, Darian; Chew, Keng-Tee; Ramanathan, Lalini; Siegel, Jerome M

    2017-12-01

    Abnormal striatal dopamine transmission has been hypothesized to cause restless legs syndrome. Dopaminergic drugs are commonly used to treat restless legs syndrome. However, they cause adverse effects with long-term use. An animal model would allow the systematic testing of potential therapeutic drugs. A high prevalence of restless legs syndrome has been reported in iron-deficient anemic patients. We hypothesized that the iron-deficient animal would exhibit signs similar to those in restless legs syndrome patients. After baseline polysomnographic recordings, iron-deficient rats received pramipexole injection. Then, iron-deficient rats were fed a standard rodent diet, and polysomnographic recording were performed for 2 days each week for 4 weeks. Iron-deficient rats have low hematocrit levels and show signs of restless legs syndrome: sleep fragmentation and periodic leg movements in wake and in slow-wave sleep. Iron-deficient rats had a positive response to pramipexole treatment. After the iron-deficient rats were fed the standard rodent diet, hematocrit returned to normal levels, and sleep quality improved, with increased average duration of wake and slow-wave sleep episodes. Periodic leg movements decreased during both waking and sleep. Hematocrit levels positively correlated with the average duration of episodes in wake and in slow-wave sleep and negatively correlated with periodic leg movements in wake and in sleep. Western blot analysis showed that striatal dopamine transporter levels were higher in iron-deficient rats. The iron-deficient rat is a useful animal model of iron-deficient anemic restless legs syndrome. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

  7. A case of reversible restless legs syndrome (RLS) and sleep-related eating disorder relapse triggered by acute right leg herpes zoster infection: literature review of spinal cord and peripheral nervous system contributions to RLS.

    Science.gov (United States)

    Mahowald, Mark W; Cramer Bornemann, Michel A; Schenck, Carlos H

    2010-06-01

    Restless legs syndrome (RLS) is thought to be due to abnormalities of iron metabolism in the central nervous system; however, occasional cases are associated with lesions of the spinal cord, spinal rootlets, and peripheral nervous system. This is a case report of RLS exacerbated by shingles with a review of the literature of extra-cerebral lesions or disorders causing or contributing to RLS. Copyright 2010 Elsevier B.V. All rights reserved.

  8. Restless legs syndrome and nocturnal leg cramps: a review and guide to diagnosis and treatment.

    Science.gov (United States)

    Tipton, Philip W; Wszołek, Zbigniew K

    2017-12-22

    Restless legs syndrome (RLS) and nocturnal leg cramps (NLCs) are common disorders affecting 7.0% and 24.1% of the population in some European countries, respectively. Patients suffering from RLS experience uncomfortable nocturnal sensations in the legs with the urge to move that dissipates while moving. NLC is characterized by abrupt muscle contraction, most often in the gastrocnemius or foot muscles, which occurs at night and may result in significant sleep disturbances. The diagnosis of these disorders has presented a challenge to health care providers because of symptom overlap with other sensory and motor disturbances with nocturnal predominance. Treatment options and approaches are lacking, partially because of our currently incomplete understanding of the pathophysiological mechanisms underlying these conditions. We reviewed the medical literature to provide a comprehensive assessment of RLS and NLC with a focus on improved diagnostic accuracy and treatment approaches.

  9. Restless Legs Syndrome and Cognitive Function: A Population-based Cross-sectional Study.

    Science.gov (United States)

    Rist, Pamela M; Elbaz, Alexis; Dufouil, Carole; Tzourio, Christophe; Kurth, Tobias

    2015-09-01

    Restless legs syndrome has been speculated to be linked to cognitive impairment through vascular risk factors or through its effect on sleep deprivation. Previous studies on the association between restless legs syndrome and cognitive function have been inconclusive. We performed a cross-sectional analysis of the association between restless legs syndrome and cognitive function using data from a large population-based study of elderly individuals residing in France. We used information from 2070 individuals from the Dijon, France center of the Three-City study who had available information on restless legs syndrome and cognitive functioning measures. Restless legs syndrome was assessed using the 4 minimal diagnostic criteria of the International Restless Legs Study Group. During the same wave in which restless legs syndrome status was assessed, cognitive functions also were assessed using 4 tests: Isaacs' test of verbal/category fluency, the Benton Visual Retention Test, the Trail Making Test B, and the Mini-Mental State Examination. We created a summary global cognitive score by summing the z scores for the 4 tests and used analysis of covariance to explore the association between restless legs syndrome and cognitive function. We did not observe any statistically significant differences in any cognitive z-score between those with restless legs syndrome and those without restless legs syndrome. The mean global z-score after multivariate adjustment was -0.003 (SE 0.173) for those with restless legs syndrome and -0.007 (SE 0.129) for those without restless legs syndrome (P-value = .98). Data from this large, population-based study do not suggest that restless legs syndrome is associated with prevalent cognitive deficits in elderly individuals. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Restless Legs Syndrome as a Comorbidity in Rheumatoid Arthritis

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    John A. Gjevre

    2013-01-01

    Full Text Available Rheumatoid arthritis (RA is a multisystem disease with a complex immunologic pathophysiology. Likewise, sleep disorders can involve a complicated interplay between the neurologic pathways, immune system, and respiratory system. Recent studies have shown an elevated prevalence of sleep abnormalities in connective tissue disorders compared to the general population. Restless legs syndrome (RLS may be present in up to 30% of RA patients. These findings may be related to cytokine release and other immunomodulatory responses. TNF-α levels relate to sleep physiology and anti-TNF-α therapy may improve sleep patterns. Most of the patients with this disorder can distinguish their RLS sensations from their arthritic symptoms. RLS is a common comorbidity seen with RA, and prompt recognition and treatment can improve patient quality of life.

  11. Does Restless Legs Syndrome increase cardiovascular risk in Attention-Deficit/Hyperactivity Disorder?

    Science.gov (United States)

    Angriman, Marco; Bruni, Oliviero; Cortese, Samuele

    2013-01-01

    Preliminary evidence suggests a possible association between Attention-Deficit/Hyperactivity Disorder and Restless Legs Syndrome with or without Periodic Limb Movements during Sleep. When comorbid, Restless Legs Syndrome/Periodic Limb Movements during Sleep might aggravate Attention-Deficit/Hyperactivity Disorder symptoms. Pharmacological treatment of Attention-Deficit/Hyperactivity Disorder may be associated, at least in some cases, with adverse cardiovascular events, including clinically significant elevation in heart rate and systemic blood pressure. However, the characteristics of patients with Attention-Deficit/Hyperactivity Disorder at risk for cardiovascular events during pharmacological treatment are poorly understood. Here, we hypothesize that Restless Legs Syndrome and/or Periodic Limb Movements during Sleep comorbid with Attention-Deficit/Hyperactivity Disorder increase cardiovascular risk via imbalance in activity of the autonomic nervous system. Such an imbalance of the could be related to alterations of sleep microarchitecture also detected by cyclic alternating pattern analysis. If empirical studies confirm our hypothesis, the clinician would be advised to systematically screen for and effectively treat Restless Legs Syndrome/Periodic Limb Movements during Sleep even before starting treatment with Attention-Deficit/Hyperactivity Disorder drugs. The management of Restless Legs Syndrome/Periodic Limb Movements during Sleep might reduce cardiovascular risk during pharmacological treatment of Attention-Deficit/Hyperactivity Disorder. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Restless legs syndrome and impact on work performance

    Directory of Open Access Journals (Sweden)

    Diana Samara

    2016-02-01

    Full Text Available Restless legs syndrome (RLS is a neurological sensorimotor disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. The RSL prevalence in the general population is 0.1% - 11.5%, and increases with age, with the highest effect of producing a primary sleep disorder (70%-80%. Women appear to be at increased risk, as do individuals with certain chronic conditions, including renal failure and anemia. The pathophysiology of RLS is incompletely understood, but it probably results from derangements in dopamine and iron metabolism, and has a genetic component. RSL could be idiopathic or secondary (usually related with iron deficiency, terminal renal failure, pregnancy, and spinal cord lesions. RLS patients usually have sleep disorders, so the disease can cause difficulties and problems in occupational and social life. Subjects with RLS symptoms appear to experience significantly more daytime problems, including being late for work, making errors at work, or missing work because of sleepiness. The diagnosis of RLS is made by following the criteria of the International Restless Legs Syndrome Study Group (IRLSSG. Pharmacologic RLS therapy, in which dopaminergic drugs constitute the first line, is effective and may have a dramatic effect on symptoms and quality of life. Identifying and treating RLS may improve sleep quality, daytime function and work performance.

  13. Restless legs syndrome and impact on work performance

    Directory of Open Access Journals (Sweden)

    Diana Samara

    2009-04-01

    Full Text Available Restless legs syndrome (RLS is a neurological sensorimotor disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. The RSL prevalence in the general population is 0.1% - 11.5%, and increases with age, with the highest effect of producing a primary sleep disorder (70%-80%. Women appear to be at increased risk, as do individuals with certain chronic conditions, including renal failure and anemia. The pathophysiology of RLS is incompletely understood, but it probably results from derangements in dopamine and iron metabolism, and has a genetic component. RSL could be idiopathic or secondary (usually related with iron deficiency, terminal renal failure, pregnancy, and spinal cord lesions. RLS patients usually have sleep disorders, so the disease can cause difficulties and problems in occupational and social life. Subjects with RLS symptoms appear to experience significantly more daytime problems, including being late for work, making errors at work, or missing work because of sleepiness. The diagnosis of RLS is made by following the criteria of the International Restless Legs Syndrome Study Group (IRLSSG. Pharmacologic RLS therapy, in which dopaminergic drugs constitute the first line, is effective and may have a dramatic effect on symptoms and quality of life. Identifying and treating RLS may improve sleep quality, daytime function and work performance.

  14. Review of periodic limb movement and restless leg syndrome

    Directory of Open Access Journals (Sweden)

    Natarajan R

    2010-01-01

    Full Text Available Periodic limb movement (PLM and Restless leg syndrome (RLS are types of sleep disorders that are not very well recognized in clinical practice. While RLS is a clinical diagnosis, the diagnosis of PLM is made by polysomnography. They share the same pathophysiology and often respond to the same treatment. To date all the epidemiological studies have reported the prevalence between 2% and 15%. It has recently become known that mild obstructive sleep apnea and upper airway resistance syndrome (UARS can masquerade as PLM syndrome. New discoveries have been made with regard to genetics and PLM and RLS. Detailed review on this subject should improve the awareness of these disorders, both among general physicians and specialists. Extensive review of journals in the past 20 years was made using Medline search.

  15. Pramipexole alters thermoregulation in restless legs syndrome.

    Science.gov (United States)

    Salminen, Aaro V; Rimpilä, Ville; Polo, Olli

    2014-12-15

    Previous studies have associated restless legs syndrome (RLS) with peripheral hypoxia and impaired thermoregulation in the lower extremities. We performed long-term monitoring of skin temperatures in order to investigate whether these findings could be explained by reduced blood flow to the peripheral tissues. 96-hour continuous measurements of skin temperature were performed both in the distal and proximal parts of the body of 15 patients with RLS and 14 healthy controls. During the recording, the patients participated in suggested immobilization tests both with and without pramipexole medication. We found no baseline differences in distal or proximal skin temperature between patients and controls in daytime or during immobilization. However, pramipexole significantly increased distal skin temperature in the patient group during immobilization (31.1°C vs. 32.9°C, p thermoregulation and the previous studies might have been biased by medication. Dopaminergic medication is a major confounding factor when assessing peripheral phenomena in RLS and should be controlled for in the future studies. © 2014 American Academy of Sleep Medicine.

  16. Clinical correlates of the restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Luis Fabiano Marin

    2012-07-01

    Full Text Available OBJECTIVE: To determine the clinical correlates of the restless legs syndrome (RLS in a Brazilian sleep disorders center. METHODS: We retrospectively studied 118 patients with RLS from January, 2004, to December, 2010. The analyzed variables were: age at disease onset, gender, race, years of school instruction, primary and secondary RLS, and treatment options. RESULTS: Among the studied patients, 83.9% were women with a female/male sex ratio of 5:1. Mean age of the patients at symptom onset ± standard deviation was 41.7±17.9 years-old. The primary RLS was found in 85% of patients. The other 15% remainders consisted of secondary forms, and they were associated with neuropathy, iron deficiency anemia, end-stage renal disease, or Parkinson's disease. Drug therapy for RLS was introduced in 67% of patients. CONCLUSIONS: Most patients presented primary RLS with an early disease onset. Further epidemiological studies are welcomed to provide better information on secondary RLS in Brazil.

  17. Actigraphic assessment of periodic leg movements in patients with restless legs syndrome.

    Science.gov (United States)

    Cippà, Maria A T; Baumann, Christian R; Siccoli, Massimiliano M; Bassetti, Claudio L; Poryazova, Rositsa; Werth, Esther

    2013-10-01

    The diagnosis of restless legs syndrome (RLS) relies upon diagnostic criteria which are based on history only, and dopaminergic treatment is not normally the first choice of treatment for all patients. It would be worthwhile to identify patients non-responsive to dopaminergic treatment beforehand, because they may suffer from a restless legs-like syndrome and may require alternative treatment. We included retrospectively 24 adult patients fulfilling the four essential criteria for restless legs and 12 age-matched healthy controls. They were investigated by ambulatory actigraphy from both legs over three nights, and patients started treatment with dopamine agonists after this diagnostic work-up. We examined 12 responders to dopaminergic treatment and 12 non-responders and studied the association between response to dopaminergic treatment and the periodic limb movement index (PLMI) as assessed with actigraphy. Demographic characteristics, excessive daytime sleepiness and fatigue at baseline were similar in all three groups. Baseline RLS severity was similar between responders and non-responders [International Restless Legs Severity Scale (IRLS): 25 ± 9 and 24 ± 8]. Group comparisons of PLMI before treatment initiation showed significant differences between the three groups. Post-hoc pairwise comparisons revealed that healthy controls had significantly lower PLMI (4.9 ± 4.5) than responders (29.3 ± 22.7) and non-responders (13.3 ± 11.2). Similarly, the PLMI in responders was lower than in non-responders. PLMI day-to-day variability did not differ between responders and non-responders and there was no correlation between treatment effect, as assessed by the decrease of the IRLS and baseline PLMI. Our retrospective study indicates that actigraphy to assess periodic limb movements may contribute to a better diagnosis of dopamine-responsive restless legs syndrome. © 2013 European Sleep Research Society.

  18. Conjoined legs: Sirenomelia or caudal regression syndrome?

    OpenAIRE

    Das, Sakti Prasad; Ojha, Niranjan; Ganesh, G Shankar; Mohanty, Ram Narayan

    2013-01-01

    Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting re...

  19. Therapeutic advances in restless legs syndrome (RLS).

    Science.gov (United States)

    Högl, Birgit; Comella, Cynthia

    2015-09-15

    Levodopa and dopamine agonists have been the main treatment for restless legs syndrome during the past decades. Although their efficacy has been well documented over the short term, long-term dopaminergic treatment is often complicated by augmentation, loss of efficacy, and other side effects. Recent large randomized controlled trials provide new evidence for the efficacy of high-potency opioids and α2δ ligands, and several post hoc analyses, meta-analyses, algorithms, and guidelines have been published, often with a specific focus, for example, on augmentation, or on management of restless legs syndrome during pregnancy. Several new contributions to understanding the pathophysiology of restless legs syndrome have been published, but at this time, whether they will have an impact on treatment possibilities in the future cannot be estimated. © 2015 International Parkinson and Movement Disorder Society.

  20. Dissociation of periodic leg movements from arousals in restless legs syndrome.

    Science.gov (United States)

    Manconi, Mauro; Ferri, Raffaele; Zucconi, Marco; Bassetti, Claudio L; Fulda, Stephany; Aricò, Debora; Ferini-Strambi, Luigi

    2012-06-01

    The purpose of this study was to characterize the nature of the relation between periodic leg movements during sleep (PLMS) and cortical arousals to contribute to the debate on the clinical significance and treatment of PLMS. A prospective, placebo-controlled, single-blind, parallel group study was carried out including 46 drug-naive patients with idiopathic restless legs syndrome (RLS). Each patient underwent 2 consecutive full-night polysomnographic studies. The first night was the baseline night. Prior to the second night, 1 group received a single oral dose of 0.25mg pramipexole, whereas a second group received a single oral dose of 0.5mg clonazepam, and the remaining patients received placebo. Sleep stages, cyclic alternating pattern (CAP), and leg movement activity were scored following standard criteria; symptoms of RLS were also assessed. Pramipexole suppressed PLMS without affecting electroencephalographic (EEG) instability (CAP) and arousals (corresponding to CAP A3 and, partially, A2 subtypes), whereas clonazepam did the opposite, reducing non-rapid eye movement sleep EEG instability without effects on PLMS. Both drugs were effective on sensory RLS symptoms. This study demonstrates that a selective pharmacological approach can disconnect PLMS from arousal events, suggesting an indirect relation between each other. These results might weaken the hypothesis of a direct pathological role of PLMS in sleep disruption and can be important for the discussion on the existence of a distinct entity called periodic limb movements disorder. Moreover, the study opens the doors to the possibility of a joint treatment for RLS targeting sensory and motor symptoms, as well as sleep instability. Copyright © 2012 American Neurological Association.

  1. Restless Legs Syndrome and Leg Motor Restlessness in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Keisuke Suzuki

    2015-01-01

    Full Text Available Sleep disturbances are important nonmotor symptoms in Parkinson’s disease (PD that are associated with a negative impact on quality of life. Restless legs syndrome (RLS, which is characterized by an urge to move the legs accompanied by abnormal leg sensations, can coexist with PD, although the pathophysiology of these disorders appears to be different. RLS and PD both respond favorably to dopaminergic treatment, and several investigators have reported a significant relationship between RLS and PD. Sensory symptoms, pain, motor restlessness, akathisia, and the wearing-off phenomenon observed in PD should be differentiated from RLS. RLS in PD may be confounded by chronic dopaminergic treatment; thus, more studies are needed to investigate RLS in drug-naïve patients with PD. Recently, leg motor restlessness (LMR, which is characterized by an urge to move the legs that does not fulfill the diagnostic criteria for RLS, has been reported to be observed more frequently in de novo patients with PD than in age-matched healthy controls, suggesting that LMR may be a part of sensorimotor symptoms intrinsic to PD. In this paper, we provide an overview of RLS, LMR, and PD and of the relationships among these disorders.

  2. Sleep Disorders

    Science.gov (United States)

    ... the day, even if you have had enough sleep? You might have a sleep disorder. The most common kinds are Insomnia - a hard time falling or staying asleep Sleep apnea - breathing interruptions during sleep Restless legs syndrome - ...

  3. Association between restless leg syndrom and slow coronary flow.

    Science.gov (United States)

    Erden, İsmail; Çakcak Erden, Emine; Durmuş, Hacer; Tıbıllı, Hakan; Tabakçı, Mustafa; Kalkan, Mehmet Emin; Türker, Yasin; Akçakoyun, Mustafa

    2014-11-01

    Restless legs syndrome (RLS) is a common sleep disorder in which patients feel unpleasent leg sensations and urge to move the legs during rest, especially at night, and symptoms are improved by leg movement. Prior studies analyzing the associations between cardiovascular disease and restless legs syndrome has shown controversial results. The goal of the study was to estimate the relationship between restless legs syndrome and slow coronary flow (SCF). The present study was cross-sectional and observational and consists of 176 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 86 patients with isolated SCF and 90 control participants with normal coronary flow (NCF). RLS was assessed the day after the coronry flow was evaluated, using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The following question was asked: "Do you have unpleasant leg sensations (like crawling, paraesthesia, or pain) combined with motor restlessness and an urge to move?" The possible responses were as follows: no, less than once/month, 2-4 times/month, 5-14 times/month, and 15 or more times per month. Those who answered that they had these feelings were asked the following two more questions: 1) "Do these symptoms occur only at rest and does moving improve them?" and 2) "Are these symptoms worsen in the evening/at night compared with the morning?" RLS is considered to be probable if the participant has answered "yes" for all three of the above questions, and has a frequency of ≥5 times/month. Student's t-test, Mann-Whitney U test, multiple logistic regression analysis were used for statistical analysis. The prevalence of restless legs syndrome was 48 (27%) and increased significantly with age. Patients with SCF have more likely had RLS than the control group (p<0.001). The age-adjusted prevalence odds of SCF were 3.11 times higher (95% CI: 1

  4. Restless legs syndrome: a rarity in the Nigerian pregnant population?

    Science.gov (United States)

    Fawale, Michael B; Ismaila, Isiaka A; Kullima, Abubakar A; Komolafe, Morenikeji A; Ijarotimi, Omotade A; Olowookere, Samuel Anu; Oluyombo, Rotimi; Adedeji, Tewogbade Adeoye

    2018-03-01

    The prevalence of RLS in pregnancy is higher when compared with the general population however it remains unknown among indigenous black Africans. Available data indicate that RLS is uncommon in sub-Saharan Africa. We embarked on this study to determine the prevalence and characteristics of RLS in an antenatal clinic sample of Nigerian pregnant women compared with a primary care sample of non-pregnant women. A total of 310 pregnant women and non-pregnant women filled out a questionnaire which incorporated the 2014 minimal criteria of the International Restless Legs Syndrome Study Group. Demographic and clinical data, including sleep duration and samples for blood hemoglobin concentration and urinalysis were obtained. The mean ages of the pregnant and non-pregnant women were 24.9 ± 5.6 years and 23.6 + 5.4 years, respectively (p = 0.003). There was no case of RLS found among pregnant women while five (1.6%) of the non-pregnant women fulfilled the criteria for RLS. Overall, the prevalence report of RLS symptoms was associated with lower mean habitual nocturnal sleep duration (p leg cramps (p leg cramps and proteinuria were independently associated with RLS. The prevalence of restless legs syndrome is low among women of child-bearing age in the Nigerian population and may be lower in pregnancy. Report of leg cramps and proteinuria are independently associated with RLS. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Complex sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Wang J

    2013-07-01

    Full Text Available Juan Wang,1,* Yan Wang,1,* Jing Feng,1,2 Bao-yuan Chen,1 Jie Cao1 1Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People's Republic of China; 2Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA *The first two authors contributed equally to this work Abstract: Complex sleep apnea syndrome (CompSAS is a distinct form of sleep-disordered breathing characterized as central sleep apnea (CSA, and presents in obstructive sleep apnea (OSA patients during initial treatment with a continuous positive airway pressure (CPAP device. The mechanisms of why CompSAS occurs are not well understood, though we have a high loop gain theory that may help to explain it. It is still controversial regarding the prevalence and the clinical significance of CompSAS. Patients with CompSAS have clinical features similar to OSA, but they do exhibit breathing patterns like CSA. In most CompSAS cases, CSA events during initial CPAP titration are transient and they may disappear after continued CPAP use for 4–8 weeks or even longer. However, the poor initial experience of CompSAS patients with CPAP may not be avoided, and nonadherence with continued therapy may often result. Treatment options like adaptive servo-ventilation are available now that may rapidly resolve the disorder and relieve the symptoms of this disease with the potential of increasing early adherence to therapy. But these approaches are associated with more expensive and complicated devices. In this review, the definition, potential plausible mechanisms, clinical characteristics, and treatment approaches of CompSAS will be summarized. Keywords: complex sleep apnea syndrome, obstructive sleep apnea, central sleep apnea, apnea threshold, continuous positive airway pressure, adaptive servo-ventilation

  6. Association of incident restless legs syndrome with outcomes in a large cohort of US veterans.

    Science.gov (United States)

    Molnar, Miklos Z; Lu, Jun L; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P

    2016-02-01

    Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all-cause mortality, incident coronary heart disease, stroke and chronic kidney disease. From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow-up time of 8.1 years (interquartile range: 7.0-8.5 years)] with baseline estimated glomerular filtration rate ≥ 60 mL min(-1) 1.73 m(-2), a propensity-matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined: (1) all-cause mortality; (2) incident coronary heart disease; (3) incident strokes; and (4) incident chronic kidney disease defined as estimated glomerular filtration rate restless legs syndrome-negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70-2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26-4.84) and 3.89 (3.07-4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74-3.66)] compared with restless legs syndrome-negative counterparts. In this large and contemporary cohort of US veterans, incident restless legs syndrome was associated with higher risk of mortality, incident coronary heart disease, stroke and chronic kidney disease. © 2015 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

  7. The restless legs syndrome (Ekbom's syndrome)

    African Journals Online (AJOL)

    1983-04-30

    Apr 30, 1983 ... same distribution as the paraesthesiae; and (v) anxiety, tension or mild depression. Paraesthesiae or creeping sensations are usually confined to the calves. They are extremely unpleasant and deep-seated in muscles or bones rather than in the skin, mostly affecting the legs between the knee and ankle.

  8. Conjoined legs: Sirenomelia or caudal regression syndrome?

    Directory of Open Access Journals (Sweden)

    Sakti Prasad Das

    2013-01-01

    Full Text Available Presence of single umbilical persistent vitelline artery distinguishes sirenomelia from caudal regression syndrome. We report a case of a12-year-old boy who had bilateral umbilical arteries presented with fusion of both legs in the lower one third of leg. Both feet were rudimentary. The right foot had a valgus rocker-bottom deformity. All toes were present but rudimentary. The left foot showed absence of all toes. Physical examination showed left tibia vara. The chest evaluation in sitting revealed pigeon chest and elevated right shoulder. Posterior examination of the trunk showed thoracic scoliosis with convexity to right. The patient was operated and at 1 year followup the boy had two separate legs with a good aesthetic and functional results.

  9. Restless Leg Syndrome in Diabetics Compared with Normal Controls

    Directory of Open Access Journals (Sweden)

    Mehdi Zobeiri

    2014-01-01

    Full Text Available Introduction. Restless leg syndrome (RLS is a common sleep disorder which is characterized by urge to move the legs accompanied by disturbing and uncomfortable leg sensation during night and rest. This common condition affects 7–10% of general population and is frequently unrecognized, misdiagnosed, and poorly managed. Several clinical conditions like diabetes have been associated with secondary form of RLS. This study analyzed the frequency and possible risk factor for RLS development in diabetic patient. Material and Methods. This descriptive case-control study was done on 140 consecutive outpatient diabetics and age, sex, and body mass index matched control group. RLS was diagnosed by criteria of the International RLS Study Group. Results. Prevalence of RLS was 28.6% in diabetes and 7.1% in control group (P=0.001. Sex difference was not significant and with rising duration of diabetes prevalence of RLS was not increased. Discussion. With regarding significant association between RLS and diabetes and its negative impact on quality of life/health outcome/sleep/daytime activity/cognitive function/ and mental state of diabetic patient/higher awareness of RLS among physicians and related health worker suggested.

  10. Restless leg syndrome in diabetics compared with normal controls.

    Science.gov (United States)

    Zobeiri, Mehdi; Shokoohi, Azita

    2014-01-01

    Introduction. Restless leg syndrome (RLS) is a common sleep disorder which is characterized by urge to move the legs accompanied by disturbing and uncomfortable leg sensation during night and rest. This common condition affects 7-10% of general population and is frequently unrecognized, misdiagnosed, and poorly managed. Several clinical conditions like diabetes have been associated with secondary form of RLS. This study analyzed the frequency and possible risk factor for RLS development in diabetic patient. Material and Methods. This descriptive case-control study was done on 140 consecutive outpatient diabetics and age, sex, and body mass index matched control group. RLS was diagnosed by criteria of the International RLS Study Group. Results. Prevalence of RLS was 28.6% in diabetes and 7.1% in control group (P = 0.001). Sex difference was not significant and with rising duration of diabetes prevalence of RLS was not increased. Discussion. With regarding significant association between RLS and diabetes and its negative impact on quality of life/health outcome/sleep/daytime activity/cognitive function/ and mental state of diabetic patient/higher awareness of RLS among physicians and related health worker suggested.

  11. The biopsychosocial effects of restless legs syndrome (RLS).

    Science.gov (United States)

    Becker, Philip M

    2006-12-01

    The symptoms of restless legs syndrome (RLS) are associated with reductions in patients' quality of life (QoL) and mental heath. Sleep disturbance, which is often the most troublesome symptom of RLS, may have a negative impact on patients' daytime cognitive abilities. Research has established a relationship between the symptoms of RLS and mood symptoms, but causality is unclear. Some studies have indicated that the symptoms of RLS precede those of depression or anxiety, and others relate the severity of mood symptoms to the severity of RLS symptoms. Associations between the sleep disturbance produced by RLS and patients' mood symptoms have also been demonstrated. The impact of RLS symptoms and their treatment on QoL, mental health, and cognition are reviewed herein.

  12. Psychosomatic symptom profiles in patients with restless legs syndrome.

    Science.gov (United States)

    Kim, Jung Bin; Koo, Yong Seo; Eun, Mi-Yeon; Park, Kun-Woo; Jung, Ki-Young

    2013-09-01

    It has been reported that restless legs syndrome (RLS) might be associated with multiple psychosomatic symptoms. We aimed to identify which psychosomatic symptom is the most related in RLS patients compared to healthy controls. We also attempted to determine the relation between psychosomatic comorbidity and RLS severity regardless of sleep-related symptoms. One hundred two newly diagnosed patients with RLS and 37 healthy control subjects participated in the present study. The RLS patients were categorized as mild and severe based on the International RLS Study Group rating scale. Data on demographics were collected. All participants completed the Pittsburgh Sleep Quality Index, Athens Insomnia Scale, and Epworth Sleepiness Scale as sleep-related questionnaires. All participants completed the Symptom Checklist-90-Revision (SCL-90-R). RLS patients were found to have pervasive comorbid psychosomatic symptoms. Somatization was found to be the most significant contributing factor (OR 1.145, 95 % CI 1.061-1.234, p psychosomatic comorbidity in RLS. Severe RLS patients were found to have poorer sleep quality than mild RLS patients. Furthermore, severe RLS patients had higher scores for most psychosomatic symptom domains in SCL-90-R. Anxiety was found to be the most independent contributing factor for psychosomatic comorbidity according to RLS severity (OR 1.145, 95 % CI 1.043-1.257, p = 0.005). Our study demonstrates that comorbid psychosomatic distress is considerable in patients with RLS. Furthermore, most psychosomatic comorbidity is increased with the RLS severity in association with poorer sleep quality.

  13. The influence of antidepressants on restless legs syndrome and periodic limb movements: A systematic review.

    Science.gov (United States)

    Kolla, Bhanu Prakash; Mansukhani, Meghna P; Bostwick, J Michael

    2018-04-01

    Restless legs syndrome is commonly co-morbid with medical conditions that are treated with antidepressant medications, such as depression, anxiety, fibromyalgia, and chronic insomnia disorder. Evidence from case reports and cross-sectional studies suggests that antidepressants may induce or worsen restless legs syndrome and increase periodic limb movements. We undertook a systematic review of the literature to identify and collate all prospective studies that measured restless legs syndrome symptoms and/or periodic limb movements following the introduction of an antidepressant. Eighteen studies were eligible for inclusion. Current data indicate that onset or exacerbation of restless legs syndrome and rise in frequency of periodic limb movements are uncommon following the initiation of an antidepressant. Among the various antidepressants, mirtazapine may be associated with higher rates of restless legs syndrome and periodic limb movements. One small study of normal volunteers suggested that venlafaxine may be associated with an increase in restless legs syndrome symptoms and periodic limb movements. Sertraline, fluoxetine, and amitriptyline appear to increase periodic limb movements that do not disrupt sleep and are thus unlikely to be clinically significant. On the other hand, bupropion may reduce restless legs syndrome symptoms, at least in the short term. Sedating antidepressants such as trazodone, nefazodone, and doxepin do not seem to aggravate periodic limb movements. The current evidence is limited by poor study design, inadequate use of standardized questionnaires, and heterogeneous populations studied for variable lengths of time. Future research should attempt to remedy these shortcomings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Is preeclampsia associated with restless legs syndrome?

    OpenAIRE

    Ramirez, J O; Cabrera, S A S; Hidalgo, H; Cabrera, S G; Linnebank, M; Bassetti, C L; Kallweit, U

    2013-01-01

    OBJECTIVE: Restless legs syndrome (RLS) is a common neurologic disorder. Secondary RLS includes pregnancy and iron deficiency. Prevalence of RLS in pregnancy ranges from 11% to 27%. We aimed to assess the frequency and characteristics of RLS in pregnancy in a Peruvian population and to evaluate the possible pregnancy or delivery complications due to RLS. METHODS: We assessed 218 consecutive expectant mothers at the inpatient clinic of the Hospital San Bartolome in Lima, Peru. Assessment wa...

  15. Restless legs syndrome and pregnancy: A review

    OpenAIRE

    Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

    2014-01-01

    Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-sta...

  16. Gabapentin enacarbil – clinical efficacy in restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Pinky Agarwal

    2010-04-01

    Full Text Available Pinky Agarwal1, Alida Griffith1, Henry R Costantino2, Narendra Vaish31Booth Gardner Parkinson’s Center, Kirkland, WA, USA; 2Costantino Consulting, Woodinville, WA, USA; 3Kirkland, WA, USAAbstract: Restless legs syndrome (RLS is a sleep-related movement disorder commonly involving an unpleasant urge to move the limbs, typically the legs. Dopaminergic agents represent the first-line therapy for RLS; however, long-term use of such drugs results in worsening symptoms due to “augmentation” or other adverse events. Gabapentin, an analog of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA, is an anticonvulsant/analgesic agent. Gabapentin is only mildly effective in relieving RLS symptoms, perhaps a result of its poor absorption from the gastrointestinal (GI tract. Gabapentin enacarbil is a prodrug of gabapentin specifically designed to enhance absorption via the GI tract, and hence provide improved circulating levels of gabapentin on metabolism. Clinical trials to date have demonstrated favorable safety and (compared to traditional gabapentin improved pharmacokinetics and efficacy in treating RLS symptoms. Thus, gabapentin enacarbil may prove to be a useful drug in treating RLS. An application of gabapentin enacarbil for treatment of RLS is currently pending with FDA for approval.Keywords: restless legs syndrome, gabapentin enacarbil, movement disorder

  17. [Restless legs syndrome and nocturnal leg pain : Differential diagnosis and treatment].

    Science.gov (United States)

    Hornyak, M; Stiasny-Kolster, K; Evers, S; Happe, S

    2011-09-01

    Pain in the legs belongs to the five most frequent regional pain symptoms. Restless legs syndrome (RLS) presents a particular differential diagnosis for pain in the legs, which is characterized by a nocturnal urge to move the legs often associated with painful sensations in the legs. It is one of the most common neurological disorders and probably the leading cause of nocturnal pain in the legs. In this overview, the diagnosis and therapy of RLS as well as aspects of pain therapy of the disorder are presented. In addition, the differential diagnoses for exclusion of other specific causes of nocturnal pain in the legs are discussed.

  18. Sleep overlap syndrome

    Directory of Open Access Journals (Sweden)

    Fariba Rezaeetalab

    2016-12-01

    Full Text Available Overlap syndrome, which is known as the coexistence of chronic obstructive pulmonary disease (COPD and obstructive sleep apnea (OSA, was first defined by Flenley. Although it can refer to concomitant occurrence of any of the pulmonary diseases and OSA, overlap syndrome is commonly considered as the coexistence of OSA and COPD. This disease has unique adverse health consequences distinct from either condition alone. Given the high prevalence of each solitary disease, overlap syndrome is also likely to be common and clinically relevant. Despite the fact that overlap syndrome has been described in the literature for nearly 30 years, paucity of evaluations and studies limited the discussion on diagnosis, prevalence, pathophysiology, treatment, and outcomes of this disease. This review article addresses these issues by reviewing several recent studies conducted in Iran or other countries. This review suggests that overlap syndrome has worse outcomes than either disease alone. Our findings accentuated the urgent need for further studies on overlap syndrome and all overlaps between OSA and chronic pulmonary disease to provide a deeper insight into diagnosis and non-invasive treatments of this disease.

  19. Restless Legs Syndrome After Single Low Dose Quetiapine Administration.

    Science.gov (United States)

    Soyata, Ahmet Z; Celebi, Fahri; Yargc, Lutfi I

    2016-01-01

    Restless legs syndrome is an underdiagnosed sensori-motor disorder and psychotropic drugs are one of the main secondary causes of the illness. The most common psychotropic agents that cause restless legs syndrome are antidepressants; however, antipsychotics have also been reported to induce restless legs syndrome. The prevalence, vulnerability factors and the underlying mechanism of antipsychotic-induced restless legs syndrome are unclear. A possible explanation is that dopaminergic blockade is the main precipitator of the syndrome. Quetiapine-induced restless legs syndrome is another point of interest because of its low binding to D2 receptors. We herein report the case of a restless legs syndrome that emerged after a single low dose quetiapine administration.

  20. Profile of altered brain iron acquisition in restless legs syndrome

    Science.gov (United States)

    Ponnuru, Padmavathi; Wang, Xin-Sheng; Patton, Stephanie M.; Allen, Richard P.; Earley, Christopher J.

    2011-01-01

    Restless legs syndrome is a neurological disorder characterized by an urgency to move the legs during periods of rest. Data from a variety of sources provide a compelling argument that the amount of iron in the brain is lower in individuals with restless legs syndrome compared with neurologically normal individuals. Moreover, a significant percentage of patients with restless legs syndrome are responsive to intravenous iron therapy. The mechanism underlying the decreased iron concentrations in restless legs syndrome brains is unknown. We hypothesize that the source of the brain iron deficit is at the blood–brain interface. Thus we analysed the expression of iron management proteins in the epithelial cells of the choroid plexus and the brain microvasculature in post-mortem tissues. The choroid plexus, obtained at autopsy, from 18 neurologically normal controls and 14 individuals who had primary restless legs syndrome was subjected to histochemical staining for iron and immunostaining for iron management proteins. Iron and heavy chain ferritin staining was reduced in the epithelial cells of choroid plexus in restless legs syndrome. Divalent metal transporter, ferroportin, transferrin and its receptor were upregulated in the choroid plexus in restless legs syndrome. Microvessels were isolated from the motor cortex of 11 restless legs syndrome and 14 control brains obtained at autopsy and quantitative immunoblot analyses was performed. Expression of heavy chain ferritin, transferrin and its receptor in the microvessels from restless legs syndrome was significantly decreased compared with the controls but divalent metal protein 1, ferroportin, prohepcidin, mitochondrial ferritin and light-chain ferritin remained unchanged. The presence of an iron regulatory protein was demonstrated in the brain microvasculature and the activity of this protein is decreased in restless legs syndrome; a finding similar to our earlier report in neuromelanin cells from the substantia

  1. Cognitive deficits associated with restless legs syndrome (RLS).

    Science.gov (United States)

    Pearson, Virginia E; Allen, Richard P; Dean, Terry; Gamaldo, Charlene E; Lesage, Suzanne R; Earley, Christopher J

    2006-01-01

    Restless legs syndrome produces significant chronic sleep loss, which despite not causing expected profound sleepiness, might nonetheless produce cognitive deficits similar to those seen with acute sleep deprivation, i.e. involving mostly pre-frontal cortical (PFC) functioning. Sixteen patients off RLS treatment for at least 2 weeks and 15 age- and gender-matched control subjects had polysomnograms (PSGs) on two consecutive nights. Cognitive tests were given in the morning after the second night. Six cognitive tests were used: two Verbal Fluency tests and the Trail Making tests were selected to be particularly sensitive to PFC function and sleep loss. Porteus Mazes and the Stroop Test were selected to reflect more general frontal and executive function. The Colored Progressive Matrices were used to assess general cognitive skills. RLS patients compared to controls showed significant (P<0.05) and sizeable (20-40%) deficits on two of the three PFC tests and marginally non-significant deficit (P<0.1) on the third. The other three tests showed no significant differences. The results indicate that RLS patients show cognitive deficits similar to that reported for one night of sleep loss.

  2. Sleep board review question: restless legs

    Directory of Open Access Journals (Sweden)

    Omobomi O

    2018-02-01

    Full Text Available No abstract available. Article truncated after 150 words. Ms. Jones (not her real name is a 63-year-old woman who states that she gets very fidgety when sitting in a theater, watching a movie or when flying long distances on a plane. She is unable to find words to describe the sensation but she states that moving her legs make them feel better. Lately, she has been getting this feeling almost every night. She reports no leg discomfort in the daytime. She denies muscle cramps her legs. She had some recent investigations done by her primary care physician because of complaints of fatigue. Which of the following will be helpful in the diagnosis and management in this patient? 1. An overnight polysomnogram showing apnea hypopnea index of 1.6 events per hour and no periodic limb movements (PLMs 2. Ferritin level of 18 ng/ml (normal range 20-200 ng/ml 3. Serum Bicarbonate of 29 mEq/L (normal range 23-29 mEq/L 4. Thyroid …

  3. Prevalence and associations of respiratory-related leg movements: the MrOS sleep study.

    Science.gov (United States)

    Aritake, Sayaka; Blackwell, Terri; Peters, Katherine W; Rueschman, Michael; Mobley, Daniel; Morrical, Michael G; Platt, Samuel F; Dam, Thuy-Tien L; Redline, Susan; Winkelman, John W

    2015-10-01

    Obstructive respiratory events often terminate with an associated respiratory-related leg movement (RRLM). Such leg movements are not scored as periodic leg movements (periodic limb movements during sleep, PLMS), although the criteria for distinguishing RRLM from PLMS differ between the American Academy of Sleep Medicine (AASM) and the World Association of Sleep Medicine (WASM)/ International Restless Legs Syndrome Study Group (IRLSSG) scoring manuals. Such LMs may be clinically significant in patients with obstructive sleep apnea (OSA). The prevalence and correlation of RRLM in men with OSA were examined. A case-control sample of 575 men was selected from all men with an apnea-hypopnea index (AHI, ≥3% desaturation criteria) ≥ 10 and good data from piezoelectric leg movement sensors at the first in-home sleep study in the MrOS cohort (mean age = 76.8 years). Sleep studies were rescored for RRLMs using five different RRLM definitions varying in both latency of leg movement onset from respiratory event termination and duration of the leg movement. The quartile of RRLM% (the number of RRLM/the number of hypopneas + apneas) was derived. The nonparametric densities of RRLM% were most influenced by alterations in the latency rather than the duration of the LM. The most liberal RRLM definition (latency 0-5 s, duration 0.5-10 s) led to a median RRLM% of 23.4 (interquartile range 12.41, 37.12) in this sample. The average AHI and arousal index increased as the quartile of RRLM% increased, as well as the prevalence of chronic obstructive pulmonary disease (COPD). The prevalence of those with a history of hypertension decreased as RRLM% increased. The non-Caucasian race was associated with lower RRLM%. Within an elderly sample with moderate to severe OSA, piezoelectric-defined RRLM% is associated with a number of sleep-related and demographic factors. Further study of the optimal definition, predictors, and consequences of RRLM is warranted. Copyright

  4. Painful legs and moving toes syndrome

    Directory of Open Access Journals (Sweden)

    Qiu-ying Ma

    2015-10-01

    Full Text Available Painful legs and moving toes syndrome (PLMT is a rare movement disorder with low diagnostic rate, which is characterized by lower limb pain with involuntary movements of feet or toes. Etiology and pathogenesis of this disease is still unclear. Patients have different clinical manifestations, so the diagnosis is difficult. Treatment methods for PLMT are numerous, but so far the treatment of this disease is still a major challenge for clinicians. Further research is still needed to guide clinical work. DOI: 10.3969/j.issn.1672-6731.2015.10.013

  5. A Data-Driven Analysis of the Rules Defining Bilateral Leg Movements during Sleep.

    Science.gov (United States)

    Ferri, Raffaele; Manconi, Mauro; Rundo, Francesco; Zucconi, Marco; Aricò, Debora; Bruni, Oliviero; Ferini-Strambi, Luigi; Fulda, Stephany

    2016-02-01

    The aim of this study was to describe and analyze the association between bilateral leg movements (LMs) during sleep in subjects with restless legs syndrome (RLS), in order to eventually support or challenge the current scoring rules defining bilateral LMs. Polysomnographic recordings of 100 untreated patients with RLS (57 women and 43 males, mean age 57 y) were included. In each recording, we selected as reference all LMs that occurred during sleep and that were separated from another ipsilateral LM by at least 10 sec of EMG inactivity. For each reference LM and an evaluation interval from 5 sec before the onset to 5 sec after the offset of the reference LM, we evaluated (1) the presence or absence of contralateral leg movement activity and (2) the distribution of the onset-to-onset and (3) the offset-to-onset differences between bilateral LMs. We selected a mean of 368 (± 222 standard deviation [SD]) reference LMs per subject. For 42% (± 22%) of the reference LMs no contralateral leg movement activity was observed within the evaluation interval. In 55% (± 22%) exactly one and in 3% (± 2%) more than one contralateral LM was observed. A further evaluation of events where exactly one contralateral LM was observed showed that in most (1) the two LMs were overlapping (93% ± 9% SD) and (2) were classified as bilateral according to the World Association of Sleep Medicine and the International Restless Legs Syndrome Study Group (WASM/ IRLSSG) (96% ± 6% SD) and (3) the American Academy of Sleep Medicine scoring rules (99% ± 2% SD). Although there was a systematic and statistically significant difference in standard LM indices during sleep based on the two different definitions of bilateral LMs, the size of the difference was not clinically meaningful (maximum individual, absolute difference in LM indices ± 2.5). In addition, we found that the duration of LMs within bilateral LM pairs was longer compared to monolateral LMs and that the duration of the single LMs in

  6. The Effects of a Gentle Yoga Program on Sleep, Mood, and Blood Pressure in Older Women with Restless Legs Syndrome (RLS): A Preliminary Randomized Controlled Trial.

    Science.gov (United States)

    Innes, Kim E; Selfe, Terry Kit

    2012-01-01

    Objective. To examine the effects of yoga versus an educational film program on sleep, mood, perceived stress, and sympathetic activation in older women with RLS. Methods. Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight, sedentary postmenopausal women. Seventy-five women were randomized to receive either an 8-week yoga (n = 38) or educational film (n = 37) program. All 75 participants completed an RLS screening questionnaire. The 20 women who met all four diagnostic criteria for RLS (n = 10 yoga, 10 film group) comprised the population for this nested study. Main outcomes assessed pre- and post-treatment included: sleep (Pittsburgh Sleep Quality Index), stress (Perceived Stress Scale), mood (Profile of Mood States, State-Trait Anxiety Inventory), blood pressure, and heart rate. Results. The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood, and significantly greater reductions in insomnia prevalence, anxiety, perceived stress, and blood pressure (all P's≤0.05). Adjusted intergroup effect sizes for psychosocial variables were large, ranging from 1.9 for state anxiety to 2.6 for sleep quality. Conclusions. These preliminary findings suggest yoga may offer an effective intervention for improving sleep, mood, perceived stress, and blood pressure in older women with RLS.

  7. The Effects of a Gentle Yoga Program on Sleep, Mood, and Blood Pressure in Older Women with Restless Legs Syndrome (RLS: A Preliminary Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Kim E. Innes

    2012-01-01

    Full Text Available Objective. To examine the effects of yoga versus an educational film program on sleep, mood, perceived stress, and sympathetic activation in older women with RLS. Methods. Participants were drawn from a larger trial regarding the effects of yoga on cardiovascular disease risk profiles in overweight, sedentary postmenopausal women. Seventy-five women were randomized to receive either an 8-week yoga (=38 or educational film (=37 program. All 75 participants completed an RLS screening questionnaire. The 20 women who met all four diagnostic criteria for RLS (=10 yoga, 10 film group comprised the population for this nested study. Main outcomes assessed pre- and post-treatment included: sleep (Pittsburgh Sleep Quality Index, stress (Perceived Stress Scale, mood (Profile of Mood States, State-Trait Anxiety Inventory, blood pressure, and heart rate. Results. The yoga group demonstrated significantly greater improvements than controls in multiple domains of sleep quality and mood, and significantly greater reductions in insomnia prevalence, anxiety, perceived stress, and blood pressure (all 's≤0.05. Adjusted intergroup effect sizes for psychosocial variables were large, ranging from 1.9 for state anxiety to 2.6 for sleep quality. Conclusions. These preliminary findings suggest yoga may offer an effective intervention for improving sleep, mood, perceived stress, and blood pressure in older women with RLS.

  8. Epidemiology of Restless Legs Syndrome in Korean Adults

    Science.gov (United States)

    Cho, Yong Won; Shin, Won Chul; Yun, Chang Ho; Hong, Sung Bong; Kim, Ju Han; Allen, Richard P.; Earley, Christopher J.

    2008-01-01

    Study Objectives: To investigate the prevalence of restless legs syndrome (RLS) in Korea. Design: A large population-based telephone interview method using the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. Setting: A computer aided telephone interview method Participants: A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed in depth. A representative sample aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. Interventions: N/A Measurements and Results: Of the respondents, 373 respondents (7.5%) of the population (pop) met the criteria for the definite or probable RLS groups: 194 (3.9% of pop) respondents fulfilled the criteria for definite RLS and 179 (3.6% of pop) respondents fulfilled the criteria for probable RLS. The prevalence of RLS was generally higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). About 90% of RLS individuals were experiencing symptoms at the time of the interview and this was similar for both RLS groups. Seventy-four respondents (1.48%) reported symptoms were moderately or severely distressing and were therefore classified as RLS “sufferers.” Of those with a diagnosis of RLS sufferer, 24.3% reported being treated for their symptoms, compared to 12.4% of RLS not designated a “sufferer.” Conclusion: RLS is common and underdiagnosed in Korea with nearly 1% of the population reporting disturbed sleep related to their RLS. These results are comparable to other countries. Citation: Cho YW; Shin WC; Yun CH; Hong SB; Kim JH; Allen RP; Earley CJ. Epidemiology of restless legs syndrome in korean adults. SLEEP 2008;31(2):219-223. PMID:18274269

  9. Restless legs syndrome in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Shahram Rafie

    2016-01-01

    Full Text Available Restless legs syndrome (RLS is a neurological disorder characterized by uncomfortable sensation of paresthesia in legs that subsequently causes involuntary and continuous movement of the lower limbs, especially at rest. Its prevalence in hemodialysis is more than that in the general population. Different risk factors have been suggested for RLS. We studied the prevalence and risk factors of RLS in 137 hemodialysis patients followed up at our center. The patients completed at least three months on dialysis and fulfilled four criteria for the diagnosis of RLS. We compared the patients with and without RLS, and the odds ratios (ORs were estimated by the logistic regression models. The prevalence of RLS was 36.5% in the study patients. Among the variables, diabetes was the only predicting factor for the development of RLS. The diabetic patients may be afflicted with RLS 2.25 times more than the non-diabetics. Women developed severe RLS 5.23 times more than men. Neurodegeneration, decrease in dopamine level, higher total oxidant status, and neuropathy in diabetic patients may explain the RLS symptoms.

  10. [Treatment of sleep apnea syndromes].

    Science.gov (United States)

    Tardif, C

    NECESSARY TREATMENT: Sleep apnea syndrome requires treatment because it affects cardiovascular and cerebrovascular morbidity and mortality and has important neuropsychological consequences with the risk of accidents due to impaired wakefulness. The patientís quality of life is greatly altered. GENERAL MEASURES: Patients should be informed of the risk due to the lack of sleep, advised that alcohol tranquilizers and hypnotic drugs are contraindicated, and counseled about loosing weight, the most difficult problem for obese patients. POSITIVE PRESSURE VENTILATION: Continuous positive pressure ventilation with a facial mask acts like a pneumatic prosthesis holding the airways open during sleep. Sleep can be reconstructed by eliminating the recorded pathological nocturnal events and thus reducing diurnal hypersomnia. Quality of life is improved and accidents related to diminished wakefulness are avoided. Death rate in treated patients is significantly lower than in non-treated patients. In France, the national health care system will reimburse positive pressure ventilation for sleep apnea syndromes recognized to cause more than 30 events per hour of recording or fragmented sleep due to respiratory impairment. OTHER TREATMENTS: Indications for other treatments in case of moderately severe sleep apnea syndrome (or if health care benefits are not recognized for positive pressure ventilation) are currently debated. No medication has been proven to be effective. Mandibular advancement ortheses are in the development stage and require multidisiplinary cooperation to verify their efficacy. Velar surgery has been proposed but is usually disappointing except for young patients actively participating in an integrated surgical treatment strategy.

  11. The effect of massage therapy on restless leg syndrome

    Directory of Open Access Journals (Sweden)

    Rahim Mirnasuri

    2016-02-01

    Full Text Available Background: Restless Leg Syndrome (RLS is a kind of mal-movement which is identified by too much movement of the feet during rest. Although a host of scientific resources have pointed to the significant effect of massage on this disease, no well-designed study to date has explored the efficiency of massage on the RLS. Materials and methods: This study adopted a quasi-experimental design with pre-and post-test. Two groups served as the participants of the study. Experimental group received treatment, while control group received no intervention. Both groups were pre- and post-tested. The participants were 300 male and female students (at higher education centers of Lorestan province, whose age ranged from 18 to 30 years. Also, their height ranged from 155-1990, while their weight was 55-85 kg. A researcher-made questionnaire, including multiple-choice questions associated with RLS which show gravity of the mal-movement on a four-point Likert scale from very weak to very strong. T-test was used for data analysis. Results: The results of the study  showed that a period of massage therapy had a significant effect on tingling therapy on the foot, the foot throbbing, burning feet, the sudden jump feet, sleep the sleep quality Conclusion: The current study revealed that performing a massage-therapy protocol have a significant effect on reducing the symptoms of RLS.

  12. Compulsive habits in restless legs syndrome patients under dopaminergic treatment.

    Science.gov (United States)

    Pourcher, Emmanuelle; Rémillard, Sophie; Cohen, Henri

    2010-03-15

    Since the introduction of levodopa therapy and dopaminergic replacement therapy to abate symptoms of idiopathic Parkinson's disease, repetitive compulsive behaviors have been reported and are now considered to be drug-related response complications. As dopamine (DA) agonists are the licensed treatment in Restless Legs Syndrome (RLS), a survey was conducted to determine the extent to which patients with RLS present compulsive behaviors. The aim of this study was to investigate the relationship between DA agonists and the occurrence of motor or behavioral compulsions, stress, depression, and sleep disturbance in RLS patients. A questionnaire was mailed three times, at four-month intervals over a period of 8 months to all patients of the Quebec Memory and Motor Skills Disorders Clinic diagnosed with RLS. In addition to recording all medication information for RLS treatment, patients were assessed on the International Restless Legs Syndrome Study Group Rating Scale (IRLS), the Beck Depression Inventory-II (BDI-II), the Sleep Scale from the Medical Outcomes Study (MOS) and on a visual analog scale for current level of stress. A section pertaining to hobby, mania, and compulsion was also included. Analyses are based on 97 out of 151 patients (64.2%) with RLS who returned the three questionnaires. Twelve patients (12.4%) on stable DA agonist therapy (average dose 0.52+/-0.59 mg Pramipexole equivalent) developed a new compulsive behavioral repertoire. Eating (3 women, 1 man), buying food or clothes (2 women, 1 man), trichotillomania (1 woman, 1 man), and gambling (1man) were among the compulsions developed under DA treatment. In addition, two women presented new tic-like phenomena. In contrast to the RLS patients without compulsive behaviors (53 treated with DA agonist; 32 untreated), those with compulsive habits reported experiencing more stress, depression and sleep problems. Patients with RLS with mood and stress states may be at greater risk of developing compulsive

  13. [Diagnosis and symptom rating scale of restless legs syndrome].

    Science.gov (United States)

    Inoue, Yuichi

    2009-05-01

    Restless legs syndrome (RLS) is a sensorimotor disorder, characterized by an irresistible urge to move the legs and usually accompanied or caused by uncomfortable and unpleasant sensations. It begins or worsens during periods of rest or inactivity, is partially or totally relieved by movement and is exacerbated or occurs mainly in the evening or night. People suffering from RLS are estimated to represent 2-3% of the general Japanese population, which is relatively lower than the estimated prevalence in western countries. Supportive diagnostic critevia include family history, the presence of periodic-leg movements (PLM) when awake or asleep, and a positive response to dopaminergic treatment. RLS phenotypes include an early onset form that is usually idiopathic with frequent familial history and a late onset form that is usually secondary to other somatic conditions that are causative factors in RLS occurrence. In all patients presenting with complaints of insomnia or discomfort in the lower limbs, diagnosis of RLS should be considered. RLS should be differentiated from akathisia, which is an urge to move the whole body in the absence of uncomfortable sensations. Polysomnographic studies and the suggested immobilization test (SIT) can detect PLM in patients that are asleep or awake. RLS may cause severe sleep disturbances, poor quality of life, depressive and anxious symptoms, and may be a risk factor for cardiovascular disease. Secondary RLS may occur due to iron deficiency, end-stage renal disease, pregnancy, peripheral neuropathy and drug use including antipsychotics and antidepressants. Small fiber neuropathy can trigger RLS or mimic its symptoms. RLS is associated with many neurological disorders, including Parkinson disease and multiple system atrophy; althoughit does not predispose to these diseases. A symptom rating scale for RLS authorized by the International RLS Study Group (IRLS) would facilitate accurate diagnosis of this condition.

  14. The role of sleep position in obstructive sleep apnea syndrome

    NARCIS (Netherlands)

    Richard, Wietske; Kox, Dennis; den Herder, Cindy; Laman, Martin; van Tinteren, Harm; de Vries, Nico

    2006-01-01

    We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group

  15. Diagnostic accuracy of behavioral, activity, ferritin, and clinical indicators of restless legs syndrome.

    Science.gov (United States)

    Richards, Kathy C; Bost, James E; Rogers, Valerie E; Hutchison, Lisa C; Beck, Cornelia K; Bliwise, Donald L; Kovach, Christine R; Cuellar, Norma; Allen, Richard P

    2015-03-01

    Lack of a valid diagnostic measure of restless legs syndrome (RLS) for persons with dementia, who do not have the cognitive ability to report complex symptoms, impedes RLS treatment and research in this population. The aim of this study was to determine the sensitivity and specificity of a combination of indicators for identifying RLS that could eventually be used to diagnose RLS in persons with dementia. 3-day, prospective instrument validation. Sleep laboratory. Cognitively intact, 107 with RLS, 105 without RLS. N/A. Serial 20-min observations with a new measure, the Behavioral Indicators Test-Restless Legs (BIT-RL); leg movements with 3 nights of the Periodic Activity Monitor-Restless Legs (PAM-RL); ferritin; sleep history; clinical data; polysomnography; Hopkins Telephone Diagnostic Interview of RLS Symptoms. The best-fitting diagnostic model for identifying RLS included previous history of iron deficiency (odds ratio [OR] 7.30), leg discomfort (OR 6.47), daytime fatigue (OR 6.15), difficulty falling asleep (OR 3.25), RLS family history (OR 2.60), BIT-RL (OR 1.49), and absence of diabetes (OR 0.27), with sensitivity 78%, specificity 79%, and 77% correctly classified. This model retained its predictive accuracy even with co-morbid sleep apnea. When compared to those without RLS, persons with RLS have observable behaviors, such as rubbing the legs, that differentiate them, but the behaviors have no circadian and activity-related variability. The final model of clinical and sleep historical data and observation for RLS behaviors using the BIT-RL had good diagnostic accuracy. © 2015 Associated Professional Sleep Societies, LLC.

  16. Non-pharmacological interventions for restless legs syndrome: a systematic review of randomised controlled trials.

    Science.gov (United States)

    Harrison, Eloise G; Keating, Jennifer L; Morgan, Prue E

    2018-03-21

    Restless legs syndrome (RLS) is a sensorimotor disorder characterised by an uncomfortable urge to move the legs. Management is primarily pharmacological. Effects for non-pharmacological, non-surgical options are published but lack systematic examination. To synthesise results of non-pharmacological/non-surgical treatment compared to no-treatment controls or alternative treatment for RLS on any relevant outcome. Databases and reference lists of reviews were searched for randomised controlled trials (RCTs) comparing non-pharmacological treatment to alternative or no treatment controls for idiopathic RLS. Search results were independently screened for inclusion by two researchers; disagreements regarding eligibility were resolved with discussion. Outcomes were summarised, and pooled where possible in meta-analysis. The search yielded 442 articles. Eleven trials met inclusion criteria. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture were significantly more effective for RLS severity than control conditions. Vibration pads, cryotherapy, and transcranial direct current stimulation were ineffective in reducing RLS severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture significantly improved some sleep-related outcomes. Few studies were identified and quality of evidence was not high. Some non-pharmacological interventions may be beneficial for reducing RLS severity and enhancing sleep. Implications for Rehabilitation The current management of restless leg syndrome is primarily pharmacological, and medications can have unwanted side effects. Repetitive transcranial magnetic stimulation, exercise, compression devices, counterstrain manipulation, infrared therapy, and standard acupuncture may reduce restless leg syndrome severity. Vibration pads, cryotherapy, yoga, compression devices, and acupuncture may improve some sleep-related outcomes in

  17. Characterizing restless legs syndrome and leg motor restlessness in patients with Parkinson's disease: A multicenter case-controlled study.

    Science.gov (United States)

    Suzuki, Keisuke; Okuma, Yasuyuki; Uchiyama, Tomoyuki; Miyamoto, Masayuki; Sakakibara, Ryuji; Shimo, Yasushi; Hattori, Nobutaka; Kuwabara, Satoshi; Yamamoto, Toshimasa; Kaji, Yoshiaki; Hirano, Shigeki; Numao, Ayaka; Hirata, Koichi

    2017-11-01

    We investigated the prevalence and impact of restless legs syndrome (RLS) and leg motor restlessness (LMR) in patients with Parkinson's disease (PD) in a multicenter study. A total of 436 PD patients and 401 age- and sex-matched controls were included in this study. RLS was diagnosed based on four essential features. LMR was diagnosed when a participant exhibited the urge to move his or her legs but did not meet the four essential features of RLS. The RLS prevalence did not differ between PD patients and controls (3.4% vs. 2.7%), while LMR prevalence was significantly higher in PD patients than in controls (12.8% vs. 4.5%). PD patients with RLS or LMR had a higher prevalence of excessive daytime sleepiness (EDS) (50.7%, vs. 6.9%), probable REM sleep behavior disorder (38.0% vs. 3.4%) and PD-related sleep problems (49.3% vs. 20.7%) than controls with RLS or LMR. RLS/LMR preceding PD onset was related to an older age of PD onset. Our study revealed an increased prevalence of LMR but not RLS in PD patients. LMR could be an early manifestation of PD; however, whether LMR is within the range of RLS or whether LMR and RLS constitute different entities in PD requires further studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Recurrent Metachronous Acute Compartment Syndrome in the Legs ...

    African Journals Online (AJOL)

    METHODS: A seven-year-old boy presented with four separate episodes of acute compartment syndrome of the legs within three years. The recurrent nature of the illness prompted detail review of the records of the child. RESULTS: There was involvement of each leg twice between the ages of three and seven years ...

  19. Restless legs syndrome associated with major diseases

    Science.gov (United States)

    Allen, Richard; Högl, Birgit; Paulus, Walter

    2016-01-01

    Recent publications on both the genetics and environmental factors of restless legs syndrome (RLS) defined as a clinical disorder suggest that overlapping genetic risk factors may play a role in primary (idiopathic) and secondary (symptomatic) RLS. Following a systematic literature search of RLS associated with comorbidities, we identified an increased prevalence of RLS only in iron deficiency and kidney disease. In cardiovascular disease, arterial hypertension, diabetes, migraine, and Parkinson disease, the methodology of studies was poor, but an association might be possible. There is insufficient evidence for conditions such as anemia (without iron deficiency), chronic obstructive pulmonary disease, multiple sclerosis, headache, stroke, narcolepsy, and ataxias. Based on possible gene–microenvironmental interaction, the classifications primary and secondary RLS may suggest an inappropriate causal relation. We recognize that in some conditions, treatment of the underlying disease should be achieved as far as possible to reduce or eliminate RLS symptoms. RLS might be seen as a continuous spectrum with a major genetic contribution at one end and a major environmental or comorbid disease contribution at the other. PMID:26944272

  20. Restless legs syndrome and pregnancy: A review

    Science.gov (United States)

    Srivanitchapoom, Prachaya; Pandey, Sanjay; Hallett, Mark

    2014-01-01

    Restless legs syndrome (RLS) is a common sensorimotor neurological disorder that is diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). The pathophysiology of RLS is still unknown and its prevalence is influenced by ethnicity, age, and gender. RLS is divided into two types by etiology: primary or idiopathic and secondary. Primary RLS is strongly influenced by a genetic component while secondary RLS is caused by other associated conditions such as end-stage renal disease or peripheral neuropathy. Another common condition associated with RLS is pregnancy. The prevalence of RLS during pregnancy is two to three times higher than in the normal population and is influenced by the trimester and the number of parity. The main mechanisms that may contribute to the pathophysiology of RLS during pregnancy are hormonal changes and iron and folate status. Standard medications for treating RLS during pregnancy are not established. Most medications have been used according to the evidence from non-pregnant patients. Therefore, consideration of the medical treatment for treating RLS during pregnancy should be balanced between the benefit of relieving the symptoms and maternal and fetal risk. In general, the prognosis of RLS during pregnancy is good and symptoms are usually relieved after delivery. PMID:24768121

  1. Peripheral Dopamine in Restless Legs Syndrome

    Directory of Open Access Journals (Sweden)

    Ulrike H. Mitchell

    2018-03-01

    Full Text Available Objective/BackgroundRestless Legs Syndrome (RLS is a dopamine-dependent disorder characterized by a strong urge to move. The objective of this study was to evalulate blood levels of dopamine and other catecholamines and blood D2-subtype dopamine receptors (D2Rs in RLS.Patients/MethodsDopamine levels in blood samples from age-matched unmedicated RLS subjects, medicated RLS subjects and Controls were evaluated with high performance liquid chromatography and dopamine D2R white blood cell (WBC expression levels were determined with fluorescence-activated cell sorting and immunocytochemistry.ResultsBlood plasma dopamine levels, but not norepinepherine or epinephrine levels, were significantly increased in medicated RLS subjects vs unmedicated RLS subjects and Controls. The percentage of lymphocytes and monocytes expressing D2Rs differed between Control, RLS medicated and RLS unmedicated subjects. Total D2R expression in lymphocytes, but not monocytes, differed between Control, RLS medicated and RLS unmedicated subjects. D2Rs in lymphocytes, but not monocytes, were sensitive to dopamine in Controls only.ConclusionDownregulation of WBCs D2Rs occurs in RLS. This downregulation is not reversed by medication, although commonly used RLS medications increase plasma dopamine levels. The insensitivity of monocytes to dopamine levels, but their downregulation in RLS, may reflect their utility as a biomarker for RLS and perhaps brain dopamine homeostasis.

  2. Cardiovascular comorbidity in patients with restless legs syndrome: current perspectives

    Directory of Open Access Journals (Sweden)

    Vargas-Pérez NJ

    2017-05-01

    Full Text Available Noel J Vargas-Pérez, Kanika Bagai, Arthur S Walters Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA Introduction: Restless legs syndrome (RLS is a sensorimotor neurological disorder associated with poor quality of life. Growing evidence links RLS and periodic limb movement in sleep (PLMS with increased risk of cardiovascular and cerebrovascular disease. This article reviews the association of RLS and PLMS with cardiovascular disease (CVD. Methods: PubMed and Medline database (1990 to July 2016 were searched for the terms “restless legs,” “restless legs syndrome,” “periodic limb movements,” “periodic limb movements in sleep” cross-referenced with “cardiovascular disease,” “heart disease,” “coronary artery disease,” “coronary heart disease,” “heart arrhythmia,” “heart failure,” “congestive heart failure,” “echocardiogram,” “echocardiographic,” “hypertension,” “high blood pressure,” “cerebrovascular disease,” “stroke,” “autonomic nervous system,” “heart rate,” “heart rate variability,” “hypoxia,” “microcirculation,” “oxidative stress,” “inflammation,” “chronic kidney disease,” “end-stage renal disease,” “renal disease,” “hemodialysis,” “multiple sclerosis,” “Parkinson,” “Parkinson’s,” “iron deficiency anemia,” and “mortality.” Other relevant articles from the reference list of the above-matched manuscripts were also reviewed. Studies that did not specify the diagnostic criteria for RLS or manuscripts in languages other than English were excluded. Articles with emphasis in RLS secondary to pregnancy were not included in this manuscript.Results: Eighty-six original articles were included in this review. Although mixed results were found regarding the association of RLS and PLMS with CVD, hypertension, stroke and mortality, an informal review of the literature does suggest that the

  3. Circadian variation of flexor withdrawal and crossed extensor reflexes in patients with restless legs syndrome.

    Science.gov (United States)

    Dafkin, Chloe; Green, Andrew; Olivier, Benita; Mckinon, Warrick; Kerr, Samantha

    2017-11-22

    An evening state of spinal hyperexcitability has been proposed to be a possible cause of evening increases in restless legs syndrome symptoms. Thus, the objective of the current study was to assess the circadian variation in spinal excitability in patients with restless legs syndrome based on flexor withdrawal reflex and crossed extensor reflex responses. The reflexes were elicited on 12 participants with restless legs syndrome and 12 healthy control participants in the evening (PM) and the morning (AM). Reflex response magnitudes were measured electromyographically and kinematically. Both the reflexes showed a circadian rhythm in participants with restless legs syndrome but not in control participants. Changes in ankle (median flexor withdrawal reflex PM: 16.0 ° versus AM: 2.8 °, P = 0.042; crossed extensor reflex PM: 0.8 ° versus AM: 0.2 °, P = 0.001) angle were significantly larger, and ankle angular velocity (median flexor withdrawal reflex PM: 38.8 ° s -1 versus AM: 13.9 ° s -1 , P = 0.049; crossed extensor reflex PM: 2.4 ° s -1 versus AM: 0.5 ° s -1 , P = 0.002) was significantly faster in the evening compared with the morning in participants with restless legs syndrome, for both reflexes. For participants with restless legs syndrome, evening change in hallux angle was significantly larger than morning responses (median PM: 5.0 ° versus AM: 1.3 °, P = 0.012). No significant differences for any of the electromyographic or kinematic variables were observed between participants with restless legs syndrome and controls. The flexor withdrawal reflex and the crossed extensor reflex show a circadian rhythm in participants with restless legs syndrome suggesting an evening increase in spinal excitability. We hypothesize the circadian variation in spinal excitability may be due to a possible nocturnal form of afferent circuitry central sensitization in the dorsal horn of the spinal cord in patients with restless legs syndrome. © 2017

  4. Sleep-Related Leg Cramps: A Review and Suggestions for Future Research.

    Science.gov (United States)

    Brown, Terry M

    2015-09-01

    Various medications and behavioral treatments for sleep-related leg cramps have been tried, but the quality of the evidence is low. Quinine seems to be effective, but dangerous. β-Agonists may be one of the more common causes of secondary leg cramps. Statins may not be implicated in leg cramps as much as has been believed. Potassium-sparing diuretics may have a higher incidence of sleep-related leg cramps than potassium-depleting diuretics. Plantar flexion of the feet may elicit most sleep-related leg cramps. More research into behavioral treatments is needed. A standardized sleep-related leg cramp questionnaire would be useful to expand research. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Restless Legs Syndrome -- Causes and Symptoms

    Science.gov (United States)

    ... miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment Sleep Apnea Overview & Facts ... Self Test & Diagnosis Treatment Snoring Overview and Facts Causes and Symptoms Self Tests & ... Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient ...

  6. Obstructive Sleep Apnea Hypopnea Syndrome

    African Journals Online (AJOL)

    hanumantp

    Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition brought to limelight in the last five decades.[1] It is a major cause of morbidity and significant cause of mortality worldwide, including developed and developing nations. A survey done in Abuja, Nigeria,[2] showed that OSAHS may be a ...

  7. Pediatric restless legs syndrome diagnostic criteria: an update by the International Restless Legs Syndrome Study Group.

    Science.gov (United States)

    Picchietti, Daniel L; Bruni, Oliviero; de Weerd, Al; Durmer, Jeffrey S; Kotagal, Suresh; Owens, Judith A; Simakajornboon, Narong

    2013-12-01

    Specific diagnostic criteria for pediatric restless legs syndrome (RLS) were published in 2003 following a workshop at the National Institutes of Health. Due to substantial new research and revision of the adult RLS diagnostic criteria, a task force was chosen by the International Restless Legs Syndrome Study Group (IRLSSG) to consider updates to the pediatric diagnostic criteria. A committee of seven pediatric RLS experts developed a set of 15 consensus questions to review, conducted a comprehensive literature search, and extensively discussed potential revisions. The committee recommendations were approved by the IRLSSG executive committee and reviewed by the IRLSSG membership. The pediatric RLS diagnostic criteria were simplified and integrated with the newly revised adult RLS criteria. Specific recommendations were developed for pediatric application of the criteria, including consideration of typical words used by children to describe their symptoms. Pediatric aspects of differential diagnosis, comorbidity, and clinical significance were then defined. In addition, the research criteria for probable and possible pediatric RLS were updated and criteria for a related condition, periodic limb movement disorder (PLMD), were clarified. Revised diagnostic criteria for pediatric RLS have been developed, which are intended to improve clinical practice and promote further research. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  8. The pathophysiology of restless legs syndrome

    International Nuclear Information System (INIS)

    Miyamoto, Masayuki; Miyamoto, Tomoyuki; Iwanami, Masaoki; Suzuki, Keisuke; Hirata, Koichi

    2009-01-01

    Restless legs syndrome (RLS) is a sensorimotor disorder that is frequently associated with periodic leg movements (PLMS). RLS is generally considered to be a central nervous system (CNS)-related disorder although no specific lesion has been found to be associated with the syndrome. Reduced intracortical inhibition has been demonstrated in RLS by transcranial magnetic stimulation. Some MRI studies have revealed the presence of morphologic changes in the somatosensory cortex, motor cortex and thalamic gray matter. The results of single photon emission computed tomography (SPECT) and positron emission tomography (PET) studies showed that the limbic and opioid systems also play important roles in the pathophysiology of RLS. A functional MRI study revealed abnormal bilateral cerebellar and thalamic activation during the manifestation of sensory symptoms, with additional red nucleus and reticular formation activity during PLMS. PLMS is likely to occur in patients with spinal cord lesions, and some patients with sensory polyneuropathy may exhibit RLS symptoms. RLS symptoms seem to depend on abnormal spinal sensorimotor integration at the spinal cord level and abnormal central somatosensory processing. PLMS appears to depend on increased excitability of the spinal cord and a decreased supraspinal inhibitory mechanism from the A11 diencephalic dopaminergic system. RLS symptoms respond very dramatically to dopaminergic therapy. The results of analysis by PET and SPECT studies of striatal D2 receptor binding in humans are inconclusive. However, studies in animal models suggest that the participation of the A11 dopaminergic system and the D3 receptor in RLS symptoms. The symptoms of RLS are aggravated in those with iron deficiency, and iron treatment ameliorates the symptoms in some patients. Neuroimaging studies, analysis of the cerebrospinal fluid, and studies on postmortem tissue and use of animal models have indicated that low brain iron concentrations and dysfunction of

  9. Suggested immobilization test for diagnosis of restless legs syndrome in Parkinson's disease.

    Science.gov (United States)

    De Cock, Valérie Cochen; Bayard, Sophie; Yu, Huan; Grini, Magda; Carlander, Bertrand; Postuma, Ron; Charif, Mahmoud; Dauvilliers, Yves

    2012-05-01

    Diagnosis of restless leg syndrome (RLS) in Parkinson's disease (PD) is difficult because of clinical confounds. The suggested immobilization test (SIT) is validated for diagnosis of primary RLS. This study evaluated the usefulness of the SIT for diagnosis of RLS in PD. We compared SIT scores, as well as polysomnography measures in 50 patients with PD (25 with RLS, 25 without), 25 patients with primary RLS, and 25 age/sex matched controls. Mean leg discomfort score was increased in patients with PD and RLS compared to PD without RLS, and also in patients with primary RLS compared to controls. Leg discomfort was significantly higher at the end of the test in patients with RLS compared to patients without RLS. Intensity of leg discomfort was similar between patients with RLS, with or without PD. Using a mean leg discomfort cutoff of 11, we showed sensitivity of 91% and specificity of 72% for RLS diagnosis in PD during symptomatic time intervals. Periodic leg movements index during the SIT did not differ between groups. Periodic leg movements index during sleep and wakefulness was increased in patients with primary RLS compared to controls, but did not differ between patients with PD, with and without RLS. The sensory SIT is a simple test that may help diagnose RLS in patients with PD. Copyright © 2012 Movement Disorder Society.

  10. Total sleep deprivation study in delayed sleep-phase syndrome.

    Science.gov (United States)

    Manzar, Md Dilshad; Hameed, Unaise Abdul; Hussain, M Ejaz

    2011-04-01

    Delayed sleep-phase syndrome (DSPS) is characterized by delayed sleep onset against the desired clock time. It often presents with symptoms of sleep-onset insomnia or difficulty in awakening at the desired time. We report the finding of sleep studies after 24 h total sleep deprivation (TSD) in a 28-year-old DSPS male patient. He had characteristics of mild chronic DSPS, which may have been precipitated by his frequent night shift assignments. The TSD improved the patients sleep latency and efficiency but all other sleep variables showed marked differences.

  11. Leg 201Tl-SPECT in chronic exertional compartment syndrome

    International Nuclear Information System (INIS)

    Elkadri, N.; Slim, I.; Blondet, C.; Choquet, Ph.; Constantinesco, A.; Lecocq, J.

    2004-01-01

    Leg 201 Tl-SPECT in chronic exertional compartment syndrome Background: The chronic exertional compartment syndrome is one of the most frequent origins regarding leg pain due to sport training. The diagnosis can be established by invasive compartment pressure measurement. The aim of this study is to evaluate the role that could have 201 Tl-SPECT for patients with suspicion of compartment syndrome. Patients and methods: 51 leg 201 Tl-SPECT exams were performed (exercise - and rest without reinjection) in 49 patients; 28 had compartment syndrome confirmed by pressure measurement. About 100 MBq of 201 Tl were injected during exercise, when pain appeared or at least after 25 minutes exercise. We studied mean percentages of level uptake for each compartment, referred to the maximal uptake of both legs. Results: 47 compartments were concerned by compartment syndrome and 361 compartments were not. Scintigraphic patterns in compartments are reversible ischaemia (45%), uptake stability (36%) or reverse redistribution (19%); these patterns are not linked to compartment syndrome. However, there is a significant difference of rest 201 Tl level uptake between compartments with and without compartment syndrome and a significant correlation between muscular pressure measurement and rest level uptake. Conclusion: 201 Tl-SPECT shows that only ischaemia does not explain compartment syndrome. Moreover, it allows to predict pressure variation during exercise but it does not offer any interest in order to select patients for muscular invasive pressure measurement. (author)

  12. The prevalence of restless leg syndrome among pregnant Saudi women

    Science.gov (United States)

    Khan, Mohmd; Mobeireek, Noha; Al-Jahdali, Yassar; Al-Dubyan, Nujood; Ahmed, Anwar; Al-Gamedi, Majed; Al-Harbi, Abdullah; Al-Jahdali, Hamdan

    2018-01-01

    Objectives: Restless legs syndrome (RLS) is common among pregnant women, but it has not been documented in pregnant Saudi Arabian women. The main purpose of this study was to estimate the extent of the prevalence of RLS and identify both the associated factors and the associated risk factors among pregnant Saudi women. Methods: A cross-sectional study was conducted among pregnant women visiting obstetric clinics at King Abdulaziz Medical City in Riyadh (KAMC-Riyadh) over the period from June 1 to November 1, 2014. We interviewed the participants and collected demographic data, number of pregnancies, duration of pregnancy, comorbidities, and symptoms of RLS. The diagnosis of RLS is based on the four criteria designated by the International RLS Study Group. Results: The total number of participants enrolled was 517, and the mean age was 30.11 ± 5.42 years. The prevalence of RLS was 21.3% (110/517) (95% confidence interval [CI]: 17.83%-25.06%). RLS symptoms were more common among women in the third trimester (24.1%) compared to the second trimester (14.3%) and first trimester (13.6%), P = 0.043. The stepwise multivariate logistic model identified insomnia (odds ratio [OR]: 3.6, 95% CI: 2.167–6.017, P = 0.001), and poor sleep quality (OR: 4.9, 95% CI: 1.473-16.454, P = 0.010) were associated with RLS. Conclusion: RLS occurs in two of ten pregnant women visiting obstetric clinics at KAMC-Riyadh and is strongly associated with insomnia and poor sleep quality. Studies are needed to explore the causality of these associations. PMID:29404269

  13. Nerve Decompression and Restless Legs Syndrome: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    James C. Anderson

    2017-07-01

    Full Text Available IntroductionRestless legs syndrome (RLS is a prevalent sleep disorder affecting quality of life and is often comorbid with other neurological diseases, including peripheral neuropathy. The mechanisms related to RLS symptoms remain unclear, and treatment options are often aimed at symptom relief rather than etiology. RLS may present in distinct phenotypes often described as “primary” vs. “secondary” RLS. Secondary RLS is often associated with peripheral neuropathy. Nerve decompression surgery of the common and superficial fibular nerves is used to treat peripheral neuropathy. Anecdotally, surgeons sometimes report improved RLS symptoms following nerve decompression for peripheral neuropathy. The purpose of this retrospective analysis was to quantify the change in symptoms commonly associated with RLS using visual analog scales (VAS.MethodsForty-two patients completed VAS scales (0–10 for pain, burning, numbness, tingling, weakness, balance, tightness, aching, pulling, cramping, twitchy/jumpy, uneasy, creepy/crawly, and throbbing, both before and 15 weeks after surgical decompression.ResultsSubjects reported significant improvement among all VAS categories, except for “pulling” (P = 0.14. The change in VAS following surgery was negatively correlated with the pre-surgery VAS for both the summed VAS (r = −0.58, P < 0.001 and the individual VAS scores (all P < 0.01, such that patients who reported the worst symptoms before surgery exhibited relatively greater reductions in symptoms after surgery.ConclusionThis is the first study to suggest improvement in RLS symptoms following surgical decompression of the common and superficial fibular nerves. Further investigation is needed to quantify improvement using RLS-specific metrics and sleep quality assessments.

  14. Complex Sleep Apnea Syndrome

    Directory of Open Access Journals (Sweden)

    Muhammad Talha Khan

    2014-01-01

    Full Text Available Complex sleep apnea is the term used to describe a form of sleep disordered breathing in which repeated central apneas (>5/hour persist or emerge when obstructive events are extinguished with positive airway pressure (PAP and for which there is not a clear cause for the central apneas such as narcotics or systolic heart failure. The driving forces in the pathophysiology are felt to be ventilator instability associated oscillation in PaCO2 arterial partial pressure of Carbon Dioxide, continuous cositive airway pressure (CPAP related increased CO2 carbon dioxide elimination, and activation of airway and pulmonary stretch receptors triggering these central apneas. The prevalence ranges from 0.56% to 18% with no clear predictive characteristics as compared to simple obstructive sleep apnea. Prognosis is similar to obstructive sleep apnea. The central apnea component in most patients on followup using CPAP therap, has resolved. For those with continued central apneas on simple CPAP therapy, other treatment options include bilevel PAP, adaptive servoventilation, permissive flow limitation and/or drugs.

  15. Validation of an algorithm for the diagnosis of Restless Legs Syndrome: The Restless Legs Syndrome-Diagnostic Index (RLS-DI).

    Science.gov (United States)

    Benes, Heike; Kohnen, Ralf

    2009-05-01

    There is a need for structured methods to improve sensitivity and specificity of diagnostic decision making in Restless Legs Syndrome (RLS). We present the RLS-Diagnostic Index (RLS-DI), a diagnostic algorithm which combines essential and supportive diagnostic criteria from patient interviews, polysomnography and neurological examination in an adaptive procedure. The RLS-DI consists of 10 items which are related to the essential diagnostic criteria established by the International RLS Study Group (five items) as well as their supportive criteria (3 items) and features associated with RLS (2 items). Items have to be completed using three categories per item that address frequency of occurrence of symptoms or certainty of presence or absence of other diagnostic information. Negative weights were given when the clinically most relevant items were not present. The RLS-DI was administered in a telephone interview to 179 patients (86 with RLS, 93 with other sleep disorders) of the 21 month cohort of one sleep center in Germany. With receiver-operating characteristics, a cut-off of >or= 11 points on a scale ranging from -22 (no RLS) to 20 (definite RLS) was identified by comparing the RLS-DI total score to the diagnosis of two independent sleep experts. Sensitivity was 93.0%, specificity was 98.9%, and 96.1% of the patients could be correctly diagnosed. Specificity was higher in items related to supportive or associated diagnostic information (95.7%) than in those related to the essential diagnostic criteria (81.7%). Patients with RLS scored a higher RLS-DI than those with primary insomnia or other neurological or psychiatric disorders (p RLS-DI demonstrated the ability to validly diagnose an actual and persistently present Restless Legs Syndrome in patients of a sleep lab population and to exclude those patients whose sleep disturbances have other causes.

  16. Sturge-Weber syndrome - legs (image)

    Science.gov (United States)

    ... nervous system (neurocutaneous) and is associated with Port Wine Stain, red vascular markings on the face and other parts of the body (shown here on the legs). This is an unusual case, due to the large size of the lesion ( ...

  17. Pivotal Role of Adenosine Neurotransmission in Restless Legs Syndrome

    Science.gov (United States)

    Ferré, Sergi; Quiroz, César; Guitart, Xavier; Rea, William; Seyedian, Arta; Moreno, Estefanía; Casadó-Anguera, Verònica; Díaz-Ríos, Manuel; Casadó, Vicent; Clemens, Stefan; Allen, Richard P.; Earley, Christopher J.; García-Borreguero, Diego

    2018-01-01

    The symptomatology of Restless Legs Syndrome (RLS) includes periodic leg movements during sleep (PLMS), dysesthesias, and hyperarousal. Alterations in the dopaminergic system, a presynaptic hyperdopaminergic state, seem to be involved in PLMS, while alterations in glutamatergic neurotransmission, a presynaptic hyperglutamatergic state, seem to be involved in hyperarousal and also PLMS. Brain iron deficiency (BID) is well-recognized as a main initial pathophysiological mechanism of RLS. BID in rodents have provided a pathogenetic model of RLS that recapitulates the biochemical alterations of the dopaminergic system of RLS, although without PLMS-like motor abnormalities. On the other hand, BID in rodents reproduces the circadian sleep architecture of RLS, indicating the model could provide clues for the hyperglutamatergic state in RLS. We recently showed that BID in rodents is associated with changes in adenosinergic transmission, with downregulation of adenosine A1 receptors (A1R) as the most sensitive biochemical finding. It was hypothesized that A1R downregulation leads to hypersensitive striatal glutamatergic terminals and facilitation of striatal dopamine release. Hypersensitivity of striatal glutamatergic terminals was demonstrated by an optogenetic-microdialysis approach in the rodent with BID, indicating that it could represent a main pathogenetic factor that leads to PLMS in RLS. In fact, the dopaminergic agonists pramipexole and ropinirole and the α2δ ligand gabapentin, used in the initial symptomatic treatment of RLS, completely counteracted optogenetically-induced glutamate release from both normal and BID-induced hypersensitive corticostriatal glutamatergic terminals. It is a main tenet of this essay that, in RLS, a single alteration in the adenosinergic system, downregulation of A1R, disrupts the adenosine-dopamine-glutamate balance uniquely controlled by adenosine and dopamine receptor heteromers in the striatum and also the A1R-mediated inhibitory

  18. Pivotal Role of Adenosine Neurotransmission in Restless Legs Syndrome

    Directory of Open Access Journals (Sweden)

    Sergi Ferré

    2018-01-01

    Full Text Available The symptomatology of Restless Legs Syndrome (RLS includes periodic leg movements during sleep (PLMS, dysesthesias, and hyperarousal. Alterations in the dopaminergic system, a presynaptic hyperdopaminergic state, seem to be involved in PLMS, while alterations in glutamatergic neurotransmission, a presynaptic hyperglutamatergic state, seem to be involved in hyperarousal and also PLMS. Brain iron deficiency (BID is well-recognized as a main initial pathophysiological mechanism of RLS. BID in rodents have provided a pathogenetic model of RLS that recapitulates the biochemical alterations of the dopaminergic system of RLS, although without PLMS-like motor abnormalities. On the other hand, BID in rodents reproduces the circadian sleep architecture of RLS, indicating the model could provide clues for the hyperglutamatergic state in RLS. We recently showed that BID in rodents is associated with changes in adenosinergic transmission, with downregulation of adenosine A1 receptors (A1R as the most sensitive biochemical finding. It was hypothesized that A1R downregulation leads to hypersensitive striatal glutamatergic terminals and facilitation of striatal dopamine release. Hypersensitivity of striatal glutamatergic terminals was demonstrated by an optogenetic-microdialysis approach in the rodent with BID, indicating that it could represent a main pathogenetic factor that leads to PLMS in RLS. In fact, the dopaminergic agonists pramipexole and ropinirole and the α2δ ligand gabapentin, used in the initial symptomatic treatment of RLS, completely counteracted optogenetically-induced glutamate release from both normal and BID-induced hypersensitive corticostriatal glutamatergic terminals. It is a main tenet of this essay that, in RLS, a single alteration in the adenosinergic system, downregulation of A1R, disrupts the adenosine-dopamine-glutamate balance uniquely controlled by adenosine and dopamine receptor heteromers in the striatum and also the A1R

  19. Restless Leg Syndrome Across the Globe: Epidemiology of the Restless Legs Syndrome/Willis-Ekbom Disease.

    Science.gov (United States)

    Koo, Brian B

    2015-09-01

    There are more than 50 epidemiologic studies measuring the prevalence of restless legs syndrome/Willis-Ekbom disease (RLS/WED) across 5 of the 6 inhabited continents (not Australia), most conducted in North America and Europe. Sufficient studies have been conducted in Asia, North America, and Europe to make inferences on RLS/WED prevalence by region. RLS/WED prevalence is thought to be highest in North America and Europe and lower in Asia. These differences across regions may be explained by cultural, environmental, and genetic factors. Future investigation is needed to determine to what extent these factors affect expression of RLS/WED according to world region. Published by Elsevier Inc.

  20. Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

    Directory of Open Access Journals (Sweden)

    Majid Malaki

    2012-01-01

    Full Text Available Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26 and 17% among the insomnia group (2 out of 12. In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

  1. Insomnia and limb pain in hemodialysis patients: what is the share of restless leg syndrome?

    Science.gov (United States)

    Malaki, Majid; Mortazavi, Fakhr Sadat; Moazemi, Sussan; Shoaran, Maryam

    2012-01-01

    Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26) and 17% among the insomnia group (2 out of 12). In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

  2. Clinical characteristics of leg restlessness in Parkinson's disease compared with idiopathic Restless Legs Syndrome.

    Science.gov (United States)

    Zhu, Xiao-Ying; Liu, Ye; Zhang, Xiao-Jin; Yang, Wen-Hao; Feng, Ya; Ondo, William G; Tan, Eng-King; Wu, Yun-Cheng

    2015-10-15

    There is limited data on motor restlessness in Parkinson's disease (PD). Here we evaluate for clinical differences between cohorts of idiopathic Restless Legs Syndrome (iRLS), PD patients with leg restlessness, and PD with RLS. We examined 276 consecutive PD patients for leg restlessness symptoms, we compared clinical features of PD patients with RLS, PD patients with leg restlessness but not meeting RLS criteria, PD patient without RLS and iRLS. A total of 262 PD patients who satisfied the inclusion criteria were analyzed. After excluding 23 possible secondary RLS or mimics, 28 were diagnosed with RLS and 18 with leg motor restlessness (LMR). Compared with iRLS patients, PD patients with RLS or LMR had older age of RLS/LMR onset, shorter duration of leg restlessness, less positive family history, different seasonal trends and more unilaterality of leg restlessness symptom (Pleg restlessness. PD with LMR had less severe Parkinsonism (Pleg restlessness (P<0.01) symptoms than PD with RLS. Clinical characteristics of PD patients with RLS and LMR were different from iRLS, differentiating these various subtypes can facilitate optimal treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. [Dopamine dysregulation syndrome in Parkinson's disease and restless legs syndrome].

    Science.gov (United States)

    Bayard, Sophie; Cochen De Cock, Valérie; Dauvillers, Yves

    2011-06-01

    Dopamine replacement therapy in Parkinson's disease (PD) improves the motor symptoms. However, it has recently been shown that a small sub-group of patients suffers from motor and behavioral disturbances associated with the use of dopamine agonists (DAs). The behavioral disorders are incentive- or reward-based repetitive symptoms regrouped under the term « dopamine dysregulation syndrome » (DDS). They include pathological gambling, hypersexuality, compulsive shopping, compulsive eating, punding, and compulsive medication use. Whether these behaviors are related to the dopaminergic medications interacting with an underlying individual vulnerability or whether the primary pathological features of Parkinson's disease play a role is not entirely understood. This review is devoted to the phenomenology of the DDS and factors influencing its susceptibility. We further review the literature studies that investigated the decision-making profile using the Iowa Gambling Task in Parkinson's disease, and the recent literature devoted to these abnormal behaviors in the restless legs syndrome (RLS). Given the potential substantial impact of the DDS on personal, familial, social, and financial well-being, patients with PD or RLS should be informed that DAs use may lead to the development of impulsive and compulsive disorders, and clinicians should include the investigation of these disorders as part of routine clinical care. The refinement of clinical strategies to predict, identify and manage DDS will help the future care of motor and non-motor symptoms of Parkinson's disease.

  4. Willis-Ekbom Disease or Restless Legs Syndrome?

    Science.gov (United States)

    Carlos, K; Prado, L B F; Carvalho, L B C; Prado, G F

    2015-09-01

    Restless Legs Syndrome (RLS) or Willis-Ekbom Disease (WED) is highly prevalent, but patients and healthcare providers alike know little about it. Furthermore, controversy persists as to the best way of diagnosing this nosological entity. To verify whether the term used to refer to this disease entity (Restless Legs Syndrome or Willis-Ekbom Disease) affects the prevalence of self-diagnosed RLS/WED in a sample of newly graduated physicians. Newly graduated physicians were asked to self-evaluate for the presence of RLS/WED. Briefly, participants were allocated randomly across two groups. One was asked to self-assess for RLS, while the other was asked to self-assess for WED. The evaluation form given to one group asked 'Do you have Restless Legs Syndrome?' whereas the form given to participants in the other group asked 'Do you have Willis-Ekbom Disease?'. Both forms also contained the four criteria for diagnosing RLS proposed by the International Restless Legs Syndrome Study Group (IRLSSG) and instructions for self-diagnosis according to these criteria. The study sample comprised 1413 newly graduated physicians. Of the 708 participants who were given the form that used the term RLS, 87 (12.28%) diagnosed themselves with the condition. Conversely, of 705 physicians given the form with the term WED, 13 (1.84%) diagnosed themselves with the condition (p Restless Legs Syndrome than when presented with the term Willis-Ekbom Disease. This suggests that the term Restless Legs Syndrome may not be the most appropriate term to denote this nosological entity. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. The validity of the PAM-RL device for evaluating periodic limb movements in sleep and an investigation on night-to-night variability of periodic limb movements during sleep in patients with restless legs syndrome or periodic limb movement disorder using this system.

    Science.gov (United States)

    Kobayashi, Mina; Namba, Kazuyoshi; Ito, Eiki; Nishida, Shingo; Nakamura, Masaki; Ueki, Yoichiro; Furudate, Naomichi; Kagimura, Tatsuo; Usui, Akira; Inoue, Yuichi

    2014-01-01

    The status of night-to-night variability for periodic limb movements in sleep (PLMS) has not been clarified. With this in mind, we investigated the validity of PLMS measurement by actigraphy with the PAM-RL device in Japanese patients with suspected restless legs syndrome (RLS) or periodic limb movement disorder (PLMD) and the night-to-night variability of PLMS among the subjects. Forty-one subjects (mean age, 52.1±16.1 years) underwent polysomnography (PSG) and PAM-RL measurement simultaneously. Thereafter, subjects used the PAM-RL at home on four more consecutive nights. The correlation between PLMS index on PSG (PLMSI-PSG) and PLM index on PAM-RL (PLMI-PAM) was 0.781 (PPAM-RL. PAM-RL is thought to be valuable for assessing PLMS even in Japanese subjects. Recording of PAM-RL for three or more consecutive nights may be required to ensure the screening reliability of a patient with suspected pathologically frequent PLMS. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Short-term attention and verbal fluency is decreased in restless legs syndrome patients.

    Science.gov (United States)

    Fulda, Stephany; Beitinger, Marie E; Reppermund, Simone; Winkelmann, Juliane; Wetter, Thomas C

    2010-11-15

    Restless legs syndrome (RLS) is a frequent sleep-related movement disorder with disturbed sleep and quality of life. RLS patients complain about increased daytime sleepiness, but there are only few and inconsistent reports about cognitive functioning in this group. We compared cognitive performance of 23 unmedicated RLS patients to that of 23 healthy controls matched individually for age, gender, and educational level. Cognitive tasks were chosen to assess short-term attention, working memory, learning and memory, verbal fluency, and executive functioning. RLS patients performed worse than controls in the area of attention and verbal fluency, and performance in these tasks was associated with RLS severity, sleep quality, depression scores, and memory. There was no difference for working memory, memory, learning, cognitive flexibility, and abstract reasoning. We conclude that there is evidence for deficits in short-term attention and verbal fluency in RLS patients. © 2010 Movement Disorder Society.

  7. Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective

    Directory of Open Access Journals (Sweden)

    Susana Cristina Lerosa Telles

    2012-11-01

    Full Text Available The primary trigger to periodic limb movement (PLM during sleep is still unknown. Its association with the restless legs syndrome (RLS is established in humans and was reported in spinal cord injury (SCI patients classified by the American Spinal Injury Association (ASIA as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

  8. Refining duration and frequency thresholds of restless legs syndrome diagnosis criteria.

    Science.gov (United States)

    Ohayon, Maurice M; Bagai, Kanika; Roberts, Laura W; Walters, Arthur S; Milesi, Cristina

    2016-12-13

    This study assesses the prevalence of restless legs syndrome (RLS) using DSM-5 criteria and determines what is the most appropriate threshold for the frequency and duration of RLS symptoms. The Sleep-EVAL knowledge base system queried the interviewed subjects on life, sleeping habits, and health. Questions on sleep and mental and organic disorders (DSM-5, ICD-10) were also asked. A representative sample of 19,136 noninstitutionalized individuals older than 18 years living in the United States was interviewed through a cross-sectional telephone survey. The participation rate was 83.2%. The prevalence of the 4 leg symptoms describing RLS occurring at least 1 d/wk varied between 5.7% and 12.3%. When the frequency was set to at least 3 d/wk, the prevalence dropped and varied between 1.8% and 4.5% for the 4 leg symptoms. Higher frequency of leg symptoms was associated with greater distress and impairment with a marked increase at 3 d/wk. Symptoms were mostly chronic, lasting for more than 3 months in about 97% of the cases. The prevalence of RLS according to DSM-5 was 1.6% (95% confidence interval 1.4%-1.8%) when frequency was set at 3 d/wk. Stricter criteria for frequency of restless legs symptoms resulted in a reduction of prevalence of the disorder. The prevalence was further reduced when clinical impact was taken into consideration. In order to avoid inflation of case rates and to identify patients in whom treatment is truly warranted, using a more conservative threshold of 3 times or greater per week appears the most appropriate. © 2016 American Academy of Neurology.

  9. A further evaluation of the cognitive deficits associated with restless legs syndrome (RLS).

    Science.gov (United States)

    Gamaldo, Charlene E; Benbrook, Amy R; Allen, Richard P; Oguntimein, Oluwamurewa; Earley, Christopher J

    2008-07-01

    Restless legs syndrome (RLS) is a common sensorimotor disorder that peaks in severity during the night and comes on with rest. As a result, this condition often results in significant chronic sleep loss, especially for those with severe disease. Chronic partial sleep restriction has been associated with conditions such as depression, anxiety, chronic pain, and decline in cognitive function. Furthermore, studies have found that RLS patients suffer from these conditions more than their unaffected peers. Thus, the morbidity rate associated with RLS has often been attributed to the chronic sleep loss that frequently accompanies this condition. However, no study has specifically compared RLS sufferers to otherwise normal sleep-restricted controls in order to assess disease morbidity independent of its sleep deprivation effects. In this study, we compared the cognitive function of RLS patients who were off treatment to sleep-restricted control subjects. A novel chronic partial sleep-restriction protocol that utilized a 14-day combined inpatient and outpatient design was implemented in order to test the differences in cognitive functioning between RLS patients and sleep-restricted controls. The brief cognitive battery included instruments assessing general intelligence and global executive function in order to control for baseline cognitive function between the groups, and then the effects of sleep loss were assessed using prefrontal lobe-specific tasks. The final sample consisted of 16 RLS (11 male and 5 female) and 13 sleep-restricted control subjects (7 male and 6 female). In order to examine the differences in cognitive functioning between sleep-restricted controls and RLS subjects, independent samples t-tests were conducted. RLS subjects performed significantly better on both the Letter Fluency (t=2.13, pRLS subjects performed better than the sleep-restricted controls on two tasks that are particularly sensitive to sleep loss. Although previous studies suggest that

  10. Efficacy and safety of dopamine agonists in restless legs syndrome.

    Science.gov (United States)

    Hornyak, Magdolna; Trenkwalder, Claudia; Kohnen, Ralf; Scholz, Hanna

    2012-03-01

    Restless legs syndrome (RLS) is a common neurological disorder causing considerable impairment to daily living. This article is an overview of a comprehensive Cochrane meta-analysis on the efficacy and safety of dopamine agonists (DAs), the first-line treatment of RLS. CENTRAL, MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for double-blind randomized controlled trials (RCTs) of DAs vs placebo. Thirty-five placebo-controlled RCTs (total number of patients=6954) were eligible. The likelihood of bias was considered to be low. The mean treatment duration of the RCTs was 10.3 (standard deviation 7.3) weeks, with treatment durations up to seven months. Overall, DAs showed a moderate improvement in the International RLS Severity Scale score (mean difference -5.7 points [95% confidence interval, CI, -6.7 to -4.7; PImpression-Improvement response (risk ratio 1.44 [95% CI 1.34-1.54; P<0.00001]) compared with placebo. Periodic limb movements decreased by -22.38/h (95% CI -27.8 to -16.9; P<0.00001) for DAs compared with placebo. Sleep quality and disease-specific quality of life increased slightly to moderately. Safety data confirmed the established safety characteristics of DAs. Augmentation, a specific side-effect of dopaminergic treatment of RLS, was not assessed adequately. This meta-analysis showed that DAs have moderate efficacy in the treatment of RLS. Actively controlled and long-term studies are still lacking. Large-scale comparative studies are needed to identify the most efficient treatments for this chronic disorder. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Epidemiology of restless legs syndrome in Korean adults.

    Science.gov (United States)

    Cho, Yong Won; Shin, Won Chul; Yun, Chang Ho; Hong, Sung Bong; Kim, Ju Han; Allen, Richard P; Earley, Christopher J

    2008-02-01

    To investigate the prevalence of restless legs syndrome (RLS) in Korea. A large population-based telephone interview method using the Korean version of the Johns Hopkins telephone diagnostic interview for the RLS. A computer aided telephone interview method. A total of 5,000 subjects (2,470 men and 2,530 women) were interviewed in depth. A representative sample aged 20 to 69 years was constituted according to a stratified, multistage random sampling method. N/A. Of the respondents, 373 respondents (7.5%) of the population (pop) met the criteria for the definite or probable RLS groups: 194 (3.9% of pop) respondents fulfilled the criteria for definite RLS and 179 (3.6% of pop) respondents fulfilled the criteria for probable RLS. The prevalence of RLS was generally higher for women than men (4.4% vs. 3.3% for definite, 8.7% vs. 6.2% for definite plus probable). About 90% of RLS individuals were experiencing symptoms at the time of the interview and this was similar for both RLS groups. Seventy-four respondents (1.48%) reported symptoms were moderately or severely distressing and were therefore classified as RLS "sufferers." Of those with a diagnosis of RLS sufferer, 24.3% reported being treated for their symptoms, compared to 12.4% of RLS not designated a "sufferer." RLS is common and underdiagnosed in Korea with nearly 1% of the population reporting disturbed sleep related to their RLS. These results are comparable to other countries.

  12. European guidelines on management of restless legs syndrome

    DEFF Research Database (Denmark)

    Garcia-Borreguero, Diego; Ferini-Strambi, Luigi; Kohnen, Ralf

    2012-01-01

    Since the publication of the first European Federation of Neurological Societies (EFNS) guidelines in 2005 on the management of restless legs syndrome (RLS; also known as Willis-Ekbom disease), there have been major therapeutic advances in the field. Furthermore, the management of RLS is now a part...

  13. Well-leg compartment syndrome after gynecological laparoscopic surgery

    DEFF Research Database (Denmark)

    Boesgaard-Kjer, Diana H; Boesgaard-Kjer, Daniel; Kjer, Jens Jørgen

    2013-01-01

    Well-leg compartment syndrome in the lower extremities after surgery in the lithotomy position is a rare but severe complication requiring early diagnosis and intervention. Several circumstances predispose to this condition as a consequence of increased intra-compartmental pressure, such as posit...

  14. Presenting Symptoms in Pediatric Restless Legs Syndrome Patients

    NARCIS (Netherlands)

    de Weerd, Al; Arico, Irene; Silvestri, Rosalia

    2013-01-01

    Objective: The diagnosis restless legs syndrome (RLS) in children depends on the history told by the child and his parents. The description of symptoms given by the child him or herself is most important. Additional criteria are, among others, the results of polysomnography (PSG). Description of the

  15. Obstructive sleep apnoea syndrome in children

    Directory of Open Access Journals (Sweden)

    Anna Włodarska

    2016-09-01

    Full Text Available Sleep-related breathing disorders in children are a clinical problem which is more and more often diagnosed by doctors nowadays. They can be the basis for diagnosing obstructive sleep apnoea syndrome that causes a number of complications: lowering the quality of life, behavioural problems, complications involving cardiovascular system. The incidence of obstructive sleep apnoea syndrome in the paediatric population is estimated to be at the level of 2%. The symptoms of obstructive sleep apnoea syndrome can be divided into daytime and night ones. Night symptoms in children include: snoring, apnoea, breathing with open mouth (both during the day and at night, dry tongue and mouth during sleep, agitated sleep in unnatural positions. Among daytime symptoms of obstructive sleep apnoea syndrome there are: irritability, aggressiveness, hyperactivity, attention deficit disorder, delayed development and growth pattern (mainly failure to thrive, learning problems, morning headaches. Parents often do not connect the night and daytime symptoms with the possible development of obstructive sleep apnoea syndrome in their children. The main predisposing factor of obstructive sleep apnoea syndrome in children is adenotonsillar hypertrophy. Effective and in most cases preferred treatment for the management of obstructive sleep apnoea syndrome in children is adenotonsillectomy. Polysomnography and polygraphy are diagnostic tools helpful in the study of sleep-related disorders. The objective of this study was to systematise the knowledge on the epidemiology, aetiology, clinical image and prevention of obstructive sleep apnoea syndrome in children.

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

    Science.gov (United States)

    Michaud, Martin; Dumont, Marie; Paquet, Jean; Desautels, Alex; Fantini, Maria Livia; Montplaisir, Jacques

    2005-07-01

    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. A 28-hour modified constant routine protocol. Sleep Disorders Center, Montreal Sacré-Coeur Hospital. 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. None. 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 immobility is closely linked to their intrinsic circadian variation.

  17. Leg orientation as a clinical sign for pusher syndrome

    Directory of Open Access Journals (Sweden)

    Johannsen Leif

    2006-08-01

    Full Text Available Abstract Background Effective control of (upright body posture requires a proper representation of body orientation. Stroke patients with pusher syndrome were shown to suffer from severely disturbed perception of own body orientation. They experience their body as oriented 'upright' when actually tilted by nearly 20° to the ipsilesional side. Thus, it can be expected that postural control mechanisms are impaired accordingly in these patients. Our aim was to investigate pusher patients' spontaneous postural responses of the non-paretic leg and of the head during passive body tilt. Methods A sideways tilting motion was applied to the trunk of the subject in the roll plane. Stroke patients with pusher syndrome were compared to stroke patients not showing pushing behaviour, patients with acute unilateral vestibular loss, and non brain damaged subjects. Results Compared to all groups without pushing behaviour, the non-paretic leg of the pusher patients showed a constant ipsiversive tilt across the whole tilt range for an amount which was observed in the non-pusher subjects when they were tilted for about 15° into the ipsiversive direction. Conclusion The observation that patients with acute unilateral vestibular loss showed no alterations of leg posture indicates that disturbed vestibular afferences alone are not responsible for the disordered leg responses seen in pusher patients. Our results may suggest that in pusher patients a representation of body orientation is disturbed that drives both conscious perception of body orientation and spontaneous postural adjustment of the non-paretic leg in the roll plane. The investigation of the pusher patients' leg-to-trunk orientation thus could serve as an additional bedside tool to detect pusher syndrome in acute stroke patients.

  18. Is there a polysomnographic signature of augmentation in restless legs syndrome?

    Science.gov (United States)

    Mitterling, Thomas; Frauscher, Birgit; Falkenstetter, Tina; Gschliesser, Viola; Ehrmann, Laura; Gabelia, David; Brandauer, Elisabeth; Poewe, Werner; Högl, Birgit

    2014-10-01

    Augmentation of restless legs syndrome (RLS) is a potentially severe side-effect of dopaminergic treatment. Data on objective motor characteristics in augmentation are scarce. The aim of this study was to investigate in detail different variables of leg movements (LM) in untreated, treated, and augmented RLS patients. Forty-five patients with idiopathic RLS [15 untreated, 15 treated (non-augmented), 15 augmented] underwent RLS severity assessment, one night of video-polysomnography with extended electromyographic montage, and a suggested immobilization test (SIT). Standard LM parameters as well as periodicity index (PI) and muscle recruitment pattern did not differ between the three groups. The ultradian distribution of periodic leg movements (PLM) in sleep during the night revealed significant differences only during the second hour of sleep (P <0.05). However, augmented patients scored highest on RLS severity scales (P <0.05) and were the only group with a substantial number of PLM during the SIT. This study demonstrates that polysomnography is of limited usefulness for the diagnosis and evaluation of RLS augmentation. In contrast, the SIT showed borderline differences in PLM, and differences on subjective scales were marked. According to these results, augmentation of RLS is a phenomenon that predominantly manifests in wakefulness. Copyright © 2014 Elsevier B.V. All rights reserved.

  19. Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Mitchell UH

    2011-05-01

    Full Text Available Ulrike H MitchellDepartment of Exercise Sciences, Brigham Young University, Provo, UT, USAAbstract: Ekbom disease (EKD, formerly known as restless legs syndrome (RLS has affected and bothered many people over the centuries. It is one of the most prevalent neurological disorders in Europe and North-America, affecting about 10% of the population. The main characteristics are the strong urge to move, accompanied or caused by uncomfortable, sometimes even distressing, paresthesia of the legs, described as a "creeping, tugging, pulling" feeling. The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which leads to decreased alertness and daytime functions. Numerous studies have been conducted assessing the efficacy of dopaminergic drugs, opioids, and other pharmacologic agents in alleviating EKD symptoms. However, there is also a growing body of evidence demonstrating the effectiveness of nonpharmacologic treatments including life style changes, physical activity programs, pneumatic compression, massage, near-infrared light therapy, and complementary therapies. The working mechanisms behind these alternatives are diverse. Some increase blood flow to the legs, therefore reducing tissue hypoxia; some introduce an afferent counter stimulus to the cortex and with that "close the gate" for aberrant nerve stimulations; some increase dopamine and nitric oxide and therefore augment bio-available neurotransmitters; and some generate endorphins producing an analgesic effect. The advantages of these treatments compared with pharmacologic agents include less or no side effects, no danger of augmentation, and less cost.Keywords: RLS, modalities, massage, intermittent compression, NIR

  20. Circadian rhythm of periodic limb movements and sensory symptoms of restless legs syndrome.

    Science.gov (United States)

    Trenkwalder, C; Hening, W A; Walters, A S; Campbell, S S; Rahman, K; Chokroverty, S

    1999-01-01

    The symptoms of restless legs syndrome (RLS) worsen while patients are sitting or lying and also worsen at night. The current study was designed to determine if the periodic limb movements (PLMs) and sensory symptoms of RLS are modulated by an independent circadian factor. We recorded sleeping and waking PLMs and waking sensory symptoms in eight volunteers with RLS for 3 successive nights and days, starting with a polysomnographic recording of 2 nights, followed by a third night of sleep deprivation and the day after sleep deprivation. This study showed that both the PLMs and sensory symptoms were worst at night with a maximum for both between midnight and 1:00 AM and a minimum between 9:00 and 11:00 AM. Sleep and drowsiness had a tendency to worsen PLMs and sensory symptoms after the night of sleep deprivation. Circadian temperature curves were normal in all four patients with adequate data collection. The highest PLM counts occurred on the falling phase of the circadian temperature curve whereas the lowest PLM counts occurred on the rising phase of the curve. We conclude that the PLM and sensory symptoms in RLS are influenced by a circadian rhythm, and that the "worsening at night" criterion of the RLS Definition Criteria is, at least in part, distinct from the "worsening while lying or sitting" criterion.

  1. Restless Legs Syndrome in an Appalachian Primary Care Population: Prevalence, Demographic and Lifestyle Correlates, and Burden

    Science.gov (United States)

    Innes, Kim E.; Flack, Kathryn L.; Selfe, Terry Kit; Kandati, Sahiti; Agarwal, Parul

    2013-01-01

    Background: Restless legs syndrome (RLS) is a common and distressing sensorimotor disorder of unknown etiology. While the epidemiology of RLS has been examined in several North American and European studies, research on RLS and RLS burden in poor, rural populations, including those residing in Appalachia, remains sparse. In this study, we investigated RLS prevalence in an Appalachian primary care population and examined the association of RLS to demographic factors, lifestyle characteristics, sleep quality, and mood disorders. Methods: Participants of this anonymous survey study were community-dwelling adults aged ≥ 18 years visiting one of 4 West Virginia primary care clinics. Data gathered included detailed information on sleep patterns, demographic characteristics, lifestyle factors, and health/medical history; the survey also included questions specific to RLS diagnosis and severity. Response rates were excellent, with 68% of eligible adults contacted returning completed surveys (N = 1,424/2,087). Pregnant women (N = 65) and those with missing data on key variables (N = 142) were excluded from the analyses. Results: Of the 1,217 participants included in the final analytic sample, 19.6% (18.2% with symptoms at least once/month) met the 4 IRLSSG diagnostic criteria in the absence of positional discomfort or leg cramps; 14.5% reported RLS symptoms at least once/week and 10.1% indicated symptoms ≥ 3×/week. Excluding respondents with diabetes, kidney disease, or anemia reduced these rates only slightly. Those with RLS were more likely to be older, female, lower income, unemployed, disabled, non-Hispanic white, and less likely to be college educated than those without RLS. Mood and sleep impairment were significantly elevated in those with RLS; after adjustment for demographic and lifestyle characteristics, health history, and other factors, those with RLS remained significantly more likely to indicate a history of depression (adjusted odds ratio [OR] = 1.9; 95

  2. Restless legs syndrome responsive to rasagiline treatment: a case report.

    Science.gov (United States)

    Babacan-Yildiz, Gulsen; Gursoy, Esra; Kolukisa, Mehmet; Celebi, Arif

    2012-01-01

    We describe a patient with idiopathic restless legs syndrome (iRLS) who was responsive to rasagiline treatment. A 70-year-old woman presented with an 8-year history of iRLS symptoms and a 1-year history of resting tremor. The patient met the UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria (UK Parkinson Disease [PD] Brain Bank criteria) for the diagnosis of idiopathic PD and the criteria of the International Restless Legs Syndrome Study Group for the diagnosis of iRLS. One milligram of rasagiline once daily was started with the diagnosis of early PD as monotherapy. At week 8, the patient was almost iRLS symptoms free. Rasagiline has also been shown to mildly improve PD symptoms. Rasagiline was well tolerated during the follow-up. We suggest that rasagiline could represent a useful therapeutic option in the treatment of iRLS.

  3. Gabapentin versus levodopa-c for the treatment of restless legs syndrome in hemodialysis patients: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Nazanin Razazian

    2015-01-01

    Full Text Available To compare the efficacy of gabapentin and levodopa-c (Levodopa/Carbidopa in reducing restless leg syndrome (RLS symptoms and sleep problems in hemodialysis patients with RLS in a four-week randomized clinical trial. The diagnosis of RLS was made using the criteria of the International Restless Legs Study Group. Each subject completed three questionnaires: IRLS questionnaire, Pittsburgh Sleep Quality Index and Epworth sleepiness scale. After four weeks of washout period for previous treatments for RLS, subjects were randomly assigned to four weeks of gabapentin (200 mg or levodopa-c (110 mg. After four weeks of therapy, the questionnaires administered at the outset of the study were re-administered. Both drugs were found effective for the management of RLS. But, the effect of gabapentin was more significant. Gabapentin significantly improved the IRLS total score (change from baseline to post-treatment ≈-17 compared with levodopa-c (change from baseline to post-treatment ≈-13 (P: 0.016. Regarding sleep parameters, levodopa improved sleep quality, sleep latency and sleep duration (P <0.0001. Gabapentin was also effective with respect to sleep parameters (P <0.0001. Our study shows that gabapentin is a safe effective therapy for RLS among hemodialysis patients. This medication may be considered as an alternative or additive treatment to current therapeutic remedies for hemodialysis patients with RLS.

  4. Crohn's Disease Is Associated With Restless Legs Syndrome

    OpenAIRE

    Weinstock, Leonard B.; Bosworth, Brian P.; Scherl, Ellen J.; Li, Ellen; Iroku, Ugonna; Munsell, Melissa A.; Mullen, Gerald E.; Walters, Arthur S.

    2010-01-01

    Extraintestinal manifestations of Crohn's disease (CD) have not previously included the central nervous system (CNS). Restless legs syndrome (RLS) is a CNS disorder that is either idiopathic or secondary to a number of diseases. The aim of this study was to determine if RLS was associated with CD because both are associated with iron deficiency, inflammation, and bacterial overgrowth. Consecutive CD outpatients (N=272) were prospectively surveyed at 4 centers for criteria for RLS. Incidence (...

  5. Genetic and Ethiopatogenetic Aspects of the Restless Legs Syndrome

    OpenAIRE

    Kemlink, David

    2006-01-01

    The restless legs syndrome (RLS) is a sensomotor disoder characterized by urge to move lower extremities and this urge is usualy associated with unpleasnat sensations. The symtoms of RLS are alleviated with movement and, on the contrary, worsen during rest. The urge presents circadian rhytmicity peaking in the evening and the first half of night. The diagnosis of RLS is set according to patients' history fulfilling the essential criteria. The prevalence of RLS is quite high in western countri...

  6. Double-blind evaluation of clonazepam on periodic leg movements in sleep.

    Science.gov (United States)

    Peled, R; Lavie, P

    1987-01-01

    Treatment with clonazepam was studied in a group of 20 patients suffering from periodic movements in sleep, in a double-blind parallel group design. Eleven complained of excessive daytime sleepiness, and nine complained of insomnia. Ten patients received clonazepam, and 10 received placebo, over a period of 1 month. Clonazepam (0.5-2 mg per night) proved to be an effective treatment of periodic movements in sleep. Polysomnographic recordings demonstrated a significant decrease in the number of leg movements and a significant improvement in sleep parameters in the clonazepam group as compared with placebo. Subjective responses to treatment corroborated the sleep laboratory findings. PMID:3437302

  7. Restless legs syndrome in post-polio syndrome: a series of 10 patients with demographic, clinical and laboratorial findings.

    Science.gov (United States)

    Marin, Luis F; Carvalho, Luciane B C; Prado, Lucila B F; Quadros, Abrahao A J; Oliveira, Acary S; Prado, Gilmar F

    2011-08-01

    Few studies have described the occurrence of restless legs syndrome in post-polio syndrome. We studied 10 consecutive patients with post-polio syndrome and symptoms of restless legs syndrome. We look at demographic, clinical and laboratorial data. A remarkable finding was the concomitant onset of symptoms of both diseases, suggesting a possible underlying mechanism. Severity of restless legs symptoms was moderate to very severe. Epidemiological studies with larger samples are needed to better establish the relationship and the incidence of restless legs syndrome in post-polio syndrome. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Possible association between vitamin D deficiency and restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Oran M

    2014-05-01

    Full Text Available Mustafa Oran,1 Cuneyt Unsal,2 Yakup Albayrak,2 Feti Tulubas,3 Keriman Oguz,4 Okan Avci,1 Nilda Turgut,4 Recep Alp,4 Ahmet Gurel3 1Department of Internal Medicine, 2Department of Psychiatry, 3Department of Biochemistry, 4Department of Neurology, Namik Kemal University, Faculty of Medicine, Tekirdağ, Turkey Background and aim: Restless legs syndrome (RLS is a distressing sleep disorder that occurs worldwide. Although there have been recent developments in understanding the pathophysiology of RLS, the exact mechanism of the disease has not been well elucidated. An increased prevalence of neurologic and psychiatric diseases involving dopaminergic dysfunction in vitamin D-deficient patients led us to hypothesize that vitamin D deficiency might result in dopaminergic dysfunction and consequently, the development of RLS (in which dopaminergic dysfunction plays a pivotal role. Thus, the aim of this study was to evaluate the relationship between vitamin D deficiency and RLS. Methods: One hundred and fifty-five consecutive patients, 18–65 years of age, who were admitted to the Department of Internal Medicine with musculoskeletal symptoms and who subsequently underwent neurological and electromyography (EMG examination by the same senior neurologist, were included in this study. The patients were divided into two groups according to serum 25-hydroxyvitamin D (25(OHD (a vitamin D metabolite used as a measure of vitamin D status level: 36 patients with serum 25(OHD levels ≥20 ng/mL comprised the normal vitamin D group, and 119 patients with serum 25(OHD levels <20 ng/mL comprised the vitamin D deficiency group. The two groups were compared for the presence of RLS and associated factors. Results: The two groups were similar in terms of mean age, sex, mean body mass index (BMI, and serum levels of calcium, phosphate, alkaline phosphatase (ALP, and ferritin. The presence of RLS was significantly higher in the vitamin D deficiency group (χ2=12.87, P<0

  9. Clinical characteristics of restless legs syndrome in end-stage renal failure and idiopathic RLS patients.

    Science.gov (United States)

    Enomoto, Minori; Inoue, Yuichi; Namba, Kazuyoshi; Munezawa, Takashi; Matsuura, Masato

    2008-04-30

    This study was done to identify the clinical characteristics of uremic restless legs syndrome (RLS). Consecutive uremic RLS patients (n = 15) and idiopathic RLS patients (iRLS; n = 20) were evaluated. The groups were compared with respect to their clinical course, subjective symptoms [using the Pittsburgh Sleep Quality Index (PSQI) and the International Restless Legs Syndrome Severity Scale (IRLS)], polysomnographic (PSG) variables, the results of the suggested immobilization test (SIT), and the drug doses used to treat RLS. The duration of the disorder was significantly shorter in the uremic RLS group than in the iRLS group. The PSQI and IRLS scores before treatment were higher in the uremic RLS group than in the iRLS group. The periodic leg movement index (PLM index) on PSG and the SIT index were also higher in the uremic RLS group (P RLS was significantly higher in the uremic RLS group (P RLS appears to deteriorate faster and to become more severe than iRLS. Moreover, uremic RLS patients appear to have a decreased response to dopaminergic agonists. (c) 2008 Movement Disorder Society.

  10. Snoring and obstructive sleep apnoea syndrome among ...

    African Journals Online (AJOL)

    Background: Obstructive sleep apnoea (OSA) syndrome is a common disorder in the community. Association between hypertension and sleep apnoea and /or snoring has been described. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSA. The study aim to describe ...

  11. Sleep Problems in Individuals with Angelman Syndrome

    Science.gov (United States)

    Didden, Robert; Korzilius, Hubert; Smits, Marcel G.; Curfs, Leopold M. G.

    2004-01-01

    Prevalence of severe sleep problems and its association with other variables were investigated with 109 individuals who have Angelman syndrome. Severe settling problems, frequent night waking, and early waking were found in 2%, 37%, and 10% of the individuals, respectively. Sleep problems were persistent in this sample. No statistically…

  12. The Relationship between Iron Deficiency and Restless Legs Syndrome in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    R Ghanei Gheshlagh

    2012-10-01

    Full Text Available Introduction: Restless legs syndrome is a neurological disorder; hemodialysis patients seem to suffer more from this syndrome. Although the pathophysiology of restless legs syndrome is still unknown, assessment of factors associated with this syndrome can help to develop medical knowledge in this field. The present study assessed the relationship between restless legs syndrome, serum iron, and serum ferritin levels in patients on hemodialysis. Methods: This descriptive study was carried out with purposive sampling method on 168 hemodialysis patients who referred to the Urmia Taleghani Hospital Hemodialysis Unit. Data were gathered using restless legs syndrome questionnaire and laboratory Index of serum iron and ferritin. Data were analyzed using descriptive and inferential statistical tests. Results: The study results revealed that 38.7 percent of samples complained from restless legs syndrome whose average score serum iron was 78±29.3 μg. Results showed in hemodialysis patients with restless legs syndrome, serum iron and serum ferritin levels were significantly lower than hemodialysis patients without restless legs syndrome (p=0. 02, p=0.005. Conclusion: Considering the high prevalence of restless legs syndrome in patients with hemodialysis, identification of factors associated with this syndrome and providing the necessary solutions for modifying or eliminating the factors, seem to be necessary. Since the relationship between indicators of iron and ferritin and restless legs syndrome in hemodialysis patients is confirmed, the results can be helpful in the treatment and management of these patients.

  13. Restless legs syndrome, periodic leg movements, and periodic limb movement disorder in children.

    Science.gov (United States)

    Durmer, Jeffrey S; Quraishi, Ghazala H

    2011-06-01

    The characteristic symptoms of restless legs syndrome (RLS) have been known for hundreds of years and were first reported in medicine in the 1600s. Clinicians must consider potential mimics, comorbid, and associated conditions when evaluating children with RLS symptoms. The traditional differentiation of RLS from periodic limb movement disorder (PLMD) is noted in children as well as adults. Because current pediatric RLS research is sparse, this article provides the most up-to-date evidence-based as well as consensus opinion-based information on the subject of childhood RLS and PLMD. Prevalence, pathophysiology, diagnosis, treatment, and clinical associations are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Leg actigraphy to quantify periodic limb movements of sleep: a systematic review and meta-analysis.

    Science.gov (United States)

    Plante, David T

    2014-10-01

    Periodic limb movements of sleep (PLMS) are repetitive, stereotyped movements that can disrupt sleep and result in insomnia, non-restorative sleep, and/or daytime sleepiness. Currently, polysomnography is the gold standard and only clinically acceptable means of quantifying PLMS. Leg-worn actigraphy is an alternative method of measuring PLMS, which may circumvent many of the economic and technical limitations of polysomnography to quantify nocturnal leg movements. However, the use of leg actigraphy as a diagnostic means of assessing PLMS has not been systematically evaluated. In this review, the use of leg-worn actigraphy to measure PLMS is systematically evaluated, using both qualitative and quantitative assessment. Findings demonstrate significant heterogeneity among a limited number of studies in terms of type of actigraph utilized, position of the device on the lower extremity, and methods employed to count PLMS. In general, common accelerometers vary in their sensitivity and specificity to detect PLMS, which is likely related to the technical specifications of a given device. A current limitation in the ability to combine data from actigraphs placed on both legs is also a significant barrier to their use in clinical settings. Further research is required to determine the optimal methods to quantify PLMS using leg actigraphy, as well as specific clinical situations in which these devices may prove most useful. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Objective Sleep Assessments in Patients with Postural Tachycardia Syndrome using Overnight Polysomnograms

    Science.gov (United States)

    Bagai, Kanika; Peltier, Amanda C.; Malow, Beth A.; Diedrich, André; Shibao, Cyndya A.; Black, Bonnie K.; Paranjape, Sachin Y.; Orozco, Carlos; Biaggioni, Italo; Robertson, David; Raj, Satish R.

    2016-01-01

    Study Objectives: Patients with postural tachycardia syndrome (POTS) commonly complain of fatigue, unrefreshing sleep, daytime sleepiness, and diminished quality of life. The study objective was to assess objective sleep quality in POTS patients using overnight polysomnography. Methods: We studied 16 patients with POTS and 15 healthy control subjects performing daytime autonomic functions tests and overnight polysomnography at the Vanderbilt Clinical Research Center. Results: There were no significant differences in the objective sleep parameters including sleep efficiency, sleep onset latency, wake time after sleep onset, REM latency, percentage of time spent in N1, N2, N3, and REM sleep, arousal index, apnea-hypopnea index, or periodic leg movement index in POTS patients as compared with healthy control subjects. There were significant negative correlations between sleep efficiency and the change in HR from supine to stand (rs = −0.527; p = 0.036) Conclusions: POTS patients do not have significant differences in objective sleep parameters as compared to control subjects based on overnight polysomnograms. Activation of the sympathetic nervous system may contribute significantly to the hyper arousal state and worsening of subjective estimates of sleep quality as previously reported in POTS patients. Citation: Bagai K, Peltier AC, Malow BA, Diedrich A, Shibao CA, Black BK, Paranjape SY, Orozco C, Biaggioni I, Robertson D, Raj SR. Objective sleep assessments in patients with postural tachycardia syndrome using overnight polysomnograms. J Clin Sleep Med 2016;12(5):727–733. PMID:26951415

  16. Effects of gabapentin enacarbil on restless legs syndrome and leg pain in dementia with Lewy bodies.

    Science.gov (United States)

    Fujishiro, Hiroshige

    2014-06-01

    Restless legs syndrome (RLS) is a common neurological disorder. Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease. Both RLS and DLB can be effectively treated by dopaminergic medications, suggesting the role of dopamine dysfunction in the pathogenesis of both diseases. Here, I report on a Japanese woman with probable DLB and RLS who was treated with gabapentin enacarbil, a non-dopaminergic agent. Because a dopamine agonist, a first-line therapy for moderate to severe RLS, caused the occurrence of metamorphopsia, an alternative treatment of gabapentin enacarbil was used; this treatment improved the patient's RLS without worsening her psychiatric symptoms. An alternative treatment is desirable for DLB patients with RLS because they often experience intolerable side-effects with a dopamine agonist, especially visual hallucinations. Administering gabapentin enacarbil also improved the continuous leg pain that occurred in conjunction with the development of RLS. Although the neurobiological mechanism in the development of pain remains unclear, a range of non-dopaminergic structures likely mediated pain processing in DLB in the present case based on neuropharmacological results. This is the first report reporting the effects of gabapentin enacarbil for RLS and leg pain in a DLB patient with psychiatric symptoms. © 2014 The Author. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

  17. Primary Sjögren’s Syndrome with Sensory Ganglionopathy and Painful Legs and Moving Toes Syndrome

    Directory of Open Access Journals (Sweden)

    Mehmet Uğur Çevik

    2014-06-01

    Full Text Available Sjogren’s syndrome is characterized by the sicca syndrome, with dryness of the mouth (xerostomia and the eyes (xerophthalmia. Sjogren's syndrome is the only connective tissue disease that has been associated with sensory neuronopathy. The syndrome of painful legs and moving toes consisting of pain in the lower limbs with spontaneous movements of the toes or feet. The association between Sjogren’s syndrome and painful legs and moving toes syndrome is a rare condition

  18. Leg ulcers in older people: a national study addressing variation in diagnosis, pain and sleep disturbance.

    Science.gov (United States)

    Hellström, Amanda; Nilsson, Camilla; Nilsson, Annina; Fagerström, Cecilia

    2016-01-21

    Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9% were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8% in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores. The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met

  19. Restless legs syndrome: differential diagnosis and management with pramipexole

    Directory of Open Access Journals (Sweden)

    Francesca Brindani

    2009-06-01

    Full Text Available Francesca Brindani, Francesca Vitetta, Franco GemignaniDepartment of Neurosciences, University of Parma, ItalyAbstract: Restless legs syndrome (RLS is a condition characterized by discomfort at rest and urge to move focused on the legs. RLS may occur as an idiopathic, often hereditary condition (primary RLS, or in association with medical conditions (secondary RLS including iron deficiency, uremia, and polyneuropathy. Current understanding of the pathophysiology of RLS points to the involvement of three interrelated components: dopaminergic dysfunction, impaired iron homeostasis, and genetic mechanisms. The diagnosis of RLS is made according to the consensus criteria by a National Institutes of Health panel: 1 an urge to move the legs, usually accompanied by uncomfortable sensations; 2 beginning or worsening during rest; 3 relieved by movement; and 4 worse, or only occurring, in the evening or at night. The differential diagnosis of RLS aims to: 1 distinguish RLS from other disorders with RLS-like symptoms and 2 identify secondary forms, with investigation of underlying diseases. The treatment of RLS demands a clinical evaluation to rule out and cure causes of secondary RLS, including iron supplementation when deficient, and to eliminate the triggering factors. The presence of neuropathy should be especially investigated in nonhereditary, late-onset RLS, in view of a possible treatment of the underlying disease. The first line treatment for idiopathic RLS is represented by dopamine agonists, in particular nonergot-derived ropinirole and pramipexole, whereas ergot dopamine agonists (cabergoline and pergolide are no longer in first-line use given the risks of cardiac valvulopathy. Although no comparative trials have been published, a meta-analysis of pramipexole versus ropinirole suggests differences in efficacy and tolerability favoring pramipexole.Keywords: restless legs syndrome, pramipexole, dopamine, agonists, small fiber neuropathy

  20. Vascular risk factors, cardiovascular disease and restless legs syndrome in men

    Science.gov (United States)

    Winter, Anke C.; Berger, Klaus; Glynn, Robert J; Buring, Julie E.; Gaziano, J. Michael; Schürks, Markus; Kurth, Tobias

    2012-01-01

    Background Prevalences of vascular risk factors, cardiovascular disease and restless legs syndrome increase with age. Prior studies analyzing the associations between vascular risk factors, cardiovascular disease, and restless legs syndrome found controversial results. We therefore aim to evaluate the association between prevalent vascular risk factors, prevalent cardiovascular disease and restless legs syndrome. Methods We conducted a cross-sectional study among 22,786 participants of the US Physicians’ Health Studies I and II. Restless legs syndrome was classified according to the four minimal diagnostic criteria. Vascular risk factors and restless legs syndrome symptoms were self-reported. Prevalent cardiovascular disease events including major cardiovascular disease, stroke and myocardial infarction were confirmed by medical record review. Age- and multivariable-adjusted logistic regression models were used to evaluate the association between vascular risk factors, prevalent cardiovascular disease events and restless legs syndrome. Results The mean age of the cohort 67.8 years. Restless legs syndrome prevalence was 7.5% and increased significantly with age. Diabetes significantly increased the odds (OR: 1.41, 95%CI: 1.21–1.65), while frequent exercise (OR: 0.78, 95%CI: 0.67–0.91) and alcohol consumption of one or more drinks per day (OR: 0.80, 95%CI: 0.69–0.92) significantly reduced the odds of restless legs syndrome in multivariable-adjusted models. Prevalent stroke showed an increased multivariable-adjusted OR of 1.40 (1.05–1.86) while men with prevalent myocardial infarction had a decreased OR of 0.73 (0.55–0.97) for restless legs syndrome. Conclusions The restless legs syndrome prevalence among US male physicians is similar to men of the same age group in other western countries. A history of diabetes is the most consistent risk factor associated with restless legs syndrome. Prevalent stroke and myocardial infarction are related to restless legs

  1. Sleep complaints in postpolio syndrome

    NARCIS (Netherlands)

    van Kralingen, K. W.; Ivanyi, B.; van Keimpema, A. R.; Venmans, B. J.; de Visser, M.; Postmus, P. E.

    1996-01-01

    OBJECTIVE: This study evaluated the prevalence of sleep-related and sleep-disordered-breathing (SDB)-related complaints in a group of postpolio patients compared with healthy controls. DESIGN: A questionnaire, consisting of the validated Sleep Wake Experience List (SWEL), and a list of questions

  2. Obstructive sleep apnea/hypopnea syndrome.

    Science.gov (United States)

    De Backer, W

    2013-06-01

    Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of partial or complete upper airway collapse during sleep that is highlighted by a reduction in, or complete cessation of, airflow despite documented on going inspiratory efforts. Due to the lack of adequate alveolar ventilation that results from the upper airway narrowing, oxygen saturation may drop and partial pressure of CO2 may occasionally increase. The events are mostly terminated by arousals. Clinical consequences are excessive daytime sleepiness related to the sleep disruption. Minimal diagnostic criteria have been defined for OSAHS. Patients should have excessive daytime sleepiness that can not be better explained by other factors, or experience two or more of the following symptoms, again that are not better explained by other factors: choking or gasping during sleep; recurrent awakenings from sleep; un-refreshing sleep; daytime fatigue; and impaired concentration. All patients should have more than five obstructed breathing events per hour during sleep. An obstructive apnea or hypopnoea can be defined as an event that lasts for ≥ 10 s and is characterized by an absence or a decrease from baseline in the amplitude of a valid measure of breathing during sleep that either reaches >50% with an oxygen desaturation of 3% or an arousal (alternatively a 30% reduction with 4% desaturation). The American Academy of Sleep Medicine (AASM) recommends these definitions. The Task Force of the AASM also states that there are common pathogenic mechanisms for obstructive apnea syndrome, central apnea syndrome, sleep hypoventilation syndrome and Cheyne-Stokes breathing. It was more preferable to discuss each of these separately; although, they could be placed under the common denominator of "sleep-disordered breathing syndrome". The definition of OSAHS using two components, daytime symptoms and breathing pattern disturbances during sleep, may suggest that there is a tight correlation

  3. Adipocytokines in sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Wysocka E

    2009-12-01

    Full Text Available Abstract Objective Biomarkers of adipose tissue may affect glucose and lipid metabolism and present pro-inflammatory properties, thus could be involved in the pathobiochemistry of cardiovascular disease (CVD. The coexistence of sleep apnea syndrome (OSA and metabolic risk factors of CVD is worth explaining. The aim of the study was to compare the serum adipocytokines in subjects with and without OSA, who had all elevated body mass index (BMI. Methods Overweight (BMI: 25.0-29.9 kg/m2 and obese (BMI: 30.0-39.9 kg/m2 OSA-suspected Caucasian males, aged 30-63, with no acute disease or chronic disorder underwent polysomnographic evaluation to select OSA-positive (AHI ≥ 5 and OSA-negative (AHI Results A decreased resistin level was observed in Over-OSA-Pos vs. Over-OSA-Neg subjects (P = 0.037 as well as in Obese-OSA-Pos vs. Obese-OSA-Neg (P = 0.045. No differences in leptin concentrations were observed. A positive correlation between leptin and BMI was in both overweight subgroups and a negative one between resistin and fasting glucose was in both obese subgroups. Conclusions OSA may decrease the serum resistin level in subjects with excess body mass and also may contribute to glucose metabolism, but has no influence on the leptin level.

  4. Restless legs syndrome: an underappreciated and distressing problem for haemodialysis patients.

    Science.gov (United States)

    Chu, L; Chu, E; Dogra, G; Chakera, A

    2014-10-01

    Restless legs syndrome is a distressing condition that is more common in patients with end-stage renal failure. Despite the significant impact it has on quality of life and the documented association between restless legs syndrome and increased mortality, limited data regarding the epidemiology of restless legs syndrome in Australian dialysis patients are available. We report a prospective study that assessed the prevalence and factors associated with restless legs syndrome in an in-centre haemodialysis population. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  5. Obstructive sleep apnea and other sleep-related syndromes.

    Science.gov (United States)

    Paiva, Teresa; Attarian, Hrayr

    2014-01-01

    Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity. © 2014 Elsevier B.V. All rights reserved.

  6. Postoperative episodic oxygen desaturation in the sleep apnoea syndrome

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1991-01-01

    We describe a patient with sleep apnoea syndrome who showed severe episodic hypoxaemia in the late postoperative period. The sleep apnoea syndrome should be studied further to evaluate its significance as a surgical risk factor.......We describe a patient with sleep apnoea syndrome who showed severe episodic hypoxaemia in the late postoperative period. The sleep apnoea syndrome should be studied further to evaluate its significance as a surgical risk factor....

  7. Leg ulcer in Werner syndrome (adult progeria): a case report.

    Science.gov (United States)

    Fumo, Giuseppe; Pau, Monica; Patta, Federico; Aste, Nicola; Atzori, Laura

    2013-03-15

    Werner syndrome (WS; MIM#277700) or adult progeria, is a rare disease, associated with mutations of a single gene (RECQL2 or WRN), located on chromosome 8 (8p12). It codes a DNA-helicase, whose defects cause genomic instability. The highest incidences are reported in Japan and Sardinia (Italy). On this major island of the Mediterranean Basin, the WS cases have been observed in the northern areas. The authors describe the apparently first case reported in southern Sardinia, a 51-year-old woman, who was born in and resides in the province of Cagliari. She presented with a 9-year history of an intractable leg ulcer and other characteristic symptoms, including "bird-like" face, high-pitched voice, premature greying, short stature, abdominal obesity in contrast with thin body type, scleroderma-like legs, decreased muscle mass, diabetes, atherosclerosis, and premature menopause. A specialized genetic Institute of Research (IRCCS-IDI, Rome) confirmed the clinical diagnosis. There is no cure or specific treatment and patients must be periodically screened for an increased risk of cardiovascular and cerebrovascular disease and malignancies. Among the many findings, leg ulcers significantly affect the patient's quality of life. This problem may send the patient to the dermatologist, who finally suspects the diagnosis. Poor response to medical treatment may require aggressive repeated surgery, with poor or temporary results.

  8. Restless Legs Syndrome in shift workers: A cross sectional study on male assembly workers

    Directory of Open Access Journals (Sweden)

    Rahimi Mohsen

    2009-09-01

    Full Text Available Abstract Background Restless Legs Syndrome (RLS is a common neurological movement disorder characterized by symptoms that follow a circadian pattern. Night and rotating shift work schedules exert adverse effects on functions of the human body by disturbing circadian rhythms, and they are known to cause sleep disturbances and insomnia. In this paper, we investigate the possible association between shift work and RLS. Methods This cross sectional study was conducted in an automobile manufacturing factory in Tehran, Iran. A total of 780 male assembly workers were recruited in three groups, each with 260 workers: workers on a permanent morning shift (A and two different rotating shift schedules (B and C with morning, afternoon and night shifts. We used the international RLS study group criteria for diagnosis of RLS, and the severity scale for severity assessment in subjects with RLS. Self administered questionnaires were used to gather information on age, smoking, work history, medical condition, and existence and severity of RLS symptoms. Results The prevalence of RLS was significantly higher in rotational shift workers (15% than workers with permanent morning work schedule (8.5%. In workers suffering from RLS, we found greater mean values of age and work experience, higher percentages of drug consumption, smoking, and co-morbid illnesses compared with subjects who did not have RLS, although these differences were statistically significant only for age, work experience and drug consumption. Conclusion Rotational shift work acts as a risk or exacerbating factor for Restless Legs Syndrome.

  9. Restless Legs Syndrome in shift workers: A cross sectional study on male assembly workers.

    Science.gov (United States)

    Sharifian, Akbar; Firoozeh, Marjan; Pouryaghoub, Gholamreza; Shahryari, Mehran; Rahimi, Mohsen; Hesamian, Mohammad; Fardi, Ali

    2009-09-14

    Restless Legs Syndrome (RLS) is a common neurological movement disorder characterized by symptoms that follow a circadian pattern. Night and rotating shift work schedules exert adverse effects on functions of the human body by disturbing circadian rhythms, and they are known to cause sleep disturbances and insomnia. In this paper, we investigate the possible association between shift work and RLS. This cross sectional study was conducted in an automobile manufacturing factory in Tehran, Iran. A total of 780 male assembly workers were recruited in three groups, each with 260 workers: workers on a permanent morning shift (A) and two different rotating shift schedules (B and C) with morning, afternoon and night shifts. We used the international RLS study group criteria for diagnosis of RLS, and the severity scale for severity assessment in subjects with RLS. Self administered questionnaires were used to gather information on age, smoking, work history, medical condition, and existence and severity of RLS symptoms. The prevalence of RLS was significantly higher in rotational shift workers (15%) than workers with permanent morning work schedule (8.5%). In workers suffering from RLS, we found greater mean values of age and work experience, higher percentages of drug consumption, smoking, and co-morbid illnesses compared with subjects who did not have RLS, although these differences were statistically significant only for age, work experience and drug consumption. Rotational shift work acts as a risk or exacerbating factor for Restless Legs Syndrome.

  10. The impact of restless legs syndrome on physical functioning in a community-dwelling population of middle-aged and elderly people.

    Science.gov (United States)

    Hanewinckel, Rens; Maksimovic, Ana; Verlinden, Vincent J A; van der Geest, Jos N; Hofman, Albert; van Doorn, Pieter A; Boon, Agnita J W; Tiemeier, Henning; Ikram, M Arfan

    2015-03-01

    To investigate whether restless legs syndrome (RLS) is associated with impaired physical functioning using subjective and objective assessments. From 2006-2013, 5,960 participants (mean age 67.2; 57.5% females) of the prospective population-based Rotterdam Study, aged 45 years and over, were cross-sectionally investigated for presence of restless legs syndrome using a questionnaire. Physical functioning was assessed subjectively with the Stanford Health Assessment Questionnaire (basic activities of daily living) and the Instrumental Activities of Daily living scale (instrumental activities of daily living). Additionally, physical functioning was assessed objectively by quantifying fine motor performance with the Purdue Pegboard Test and by quantifying gait with an electronic walkway. Restless legs syndrome was present in 13.7% of the participants. Persons with restless legs had more impairment in basic (difference in score 0.65, 95% CI 0.41;0.90) and instrumental activities of daily living (difference in score 0.28, 95% CI 0.09;0.48) than persons without restless legs. This association was strongest when symptoms were present two or more times a week (basic activities of daily living score difference 1.69, 95% CI 1.28;2.09). The association between restless legs syndrome and activities of daily living attenuated after adjusting for sleep quality or depressive symptoms. There was no association with the Purdue Pegboard Test score nor with gait. Individuals with restless legs syndrome experienced significantly more impairment in activities of daily function than persons without restless legs. This seemed to be (partly) mediated by poor sleep quality and depressive symptoms. No association was found with objectively assessed physical functioning. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Sleep disorders in Parkinson?s disease

    OpenAIRE

    Jahan, Israt; Hauser, Robert A; Sullivan, Kelly L; Miller, Amber; Zesiewicz, Theresa A

    2009-01-01

    Sleep disorders occur commonly in Parkinson?s disease (PD), and reduce quality of life. Sleep-related problems in PD include insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder, sleep apnea, parasomnias, excessive daytime sleepiness, and sleep attacks. This article reviews sleep disorders and their treatment in PD.

  12. Pathological gambling plus hypersexuality in restless legs syndrome: a new case.

    Science.gov (United States)

    d'Orsi, Giuseppe; Demaio, Vincenzo; Specchio, L M

    2011-08-01

    Emerging clinical data indicate that dopaminergic agonists used to treat restless legs syndrome may be associated with dopamine dysregulation syndrome, particularly pathological gambling. We report a new case with pathological gambling plus hypersexuality and impotence in an old patient treated with a small dose (0.18 mg daily at bedtime) of pramipexole for restless legs syndrome for 5 months. The time relationship and the resolution upon discontinuation of dopaminergic agonists suggest a causative association. Our new case confirms that restless legs syndrome patients should be cautioned about potential dopamine dysregulation syndrome coinciding with dopaminergic agonists, as it can be reversed by drug withdrawal.

  13. Sleep in Children and Adolescents with Angelman Syndrome: Association with Parent Sleep and Stress

    Science.gov (United States)

    Goldman, S. E.; Bichell, T. J.; Surdyka, K.; Malow, B. A.

    2012-01-01

    Background: Sleep concerns are common in children with Angelman syndrome, with 20-80% of individuals having a decreased sleep need and/or abnormal sleep-wake cycles. The impact of these sleep behaviours on parental sleep and stress is not known. Method: Through the use of standardised questionnaires, wrist actigraphy and polysomnography, we…

  14. Restless legs syndrome: associated non-motor symptoms and medical comorbidities: a controlled study

    Directory of Open Access Journals (Sweden)

    Sanghera MK

    2015-10-01

    Full Text Available Manjit K Sanghera,1 Samantha G Sales,2 Jennifer L Robinson,1 Juhee Song,3 Elmyra V Encarnacion,4 R Malcolm Stewart5 1Department of Neurosurgery, Baylor-Scott and White Hospital, Temple, TX, 2Texas A & M College of Medicine, College Station, TX, 3Department of Biostatistics, Baylor-Scott and White Hospital, Temple, TX, 4Department of Neurology, Baylor-Scott and White Hospital, Temple, TX, 5Human Performance Laboratory, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA Introduction: Restless legs syndrome (RLS is a chronic sensorimotor disorder characterized by discomfort or pain, predominantly in the legs, resulting in an urge to move during times of rest. These disturbances are often accompanied by sleep fragmentation, which can significantly increase medical comorbidities over time and can have a detrimental effect on a patient's overall quality of life. In this retrospective study, we examined the temporal relationship between the time of RLS diagnosis and the onset of non-motor symptoms (NMS and medical comorbidities. Patients and methods: Thirty-six RLS patients were evaluated for age at: symptom onset, time of diagnosis, time of occurrence of NMS, and medical comorbidities. We used structured interviews, validated questionnaires, and past medical records to aggregate and verify patient data. There was no clinical evidence to suggest secondary RLS in any patient at time of diagnosis. Results: Twenty-five patients were diagnosed as having RLS alone and eleven were diagnosed with RLS and Parkinson's disease (RLS + PD. In the RLS + PD group, irrespective of which disorder presented first, we found that patients exhibited symptoms of RLS at a significantly later age than those patients with RLS alone (P<0.05. The incidence and severity of NMS were significantly higher in the RLS + PD group compared to RLS alone and controls (P<0.001. Increased risk of RLS was identified in patients exhibiting mood changes and sleep deficits, and these

  15. Restless Legs Syndrome and Its Associated Risk Factors in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Shahrul Azmin

    2013-01-01

    Full Text Available Introduction. Restless legs syndrome has been shown to negatively impact the quality of life of patients. Studies have shown an association between restless legs syndrome and Parkinson’s disease. We attempted to investigate the prevalence of restless legs syndrome in Parkinson’s disease patients and to identify associated risk factors. Method. This was a cross-sectional study among patients with idiopathic Parkinson’s disease. Exclusion criterion was a Mini Mental State Examination score of less than 21/30. The International Restless Legs Syndrome Study Group criterion was used to identify patients with restless legs syndrome. Results. A total of 113 patients were recruited. The prevalence rate of restless legs syndrome in our cohort was 9.7% and was significantly associated with a younger onset of Parkinson’s disease (P=0.023, male gender (P=0.045, higher Mini Mental State Examination score (P=0.004, and less advanced Hoehn & Yahr stage (P=0.014. Conclusion. The prevalence rate of restless legs syndrome in our Parkinson’s disease population is in keeping with other studies published worldwide. The significance of the association between a younger onset of Parkinson’s disease and restless legs syndrome needs to be further investigated.

  16. Restless legs syndrome and its associated risk factors in Parkinson's disease.

    Science.gov (United States)

    Azmin, Shahrul; Khairul Anuar, Abdul Manaf; Nafisah, Wan Yahya; Tan, Hui Jan; Raymond, Azman Ali; Hanita, Othman; Shah, Shamsul Azhar; Norlinah, Mohamed Ibrahim

    2013-01-01

    Introduction. Restless legs syndrome has been shown to negatively impact the quality of life of patients. Studies have shown an association between restless legs syndrome and Parkinson's disease. We attempted to investigate the prevalence of restless legs syndrome in Parkinson's disease patients and to identify associated risk factors. Method. This was a cross-sectional study among patients with idiopathic Parkinson's disease. Exclusion criterion was a Mini Mental State Examination score of less than 21/30. The International Restless Legs Syndrome Study Group criterion was used to identify patients with restless legs syndrome. Results. A total of 113 patients were recruited. The prevalence rate of restless legs syndrome in our cohort was 9.7% and was significantly associated with a younger onset of Parkinson's disease (P = 0.023), male gender (P = 0.045), higher Mini Mental State Examination score (P = 0.004), and less advanced Hoehn & Yahr stage (P = 0.014). Conclusion. The prevalence rate of restless legs syndrome in our Parkinson's disease population is in keeping with other studies published worldwide. The significance of the association between a younger onset of Parkinson's disease and restless legs syndrome needs to be further investigated.

  17. Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia.

    Science.gov (United States)

    Togo, Fumiharu; Natelson, Benjamin H; Cherniack, Neil S; FitzGibbons, Jennifer; Garcon, Carmen; Rapoport, David M

    2008-01-01

    We evaluated polysomnograms of chronic fatigue syndrome (CFS) patients with and without fibromyalgia to determine whether patients in either group had elevated rates of sleep-disturbed breathing (obstructive sleep apnea or upper airway resistance syndrome) or periodic leg movement disorder. We also determined whether feelings of unrefreshing sleep were associated with differences in sleep architecture from normal. We compared sleep structures and subjective scores on visual analog scales for sleepiness and fatigue in CFS patients with or without coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy subjects. None had current major depressive disorder, and all were studied at the same menstrual phase. CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency, and less rapid eye movement sleep than controls. A possible explanation for the unrefreshing quality of sleep in CFS patients was revealed by stratification of patients into those who reported more or less sleepiness after a night's sleep (a.m. sleepier or a.m. less sleepy, respectively). Those in the sleepier group reported that sleep did not improve their symptoms and had poorer sleep efficiencies and shorter runs of sleep than both controls and patients in the less sleepy group; patients in the less sleepy group reported reduced fatigue and pain after sleep and had relatively normal sleep structures. This difference in sleep effects was due primarily to a decrease in the length of periods of uninterrupted sleep in the a.m. sleepier group. CFS patients had significant differences in polysomnographic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due neither to diagnosable sleep disorders nor to coexisting fibromyalgia but primarily to a

  18. Epidemiology of Restless Legs Syndrome: A Synthesis of the Literature

    Science.gov (United States)

    Ohayon, Maurice M.; O'Hara, Ruth; Vitiello, Michael V.

    2011-01-01

    Restless legs syndrome (RLS) has gained considerable attention in the recent years: nearly 50 community-based studies have been published in the last decade around the world. The development of strict diagnostic criteria in 1995 and their revision in 2003 helped to stimulate research interest on this syndrome. In community-based surveys, RLS has been studied as: (1) a symptom only, (2) a set of symptoms meeting minimal diagnostic criteria of the IRLSSG, (3) meeting minimal criteria accompanied with a specific frequency and/or severity, and (4) a differential diagnosis. In the first case, prevalence estimates in the general adult population ranged from 9.4% to 15%. In the second case, prevalence ranged from 3.9% to 14.3%. When frequency/severity is added, prevalence ranged from 2.2% to 7.9% and when differential diagnosis is applied prevalence estimates are between 1.9% and 4.6%. In all instances, RLS prevalence is higher in women than in men. It also increases with age in European and North American countries but not in Asian countries. Symptoms of anxiety and depression have been consistently associated with RLS. Overall, individuals with RLS have a poorer health than non-RLS but evidence for specific disease associations is mixed. Future epidemiological studies should focus on systematically adding frequency and severity in the definition of the syndrome in order to minimize the inclusion of cases mimicking RLS. PMID:21795081

  19. Differential diagnosis of unpleasant sensations in the legs: prevalence of restless legs syndrome in a primary care population.

    Science.gov (United States)

    Möller, Caroline; Wetter, Thomas C; Köster, Jürgen; Stiasny-Kolster, Karin

    2010-02-01

    Restless legs syndrome (RLS) is a common neurological condition. We investigated the prevalence of RLS in patients suffering from unpleasant sensations in the legs. We included 16,543 patients consulting one of 312 primary care practices in Germany on November 8, 2007. All patients filled out a self-assessment questionnaire. Patients who reported suffering from unpleasant sensations in the legs were then assessed by the physician. Main outcome measures were the overall prevalence of unpleasant sensations in the legs and the prevalence of RLS; the most common differential diagnoses in the subpopulation suffered from unpleasant leg sensations. Out of all participating patients 7704 (46.6%) suffered from unpleasant sensations in the legs and 1758 (10.6%) were diagnosed with RLS according to the four essential clinical criteria. Among patients with unpleasant leg sensations, the prevalence of RLS was considerably higher (22.7%) than in the total population. The most common differential diagnoses were osteoarthritis (21.5%), disc lesion (19.2%), varicose veins (18.8%) and muscle cramps (14.6%). Of the patients with RLS 53.4% had already consulted their physician about their leg problems in the past. Still, only 20.1% of the RLS patients had received the correct diagnosis. Comorbidity rates were significantly increased in RLS patients compared to patients suffering from leg symptoms of other origin. This study showed a high prevalence of RLS in primary care patients with unpleasant sensations in the legs. Thus, in patients presenting with these symptoms the diagnosis of RLS should routinely be considered. 2009 Elsevier B.V. All rights reserved.

  20. Living with Restless Legs Syndrome/Willis-Ekbom Disease.

    Science.gov (United States)

    Tachibana, Naoko

    2015-09-01

    Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is commonly seen in patients with end-stage renal disease (ESRD), but this condition has not been properly recognized. The prevalence of RLS/WED in ESRD shows the ethnic variation (7%-68%), with the similar tendency of primary RLS/WED. Although RLS/WED in ESRD is defined in secondary RLS/WED, the factors of ESRD that are involved in the genesis of RLS/WED remain unknown. Even after renal transplantation, RLS/WED symptoms do not completely disappear, and genetic predisposition to RLS/WED may play an important role in causing RLS/WED. Long-term intervention for RLS/WED and ESRD will be necessary. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Restless Legs Syndrome/Willis-Ekbom Disease and Pregnancy.

    Science.gov (United States)

    Prosperetti, Chiara; Manconi, Mauro

    2015-09-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease is 3-fold more prevalent in pregnant than in non-pregnant women. Symptoms are particularly strong and frequent during the third trimester of pregnancy and disappear around delivery. A pre-existing form of RLS tends to worsen during pregnancy. Women who experience RLS during pregnancy have a higher risk of symptoms in further pregnancies and of developing a primary form of RLS later in life, than women free of symptoms during pregnancy. This article reviews the literature for pregnancy-related RLS, with particular attention to its epidemiology, course, possible mechanisms, management, and the impact of symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Pengaruh Latihan Kekuatan terhadap Restless Legs Syndrome Pasien Hemodialisis

    Directory of Open Access Journals (Sweden)

    Anggriyana Tri Widianti

    2017-10-01

    Full Text Available Restless legs syndrome (RLS adalah gangguan sensorimotor yang banyak terjadi pada pasien hemodialisis (HD. Terapi farmakologi merupakan pilihan utama penanganan RLS yang justru berisiko menimbulkan efek samping. Optimalisasi fisik pasien HD melalui latihan kekuatan dinilai berpotensi efektif memperbaiki restless legs syndrome. Belum terdapat penelitian yang mengklarifikasi pengaruh latihan kekuatan terhadap RLS. Penelitian ini bertujuan untuk mengidentifikasi pengaruh latihan kekuatan terhadap skala RLS pada pasien HD di Unit Hemodialisis di RS Margono Soekardjo dan RSUD Banyumas. Metode quasi eksperimen dengan pre-post test with control group design ini menggunakan sampel sebanyak 32 pasien HD (15 pasien intervensi dan 17 pasien kontrol dengan teknik cluster random sampling. Cluster random sampling dalam penelitian ini adalah penggunaan tempat penelitian sebagai kelas, yaitu satu rumah sakit untuk intervensi dan rumah sakit lainnya digunakan untuk kontrol. Latihan kekuatan pada ekstremitas atas dan bawah diberikan 2 minggu sekali saat proses hemodialisis berlangsung selama 8 minggu. Skala RLS diukur menggunakan IRLS Scale. Data yang terkumpul dianalisis menggunakan uji t tidak berpasangan. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan antar kelompok dari usia, ureum, adekuasi, lama HD, jenis kelamin, penyakit kormobid maupun penggunaan obat. Antar kelompok memperlihatkan terdapat perbedaan nilai TIBC (p=0,000. Skala RLS kelompok intervensi menunjukan perbaikan dengan selisih mean -1 yang menandakan penuruan skala, adapun pada kelompok kontrol justru terlihat peningkatan kondisi RLS dengan selisih mean 1,29. Analisis antar kelompok terlihat signifikansi berbeda (p=0,035 yang menunjukkan terdapat pengaruh latihan kekuatan terhadap skala RLS. Latihan kekuatan penting sebagai bagian dalam pengelolaan pasien uremik RLS.

  3. Adenosine receptors as markers of brain iron deficiency: Implications for Restless Legs Syndrome

    Science.gov (United States)

    Quiroz, César; Gulyani, Seema; Ruiqian, Wan; Bonaventura, Jordi; Cutler, Roy; Pearson, Virginia; Allen, Richard P.; Earley, Christopher J.; Mattson, Mark P.; Ferré, Sergi

    2016-01-01

    Deficits of sensorimotor integration with periodic limb movements during sleep (PLMS) and hyperarousal and sleep disturbances in Restless Legs Syndrome (RLS) constitute two pathophysiologically distinct but interrelated clinical phenomena, which seem to depend mostly on alterations in dopaminergic and glutamatergic neurotransmission, respectively. Brain iron deficiency is considered as a main pathogenetic mechanism in RLS. Rodents with brain iron deficiency represent a valuable pathophysiological model of RLS, although they do not display motor disturbances. Nevertheless, they develop the main neurochemical dopaminergic changes found in RLS, such as decrease in striatal dopamine D2 receptor density. On the other hand, brain iron deficient mice exhibit the characteristic pattern of hyperarousal in RLS, providing a tool to find the link between brain iron deficiency and sleep disturbances in RLS. The present study provides evidence for a role of the endogenous sleep-promoting factor adenosine. Three different experimental preparations, long-term (22 weeks) severe or moderate iron-deficient (ID) diets (3- or 7-ppm iron diet) in mice and short-term (3 weeks) severe ID diet (3-ppm iron diet) in rats, demonstrated a significant downregulation (Western blotting in mouse and radioligand binding saturation experiments in rat brain tissue) of adenosine A1 receptors (A1R) in the cortex and striatum, concomitant to striatal D2R downregulation. On the other hand, the previously reported upregulation of adenosine A2A receptors (A2AR) was only observed with severe ID in both mice and rats. The results suggest a key role for A1R downregulation in the PLMS and hyperarousal in RLS. PMID:27600688

  4. Adenosine receptors as markers of brain iron deficiency: Implications for Restless Legs Syndrome.

    Science.gov (United States)

    Quiroz, César; Gulyani, Seema; Ruiqian, Wan; Bonaventura, Jordi; Cutler, Roy; Pearson, Virginia; Allen, Richard P; Earley, Christopher J; Mattson, Mark P; Ferré, Sergi

    2016-12-01

    Deficits of sensorimotor integration with periodic limb movements during sleep (PLMS) and hyperarousal and sleep disturbances in Restless Legs Syndrome (RLS) constitute two pathophysiologically distinct but interrelated clinical phenomena, which seem to depend mostly on alterations in dopaminergic and glutamatergic neurotransmission, respectively. Brain iron deficiency is considered as a main pathogenetic mechanism in RLS. Rodents with brain iron deficiency represent a valuable pathophysiological model of RLS, although they do not display motor disturbances. Nevertheless, they develop the main neurochemical dopaminergic changes found in RLS, such as decrease in striatal dopamine D 2 receptor density. On the other hand, brain iron deficient mice exhibit the characteristic pattern of hyperarousal in RLS, providing a tool to find the link between brain iron deficiency and sleep disturbances in RLS. The present study provides evidence for a role of the endogenous sleep-promoting factor adenosine. Three different experimental preparations, long-term (22 weeks) severe or moderate iron-deficient (ID) diets (3- or 7-ppm iron diet) in mice and short-term (3 weeks) severe ID diet (3-ppm iron diet) in rats, demonstrated a significant downregulation (Western blotting in mouse and radioligand binding saturation experiments in rat brain tissue) of adenosine A 1 receptors (A1R) in the cortex and striatum, concomitant to striatal D2R downregulation. On the other hand, the previously reported upregulation of adenosine A 2A receptors (A2AR) was only observed with severe ID in both mice and rats. The results suggest a key role for A1R downregulation in the PLMS and hyperarousal in RLS. Published by Elsevier Ltd.

  5. Sleep apnea syndrome and cognition

    Directory of Open Access Journals (Sweden)

    Emilia eSforza

    2012-05-01

    Full Text Available Obstructive sleep apnea (OSA is a sleep-related breathing disorder characterized by repetitive episodes of airflow cessation resulting in brief arousals and intermittent hypoxemia. Several studies have documented significant daytime cognitive and behavioral dysfunction that seems to extend beyond that associated with simple sleepiness and that persists in some patients after therapeutic intervention. A still unanswered question is whether cognitive symptoms in OSA are primarily a consequence of sleep fragmentation and hypoxemia, or whether they coexist independently from OSA. Moreover, very little is known about OSA effects on cognitive performances in the elderly in whom an increased prevalence of OSA is present.In this review we will consider recent reports in the association between sleep apnea and cognition, with specific interest in elderly subjects, in whom sleep disturbances and age-related cognitive decline naturally occur. This will allow us to elucidate the behavioral and cognitive functions in OSA patients and to gain insight into age differences in the cognitive impairment.Clinically, these outcomes will aid clinicians in the evaluation of diurnal consequences of OSA and the need to propose early treatment.

  6. Characterisation of Sleep Problems in Children with Williams Syndrome

    Science.gov (United States)

    Annaz, Dagmara; Hill, Catherine M.; Ashworth, Anna; Holley, Simone; Karmiloff-Smith, Annette

    2011-01-01

    Sleep is critical to optimal daytime functioning, learning and general health. In children with established developmental disorders sleep difficulties may compound existing learning difficulties. The purpose of the present study was to evaluate the prevalence and syndrome specificity of sleep problems in Williams syndrome (WS), a…

  7. Multiple sleep latency measures in narcolepsy and behaviourally induced insufficient sleep syndrome

    OpenAIRE

    Marti, I; Valko, P O; Khatami, R; Bassetti, C L; Baumann, C R

    2009-01-01

    BACKGROUND: Short mean latencies to the first epoch of non-rapid eye movement sleep stage 1 (NREM1) and the presence of 2 sleep onset REM (SOREM) periods on multiple sleep latency test (MSLT) occur in both narcolepsy-cataplexy (NC) and behaviourally induced insufficient sleep syndrome (BIISS). It is not known whether specific MSLT findings help differentiate the two disorders. METHODS: We analyzed MSLT data including sleep latencies to and between different sleep stages of 60 age-, gender- an...

  8. Parental Report of Sleep Problems in Down Syndrome

    Science.gov (United States)

    Breslin, J. H.; Edgin, J. O.; Bootzin, R. R.; Goodwin, J. L.; Nadel, L.

    2011-01-01

    Background: Children with Down syndrome (DS) suffer from sleep problems, including sleep maintenance problems, as well as snoring, and other symptoms of disordered breathing. To examine sleep in DS, we gave parents a questionnaire assessing their child's sleep. Materials and methods: The parents of 35 children with DS (mean age = 12.65 years,…

  9. Adults with Attention Deficit Hyperactivity Disorder Report High Symptom Levels of Troubled Sleep, Restless Legs, and Cataplexy

    Directory of Open Access Journals (Sweden)

    Bjørn Bjorvatn

    2017-09-01

    Full Text Available Objective: To compare the occurrence of a spectrum of different self-reported sleep problems in adults with ADHD and a control group, and to study the impact of current ADHD medication use and clinical ADHD subtype.Method: Cross-sectional study of 268 clinically ascertained adult ADHD patients (DSM-IV criteria and 202 randomly selected controls. Sleep problems were self-reported using validated questions, partly from Global Sleep Assessment Questionnaire.Results: ADHD patients reported more sleep problems than controls: Lifetime occurrence of sleep problems (82.6 vs. 36.5%, hypnotics use (61.4 vs. 20.2%, current sleep duration below 6 h (26.6 vs. 7.6%, and symptoms/signs during the past 4 weeks of excessive daytime sleepiness, cataplexy, loud snoring, breathing pauses during sleep, restless legs, and periodic limb movements in sleep (significant odds ratios ranged from 1.82 to 14.55. Current ADHD medication use was associated with less cataplexy compared with not using medication. Patients with inattentive subtype reported better sleep quality and less restless legs than patients with hyperactive/impulsive subtypes.Conclusions: Adults with ADHD reported a very high occurrence of many different self-reported sleep problems, underlining the importance of screening for sleep disorders. Among the ADHD patients, medication use was not associated with more sleep-related symptoms, but in fact less cataplexy. When comparing ADHD subtypes, the inattentive subtype was associated with less sleep problems.

  10. Periodic Limbic Movement Disorder during Sleep as Diabetes-Related Syndrome? A Polysomnographic Study

    Science.gov (United States)

    Rizzi, M.; Barrella, M.; Kotzalidis, G. D.; Bevilacqua, M.

    2011-01-01

    Introduction. Periodic limb movements during sleep (PLMs) is common in the elderly. When quality-of-life drops due to sleep disturbances, we speak about periodic limb movement disorder during sleep (PLMD). Another similar disorder, restless legs syndrome (RLS), is considered to be related to diabetes; RLS and PLMDs are genetically related. Our aim was to detect PLMDs in a population of diabetic patients and identify them as possible hallmarks of these autonomic disorders. Material and Methods. We selected 41 type-2 diabetics with no sleep comorbidity, and compared them with 38 healthy matched volunteers. All participants underwent the Epworth Sleepiness Scale (ESS) and polysomnography (PSG). A periodic limb movement (PLM) index >5, that is, the higher number of PLMs/sleep hour for the entire night, was considered as abnormal. Results. Diabetics showed lower sleep efficiency than controls on the ESS, lower proportions of REM and non-REM sleep, and higher arousal and PLM indexes, as assessed through PSG. PLMDs were diagnosed in 13 of 41 diabetic patients (31%); the latter showed lower sleep efficiency, lower non-REM slow-wave sleep, and increased arousal and PLM indexes. Conclusion. The relationship between PLMs-related sleep fragmentation and endocrine carbohydrate metabolism regulation might be casual or genetically determined. This deserves further investigations. PMID:22363869

  11. [High prevalence of restless legs syndrome in multiple sclerosis].

    Science.gov (United States)

    Douay, X; Waucquier, N; Hautecoeur, P; Vermersch, P

    2009-02-01

    Prevalence of restless legs syndrome (RLS), a clinically defined disorder, varies from 2.5 to 15% among populations. In the French adult population, prevalence is estimated to be 8.5%. RLS is often secondary to a variety of disorders. Neurological conditions usually associated with RLS are neuropathies and Parkinson's disease. There are few studies of its association with multiple sclerosis (MS). The aim of this study was to estimate RLS prevalence in a population of French MS patients. During one month, 17 neurologists from the G-SEP group prospectively recruited 242 patients who fulfilled the Mc Donald criteria for MS. Each patient underwent a standardised questionnaire to verify the international criteria of RLS. We collected date of birth, gender, MS course (relapsing remitting, primary progressive and secondary progressive) and MS duration. Forty-one subjects (18%) met the criteria for RLS. Comparing the RLS group with the group without RLS, no significant differences were found in age, gender and MS duration. RLS was more prevalent in the relapsing remitting MS group. Prevalence of RLS seems to be doubled in MS patients compared to the general population. This finding warrants further study. Identification of this syndrome in MS patients might lead to specific treatments.

  12. Cross syndrome comparison of sleep problems in children with Down syndrome and Williams syndrome.

    Science.gov (United States)

    Ashworth, Anna; Hill, Catherine M; Karmiloff-Smith, Annette; Dimitriou, Dagmara

    2013-05-01

    Based on previous findings of frequent sleep problems in children with Down syndrome (DS) and Williams syndrome (WS), the present study aimed to expand our knowledge by using parent report and actigraphy to define sleep problems more precisely in these groups. Twenty-two school-aged children with DS, 24 with WS and 52 typically developing (TD) children took part in the study. Each child wore an actiwatch for a minimum of four nights and parents completed the Children's Sleep Habits Questionnaire (CSHQ). Sleep problems were common in both developmental disorders. Children with DS had the greatest sleep disruption, with frequent and longer night wakings as well as restlessness. Parents reported symptoms of sleep-disordered breathing and a range of other problems including grinding teeth, bedtime resistance and sleep anxiety. Children with WS had problems initiating sleep and parents also reported bed-wetting and body pain. Despite these problems, the mean actual sleep time, as measured by actigraphy, did not differ between the three groups. CSHQ reports were in agreement with actigraphy for children's sleep duration, but this was not the case for sleep latency, restlessness and the night wakings variables. Sleep problems in DS and WS are common and appear to be syndrome-specific. Due to the inaccuracy of parent report, it is recommended that children at risk undergo objective measures of sleep assessment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Cross Syndrome Comparison of Sleep Problems in Children with Down Syndrome and Williams Syndrome

    Science.gov (United States)

    Ashworth, Anna; Hill, Catherine M.; Karmiloff-Smith, Annette; Dimitriou, Dagmara

    2013-01-01

    Based on previous findings of frequent sleep problems in children with Down syndrome (DS) and Williams syndrome (WS), the present study aimed to expand our knowledge by using parent report and actigraphy to define sleep problems more precisely in these groups. Twenty-two school-aged children with DS, 24 with WS and 52 typically developing (TD)…

  14. Sleep phenotypes in infants and toddlers with neurogenetic syndromes.

    Science.gov (United States)

    Abel, Emily A; Tonnsen, Bridgette L

    2017-10-01

    Although sleep problems are well characterized in preschool- and school-age children with neurogenetic syndromes, little is known regarding the early emergence of these problems in infancy and toddlerhood. To inform syndrome-specific profiles and targets for intervention, we compared parent-reported sleep problems in infants and toddlers with Angelman syndrome (AS), Williams syndrome (WS), and Prader-Willi syndrome (PWS) with patterns observed among same-aged typically developing (TD) controls. Mothers of 80 children (18 AS, 19 WS, 19 PWS, and 24 TD) completed the Brief Infant Sleep Questionnaire. Primary dependent variables included (1) sleep onset latency, (2) total sleep duration, (3) daytime and nighttime sleep duration, and (4) sleep problem severity, as measured by both maternal impression and National Sleep Foundation guidelines. Sleep problems are relatively common in children with neurogenetic syndromes, with 41% of mothers reporting problematic sleep and 29% of children exhibiting abnormal sleep durations as per national guidelines. Across genetic subgroups, problems are most severe in children with AS and WS, particularly in relation to nighttime sleep duration. Although atypical sleep is characteristically reported in each syndrome later in development, infants and toddlers with PWS exhibited largely typical patterns, potentially indicating delayed onset of sleep problems in concordance with other medical features of PWS. Our findings suggest that sleep problems in neurogenetic syndromes emerge as early as infancy and toddlerhood, with variable profiles across genetic subgroups. This work underscores the importance of early sleep screenings as part of routine medical care of neurosyndromic populations and the need for targeted, syndrome-sensitive treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Obstructive sleep apnea syndrome and growth failure.

    Science.gov (United States)

    Esteller, E; Villatoro, J C; Agüero, A; Lopez, R; Matiñó, E; Argemi, J; Girabent-Farrés, M

    2018-05-01

    Obstructive sleep apnea syndrome is a common problem among children and is recognized as a cause of significant medical morbidity. Since the 1980s, it has been suggested that obstructive sleep apnea syndrome is a risk factor for growth failure in children. In many cases, it has been shown that growth failure is reversible once the obstructive sleep apnea syndrome is resolved. The objectives of this study were to analyze and compare growth failure prevalence in a Mediterranean population of children with obstructive sleep apnea syndrome and healthy children matched in age and sex, and to assess the effectiveness of tonsillectomy and adenoidectomy in resolving growth retardation. We compared 172 children with obstructive sleep apnea syndrome (apnea-hypopnea index ≥ 3) who had undergone tonsillectomy and adenoidectomy with 172 healthy controls in terms of key anthropometric parameters. Most of the criteria used for growth failure were higher to a statistically significant degree in the study group vs the control group: height-for-age ≤ 3rd percentile (7.56% vs 2.91%; p = 0.044), weight-for-age ≤ 5th percentile (9.30% vs 2.33%; p = 0.005), weight-for-age ≤ 3rd percentile (8.14% vs 2.33%; p = 0.013) and height and/or weight for-age ≤ 5th percentile (13.95% vs 5.81%; p = 0.009). The height-for-age ≤ 5th percentile was almost at the limit of statistical significance (8.72% for the study group vs 4.65% for the control group; p = 0.097). At one-year post-surgery follow-up, 10 of 15 children with height-for-age ≤ 5th percentile had achieved catch-up growth (66.6%), and 14 of 24 children with height- and/or weight-for-age ≤ 5th percentile had normalized growth (58.33%). For children with failure to thrive or who have growth failure, physicians should consider the possibility of obstructive sleep apnea. A significant number of children with obstructive sleep apnea concurrent with growth failure could benefit from

  16. Restless Legs Syndrome: Current Concepts about Disease Pathophysiology

    Science.gov (United States)

    Koo, Brian B.; Bagai, Kanika; Walters, Arthur S.

    2016-01-01

    Background In the past few decades, much has been learned about the pathophysiology of restless legs syndrome (RLS). Investigators have studied neuropathology, imaging, electrophysiology, and genetics of RLS, identifying brain regions and biological systems affected in RLS. This manuscript will review RLS pathophysiology literature, examining the RLS state through consideration of the neuroanatomy, then the biological, organ, and genetic systems. Methods Pubmed (1966 to April 2016) was searched for the term “restless legs syndrome” cross-referenced with “pathophysiology,” “pathogenesis,” “pathology,” or “imaging.” English language papers were reviewed. Studies that focused on RLS in relation to another disease were not reviewed. Results Although there are no gross structural brain abnormalities in RLS, widespread brain areas are activated, including the pre- and post-central gyri, cingulate cortex, thalamus, and cerebellum. Pathologically, the most consistent finding is striatal iron deficiency in RLS patients. A host of other biological systems are also altered in RLS, including the dopaminergic, oxygen-sensing, opioid, glutamatergic, and serotonergic systems. Polymorphisms in genes including BTBD9 and MEIS1 are associated with RLS. Discussion RLS is a neurologic sensorimotor disorder that involves pathology, most notably iron deficiency, in motor and sensory brain areas. Brain areas not subserving movement or sensation such as the cingulate cortex and cerebellum are also involved. Other biological systems including the dopaminergic, oxygen-sensing, opioid, glutamatergic, and serotonergic systems are involved. Further research is needed to determine which of these anatomic locations or biological systems are affected primarily, and which are affected in a secondary response. PMID:27536462

  17. Restless leg syndrome in patients with spinal cord injury.

    Science.gov (United States)

    Kumru, Hatice; Vidal, Joan; Benito, Jesus; Barrio, Manuela; Portell, Enric; Valles, Margarita; Flores, Cecilia; Santamaria, Joan

    2015-12-01

    The presence of restless leg syndrome (RLS) in patients with spinal cord injury (SCI) is not well established. We studied the frequency and severity of RLS in a population of patients with SCI and the effect of treatment with dopaminergic drugs when clinically indicated. Consecutive patients with SCI admitted to an out-patient clinic of a neurorehabilitation hospital (n:195) were evaluated for the presence of RLS between February 2013 and May 2014. A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on gender, age, time since SCI, level and severity of SCI, was obtained. The mean age was 54.7 ± 15.6 years (range: 22-81 year); with time since SCI: 16.9 ± 11.4 years (range: 1-50 years). Thirty-five of 195 patients (17.9%) presented RLS. Twenty-two out of 154 (14.3%) patients with cervicothoracic SCI and 13 out of 41 (31.7%) patients with lumbosacral SCI presented RLS. Restless leg symptoms were mild in 2 patients, moderate in 10 patients, severe in 12 patients and very severe in 11. Ten patients received dopaminergic agonist treatment with a significant reduction in RLS severity scale from 29.1 ± 5.9 to 10.2 ± 7.9. RLS occurs frequently in SCI patients and responds to dopaminergic treatment. Physicians have to be aware of this diagnosis to avoid unnecessary suffering in this patient population. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Restless Legs Syndrome: Current Concepts about Disease Pathophysiology

    Directory of Open Access Journals (Sweden)

    Brian B. Koo

    2016-07-01

    Full Text Available Background: In the past few decades, much has been learned about the pathophysiology of restless legs syndrome (RLS. Investigators have studied neuropathology, imaging, electrophysiology, and genetics of RLS, identifying brain regions and biological systems affected in RLS. This manuscript will review RLS pathophysiology literature, examining the RLS state through consideration of the neuroanatomy, then the biological, organ, and genetic systems. Methods: Pubmed (1966 to April 2016 was searched for the term “restless legs syndrome” cross-referenced with “pathophysiology,” “pathogenesis,” “pathology,” or “imaging.” English language papers were reviewed. Studies that focused on RLS in relation to another disease were not reviewed. Results: Although there are no gross structural brain abnormalities in RLS, widespread brain areas are activated, including the pre- and post-central gyri, cingulate cortex, thalamus, and cerebellum. Pathologically, the most consistent finding is striatal iron deficiency in RLS patients. A host of other biological systems are also altered in RLS, including the dopaminergic, oxygen-sensing, opioid, glutamatergic, and serotonergic systems. Polymorphisms in genes including BTBD9 and MEIS1 are associated with RLS. Discussion: RLS is a neurologic sensorimotor disorder that involves pathology, most notably iron deficiency, in motor and sensory brain areas. Brain areas not subserving movement or sensation such as the cingulate cortex and cerebellum are also involved. Other biological systems including the dopaminergic, oxygen-sensing, opioid, glutamatergic, and serotonergic systems are involved. Further research is needed to determine which of these anatomic locations or biological systems are affected primarily, and which are affected in a secondary response.

  19. Prevalence of Restless Legs Syndrome in Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Takahara, Ikuko; Takeshima, Fuminao; Ichikawa, Tatsuki; Matsuzaki, Toshihisa; Shibata, Hidetaka; Miuma, Satoshi; Akazawa, Yuko; Miyaaki, Hisamitsu; Taura, Naota; Nakao, Kazuhiko

    2017-03-01

    There has been increased interest in sleep disorders in patients with inflammatory bowel disease (IBD). Studies in North America and Europe reported that the prevalence of restless legs syndrome (RLS) is much higher in patients with Crohn's disease (CD) than in the general population. The aim of this study was to reveal the prevalence and clinical features of RLS in Japanese patients with IBD and investigate the influence of RLS on sleep quality and quality of life (QOL). The study included 80 outpatients with IBD who visited Nagasaki University Hospital between December 2012 and July 2014. All patients completed the international RLS study group rating scale, a validated measure of the presence of RLS. Sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), and health-related QOL was assessed using the Japanese version of the 36-item short form healthy profile (SF-36) version 2. The prevalence of RLS in patients with IBD was 20%, including rates of 21.7% in patients with ulcerative colitis (UC) and 17.6% in patients with CD. Among patients with CD, the proportion of women and serum level of CRP were higher in the RLS group than in the non-RLS group. Among those with UC, there were no differences in clinical characteristics between the RLS and non-RLS groups. Patients in the RLS group slept significantly less well than those in the non-RLS group (PSQI > 5; 62.5 vs. 34.4%, P < 0.05). No significant relationships were observed between QOL indices and the presence of RLS (SF-36 physical score, 46.8 vs. 50.1; mental score, 43.8 vs. 45.7; role/social score, 48.1 vs. 49.2). RLS occurs frequently in Japanese patients with UC as well as CD. RLS affects sleep quality but not QOL, and it should be considered one of the causes of sleep disturbance in patients with IBD.

  20. Sleep disorders in Cornelia de Lange syndrome.

    Science.gov (United States)

    Zambrelli, Elena; Fossati, Chiara; Turner, Katherine; Taiana, Matteo; Vignoli, Aglaia; Gervasini, Cristina; Russo, Silvia; Furia, Francesca; Masciadri, Maura; Ajmone, Paola; Kullman, Gaia; Canevini, Maria Paola; Selicorni, Angelo

    2016-06-01

    Cornelia de Lange syndrome (CdLS) is a rare genetic disorder characterized by growth retardation, intellectual disability, limb defects, typical facial dysmorphism, and other systemic involvement. Sleep disturbances have been frequently reported in CdLS, but these have not been completely characterized, and prevalence data are conflicting. The aim of this paper is to characterize and determine the prevalence of sleep disorders in CdLS patients by means of a validated questionnaire. From November 2012 to November 2013, we asked 46 consecutive parents/caregivers of CdLS patients aged more than 3 years old to fill out the sleep disturbances scale for children (SDSC). The subjects were also characterized by the presence of epilepsy, intellectual disability (ID), behavioral problems, CdLS severity score, gastroesophageal reflux disease (GERD), and genetic test results. An abnormal total sleep score was found in 7 patients (15.2%), 26 (56.5%) showed a borderline total score, and 18 (39.1%) had an abnormal score for at least one SDSC factor. In our study sleep disorders were found to be positively associated to presence of epilepsy, GERD, ID, and behavioral disturbances. No correlation was evident with specific mutations of the different genes, BMI, and severity score. Our results confirm that sleep disorders represent a common problem in CdLS, with higher incidence than in the normal population. In these patients sleep disorders seem to be more prevalent in comorbid settings, representing a clinical indicator for different medical and neuropsychiatric disorders. Better knowledge and characterization of typology of sleep disorders in CdLS patients could permit a more specific therapeutic approach. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Vascular risk factors, cardiovascular disease and restless legs syndrome in women

    Science.gov (United States)

    Winter, Anke C.; Schürks, Markus; Glynn, Robert J; Buring, Julie E.; Gaziano, J. Michael; Berger, Klaus; Kurth, Tobias

    2013-01-01

    Background Previous studies evaluating the association between cardiovascular disease and vascular risk factors with restless legs syndrome showed inconsistent results, especially for the potential relation between various vascular risk factors and restless legs syndrome. We therefore aimed to analyze the relationship between vascular risk factors, prevalent cardiovascular disease and restless legs syndrome. Methods This is a cross-sectional study of 30,262 female health professionals participating in the Women's Health Study (WHS). Restless legs syndrome was defined according to diagnostic criteria of the International Restless Legs Study Group. Information on vascular risk factors (diabetes, hypertension, hypercholesterolemia, body mass index, alcohol, smoking, exercise, family history of myocardial infarction) was self-reported. Cardiovascular disease events (coronary revascularization, myocardial infarction, stroke) were confirmed by medical record review. Prevalent major cardiovascular disease was defined as non-fatal stroke or non-fatal myocardial infarction. Logistic regression models were used to evaluate the association between vascular risk factors, prevalent cardiovascular disease and restless legs syndrome. Results Of the 30,262 participants (mean age: 63.6 years), 3,624 (12.0%) reported restless legs syndrome. In multivariable-adjusted models, body mass index (OR for BMI ≥35kg/m2: 1.35, 95% CI: 1.17–1.56), diabetes (OR: 1.19, 95%CI: 1.04–1.35), hypercholesterolemia (OR: 1.17, 95% CI: 1.09–1.26), smoking status (OR for ≥15 cigarettes/day: 1.41, 95%CI: 1.19–1.66) and exercise (OR for exercise ≥ 4 times/week: 0.84, 95%CI: 0.74–0.95) were associated with restless legs syndrome prevalence. We found no association between prevalent cardiovascular disease (major cardiovascular disease, myocardial infarction, stroke) and restless legs syndrome prevalence. Women who underwent coronary revascularization had a multivariable-adjusted OR of 1.39 (1

  2. Sleep symptoms predict the development of the metabolic syndrome.

    Science.gov (United States)

    Troxel, Wendy M; Buysse, Daniel J; Matthews, Karen A; Kip, Kevin E; Strollo, Patrick J; Hall, Martica; Drumheller, Oliver; Reis, Steven E

    2010-12-01

    Sleep complaints are highly prevalent and associated with cardiovascular disease (CVD) morbidity and mortality. This is the first prospective study to report the association between commonly reported sleep symptoms and the development of the metabolic syndrome, a key CVD risk factor. Participants were from the community-based Heart Strategies Concentrating on Risk Evaluation study. The sample was comprised of 812 participants (36% African American; 67% female) who were free of metabolic syndrome at baseline, had completed a baseline sleep questionnaire, and had metabolic syndrome evaluated 3 years after baseline. Apnea-hypopnea index (AHI) was measured cross-sectionally using a portable monitor in a subset of 290 participants. Logistic regression examined the risk of developing metabolic syndrome and its components according to individual sleep symptoms and insomnia syndrome. Specific symptoms of insomnia (difficulty falling asleep [DFA] and "unrefreshing" sleep), but not a syndromal definition of insomnia, were significant predictors of the development of metabolic syndrome. Loud snoring more than doubled the risk of developing the metabolic syndrome and also predicted specific metabolic abnormalities (hyperglycemia and low high-density lipoprotein cholesterol). With further adjustment for AHI or the number of metabolic abnormalities at baseline, loud snoring remained a significant predictor of metabolic syndrome, whereas DFA and unrefreshing sleep were reduced to marginal significance. Difficulty falling asleep, unrefreshing sleep, and, particularly, loud snoring, predicted the development of metabolic syndrome in community adults. Evaluating sleep symptoms can help identify individuals at risk for developing metabolic syndrome.

  3. OBSTRUCTIVE SLEEP APNOEA SYNDROME AND CARDIOVASCULAR DISEASES

    Directory of Open Access Journals (Sweden)

    D. A. Anichkov

    2014-07-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is observed in the population with a frequency of 5–15 %. The importance of OSAS is due to its close relationship with cardiovascular diseases. OSAS increases a risk for sudden cardiac death and is an independent predictor of chronic heart failure in males. OSAS is shown to be associated with the preclinical forms of atherosclerosis and left ventricular dysfunction.

  4. Periodic limb movements and restless legs syndrome in children with a history of prematurity.

    Science.gov (United States)

    Cielo, Christopher M; DelRosso, Lourdes M; Tapia, Ignacio E; Biggs, Sarah N; Nixon, Gillian M; Meltzer, Lisa J; Traylor, Joel; Kim, Ji Young; Marcus, Carole L

    2017-02-01

    Little is known about the pediatric population at an increased risk of restless legs syndrome (RLS) and periodic limb movement disorder (PLMD). Polysomnographic data from the Caffeine for Apnea of Prematurity-Sleep (CAPS) study showed a high prevalence of elevated periodic limb movement index (PLMI) in a cohort of ex-preterm children, but the clinical importance of this finding, such as association with RLS, is unknown. We hypothesized that ex-preterm children would have a high prevalence of RLS and PLMD. Ex-preterm children enrolled in CAPS, now aged 5-12 years, completed home polysomnography (PSG) and standardized questionnaires. A diagnosis of RLS or PLMD was established by participants meeting the International Classification of Sleep Disorders, 3rd edition, criteria based on questionnaires and polysomnograms. The clinically available serum ferritin levels were assessed. In total, 167 participants underwent polysomnography and completed all questionnaires. The overall prevalence of RLS was 14/167 (8.4%). An additional 13 subjects (7.8%) were found to have PLMD. Of the 26 participants who had PLMI > 5/h, seven (26.9%) had RLS and 13 (50%) had PLMD. The serum ferritin levels were prematurity have a high prevalence of RLS, particularly those with elevated periodic limb movements. Iron deficiency likely contributes to RLS and PLMD symptoms in this population. Clinicians evaluating ex-preterm children with sleep disturbances should evaluate for RLS and PLMD. Further studies including serum ferritin evaluation are required to confirm these findings. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery.

    Science.gov (United States)

    Pereira, José Carlos; Silva Neto, João Luiz Pereira da; Pradella-Hallinan, Márcia

    2011-01-01

    There are no data adressing the prevalence of restless legs syndrome in subjects who have knee prosthesis. Therefore, we conducted a cross-sectional survey of subjects who underwent knee prosthesis surgery. A total of 107 subjects (30 male, 77 female) were interviewed over the telephone regarding restless legs syndrome symptoms. If the patients exhibited symptoms of the syndrome, we conducted face-to-face interviews. Lastly, a therapeutic test with pramipexole was proposed for each subject. In our cohort, 7 males (23%) and 30 females (39%) had restless legs syndrome. Of these, 6 males and 23 females were submitted to face-to-face-interview. Of the males, 5 (83%) had restless legs after the knee surgery-exclusively in the operated leg- and reported no family restless legs history. One man had a prior case of bilateral restless legs syndrome, a positive family history and claimed exacerbation of symptoms in the operated leg. Among the females, 16 (69%) had restless legs prior to surgery. A total of 10 female patients reported bilateral symptoms, with fewer symptoms in the operated leg, while 6 displayed a worse outcome in the operated leg. The 7 females (31%) without restless legs prior to surgery and without a family history experienced symptoms only in the operated leg. All subjects responded favorably to the pramipexole therapeutic test. Our results suggest that secondary unilateral restless legs syndrome may ensue from knee prosthesis surgery and that the symptoms are generated in the peripheral nervous system.

  6. Relationship between quality of life and restless legs syndrome among a community-dwelling population in Japan

    Directory of Open Access Journals (Sweden)

    Kubo K

    2016-04-01

    Full Text Available Kazutoshi Kubo,1 Norio Sugawara,1,2 Ayako Kaneda,1 Ippei Takahashi,3 Kazuhiko Nakamura,1 Shigeyuki Nakaji,3 Norio Yasui-Furukori1 1Department of Neuropsychiatry, Hirosaki University School of Medicine, Hirosaki, 2Department of Psychiatry, Aomori Prefectural Center for Mental Health and Welfare, Aomori, 3Department of Social Medicine, Hirosaki University School of Medicine, Hirosaki, Japan Objectives: Restless legs syndrome (RLS is a sensorimotor disturbance that causes the production of impulses and dysesthesia and makes the patients feel as though they must move their lower extremities. Because the symptoms of RLS in the lower limbs tend to develop at night, RLS could cause sleep disorders. We investigated an association between the symptoms of RLS and the health-related quality of life among community-dwelling individuals in Japan. Methods: In this cross-sectional survey, we enrolled 985 volunteers who participated in the Iwaki Health Promotion Project in 2013. The symptoms of RLS were evaluated by the criteria of the International Restless Legs Syndrome Study Group. The assessments included an interview to obtain sociodemographic data, the second version of the Short Form Health Survey, the Center for Epidemiological Studies Depression scale, and the Pittsburgh Sleep Quality Index. A multiple regression analysis was used to assess the relationship between the symptoms of RLS and subscores of the Short Form Health Survey, Version 2. Results: The overall prevalence of RLS in our participants was 1.0%. We found a significant and negative association between symptoms of RLS and physical functioning, role – physical functioning, bodily pain, social functioning, and the physical composite summary score. Conclusion: After adjusting for confounders such as age, sex, and comorbidity, the burden of RLS appears to be mainly a physical problem. Impaired health-related quality of life among community individuals with RLS emphasizes the importance of

  7. Alleviation of Severe Restless Legs Syndrome (RLS) Symptoms by Cigarette Smoking

    OpenAIRE

    Oksenberg, Arie

    2010-01-01

    Cigarette smoking is in general considered an aggravating factor for restless legs syndrome (RLS). The author presents a case in which cigarette smoking has produced for many years a consistent and effective alleviation of RLS symptoms.

  8. A pilot study to evaluate simulated driving performance and cognitive function in healthy subjects and patients with restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Chen D

    2013-10-01

    Full Text Available Dan Chen,1 Paula Shaw,2 Daniel M Canafax,1,3 James Catesby Ware4 1XenoPort, Inc., Santa Clara, CA, USA; 2Charles River Northwest, Tacoma, WA, USA; 3Theravance Inc., South San Francisco, CA, USA; 4Division of Sleep Medicine, Eastern Virginia Medical School, Norfolk, VA, USA Objective: Symptoms of restless legs syndrome (RLS usually occur during the evening and night time, resulting in disrupted sleep and subsequent daytime fatigue. This study compared simulated driving performance, alertness, and cognitive function between healthy subjects and patients with a diagnosis of RLS. Methods: Fifteen healthy subjects and 15 untreated RLS subjects were enrolled and completed two driving tests. The first test occurred at 4 PM followed by the second test at 8 AM the next morning. Outcome measures included lane position variability (LPV, speed variability, frequency of simulated crashes (off-road events or collision, and brake reaction time. Other assessments included visual analog scale (VAS of alertness and the Brief Assessment of Cognition (BAC. Results: Overall, RLS patients and healthy subjects performed similarly on driving assessments. Two subjects within each group experienced off-road events. RLS patients had less alertness on the VAS than healthy subjects before and after driving assessments. Both groups scored similarly on the cognitive function assessments. Conclusion: Despite reported diminished alertness, RLS patients did not demonstrate impairment in driving or cognitive performance. Keywords: restless legs syndrome, simulated driving performance, cognitive function

  9. Gabapentin enacarbil for the treatment of restless legs syndrome (RLS).

    Science.gov (United States)

    Burke, Rachel A; Faulkner, Michele A

    2011-12-01

    Gabapentin enacarbil is a new treatment for restless legs syndrome (RLS). It is a prodrug of the anticonvulsant gabapentin. However, unlike gabapentin, gabapentin enacarbil does not demonstrate saturable absorption. This allows for once-daily dosing and less variability in serum levels. This review focuses on therapies used to treat RLS, both historical and recent. Data from available trials are summarized, with a particular focus on the efficacy and safety of gabapentin enacarbil. Potential advantages and disadvantages of this therapy in comparison with other RLS treatment modalities are discussed. Placebo-controlled trials of gabapentin enacarbil demonstrate considerable efficacy in the treatment of RLS. However, head-to-head trials comparing gabapentin enacarbil with other medications used in the treatment of RLS, including gabapentin, are lacking. Potential advantages with gabapentin enacarbil related to its pharmacokinetic profile are thus difficult to ascertain. Efficacy of gabapentin enacarbil appears comparable with that of the dopamine agonists, long considered the therapy of choice in patients with RLS. Given the lack of direct-comparison trials, and the significant cost differential of gabapentin enacarbil versus established therapies, the drug is likely to be used for patients who have failed other medication trials, or those who experience prolonged symptoms and prefer once-daily dosing.

  10. Iron and restless legs syndrome: Treatment, genetics and pathophysiology

    Science.gov (United States)

    Connor, James R.; Patton, Stephanie; Oexle, Konrad; Allen, Richard

    2017-01-01

    In this article, we review the original findings from MRI and autopsy studies that demonstrated brain iron status is insufficient in individuals with restless legs syndrome (RLS). The concept of deficient brain iron status is supported by proteomic studies from cerebrospinal fluid (CSF) and from the clinical findings where intervention with iron, either dietary or intravenous, can improve RLS symptoms. Therefore, we include a section on peripheral iron status and how peripheral status may influence both the RLS symptoms and treatment strategy. Given the impact of iron in RLS, we have evaluated genetic data to determine if genes are directly involved in iron regulatory pathways. The result was negative. In fact, even the HFE mutation C282Y could not be shown to have a protective effect. Lastly, a consistent finding in conditions of low iron is increased expression of proteins in the hypoxia pathway. Although there is lack of clinical data that RLS patients are hypoxic, there are intriguing observations that environmental hypoxic conditions worsen RLS symptoms; in this chapter we review very compelling data for activation of hypoxic pathways in the brain in RLS patients. In general, the data in RLS point to a pathophysiology that involves decreased acquisition of iron by cells in the brain. Whether the decreased ability is genetically driven, activation of pathways (eg, hypoxia) that are designed to limit cellular uptake is unknown at this time; however, the data strongly support a functional rather than structural defect in RLS, suggesting that an effective treatment is possible. PMID:28057495

  11. Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

    Science.gov (United States)

    Guo, Shiyi; Huang, Jinsha; Jiang, Haiyang; Han, Chao; Li, Jie; Xu, Xiaoyun; Zhang, Guoxin; Lin, Zhicheng; Xiong, Nian; Wang, Tao

    2017-01-01

    Restless legs syndrome (RLS), a common neurological sensorimotor disorder in western countries, has gained more and more attention in Asian countries. The prevalence of RLS is higher in older people and females. RLS is most commonly related to iron deficiency, pregnancy and uremia. The RLS symptoms show a significant circadian rhythm and a close relationship to periodic limb movements (PLMs) in clinical observations, while the pathophysiological pathways are still unknown. The diagnostic criteria have been revised in 2012 to improve the validity of RLS diagnosis. Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology. Dopaminergic (DA) system dysfunction in A11 cell groups has been recognized long ago from clinical treatment and autopsy. Nowadays, it is believed that iron dysfunction can affect DA system from different pathways and opioids have a protective effect on DA system. Several susceptible single nucleotide polymorphisms such as BTBD9 and MEIS1, which are thought to be involved in embryonic neuronal development, have been reported to be associated with RLS. Several pharmacological and non-pharmacological treatment are discussed in this review. First-line treatments of RLS include DA agents and α2δ agonists. Augmentation is very common in long-term treatment of RLS which makes prevention and management of augmentation very important for RLS patients. A combination of different types of medication is effective in preventing and treating augmentation. The knowledge on RLS is still limited, the pathophysiology and better management of RLS remain to be discovered. PMID:28626420

  12. Restless Legs Syndrome: From Pathophysiology to Clinical Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Shiyi Guo

    2017-06-01

    Full Text Available Restless legs syndrome (RLS, a common neurological sensorimotor disorder in western countries, has gained more and more attention in Asian countries. The prevalence of RLS is higher in older people and females. RLS is most commonly related to iron deficiency, pregnancy and uremia. The RLS symptoms show a significant circadian rhythm and a close relationship to periodic limb movements (PLMs in clinical observations, while the pathophysiological pathways are still unknown. The diagnostic criteria have been revised in 2012 to improve the validity of RLS diagnosis. Recent studies have suggested an important role of iron decrease of brain in RLS pathophysiology. Dopaminergic (DA system dysfunction in A11 cell groups has been recognized long ago from clinical treatment and autopsy. Nowadays, it is believed that iron dysfunction can affect DA system from different pathways and opioids have a protective effect on DA system. Several susceptible single nucleotide polymorphisms such as BTBD9 and MEIS1, which are thought to be involved in embryonic neuronal development, have been reported to be associated with RLS. Several pharmacological and non-pharmacological treatment are discussed in this review. First-line treatments of RLS include DA agents and α2δ agonists. Augmentation is very common in long-term treatment of RLS which makes prevention and management of augmentation very important for RLS patients. A combination of different types of medication is effective in preventing and treating augmentation. The knowledge on RLS is still limited, the pathophysiology and better management of RLS remain to be discovered.

  13. Impaired vascular endothelial function in patients with restless legs syndrome: a new aspect of the vascular pathophysiology.

    Science.gov (United States)

    Koh, Seung Yon; Kim, Min Seung; Lee, Sun Min; Hong, Ji Man; Yoon, Jung Han

    2015-12-15

    Restless legs syndrome (RLS) is a common sleep disorder in which patients feel unpleasant leg sensations and the urge to move their legs during rest, particularly at night. Leg movement improves these symptoms. Although several studies have demonstrated an association between cardiovascular disease and RLS, the mechanisms underlying this relationship remain unclear. Recent studies have shown changes in the peripheral microvasculature, including altered blood flow and capillary tortuosity, and peripheral hypoxia. Vascular endothelial dysfunction can be assessed noninvasively with ultrasound measurements of brachial artery flow-mediated dilatation (FMD). Therefore, this study investigated FMD in RLS patients to determine the involvement of microvascular alterations in this disorder. The study enrolled 25 drug-naïve RLS patients and 25 sex- and age-matched controls and compared the FMD values of the two groups. RLS was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group. FMD was significantly lower in the RLS patients (6.6 ± 1.2%) compared to the controls (8.4 ± 1.8%; p<0.05) and the RLS patients showed a weak, negative correlation between RLS severity and FMD (r=-0.419, p=0.04). Multivariate linear regression analysis revealed that RLS (B=-1.87, 95% confidence interval [CI] -2.72 to -1.02; p<0.001) and age (B=-0.06; 95% CI -0.12 to -0.02; p<0.001) were significantly and inversely correlated with FMD. This study demonstrated that RLS patients have poorer vascular endothelial function than normal healthy subjects and provides further evidence supporting the involvement of peripheral systems in the generation of RLS. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. A retrospective review of the sleep characteristics in patients with chronic fatigue syndrome and fibromyalgia.

    Science.gov (United States)

    Spitzer, A Robert; Broadman, Melissa

    2010-01-01

    This study characterizes findings on sleep testing and Human Leukocyte Antigen (HLA) markers in a group of patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS). One hundred eighteen patients seen in a general neurology practice over 5 years meeting standard clinical criteria for FM or CFS were analyzed retrospectively. Cases of untreated sleep apnea or restless legs syndrome were excluded prior to inclusion in this study. Ninety-two patients had multiple sleep latency testing (MSLT). Seventy-three (80%) were abnormal by standard criteria. Of 57 females having positive MSLTs, 22 (39%) had one or more periods of sleep onset rapid eye movement (SOREM), and 5 of 16 (31%) males with positive MSLTs had one or more SOREM. Highly fragmented sleep, as previously described in FM, was seen but not analyzed quantitatively. HLA DQB1*0602 was obtained in 74 patients, and positive in 32 (43%), P < 0.0001 compared with published values in 228 populations. In our patients, who presented with neuromuscular fatigue or generalized pain, we found a sleep disorder characterized by objective hypersomnia. Some patients had characteristics of narcolepsy. Objective assessment by sleep studies can assist the diagnostic process, aid future research, and provide rationale for treatment.

  15. Ferric carboxymaltose in patients with restless legs syndrome and nonanemic iron deficiency: A randomized trial.

    Science.gov (United States)

    Trenkwalder, Claudia; Winkelmann, Juliane; Oertel, Wolfgang; Virgin, Garth; Roubert, Bernard; Mezzacasa, Anna

    2017-10-01

    Compromised iron status is important in restless legs syndrome pathophysiology. We compared the efficacy and tolerability of ferric carboxymaltose (single intravenous dose) versus placebo for restless legs syndrome treatment in iron-deficient nonanemic patients. Patients with moderate to severe restless legs syndrome and serum ferritin Restless Legs Syndrome Severity Scale score from baseline to week 4 was the primary end point; week 12 was a secondary end point. Ferric carboxymaltose treatment (n = 59) led to nonsignificant improvement over placebo (n = 51) in International Restless Legs Syndrome Severity Scale score at week 4 (difference [95% confidence interval], -2.5 [-5.93 to 1.02], P = 0.163), reaching significance by week 12 (-4.66 [-8.59 to -0.73], P = 0.021). In patients who responded to treatment, ferric carboxymaltose may require more time to stabilize restless legs syndrome than previously assumed. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. © 2017 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

  16. Association of restless legs syndrome, pain, and mood disorders in Parkinson's disease.

    Science.gov (United States)

    Rana, Abdul Qayyum; Qureshi, Abdul Rehman M; Rahman, Labiba; Jesudasan, Ajantha; Hafez, Kevin K; Rana, Mohammad A

    2016-01-01

    The objectives of the study were to analyze the association between Parkinson's disease and restless legs syndrome, and to explore the relationship between mood disorder comorbidity (anxiety and depression), pain, and restless legs syndrome. This study included 123 Parkinson's disease patients and 123 non-Parkinson's disease patients matched for age and gender, and evaluated for anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence. This was performed using semi-structured interviews and a neurological examination through the restless legs syndrome diagnostic criteria and the following inventories; Hospital Anxiety and Depression Scale, Brief Pain Inventory, and Pain Disability Index. Parkinson's disease patients had significantly greater anxiety severity, depression severity, pain severity, pain interference, pain disability, and restless legs syndrome prevalence in comparison to controls. In addition, Parkinson's disease patients' comorbid for anxiety and depression had significantly greater pain severity, pain interference, and pain disability, but not RLS prevalence, in comparison to Parkinson's disease only, Parkinson's disease anxiety, and Parkinson's disease depression patients. Pain interference, pain severity, and pain disability is greater among Parkinson's disease patients with anxiety and depression, in comparison to Parkinson's disease patients without anxiety and depression. On the contrary, the prevalence of restless legs syndrome was not found to be relevant.

  17. Sleep in ring chromosome 20 syndrome: a peculiar electroencephalographic pattern.

    Science.gov (United States)

    Zambrelli, Elena; Vignoli, Aglaia; Nobili, Lino; Didato, Giuseppe; Mastrangelo, Massimo; Turner, Katherine; Canevini, Maria Paola

    2013-01-01

    Ring chromosome 20 [r(20)] syndrome is a chromosomal disorder characterized by epilepsy and intellectual disability. Distinctive electroclinical features and wakefulness EEG patterns have been described. The EEG features of sleep have not yet been evaluated. We studied the pattern of sleep in six patients aged 2-59 years who underwent at least one polysomnographic recording. Their sleep pattern evolution is described as deterioration ranging from normal to destructured NREM/REM sleep. NREM sleep alterations were observed from childhood and were more evident in adulthood. EEG abnormalities detected during wakefulness persisted, with morphological changes, during sleep. During NREM sleep all the subjects presented high amplitude delta sequences with a sharply contoured or notched appearance, prevalent over frontal regions. The theta rhythm of wakefulness was seen to persist during REM sleep. Ring chromosome 20 syndrome shows sleep alterations that seem to be age-related. A potential role of cortical and thalamocortical dysfunction is discussed.

  18. Restless Legs Syndrome -- Self-Tests and Diagnosis

    Science.gov (United States)

    ... miles): 10 25 50 Share: Essentials in Sleep Insomnia Overview & Facts Symptoms & Causes Diagnosis & Self Tests Treatment Sleep Apnea Overview & Facts ... Self Test & Diagnosis Treatment Snoring Overview and Facts Causes and Symptoms Self Tests & ... Insomnia Short Sleeper Hypersomnias Narcolepsy Insufficient ...

  19. Restless legs syndrome in Korean patients with drug-naïve Parkinson's disease: a nation-wide study.

    Science.gov (United States)

    Shin, Hee-Young; Youn, Jinyoung; Yoon, Won Tae; Kim, Ji Sun; Cho, Jin Whan

    2013-03-01

    Restless legs syndrome is a common neurologic disorder, and there is increasing evidence for a dopaminergic link between Parkinson's disease and restless legs syndrome. However, most previous studies did not take into account the effects of dopaminergic medication. We conducted a nation-wide, cross-sectional study to determine the prevalence and clinical characteristics of restless legs syndrome in Korean drug-naïve Parkinson's disease patients. One hundred and fifty-one drug-naïve patients with Parkinson's disease were enrolled from 18 centers in South Korea over the course of one year. Clinical profiles of parkinsonism, restless legs syndrome, psychiatric symptoms, and laboratory data were collected. The findings of subjects with and without restless legs syndrome were compared. The prevalence of restless legs syndrome in drug-naïve patients with Parkinson's disease was 16.5%. Subjects with restless legs syndrome had a higher mean Hoehn and Yahr stage and more severe limb parkinsonism, especially tremor. There was, however, no difference in iron metabolism between patients with and without restless legs syndrome. Analysis demonstrated that Beck's depression inventory score was associated with the severity of restless legs syndrome. Our study demonstrated an increased prevalence of restless leg syndrome in drug-naïve patients with Parkinson's disease than in the general population. Based on the association between parkinsonism and restless legs syndrome, and the unique characteristics of restless legs syndrome in patients with Parkinson's disease, we suggest that the pathophysiology of restless legs syndrome in Parkinson's disease differs from that in patients without Parkinson's disease. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Sleep disorders in Parkinson disease.

    Science.gov (United States)

    Iranzo de Riquer, Alex; Bergareche, Alberto; Campos, Victor

    2011-11-01

    Sleep is affected in a large number of patients with Parkinson disease. The mechanisms by which this occurs and the different types of sleep disorders that a patient with Parkinson disease may suffer (insufficient or fragmented sleep, persistent excessive daytime sleepiness, sudden onset of sleep episodes, obstructive sleep apnea (OSA), rapid eye movement sleep behavior disorder, and restless legs syndrome) will be reviewed in this study, as well as their relationship with the dopaminergic system. Finally, the most effective treatments will be proposed.

  1. Clinical symptoms of sleep apnea syndrome and automobile accidents

    DEFF Research Database (Denmark)

    Haraldsson, P O; Carenfelt, C; Diderichsen, Finn

    1990-01-01

    Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by ca...

  2. OBSTRUCTIVE SLEEP APNOEA HYPOPNEA SYNDROME – AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    ISMAIL T

    2011-01-01

    Full Text Available Obstructive sleep apnoea hypopnoea syndrome (OSAHS is a common cause of breathing-related sleep disorder, causing excessive daytime sleepiness. Common clinical features of OSAHS include snoring, fragmented sleep, daytime somnolence and fatigue. This article aims to provide a comprehensive review of the condition, including its management.

  3. Relationship between primary restless legs syndrome and migraine with aura.

    Science.gov (United States)

    Acar, Bilgehan Atılgan; Acar, Türkan; Alagöz, Aybala Neslihan; Karacan, Alper; Varım, Ceyhun; Uyanık, Mehmet Şevki; Kaya, Tezcan; Akdemir, Ramazan

    2016-08-01

    In this study, the prevalence and characteristics of definite migraine in primary restless legs syndrome (pRLS) patients and matched control patients (CPs) were investigated. We evaluated 63 consecutive adult pRLS patients and 141 age- and sex-matched controls in this case-control study. The diagnosis of migraine and its subtypes were defined based on The International Classification of Headache Disorders-II. Only those with "definite" migraine were included in the study. The mean age of 63 adult pRLS patients (15 men and 48 women) who participated in the study was 49.4 years. A total of 27 patients (42.9%) had definite migraine. Of these migraineurs, seven (11.1%) were without aura and 20 (31.8%) were with aura. The mean age of the 141 matched CPs was 48.7 years. A total of 32 CPs (22.7%) experienced migraine. Among these 32 migraineurs, 28 (19.9%) were without aura and four (2.8%) were with aura. Migraine and migraine with aura were significantly more common in pRLS patients than in CPs. pRLS patients with migraine were more anxious and experienced a shorter duration of RLS symptoms than pRLS patients without migraine. Migraineurs in the pRLS group tended to have high scores for severity of migraine headache by Visual Analog Scale score and high levels of disability by Migraine Disability Assessment grading than those in the control group. pRLS patients showed a positive association with definite migraine headaches. In contrast to results highlighted in recent studies, we found a strong link between migraine with aura and pRLS. Copyright © 2016. Published by Elsevier Taiwan.

  4. Relationship between primary restless legs syndrome and migraine with aura

    Directory of Open Access Journals (Sweden)

    Bilgehan Atılgan Acar

    2016-08-01

    Full Text Available In this study, the prevalence and characteristics of definite migraine in primary restless legs syndrome (pRLS patients and matched control patients (CPs were investigated. We evaluated 63 consecutive adult pRLS patients and 141 age- and sex-matched controls in this case–control study. The diagnosis of migraine and its subtypes were defined based on The International Classification of Headache Disorders-II. Only those with “definite” migraine were included in the study. The mean age of 63 adult pRLS patients (15 men and 48 women who participated in the study was 49.4 years. A total of 27 patients (42.9% had definite migraine. Of these migraineurs, seven (11.1% were without aura and 20 (31.8% were with aura. The mean age of the 141 matched CPs was 48.7 years. A total of 32 CPs (22.7% experienced migraine. Among these 32 migraineurs, 28 (19.9% were without aura and four (2.8% were with aura. Migraine and migraine with aura were significantly more common in pRLS patients than in CPs. pRLS patients with migraine were more anxious and experienced a shorter duration of RLS symptoms than pRLS patients without migraine. Migraineurs in the pRLS group tended to have high scores for severity of migraine headache by Visual Analog Scale score and high levels of disability by Migraine Disability Assessment grading than those in the control group. pRLS patients showed a positive association with definite migraine headaches. In contrast to results highlighted in recent studies, we found a strong link between migraine with aura and pRLS.

  5. Brain imaging and networks in restless legs syndrome

    Science.gov (United States)

    Rizzo, Giovanni; Li, Xu; Galantucci, Sebastiano; Filippi, Massimo; Cho, Yong Won

    2018-01-01

    Several studies provide information useful to our understanding of restless legs syndrome (RLS), using various imaging techniques to investigate different aspects putatively involved in the pathophysiology of RLS, although there are discrepancies between these findings. The majority of magnetic resonance imaging (MRI) studies using iron-sensitive sequences supports the presence of a diffuse, but regionally variable low brain-iron content, mainly at the level of the substantia nigra, but there is increasing evidence of reduced iron levels in the thalamus. Positron emission tomography (PET) and single positron emission computed tomography (SPECT) findings mainly support dysfunction of dopaminergic pathways involving not only the nigrostriatal but also mesolimbic pathways. None or variable brain structural or microstructural abnormalities have been reported in RLS patients; reports are slightly more consistent concerning levels of white matter. Most of the reported changes were in regions belonging to sensorimotor and limbic/nociceptive networks. Functional MRI studies have demonstrated activation or connectivity changes in the same networks. The thalamus, which includes different sensorimotor and limbic/nociceptive networks, appears to have lower iron content, metabolic abnormalities, dopaminergic dysfunction, and changes in activation and functional connectivity. Summarizing these findings, the primary change could be the reduction of brain iron content, which leads to dysfunction of mesolimbic and nigrostriatal dopaminergic pathways, and in turn to a dysregulation of limbic and sensorimotor networks. Future studies in RLS should evaluate the actual causal relationship among these findings, better investigate the role of neurotransmitters other than dopamine, focus on brain networks by connectivity analysis, and test the reversibility of the different imaging findings following therapy. PMID:27838239

  6. Idiopathic restless legs syndrome: abnormalities in central somatosensory processing.

    Science.gov (United States)

    Schattschneider, Jörn; Bode, Andre; Wasner, Gunnar; Binder, Andreas; Deuschl, Günther; Baron, Ralf

    2004-08-01

    Neurophysiological studies have shown an impairment of temperature perception in secondary and idiopathic restless legs syndrome (RLS). It is unclear whether these deficits are caused by peripheral nerve fibre damage or by central impairment of somatosensory processing. The aim of the present study was (1) to determine the frequency of thermal hypaesthesia in a large population of secondary and idiopathic RLS patients; (2) to differentiate between a peripheral and central disturbance of somatosensory processing and (3) to correlate these findings with the clinical manifestation of the disease. From the results of clinical examination, nerve conduction studies and blood samples the patients were divided into secondary and idiopathic RLS groups. The severity of RLS symptoms was assessed by standardized questionnaires. Quantitative sensory testing (QST) assessing temperature perception was performed in all patients. The peripheral function of small nerve fibres was evaluated by the quantitative nociceptor axon reflex test (QNART). 22 secondary and 20 idiopathic RLS patients participated in the study. Impairment of temperature perception (QST) was found in 72% of the secondary RLS patients and in 55% of idiopathic RLS patients. The peripheral C-fibre function (QNART) was normal in idiopathic RLS patients. In contrast it was significantly impaired in secondary RLS patients compared with idiopathic RLS patients and age matched controls. There was no correlation between the results obtained in QST and clinical scores. Impairment of temperature perception is present in a high percentage of RLS patients. In secondary RLS the sensory deficits are at least in part caused by small fibre neuropathy. In idiopathic RLS a functional impairment of central somatosensory processing is present.

  7. Reliability, validity, and responsiveness of the Japanese version of International Restless Legs Syndrome Study Group rating scale for restless legs syndrome in a clinical trial setting.

    Science.gov (United States)

    Inoue, Yuichi; Oka, Yasunori; Kagimura, Tatsuo; Kuroda, Kenji; Hirata, Koichi

    2013-09-01

    This study was conducted to verify the reliability, validity, and responsiveness of the Japanese version of the International Restless Legs Syndrome Study Group Rating Scale for restless legs syndrome (J-IRLS) as a sub-study of a clinical trial of pramipexole against restless legs syndrome. After evaluating the test-retest reliability, concurrent validity and construct validity were analyzed. The responsiveness of J-IRLS was confirmed by evaluating the correlations between the changes in J-IRLS total score after treatment, Clinical Global Impression Improvement Scale (CGI-I), and Patient Global Impression. Test-retest reliability of J-IRLS was good (intra-class correlation coefficient, 0.877; 95% confidence interval, 0.802-0.925). The correlation coefficient of J-IRLS total score and CGI-S score for the first and second visit was 0.804 and 0.796, respectively (both P restless legs syndrome and for assessing drug efficacy. © 2013 The Authors. Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology.

  8. Effects of immobility on sensory and motor symptoms of restless legs syndrome.

    Science.gov (United States)

    Michaud, Martin; Lavigne, Gilles; Desautels, Alex; Poirier, Gaétan; Montplaisir, Jacques

    2002-01-01

    Restless legs syndrome (RLS) is defined by an irresistible need to move associated with leg paresthesia. Two additional features are essential for diagnosis: (1) worsening of symptoms at rest with temporary relief by activity, and (2) worsening of symptoms during the evening and/or during the night. The suggested immobilization test (SIT) has been developed to evaluate the presence of these criteria. This test quantifies leg movements and leg discomfort during a 1-hour period of immobility prior to bedtime. We used the SIT to evaluate the effects of immobility on leg discomfort and leg movements experienced by 19 patients with RLS and 19 control subjects. Results show that immobility significantly worsens both leg discomfort and periodic leg movements (PLM) in patients with RLS but not in controls. Patients with RLS showed a higher leg discomfort score (32.6 +/- 15.1 mm vs. 5.7 +/- 7.9 mm; P < 0.00001), a greater maximum leg discomfort value (63.4 +/- 27.4 mm vs. 13.7 +/- 23.0 mm; P < 0.00001) and a greater PLM index (88.4 +/- 62.6 vs. 10.4 +/- 20.6; P < 0.00004) than control subjects. These results further validate the use of the SIT as a diagnostic and research tool for RLS and confirm the contention of the International RLS study group that RLS symptoms worsen at rest. Copyright 2001 Movement Disorder Society.

  9. Treatment Options in Intractable Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED).

    Science.gov (United States)

    Rinaldi, Fabrizio; Galbiati, Andrea; Marelli, Sara; Ferini Strambi, Luigi; Zucconi, Marco

    2016-02-01

    Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) is a common condition characterized by an irresistible urge to move the legs, concomitant with an unpleasant sensation in the lower limbs, which is typically relieved by movement. Symptoms occur predominantly at rest and prevail in the afternoon or evening. Treatment of patients with RLS/WED is indicated for those patients who suffer from clinically relevant symptoms. The management of mild forms of RLS/WED is mainly based on dopamine agonists (DA) therapy (including pramipexole and ropinirole) and α-2-δ calcium-channel ligand. Nevertheless, with passing of time, symptoms tend to become more severe and the patient can eventually develop pharmacoresistance. Furthermore, long-term treatment with dopaminergic agents may be complicated by the development of augmentation, which is defined by an increase in the severity and frequency of RLS/WED symptoms despite adequate treatment. Here, we discuss which are the best therapeutic options when RLS/WED becomes intractable, with a focus on advantages and side effects of the available medications. Prevention strategies include managing lifestyle changes and a good sleep hygiene. Different drug options are available. Switching to longer-acting dopaminergic agents may be a possibility if the patient is well-tolerating DA treatment. An association with α-2-δ calcium-channel ligand is another first-line approach. In refractory RLS/WED, opioids such as oxycodone-naloxone have demonstrated good efficacy. Other pharmacological approaches include IV iron, benzodiazepines such as clonazepam, and antiepileptic drugs, with different level of evidence of efficacy. Therefore, the final decision regarding the agent to use in treating severe RLS/WED symptoms should be tailored to the patient, taking into account the symptomatology, comorbidities, the availability of treatment and the history of the disease.

  10. Metabolic aspects of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    M. R. Bonsignore

    2009-06-01

    Full Text Available Insulin resistance is often associated with obstructive sleep apnoea syndrome (OSAS and could contribute to cardiovascular risk in OSAS. Sleep loss and intermittent hypoxia could contribute to the pathogenesis of the metabolic alterations associated with obesity, a common feature of OSAS. The biology of the adipocyte is being increasingly studied, and it has been found that hypoxia negatively affects adipocyte function. In November 2007, the European Respiratory Society and two EU COST Actions (Cardiovascular risk in OSAS (B26 and Adipose tissue and the metabolic syndrome (BM0602, held a Research Seminar in Düsseldorf, Germany, to discuss the following: 1 the effects of hypoxia on glucose metabolism and adipocyte function; 2 the role of inflammatory activation in OSAS and obesity; 3 the alarming rates of obesity and OSAS in children; 4 the harmful effects of the metabolic syndrome in OSAS; 5 the effects of OSAS treatment on metabolic variables; and 6 the relationship between daytime sleepiness and hormonal and inflammatory responses. Insulin resistance in skeletal muscle, the role of the endocannabinoid system and novel pharmacological approaches to treat insulin resistance were also discussed. As obesity and hypoxia could be the basic links between OSAS and adipocyte dysfunction, further research is needed to translate these new data into clinical practice.

  11. Restless legs syndrome is highly prevalent in patients with post-polio syndrome.

    Science.gov (United States)

    Marin, Luis Fabiano; Carvalho, Luciane B C; Prado, Lucila B F; Oliveira, Acary S B; Prado, Gilmar F

    2017-09-01

    Few studies have quantified the prevalence of restless legs syndrome (RLS) in patients with post-polio syndrome (PPS). Our objective was to assess the prevalence and severity of RLS in patients with PPS and to examine the demographic characteristics of this population. This was a cross-sectional study conducted from April 2010 to May 2012 at the outpatient Neuromuscular Disorders clinic of Universidade Federal de São Paulo, São Paulo, Brazil. We evaluated 119 patients with PPS, consecutively recruited, and investigated for RLS based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). Patients were evaluated with the Brazilian version of the IRLSSG severity scale. The prevalence of RLS was 36% (n = 43; 32 women and 11 men). The ages at onset of RLS (median = 41 years) and PPS (median = 41 years) were concurrent, and the correlation between onset of symptoms of RLS and onset of symptoms of PPS was positive and very strong (Spearman r = 0.93, p = 0.01). The median RLS severity was 23 (range, 20-28). Low educational achievement and depression were predictive of RLS development. In the largest population of patients with PPS studied to date, our results indicate a high prevalence of RLS, marked disease severity, and concomitant onset of both conditions in many patients with PPS. Further studies are needed to elucidate a possible pathophysiologic mechanism linking these two conditions. We suggest that all post-polio patients with sensory and motor complaints in the legs be investigated for RLS. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Associations of Leg Fat Accumulation with Adiposity-Related Biological Factors and Risk of Metabolic Syndrome

    Science.gov (United States)

    Zhang, Xiaomin; Hu, Emily A.; Wu, Hongyu; Malik, Vasanti; Sun, Qi

    2012-01-01

    The association between regional fat mass distribution and cardiometabolic risk factors has been inconsistent in the literature, and data for ethnic minority groups, such as non-Hispanic blacks and Hispanics, are lacking. We aimed to examine this association among 8802 US residents who participated in the 1999-2004 US National Health and Nutrition Examination Survey (NHANES). Body composition was measured using dual-energy X-ray absorptiometry (DXA). Leg fat indices included leg fat mass (FM), leg fat mass percent (FM%), leg to whole body FM ratio (leg/whole) and leg to trunk FM ratio (leg/trunk). We evaluated the correlation between leg fat indices and adiposity-related risk factors, as well as the association of these indices with metabolic syndrome (MetS). After adjusting for covariates including age, gender, and trunk FM or trunk FM%, higher leg FM and leg FM% were, in general, correlated favorably with adiposity-related risk factors and associated with lower odds of MetS in all ethnicities, including non-Hispanic whites and blacks and Hispanic groups. In addition, in all multivariate-adjusted models, leg/whole and leg/trunk ratios were strongly associated with lower levels of most risk factors and decreased odds of MetS in these ethnicities (all odds ratios comparing extreme quintiles leg fat accumulation is inversely associated with adiposity-related biological factors and risk of MetS in both whites and ethnic groups, suggesting that regional fat distribution plays an important role in the etiology of adiposity-related diseases in these populations. PMID:23404933

  13. The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension

    Science.gov (United States)

    Kandati, Sahiti; Flack, Kathryn L.; Agarwal, Parul; Selfe, Terry Kit

    2016-01-01

    Abstract Background: Restless legs syndrome (RLS), a burdensome sleep disorder, has been associated with cardiovascular disease (CVD), hypertension, diabetes, and related disorders. However, the relationship of RLS to history of pregnancy-induced hypertension (PIH), a predictor of subsequent CVD, diabetes, and associated conditions, remains little explored. In this study, we investigated the relationship of RLS to history of PIH in a sample of primary care patients. Methods: Participants were women aged ≥40 years drawn from an anonymous survey study of West Virginia primary care patients. Data collected included detailed information on demographics, lifestyle factors, sleep patterns, and reproductive/medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or unsure about their pregnancy status were excluded from the analyses. Results: Of the 498 participants in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms ≥once/week, 11.9% with symptoms ≥3 times/week); 73 (16.5% of parous women) reported a history of PIH, defined as physician-diagnosed preeclampsia or gestational hypertension. After adjustment for demographics, lifestyle characteristics, obesity, reproductive history, health conditions, and other factors, those reporting a history of PIH were approximately twice as likely to meet criteria for RLS (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.1, 3.6). These associations increased in magnitude with increasing symptom frequency (adjusted OR for RLS with symptoms ≥3 times/week = 3.8; CI 1.9, 7.6; p for trend = 0.003). Conclusions: History of PIH was strongly and positively related to current RLS in this study of primary care patients; these findings further support a possible role for metabolic dysregulation in RLS etiology. PMID:26913940

  14. The Relationship of Restless Legs Syndrome to History of Pregnancy-Induced Hypertension.

    Science.gov (United States)

    Innes, Kim E; Kandati, Sahiti; Flack, Kathryn L; Agarwal, Parul; Selfe, Terry Kit

    2016-04-01

    Restless legs syndrome (RLS), a burdensome sleep disorder, has been associated with cardiovascular disease (CVD), hypertension, diabetes, and related disorders. However, the relationship of RLS to history of pregnancy-induced hypertension (PIH), a predictor of subsequent CVD, diabetes, and associated conditions, remains little explored. In this study, we investigated the relationship of RLS to history of PIH in a sample of primary care patients. Participants were women aged ≥40 years drawn from an anonymous survey study of West Virginia primary care patients. Data collected included detailed information on demographics, lifestyle factors, sleep patterns, and reproductive/medical history; the survey also included an RLS diagnostic questionnaire. Women who were pregnant or unsure about their pregnancy status were excluded from the analyses. Of the 498 participants in the final analytic sample, 24.5% met diagnostic criteria for RLS (17.9% with symptoms ≥once/week, 11.9% with symptoms ≥3 times/week); 73 (16.5% of parous women) reported a history of PIH, defined as physician-diagnosed preeclampsia or gestational hypertension. After adjustment for demographics, lifestyle characteristics, obesity, reproductive history, health conditions, and other factors, those reporting a history of PIH were approximately twice as likely to meet criteria for RLS (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.1, 3.6). These associations increased in magnitude with increasing symptom frequency (adjusted OR for RLS with symptoms ≥3 times/week = 3.8; CI 1.9, 7.6; p for trend = 0.003). History of PIH was strongly and positively related to current RLS in this study of primary care patients; these findings further support a possible role for metabolic dysregulation in RLS etiology.

  15. Effect of sensory stimuli on restless legs syndrome: a randomized crossover study.

    Science.gov (United States)

    Rozeman, Anouk D; Ottolini, Truus; Grootendorst, Diana C; Vogels, Oscar J M; Rijsman, Roselyne M

    2014-08-15

    A variety of sensory stimuli relieve restless legs syndrome symptoms. Because systematic evaluations of sensory stimulation in restless legs syndrome are largely lacking, we performed a randomized crossover study to evaluate the effect of external sensory stimulation on restless legs syndrome symptoms. Eighteen patients underwent 3 consecutive suggestive immobilization tests with the order of the following 3 conditions randomly assigned: no electrical stimulation (condition 1), tactile and proprioceptive sensory stimulation (condition 2), and tactile sensory stimulation only (condition 3). Restless legs syndrome symptoms were quantified by visual analog scales, and periodic leg movements during wake were measured. Baseline visual analogue scale score was 4.5 (range 0-60) in condition 1, 10.5 (range 0-96) in condition 2, and 8.5 in condition 3 (p = 0.21). There was a tendency towards a higher maximum visual analogue scale score and visual analogue scale score at the end of the suggested immobilization test in the conditions with tactile sensory stimulation, though not significant (p = 0.74 and p = 0.29, respectively). Fifteen patients suffered from periodic leg movements during wake. Median indices were 18 (range 0-145) in condition 1, 26 (range 0-190) in condition 2, and 49 (range 0-228) in condition 3 (p = 0.76). We found a tendency towards less leg discomfort in the conditions in which an external sensory input was applied. This potential benefit of sensory stimuli on restless legs syndrome severity merits further investigation as this could open new ways towards a better pathophysiological understanding and non-pharmacological treatments.

  16. Post Hoc Analysis of Data from Two Clinical Trials Evaluating the Minimal Clinically Important Change in International Restless Legs Syndrome Sum Score in Patients with Restless Legs Syndrome (Willis-Ekbom Disease).

    Science.gov (United States)

    Ondo, William G; Grieger, Frank; Moran, Kimberly; Kohnen, Ralf; Roth, Thomas

    2016-01-01

    Determine the minimal clinically important change (MCIC), a measure determining the minimum change in scale score perceived as clinically beneficial, for the international restless legs syndrome (IRLS) and restless legs syndrome 6-item questionnaire (RLS-6) in patients with moderate to severe restless legs syndrome (RLS/Willis-Ekbom disease) treated with the rotigotine transdermal system. This post hoc analysis analyzed data from two 6-mo randomized, double-blind, placebo-controlled studies (SP790 [NCT00136045]; SP792 [NCT00135993]) individually and as a pooled analysis in rotigotine-treated patients, with baseline and end of maintenance IRLS and Clinical Global Impressions of change (CGI Item 2) scores available for analysis. An anchor-based approach and receiver operating characteristic (ROC) curves were used to determine the MCIC for the IRLS and RLS-6. We specifically compared "much improved vs minimally improved," "much improved/very much improved vs minimally improved or worse," and "minimally improved or better vs no change or worse" on the CGI-2 using the full analysis set (data as observed). The MCIC IRLS cut-off scores for SP790 and SP792 were similar. Using the pooled SP790+SP792 analysis, the MCIC total IRLS cut-off score (sensitivity, specificity) for "much improved vs minimally improved" was -9 (0.69, 0.66), for "much improved/very much improved vs minimally improved or worse" was -11 (0.81, 0.84), and for "minimally improved or better vs no change or worse" was -9 (0.79, 0.88). MCIC ROC cut-offs were also calculated for each RLS-6 item. In patients with RLS, the MCIC values derived in the current analysis provide a basis for defining meaningful clinical improvement based on changes in the IRLS and RLS-6 following treatment with rotigotine. © 2016 American Academy of Sleep Medicine.

  17. Use of near-infrared light to reduce symptoms associated with restless legs syndrome in a woman: a case report

    Directory of Open Access Journals (Sweden)

    Mitchell Ulrike H

    2010-08-01

    Full Text Available Abstract Introduction We describe a potential new treatment option for patients suffering from restless legs syndrome. Contemporary treatment for restless legs syndrome consists mostly of dopaminergic drugs that leave some patients feeling nauseated and dizzy. A non-invasive, drug-free option would open new doors for patients suffering from restless legs syndrome. Case presentation A 69-year-old Caucasian woman met International Restless Legs Syndrome Study Group criteria for the diagnosis of restless legs syndrome. She had been afflicted with restless legs syndrome for over 30 years and tried many of the available pharmaceutical remedies without success. For this study she received 30-minute treatment sessions with near-infrared light, three times a week for four weeks. The restless legs syndrome rating scale was used to track symptom changes; at baseline she scored "27" on the 0 to 40 point scale, which is considered to be "severe". Our patient was almost symptom free at week two, indicated by a score of "2" on the rating scale. By week four she was completely symptom free. The symptoms slowly returned during week three post treatment. Conclusions The findings suggest that near-infrared light may be a feasible method for treating patients suffering from restless legs syndrome. Undesirable side-effects from medication are non-existent. This study might revive the neglected vascular mechanism theory behind restless legs syndrome and encourage further research into this area.

  18. The Predictors of Obesity Hypoventilation Syndrome in Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Aylin Pıhtılı

    2017-02-01

    Full Text Available Background: As obesity increases, the frequency of obstructive sleep apnea and obesity hypoventilation syndrome increases also. However, obesity hypoventilation syndrome frequency is not known, as capnography and arterial blood gas analysis are not routinely performed in sleep laboratories. Aims: To investigate the frequency and predictors of obesity hypoventilation syndrome in obese subjects. Study Design: Retrospective clinical study Methods: Obese subjects who had arterial blood gas analysis admitted to the sleep laboratory and polysomnography were retrospectively analyzed. Subjects with restrictive (except obesity and obstructive pulmonary pathologies were excluded. Demographics, Epworth-Sleepiness-Scale scores, polysomnographic data, arterial blood gas analysis, and spirometric measurements were recorded. Results: Of the 419 subjects, 45.1% had obesity hypoventilation syndrome. Apnea hypopnea index (p<0.001, oxygen desaturation index (p<0.001 and sleep time with SpO2<90% (p<0.001 were statistically higher in subjects with obesity hypoventilation syndrome compared to subjects with eucapnic obstructive sleep apnea. The nocturnal mean SpO2 (p<0.001 and lowest SpO2 (p<0.001 were also statistically lower in subjects with obesity hypoventilation syndrome. Logistic regression analysis showed that the lowest SpO2, oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% were related factors for obesity hypoventilation syndrome. Conclusion: Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high

  19. Undiagnosed obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis.

    NARCIS (Netherlands)

    Pijpers, M.; Poels, P.J.P.; Vaandrager, J.M.; Hoog, M. de; Berg, S.W. van den; Hoeve, H.J.; Joosten, K.F.

    2004-01-01

    Children with syndromal craniofacial synostosis have a high risk for obstructive sleep apnea syndrome. Early diagnosis and treatment can relieve symptoms and morbidity. Little is known about the development and natural history of obstructive sleep apnea syndrome through life. The aim of this study

  20. Restless legs syndrome: relationship between prevalence and latitude.

    Science.gov (United States)

    Koo, Brian B

    2012-12-01

    Restless legs syndrome (RLS) has a broad worldwide prevalence between 0.01% and 18.3%. While differences in RLS definitions and data ascertainment methods account for some variability, other factors likely contribute. The circadian nature of RLS and the fact that RLS symptoms track with endogenous melatonin levels suggest that light or ultraviolet radiation (UVR) may be related to RLS expression. As the amount of UVR decreases with latitude, we considered the potential effect of geography on RLS prevalence with the thought being that RLS prevalence rises with increasing latitude. RLS epidemiologic studies were sought via Pubmed search in the period between January 1, 1992 and November 15, 2010. Prevalence was mapped for each country or specific region studied and examined by continent. Pearson's correlational testing was carried out for RLS prevalence and latitude of the region studied. Global RLS prevalence ranges from 0.01% in Africa, 0.7% to 12.5% in Asia, 2.0% to 18.9% in the Americas, and 3.2% to 18.3% in Europe. Mapping RLS prevalence by country or region in both the Americas and in Europe suggests increasing RLS frequency with greater northern latitude. RLS prevalence is positively correlated with northern latitude in both North America and Europe with correlation coefficients of r = 0.77 (0.15, 0.96; p = 0.02) and r = 0.74 (0.44, 0.89; p = 0.0002), respectively. In Europe, lower latitudinal countries like Greece and Turkey had RLS prevalence (per 1,000 persons) of 38 and 34, respectively, middle latitudinal countries like France and England of 108 and 86, respectively, and high latitudinal countries like Norway and Iceland of 143 and 183, respectively. RLS epidemiology indicates an increase in RLS frequency in northern latitudinal countries as a function of distance from the equator, an effect most evident in Europe. This suggests that factors that track with latitude like UVR may be involved in the expression of RLS.

  1. Nasal Involvement in Obstructive Sleep Apnea Syndrome

    Science.gov (United States)

    Michels, Daniel de Sousa; Rodrigues, Amanda da Mota Silveira; Nakanishi, Márcio; Sampaio, André Luiz Lopes; Venosa, Alessandra Ramos

    2014-01-01

    Numerous studies have reported an association between nasal obstruction and obstructive sleep apnea syndrome (OSAS), but the precise nature of this relationship remains to be clarified. This paper aimed to summarize data and theories on the role of the nose in the pathophysiology of sleep apnea as well as to discuss the benefits of surgical and medical nasal treatments. A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in OSAS. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex, and the role of nitric oxide (NO). Pharmacological treatment presents some beneficial effects on the frequency of respiratory events and sleep architecture. Nonetheless, objective data assessing snoring and daytime sleepiness are still necessary. Nasal surgery can improve the quality of life and snoring in a select group of patients with mild OSAS and septal deviation but is not an effective treatment for OSA as such. Despite the conflicting results in the literature, it is important that patients who are not perfectly adapted to CPAP are evaluated in detail, in order to identify whether there are obstructive factors that could be surgically corrected. PMID:25548569

  2. Restless legs syndrome in end stage renal disease patients undergoing maintenance hemodialysis

    International Nuclear Information System (INIS)

    Jamal, Y.; Siddiqui, U.A.

    2014-01-01

    To study the frequency of restless legs syndrome in patients of end stage renal disease undergoing maintenance hemodialysis. Design: Cross sectional descriptive study. Place and Duration of Study: Department of medicine, CMH Multan from Nov 2010 to April 2011. Patients and Methods: One hundred and ninety four (n=194) patients of End stage renal disease who had been on maintenance hemodialysis for at least 3 months, were included in the study after full informed consent and using consecutive sampling. Patients having dementia, psychiatric illness, pregnancy, hypothyroidism, Parkinson's disease and alcoholics were excluded from the study. Patients who fulfilled all four diagnostic criteria for restless legs syndrome as proposed by International restless legs syndrome study group (IRLSSG), by direct questioning were diagnosed as having restless legs syndrome. Results: The frequency of restless legs syndrome was found to be 12.4% in patients undergoing hemodialysis (10.5% in males versus 16% in females). The mean duration of hemodialysis was higher among RLS positive patients (12.88 +- 5.543 months) as compared to RLS negative patients (6.94 +- 4.610 months). Conclusion: RLS is a frequent, under-diagnosed co-morbidity in patients undergoing maintenance hemodialysis. (author)

  3. Sleep in children with Angelman syndrome: Parental concerns and priorities.

    Science.gov (United States)

    Trickett, Jayne; Heald, Mary; Oliver, Chris

    2017-10-01

    Angelman syndrome is a rare genetic syndrome, in which sleep disturbances are reported for 20-80% of individuals (Williams et al., 2006). This interview study delineated parental perceptions of sleep problems experienced by children with Angelman syndrome and the impact on parental sleep quality, health and wellbeing. The nature of desired interventions was also explored. Semi-structured interviews were completed with parents of 50 children, aged 16 months-15 years with Angelman syndrome who experienced current or historic sleep problems; predominantly night waking and settling problems. Parents were concerned by the impact of their child's sleep quality upon their own ability to function during the day. The importance of considering parental experiences was evidenced by variability in coping e.g. despite the persistence of sleep problems 20% of parents did not feel the need for any additional support. Amongst a range of types of further support desired, 27% cited further support with a behavioural intervention, and information about the trajectory of sleep problems in Angelman syndrome (18%). The results suggest that behavioural interventions supporting both children and parents in improving their sleep quality and well-being, and longitudinal research into sleep problems should be prioritised. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. A new clinical sign probably associated to left hemiplegia with left hemineglect syndrome: the crossed legs.

    Science.gov (United States)

    Bazan, Rodrigo; Fernandes, Thiago; Braga, Gabriel; Luvizutto, Gustavo; Resende, Luiz

    2014-06-01

    To describe a new clinical sign associated with left unilateral neglect syndrome (UNS) in patients with ischemic stroke. Head computed tomography (CT) and National Institute of Health Stroke Scale were obtained in 150 patients with ischemic stroke. Those with right cerebral vascular lesions, left hemiplegia and right leg persistently crossed over the left were submitted to specific tests for UNS. The tests were also applied to 30 patients with right cerebral vascular lesions, left hemiplegia but without crossed legs. From 9 patients with persistent tendency to cross the right leg over the left, UNS was detected in 8. One patient died before the clinical tests were applied. Of the 30 patients without the crossed legs, 20 had normal clinical tests for UNS and 10 had minimal alterations, not sufficient for the diagnosis of UNS. The right leg crossed over the left may represent a new neurological semiotic sign associated with left hemiplegia and left UNS.

  5. [Sleep psychiatry].

    Science.gov (United States)

    Chiba, Shigeru

    2013-01-01

    Sleep disorders are serious issues in modern society. There has been marked scientific interest in sleep for a century, with the discoveries of the electrical activity of the brain (EEG), sleep-wake system, rapid eye movement (REM) sleep, and circadian rhythm system. Additionally, the advent of video-polysomnography in clinical research has revealed some of the consequences of disrupted sleep and sleep deprivation in psychiatric disorders. Decades of clinical research have demonstrated that sleep disorders are intimately tied to not only physical disease (e. g., lifestyle-related disease) but psychiatric illness. According to The International Classification of Sleep Disorders (2005), sleep disorders are classified into 8 major categories: 1) insomnia, 2) sleep-related breathing disorders, 3) hypersomnias of central origin, 4) circadian rhythm sleep disorders, 5) parasomnias, 6) sleep-related movement disorders, 7) isolated symptoms, and 8) other sleep disorders. Several sleep disorders, including obstructive sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder, sleepwalking, REM sleep behavior disorder, and narcolepsy, may be comorbid or possibly mimic numerous psychiatric disorders, and can even occur due to psychiatric pharmacotherapy. Moreover, sleep disorders may exacerbate underlying psychiatric disorders when left untreated. Therefore, psychiatrists should pay attention to the intimate relationship between sleep disorders and psychiatric symptoms. Sleep psychiatry is an academic field focusing on interrelations between sleep medicine and psychiatry. This mini-review summarizes recent findings in sleep psychiatry. Future research on the bidirectional relation between sleep disturbance and psychiatric symptoms will shed light on the pathophysiological view of psychiatric disorders and sleep disorders.

  6. Restless legs syndrome (RLS) with expansion of symptoms to the face.

    Science.gov (United States)

    Buchfuhrer, Mark J

    2008-01-01

    It has been well established that restless legs syndrome (RLS) manifests with symptoms most frequently in the legs followed by the arms. Other body parts may be affected but it has been somewhat controversial as to whether symptoms may extend to the face. We are reporting two cases of RLS showing unusual extension of symptoms. These two patients presented with symptoms which extended to body parts beyond the legs, including to the face. The facial symptoms can be relieved by walking, massage or medication. It is important to be aware of unusual extension of symptoms either as progression of the disease or as manifestation of augmentation.

  7. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults : a randomised trial

    NARCIS (Netherlands)

    Hallegraeff, Joannes M.; van der Schans, Cees P.; de Ruiter, Renee; de Greef, Mathieu H. G.

    Question: In adults who experience nocturnal leg cramps, does stretching of the calf and hamstring muscles each day just before sleep reduce the frequency and severity of the cramps? Design: A randomised trial with concealed allocation and intention-to-treat analysis. Participants: Eighty adults

  8. Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial

    NARCIS (Netherlands)

    dr. M.H. de Greef; Dr. C.P. van der Schans; R. de Ruiter; J.M. Hallegraeff

    2012-01-01

    QUESTION: In adults who experience nocturnal leg cramps, does stretching of the calf and hamstring muscles each day just before sleep reduce the frequency and severity of the cramps? DESIGN: A randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Eighty adults

  9. Sleep problems and obstructive sleep apnea in children with down syndrome, an overwiew.

    Science.gov (United States)

    Maris, Mieke; Verhulst, Stijn; Wojciechowski, Marek; Van de Heyning, Paul; Boudewyns, An

    2016-03-01

    Children with Down syndrome (DS) have a high prevalence of sleep problems, including behavioural sleep disturbances and obstructive sleep apnea. Sleep problems are associated with a wide range of adverse health effects. Since children with DS are already known to have many comorbidities, they are particularly susceptible for the negative impact of sleep problems. Aim of this study is (1) to evaluate the prevalence of sleep problems in children with DS, (2) compare the prevalence of sleep problems in children with DS with a community sample of typical developing school-aged children, and (3) to correlate the existence of sleep problems in children with DS and OSA. Children enrolled at the multidisciplinary Down team of the University Hospital Antwerp and seen at the ENT department were eligible for this study. The prevalence of sleep problems was evaluated by the use of the Child Sleep Habits Questionnaire (CSHQ) and a full overnight polysomnography was performed to screen for obstructive sleep apnea. Parents of fifty-four children with DS, aged 7.5 years (5.4-11.6), completed the CSHQ and an overall prevalence of sleep problems was found in 74.1%. In 57.1% of the children OSA was diagnosed with a median obstructive apnea-hypopnea index (oAHI) 7.25/h (5.7-9.8). Overall sleep problems were not age-or gender related, however boys suffer more from daytime sleepiness. Symptoms of sleep disordered breathing correlate with parasomnias, a longer sleep duration and more daytime sleepiness. No correlation was found between sleep problems and underlying OSA. Children with Down syndrome have a significantly higher prevalence of sleep problems, compared to normal developing healthy school-aged children. We didn't find any correlation between the parental report of sleep problems and underlying OSA, or OSA severity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care

    Directory of Open Access Journals (Sweden)

    Monti Giorgio

    2011-02-01

    Full Text Available Abstract Background Restless legs syndrome (RLS is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. Methods The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG-sponsored task force consisting of experts and primary care practioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. Results The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. Conclusion The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here.

  11. Algorithms for the diagnosis and treatment of restless legs syndrome in primary care.

    Science.gov (United States)

    Garcia-Borreguero, Diego; Stillman, Paul; Benes, Heike; Buschmann, Heiner; Chaudhuri, K Ray; Gonzalez Rodríguez, Victor M; Högl, Birgit; Kohnen, Ralf; Monti, Giorgio Carlo; Stiasny-Kolster, Karin; Trenkwalder, Claudia; Williams, Anne-Marie; Zucconi, Marco

    2011-02-27

    Restless legs syndrome (RLS) is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored task force consisting of experts and primary care practitioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here.

  12. Sleep disturbances in Angelman syndrome: a questionnaire study.

    Science.gov (United States)

    Bruni, Oliviero; Ferri, Raffaele; D'Agostino, Gaetana; Miano, Silvia; Roccella, Michele; Elia, Maurizio

    2004-06-01

    Only few studies are available on sleep disorders in Angelman syndrome (AS), a neurodevelopmental disorder with several behavior disturbances. The aim of this study was to determine the prevalence of sleep disorders in a relatively large group of AS subjects, compared to that of age-matched controls. Forty-nine consecutive parents of patients with AS (26 males and 23 females aged 2.3-26.2 years) were interviewed and filled out a comprehensive sleep questionnaire. Based on their genetic etiology, four groups were defined: deletion of chromosome 15q11-13 (25 subjects); methylation imprinting mutation (six subjects), UBE3A mutations (seven subjects) and paternal uniparental disomy (five subjects). In the remaining cases genetic testings were negative. A significantly high frequency of disorders of initiating and maintaining sleep, prolonged sleep latency, prolonged wakefulness after sleep onset, high number of night awakenings and reduced total sleep time were found in our AS patients, as compared to age-matched controls. We also found other types of sleep disorders, never reported before, such as enuresis, bruxism, sleep terrors, somnambulism, nocturnal hyperkinesia, and snoring. No differences were found between the four genetic aetiology groups. Moreover, we did not find important improvement of sleep disturbances from pre-pubertal to post-pubertal ages. Our data confirm the significant presence of sleep/wake rhythms fragmentation, peculiar of AS, and also demonstrate the presence of several other types of sleep disturbances in this syndrome.

  13. Time structure of leg movement activity during sleep in attention-deficit/hyperactivity disorder and effects of levodopa.

    Science.gov (United States)

    Ferri, Raffaele; Bruni, Oliviero; Novelli, Luana; Picchietti, Matthew A; Picchietti, Daniel L

    2013-04-01

    To evaluate the leg movement (LM) time structure (periodicity and night distribution) during sleep in children with attention-deficit/hyperactivity disorder (ADHD) and their eventual changes after treatment with levodopa (L-DOPA). One group of ADHD patients (n=18) and another group of normal controls (n=17) were recruited; those with ADHD were randomized to L-DOPA or placebo therapy. At baseline (both groups) and after therapy (only patients) subjects underwent full-night polysomnography (PSG) and the leg motor pattern was evaluated with advanced tools of analysis particularly able to detect and describe LM time structure (periodicity and distribution). With respect to controls ADHD children showed prolonged sleep latency, increased number of stage shifts, awakenings, and percentage of sleep stage 1. Arousal index was higher in ADHD and also their PLMS index was slightly but considerably higher than controls; however, their periodicity was low and not different from controls. Only sleep latency was significantly reduced by L-DOPA treatment with all the other parameters (sleep scoring and LM activity) remaining substantially unmodified. LMs during sleep in children with ADHD do not show a highly periodic character and are not considerably modified by L-DOPA treatment; this finding has potential implications for drug treatment that might target the most prominent changes observed in our study including arousals and sleep structure disruption. Copyright © 2013 Elsevier B.V. All rights reserved.

  14. When gender matters: restless legs syndrome. Report of the "RLS and woman" workshop endorsed by the European RLS Study Group.

    Science.gov (United States)

    Manconi, Mauro; Ulfberg, Jan; Berger, Klaus; Ghorayeb, Imad; Wesström, Jan; Fulda, Stephany; Allen, Richard P; Pollmächer, Thomas

    2012-08-01

    Sleep is an essential human behavior that shows prominent gender differences. Disturbed sleep, in particular, is much more prevalent in females than males. Restless legs syndrome (RLS) as one cause of disturbed sleep was observed to be somewhat more common among women than men in Ekbom's 1945 seminal series of clinical cases with the disease. He, however, reported this gender difference mainly for those with more severe symptoms. Since then numerous studies have reported that women are affected by RLS about twice as often as males for mild as well as moderate to severe RLS. The present review focuses on RLS in females from the perspectives of both epidemiology and pathophysiology. RLS will generally become worse or might appear for the first time during pregnancy. Parity increases the risk of RLS later in life suggesting that pregnancy is a specific behavioral risk factor for developing RLS. Some evidence suggests that dysfunction in iron metabolism and high estrogen levels might contribute to RLS during pregnancy. But, menopause does not lower the incidence of RLS nor does hormone replacement therapy lead to an increase, suggesting a quite complex uncertain role of hormones in the pathophysiology of RLS. Therefore, further, preferably longitudinal studies are needed to unravel the factors causing RLS in women. These studies should include genetic, clinical and polysomnographic variables, as well as hormonal measures and variables assessing iron metabolism. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Defining the phenotype of restless legs syndrome/Willis-Ekbom disease (RLS/WED): a clinical and polysomnographic study.

    Science.gov (United States)

    Rinaldi, Fabrizio; Galbiati, Andrea; Marelli, Sara; Cusmai, Maria; Gasperi, Alessandro; Oldani, Alessandro; Zucconi, Marco; Padovani, Alessandro; Ferini Strambi, Luigi

    2016-02-01

    Clinical features variability between familial and sporadic restless legs syndrome/Willis-Ekbom disease (RLS/WED) has been previously reported. With this retrospective cohort study, we aimed to determine the clinical and polysomnographic characteristics of 400 RLS/WED patients. Patients with familial RLS/WED were significantly younger than sporadic RLS/WED, while clinical and polysomnographic characteristics were similar in both groups. No difference was found for the age-at-onset between idiopathic and secondary RLS/WED. Periodic limb movements (PLM) index and REM sleep time were higher in idiopathic RLS/WED. Time of onset of symptoms was in the evening or at bedtime in 28.04 and 37.80% of patients, respectively, while in 21.34% of patients onset was more than 1 h after sleep onset. Impulse control and compulsive behaviours (ICBs) were found in 13.29% patients on dopamine agonist therapy. Our analyses support the hypothesis that patients with a familial history of RLS/WED may have a genetic component. Nevertheless, the dichotomy between early and late onset disease seems to be less sharp than previously reported. A large proportion of RLS/WED patients can have atypical features, therefore making the diagnosis challenging. Some cases can be missed even when the patient refers to a sleep specialist, as revealed by the partial absence of daytime symptoms, the high comorbidity with insomnia and other sleep complaints and the high percentage of symptoms beginning after sleep onset. This draws attention on the importance of a careful evaluation of the patient, to recognize potentially treatable secondary forms of RLS/WED.

  16. Efficacy of an eight-week yoga intervention on symptoms of restless legs syndrome (RLS): a pilot study.

    Science.gov (United States)

    Innes, Kim E; Selfe, Terry Kit; Agarwal, Parul; Williams, Kimberly; Flack, Kathryn L

    2013-06-01

    Restless legs syndrome (RLS) is a common and highly burdensome sleep disorder. While relaxation therapies, including yoga, are often recommended for RLS management, rigorous supporting research is sparse. The goal of this preliminary study was to assess the effects of yoga on RLS symptoms and related outcomes in women with RLS. Participants were 13 nonsmoking women with moderate to severe RLS, who did not have diabetes, sleep apnea, or other serious concomitant chronic conditions, and who were not pregnant. The intervention was a gentle, 8-week Iyengar yoga program. Core outcomes assessed pre- and post-treatment were RLS symptoms and symptom severity (International RLS Scale [IRLS] and RLS ordinal scale), sleep quality (Medical Outcomes Study Sleep Scale), mood (Profile of Mood States), and perceived stress (Perceived Stress Scale). Participants also completed yoga logs and a brief exit questionnaire regarding their experience with the study. Ten (10) women, aged 32-66 years, completed the study. Participants attended an average 13.4±0.5 (of 16 possible) classes, and completed a mean of 4.1±0.3 (of 5 possible) homework sessions/week. At follow-up, participants demonstrated striking reductions in RLS symptoms and symptom severity, with symptoms decreasing to minimal/mild in all but 1 woman and no participant scoring in the severe range by week 8. Effect sizes (Cohen's d) were large: 1.6 for IRLS total, and 2.2 for RLS ordinal scale. IRLS scores declined significantly with increasing minutes of homework practice per session (r=0.70, p=0.025) and total homework minutes (r=0.64, pRLS symptoms and symptom severity, reducing perceived stress, and improving sleep and mood in women with RLS.

  17. Sternberg working memory performance following treatment with pramipexole in patients with moderate-to-severe restless legs syndrome.

    Science.gov (United States)

    Jung, Ki-Young; Kim, Sung Min; Song, Jin-Young; Lee, Byeong Uk; Lee, Chany; Lee, Sang Kun; Koo, Yong Seo; Cho, Yong Won; Choi, Jeong Woo; Kim, Kyung Hwan

    2015-06-01

    We recently reported that the P300 amplitude related to the Sternberg working memory (WM) task was significantly lower in drug-naïve severe restless legs syndrome (RLS) patients than controls. Here, we evaluated the effects of pramipexole on the Sternberg WM task performance by event-related potential (ERP) study. Thirteen drug-naïve RLS patients (52.0 ± 9.48 years) were enrolled in the study. Pramipexole was administered over a period of 12 weeks every night 1 h before bedtime. Two ERP studies were carried out: the first was performed just before giving the first dose of pramipexole and the second was conducted at 12-16 weeks after commencement of pramipexole administration. P300 amplitudes and reaction times were compared before and after treatment considering brain regions and memory load as within-subject factors. Clinical and sleep-related variables were correlated with P300 amplitude. After treatment with pramipexole, the International RLS Severity Scale (IRLS) score was significantly decreased. Sleep quality and depression were also significantly improved. Omission error was significantly reduced without significant change of commission error. Reaction time was significantly shortened, regardless of memory load size, following treatment with pramipexole. Parietal P300 amplitude was significantly increased after treatment with pramipexole for all memory load sizes. Increase of frontal P300 amplitude was significantly correlated with improvement of sleep duration, IRLS, Insomnia Severity Index, and Pittsburgh Sleep Quality Index score. Our study suggested that pramipexole improves WM performance in patients with RLS in addition to improving RLS symptoms, sleep disturbance, and depression. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Management of symptoms of Restless Legs Syndrome with use of a traction straight leg raise: a preliminary case series.

    Science.gov (United States)

    Dinkins, Eric M; Stevens-Lapsley, Jennifer

    2013-08-01

    Restless Legs Syndrome (RLS) is estimated to affect 5-15 percent of the U.S. population. There are few studies investigating non-pharmacological treatments for RLS, such as physical therapy and/or peripheral neural mobilization. The traction straight leg raise (tSLR) technique is one such mobilization that may affect central and peripheral neural pathways and reduce RLS symptoms. The purpose of this study is to determine the effects of a tSLR on the symptoms associated with RLS. A cohort of fifteen people was enrolled. Thirteen subjects (11 female) between the ages of 32-64 completed the study. Subjects completed two questionnaires to quantify their severity of RLS before treatment was initiated and at the final session. These measures included: the Restless Legs Syndrome Rating Scale (RLSRS) 0-40, an RLS Ordinal Scale, and a Global Rating of Change (GROC) assessments (-7, 0, +7). Patients were treated with tSLR bilaterally for four total visits on days 1, 3, 8, and 15. Results indicated an RLSRS pre-treatment average of 24.8 (severe) and post-treatment average of 9.2 (mild), representing a 63% improvement from baseline (p < 0.05). Ten of 13 subjects reported a GROC of +4 or higher at the final session, indicating at least a moderate improvement in patient status from baseline. Our results indicate that following a series of tSLR treatments symptoms were reduced in individuals with idiopathic RLS. A prospective, randomized controlled trial is necessary to evaluate the potential for a tSLR to effectively manage idiopathic RLS symptoms. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Hubungan Phantom Vibration Syndrome Terhadap Sleep Disorder dan Kondisi Stress

    Directory of Open Access Journals (Sweden)

    Ajeng Yeni Setianingrum

    2017-10-01

    Full Text Available Phantom vibration syndrome is a condition where a person would feel the sensation of vibration of a cell phone as if there were incoming notification but the fact is not. This research investigated the relationship between phantom vibration syndromes, sleep disorder and stress condition. Questionnaires were distributed to 120 participants with age range 18 to 23 years old. Data of participants showed that all of participants using a smart mobile phone and 24% of them have more than one cell phone. Time usage of cell phone is at least 1 hour. 23% of participants using a cell phone for social media activity, followed by 21% related to entertainment (music, video and games. The results showed a positive relationship between phantom vibration syndrome, sleep disorder and stress condition. Insomnia contributed a greater influence on stress condition. However, the phantom vibration syndrome is more directly affecting the sleep apnea compared to insomnia and stress condition. Therefore, the phantom vibration syndrome more affects stress condition indirectly, through sleep disorder (sleep apnea and insomnia. Consequently, phantom vibration syndrome has a strong relationship with stress condition at the time of the phantom vibration syndrome can cause sleep disorder.

  20. Sleep quality and the metabolic syndrome: the role of sleep duration and lifestyle.

    Science.gov (United States)

    Mesas, Arthur Eumann; Guallar-Castillón, Pilar; López-García, Esther; León-Muñoz, Luz María; Graciani, Auxiliadora; Banegas, José Ramón; Rodríguez-Artalejo, Fernando

    2014-03-01

    This study examined the association between sleep quality and the metabolic syndrome and whether if it is independent of sleep duration and if it can be explained by lifestyles linked to sleep quality. Cross-sectional study conducted from 2008 to 2010 with 10 342 individuals representative of the population aged ≥18 years in Spain. Poor sleep quality was ascertained through self-reported difficulty falling asleep, difficulty maintaining sleep and sleeping pill consumption. Metabolic syndrome was defined according to the recent harmonized definition. Analyses were conducted with logistic regression and adjusted for the main confounders. Difficulty falling asleep was associated with higher frequency of metabolic syndrome after adjustment for sociodemographic variables, lifestyle and diagnosed morbidity [odds ratio (OR) = 1.25; 95% confidence interval (CI) = 1.06-1.47]. The association was slightly attenuated after further adjusting for sleep duration (OR = 1.23; 95% CI = 1.04-1.46) and held after additional adjustment for energy intake, adherence to a Mediterranean dietary pattern, energy spent in physical activity and time watching TV (OR = 1.20; 95% CI = 1.01-1.42). No associations were found between metabolic syndrome and other sleep quality indicators. Difficulty falling asleep was associated with high blood pressure in the fully adjusted analyses (OR = 1.17; 95% CI = 1.00-1.37) but not with the rest of components of metabolic syndrome. Difficulty falling asleep is associated with metabolic syndrome and, in particular, with high blood pressure. This association is independent of sleep duration and is not due to lifestyles related to poor sleep. This finding should be replicated in prospective studies using objective sleep measures; also, the influence of antihypertensive and lipid-lowering drug treatment on this association should be further studied. Copyright © 2013 John Wiley & Sons, Ltd.

  1. Assessing the severity of sleep apnea syndrome based on ballistocardiogram.

    Directory of Open Access Journals (Sweden)

    Zhu Wang

    Full Text Available Sleep Apnea Syndrome (SAS is a common sleep-related breathing disorder, which affects about 4-7% males and 2-4% females all around the world. Different approaches have been adopted to diagnose SAS and measure its severity, including the gold standard Polysomnography (PSG in sleep study field as well as several alternative techniques such as single-channel ECG, pulse oximeter and so on. However, many shortcomings still limit their generalization in home environment. In this study, we aim to propose an efficient approach to automatically assess the severity of sleep apnea syndrome based on the ballistocardiogram (BCG signal, which is non-intrusive and suitable for in home environment.We develop an unobtrusive sleep monitoring system to capture the BCG signals, based on which we put forward a three-stage sleep apnea syndrome severity assessment framework, i.e., data preprocessing, sleep-related breathing events (SBEs detection, and sleep apnea syndrome severity evaluation. First, in the data preprocessing stage, to overcome the limits of BCG signals (e.g., low precision and reliability, we utilize wavelet decomposition to obtain the outline information of heartbeats, and apply a RR correction algorithm to handle missing or spurious RR intervals. Afterwards, in the event detection stage, we propose an automatic sleep-related breathing event detection algorithm named Physio_ICSS based on the iterative cumulative sums of squares (i.e., the ICSS algorithm, which is originally used to detect structural breakpoints in a time series. In particular, to efficiently detect sleep-related breathing events in the obtained time series of RR intervals, the proposed algorithm not only explores the practical factors of sleep-related breathing events (e.g., the limit of lasting duration and possible occurrence sleep stages but also overcomes the event segmentation issue (e.g., equal-length segmentation method might divide one sleep-related breathing event into

  2. [Depressive symptomatology and sleep apnea syndrome].

    Science.gov (United States)

    Pochat, M D; Ferber, C; Lemoine, P

    1993-01-01

    The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative

  3. Idiopathic Acute Isolated Lateral Compartment Syndrome of a Lower Leg: A Magnetic Resonance Imaging Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Dong Heon; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Lee, Han Bee [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Bae, Kyung Eun [Dept. of Radiology, Seoul Asan Hospital, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2013-01-15

    Acute compartment syndrome of the lower leg is usually associated with major trauma such as fracture, and most commonly occurs in the anterior or deep posterior compartments. Isolated lateral compartment syndrome is less typical and usually associated with minor trauma or exertion. There are a few reports of the acute compartment syndrome which develops without an obvious cause. However, there are few reports of idiopathic acute isolated lateral compartment syndrome, and there are no reports of the radiologic findings. This study presents a radiologic finding of idiopathic acute isolated lateral compartment of lower leg, which shows localized enlargement of the peroneal muscles with peripheral convex bowing and change of their signal intensity with fluid signal along the adjacent fascial planes on magnetic resonance imaging.

  4. Effects of edentulism in obstructive sleep apnea syndrome

    African Journals Online (AJOL)

    2014-11-29

    Nov 29, 2014 ... Objectives: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. Materials and Methods: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic. Department archives between the years of 2009 and ...

  5. Effects of edentulism in obstructive sleep apnea syndrome ...

    African Journals Online (AJOL)

    Objectives: The purpose of this study was to investigate the effects of edentulism in obstructive sleep apnea syndrome (OSAS) patients. Materials and Methods: The study patients' were selected from the Gaziantep University Sleep Clinic and Orthodontic Department archives between the years of 2009 and 2011.

  6. Obstructive Sleep Apnea Hypopnea Syndrome | Mbata | Annals of ...

    African Journals Online (AJOL)

    Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition which is on the increase in the past 50 years. It causes significant morbidity and mortality in both developed and developing nations of the world. To review the relevant literature on obstructive sleep apnea. Literature review was ...

  7. Obstructive Sleep Apnea Syndrome: Pathogenetic Aspects and Treatment

    NARCIS (Netherlands)

    H. Boot (Hendrik)

    2000-01-01

    textabstractAlmost twenty years ago obstmctive sleep apnea was considered to be a medical curiosity that was of little importance, and snoring was merely the subject of humor than one of serious investigation. Although the clinical manifestations of sleep apnea syndrome have been described as early

  8. Definition of obstructive sleep apnea-hypopnea syndrome (OSAHS

    Directory of Open Access Journals (Sweden)

    Karem Josefina Parejo-Gallardo

    2017-08-01

    Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is one of the most prevalent sleep disorders in the general population, and is associated with different biological alterations that can trigger important cognitive, metabolic and cardiovascular problems. This article aims at defining and providing the minimum diagnostic criteria, both clinical and polysomnographic, currently in use.

  9. Restless legs syndrome and post polio syndrome: a case-control study.

    Science.gov (United States)

    Romigi, A; Pierantozzi, M; Placidi, F; Evangelista, E; Albanese, M; Liguori, C; Nazzaro, M; Risina, B U; Simonelli, V; Izzi, F; Mercuri, N B; Desiato, M T

    2015-03-01

    The aim was to investigate the prevalence of restless legs syndrome (RLS), fatigue and daytime sleepiness in a large cohort of patients affected by post polio syndrome (PPS) and their impact on patient health-related quality of life (HRQoL) compared with healthy subjects. PPS patients were evaluated by means of the Stanford Sleepiness Scale and the Fatigue Severity Scale (FSS). The Short Form Health Survey (SF-36) questionnaire was utilized to assess HRQoL in PPS. RLS was diagnosed when standard criteria were met. Age and sex matched healthy controls were recruited amongst spouses or friends of PPS subjects. A total of 66 PPS patients and 80 healthy controls were enrolled in the study. A significantly higher prevalence of RLS (P < 0.0005; odds ratio 21.5; 95% confidence interval 8.17-57) was found in PPS patients (PPS/RLS+ 63.6%) than in healthy controls (7.5%). The FSS score was higher in PPS/RLS+ than in PPS/RLS- patients (P = 0.03). A significant decrease of SF-36 scores, including the physical function (P = 0.001), physical role (P = 0.0001) and bodily pain (P = 0.03) domains, was found in PPS/RLS+ versus PPS/RLS- patients. Finally, it was found that PPS/RLS+ showed a significant correlation between International Restless Legs Scale score and FSS (P < 0.0001), as well as between International Restless Legs Scale score and most of the SF-36 items (physical role P = 0.0018, general health P = 0.0009, vitality P = 0.0022, social functioning P = 0.002, role emotional P = 0.0019, and mental health P = 0.0003). Our findings demonstrate a high prevalence of RLS in PPS, and that RLS occurrence may significantly influence the HRQoL and fatigue of PPS patients. A hypothetical link between neuroanatomical and inflammatory mechanisms in RLS and PPS is suggested. © 2014 EAN.

  10. Evaluation of oral iron treatment in pediatric restless legs syndrome (RLS).

    Science.gov (United States)

    Mohri, Ikuko; Kato-Nishimura, Kumi; Kagitani-Shimono, Kuriko; Kimura-Ohba, Shihoko; Ozono, Keiichi; Tachibana, Naoko; Taniike, Masako

    2012-04-01

    We conducted a retrospective chart review of children with restless legs syndrome (RLS) to evaluate the efficacy of oral iron treatment, which was administered open-label during the course of clinical care. In addition, we provided detailed clinical information about RLS in this pediatric cohort. The study included 30 consecutive Japanese children with RLS who visited the Pediatric Sleep Clinic at Osaka University Hospital, and consisted of 17 boys and 13 girls, aged 2-14 years (mean ± SD, 6.5 ± 2.8). All-night polysomnography was performed in 18 patients and serum ferritin levels were measured in all the patients. After the diagnosis of RLS, iron was administered at doses between 1.6 and 7.8 mg/kg/day (3.2 ± 1.3). Serum ferritin was re-evaluated 3-6 months after iron treatment, or when RLS symptoms had disappeared. The patient age at onset of RLS symptoms ranged from six months to 13 years (4.3 ± 3.6). A positive family history was recognized in 19 children (63.3%). Serum ferritin levels before therapy were 9-62 ng/ml (26.6 ± 12.8) and oral iron supplementation was reported to be highly effective in 17 children, effective in 10, and ineffective in three. The serum ferritin level at follow-up was 23-182 ng/ml (83.5 ± 49.8). The onset of treatment effect was within approximately three months. Iron treatment could be effective in Japanese pediatric RLS. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Default mode network disturbances in restless legs syndrome/Willis-Ekbom disease.

    Science.gov (United States)

    Ku, Jeonghun; Lee, Yeong Seon; Chang, HyukWon; Earley, Christopher J; Allen, Richard P; Cho, Yong Won

    2016-07-01

    The unusual sensations of restless legs syndrome/Willis-Ekbom disease (RLS/WED) are induced by rest or a low arousal state with a circadian variation in the threshold for induction. It has been suggested that the emergence of RLS/WED symptoms relates to abnormal brain functions dealing with internally generated stimuli. The purpose of this study was to investigate the changes in the default mode network (DMN) in RLS/WED subjects. Sixteen drug-naïve, idiopathic, RLS/WED subjects, and 16 age-matched and gender-matched healthy subjects were scanned in an asymptomatic resting state. A comparison of the DMN was conducted between the two groups. Resting state functional magnetic resonance imaging (MRI), Korean versions of the International RLS scale, and other sleep questionnaires were used. The results showed reductions in the DMN connectivity in the left posterior cingulate cortex, the right orbito-frontal gyrus, the left precuneus, and the right subcallosal gyrus of the RLS/WED subjects. The DMN connectivity was increased in sensory-motor-associated circuits, which included the right superior parietal lobule, the right supplementary motor area, and the left thalamus. In addition, the connectivity between the DMN and thalamus was negatively correlated with that in the orbito-frontal gyrus and the subcallosal gyrus in the subjects. The results showed disturbances of the DMN in RLS/WED subjects that influence the thalamic relay sensory-motor-associated circuit. These findings may underscore the fact that RLS/WED subjects have disturbances in default mode network functions involving internal stimuli in the resting state. This may be related to compensatory changes to maintain resting. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Proposed dose equivalence between clonazepam and pramipexole in patients with restless legs syndrome.

    Science.gov (United States)

    Shinno, Hideto; Oka, Yasunori; Otsuki, Manabu; Tsuchiya, Satoshi; Mizuno, Soichi; Kawada, Seiichi; Innami, Toshihiko; Sasaki, Akira; Hineno, Takashi; Sakamoto, Tetsuro; Inami, Yasushi; Nakamura, Yu; Horiguchi, Jun

    2010-04-16

    Dopamine agonists are accepted as the first-line medications for restless legs syndrome (RLS). In some Asian countries, clonazepam is one of the prevalent medications for RLS because of its effect on sleep disturbances. To date, there have not been any studies that examined equivalent doses of pramipexole and clonazepam. To evaluate equivalent doses of pramipexole and clonazepam in RLS, we investigated the efficacy and tolerability after conversion from clonazepam to pramipexole, and examined dose equivalence between the two prescriptions. In a prospective, open-label, multicenter study, 26 RLS patients treated with clonazepam (mean age: 69.2+/-11.0years old) were enrolled and then rapidly switched to pramipexole using a conversion calculation of 4:1 for daily doses. Then the daily dose of pramipexole was up titrated or tapered by 0.125mg/day at each subsequent examination. RLS symptoms and daytime somnolence were evaluated using the International RLS Study Group rating scale (IRLS), Clinical Global Impressions - Severity of illness (CGI-S) and the Epworth Sleepiness Scale (ESS), respectively. Conversion from clonazepam to pramipexole resulted in significant reductions of IRLS (16.3+/-8.7 to 9.1+/-6.3) and ESS (6.5+/-4.2 to 4.4+/-3.2). CGI scores demonstrated improvement after conversion. In 4 patients (15%), adverse events such as somnolence, sensation of oppression in the lower limbs, diarrhea, or nausea were present. Correlation analysis demonstrated a significant relationship between these daily doses. Spearman's correlation coefficient was 0.662. Our study, however, has some limitations since it is an open-label trial and includes only 26 patients. Further studies using a double-blind design or a crossover design are recommended. Statistical analysis demonstrated a 4:1 conversion for clonazepam to pramipexole. When switchover from clonazepam to pramipexole is done, this conversion ratio may be helpful to determine the initial dose of pramipexole for treating

  13. Outcome of sleepiness and fatigue scores in obstructive sleep apnea syndrome patients with and without restless legs syndrome after nasal CPAP Evolução dos índices de sonolência e fadiga em pacientes com síndrome da apnéia obstrutiva do sono portadores ou não de associação com síndrome das pernas inquietas após CPAP nasal

    Directory of Open Access Journals (Sweden)

    Raimundo Nonato Delgado Rodrigues

    2007-03-01

    Full Text Available BACKGROUND & PURPOSE: The association of obstructive sleep apnea syndrome (OSAS and restless legs syndrome (RLS has been reported in the literature for many years. Both conditions may be responsible for fatigue and somnolence complaints secondary to nocturnal sleep disruption. The primary concern of this study is to evaluate the outcome of fatigue and daytime sleepiness symptoms at baseline and after continuous positive air pressure (CPAP treatment in OSAS patients with and without RLS. METHOD: A prospective and comparative study between a group of 13 patients with OSAS and a group of 17 patients with OSAS+RLS. Laboratory blood tests and polysomnography were performed at baseline. The Epworth Sleepiness Scale (ESS and the Pichot’s questionnaire of fatigue/depression (PIC were applied before and after 3 months of CPAP treatment. Results were compared. RESULTS: No significant differences were found on PSG and laboratory results at baseline. Both groups had similar ESS and PIC scores at baseline (p=0.73 and 0.08, respectively. After n-CPAP, OSAS+RLS patients showed higher ESS and PIC scores (p=0.017 and 0.03, respectively. CONCLUSIONS: Despite a favorable general response, n-CPAP seemed less effective in treating fatigue and sleepiness in the OSAS+RLS group.OBJETIVO: A associação síndrome de apnéia obstrutiva do sono / síndrome de pernas inquietas (SAOS-SPI tem sido mencionada na literatura há muito. Ambas podem ser responsáveis por queixas de fadiga e sonolência secundárias à fragmentação do sono noturno. O objetivo deste estudo é avaliar a evolução dos sintomas de fadiga e sonolência diurna excessiva antes e após o tratamento com pressão aérea positiva contínua (CPAP em pacientes portadores de SAOS, com e sem SPI. MÉTODO: Estudo prospectivo e comparativo entre um grupo de 13 pacientes com SAOS e um grupo de 17 com SAOS +SPI. Exames laboratoriais e polissonografia (PSG foram realizados no início do estudo. A escala de sonol

  14. Increased prevalence of restless legs syndrome in patients with Crohn’s disease

    NARCIS (Netherlands)

    Hoek, Patrick D.; Smits, Marcel G.; Roos, de N.M.; Rijsman, Roselyne M.; Witteman, B.J.M.

    2015-01-01

    OBJECTIVE:
    To determine (a) the incidence of restless legs syndrome (RLS) in patients with Crohn's disease (CD), (b) whether and how the occurrence and severity of RLS is related to severity of CD, and (c) how RLS influences the quality of life of CD patients.
    BASIC METHODS:
    We carried

  15. Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Alan Christmann Fröhlich

    2015-03-01

    Full Text Available The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

  16. PTPRD (protein tyrosine phosphatase receptor type delta) is associated with restless legs syndrome

    Czech Academy of Sciences Publication Activity Database

    Schormair, B.; Kemlink, D.; Roeske, D.; Eckstein, G.; Xiong, L.; Lichtner, P.; Ripke, S.; Trenkwalder, C.; Zimprich, A.; Stiasny-Kolster, K.; Oertel, W.; Bachmann, C. G.; Paulus, W.; Högl, B.; Frauscher, B.; Gschliesser, V.; Poewe, W.; Peglau, I.; Vodička, Pavel; Vávrová, J.; Šonka, K.; Nevšímalová, S.; Montplaisir, J.; Turecki, G.; Rouleau, G.; Gieger, Ch.; Illig, T.; Wichmann, H.E.; Holsboer, F.; Müller-Myhsok, B.; Meitinger, T.; Winkelmann, J.

    2008-01-01

    Roč. 40, č. 8 (2008), s. 946-948 ISSN 1061-4036 R&D Projects: GA MZd NR8563 Institutional research plan: CEZ:AV0Z50390703 Keywords : PTPRD * syndrom restless legs Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 30.259, year: 2008

  17. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome

    NARCIS (Netherlands)

    Eijsvogel, Michiel M.; Ubbink, Rinse; Dekker, Janita; Oppersma, Eline; de Jongh, Frans H.; van der Palen, Job; Brusse-Keizer, Marjolein G.

    2015-01-01

    Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. 29 patients were treated with the Sleep

  18. Sleep in individuals with Cri du Chat syndrome: a comparative study

    NARCIS (Netherlands)

    Maas, A.P.H.M.; Didden, H.C.M.; Korzilius, H.P.L.M.; Braam, W.J.; Smits, M.G.; Curfs, L.M.G.

    2009-01-01

    Background Sleep problems are common in individuals with intellectual disability. Little is known about sleep in children and adults with Cri du Chat syndrome (CDC). Method Sleep was investigated in 30 individuals with CDC using a sleep questionnaire. Sleep problems and sleep behaviours in

  19. Sleep in Individuals with Cri du Chat Syndrome: A Comparative Study

    Science.gov (United States)

    Maas, A. P. H. M.; Didden, R.; Korzilius, H.; Braam, W.; Smits, M. G.; Curfs, L. M. G.

    2009-01-01

    Background: Sleep problems are common in individuals with intellectual disability. Little is known about sleep in children and adults with Cri du Chat syndrome (CDC). Method: Sleep was investigated in 30 individuals with CDC using a sleep questionnaire. Sleep problems and sleep behaviours in individuals with CDC were compared with individuals with…

  20. [Relationship between sleep architecture and blood pressure dynamic change in patients with sleep apnea syndrome].

    Science.gov (United States)

    Zhu, Y Q; Long, Q; Wang, C; Shuai, X J; Chen, B; Kong, J; Wei, Y L

    2016-07-26

    To investigate sleep architecture and blood pressure dynamic change in patients with Sleep apnea syndrome by electrocardiogram-based cardiopulmonary coupling analysis system. Seventy-nine sleep disorder participants (PSQI≥8) were enrolled. Electrocardiogram-based cardiopulmonary coupling analysis device and ambulatory blood pressure monitoring were synchronously used to evaluate sleep architecture and blood pressure circadian rhythm. The patients were divided into SAS group (47 participants) and non-SAS group (32 participants) according to the Apnea Hypopnea Index (AHI) that calculated by CPC device. The data of sleep architecture and blood pressure variability were compared between two groups. Compared with non-SAS group, SAS group have less proportion of deep sleep, more proportion of light sleep, higher mean blood pressure in 24 hours and daytime, lower nocturnal blood pressure dipping, faster mean heart rate in night time (Pdream time (-0.6≤rApnea Syndrome. The severity of Sleep Apnea Syndrome has a positive correlation with the severity of abnormal sleep architecture and the degree of blood pressure elevation.

  1. Sleep in Angelman syndrome: A review of evidence.

    Science.gov (United States)

    Spruyt, Karen; Braam, Wiebe; Curfs, Leopold Mg

    2018-02-01

    Sleep problems are reported to be extremely prevalent in individuals with developmental disabilities. The consensus guidelines for Angelman syndrome (AS) consider abnormal sleep-wake cycles and diminished need for sleep as associated features. We report an integrative research review and a meta-analysis of studies with sleep as the primary aim of investigation in an AS sample. 14 studies met eligibility criteria with half of them being surveys. Thirteen of the 17 conceptually formed sleep disorder item-groups showed to be significant for individuals with AS. There is evidence that arousal during sleep, somnolence and possibly short sleep duration are the primary sleep problems in individuals with AS. According to the results of this review and meta-analyses, there is clear evidence for sleep problems in individuals with AS. Individual effect sizes remain overall small, but nevertheless findings suggest disorders of arousal and sleepiness to be distinctive. In light of these findings, other sleep complaints in individuals with AS should be carefully examined. Consistent standards for research on sleep in individuals with AS are critical for new lines of investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Sleep in the unresponsive wakefulness syndrome and minimally conscious state.

    Science.gov (United States)

    Cologan, Victor; Drouot, Xavier; Parapatics, Silvia; Delorme, Arnaud; Gruber, Georg; Moonen, Gustave; Laureys, Steven

    2013-03-01

    The goal of our study was to investigate different aspects of sleep, namely the sleep-wake cycle and sleep stages, in the vegetative state/unresponsive wakefulness syndrome (VS/UWS), and minimally conscious state (MCS). A 24-h polysomnography was performed in 20 patients who were in a UWS (n=10) or in a MCS (n=10) because of brain injury. The data were first tested for the presence of a sleep-wake cycle, and the observed sleep patterns were compared with standard scoring criteria. Sleep spindles, slow wave sleep, and rapid eye movement sleep were quantified and their clinical value was investigated. According to our results, an electrophysiological sleep-wake cycle was identified in five MCS and three VS/UWS patients. Sleep stages did not always match the standard scoring criteria, which therefore needed to be adapted. Sleep spindles were present more in patients who clinically improved within 6 months. Slow wave sleep was present in eight MCS and three VS/UWS patients but never in the ischemic etiology. Rapid eye movement sleep, and therefore dreaming that is a form of consciousness, was present in all MCS and three VS/UWS patients. In conclusion, the presence of alternating periods of eyes-open/eyes-closed cycles does not necessarily imply preserved electrophysiological sleep architecture in the UWS and MCS, contrary to previous definition. The investigation of sleep is a little studied yet simple and informative way to evaluate the integrity of residual brain function in patients with disorders of consciousness with possible clinical diagnostic and prognostic implications.

  3. Role of sleep endoscopy in obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Suzan Salama

    2013-07-01

    Conclusion: Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity.

  4. The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients

    Science.gov (United States)

    Shahgholian, Nahid; Jazi, Shahrzad Khojandi; Karimian, Jahangir; Valiani, Mahboubeh

    2016-01-01

    Background: Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. Materials and Methods: This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30–40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA), paired t-test, and least significant difference (LSD) post hoc test]. Results: There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P restless leg syndrome severity were significantly higher in reflexology and stretching exercises groups compared to the control group (P restless leg syndrome. These two methods of treatment are recommended to the patients. PMID:27186197

  5. Restless legs syndrome: a new entity of neuropathic pain? Treatment with prolonged release oxycodone/naloxone combination

    Directory of Open Access Journals (Sweden)

    Gemignani F

    2016-04-01

    Full Text Available Franco Gemignani,1 Andrea Melpignano,1,2 Giulia Milioli,1,2 Silvia Riccardi,1,2 Liborio Parrino1,2 1Neurology Unit, Department of Neurosciences, University of Parma, Parma, Italy; 2Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy Abstract: Restless legs syndrome (RLS is a disorder of sensorimotor integration characterized by an urge to move the legs when at rest, especially at night or in the evening, which is relieved by movement. Sensory symptoms may be prominent, often exhibiting features consistent with neuropathic pain. Iron deficiency and genetic factors are implicated in RLS causation in most patients. The pathogenetic model of impaired circadian dopaminergic modulation of sensorimotor integration circuitry at the spinal level is fitting with the co-occurrence of movement disorders, sensory symptoms, and sleep disruption in RLS. Accordingly, levodopa and dopamine agonists are effective for RLS symptoms, which compensate for the impaired descending control by diencephalo-spinal dopa(minergic pathway. Dopamine agonists are usually indicated as the first-line therapy, but their use in long-term treatment is often complicated by augmentation and impulse control disorder, thus alpha-2-delta ligands also are now considered the first line of treatment. It has been recognized that endogenous opioid system is also involved in the mechanisms generating RLS, possibly through an impaired modulation of pain pathways. Opioids can be considered as an alternative therapy, particularly in patients with augmentation and/or refractory to other treatments. Recently introduced prolonged-release oxycodone–naloxone was efficacious for short-term treatment of patients with severe RLS inadequately controlled with previous treatment. It will be important to assess whether opioids, as well as other drugs, are especially effective in definite RLS subtypes such as the painful phenotype. Keywords: small fiber neuropathy

  6. Movements Mimicking Myoclonus Associated with Spinal Cord Pathology: Is this a "Pure Motor Restless Legs Syndrome"?

    Directory of Open Access Journals (Sweden)

    William G. Ondo

    2012-05-01

    Full Text Available Background: The neuroanatomic substrate of restless legs syndrome (RLS is poorly understood, and the diagnosis is clinically made based upon subjective sensory symptoms, although a motor component is usually present. Case Report: We report two cases of elderly patients with spinal pathology who were referred by neurologists for myoclonus. Both had semi-rhythmic leg movements that partially improved while standing, but denied any urge to move. These movements improved dramatically with pramipexole, a dopamine agonist used for RLS. Discussion: We propose that this “myoclonus” is actually the isolated stereotypic motor component of RLS.

  7. Self-reported sleep disturbance and survival in myelodysplastic syndromes.

    Science.gov (United States)

    Luskin, Marlise R; Cronin, Angel M; Owens, Robert L; DeAngelo, Daniel J; Stone, Richard M; Wadleigh, Martha; Steensma, David P; Abel, Gregory A

    2017-05-01

    Neither the prevalence of sleep disturbance nor its association with fatigue and overall survival (OS) are well understood for patients with myelodysplastic syndromes (MDS). New patients at our institution (n = 251; 2006-2014) completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, which includes questions about sleep and fatigue. Fifty-three per cent reported at least 'a little' trouble sleeping. In multivariable models, anaemia and sleep disturbance were associated with fatigue (both P < 0·001). Additionally, in separate models, sleep disturbance (P = 0·002) and fatigue (P = 0·04) both predicted OS. Our data suggest that improving sleep quality may impact MDS-related fatigue and OS. © 2017 John Wiley & Sons Ltd.

  8. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing

    DEFF Research Database (Denmark)

    Jennum, P; Riha, R L

    2009-01-01

    Epidemiological studies have revealed a high prevalence of sleep-disordered breathing in the community (up to 20%). A subset of these patients has concurrent symptoms of excessive daytime sleepiness attributable to their nocturnal breathing disorder and is classified as having obstructive sleep....... In moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome, treatment with continuous positive airway pressure has been shown to be effective. Questions remain as to how to screen patients with sleep-disordered breathing. Should time-consuming diagnostic procedures with high sensitivity and specificity...... apnoea/hypopnoea syndrome (4-5% of the middle-aged population). There is strong evidence for an association of sleep apnoea with cardiovascular and cerebrovascular morbidity, as well as adverse public health consequences. Treatment and diagnosis have remained largely unchanged over the past 25 yrs...

  9. Impulse Control Disorders with the use of Dopaminergic Agents in Restless Legs Syndrome: a Case-Control Study

    Science.gov (United States)

    Cornelius, Jason R.; Tippmann-Peikert, Maja; Slocumb, Nancy L.; Frerichs, Courtney F.; Silber, Michael H.

    2010-01-01

    Study Objectives: To determine the frequency of impulse control disorders (ICDs) with the use of dopaminergic agents in restless legs syndrome (RLS). Design: Prospective case-control study using a screening questionnaire for ICDs, followed by phone interview to confirm diagnoses for those meeting preset scoring thresholds on the questionnaire. Setting: Academic, comprehensive sleep medicine center. Patients or Participants: (1) One hundred patients with RLS treated with dopaminergic agents, (2) 275 patients with obstructive sleep apnea (OSA) without RLS or exposure to dopaminergic agents; and (3) 52 patients with RLS who were never treated with dopaminergic agents. Subjects with parkinsonism were excluded. Interventions: Not applicable. Measurements and Results: Based on the questionnaire, frequencies of ICDs for the RLS treatment group were 10% compulsive shopping, 7% pathologic gambling, 23% compulsive eating, 8% hypersexuality, and 10% punding. These values were statistically significant when compared with control subjects with OSA for compulsive shopping and pathologic gambling. With additional information from the phone interview, adjusted frequencies for the RLS treatment group were 9% compulsive shopping, 5% pathologic gambling, 11% compulsive eating, 3% hypersexuality, 7% punding, and 17% any ICD. These values were statistically significant when compared with those of control subjects with OSA for compulsive shopping, pathologic gambling, punding, and any ICD, as well as for compulsive shopping when compared with control subjects with RLS who were not treated with dopaminergic agents. In the RLS treatment group, a statistically significant dose effect was found for pramipexole in those subjects confirmed to have ICDs by both the questionnaire and phone interview. Mean duration of treatment at ICD onset was 9.5 months. Conclusions: ICDs are common with the use of dopaminergic agents for treatment of RLS. Given the potentially devastating psychosocial

  10. Increased prevalence of nocturnal smoking in restless legs syndrome (RLS).

    Science.gov (United States)

    Provini, F; Antelmi, E; Vignatelli, L; Zaniboni, A; Naldi, G; Calandra-Buonaura, G; Vetrugno, R; Plazzi, G; Pizza, F; Montagna, P

    2010-02-01

    We investigated the prevalence of nocturnal smoking (NS) in patients with RLS. One hundred RLS patients living in Emilia-Romagna (Northern Italy) and 100 matched controls, randomly selected from the general population, underwent interviews for the presence of nocturnal smoking and for obsessive-compulsive traits, depression, excessive daytime sleepiness (EDS) and subjective sleep quality. NS was more prevalent in RLS patients than controls (lifetime prevalence: 12% vs. 2%, P=0.012). Patients with NS had more frequently Sleep-Related Eating Disorders (SRED) than patients without NS (83.3% vs. 26.1%, P=0.0002). Pathological and borderline Maudsley Obsessive-Compulsive Inventory (MOCI) values as well as pathological values at the Beck Depression Inventory (BDI) increased from controls to RLS patients without NS to RLS patients with NS (P=0.005 and P=0.01, respectively). We demonstrate an increased prevalence of NS in patients with RLS, in many cases associated with increased SRED. NS may be associated with psychopathological traits in RLS and may be relevant in the management of RLS patients. 2009 Elsevier B.V. All rights reserved.

  11. latrogenic chronic compartment syndrome of leg due to ruptured ...

    African Journals Online (AJOL)

    A 45 year old male complaining of chronic pain and swelling of his left calf with features suggestive of chronic compartment syndrome following therapeutic aspiration of a popliteal cyst has been presented. It is a rare type of presentation which has not been reported to the knowledge of the authors. Review of literature and

  12. Leg ulcers associated with Klinefelter’s syndrome: a case report and review of the literature

    OpenAIRE

    Shanmugam, Victoria K; Tsagaris, Katina C; Attinger, Christopher E

    2011-01-01

    We present the case of a young man with type II diabetes, stage III chronic kidney disease, hypertension, obstructive sleep apnea and diabetes who presented to the Georgetown University Hospital Center for Wound Healing with refractory lower extremity ulcers. Autoimmune work-up was negative. However, chromosome analysis showed a genetic variant of Klinefelter’s syndrome (48 XXYY). Lower extremity ulceration is a recognised complication of Klinefelter’s syndrome. The pathogenesis of ulcers in ...

  13. Management of common sleep disorders.

    Science.gov (United States)

    Ramar, Kannan; Olson, Eric J

    2013-08-15

    Sleep disorders are common and affect sleep quality and quantity, leading to increased morbidity. Patients with sleep disorders can be categorized as those who cannot sleep, those who will not sleep, those with excessive daytime sleepiness, and those with increased movements during sleep. Insomnia, defined as difficulty initiating or maintaining sleep that results in daytime impairment, is diagnosed using history findings and treated with cognitive behavior therapy, with or without sleep hypnotics. Restless legs syndrome is characterized by an urge to move the legs that worsens with rest, is relieved by movement, and often occurs in the evening or at night. Restless legs syndrome is treated based on the frequency of symptoms. Narcolepsy is characterized by excessive sleepiness, cataplexy, hypnagogic or hypnopompic hallucinations, and sleep paralysis. It is diagnosed using a sleep log or actigraphy, followed by overnight polysomnography and a multiple sleep latency test. Narcolepsy is treated with stimulants, such as modafinil; selective serotonin reuptake inhibitors; or gamma hydroxybutyric acid (sodium oxybate). Patients with snoring and witnessed apneas may have obstructive sleep apnea, which is diagnosed using overnight polysomnography. Continuous positive airway pressure is the most common and effective treatment for obstructive sleep apnea. Rapid eye movement sleep behavior disorder is characterized by increased muscle tone during rapid eye movement sleep, resulting in the patient acting out dreams with possible harmful consequences. It is diagnosed based on history and polysomnography findings, and treated with environmental safety measures and melatonin or clonazepam.

  14. Analysis of sleep characteristics in post-polio syndrome patients.

    Science.gov (United States)

    Silva, Tatiana Mesquita E; Moreira, Gustavo Antonio; Quadros, Abrahão Augusto Juviniano; Pradella-Hallinan, Márcia; Tufik, Sergio; Oliveira, Acary Souza Bulle

    2010-08-01

    The main post-polio syndrome (PPS) symptoms are new weakness, new atrophy, fatigue, pain and sleep disturbances. Polysomnography is the gold standard for sleep analysis. To analyze sleep patterns in PPS patients. Sixty patients (mean age 46.8+/-11.3 years) at the Federal University of São Paulo (UNIFESP/EPM) complaining of sleep disturbances were evaluated by means of polysomnography, performed at the Sleep Institute. Sleep efficiency was lower due to high sleep latency and arousal index. The apnea and hypopnea index (AHI) and the periodic limb movements (PLM) index were higher. Sleep architecture was also impaired. There were no abnormalities of oxygen saturation, carbon dioxide levels, respiratory rate or heart rate. New post-polio sleep disturbances were isolated symptoms. It appears that these symptoms were not due to post-polio features, but rather, that they were due to dysfunction of the surviving motor neurons in the brainstem. Abnormal dopamine production, which is responsible for many sleep-related breathing disorders and abnormal movements, may also have been implicated in the present findings.

  15. Restless legs syndrome secondary to pontine infarction: Clinical analysis of five cases

    Directory of Open Access Journals (Sweden)

    Hou-Zhen Tuo

    2017-09-01

    Full Text Available Objective: Pontine infarction is a common type of stroke in the cerebral deep structures, resulting from occlusion of small penetrating arteries, may manifest as hemi-paralysis, hemi-sensory deficit, ataxia, vertigo, and bulbar dysfunction, but patients presenting with restless legs syndrome (RLS are extremely rare. Herein, we reported five cases with RLS as a major manifestation of pontine infarction. Methods: Five cases of pontine infarction related RLS were collected from July 2013 to February 2016. The diagnosis of RLS was made according to criteria established by the International RLS Study Group (IRLSSG in 2003. Neurological functions were assessed according to the National Institutes of Health Stroke Scale (NIHSS and modified Rankin Scale (mRS. Severity of RLS was based on the International RLS Rating Scale (IRLS-RS. Sleep quality was assessed by Epworth Rating Scale (ERS, and individual emotional and psychological states were assessed by Hamilton Depression Scale (HDS and Hamilton Anxiety Scale (HAS. Results: The laboratory data at the onset including hemoglobin, serum concentration of homocysteine, blood urea nitrogen (BUN, creatinine, electrolytes, and thyroid hormones were normal. The electroencephalogram (EEG, lower-extremity somatosensory evoked potential (SEP, and nerve conduction velocity (NCV in four limbs were normal. The average period of follow-up was 34.60 ± 12.76 months. The MRI examination showed acute or subacute pontine infarction lesions, 3 cases in the rostral inner side, 1 case in the rostral lateral and inner side, and 1 case in rostral lateral side. The neurological deficits included weakness in 4 cases, contralateral sensory deficit in 1 case, and ataxia in 2 cases. All 5 patients presented with symptom of RLS at or soon after the onset of infarction and 4 patients experienced uncomfortable sensations in the paralyzed limbs contralateral to the ischemic lesion. Their neurological deficits improved significantly 2

  16. Long-Term Treatment of Restless Legs Syndrome (RLS): An Approach to Management of Worsening Symptoms, Loss of Efficacy, and Augmentation.

    Science.gov (United States)

    Mackie, Susan; Winkelman, John W

    2015-05-01

    Restless legs syndrome (RLS) is a common, frequently chronic, sensorimotor neurological disorder characterized by nocturnal leg dysesthesias and an irresistible urge to move the legs, usually resulting in sleep disturbance. Dopaminergic agonists, alpha-2-delta calcium-channel ligands, and opioids have all demonstrated efficacy to relieve symptoms of RLS and improve sleep. However, long-term treatment with dopamine agonists (the most commonly prescribed agents) is often characterized by worsening symptoms and loss of efficacy. A more worrisome complication of dopaminergic agents is augmentation, an iatrogenic worsening of RLS symptoms that can produce progressively more severe symptoms resulting in around-the-clock restlessness and near sleeplessness. Recent research has yielded consensus regarding a precise definition of augmentation and has contributed to improved knowledge regarding strategies for preventing this complication. When RLS symptoms worsen during the course of treatment, the clinician must consider the myriad of environmental, medical, pharmacologic, and psychiatric factors that can exacerbate RLS. In the absence of fully developed, evidence-based guidelines there remains uncertainty regarding the optimal management strategy if augmentation develops. However, we discuss several key principles based on the available published data and the authors' clinical experience. We also explore the recent increasing interest in alternative initial treatment strategies that avoid dopamine agonists and their associated complications altogether.

  17. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea.

    Science.gov (United States)

    de Godoy, Luciana Balester Mello; Luz, Gabriela Pontes; Palombini, Luciana Oliveira; E Silva, Luciana Oliveira; Hoshino, Wilson; Guimarães, Thaís Moura; Tufik, Sergio; Bittencourt, Lia; Togeiro, Sonia Maria

    2016-01-01

    To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS), mild Obstructive Sleep Apnea (OSA) and normal individuals. UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale-ESS-≥ 10) and/or fatigue (Modified Fatigue Impact Scale-MFIS-≥ 38) associated to Apnea/hypopnea index (AHI) ≤ 5 and Respiratory Disturbance Index (RDI) > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10) and/or fatigue (MFIS ≥ 38) associated to AHI ≥ 5 and ≤ 15 events/hour. "Control group" criteria were AHI sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in "control group"), adjusted for age, gender, body mass index (BMI) and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT) was performed five times (each two hours) from 8 a.m. to 4 p.m. UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire-FOSQ-and Pittsburgh Sleep Quality Index-PSQI: p sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.

  18. Prevalence of restless legs syndrome and associated factors in an otherwise healthy population

    DEFF Research Database (Denmark)

    Didriksen, Maria; Rigas, Andreas S; Allen, Richard P

    2017-01-01

    OBJECTIVE: Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by uncomfortable sensations in the legs. RLS often occurs as a comorbid condition. Besides an increased risk of iron deficiency, blood donors are considered to be generally healthy. Blood donors are ther......OBJECTIVE: Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by uncomfortable sensations in the legs. RLS often occurs as a comorbid condition. Besides an increased risk of iron deficiency, blood donors are considered to be generally healthy. Blood donors...... are therefore an ideal population for studying factors associated with RLS occurrence, herein the role of iron. It is suggested that RLS is linked to sex, age, low socioeconomic status, unhealthy lifestyle, and iron deficiency. The objective of this study is therefore to estimate the RLS prevalence and identify...... associated biological, sociodemographic, economic, and lifestyle factors in a population of blood donors. METHODS: A total of 13,448 blood donors enrolled in the Danish Blood Donor Study from May 2015 to May 2016. RLS cases were identified using the validated Cambridge-Hopkins RLS-questionnaire. Logistic...

  19. The relationship between shoulder impingement syndrome and sleep quality.

    Science.gov (United States)

    Tekeoglu, I; Ediz, L; Hiz, O; Toprak, M; Yazmalar, L; Karaaslan, G

    2013-02-01

    The aim of this study was to examine potential relationship between subjective sleep quality and degree of pain in patients with shoulder impingement syndrome (SIS). Fourty patients with shoulder impingement syndrome were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Shoulder Disability Questionnaire (SDQ). Forty three of age and sex matched healthy subjects were included in the control group. There was a significant difference between the patient and control groups in terms of all PSQI global scores and subdivisions (p shoulder pain was found obviously in patients with SIS. For this reason, patients with shoulder pain due to SIS may benefit from the pain killers and cognitive-behavioral interventions that specifically target sleep disturbances. Further studies which contain polysomnographic assessments, as well as determine psychologic status are still needed to put forth sleep quality in patients with SIS.  

  20. Computerized analysis of snoring in sleep apnea syndrome

    OpenAIRE

    Shiomi,Fabio Koiti; Pisa,Ivan Torres; Campos,Carlos José Reis de

    2011-01-01

    The International Classification of Sleep Disorders lists 90 disorders. Manifestations, such as snoring, are important signs in the diagnosis of the Obstructive Sleep Apnea Syndrome; they are also socially undesirable. OBJECTIVE: The aim of this paper was to present and evaluate a computerized tool that automatically identifies snoring and highlights the importance of establishing the duration of each snoring event in OSA patients. MATERIAL AND METHODS: The low-sampling (200 Hz) electrical si...

  1. Sleep Disturbances in Adolescents and Young Adults with Autism and Asperger Syndrome

    Science.gov (United States)

    Oyane, Nicolas M. F.; Bjorvatn, Bjorn

    2005-01-01

    Sleep problems are commonly reported in children with autistic disorders. Most studies are based on sleep questionnaires and sleep diaries, but polysomnographic and actigraphic data have also been used. In this study we investigated sleep in older individuals (aged 15-25 years) with autism and Asperger syndrome, using sleep questionnaires, sleep…

  2. Caregiver Reports of Sleep Problems on a Convenience Sample of Children with Fragile X Syndrome

    Science.gov (United States)

    Kronk, Rebecca; Dahl, Ronald; Noll, Robert

    2009-01-01

    Caregivers reported on sleep in a convenience sample of 90 children with fragile X syndrome utilizing a standardized assessment tool, the Children's Sleep Habits Questionnaire (CSHQ), and a 14-day sleep diary. CSHQ data indicated that 47% of participants had sleep problems at a level that suggested referral and further evaluation. Sleep diary data…

  3. Deficient Sleep in Mouse Models of Fragile X Syndrome

    Directory of Open Access Journals (Sweden)

    R. Michelle Saré

    2017-09-01

    Full Text Available In patients with fragile X syndrome (FXS, sleep problems are commonly observed but are not well characterized. In animal models of FXS (dfmr1 and Fmr1 knockout (KO/Fxr2 heterozygote circadian rhythmicity is affected, but sleep per se has not been examined. We used a home-cage monitoring system to assess total sleep time in both light and dark phases in Fmr1 KO mice at different developmental stages. Fmr1 KOs at P21 do not differ from controls, but genotype × phase interactions in both adult (P70 and P180 groups are statistically significant indicating that sleep in Fmr1 KOs is reduced selectively in the light phase compared to controls. Our results show the emergence of abnormal sleep in Fmr1 KOs during the later stages of brain maturation. Treatment of adult Fmr1 KO mice with a GABAB agonist, R-baclofen, did not restore sleep duration in the light phase. In adult (P70 Fmr1 KO/Fxr2 heterozygote animals, total sleep time was further reduced, once again in the light phase. Our data highlight the importance of the fragile X genes (Fmr1 and Fxr2 in sleep physiology and confirm the utility of these mouse models in enhancing our understanding of sleep disorders in FXS.

  4. Review of quality of life instruments for the restless legs syndrome/Willis-Ekbom Disease (RLS/WED): critique and recommendations.

    Science.gov (United States)

    Walters, Arthur S; Frauscher, Birgit; Allen, Richard; Benes, Heike; Chaudhuri, K Ray; Garcia-Borreguero, Diego; Lee, Hochang B; Picchietti, Daniel L; Trenkwalder, Claudia; Martinez-Martin, Pablo; Stebbins, Glenn T; Schrag, Anette

    2014-12-15

    Over the last decade therapeutic, pathogenetic, epidemiological and genetic research in restless legs syndrome/Willis-Ekbom Disease (RLS/WED) has required the development of specific quality of life scales and sleep scales. A Movement Disorder Society Task Force formally evaluated the quality of these scales. A literature search retrieved 5 quality of life instruments specific to RLS. As per MDS protocol, each scale was evaluated by 3 criteria which included (a) use in RLS, (b) use by research or clinical groups other than the group that developed the scale, and (c) formal validation and adequate clinimetric properties. Scales were categorized as "Recommended" when all 3 criteria were met, "Suggested" when used for RLS but only one of the other criteria was met, and "Listed" when used in RLS but there was absence of the other two criteria. Details regarding the development, use and clinimetric properties of each instrument are summarized along with the recommendations of the Task Force. The Restless Legs Syndrome Quality of Life Scale-Abetz (RLS-QOL-Abetz) is the only scale designated as Recommended for use in cross-sectional assessments and treatment-related changes in RLS quality of life. Daily diaries hold future promise for the evaluation of RLS symptoms without the need for retrospective recall. An important need is the development of pediatric RLS quality of life instruments. © 2014 American Academy of Sleep Medicine.

  5. The trajectories of sleep disturbances in Rett syndrome.

    Science.gov (United States)

    Wong, Kingsley; Leonard, Helen; Jacoby, Peter; Ellaway, Carolyn; Downs, Jenny

    2015-04-01

    Rett syndrome is a rare neurodevelopmental disorder usually affecting females, and is associated with a mutation in the MECP2 gene. Sleep problems occur commonly and we investigated the trajectories and influences of age, mutation and treatments. Data were collected at six time points over 12 years from 320 families registered with the Australian Rett Syndrome Database. Regression analysis was used to investigate relationships between sleep disturbances, age, mutation type and use of treatment, and latent class growth analysis was performed to identify sleep problem phenotypes and model the effect of mutation type. The age range of subjects was 2.0-35.8 years. The study showed that sleep problems occurred in more than 80% of individuals and the prevalence decreased with age. Night laughing and night screaming occurred in 77 and 49%, respectively, when younger. Those with a large deletion had a higher prevalence of night laughing, which often occurred frequently. Treatment was associated with a 1.7% reduction in risk of further sleep problems. High and low baseline prevalence groups were identified. Approximately three-quarters of girls and women with sleep disturbances were in the high baseline group and problems persisted into adulthood. Conversely, 57% with night laughing and 42% with night screaming in the high baseline group exhibited mild improvement over time. Mutation type was not found to be a significant predictor of group membership. In conclusion, the evolution of sleep problems differed between subgroups of girls and women with Rett syndrome, in part explained by age and genotype. Treatment was not associated with improvement in sleep problems. © 2014 European Sleep Research Society.

  6. Iron status and chronic kidney disease predict restless legs syndrome in an older hospital population.

    LENUS (Irish Health Repository)

    Quinn, Colin

    2011-03-01

    Iron deficiency is important in the pathogenesis of restless legs syndrome (RLS), and serum ferritin measurement, using a cutoff of 45-50ng\\/ml, is widely recommended as the optimal screening test for iron deficiency in RLS. Serum ferritin often increases with inflammation, and a higher cutoff may be better in those with acute and chronic inflammatory conditions, including those with chronic kidney disease (CKD).

  7. Restless Legs Syndrome in End Stage Renal Disease Patients on Haemodialysis

    OpenAIRE

    Haider, Irfan; Anees, Muhammad; Shahid, Syed Adnan Hussain

    2014-01-01

    Objective: This study was cross sectional survey conducted to find the prevalence of Restless legs syndrome (RLS) in end stage renal disease (ESRD) patients on haemodialysis (HD). Methods: Data were obtained from 250 patients on chronic maintenance HD. To assess the prevalence of RLS, Clinical diagnostic criteria for RLS was used which is established by the International RLS Study Group. Results: Total 250 patients were included in this study. 153 (61.2%) patients were male and 97 (38.8%) wer...

  8. Restless legs syndrome in Czech patients with multiple sclerosis: An epidemiological and genetic study

    Czech Academy of Sciences Publication Activity Database

    Vávrová, J.; Kemlink, D.; Šonka, K.; Havrdová, E.; Horáková, D.; Pardini, Barbara; Müller-Myhsok, B.; Winkelmann, J.

    2012-01-01

    Roč. 13, č. 7 (2012), s. 848-851 ISSN 1389-9457 R&D Projects: GA MZd NR8563 Grant - others:GA ČR(CZ) GD309/08/H079; GA MZd(CZ) NT12141 Institutional research plan: CEZ:AV0Z50390512 Keywords : Secondary restless legs syndrome * Multiple sclerosis * Genetic association study Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 3.487, year: 2012

  9. Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

    OpenAIRE

    Majid Malaki; Fakhr Sadat Mortazavi; Sussan Moazemi; Maryam Shoaran

    2012-01-01

    Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, ...

  10. Neurological implications of obstructive sleep apnea-hypopnea syndrome (OSAHS

    Directory of Open Access Journals (Sweden)

    Marco Venegas-Mariño

    2017-08-01

    Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is a pathology with frequent systemic repercussions. One of the most affected organs is the brain, as well as the central nervous system, thus becoming a cerebrovascular risk factor regardless of other factors. This syndrome may increase the frequency and severity of primary central nervous system diseases such as epilepsy and dementia syndromes. A cardinal symptom of OSAHS is headache, which has specific characteristics; in addition, different pathophysiological mechanisms involved in its development have been identified such as frequent micro-arousals from sleep, secondary daytime sleepiness, altered attention capacity, concentration, motor reaction, affection, among others. Together, these mechanisms affect other higher mental functions including judgment, reasoning or memory. Factors like hypoxemia, hypercapnia, increased heart rate and blood pressure, adrenaline secretion, noradrenaline or cortisol during sleep contribute to the endothelial alteration responsible for cerebrovascular disease.

  11. Restless legs syndrome in patients with sequelae of poliomyelitis.

    Science.gov (United States)

    Kumru, Hatice; Portell, Enric; Barrio, Manuela; Santamaria, Joan

    2014-10-01

    No studies have examined the association between RLS and the sequelae of poliomyelitis (PM). We studied the frequency and severity of RLS in a group of consecutive patients with the sequelae of poliomyelitis (PM) and the effect of treatment with dopaminergic drugs. A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on sex, age, age at onset, site affected by PM, disease duration of PM, and history of post-polio syndrome (pPS) was obtained in a cohort of 52 PM patients. The mean age was 55.9 ± 6.5 years; 39 patients had post-polio syndrome (75%). RLS was diagnosed in 21 (40.4%) patients. Sixteen of the 21 patients (76.2%) with RLS had pPS, which was similar to the non-RLS group (74.2% patients with pPS). RLS symptoms were very severe in 5 patients, severe in 13, moderate in 2 and mild in 1. Nineteen of the 21 patients with RLS had symptoms predominantly in the more affected lower limb (90% of patients). Sixteen patients received dopaminergic agonist treatment with a significant reduction in their scores on the RLS severity scale from 28.3 ± 4.7 to 6.9 ± 7.3 (p < 0.001). RLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Rating of daytime and nighttime symptoms in RLS: validation of the RLS-6 scale of restless legs syndrome/Willis-Ekbom disease.

    Science.gov (United States)

    Kohnen, Ralf; Martinez-Martin, Pablo; Benes, Heike; Trenkwalder, Claudia; Högl, Birgit; Dunkl, Elmar; Walters, Arthur S

    2016-04-01

    The International Restless Legs Scale (IRLS) is the most widely used of the scales rating the severity of restless legs syndrome/Willis-Ekbom disease (RLS/WED). It has been well validated and is the primary end point for most of the therapeutic and nontherapeutic studies of RLS/WED. It has excellent psychometric properties, although it does not capture the severity of RLS under a wide variety of circumstances and times of day. Moreover, the IRLS has a large placebo effect. The Restless Legs Syndrome-6 Scale (RLS-6), however, takes another potentially valuable approach. Six items are rated on a 0-10 scale from no symptoms at 0 to very severe at 10. In addition to questions on satisfaction with sleep and sleepiness, the scale rates the severity of RLS for the past week under four separate circumstances: while falling asleep, during the night, during the day while sitting or lying, and during the day when moving around. The purpose of the current study is to report the validation of the RLS-6 under baseline and therapeutic conditions. The RLS-6 seems to be an acceptable, reliable, precise, valid, and responsive instrument for the assessment of RLS severity in a specific and pragmatic manner. At present, we view the RLS-6 not as a replacement for the IRLS but as a supplement, as each scale provides information not captured by the other. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  13. Whole body and local cryotherapy in restless legs syndrome: A randomized, single-blind, controlled parallel group pilot study.

    Science.gov (United States)

    Happe, Svenja; Evers, Stefan; Thiedemann, Christian; Bunten, Sabine; Siegert, Rudolf

    2016-11-15

    Treatment of restless legs syndrome (RLS) is primarily based on drugs. Since many patients report improvement of symptoms due to cooling their legs, we examined the efficacy of cryotherapy in RLS. 35 patients (28 women, 60.9±12.5years) with idiopathic RLS and symptoms starting not later than 6pm were randomized into three groups: cold air chamber at -60°C (n=12); cold air chamber at -10°C (n=12); local cryotherapy at -17°C (n=11). After a two week baseline, the different therapies were applied three minutes daily at 6pm over two weeks, followed by a four week observation period. The patients completed several questionnaires regarding RLS symptoms, sleep, and quality of life on a weekly basis (IRLS, ESS), VAS and sleep/morning protocol were completed daily, MOSS/RLS-QLI were completed once in each period. Additionally, the PLM index was measured by a mobile device at the end of baseline, intervention, and follow-up. The IRLS score was chosen as primary efficacy parameter. At the end of follow-up, significant improvement of RLS symptoms and quality of life could be observed only in the -60°C group as compared to baseline (IRLS: p=0.009; RLS-QLI: p=0.006; ESS: p=0.020). Local cryotherapy led to improvement in quality of life (VAS4: p=0.028; RLS-QLI: p=0.014) and sleep quality (MOSS: p=0.020; MOSS2: p=0.022) but not in IRLS and ESS. In the -10°C group, the only significant effect was shortening of number of wake phases per night. Serious side-effects were not reported. Whole body cryotherapy at -60°C and, to a less extent, local cryotherapy seem to be a treatment option for RLS in addition to conventional pharmacological treatment. However, the exact mode of cryotherapy needs to be established. Copyright © 2016. Published by Elsevier B.V.

  14. Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis

    Directory of Open Access Journals (Sweden)

    Jose Carlos Pereira Jr.

    2010-01-01

    Full Text Available Data collected from medical literature indicate that dopaminergic agonists alleviate Restless Legs Syndrome symptoms while dopaminergic agonists antagonists aggravate them. Dopaminergic agonists is a physiological regulator of thyroid-stimulating hormone. Dopaminergic agonists infusion diminishes the levels of thyroid hormones, which have the ability to provoke restlessness, hyperkinetic states, tremors, and insomnia. Conditions associated with higher levels of thyroid hormones, such as pregnancy or hyperthyroidism, have a higher prevalence of Restless Legs Syndrome symptoms. Low iron levels can cause secondary Restless Legs Syndrome or aggravate symptoms of primary disease as well as diminish enzymatic activities that are involved in dopaminergic agonists production and the degradation of thyroid hormones. Moreover, as a result of low iron levels, dopaminergic agonists diminishes and thyroid hormones increase. Iron therapy improves Restless Legs Syndrome symptoms in iron deprived patients. Medical hypothesis. To discuss the theory that thyroid hormones, when not counterbalanced by dopaminergic agonists, may precipitate the signs and symptoms underpinning Restless Legs Syndrome. The main cause of Restless Legs Syndrome might be an imbalance between the dopaminergic agonists system and thyroid hormones.

  15. My Non-Restorative Sleep Syndrome

    Directory of Open Access Journals (Sweden)

    Chakravarthy Ambar

    2000-01-01

    Full Text Available Personal experience of systemic effects of late night sleep deprivation and non-restorative sleep-a common experience amongst doctors, has been described. Results of some simple self-experimentations have been mentioned to highlight the possible pathogenetic mechanisms.

  16. Exploration of Differences in Types of Sleep Disturbance and Severity of Sleep Problems between Individuals with Cri du Chat Syndrome, Down's Syndrome, and Jacobsen Syndrome: A Case Control Study

    Science.gov (United States)

    Maas, Anneke P. H. M.; Didden, Robert; Korzilius, Hubert; Curfs, Leopold M. G.

    2012-01-01

    The prevalence of sleep problems in individuals with intellectual disability (ID) seems to vary between genetic syndromes associated with ID. Different types of sleep disturbances may indicate underlying causes of sleep problems and these types of sleep disturbances may vary between different genetic syndromes. We examined and compared five types…

  17. Relationship of symptoms with sleep-stage abnormalities in obstructive sleep apnea-hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Md Basunia

    2016-09-01

    Full Text Available Background: Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS present with a variety of sleep-related symptoms. In polysomnography, sleep architecture is almost always abnormal, but it is not known which of the sleep-stage abnormalities are related to symptoms. Finding key sleep-stage abnormality that cause symptoms may be of therapeutic importance to alleviate symptoms. So far the mainstay of treatment is continuous positive airway pressure (CPAP/bi-level positive airway pressure (BIPAP therapy, but many patients are non-compliant to it. Correcting the sleep-stage abnormality that cause symptoms by pharmacotherapy may become an important adjunct to CPAP/BIPAP therapy. Methods: A cross-sectional study. Adult subjects who attended a sleep laboratory for diagnostic polysomnography for a period of 1 month were recruited consecutively. OSAHS was diagnosed using American Academy of Sleep Medicine criteria. Subjects filled a questionnaire for symptoms prior to polysomnography. Results: Thirty subjects, of whom 83.3% were obese, met diagnostic criteria, with males constituting 46.7% and females constituting 53%. Mean age was 53.40±11.60 years. Sleep architecture comprised N1 19.50±19.00%, N2 53.93±13.39%, N3 3.90±19.50%, and rapid eye movement 8.92±6.21%. Excessive fatigue or sleepiness, waking up tired, falling asleep during the day, trouble paying attention, snoring and insomnia were significantly related to decreased N3 sleep. Conclusions: Most of the symptoms in OSAHS in adults are related to decreased stage N3 sleep. If confirmed by larger controlled studies, correcting N3 sleep deficiency by pharmacotherapy may become an important adjunct to CPAP/BIPAP therapy to alleviate symptoms.

  18. Sleep quality and facial pain in fibromyalgia syndrome.

    Science.gov (United States)

    Pimentel, Marcele Jardim; Gui, Maisa Soares; Reimão, Rubens; Rizzatti-Barbosa, Célia Marisa

    2015-04-01

    This study aims to evaluate the sleep conditions in fibromyalgia syndrome and the influence of the temporomandibular disorders (TMDs) and fibromyalgia association in self-reported sleep quality. Forty female patients with fibromyalgia (FMS) were compared with 40 healthy women [control group (CG)]. Three questionnaires were used (i.e. RDC/TMD to diagnose TMD and to determine pain intensity and disability and Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to assess sleep conditions). Statistical analyses were performed using the Wilcoxon-Mann-Whitney test to ordinal variables, Student's t-test to obtain the quantitative total scores of PSQI and chronic pain classification, Spearman's rho to determine the correlation between facial pain and quality sleep, and Fisher's exact test for other variables. A moderate correlation between facial pain intensity and low sleep quality was found (rho = 0·56; P0·05). Excessive daytime sleepiness was more prevalent in FMS (37·5%; PFibromyalgia patients experience intense facial pain in addition to poor sleep and high disabilities. TMD and FMS association do not appear to worsen this condition; however, facial pain intensity was correlated with low sleep quality.

  19. Academic Performance among Adolescents with Behaviorally Induced Insufficient Sleep Syndrome

    Science.gov (United States)

    Lee, Yu Jin; Park, Juhyun; Kim, Soohyun; Cho, Seong-Jin; Kim, Seog Ju

    2015-01-01

    Study Objectives: The present study investigated academic performance among adolescents with behaviorally induced insufficient sleep syndrome (BISS) and attempted to identify independent predictors of academic performance among BISS-related factors. Methods: A total of 51 students with BISS and 50 without BISS were recruited from high schools in South Korea based on self-reported weekday sleep durations, weekend oversleep, and the Epworth Sleepiness Scale (ESS). Participants reported their academic performance in the form of class quartile ranking. The Korean version of the Composite Scale (KtCS) for morningness/eveningness, the Beck Depression Inventory (BDI) for depression, and the Barratt Impulsiveness Scale-II (BIS-II) for impulsivity were administered. Results: Adolescents with BISS reported poorer academic performance than adolescents without BISS (p = 0.02). Adolescents with BISS also exhibited greater levels of eveningness (p academic performance among adolescents with BISS even after controlling for ESS, KtCS, BDI, and BIS-II (β = 0.42, p academic performance and that sleep debt, as represented by weekend oversleep, predicts poorer academic performance independent of depression, impulsiveness, weekday sleep duration, daytime sleepiness, and morningness/eveningness among adolescents with BISS. Citation: Lee YJ, Park J, Kim S, Cho SJ, Kim SJ. Academic performance among adolescents with behaviorally induced insufficient sleep syndrome. J Clin Sleep Med 2015;11(1):61–68. PMID:25515277

  20. Pathophysiology of obstructive sleep apnea-hypopnea syndrome (OSAHS

    Directory of Open Access Journals (Sweden)

    Marco Venegas-Mariño

    2017-08-01

    Full Text Available Obstructive sleep apnea-hypopnea syndrome (OSAHS is a disease characterized by recurrent upper airway obstruction (UAO, with decreased airflow, intermittent hypoxemia, and awakening during sleep. Two essential factors are related to the pathophysiology of OSAHS: anatomical alterations and reduction or absence of neural control. While studying OSAHS, the site or sites of obstruction of the UA should be identified; they may extend from the nasal wings to the hypopharynx. Another important factor in this syndrome is the nervous influence on muscle tone of the hypopharynx, as well as the changes in blood pH, which are secondary to micro-arousals. Body position and sleep stage determine the severity. The pathophysiology of OSAHS should be understood to properly study a patient and provide the best treatment option.

  1. Sleep apnea syndrome: experience of the pulmonology department ...

    African Journals Online (AJOL)

    Introduction Sleep apnea syndrome is a highly prevalent disorder that is still underdiagnosed and undertreated and whose obstructive form is the most common. The diagnosis is suspected on clinical signs collected by interrogation and questionnaires (Berlin questionnaire and Epworth sleepiness scale), then confirmed by ...

  2. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance.

    Science.gov (United States)

    Allen, Richard P; Picchietti, Daniel L; Garcia-Borreguero, Diego; Ondo, William G; Walters, Arthur S; Winkelman, John W; Zucconi, Marco; Ferri, Raffaele; Trenkwalder, Claudia; Lee, Hochang B

    2014-08-01

    In 2003, following a workshop at the National Institutes of Health, the International Restless Legs Syndrome Study Group (IRLSSG) developed updated diagnostic criteria for restless legs syndrome/Willis-Ekbom disease (RLS/WED). These criteria were integral to major advances in research, notably in epidemiology, biology, and treatment of RLS/WED. However, extensive review of accumulating literature based on the 2003 NIH/IRLSSG criteria led to efforts to improve the diagnostic criteria further. The clinical standards workshop, sponsored by the WED Foundation and IRLSSG in 2008, started a four-year process for updating the diagnostic criteria. That process included a rigorous review of research advances and input from clinical experts across multiple disciplines. After broad consensus was attained, the criteria were formally approved by the IRLSSG executive committee and membership. Major changes are: (i) addition of a fifth essential criterion, differential diagnosis, to improve specificity by requiring that RLS/WED symptoms not be confused with similar symptoms from other conditions; (ii) addition of a specifier to delineate clinically significant RLS/WED; (iii) addition of course specifiers to classify RLS/WED as chronic-persistent or intermittent; and (iv) merging of the pediatric with the adult diagnostic criteria. Also discussed are supportive features and clinical aspects that are important in the diagnostic evaluation. The IRLSSG consensus criteria for RLS/WED represent an international, interdisciplinary, and collaborative effort intended to improve clinical practice and promote further research. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  3. Psychiatric implications of obstructive sleep apnea-hypopnea syndrome (OSAHS

    Directory of Open Access Journals (Sweden)

    Franklin Escobar-Córdoba

    2017-08-01

    Full Text Available Sleep apnea is a syndrome that affects multiple systems and produces varied symptoms. This article reviews the most frequent psychiatric illnesses associated with this condition, as well as the need for an adequate diagnosis and an interdisciplinary treatment. The most common entity observed in patients with sleep apnea is depression, probably caused by sleep fragmentation, which alters the production of neurotransmitters in the brain. Anxiety is the second most common entity, perhaps, due to the release of catecholamines at night. Other symptoms associated with sleep apnea can be found, and should be reviewed and improved with appropriate treatment; addressing such symptoms could also improve the quality of life of patients, since attention, concentration and memory would increase or decrease irritability and other symptoms.

  4. Melatonin Effects in REM Sleep Behavior Disorder Associated with Obstructive Sleep Apnea Syndrome: A Case Series.

    Science.gov (United States)

    Schaefer, Carolin; Kunz, Dieter; Bes, Frederik

    2017-01-01

    REM sleep behavior disorder (RBD), with its main clinical symptoms of nightmares with dream-enacting behavior, is considered as a possible precursor of neurodegenerative disease. Obstructive Sleep Apnea Syndrome (OSAS) is known to be capable of provoking RBD-like symptoms by apneic event related arousals. The two sleep related pathologies must coincide in a relevant number of individuals because of overlapping prevalence in similar age groups. Until now RBD symptoms coexisting with OSAS are rarely described in scientific literature and in fact considered as OSAS mimicking RBD. We report four cases with a severe clinical RBD syndrome which were polysomnographically also diagnosed with concomitant OSAS (AHI range: 10.1 -53.2/h). Treatment with 2 mg prolonged release melatonin led to a relevant clinical improvement of RBD symptoms in all patients, so far untreated for the sleep related breathing disorder. Measure of REM sleep without atonia (RSWA) in polysomnography showed values ranging from 5.1 to 20.4% determined with the Montplaisir method. Surprisingly, RSWA values in PSG with melatonin were high, probably because of the still untreated OSAS. We presume that in patients with RBD and OSAS both pathologies contribute in varying degrees to the emergence of RBD symptoms by a destabilization of REM sleep. We suggest by consequence to consider a therapeutic strategy including the treatment of both disorders for an optimal therapeutic response. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  5. EVALUATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA - OVERLAP SYNDROME

    Directory of Open Access Journals (Sweden)

    Vaddadi Sailendra

    2016-09-01

    Full Text Available BACKGROUND The drop in oxygen saturation during sleep is more than during exercise and patients of COPD who spend more time in sleeping. Significant sleep desaturation and the sleep disturbances are greater in overlap syndrome than in OSA alone. The present study is conducted in Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, to find the prevalence of obstructive sleep apnoea in the patients with COPD. AIMS The present study was a cross-sectional study prospectively carried out with an aim to evaluate the breathing disorders during sleep in patients with COPD and to correlate these disorders with the stage of the disease. SETTINGS AND DESIGN The study Cohort was constituted by patients of COPD registered into Chest OPD or admitted in Indoor units of Gayathri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam, AP, India, from July 2014 to May 2016. A total of thirty six consecutive COPD patients who consented to be enrolled into the study were classified into Mild, Moderate and Severe stages based on the Indian Guidelines for the management of COPD. METHODS AND MATERIAL Spirometric evaluation and bronchial reversibility testing was conducted in all the patients. Arterial Blood Gas Analysis was done using ABL3 arterial blood gas analyser (Radiometer, Copenhagen. POLYSOMNOGRAPHY Patients were hooked to Compumedics ProFusion Polysomnographic Machine (Compumedics Private Limited 2001, USA, by standard gold cups/electrodes. Thereafter, the patients were subjected to a full night sleep study (Overnight polysomnography. The electrode and sensor connection system utilises E-series EEG/PSG system in order to record the PSG study. The impedance of electrodes was checked and set to <10. A total of 20 leads were utilised for the study. The various parameters monitored included Electroencephalogram (EEG, Electro-oculogram (EOG, Electrocardiogram (ECG, chin and leg Electromyogram (EMG

  6. Impulse control disorders with the use of dopaminergic agents in restless legs syndrome: a case-control study.

    Science.gov (United States)

    Cornelius, Jason R; Tippmann-Peikert, Maja; Slocumb, Nancy L; Frerichs, Courtney F; Silber, Michael H

    2010-01-01

    To determine the frequency of impulse control disorders (ICDs) with the use of dopaminergic agents in restless legs syndrome (RLS). Prospective case-control study using a screening questionnaire for ICDs, followed by phone interview to confirm diagnoses for those meeting preset scoring thresholds on the questionnaire. Academic, comprehensive sleep medicine center. (1) One hundred patients with RLS treated with dopaminergic agents, (2) 275 patients with obstructive sleep apnea (OSA) without RLS or exposure to dopaminergic agents; and (3) 52 patients with RLS who were never treated with dopaminergic agents. Subjects with parkinsonism were excluded. Not applicable. Based on the questionnaire, frequencies of ICDs for the RLS treatment group were 10% compulsive shopping, 7% pathologic gambling, 23% compulsive eating, 8% hypersexuality, and 10% punding. These values were statistically significant when compared with control subjects with OSA for compulsive shopping and pathologic gambling. With additional information from the phone interview, adjusted frequencies for the RLS treatment group were 9% compulsive shopping, 5% pathologic gambling, 11% compulsive eating, 3% hypersexuality, 7% punding, and 17% any ICD. These values were statistically significant when compared with those of control subjects with OSA for compulsive shopping, pathologic gambling, punding, and any ICD, as well as for compulsive shopping when compared with control subjects with RLS who were not treated with dopaminergic agents. In the RLS treatment group, a statistically significant dose effect was found for pramipexole in those subjects confirmed to have ICDs by both the questionnaire and phone interview. Mean duration of treatment at ICD onset was 9.5 months. ICDs are common with the use of dopaminergic agents for treatment of RLS. Given the potentially devastating psychosocial consequences of these behaviors, it is critical to actively screen for ICDs in this population.

  7. Review of diagnostic instruments for the restless legs syndrome/Willis-Ekbom Disease (RLS/WED): critique and recommendations.

    Science.gov (United States)

    Walters, Arthur S; Frauscher, Birgit; Allen, Richard; Benes, Heike; Chaudhuri, K Ray; Garcia-Borreguero, Diego; Lee, Hochang B; Picchietti, Daniel L; Trenkwalder, Claudia; Martinez-Martin, Pablo; Stebbins, Glenn T; Schrag, Anette

    2014-12-15

    Over the last decade, increased research on therapy, pathogenesis, epidemiological and genetic aspects of restless legs syndrome/Willis-Ekbom Disease (RLS/WED) has necessitated development of diagnostic instruments specific to RLS. The Movement Disorder Society commissioned a task force to formally evaluate the available evidence on diagnostic instruments in RLS. A literature search identified 4 instruments specific to RLS. Each instrument was evaluated by 3 criteria, which included (a) use in RLS, (b) use by groups other than the group that developed the instrument, and (c) formal validation and adequate clinimetric properties. Instruments were then qualified as "Recommended" when all 3 criteria were met, "Suggested" when used for RLS but only one of the other criteria are met, and "Listed" when used in RLS but there is absence of the other 2 criteria. Details regarding the development, use, and clinimetric properties of each instrument are summarized, along with the recommendations of the committee. The Recommended diagnostic instruments are the Hening Telephone Diagnostic Interview (HTDI), the Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq), and the RLS Diagnostic Index (RLS-DI). An unmet need is the development of a diagnostic instrument for pediatric RLS. Diagnostic instruments are particularly useful in studies where patients are not personally interviewed or examined in the office setting. © 2014 American Academy of Sleep Medicine.

  8. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome

    NARCIS (Netherlands)

    Eijsvogel, Michiel M.; Ubbink, Rinse; Dekker, Janita; Mos-Oppersma, Eline; de Jongh, Franciscus H.C.; van der Palen, Jacobus Adrianus Maria; Brusse-Keizer, Marjolein G.J.

    2015-01-01

    Study Objective Positional therapy (PT) is an effective therapy in positional obstructive sleep apnea syndrome (POSAS) when used, but the compliance of PT is low. The objective of this study was to investigate whether a new kind of PT is effective and can improve compliance. Methods 29 patients were

  9. Sleep in Individuals with Angelman Syndrome: Parent Perceptions of Patterns and Problems

    Science.gov (United States)

    Walz, Nicolay Chertkoff; Beebe, Dean; Byars, Kelly

    2005-01-01

    The diagnostic criteria for Angelman syndrome includes sleep disturbance as an associated characteristic. There are, however, few researchers who have examined sleep problems in this population. Our goal in this study was to better characterize the sleep patterns and problems in individuals with Angelman syndrome. Parents of 339 individuals…

  10. Cotton-wool spot in a patient with sleep apnea syndrome

    OpenAIRE

    Kitagawa, Kiyotaka; Hayasaka, Seiji; Nagaki, Yasunori

    2003-01-01

    A 55-year-old woman complained of visible floaters in the right eye. The patient had a cotton-wool spot in the right fundus and sleep apnea syndrome. After treatment with nasal continuous positive airway pressure during sleep, the cotton-wool spot disappeared. Sleep apnea syndrome should be added to the list of causes of cotton-wool spots.

  11. Links between Sleep and Daytime Behaviour Problems in Children with Down Syndrome

    Science.gov (United States)

    Esbensen, A. J.; Hoffman, E. K.; Beebe, D. W.; Byars, K. C.; Epstein, J.

    2018-01-01

    Background: In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and…

  12. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea.

    Directory of Open Access Journals (Sweden)

    Luciana Balester Mello de Godoy

    Full Text Available To compare sleep quality and sustained attention of patients with Upper Airway Resistance Syndrome (UARS, mild Obstructive Sleep Apnea (OSA and normal individuals.UARS criteria were presence of excessive daytime sleepiness (Epworth Sleepiness Scale-ESS-≥ 10 and/or fatigue (Modified Fatigue Impact Scale-MFIS-≥ 38 associated to Apnea/hypopnea index (AHI ≤ 5 and Respiratory Disturbance Index (RDI > 5 events/hour of sleep or more than 30% of total sleep time with flow limitation. Mild OSA was considered if the presence of excessive daytime sleepiness (ESS ≥ 10 and/or fatigue (MFIS ≥ 38 associated to AHI ≥ 5 and ≤ 15 events/hour. "Control group" criteria were AHI < 5 events/hour and RDI ≤ 5 events/hour and ESS ≤ 9, without any sleep, clinical, neurological or psychiatric disorder. 115 individuals (34 UARS and 47 mild OSA patients and 34 individuals in "control group", adjusted for age, gender, body mass index (BMI and schooling years, performed sleep questionnaires and sustained attention evaluation. Psychomotor Vigilance Task (PVT was performed five times (each two hours from 8 a.m. to 4 p.m.UARS patients had worse sleep quality (Functional Outcomes of Sleep Questionnaire-FOSQ-and Pittsburgh Sleep Quality Index-PSQI: p < 0.05 and more fatigue than mild OSA patients (p = 0.003 and scored significantly higher in both Beck inventories than "control group" (p < 0.02. UARS patients had more lapses early in the morning (in time 1 compared to the results in the afternoon (time 5 than mild OSA (p = 0.02. Mild OSA patients had more lapses in times 2 than in time 5 compared to "control group" (p = 0.04.UARS patients have a worse sleep quality, more fatigue and a worse early morning sustained attention compared to mild OSA. These last had a worse sustained attention than controls.

  13. Sleep Disturbances and Behavioural Problems in Adults with Prader-Willi Syndrome

    Science.gov (United States)

    Maas, A. P. H. M.; Sinnema, M.; Didden, R.; Maaskant, M. A.; Smits, M. G.; Schrander-Stumpel, C. T. R. M.; Curfs, L. M. G.

    2010-01-01

    Background: Individuals with Prader-Willi syndrome (PWS) are at risk of sleep disturbances, such as excessive daytime sleepiness (EDS) and sleep apnoea, and behavioural problems. Sleep disturbances and their relationship with other variables had not been researched extensively in adults with PWS. Method: Sleep disturbances and behavioural problems…

  14. Restless Legs Syndrome (RLS) and Parkinson's disease (PD)-related disorders or different entities?

    Science.gov (United States)

    Möller, Jens Carsten; Unger, Marcus; Stiasny-Kolster, Karin; Oertel, Wolfgang Hermann

    2010-02-15

    The relationship between Restless Legs Syndrome (RLS) and Parkinson's disease (PD) is still controversial. Most genetic, pathological, and imaging data argue against a close association of these two disorders. Still, many studies reported an increased prevalence of RLS in PD patients. These studies are difficult to interpret because the current diagnostic criteria for RLS have not been validated in PD patients. Although many PD patients suffer from motor restlessness due to parkinsonism and may thus mimic RLS, the risk for (secondary) RLS in PD patients is probably slightly increased. This review provides an overview of the current pertinent literature and discusses the possible association between RLS and PD.

  15. Dopaminergic treatment of restless legs syndrome in spinal cord injury patients with neuropathic pain.

    Science.gov (United States)

    Kumru, Hatice; Albu, Sergiu; Vidal, Joan; Barrio, Manuela; Santamaria, Joan

    2016-01-01

    Recent studies report high incidence of restless legs syndrome (RLS) in patients with spinal cord injury (SCI), who may also present pain and sensory disturbances. In the present manuscript, we examine and discuss diagnostic and treatment challenges of comorbid RLS and neuropathic pain (NP) in SCI. We evaluated seven men with a mean age of 55.6 (s.d.=14.0) years, with chronic complete or incomplete SCI at the thoracic or lumbar level, for complaints of sensory disturbances in the legs, which initially were attributed to drug-resistant NP. Because overlapped RLS was suspected, clinical evaluation of NP and RLS, serum ferritin and iron level assessment, and video polysomnographic (VPSG) studies were conducted. Pramipexole (0.18 mg q.d. -1 ) was added to treat RLS, and a follow-up was performed at 2 months. We found that in six subjects the RLS was comorbid with NP and in one subject the symptoms of RLS were misdiagnosed as NP. VPSG revealed periodic limb movements (PLMs) in all patients, including PLMs of the legs, arms or both. Serum ferritin was patients. RLS improved significantly after 2 months with pramipexole. On the basis of current findings, we recommend physicians to be aware of the comorbidity between RLS and NP secondary to SCI to include suitable diagnostic procedures and effective treatments.

  16. Neuroleptics as a cause of painful legs and moving toes syndrome.

    Science.gov (United States)

    Azzi, Jacques; Atweh, Samir; Saade, Nayef; Jabbour, Rosette

    2014-12-22

    Painful legs and moving toes syndrome is rare. It is predominantly diagnosed in middle-aged adults following a history of spinal cord surgery or trauma. The syndrome consists of abnormal repetitive movements, most commonly in the lower extremities, accompanied by pain in the affected limb. Pain usually precedes the movements. We report a case in a young patient that we believe was induced by the intake of a low-potency neuroleptic, which was prescribed to him for anxiety. The patient was treated with carbamazepine with mild relief of pain and later on with botulinum injection, which significantly reduced the movements and mildly improved the pain. After stopping the treatment, the beneficial effect lasted for about 3 months after which his condition gradually returned to its initial state. 2014 BMJ Publishing Group Ltd.

  17. [Differentiation of arousal in sleep before and after CPAP therapy in patients with pronounced sleep apnea syndrome].

    Science.gov (United States)

    Fietze, I; Warmuth, R; Waschke, K; Witt, C; Baumann, G

    1995-03-01

    The sleep apnea syndrome is often associated with the syndromes of daytime exhaustion and involuntary daytime sleeping fits. The cause is assumed to be fragmentary sleep resulting from night-time arousal. The central nervous activation reactions caused by apnea or hypopnea, respectively, and not the movement arousal determine the sleep structure. We have examined 10 male patients in the age range 40-55 years (48 +/- 6 SD) before and during the first 3 nights of CPAP therapy. Cardiorespiratory polysomnography was performed in all four nights. Sleep way analyzed visually and differentiation was made between respiratory (RA) and movement arousal (MA). All 10 patients had a pronounced sleep apnea syndrome. Deep and dream sleep were reduced, significantly more respiratory arousals occurred than movement arousals. The SWS latency was shortened in the first therapy night, the deep and dream sleep proportions increased and the RA decreased significantly. No further significant changes in the sleep parameters occurred during the second and third nights. We found that the number of apnea/hypopnea was not equal to the number of RA. When less arousal was recognized it was suggestive of a deficit of the diversion function while more RA was indicative of additional respiratory events, e.g. pharyngeal obstructions and hyperventilations which were not recognized as apnea or hypopnea. In addition to its role in the differential diagnosis of sleeping disorders, in particular sleep apnea, arousal differentiation is also an important criterion for estimating the efficiency of CPAP therapy.

  18. Prevalence and Clinical Characteristics of the Restless Legs Syndrome (RLS in Patients Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD in Antioquia

    Directory of Open Access Journals (Sweden)

    Ana Carolina Sierra Montoya

    2018-02-01

    Full Text Available Introduction: Attention Deficit Hyperactivity Disorder (ADHD is the most common behavioral issue for children. One of the sleeping disorders most frequently related to ADHD is the Restless Legs Syndrome (RLS, characterized by an irresistible urge to move the legs, something that is generally associated with paresthesias and motor restlessness. The prevalence rate of RLS in children diagnosed with ADHD is close to 18%, but in Colombia, these cases have been hardly studied. Objective: To determine the frequency of RLS, in children with ADHD. Methods: A cross-sectional study, filled out by parents of children diagnosed with ADHD, were analyzed. This questionnaire contained clinical criteria for classifying ADHD according to the DSM-IV, as well as diagnostic criteria for RLS by the National Institutes of Health (2003. Results: A predominance rate of 65.6% in combined ADHD was observed in children with RLS criteria. Upon carrying out an exploratory data analysis, it was found that having a family history of RLS and belonging to the middle or low socioeconomic strata are conditions associated with the presence of RLS in children with ADHD, with a significant p (p < 0.000 and a PR of 4.47 (3.16-6.32. Conclusions: The prevalence of RLS was similar to the findings of other clinical investigations. However, it highlights new prevalence values in relation to the comorbidity between ADHD and RLS, suggesting the need for new clinical and therapeutic alternatives amidst the presence of both syndromes.

  19. Intractable restless legs syndrome: role of prolonged-release oxycodone–naloxone

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    de Biase S

    2016-02-01

    Full Text Available Stefano de Biase,1 Mariarosaria Valente,1,2 Gian Luigi Gigli1,21Neurology Unit, Department of Experimental and Clinical Medical Sciences, University of Udine Medical School, 2Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, ItalyAbstract: Restless legs syndrome (RLS is a common neurological disorder characterized by an irresistible urge to move the legs accompanied by uncomfortable sensations that occur at night or at time of rest. Pharmacological therapy should be limited to patients who suffer from clinically relevant symptoms. Chronic RLS is usually treated with either a dopamine agonist (pramipexole, ropinirole, rotigotine or an α2δ calcium-channel ligand (gabapentin, gabapentin enacarbil, pregabalin. Augmentation is the main complication of long-term dopaminergic treatment, and frequently requires a reduction of current dopaminergic dose or a switch to nondopaminergic medications. Opioids as monotherapy or add-on treatment should be considered when alternative satisfactory regimens are unavailable and the severity of symptoms warrants it. In a recent Phase III trial, oxycodone–naloxone prolonged release (PR demonstrated a significant and sustained effect on patients with severe RLS inadequately controlled by previous treatments. The adverse-event profile was consistent with the safety profile of opioids. The most frequent adverse events were fatigue, constipation, nausea, headache, hyperhidrosis, somnolence, dry mouth, and pruritus. Adverse events were usually mild or moderate in intensity. No cases of augmentation were reported. Oxycodone–naloxone PR is approved for the second-line symptomatic treatment of adults with severe to very severe idiopathic RLS after failure of dopaminergic treatment. Further studies are needed to evaluate if oxycodone–naloxone PR is equally efficacious as a first-line treatment. Moreover, long-term comparative studies between opioids, dopaminergic drugs and α2

  20. Depressive symptoms and childhood sleep apnea syndrome

    OpenAIRE

    Carotenuto, M.; Esposito, M.; Parisi, L.; Gallai, B.; Marotta, R.; Pascotto, A.; Roccella, M.

    2012-01-01

    Marco Carotenuto,1 Maria Esposito,1 Lucia Parisi,2 Beatrice Gallai,3 Rosa Marotta,4 Antonio Pascotto,1 Michele Roccella21Sleep Clinic for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, Italy; 2Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy; 3Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, 4Department of Psychiatry, "Magna Graecia" University of Catan...

  1. Sleep apnea syndrome after irradiation of the neck

    International Nuclear Information System (INIS)

    Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T.

    1989-01-01

    After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema

  2. Sleep apnea syndrome after irradiation of the neck

    Energy Technology Data Exchange (ETDEWEB)

    Herlihy, J.P.; Whitlock, W.L.; Dietrich, R.A.; Shaw, T. (Pulmonary Disease Service, Presidio of San Francisco, CA (USA))

    1989-12-01

    After irradiation of the neck for a squamous cell carcinoma of the tonsillar pillar and vocal cord, a 71-year-old man presented with a rapidly progressive sleep apnea syndrome. Previous reports describe the condition of patients with obstructive sleep apnea that developed after neck irradiation and secondary to supraglottic edema. Our patient had an obstructive component to his apnea similar to that described in previous cases, but, in addition, he had hypothyroidism. Myxedema is a well-described cause of both obstructive and central apnea. We believe both contributed to his condition. He was successfully treated by placement of a tracheostomy and by thyroid supplementation. In patients who present with sleep apnea after neck irradiation, especially with acute or severe symptoms, the differential diagnosis should include both a central cause from hypothyroidism as well as a peripheral obstructive cause from laryngeal edema.

  3. Association between sleep duration and sleep quality, and metabolic syndrome in Taiwanese police officers

    Directory of Open Access Journals (Sweden)

    Jen-Hung Chang

    2015-12-01

    Full Text Available Objectives: This study’s objective was to examine association between sleep duration and sleep quality, and metabolic syndrome (MetS and its components in Taiwanese male police officers. Material and Methods: Male police officers who underwent annual health examinations were invited to join the study and eventually a total of 796 subjects was included in it. The study subjects were divided into 5 groups according to the length (duration of sleep: < 5, 5–5.9, 6–6.9, 7–7.9 and ≥ 8 h per day, and the global Pittsburgh Sleep Quality Index was used to categorize their sleep quality as good or poor. To analyze the association between sleep problems and MetS, adjusted odds ratio and respective 95% confidence intervals (CI were computed. Results: The prevalence of MetS in Taiwanese male police officers was 24.5%. Abdominal obesity had the highest proportion (36.2% among 5 components of MetS. More than 1/2 of the police officers (52.3% had poor sleep quality. Police officers with higher scores of sleep disturbances had a higher prevalence of MetS (p = 0.029 and abdominal obesity (p = 0.009. After adjusting for age, low-density lipoprotein cholesterol, smoking status, alcohol drinking habit, physical habitual exercise, snoring and type of shift work, the police officers who slept less than 5 h were 88% more likely to suffer from abdominal obesity than those who slept 7–7.9 h (95% CI: 1.01–3.5. Sleep quality was not associated with MetS and its components. Conclusions: The police officers who slept less than 5 h were more likely to experience abdominal obesity in Taiwan, and those with higher scores of sleep disturbances had a higher prevalence of MetS and abdominal obesity. It is recommended that police officers with short sleep duration or sleep disturbances be screened for MetS and waist circumference in order to prevent cardiovascular diseases.

  4. Compartment and Crush Syndromes After Sleep Deprivation and a Therapeutic Dose of Zolpidem

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    Martin R. Huecker

    2017-07-01

    Full Text Available Despite extensive review in the literature, compartment syndrome and crush syndrome remain difficult to diagnose. Trauma, toxins and reperfusion have been associated with these syndromes. Cases involving alcohol and drug abuse have described patients “found down” compressing an extremity. We present a case of a registered nurse who developed compartment syndrome in multiple limbs due to prolonged sleep after sleep deprivation and zolpidem use. To our knowledge, this is the first case of compartment syndrome or crush syndrome to have occurred in the setting of zolpidem use. Sleep disruption in healthcare workers represents a public health issue with dangerous sequelae, both acute and chronic.

  5. Targeted disruption of supraspinal motor circuitry reveals a distributed network underlying Restless Legs Syndrome (RLS)-like movements in the rat.

    Science.gov (United States)

    Guo, Chun-Ni; Yang, Wen-Jia; Zhan, Shi-Qin; Yang, Xi-Fei; Chen, Michael C; Fuller, Patrick M; Lu, Jun

    2017-08-29

    In this study we uncovered, through targeted ablation, a potential role for corticospinal, cerebello-rubro-spinal, and hypothalamic A11 dopaminergic systems in the development of restless legs syndrome (RLS)-like movements during sleep. Targeted lesions in select basal ganglia (BG) structures also revealed a major role for nigrostriatal dopamine, the striatum, and the external globus pallidus (GPe) in regulating RLS-like movements, in particular pallidocortical projections from the GPe to the motor cortex. We further showed that pramipexiole, a dopamine agonist used to treat human RLS, reduced RLS-like movements. Taken together, our data show that BG-cortico-spinal, cerebello-rubro-spinal and A11 descending projections all contribute to the suppression of motor activity during sleep and sleep-wake transitions, and that disruption of these circuit nodes produces RLS-like movements. Taken together with findings from recent genomic studies in humans, our findings provide additional support for the concept that the anatomic and genetic etiological bases of RLS are diverse.

  6. Medical treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS

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    Karem Parejo-Gallardo

    2017-08-01

    Full Text Available The treatment of the obstructive sleep apnea syndrome (OSAHS seeks to solve the signs and symptoms related to the disease, as well as to reduce the apnea-hypopnea index (AHI and the desaturations, to achieve a decrease of associated risks and comorbidities. However, this disease requires long-term treatment, with combined therapies developed by a multidisciplinary team. Medical treatment should be performed on all patients, even if additional therapies are necessary. In addition, this syndrome may be associated with other diseases that need specific treatment.

  7. A Case of Painless Legs and Moving Toes Syndrome in Parkinson’s Disease Responsive to Dopaminergic Therapy

    Directory of Open Access Journals (Sweden)

    Sumihiro Kawajiri

    2016-01-01

    Full Text Available Painless Legs and Moving Toes Syndrome (PoLMT is a rare movement disorder characterized by flexion, extension, abduction, adduction, and torsion of toes without pain. It is considered a variant of Painful Legs and Moving Toes Syndrome (PLMT, which is characterized by similar movements but with pain. Although neuropathy and several central nervous system (CNS involvements have been reported to be associated with PoLMT, the actual cause and mechanism remain unclear. Here we describe the first case of PoLMT in Parkinson’s Disease (PD, parallel to parkinsonism in severity, who demonstrated a good response to dopaminergic therapy.

  8. A Rare Cause of Obstructive Sleep Apnea Syndrome: Retropharyngeal Lipoma

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    Okan Dilek

    2017-01-01

    Full Text Available Lipoma is the most common benign mesenchymal neoplasm. About 16% of lipomas arise in the head and neck region, especially in the posterior neck. Large lipomas that originate from the retropharyngeal space may cause dyspnea, dysphagia, and snoring and occasionally may lead to obstructive sleep apnea syndrome (OSAS. Herein, we report a 45-year-old male patient with OSAS caused by a giant retropharyngeal lipoma with emphasis on CT findings.

  9. Evaluation of Cardiovascular Risk Factors and Restless Legs Syndrome in Women and Men: A Preliminary Population-Based Study in China.

    Science.gov (United States)

    Liu, Yuqiong; Liu, Gangqiong; Li, Ling; Yang, Jing; Ma, Shengli

    2018-03-15

    Many studies have investigated the association between restless legs syndrome (RLS) and cardiovascular risk factors, leading to conflicting results. Therefore, the aim of the current study was to determine whether RLS is associated with cardiovascular risk factors and disease. This cross-sectional study included 5,324 consecutive subjects who visited the Physical Examination Center of The First Affiliated Hospital of Zhengzhou University for their yearly routine physical examination. Participants underwent a face-to-face interview with a neurologist for the assessment of RLS, based on the International Restless Legs Study Group criteria. They also completed a questionnaire related to cardiovascular risk factors and other health-related and demographic information. Logistic regression was used to assess which of the demographic and cardiovascular risk factors increased the odds of RLS. Then, unadjusted and adjusted models were designed to determine whether RLS was associated with increased odds of cardiovascular disease, coronary artery disease, or hypertension. RLS was observed in 9.2% of the participants. Multivariable logistic regression models, which included the covariates age, sex, body mass index, smoking status, hypercholesterolemia, and Pittsburgh Sleep Quality Index score (dichotomized at 5), demonstrated that female sex (odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.99-2.95), smoking (OR: 1.96, 95% CI: 1.31-2.92), high cholesterol (OR: 1.30, 95% CI: 1.03-1.64), and PSQI score > 5 (OR: 5.61, 95% CI: 2.14-14.69) are significantly associated with RLS. Additionally, RLS was associated with hypertension, after adjusting for age, sex, body mass index, smoking, hypercholesterolemia, Pittsburgh Sleep Quality Index score > 5, diabetes, anemia, and decreased renal function. RLS is associated with the prevalence of hypertension but not with that of cardiovascular disease or coronary artery disease. © 2018 American Academy of Sleep Medicine.

  10. Sleep Dysfunction in Parkinson's Disease.

    Science.gov (United States)

    Falup-Pecurariu, Cristian; Diaconu, Ştefania

    2017-01-01

    The spectrum of sleep problems in Parkinson's disease (PD) is broad. These symptoms are recognized as being clinically relevant by the PD patients and may seriously affect their quality of life. Some studies reveal the occurrence of sleep disorders in more than half of the PD patients. The etiology is multifactorial and it mainly involves the degeneration of the sleep-regulating structures. Sleep disorders in PD can be classified into: disturbances of sleep and disturbances of wakefulness. Generic and specific scales were designed to help the screening and evaluation of sleep dysfunction. Further assessment can be done using sleep recording techniques, like actigraphy or polysomnography. All types of sleep disturbances may be encountered in PD: insomnia, excessive daytime sleepiness, rapid eye movement sleep behavior disorders, and restless legs syndrome. This chapter will focus on reviewing the main characteristics, pathophysiology, assessment, and management of the most frequent sleep disturbances encountered in PD. © 2017 Elsevier Inc. All rights reserved.

  11. Sleep in Epilepsy

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    Kurupth Radhakrishnan

    2014-03-01

    Full Text Available The relationship between sleep and epilepsy is bidirectional. While certain types ofseizures occur almost exclusively during sleep, sleep deprivation can precipitateseizures and can activate interictal epileptiform discharges (IEDs in theelectroencephalogram (EEG. While non-rapid eye movement sleep is an activator ofIEDs and seizures, rapid eye movement sleep suppresses them. Nocturnal seizuresneed to be distinguished from parasomnias. Epileptic seizures and IEDs result inchanges of sleep architecture, while antiepileptic drugs have variable effect on sleepand wakefulness. Nearly one-third of patients with epilepsy complain day timesomnolence. In addition to nocturnal seizures and antiepileptic drugs (AEDs,associated sleep disorders such as sleep apnoea and restless leg syndromes might beresponsible for daytime sleepiness in persons with epilepsy.

  12. Exploration of differences in types of sleep disturbance and severity of sleep problems between individuals with Cri du Chat syndrome, Down's syndrome, and Jacobsen syndrome: A case control study

    NARCIS (Netherlands)

    Maas, A.P.H.M.; Didden, H.C.M.; Korzilius, H.P.L.M.; Curfs, L.M.G.

    2012-01-01

    The prevalence of sleep problems in individuals with intellectual disability (ID) seems to vary between genetic syndromes associated with ID. Different types of sleep disturbances may indicate underlying causes of sleep problems and these types of sleep disturbances may vary between different

  13. Validation of the Multiple Suggested Immobilization Test: A Test for the Assessment of Severity of Restless Legs Syndrome (Willis-Ekbom Disease).

    Science.gov (United States)

    Garcia-Borreguero, Diego; Kohnen, Ralf; Boothby, Lindsay; Tzonova, Desislava; Larrosa, Oscar; Dunkl, Elmar

    2013-07-01

    To validate the Multiple Suggested Immobilization Test (m-SIT), a symptom-provocation test measuring restless legs syndrome (RLS) severity multiple times a day while the patient is awake and resting under controlled conditions. The m-SIT was designed to overcome some limitations in measuring RLS severity with rating scales. Patients completed two m-SITs on 2 consecutive days while on 24-h dopaminergic medication. After treatment discontinuation, they completed one more m-SIT 3 days later. Controls performed only one m-SIT. Sleep laboratory. Nineteen patients with RLS and 10 healthy controls. The original m-SIT consisted of seven modified 60-min SITs performed every 2 h between noon and midnight. During each SIT, the subject reclined quietly but could move his or her legs without restriction to alleviate symptoms. Every 10 min, periodic leg movements during wakefulness (PLMW) were evaluated and the m-SIT Disturbance Scale (m-SIT-DS; range 0-10) was completed. The m-SIT, composed of 6:00pm, 8:00pm, 10:00pm, and 12:00pm SITs, discriminated patients from controls (mean m-SIT-DS: 2.68 ± 2.35 versus 0.08 ± 0.26; mean PLMW/h, P = 0.0001) and between treatment groups (on medication versus taken off medication; mean m-SIT-DS, P = 0.0001; mean PLMW/h, P 0.4). The m-SIT is a valid and reliable test to evaluate RLS severity and treatment response, and could be useful in the future to confirm diagnosis and identify daytime symptoms. Although it was primarily designed for clinical trials, it might be useful in clinical settings because it provides a standardized testing condition to measure RLS symptoms. Garcia-Borreguero D; Kohnen R; Boothby L; Tzonova D; Larrosa O; Dunkl E. Validation of the Multiple Suggested Immobilization Test: a test for the assessment of severity of restless legs syndrome (Willis-Ekbom disease). SLEEP 2013;36(7):1101-1109.

  14. Academic performance among adolescents with behaviorally induced insufficient sleep syndrome.

    Science.gov (United States)

    Lee, Yu Jin; Park, Juhyun; Kim, Soohyun; Cho, Seong-Jin; Kim, Seog Ju

    2015-01-15

    The present study investigated academic performance among adolescents with behaviorally induced insufficient sleep syndrome (BISS) and attempted to identify independent predictors of academic performance among BISS-related factors. A total of 51 students with BISS and 50 without BISS were recruited from high schools in South Korea based on self-reported weekday sleep durations, weekend oversleep, and the Epworth Sleepiness Scale (ESS). Participants reported their academic performance in the form of class quartile ranking. The Korean version of the Composite Scale (KtCS) for morningness/eveningness, the Beck Depression Inventory (BDI) for depression, and the Barratt Impulsiveness Scale-II (BIS-II) for impulsivity were administered. Adolescents with BISS reported poorer academic performance than adolescents without BISS (p = 0.02). Adolescents with BISS also exhibited greater levels of eveningness (p academic performance among adolescents with BISS even after controlling for ESS, KtCS, BDI, and BIS-II (β = 0.42, p academic performance and that sleep debt, as represented by weekend oversleep, predicts poorer academic performance independent of depression, impulsiveness, weekday sleep duration, daytime sleepiness, and morningness/eveningness among adolescents with BISS. © 2015 American Academy of Sleep Medicine.

  15. Depressive symptoms and childhood sleep apnea syndrome

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    Carotenuto M

    2012-08-01

    Full Text Available Marco Carotenuto,1 Maria Esposito,1 Lucia Parisi,2 Beatrice Gallai,3 Rosa Marotta,4 Antonio Pascotto,1 Michele Roccella21Sleep Clinic for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Naples, Italy; 2Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy; 3Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, 4Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, ItalyBackground: The relationship between sleep and mood regulation is well known, and some reports suggest a key role of sleep-related breathing disorders (SRBD in the development of the symptomatology of depression, even if no conclusive data are actually found in the clinical literature. The aim of this study was to assess the relationship between SRBD and depressive symptoms in a population of school-aged children.Methods: The study population comprised 94 children affected by SRBD and 107 healthy children. To identify the severity of SRBD, an overnight respiratory evaluation was performed. All subjects filled out the Italian version of the Children Depression Inventory (CDI to screen for the presence of depressive symptoms.Results: The group with SRBD showed higher CDI scores than the group without SRBD, with a positive correlation found between CDI scores, apnea-hypopnea index, and oxygen desaturation index values. Logistic regression showed that an apnea-hypopnea index ≥ 3 and an oxygen desaturation index ≥ 1 could be risk factors for development of depressive symptoms. According to receiver-operating characteristic curve analysis, the cutoff point for the apnea-hypopnea index that could cause a pathological CDI score (≥19 was >5.66, and the cutoff point for the oxygen desaturation index was >4.2. The limitations of this study are that our data are derived from one single psychometric test and not from a complete psychiatric evaluation, and our

  16. Aerobic Exercise Improves Signs of Restless Leg Syndrome in End Stage Renal Disease Patients Suffering Chronic Hemodialysis

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    Mojgan Mortazavi

    2013-01-01

    Full Text Available Background. Restless leg syndrome (RLS is one of the prevalent complaints of patients with end stage renal diseases suffering chronic hemodialysis. Although there are some known pharmacological managements for this syndrome, the adverse effect of drugs causes a limitation for using them. In this randomized clinical trial we aimed to find a nonpharmacological way to improve signs of restless leg syndrome and patients’ quality of life. Material and Methods. Twenty-six patients were included in the study and divided into 2 groups of control and exercise. The exercise group used aerobic exercise during their hemodialysis for 16 weeks. The quality of life and severity of restless leg syndrome were assessed at the first week of study and final week. Data were analyzed using SPSS software. Results. The difference of means of RLS signs at the first week of study and final week was in exercise group and in control group. There was not any statistical difference between control group and exercise group in quality of life at the first week of study and final week. Conclusions. We suggest using aerobic exercise for improving signs of restless leg syndrome, but no evidence was found for its efficacy on patient’s quality of life.

  17. Sleep Disturbances in Individuals With Phelan-McDermid Syndrome: Correlation With Caregivers' Sleep Quality and Daytime Functioning.

    Science.gov (United States)

    Bro, Della; O'Hara, Ruth; Primeau, Michelle; Hanson-Kahn, Andrea; Hallmayer, Joachim; Bernstein, Jonathan A

    2017-02-01

    The aims of this study were to document sleep disturbances in individuals with Phelan-McDermid syndrome (PMS), to assess whether these individuals had been evaluated for sleep disorders, and to examine relationships between the sleep behavior of these individuals and the sleep behavior and daytime functioning of their caregivers. Participants were 193 caregivers of individuals with PMS recruited by the Phelan-McDermid Syndrome Foundation. Data were collected through a survey comprising 2 questionnaires: the Children's Sleep Habits Questionnaire (CSHQ) and the Parents' Sleep Habits Questionnaire. Data were analyzed using multiple linear regression analyses, Pearson correlation analyses, and independent-samples t-tests. Ninety percent of individuals with PMS showed evidence of marked sleep disturbance based on caregiver responses to the CSHQ. However, only 22% of individuals had undergone a formal sleep assessment. Reported increased sleep disturbance in individuals with PMS was a statistically significant predictor of reported increased sleep disturbance and daytime sleepiness in their caregivers. Sleep disturbance may be present in a substantial proportion of individuals with PMS and is negatively associated with caregivers' well-being. However, most individuals with PMS have not been evaluated for sleep disorders. When properly diagnosed, many sleep disorders can be alleviated with intervention. Thus, routine screening for and evaluation of sleep disturbances in individuals with PMS may have long-term positive impacts on the well-being of these individuals and their caregivers. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  18. Sleep disturbances in Parkinson's disease patients and management options

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    Claassen DO

    2011-12-01

    Full Text Available Daniel O Claassen, Scott J KutscherDepartment of Neurology, Vanderbilt University, Nashville, TN, USAAbstract: Sleep disturbances are among the most common nonmotor complaints of patients with Parkinson's disease (PD, and can have a great impact on quality of life. These disturbances manifest in a variety of ways; for instance, insomnia, sleep fragmentation, and excessive daytime sleepiness. Sleep-related movement disorders such as restless legs syndrome and periodic leg movements may share a common pathophysiology, and occurrence of rapid eye movement behavior disorder may predate the onset of PD or other synucleinopathies by several years. Medications for PD can have a significant impact on sleep, representing a great challenge to the treating physician. Awareness of the complex relationship between PD and sleep disorders, as well as the varied way in which sleep disturbances appear, is imperative for successful long-term management.Keywords: sleep disorders, insomnia, restless legs syndrome, Parkinson disease, fatigue, REM behavior disorder

  19. Papilledema in obstructive sleep apnea syndrome

    International Nuclear Information System (INIS)

    Gaayathri, N.; Kalthum, U.; Jemaima, C.H.

    2015-01-01

    We report a diagnostically challenging case of papilloedema in a morbidly obese, 25 year old male who presented to us with blurring of vision of both eyes, but more marked in the right. Fundus examination revealed severe papilloedema, with corresponding visual field and colour vision defects. He was worked up for possible life threatening causes of papilloedema like intracranial space occupying lesion but his CT scan was normal. As his hematocrit was in the polycythemic range, multiple venesections were performed in fear that the hyperviscosity picture could be a contributing factor. However there was no change in symptoms or the fundus appearance. We could not come to a diagnosis of idiopathic intracranial hypertension too because he refused lumbar puncture. A sleep study was done as he did give symptoms of mild obstructive sleep apnea but the results were that of severe disease. He was given therapeutic nocturnal oxygen by CPAP to prevent further cardiovascular and respiratory complications and interestingly enough it helped in treating the papilloedema. He was seen 2 months after commencement of continuous positive airway pressure (CPAP) with good functional and anatomical recovery. (author)

  20. Treatment of restless legs syndrome Tratamento da síndrome das pernas inquietas

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    Tiago Spolador

    2006-12-01

    Full Text Available OBJECTIVE: Restless legs syndrome is a neurological disorder characterized by a desire to move limbs, which is usually only present or worsens during rest or at night. The objective of this article was to review the available literature about pharmacological treatment for this disorder. METHOD: A search of recent literature was undertaken on online databases (Medline, Pubmed, Scielo and Lilacs. RESULTS: 502 articles were retrieved, of which 30 were selected. Dopaminergic agents, anticonvulsants, opioids, benzodiazepines, zolpidem, entacapone and ketamine were all effective on the restless legs syndrome treatment. One study showed that iron was not effective. CONCLUSIONS: Based on few double-blind, randomized, controlled trials, it seems that the best options to treat restless legs syndrome patients are gabapentin and L-dopa associated to its sustained release formulation.OBJETIVO: A síndrome das pernas inquietas é um transtorno neurológico caracterizado por um desejo incontrolável de mover os membros, que comumente está somente presente ou piora ao descanso ou à noite. O objetivo do trabalho foi a revisão da literatura disponível sobre o tratamento farmacológico para a síndrome das pernas inquietas. MÉTODO: Pesquisa da literatura recente realizada em bases de dados eletrônicas (Medline, Pubmed, Scielo e Lilacs. RESULTADOS: Quinhentos e dois artigos foram encontrados, dos quais 30 foram selecionados. Os agentes dopaminérgicos, os anticonvulsantes, os opióides, os benzodiazepínicos, o zolpidem, o entacapone e a ketamina foram eficazes no tratamento da síndrome das pernas inquietas. Um estudo mostrou que o ferro não foi eficaz. CONCLUSÕES: Baseado nos poucos estudos duplo-cegos, randomizados e controlados, parece que as melhores opções para tratar os pacientes com síndrome das pernas inquietas são a gabapentina e L-dopa associada à sua formulação de liberação lenta.

  1. Sleep microstructure dynamics and neurocognitive performance in obstructive sleep apnea syndrome patients.

    Science.gov (United States)

    Karimzadeh, Foroozan; Nami, Mohammad; Boostani, Reza

    2017-01-01

    The present study examined the relationship between the increment in cyclic alternating patterns (CAPs) in sleep electroencephalography and neurocognitive decline in obstructive Sleep Apnea Syndrome (OSAS) patients through source localization of the phase-A of CAPs. All-night polysomnographic recordings of 10 OSAS patients and 4 control subjects along with their cognitive profile using the Addenbrooke's Cognitive Examination (ACE) test were acquired. The neuropsychological assessment involved five key domains including attention and orientation, verbal fluency, memory, language and visuo-spatial skills. The standardized low-resolution brain electromagnetic tomography (sLORETA) tool was used to source-localize the phase-A of CAPs in sleep EEG aiming to investigate the correlation between CAP phase-A and cognitive functions. Our findings suggested a significant increase in CAP rates among OSAS subjects versus control subjects. Moreover, sLORETA revealed that CAP phase-A is mostly activated in frontoparietal cortices. As CAP rate increases, the activity of phase-A in such areas is dramatically enhanced leading to arousal instability, lower sleep efficiency and a possibly impaired cortical capacity to consolidate cognitive inputs in frontal and parietal areas during sleep. As such, cognitive domains including verbal fluency, memory and visuo-spatial skills which predominantly relate to frontoparietal areas tend to be affected. Based on our findings, CAP activity may possibly be considered as a predictor of cognitive decline among OSAS patients.

  2. The Main Symptoms in Dorsal Sleep Apnea - Hypopnea Syndrome

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    Mihaela Alexandra POP

    2014-09-01

    Full Text Available OSAHS is a chronic, multifactorial disease, accompanied by significant and complex symptoms. The aim of this study was to evaluate the relationship between OSAHS and dorsal AHI in order to improve early diagnosis of dorsal sleep apnea-hypopnea syndrome. There were significant statistical differences between: the dorsal AHI Mean of the group without excessive daytime sleepiness as opposed to the dorsal AHI Mean of the group with excessive daytime sleepiness; the dorsal AHI Mean of the group without snoring as opposed to the dorsal AHI Mean of the group with snoring; the dorsal AHI Mean of the group without restless sleep as opposed to the dorsal AHI Mean of the group with restless sleep; the dorsal AHI Mean of the group without dyspnea as opposed to the dorsal AHI Mean of the group with dyspnea; the dorsal AHI Mean of the group without night sweats as opposed to the dorsal AHI Mean of the group with night sweats; the dorsal AHI Mean of the group without irritability as opposed to the dorsal AHI Mean of the group with irritability and the dorsal AHI Mean of the group without nightmares as opposed to the dorsal AHI Mean of the group with nightmares. Through this study we highlighted that excessive daytime sleepiness and snoring are prevalent symptoms in dorsal OSAHS. The presence of these symptoms in patients with sleep disorders may improve early diagnosis and the choice of an appropriate treatment for dorsal sleep apnea- hypopnea syndrome, thus participating in improving the patient’s life quality

  3. Defining morphology of periodic leg movements in sleep: an evidence-based definition of a minimum window of sustained activity.

    Science.gov (United States)

    Skeba, Patrick; Fulda, Stephany; Hiranniramol, Kasidet; Earley, Christopher J; Allen, Richard P

    2016-12-01

    Current standard guidelines for scoring periodic leg movements (PLM) define the start and end of a movement but fail to explicitly specify the movement morphology necessary to classify an EMG event as a PLM, rather than some other muscle event. This is currently left to the expert visual scorer to determine. This study aimed to define this morphology to provide a consistent standard for visual scoring and to improve automatic periodic leg movements in sleep scoring. A review of expert PLM scoring produced a hypothesized morphology criterion: a window of high EMG activity within the movement lasting at least 0.5 s. Two diverse expert visual scorers were independently presented with images of EMG tracings from candidate leg movements (CLM) that either passed or failed this requirement (aka "full" or "empty" movements, respectively), and indicated whether each should be scored as CLM. The 0.5-s window was compared with alternatives of 0.25 and 0.75 windows. Expert scorers on average identified 94 % of "full" movements as CLM in contrast to only 8.5 % of "empty" movements. The proposed minimum window of 0.5 s also resulted in the highest agreement between visual scorers and between scorers and an automatic program. An added criterion requiring 0.5 s of high EMG activity within a valid CLM improves the accuracy of automatic scoring algorithms in relation to the gold standard of expert visual scorers. Our results suggest that this rule is an accurate representation of the morphology feature used by experts. This new rule has the potential to improve consistency and accuracy of visual and automatic scoring of PLM.

  4. Sleep disorders in cerebellar ataxias

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    José L. Pedroso

    2011-04-01

    Full Text Available Cerebellar ataxias comprise a wide range of etiologies leading to central nervous system-related motor and non-motor symptoms. Recently, a large body of evidence has demonstrated a high frequency of non-motor manifestations in cerebellar ataxias, specially in autosomal dominant spinocerebellar ataxias (SCA. Among these non-motor dysfunctions, sleep disorders have been recognized, although still under or even misdiagnosed. In this review, we highlight the main sleep disorders related to cerebellar ataxias focusing on REM sleep behavior disorder (RBD, restless legs syndrome (RLS, periodic limb movement in sleep (PLMS, excessive daytime sleepiness (EDS, insomnia and sleep apnea.

  5. Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy: Rate and risk factors in a retrospective study.

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    Masayoshi Takahashi

    Full Text Available To investigate the rate of and risk factors for restless legs syndrome (RLS augmentation in Japanese patients receiving pramipexole (PPX treatment. Records of 231 consecutive patients with idiopathic RLS who received PPX therapy for more than one month in a single sleep disorder center were analyzed retrospectively. Augmentation was diagnosed based on the Max Planck Institute criteria; associated factors were identified by logistic regression analysis. Mean age at PPX initiation was 60.6 ± 14.9 years and mean treatment duration was 48.5 ± 26.4 months. Augmentation was diagnosed in 21 patients (9.1%. Daily PPX dose and treatment duration were significantly associated with augmentation. By analyzing the receiver operating characteristic curve, a PPX dose of 0.375 mg/day was found to be the optimal cut-off value for predicting augmentation. After stratifying patients according to PPX treatment duration, at median treatment duration of 46 months, optimal cut-off values for daily doses were 0.375 and 0.500 mg/day for <46 months and ≥46 months of treatment, respectively. The RLS augmentation with PPX treatment in Japanese patients was occurred at rate of 9.1%, being quite compatible with previously reported rates in Caucasian patients. The symptom could appear within a relatively short period after starting the treatment in possibly vulnerable cases even with a smaller drug dose. Our results support the importance of keeping doses of PPX low throughout the RLS treatment course to prevent augmentation.

  6. Efficacy of Intravenous Iron Sucrose in Hemodialysis Patients with Restless Legs Syndrome (RLS): A Randomized, Placebo-Controlled Study.

    Science.gov (United States)

    Deng, Yinghui; Wu, Jinglin; Jia, Qiang

    2017-03-12

    BACKGROUND Restless legs syndrome (RLS) is a common disorder in hemodialysis (HD) patients that causes sleep disturbances and diminished quality of life. Because iron deficiency has been implicated in the pathogenesis of RLS, we sought to investigate the effects of intravenous (IV) iron sucrose on symptoms of RLS in HD patients. MATERIAL AND METHODS The study was a randomized, placebo-controlled study of 1000 mg iron sucrose versus normal saline as placebo. Patients were evaluated at baseline and 2 weeks after the last injection. The severity of RLS was assessed using the International RLS Study Group rating scale (IRLS). Blood samples were taken to measure iron parameters reflecting the iron status, including serum ferritin (SF) concentration, percentage transferrin saturation (TSAT%) and hemoglobin (Hb), and other biochemical parameters as safety assessments, including creatinine (Cr), urea, intact parathyroid hormone (iPTH), and the index of urea clearance (Kt/V). Adverse events were monitored in all subjects during the period of infusion. RESULTS After 2 weeks, IRLS scores decreased more in the IV-iron group (-7.38±2.03) than in the placebo group (-0.81±2.61) (P=0.000). Serum ferritin, TSAT, and hemoglobin increased more in the IV-iron group (227.63±77.64 µg/L; 26.06±7.77%; 13.98±3.62g/L, respectively) than in the placebo group (SF, p=0.000; TSAT, p=0.000; Hb, p=0.000, respectively). There were no significant differences between IV-iron and placebo groups in Cr, urea, iPTH, and Kt/V. No adverse effects were observed in the study. CONCLUSIONS IV iron sucrose is a safe and effective treatment for reducing RLS symptoms in HD patients over the short-term.

  7. Restless legs syndrome after high-risk TIA and minor stroke: association with reduced quality of life.

    Science.gov (United States)

    Boulos, Mark I; Wan, Anthony; Black, Sandra E; Lim, Andrew S; Swartz, Richard H; Murray, Brian J

    2017-09-01

    Restless legs syndrome (RLS) is a movement disorder that is associated with poor quality of life and depressive symptoms in the general population. Emerging evidence suggests that RLS is closely associated with cerebrovascular disease. We assessed the effect of RLS on quality of life after stroke and transient ischemic attack (TIA). In this single-center prospective study, we recruited patients within 14 days of high-risk TIA or minor stroke. Patients were diagnosed with RLS using a questionnaire based on the 2003 International RLS Study Group criteria, and diagnoses were confirmed by a sleep neurologist. Follow-up assessments were conducted within 2-6 months of recruitment. The outcome of quality of life was measured using the Stroke-specific Quality of Life (SS-QoL). Of the 94 patients recruited into the study, 23 (24.4%) were diagnosed with RLS: 11 were newly diagnosed with RLS and 12 had RLS preceding the index stroke/TIA. There were no significant differences in baseline characteristics between those with or without RLS. Median SS-QoL in patients with RLS was lower at baseline (p = 0.008) and at follow-up (p = 0.002). RLS patients had more depressive symptoms at follow-up (p = 0.007). Ordinal logistic regression demonstrated that RLS was negatively associated with quality of life at baseline (OR = 0.28; p = 0.010) and at follow-up (OR = 0.14; p = 0.029), independent of functional outcome and depressive symptoms. RLS is common after stroke or TIA and negatively affects the quality of life. Screening for RLS after cerebrovascular events may be warranted, and future research should assess whether treatment of RLS can improve post-stroke quality of life. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A mixed treatment comparison of gabapentin enacarbil, pramipexole, ropinirole and rotigotine in moderate-to-severe restless legs syndrome

    NARCIS (Netherlands)

    Sun, Ying; van Valkenhoef, Gert; Morel, Thomas

    2014-01-01

    Objective: A mixed treatment comparison (MTC) was performed to investigate the relative efficacy and safety of licensed pharmaceuticals for moderate-to-severe restless legs syndrome (RLS). Methods: RLS trials published over the past 10 years were identified via systematic literature searches of

  9. Sonographic abnormalities in idiopathic restless legs syndrome (RLS) and RLS in Parkinson's disease.

    Science.gov (United States)

    Ryu, Jung Ho; Lee, Myung Sik; Baik, Jong Sam

    2011-03-01

    We aimed to investigate and compare sonographic abnormalities in the substantia nigra (SN) in patients with idiopathic restless legs syndrome (iRLS), those with RLS and Parkinson's disease (RLS-PD), those with idiopathic Parkinson's disease (iPD), and healthy controls. Study participants totaled 60 patients with RLS (41 iRLS, 19 RLS-PD), 25 iPD patients, and 35 age-matched healthy controls. Comparing all groups, the SN region's echogenicity area in the iRLS patients was significantly decreased compared with that in the PD-RLS, iPD, and control groups (p RLS group demonstrated a significantly increased echogenicity area compared with the control group (p RLS-PD group's sonological results and clinical findings were different from those of the iRLS group. Copyright © 2010 Elsevier Ltd. All rights reserved.

  10. Achievements, challenges, and future perspectives of epidemiologic research in restless legs syndrome (RLS).

    Science.gov (United States)

    Picchietti, Daniel L; Van Den Eeden, Stephen K; Inoue, Yuichi; Berger, Klaus

    2017-03-01

    In the 20 years since the initial consensus on a common definition for restless legs syndrome (RLS), over 600 scientific reports on epidemiological aspects of RLS have been published. Most are descriptive and address important issues such as prevalence, familial patterns, comorbidities, and quality of life. While the establishment of prospective cohort studies and the use of secondary data sources are rather new to RLS research, both options significantly broaden the possibilities for analysis of disease risk factors. These two options, as well as the inclusion of a broader phenotyping of individual patients, have great potential to elucidate etiologic factors for RLS and expand knowledge about this common disorder. This article summarizes achievements in the area of RLS epidemiology, describes current challenges, and highlights future perspectives in the field. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Restless legs syndrome in Parkinson's disease: clinical characteristics and biochemical correlations

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    Tiago Machado Guerreiro

    2010-12-01

    Full Text Available Restless legs syndrome (RLS is a neurological disorder that responds to dopaminergic drugs, indicating a common pathophysiology with Parkinson's disease (PD. The prevalence of RLS was estimated in a group of PD patients and its clinical and biochemical characteristics were analysed. Forty-eight patients with PD were evaluated into two groups, with and without RLS. Clinical characteristics assessed in both groups were age, gender, duration of PD, Hoehn and Yahr, and Schwab and England scales. Laboratory variables such as hemoglobin, s-iron, s-ferritin and creatinine were obtained. The prevalence of RLS was 18.75%. No significant differences regarding clinical variables and biochemical parameters were observed. The high prevalence of RLS found in PD patients suggests the concept of a common etiological link and it seems that secondary causes did not play a central role in the pathophysiology of RLS in this group of parkinsonian patients.

  12. Restless Legs Syndrome/Willis-Ekbom Disease and Growing Pains in Children and Adolescents.

    Science.gov (United States)

    Simakajornboon, Narong; Dye, Thomas J; Walters, Arthur S

    2015-09-01

    Recent studies have shown that restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are common in pediatric population. The diagnostic criteria for Pediatric RLS have recently been updated to simplify and integrate with newly revised adult RLS criteria. Management of RLS and PLMD involves pharmacologic and nonpharmacologic interventions. Children with low iron storage are likely to benefit from iron therapy. Although, there is limited information on pharmacologic therapy, there are emerging literatures showing the effectiveness of dopaminergic medications in the management of RLS and PLMD in children. This article covers clinical evaluation of RLS and PLMD in children and the relationship with growing pains. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Differential Diagnoses of Restless Legs Syndrome/Willis-Ekbom Disease: Mimics and Comorbidities.

    Science.gov (United States)

    Chokroverty, Sudhansu

    2015-09-01

    Restless legs syndrome (RLS) mimics cannot always be differentiated from RLS/Willis-Ekbom disease (WED) based on 4 essential criteria; hence, a fifth criterion has recently been established. RLS comorbidities may provide us important clues for understanding the neurobiology of RLS/WED. Iron-dopamine connection, hypoxia pathway activation, and dopamine-opioid interaction are important pathophysiological mechanisms in RLS; this knowledge is derived from our understanding of RLS associations with a variety of medical, neurologic, and other conditions. Clinicians must formulate an RLS differential diagnosis based on history and physical examination, but laboratory tests may sometimes be needed to arrive at a correct diagnosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Importance of donor history of restless leg syndrome and pica to asses iron deficiency.

    Science.gov (United States)

    Singh, Ashutosh; Chaudhary, Rajendra; Sonker, Atul; Pandey, Hem Chandra

    2016-04-01

    Iron deficiency is associated with neuropsychological changes such as restless leg syndrome (RLS), pica, hair loss, etc. Our objective was to assess usefulness of history of RLS and pica in relation with iron stores in blood donors. During medical examination, apart from routine questionnaires specific history of RLS and pica was elicited. Along with hemoglobin markers of iron deficiency such as s. iron, s. ferritin and mean corpuscular volume were analyzed. Out of 400 blood donors 41 had h/o pica/RLS/pagophagia. Positive and negative predictive value of above history is 73.17% and 80.5% respectively. We recommend the use of a screening question for pica and/or RLS in blood donor questionnaire. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Deep Vein Thrombosis of the Left Leg: A Case of May-Thurner Syndrome

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    Jiten Desai

    2018-02-01

    Full Text Available A 56-year-old woman presented with gradually worsening shortness of breath associated with dull left leg pain over 5 days. She denied any recent travel, recent surgeries or immobilization. CT pulmonary angiography and CT venography revealed multiple bilateral pulmonary emboli and extensive left pelvic and left lower extremity deep vein thromboses. Contrast-enhanced CT showed that the right common iliac artery crossed the left common iliac vein and compressed it externally, indicative of May–Thurner syndrome. Catheter-directed thrombolysis of the left lower extremity was performed and heparin infusion was started. The patient also underwent left iliac vein balloon angioplasty with stenting and infra-renal inferior vena cava filter placement via the jugular approach to prevent further embolization.

  16. Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome.

    Science.gov (United States)

    Voon, Valerie; Schoerling, Andrea; Wenzel, Sascha; Ekanayake, Vindhya; Reiff, Julia; Trenkwalder, Claudia; Sixel-Döring, Friederike

    2011-09-28

    Low doses of dopamine agonists (DA) and levodopa are effective in the treatment of restless legs syndrome (RLS). A range of impulse control and compulsive behaviours (ICBs) have been reported following the use of DAs and levodopa in patients with Parkinson's disease. With this study we sought to assess the cross-sectional prevalence of impulse control behaviours (ICBs) in restless legs syndrome (RLS) and to determine factors associated with ICBs in a population cohort in Germany. Several questionnaires based on validated and previously used instruments for assessment of ICBs were mailed out to patients being treated for RLS. Final diagnoses of ICBs were based on stringent diagnostic criteria after psychiatric interviews were performed. 10/140 RLS patients of a clinical cohort (7.1%) were finally diagnosed with ICBs, 8 of 10 on dopamine agonist (DA) therapy, 2 of 10 on levodopa. 8 of the 10 affected patients showed more than one type of abnormal behaviour. Among those who responded to the questionnaires 6/140 [4.3%] revealed binge eating, 5/140 [3.6%] compulsive shopping, 3/140 [2.1%] pathological gambling, 3/140 [2.1%] punding, and 2/140 [1.4%] hypersexuality in psychiatric assessments. Among those who did not respond to questionnaires, 32 were randomly selected and interviewed: only 1 patient showed positive criteria of ICBs with compulsive shopping and binge eating. ICBs were associated with higher DA dose (p = 0.001), younger RLS onset (p = 0.04), history of experimental drug use (p = 0.002), female gender (p = 0.04) and a family history of gambling disorders (p = 0.02), which accounted for 52% of the risk variance. RLS patients treated with dopaminergic agents and dopamine agonists in particular, should be forewarned of potential side effects. A careful history of risk factors should be taken.

  17. Frequency of impulse control behaviours associated with dopaminergic therapy in restless legs syndrome

    Directory of Open Access Journals (Sweden)

    Reiff Julia

    2011-09-01

    Full Text Available Abstract Background Low doses of dopamine agonists (DA and levodopa are effective in the treatment of restless legs syndrome (RLS. A range of impulse control and compulsive behaviours (ICBs have been reported following the use of DAs and levodopa in patients with Parkinson's disease. With this study we sought to assess the cross-sectional prevalence of impulse control behaviours (ICBs in restless legs syndrome (RLS and to determine factors associated with ICBs in a population cohort in Germany. Methods Several questionnaires based on validated and previously used instruments for assessment of ICBs were mailed out to patients being treated for RLS. Final diagnoses of ICBs were based on stringent diagnostic criteria after psychiatric interviews were performed. Results 10/140 RLS patients of a clinical cohort (7.1% were finally diagnosed with ICBs, 8 of 10 on dopamine agonist (DA therapy, 2 of 10 on levodopa. 8 of the 10 affected patients showed more than one type of abnormal behaviour. Among those who responded to the questionnaires 6/140 [4.3%] revealed binge eating, 5/140 [3.6%] compulsive shopping, 3/140 [2.1%] pathological gambling, 3/140 [2.1%] punding, and 2/140 [1.4%] hypersexuality in psychiatric assessments. Among those who did not respond to questionnaires, 32 were randomly selected and interviewed: only 1 patient showed positive criteria of ICBs with compulsive shopping and binge eating. ICBs were associated with higher DA dose (p = 0.001, younger RLS onset (p = 0.04, history of experimental drug use (p = 0.002, female gender (p = 0.04 and a family history of gambling disorders (p = 0.02, which accounted for 52% of the risk variance. Conclusion RLS patients treated with dopaminergic agents and dopamine agonists in particular, should be forewarned of potential side effects. A careful history of risk factors should be taken.

  18. Obstructive sleep apnea syndrome and cognitive impairment: effects of CPAP

    Directory of Open Access Journals (Sweden)

    Alessandra Giordano

    2011-10-01

    Full Text Available Obstructive Sleep Apnea Syndrome (OSAS is a sleep disorder characterised by repetitive episodes of upper airway obstruction (apnea or reduced airflow (hypopnoea despite persistent respiratory effort. Apnea is defined as the cessation of breathing for at least 10 seconds during sleep, while hypopnoea is defined as at least 30% reduction in airflow for 10 seconds associated with oxygen desaturation and sleep fragmentation. The presence in the general population is about 4%. The principal symptoms are: excessive daytime sleepiness (EDS, snoring, dry throat, morning headache, night sweats, gastro-esophageal reflux, and increased blood pressure.Long term complications can be: increased cardio-cerebrovascular risk and cognitive impairment such as deficiency in attention, vigilance, visual abilities, thought, speech, perception and short term memory.Continuous Positive Airway Pressure (CPAP is currently the best non-invasive therapy for OSAS.CPAP guarantees the opening of upper airways using pulmonary reflexive mechanisms increasing lung volume during exhalation and resistance reduction, decreasing electromyografical muscular activity around airways.The causes of cognitive impairments and their possible reversibility after CPAP treatment have been analysed in numerous studies. The findings, albeit controversial, show that memory, attention and executive functions are the most compromised cognitive functions.The necessity of increasing the patient compliance with ventilotherapy is evident, in order to prevent cognitive deterioration and, when possible, rehabilitate the compromised functions, a difficult task for executive functions.

  19. Relationship quality of persons with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Tramonti, Francesco; Maestri, Michelangelo; Carnicelli, Luca; Fava, Giulia; Lombardi, Valentina; Rossi, Martina; Fabbrini, Monica; Di Coscio, Elisa; Iacopini, Elena; Bonanni, Enrica

    2017-09-01

    In the field of sleep disorders, the quality of couple relationship is arousing increasing attention, given its implications for quality of life and treatment adherence. The aim of the present study was to evaluate relationship quality in a sample of treated or untreated patients with Obstructive Sleep Apnoea Syndrome. Eighty-seven patients were recruited in a hospital-based Centre for Sleep Medicine. Subjects were administered the Dyadic Adjustment Scale (DAS) to evaluate relationship quality, and the Epworth Sleepiness Scale (ESS). Apnoea-hypopnoea indexes (AHI) were collected through nocturnal polysomnography or home testing with a portable monitoring device. Although the DAS average scores were similar to local normative values, relationship quality was significantly lower in the untreated patients when compared with the ones treated. The ESS scores showed a negative correlation with many DAS scores, whereas no significant correlation emerged for AHI. Such data suggest a significant impact of perceived sleep apnoea symptoms on marital satisfaction, even though in the absence of striking differences between the whole sample and the general population.

  20. Unraveling the Neurobiology of Sleep and Sleep Disorders Using Drosophila.

    Science.gov (United States)

    Chakravarti, L; Moscato, E H; Kayser, M S

    2017-01-01

    Sleep disorders in humans are increasingly appreciated to be not only widespread but also detrimental to multiple facets of physical and mental health. Recent work has begun to shed light on the mechanistic basis of sleep disorders like insomnia, restless legs syndrome, narcolepsy, and a host of others, but a more detailed genetic and molecular understanding of how sleep goes awry is lacking. Over the past 15 years, studies in Drosophila have yielded new insights into basic questions regarding sleep function and regulation. More recently, powerful genetic approaches in the fly have been applied toward studying primary human sleep disorders and other disease states associated with dysregulated sleep. In this review, we discuss the contribution of Drosophila to the landscape of sleep biology, examining not only fundamental advances in sleep neurobiology but also how flies have begun to inform pathological sleep states in humans. © 2017 Elsevier Inc. All rights reserved.

  1. Sleep Disturbance and Expressive Language Development in Preschool-Age Children with Down Syndrome

    Science.gov (United States)

    Edgin, Jamie O.; Tooley, Ursula; Demara, Bianca; Nyhuis, Casandra; Anand, Payal; Spanò, Goffredina

    2015-01-01

    Recent evidence has suggested that sleep may facilitate language learning. This study examined variation in language ability in 29 toddlers with Down syndrome (DS) in relation to levels of sleep disruption. Toddlers with DS and poor sleep (66%, n = 19) showed greater deficits on parent-reported and objective measures of language, including…

  2. The Impact of Sleep Disruption on Executive Function in Down Syndrome

    Science.gov (United States)

    Chen, C.-C.; Spano, G.; Edgin, J. O.

    2013-01-01

    The high prevalence of sleep disorders, particularly obstructive sleep apnea, is well established in children with Down syndrome. However, only a few studies have focused on older children and young adults in this population. Given the presence of sleep disorders and the early emergence of Alzheimer's disease, more work is needed to examine the…

  3. Sleep-Disordered Breathing and Cognitive Functioning in Preschool Children with and without Down Syndrome

    Science.gov (United States)

    Joyce, A.; Dimitriou, D.

    2017-01-01

    Background: Sleep affects children's cognitive development, preparedness for school and future academic outcomes. People with Down syndrome (DS) are particularly at risk for sleep-disordered breathing (SDB). To our knowledge, the association between SDB and cognition in preschoolers with DS is unknown. Methods: We assessed sleep by using…

  4. Management of sleeping problems with Wolf-Hirschhorn syndrome: A case study

    NARCIS (Netherlands)

    Curfs, L.M.G.; Didden, H.C.M.; Sikkema, S.P.E.; Die-Smulders, C.E.M. de

    1999-01-01

    Sleeping problems are common among children with Wolf-Hirschhorn syndrome. Extinction may be effective if sleeping problems have been shaped and are positively reinforced by parental attention. The present study shows that extinction was effective in the treatment of severe sleeping problems in a

  5. Evaluation of a Behavioral Treatment Package to Reduce Sleep Problems in Children with Angelman Syndrome

    Science.gov (United States)

    Allen, Keith D.; Kuhn, Brett R.; DeHaai, Kristi A.; Wallace, Dustin P.

    2013-01-01

    The purpose of this investigation was to evaluate the effectiveness of a behavioral treatment package to reduce chronic sleep problems in children with Angelman Syndrome. Participants were five children, 2-11 years-of-age. Parents maintained sleep diaries to record sleep and disruptive nighttime behaviors. Actigraphy was added to provide…

  6. Brief Report: Behaviorally Induced Insufficient Sleep Syndrome in Older Adolescents: Prevalence and Correlates

    Science.gov (United States)

    Pallesen, Stale; Saxvig, Ingvild West; Molde, Helge; Sorensen, Eli; Wilhelmsen-Langeland, Ane; Bjorvatn, Bjorn

    2011-01-01

    The aim of the present study was to investigate the prevalence of "behaviorally induced insufficient sleep syndrome (BIISS)" which is a newly defined hypersomnia, among adolescents. BIISS is characterized by excessive daytime sleepiness, short habitual sleep duration and sleeping considerably longer than usual during weekend/vacations.…

  7. Outcomes of long-term iron supplementation in pediatric restless legs syndrome/periodic limb movement disorder (RLS/PLMD).

    Science.gov (United States)

    Dye, Thomas J; Jain, Sejal V; Simakajornboon, Narong

    2017-04-01

    Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) are thought to center around a genetically mediated sensitivity to iron insufficiency. Previous studies have shown the effectiveness of short-term iron therapy in children with low iron storage. Little is known, however, about long-term iron treatment in children with RLS and PLMD. Therefore, we performed this study to assess the long-term effect of iron therapy in children with RLS and PLMD. A retrospective chart review was performed for children who met the following criteria: A) diagnosed as having either RLS or PLMD, B) started on iron supplementation, C) followed up for >2 years in a sleep clinic. Baseline values for iron, ferritin, and periodic limb movement of sleep index (PLMS index) were defined in the three months leading up to the initiation of iron therapy. Values were also computed for follow-up periods of 3-6 months, 1-2 years, and >2 years. Serum iron and ferritin levels and PLMS index were compared between baseline and all subsequent follow-ups. In total, 105 patients met inclusion criteria, of whom 64 were diagnosed with PLMD alone, seven with RLS alone, and 35 with both RLS and PLMD. The average age was 10.2 ± 5.3 years. Compared to the baseline (27.4 ± 12.1 ng/ml), the average ferritin values at 3-6 months (45.62 ± 21.2 ng/ml, p 2 years (54.7 ± 40.5 ng/ml, p 2 years (10 ± 14.5/h, p 2 years after iron therapy initiation in our RLS/PLMD cohort with a long-term follow-up. Iron therapy appears to lead to long-lasting improvements in children with RLS/PLMD. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life.

    Science.gov (United States)

    Giannaki, Christoforos D; Aristotelous, Panagiotis; Stefanakis, Manos; Hadjigeorgiou, Georgios M; Manconi, Mauro; Leonidou, Eleni; Sakkas, Giorgos K; Pantzaris, Marios

    2018-03-26

    Objectives Restless legs syndrome (RLS) symptoms are common in Multiple Sclerosis (MS) patients. The aim of the current study was to examine for the first time whether RLS could affect the functional capacity and various contributing parameters related to quality of life and fatigue in MS patients. Methods According to their RLS status, 50 relapsing-remitting MS patients were divided into the RLS (n = 10) and non-RLS groups (n = 40). Specific questionnaires were used in order to assess the health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, and depression symptoms of the patients. Functional capacity was examined using a battery of functional tests. Total body and visceral fat levels were assessed via bioelectrical impedance analyzers. Results Sleep quality, depression, fatigue, and HRQoL levels were found to be significantly worse in the patients with RLS compared to their free-RLS counterparts (P < 0.05). In addition, patients with RLS were found to exhibit further impairments in their performance in various functional tests related mainly with strength levels of lower extremities (P < 0.05). Finally, the patients with RLS were found to have significantly higher both total and trunk fat levels compared to patients without RLS (P < 0.05). A strong correlation was observed between the severity of RLS symptoms, sleep quality, fatigue, and QoL levels. Discussion It seems that RLS contributes even further to impairments on sleep quality, fatigue, functional capacity, and therefore HRQoL levels in relapsing-remitting MS patients, whilst for the first time a link between high fat levels has been revealed.

  9. [The Overlap Syndrome: association of COPD and Obstructive Sleep Apnoea].

    Science.gov (United States)

    Weitzenblum, E; Chaouat, A; Kessler, R; Canuet, M; Hirschi, S

    2010-04-01

    Chronic obstructive pulmonary disease (COPD) and the obstructive sleep apnoea-hypopnoea syndrome (OSAHS) are both common diseases affecting respectively 10 and 5% of the adult population over 40 years of age. Their coexistence, which is denominated "Overlap Syndrome", can be expected to occur in about 0.5% of this population. Two recent epidemiologic studies have shown that the prevalence of OSAHS is not higher in COPD than in the general population, and that the coexistence of the two conditions is due to chance and not through a pathophysiological linkage. Patients with "overlap" have a higher risk of sleep-related O(2) desaturation than do patients with COPD alone and the same degree of bronchial obstruction. They have an increased risk of developing hypercapnic respiratory failure and pulmonary hypertension when compared with patients with OSAHS alone and with patients with "usual" COPD. In patients with overlap, hypoxaemia, hypercapnia, and pulmonary hypertension can be observed in the presence of mild to moderate bronchial obstruction, which is different from "usual" COPD. Treatment of the overlap syndrome consists of nasal continuous positive airway pressure or nocturnal non-invasive ventilation (NIV), with or without nocturnal O(2). Patients who are markedly hypoxaemic during the daytime (PaO(2)<55-60 mmHg) should be given conventional long-term O(2) therapy in addition to nocturnal ventilation. Copyright 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  10. The Evaluation of Diastolic Hypertention in Sleep Overlap Syndrome

    Directory of Open Access Journals (Sweden)

    Fariba Rezaeetalab

    2015-01-01

    Full Text Available Introduction: The overlap syndrome, consisting ofobstructive sleep apnea hypopnea syndrome (OSAHS and chronic obstructvie pulmonary disease (COPD is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension.The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood presssure (DBP in overlap  patients. Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurment of resting diastolic blood pressure (DBP in patients with overlap syndrome in Sleep Laboartory of Imam Reza Hospital, Mashhad, Iran from October 2011 to December 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index (AHI (AHI 30.Descriptive statistics included age, body mass index (BMI, OSA, Apnea-Hypopnea Index (AHI, DBP, and neck circumference. Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups (80±0.50, 95±0.60, and 105±0.65, respectively (p

  11. Links between sleep and daytime behaviour problems in children with Down syndrome.

    Science.gov (United States)

    Esbensen, A J; Hoffman, E K; Beebe, D W; Byars, K C; Epstein, J

    2018-02-01

    In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  12. Sleep Architecture in Night Shift Workers Police Officers with Obstructive Sleep Apnea-hypopnea Syndrome

    Directory of Open Access Journals (Sweden)

    Selene Verde-Tinoco

    Full Text Available Introduction: Reduced sleep to increase work hours is common among police officers, when this situation is combined with Obstructive sleep apnea/hypopnea syndrome (OSAHS, health consequences are greater, therefore we believe there is a need of research for these alterations. The aim of this study was to measure the changes in sleep architecture (SA in police officers who currently have Night shift work (NSW and OSAHS. Methods: We compared SA in 107 subjects divided in three groups: the first group included police officers with NSW and severe OSAHS (n = 48; the second group were non-police officers with diurnal work time and severe OSAHS (n = 48 and the third group was formed by healthy controls (n = 11. Polysomnography (PSG variables and Epworth sleepiness scale (ESS scores were compared. Results: SA was more disrupted in the group of police officers with NSW and OSAHS than in patients with OSAHS only and in the control group. Police officers with NSW and OSAHS presented an increased number of electroencephalographic activations, apnea/hypopnea index, and sleep latency, and showed lower scores of oxygen saturation, and in the ESS. Multivariate analysis revealed significant influence of age and Body mass index (BMI. Conclusions: Data suggested with caution an additive detrimental effect of NSW and OSAHS in SA and ESS of police officers. However age and BMI must be also taken into account in future studies.

  13. Increased overall cortical connectivity with syndrome specific local decreases suggested by atypical sleep-EEG synchronization in Williams syndrome.

    Science.gov (United States)

    Gombos, Ferenc; Bódizs, Róbert; Kovács, Ilona

    2017-07-21

    Williams syndrome (7q11.23 microdeletion) is characterized by specific alterations in neurocognitive architecture and functioning, as well as disordered sleep. Here we analyze the region, sleep state and frequency-specific EEG synchronization of whole night sleep recordings of 21 Williams syndrome and 21 typically developing age- and gender-matched subjects by calculating weighted phase lag indexes. We found broadband increases in inter- and intrahemispheric neural connectivity for both NREM and REM sleep EEG of Williams syndrome subjects. These effects consisted of increased theta, high sigma, and beta/low gamma synchronization, whereas alpha synchronization was characterized by a peculiar Williams syndrome-specific decrease during NREM states (intra- and interhemispheric centro-temporal) and REM phases of sleep (occipital intra-area synchronization). We also found a decrease in short range, occipital connectivity of NREM sleep EEG theta activity. The striking increased overall synchronization of sleep EEG in Williams syndrome subjects is consistent with the recently reported increase in synaptic and dendritic density in stem-cell based Williams syndrome models, whereas decreased alpha and occipital connectivity might reflect and underpin the altered microarchitecture of primary visual cortex and disordered visuospatial functioning of Williams syndrome subjects.

  14. Willis-Ekbom Disease Foundation revised consensus statement on the management of restless legs syndrome.

    Science.gov (United States)

    Silber, Michael H; Becker, Philip M; Earley, Christopher; Garcia-Borreguero, Diego; Ondo, William G

    2013-09-01

    Restless legs syndrome (RLS)/Willis-Ekbom disease (WED) is a common disorder, occurring at least twice a week and causing at least moderate distress in 1.5% to 2.7% of the population. It is important for primary care physicians to be familiar with this disorder and its management. Much has changed in its management since our previous algorithm was published in 2004, including the availability of several new drugs. This revised algorithm was written by members of the Medical Advisory Board of the Willis-Ekbom Disease Syndrome Foundation based on scientific evidence and expert opinion. It considers the management of RLS/WED under intermittent RLS/WED, chronic persistent RLS/WED, and refractory RLS/WED. Nonpharmacological approaches, including mental alerting activities, avoiding substances or medications that may exacerbate RLS, and the role of iron supplementation, are outlined. Chronic persistent RLS/WED should be treated with either a nonergot dopamine agonist or a calcium channel α-2-δ ligand. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS/WED and describe management approaches, including combination therapy and the use of high-potency opioids. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  15. [Metabolic syndrome and bipolar disorder: Is sleep the missing link?

    Science.gov (United States)

    Brochard, H; Boudebesse, C; Henry, C; Godin, O; Leboyer, M; Étain, B

    2016-12-01

    To examine the pathophysiologic mechanisms that may link circadian disorder and metabolic syndrome in bipolar disorder (BP). A systematic review of the literature was conducted from January 2013 to January 2015, using the Medline and Cochrane databases, using the keywords "metabolic syndrome", "obesity", "leptin" and "circadian disorders", "sleeping disorders" and cross-referencing them with "bipolar disorder". The following types of publications were candidates for review: (i) clinical trials; (ii) studies involving patients diagnosed with bipolar disorder; (iii) studies involving patients with sleeping disorder; or (iv) data about metabolic syndrome. Forty articles were selected. The prevalence of metabolic syndrome in BP was significantly higher compared to the general population (from 36 to 49% in the USA [Vancampfort, 2013]), and could be explained by several factors including reduced exercise and poor diet, genetic vulnerability, frequent depressive episodes, psychiatric comorbidity and psychotropic treatment. This high frequency of metabolic syndrome worsens the prognosis of these patients, increasing morbidity and mortality. Secondly, patients with BP experienced circadian and sleep disturbance, including modification in melatonin secretion. These perturbations are known to persist in periods of mood stabilization and are found in patients' relatives. Circadian disturbances are factors of relapse in bipolar patients, and they may also have a role in the metabolic comorbidities of these patients. Recent studies show that in populations of patients with bipolar disorder, a correlation between circadian disturbance and metabolic parameters are found. To identify the pathophysiological pathway connecting both could lead to a better comprehension of the disease and new therapeutics. In the overall population, mechanisms have been identified linking circadian and metabolic disorder involving hormones like leptin and ghrelin. These hormones are keys to

  16. Airway inflammation in patients affected by obstructive sleep apnea syndrome.

    Science.gov (United States)

    Salerno, F G; Carpagnano, E; Guido, P; Bonsignore, M R; Roberti, A; Aliani, M; Vignola, A M; Spanevello, A

    2004-01-01

    Obstructive sleep apnea syndrome (OSAS) has been shown to be associated to upper airway inflammation. The object of the present study was to establish the presence of bronchial inflammation in OSAS subjects. In 16 subjects affected by OSAS, and in 14 healthy volunteers, airway inflammation was detected by the cellular analysis of the induced sputum. OSAS patients, as compared to control subjects, showed a higher percentage of neutrophils (66.7+/-18.9 vs. 25.8+/-15.6) (Pbronchial inflammation characterized by a significant increase in neutrophils.

  17. The roles of dentisty in obstructive sleep apnea syndrome

    International Nuclear Information System (INIS)

    Kikuchi, Makoto; Higurashi, Naoki; Miyazaki, Soichiro

    2007-01-01

    The roles of dentistry in obstructive sleep apnea syndrome (OSAS) are mainly: Craniofacial skeletal diagnosis, Treatment by oral appliance, Prevention of craniofacial skeletal problem. We use cephalometrics, CT and MRI to diagnose craniofacial skeleton of the patients and treat the OSAS patient by the oral appliance. We could make the airway of the OSAS patients bigger by the orthodontic treatment and ENT doctor could make the airway of the patient's patency by removing tonsils and adenoids. If the patient has the airway patency, the mandible of the patient could grow naturally in advanced position and have the airway bigger, consequently the patient could avoid OSAS in his future. (author)

  18. Relationship between Sleep and Pain in Adolescents with Juvenile Primary Fibromyalgia Syndrome

    Science.gov (United States)

    Olsen, Margaret N.; Sherry, David D.; Boyne, Kathleen; McCue, Rebecca; Gallagher, Paul R.; Brooks, Lee J.

    2013-01-01

    Study Objectives: To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality. Design: Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study. Patients: Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment. Interventions: Multidisciplinary pain treatment, including intensive exercise therapy. Measurements and Results: Pain and disability were measured by a pain visual analog scale (VAS) and the Functional Disability Inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change. Conclusions: Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality. Citation: Olsen MN; Sherry DD; Boyne K; McCue R; Gallagher PR; Brooks LJ. Relationship between sleep and pain in adolescents with juvenile primary fibromyalgia syndrome. SLEEP 2013

  19. Sundown Syndrome, Sleep Quality, and Walking Among Community-Dwelling People With Alzheimer Disease.

    Science.gov (United States)

    Shih, Yen-Hua; Pai, Ming-Chyi; Huang, Ying-Che; Wang, Jing-Jy

    2017-05-01

    Sundown syndrome and sleep disturbances cause people with Alzheimer disease (PAD) and caregivers suffering. Studies have indicated that physical exercise could have a positive impact on sundown syndrome, yet no research has ever explored the relationship between walking and sundown syndrome. The aims of this study were to examine the relationship between sundown syndrome and sleep quality, and determine whether the severity of dementia, sleep quality, and weekly duration of walking influenced sundown syndrome, and to assess differences in sundown syndrome and sleep quality in relation to the accompanying walker and weekly duration of walking among people with Alzheimer disease living in the community. A cross-sectional observation study was conducted. A total 184 participants were recruited from dementia outpatient clinics of several hospitals and long-term care resource management centers in southern Taiwan. The Chinese version of the Cohen-Mansfield Agitation Inventory, Community form was used to assess sundown syndrome, and the Chinese version of the Pittsburgh Sleep Quality Index was used to measure sleep quality. Pearson correlation, multiple regression, and 1-way analysis of variance were performed for data analysis. The results indicated that sundown syndrome was significantly correlated with sleep quality (r = 0.374), whereas severity of dementia, sleep quality, and weekly duration of walking were influencing factors of sundown syndrome and accounted for a total of 24.8% of the variance (adjusted R 2  = 0.222, F 6,177  = 9.709). In addition, PAD who walked with relatives showed less sundown syndrome (F 3,180  = 4.435, P = .005) and better sleep quality (F 3,180  = 3.565, P = .015) compared with those walking with nonrelatives. Also, longer walking time led to less sundown syndrome (F 4,179  = 4.351, P = .002) and better sleep quality (F 4,179  = 3.592, P = .008). Advanced dementia, poor sleep quality, and shorter weekly duration of

  20. Preferences in Sleep Position Correlate With Nighttime Paresthesias in Healthy People Without Carpal Tunnel Syndrome.

    Science.gov (United States)

    Roth Bettlach, Carrie L; Hasak, Jessica M; Krauss, Emily M; Yu, Jenny L; Skolnick, Gary B; Bodway, Greta N; Kahn, Lorna C; Mackinnon, Susan E

    2017-10-01

    Carpal tunnel syndrome has been associated with sleep position preferences. The aim of this study is to assess self-reported nocturnal paresthesias and sleeping position in participants with and without carpal tunnel syndrome diagnosis to further clinical knowledge for preventive and therapeutic interventions. A cross-sectional survey study of 396 participants was performed in young adults, healthy volunteers, and a patient population. Participants were surveyed on risk factors for carpal tunnel syndrome, nocturnal paresthesias, and sleep preferences. Binary logistic regression analysis was performed comparing participants with rare and frequent nocturnal paresthesias. Subanalyses for participants without carpal tunnel syndrome under and over 21 years of age were performed on all factors significantly associated with subclinical compression neuropathy in the overall population. Thirty-three percent of the study population experienced nocturnal paresthesias at least weekly. Increased body mass index ( P < .001) and sleeping with the wrist flexed ( P = .030) were associated with a higher frequency of nocturnal paresthesias. Side sleeping was associated with less frequent nocturnal symptoms ( P = .003). In participants without carpal tunnel syndrome, subgroup analysis illustrated a relationship between nocturnal paresthesias and wrist position. In participants with carpal tunnel syndrome, sleeping on the side had a significantly reduced frequency of nocturnal paresthesias. This study illustrates nocturnal paresthesias in people without history of carpal tunnel syndrome including people younger than previously reported. In healthy patients with upper extremity subclinical compression neuropathy, sleep position modification may be a useful intervention to reduce the frequency of nocturnal symptoms prior to developing carpal tunnel syndrome.

  1. Neck Circumference Is a Predictor of Metabolic Syndrome and Obstructive Sleep Apnea in Short-Sleeping Obese Men and Women

    Science.gov (United States)

    de Jonge, Lilian; Piaggi, Paolo; Mattingly, Megan; Zhao, Xiongce; Lucassen, Eliane; Rother, Kristina I.; Sumner, Anne E.; Csako, Gyorgy

    2014-01-01

    Abstract Background: The constellation of metabolic syndrome, although controversial with regard to its clinical usefulness, is epidemiologically related to increased diabetes risk and cardiovascular mortality. Our goal was to investigate the associations among neck circumference (NC), obstructive sleep apnea syndromes (OSAS), and metabolic syndrome in obese men and women sleeping less than 6.5 hr per night. Methods: This was a cross-sectional study of obese men and premenopausal obese women sleeping less than 6.5 hr per night. We enrolled 120 individuals (92 women), age 40.5±6.9 years and body mass index (BMI) 38.6±6.5 kg/m2. Metabolic syndrome severity was assessed by a score and OSAS was defined as a respiratory disturbance index (RDI) ≥5. Metabolic end endocrine parameters were measured, and sleep duration was determined by actigraphy and validated questionnaires. Results: Metabolic syndrome was found in 41% and OSAS in 58% (28% had both). Subjects with metabolic syndrome were 3 years older and more often Caucasian; they had higher RDI scores, larger NC, more visceral fat, lower serum adiponectin, higher 24-hr urinary norepinephrine (NE) excretion, and lower growth hormone concentrations. A NC of ≥38 cm had a sensitivity of 54% and 58% and a specificity of 70% and 79% in predicting the presence of metabolic syndrome and OSAS, respectively. RDI, adiponectin, and NC accounted for approximately 30% of the variability in the metabolic syndrome score, as estimated by an age-, gender-, and race-corrected multivariate model (R2=0.376, Pmetabolic syndrome in short-sleeping obese men and premenopausal obese women. Addition of NC to the definition of metabolic syndrome should be considered and needs to be validated in future studies. PMID:24571423

  2. Exploring sleep disorders in patients with chronic kidney disease

    OpenAIRE

    Nigam, Gaurav; Camacho, Macario; Chang, Edward T; Riaz, Muhammad

    2018-01-01

    Kidney disorders have been associated with a variety of sleep-related disorders. Therefore, researchers are placing greater emphasis on finding the role of chronic kidney disease (CKD) in the development of obstructive sleep apnea and restless legs syndrome. Unfortunately, the presence of other sleep-related disorders with CKDs and non-CKDs has not been investigated with the same clinical rigor. Recent studies have revealed that myriad of sleep disorders are associated with CKDs. Furthermore,...

  3. Measurement of Quality to Improve Care in Sleep Medicine

    OpenAIRE

    Morgenthaler, Timothy I.; Aronsky, Amy J.; Carden, Kelly A.; Chervin, Ronald D.; Thomas, Sherene M.; Watson, Nathaniel F.

    2015-01-01

    The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apne...

  4. [Sleep disturbances in Smith-Magenis syndrome: treatment with melatonin and beta-adrenergic antagonists].

    Science.gov (United States)

    Van Thillo, A; Devriendt, K; Willekens, D

    2010-01-01

    Smith-Magenis syndrome is a generic disorder, characterised by physical, neurological and behavioural features and caused by a 17p11.2 deletion. Patients with this syndrome typically display an inversion of the sleep-wake cycle. In this article we describe clinical developments in a two-year-old girl with Smith-Magenis syndrome whose sleep problems were successfully treated with melatonin and beta-adrenergic blockers. We also mention relevant data obtained in our literature search.

  5. Sleep-Related Eating Disorder: A Case Report of a Progressed Night Eating Syndrome

    Directory of Open Access Journals (Sweden)

    Sayed Shahabuddin Hoseini

    2012-07-01

    Full Text Available Night eating syndrome is a common disorder in eating behaviors that occurs in close relation to the night time sleep cycle. Although eating disorders are common in society, night eating syndrome has been left neglected by health care professionals. In this report we present a case of eating disorder that exhibits some novel features of night eating syndrome. Our case was a progressed type of eating disorder which may increase awareness among physicians about sleep-related eating disorders.

  6. Sleep-Related Eating Disorder: A Case Report of a Progressed Night Eating Syndrome

    OpenAIRE

    Sayed Shahabuddin Hoseini; Zhamak Khorgami; Ahmad Reza Dehpour; Nasrin Shoar; Mohammad Naderan; Saeed Shoar

    2012-01-01

    Night eating syndrome is a common disorder in eating behaviors that occurs in close relation to the night time sleep cycle. Although eating disorders are common in society, night eating syndrome has been left neglected by health care professionals. In this report we present a case of eating disorder that exhibits some novel features of night eating syndrome. Our case was a progressed type of eating disorder which may increase awareness among physicians about sleep-related eating disorders.

  7. Sleep-related eating disorder: a case report of a progressed night eating syndrome.

    Science.gov (United States)

    Shoar, Saeed; Naderan, Mohammad; Shoar, Nasrin; Dehpour, Ahmad Reza; Khorgami, Zhamak; Hoseini, Sayed Shahabuddin

    2012-01-01

    Night eating syndrome is a common disorder in eating behaviors that occurs in close relation to the night time sleep cycle. Although eating disorders are common in society, night eating syndrome has been left neglected by health care professionals. In this report we present a case of eating disorder that exhibits some novel features of night eating syndrome. Our case was a progressed type of eating disorder which may increase awareness among physicians about sleep-related eating disorders.

  8. OBSTRUCTIVE SLEEP APNEA-HYPOPNEA SYNDROME. MODERN VIEW ON THE PROBLEM

    Directory of Open Access Journals (Sweden)

    G .M. Fomych

    2013-12-01

    Full Text Available Obstructive sleep apnea syndrome is a common chronic syndrome that significantly affects the quality of life of patients and often requires lifelong care. This review deals with modern ideas about the prevalence, causes, clinical presentation, diagnosis and treatment of obstructive sleep apnea syndrome. Using modern methods of diagnosis and the correct approach to such patients helps prevent unwanted effects and significantly improves quality of life.

  9. Neuroendocrine Alterations in Obese Patients with Sleep Apnea Syndrome

    Directory of Open Access Journals (Sweden)

    Fabio Lanfranco

    2010-01-01

    Full Text Available Obstructive sleep apnea syndrome (OSAS is a serious, prevalent condition that has significant morbidity and mortality when untreated. It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH secretion coupled to reduced insulin-like growth factor-I (IGF-I concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL rhythm. A disrupted Hypothalamus-Pituitary-Adrenal (HPA axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism. Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences. The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death.

  10. Obstructive sleep apnoea syndrome in children and anaesthesia

    Directory of Open Access Journals (Sweden)

    A Rudra

    2010-01-01

    Full Text Available Obstructive sleep apnoea syndrome (OSAS is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

  11. Timing of muscle response to a sudden leg perturbation: comparison between adolescents and adults with Down syndrome.

    Directory of Open Access Journals (Sweden)

    Maria Stella Valle

    Full Text Available Movement disturbances associated with Down syndrome reduce mechanical stability, worsening the execution of important tasks such as walking and upright standing. To compensate these deficits, persons with Down syndrome increase joint stability modulating the level of activation of single muscles or producing an agonist-antagonist co-activation. Such activations are also observed when a relaxed, extended leg is suddenly released and left to oscillate passively under the influence of gravity (Wartenberg test. In this case, the Rectus femoris of adults with Down syndrome displayed peaks of activation after the onset of the first leg flexion. With the aim to verify if these muscular reactions were acquired during the development time and to find evidences useful to give them a functional explanation, we used the Wartenberg test to compare the knee joint kinematics and the surface electromyography of the Rectus femoris and Biceps femoris caput longus between adolescents and adults with Down syndrome. During the first leg flexion, adolescents and adults showed single Rectus femoris activations while, a restricted number of participants exhibited agonist-antagonist co-activations. However, regardless the pattern of activation, adults initiated the muscle activity significantly later than adolescents. Although most of the mechanical parameters and the total movement variability were similar in the two groups, the onset of the Rectus femoris activation was well correlated with the time of the minimum acceleration variability. Thus, in adolescents the maximum mechanical stability occurred short after the onset of the leg fall, while adults reached their best joint stability late during the first flexion. These results suggest that between the adolescence and adulthood, persons with Down syndrome explore a temporal window to select an appropriate timing of muscle activation to overcome their inherent mechanical instability.

  12. Sleep disorders and their clinical significance in children with Down syndrome.

    Science.gov (United States)

    Stores, Gregory; Stores, Rebecca

    2013-02-01

    Our aim was to review basic aspects of sleep disorders in children with Down syndrome in the light of present-day findings of such disorders in children in general, including other groups of children with developmental disabilities. A literature search of adverse developmental effects of sleep disturbance, types of sleep disturbance in children with Down syndrome, their aetiology, including possible contributions of physical and psychiatric comorbidities and medication effects, principles of assessment and diagnosis, and treatment issues, was carried out. Sleep disturbance is particularly common in children with developmental disorders including Down syndrome. Although there are just three basic sleep problems (sleeplessness or insomnia, excessive daytime sleepiness, and parasomnias) there are many possible underlying causes (sleep disorders), the nature of which dictates the particular treatment required. In children with Down syndrome, in addition to the same influences in other children, various comorbid physical and psychiatric conditions are capable of disturbing sleep. Possible adverse medication effects also need to be considered. Screening for sleep disorders and their causes should be routine; positive findings call for detailed diagnosis. Management should acknowledge the likely multifactorial aetiology of the sleep disorders in Down syndrome. Successful treatment can be expected to alleviate significantly the difficulties of both child and family. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

  13. Intradialytic aerobic exercise training ameliorates symptoms of restless legs syndrome and improves functional capacity in patients on hemodialysis: a pilot study.

    Science.gov (United States)

    Sakkas, Giorgos K; Hadjigeorgiou, Georgios M; Karatzaferi, Christina; Maridaki, Maria D; Giannaki, Christoforos D; Mertens, Peter R; Rountas, Christos; Vlychou, Marianna; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2008-01-01

    We present the first study on the influence of exercise training on restless legs syndrome (RLS) in patients on hemodialysis (HD). Restless legs syndrome has been treated pharmacologically with satisfactory results; however, side effects and rebound phenomena have been reported. Intradialytic exercise training effectively counteracts uremia-induced catabolism; nevertheless, it remains unknown whether patients with RLS undergoing HD benefit from such programs. The aims of the current study were to evaluate the effect of 16-weeks aerobic exercise training in the severity of RLS and in the functional capacity and the quality of life of patients with RLS on HD. Fourteen patients on HD (four female, mean age 59 +/- 16 years) with untreated RLS were assigned, according to their will, to either the exercise group (Ex-group, n = 7), and participated in a 16-week supervised intradialytic aerobic exercise training, or to the control group (Con-group, n = 7), and continued usual activities. Primary aim was to compare the International RLS (IRLS) study group rating scale, functional ability, and quality of life in baseline and the end of the 16 weeks. Exercise training reduced IRLS score by 42% (p = 0.02). Furthermore, it significantly improved indices of functional ability (p = 0.02), exercise capacity (p = 0.01), quality of life (p = 0.03), and sleep quality (p = 0.01). In the Con-group no changes were observed. In conclusion, aerobic exercise training is safe and efficacious in reducing RLS symptoms and improving quality of life in patients with RLS on HD.

  14. Sexual function status in women with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Köseoğlu, Nalan; Köseoğlu, Hikmet; Itil, Oya; Oztura, Ibrahim; Baklan, Bariş; Ikiz, Ahmet Omer; Esen, Ahmet Adil

    2007-09-01

    Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied. In this prospective study, we aimed to determine sexual function status in women with OSAS and its relationship with the disease parameters of OSAS. Women, who were diagnosed with OSAS with polysomnography performed in the sleep center of our university hospital, formed the study population. Women with any genital deformity, postmenopausal women, and women without a regular partner were excluded from the study. General demographic properties, medical histories, polysomnography parameters, and frequency of intercourse per month were noted for each patient. Patients completed the Sexual Function Questionnaire Version 2 (SFQ-V2) and Epworth Sleepiness Scale. The patients were grouped as mild, moderate, and severe OSAS according to the level of respiratory disturbance index (RDI). Scores of sexual function domains were determined from SFQ, and their relationships with parameters of polysomnography and demographics were studied. Twenty-five patients were included in the study. Mean age was 48.1 +/- 2.7 years. All were married with a mean marriage duration of 25.6 +/- 3.3 years. Mean frequency of intercourse per month was 3.3 +/- 1.8. All domains of sexual functions except pain and enjoyment significantly decreased with increasing severity of OSAS. When we controlled for factors of age and co-morbid diseases, correlation analyses showed significant negative correlation between levels of RDI and all domains of sexual functions except pain and enjoyment (P < 0.05). Obstructive sleep apnea syndrome negatively impacts sexual function in women independent of age and associated co-morbid diseases.

  15. The Importance of Sleep: Attentional Problems in School-Aged Children With Down Syndrome and Williams Syndrome.

    Science.gov (United States)

    Ashworth, Anna; Hill, Catherine M; Karmiloff-Smith, Annette; Dimitriou, Dagmara

    2015-01-01

    In typically developing (TD) children, sleep problems have been associated with day-time attentional difficulties. Children with developmental disabilities often suffer with sleep and attention problems, yet their relationship is poorly understood. The present study investigated this association in school-aged children with Down syndrome (DS) and Williams syndrome (WS). Actigraphy and pulse oximetry assessed sleep and sleep-disordered breathing respectively, and attention was tested using a novel visual Continuous Performance Task (CPT).Attentional deficits were evident in both disorder groups. In the TD group, higher scores on the CPT were related to better sleep quality, higher oxyhemoglobin saturation (SpO2), and fewer desaturation events. Sleep quality, duration, and SpO2 variables were not related to CPT performance for children with DS and WS.

  16. Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties.

    Science.gov (United States)

    Ferré, A

    2016-02-11

    Chronic fatigue syndrome (CFS) is characterised by the presence of intractable fatigue and non-restorative sleep, symptoms which are also very prevalent in multiple diseases and appear as side effects of different drugs. Numerous studies have shown a high prevalence of sleep disorders in patients with CFS. However, non-restorative sleep and fatigue are frequently symptoms of the sleep disorders themselves, so primary sleep disorders have to be ruled out in many cases of CFS. This review was performed using a structured search of the MeSH terms ([Sleep]+[Chronic fatigue syndrome]) in the PubMed database. Identifying primary sleep disorders in patients meeting diagnostic criteria for CFS will allow for a more comprehensive treatment approach involving new diagnostic and therapeutic strategies that may improve quality of life for these patients. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  17. Three Siblings with Prader-Willi Syndrome: Brief Review of Sleep and Prader-Willi Syndrome

    Directory of Open Access Journals (Sweden)

    Arina Bingeliene

    2015-01-01

    Full Text Available Prader-Willi syndrome (PWS is a genetic disorder characterized by short stature, mental retardation, hypotonia, functionally deficient gonads, and uncontrolled appetite leading to extreme obesity at an early age. Patients with this condition require multidisciplinary medical care, which facilitates a significant improvement in quality of life. PWS is the first human disorder to be attributed to genomic imprinting. Prevalence varies in the literature, ranging from 1 in 8,000 in the Swedish population to 1 in 54,000 in the United Kingdom. Rarely, the genetic mechanism responsible for Prader-Willi syndrome can be inherited. We report a highly unique case of three siblings who share this condition. This report describes a case of two brothers and one half sister with PWS. All three siblings have sleep-related complaints. The sister died at the age of 24 years in her sleep, with the cause of death reported as obstructive sleep apnea. The outcome was positive in both of the brothers’ cases as a result of professional medical care and specific tailored recommendations implemented by their mother. A review of the relevant literature vis-à-vis sleep and PWS is provided.

  18. [Obstructive Sleep Apnea Syndrome and Pregnancy].

    Science.gov (United States)

    Orth, M; Schäfer, T; Schiermeier, S; Rasche, K

    2018-03-01

    Die Schwangerschaft hat einen erheblichen Einfluss auf Atmungsregulation und Atemmechanik sowie auf die Schlafregulation: Durch seine Größenzunahme schränkt der Uterus zwar die maximale willkürliche Ventilation ein, das Schwangerschaftshormon Progesteron hingegen bewirkt eine kompensierende Bronchodilatation und eine markante Hyperventilation mit arteriellen PCO 2 -Werten der Schwangeren unter 30 mmHg. Die Schlafqualität nimmt in der Schwangerschaft ab, insbesondere aufgrund steigender Hormonspiegel des Progesterons, einer generellen Stoffwechselsteigerung, Nykturie, fetaler Bewegungen und wegen der Begünstigung schlafbezogener Atmungsstörungen. Beim Embryo entwickelt sich bereits in der 4. Woche die Lungenanlage und reift über ein pseudoglanduläres, kanalikuläres, sakkuläres zum alveolaren Stadium. Ab Schwangerschaftswoche 29 – 30 sezernieren Typ-2-Alveozyten Surfactant. Ab der Mitte des zweiten Trimenons sind fetale Atembewegungen nachweisbar. Ohne sie fehlt der Stimulus für ein adäquates Lungenwachstum. Sie sind abhängig vom Ruhe-/Aktivitätsrhythmus des Fetusses und antworten auf erhöhten Kohlendioxidpartialdruck, während sie durch Sauerstoffmangel inhibiert werden. Die innere Uhr entwickelt sich beim Fetus im letzten Trimester und wird durch Zeitgeber der Mutter, zum Beispiel durch den Melatoninspiegel synchronisiert. In den letzten 10 Wochen der Schwangerschaft lassen sich Phasen ruhigen (NREM-) und aktiven (REM-)Schlafes differenzieren. Schwangerschaft und intrauterine Entwicklung sind von erheblichen Veränderungen von Atmung und Schlaf bei Mutter und Kind begleitet, die Ansatzpunkte pathophysiologischer Entwicklungen sein können.Schlafbezogene Atmungsstörungen (SBAS) in Form von Schnarchen oder obstruktivem Schlafapnoe-Syndrom (OSAS) sind auch bei Frauen insbesondere nach der Menopause häufige Schlafstörungen. Aber auch prämenopausal tritt das OSAS mit einer Häufigkeit von mehr als 2 % auf. Einige während der

  19. Associations of sleep disturbance with ADHD

    DEFF Research Database (Denmark)

    Hvolby, A.

    2015-01-01

    Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals...... with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance......, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian...

  20. Effects on neuropsychological performance and sleep quality in patients with obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Cristina Staub

    2009-11-01

    Full Text Available Patients with obstructive sleep apnea syndrome (OSAS may have impaired neuropsychological performance. The aim of the study is to assess neuropsychological function in OSAS patients before and on continous positive airway pressure (CPAP therapy to assess different neuropsychological tests – especially of sensomotor memory – in OSAS patients, and to relate neuropsychological test results to polysomnographic findings. Therefore, 36 normal controls and 18 OSAS patients performed tests of attention capacity and memory with retrieval in the evening and the following morning. Six weeks later, the tests were repeated (patients on CPAP. Controls performed significantly better than patients in the tests of attention and of memory of facts without and on CPAP therapy. Moreover, good compliance of CPAP therapy was not associated with better performance. However, there was no significant difference between controls and patients in the tests of sensomotor memory. The neuropsychological results depended on oxygen values, the arousal index, and sleep stages. There is no group difference in overnight improvement in the neuropsychological tests, which could indicate that sleep has an important function in homeostatic regulation rather than in consolidation.

  1. The prevalence and related factors of restless leg syndrome in the community dwelling elderly; in Kayseri, Turkey: A cross-sectional study.

    Science.gov (United States)

    Safak, Elif Deniz; Gocer, Semsinur; Mucuk, Salime; Ozturk, Ahmet; Akin, Sibel; Arguvanli, Sibel; Mazicioglu, Mumtaz M

    2016-01-01

    The aim of this study is to determine the prevalence and related factors of restless leg syndrome (RLS) in the community-dwelling elderly living in Kayseri. This is a cross-sectional population based study in 960 community-dwelling elderly living in an urban area. We sampled 1/100 of elderly people aged 60 years and older. The diagnosis of RLS was made according to the criteria of the International RLS Study Group. The demographic data were collected by face-to-face interviews. Additionally, the Mini-Mental State Examination, Geriatric Depression Scale and anthropometric measurements were used. Logistic regression analyses were performed to define risk factors for RLS. We excluded elderly people with cognitive impairment (295). One hundred and five (15.8%) of the remaining 665 elderly subjects met the criteria to diagnose RLS. There was female predominance (3/1). Gender, length of education, employment status, smoking, hypertension, diabetes mellitus, depressive mood, high body mass index, and high waist circumferences, sleep quality, sleep duration, and difficulty in falling asleep in the first 30min were all detected as risk factors for RLS. However in logistic regression analysis, being a housewife, sleeping less than 6h a day and having diabetes was found as significantly related risk factors for RLS. This is the first epidemiologic study of RLS conducted in the Turkish community-dwelling elderly in an urban area. RLS is a common but underestimated disease in the elderly. Although RLS is prevalent we found very few risk factors for RLS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. High altitude pulmonary edema, down syndrome, and obstructive sleep apneas.

    Science.gov (United States)

    Richalet, Jean-Paul; Chenivesse, Cécile; Larmignat, Philippe; Meille, Laurent

    2008-01-01

    A 24-year-old adult with a Down syndrome was admitted in December 2006 at the Moutiers hospital in the French Alps for an acute inaugural episode of high altitude pulmonary edema (HAPE) that occurred in the early morning of day 3 after his arrival to La Plagne (2000 m). This patient presented an interventricular septal defect operated on at the age of 7, a hypothyroidism controlled by 50 microg levothyrox, a state of obesity (BMI 37.8 kg/m(2)), and obstructive sleep apneas with a mean of 42 obstructive apneas or hypopneas per hour, treated with continuous positive airway pressure (CPAP). The patient refused to use his CPAP during his stay in La Plagne. At echocardiography, resting parameters were normal, with a left ventricular, ejection fraction of 60%, a normokinetic right ventricle, and an estimated systolic pulmonary artery pressure (sPAP) of 30 mmHg. At exercise, sPAP rose to 45 mmHg and the right ventricle was still normokinetic and not dilated. An exercise hypoxic tolerance test performed at 60 W and at the equivalent altitude of 3300 m revealed a severe drop in arterial oxygen saturation down to 60%, with an abnormal low ventilatory response to hypoxia, suggesting a defect in peripheral chemosensitivity to hypoxia. In conclusion, patients with Down syndrome, including adults with no cardiac dysfunction and regular physical activity, are at risk of HAPE even at moderate altitude when they suffer from obstructive sleep apneas associated with obesity and low chemoresponsiveness. This observation might be of importance since an increasing number of young adults with Down syndrome participate in recreational or sport activities, including skiing and mountaineering.

  3. A family with Parkinsonism, essential tremor, restless legs syndrome, and depression.

    Science.gov (United States)

    Puschmann, A; Pfeiffer, R F; Stoessl, A J; Kuriakose, R; Lash, J L; Searcy, J A; Strongosky, A J; Vilariño-Güell, C; Farrer, M J; Ross, O A; Dickson, D W; Wszolek, Z K

    2011-05-10

    Previous epidemiologic and genetic studies have suggested a link between Parkinson disease (PD), essential tremor (ET), and restless legs syndrome (RLS). We describe the clinical, PET, and pathologic characteristics of an extensive kindred from Arkansas with hereditary PD, ET, and RLS. The pedigree contains 138 individuals. Sixty-five family members were examined neurologically up to 3 times from 2004 to 2010. Clinical data were collected from medical records and questionnaires. Genetic studies were performed. Five family members underwent multitracer PET. Two individuals with PD were examined postmortem. Eleven family members had PD with generally mild and slowly progressive symptoms. Age at onset was between 39 and 74 years (mean 59.1, SD 13.4). All individuals treated with l-dopa responded positively. Postural or action tremor was present in 6 individuals with PD, and in 19 additional family members. Fifteen persons reported symptoms of RLS. PET showed reduced presynaptic dopamine function typical of sporadic PD in a patient with PD and ET, but not in persons with ET or RLS. The inheritance pattern was autosomal dominant for PD and RLS. No known pathogenic mutation in PD-related genes was found. Fourteen of the family members with PD, ET, or RLS had depression. Neuropathologic examination revealed pallidonigral pigment spheroid degeneration with ubiquitin-positive axonal spheroids, TDP43-positive pathology in the basal ganglia, hippocampus, and brainstem, and only sparse Lewy bodies. Familial forms of PD, ET, RLS, and depression occur in this family. The genetic cause remains to be elucidated.

  4. The emergence of devastating impulse control disorders during dopamine agonist therapy of the restless legs syndrome.

    Science.gov (United States)

    Dang, Dien; Cunnington, David; Swieca, John

    2011-01-01

    The Restless Legs Syndrome is a common sensorimotor disorder, typically amenable to treatment with dopamine agonist therapy. Dopamine agonists have been associated with emergent impulse control disorders (ICDs) when used in patients with Parkinson disease, and ICDs have now been reported in individuals with RLS on dopamine agonist therapy. Our aim was to characterize cases of emergent ICDs in Australian patients with focus on the dopamine agonists implicated and the social significance of ICDs. A series of RLS patients on dopamine agonist therapy were identified with ICDs over a 2-year period. Additional cases of ICDs were found using a mailout questionnaire designed to capture those with high impulsivity. These patients were assessed using the Barratt Impulsiveness Scale, Version 11, and a modified Minnesota Impulse Disorders Interview. Case records and medication schedules were evaluated. Twelve cases of patients with de novo ICDs were found with a range of impulsive behaviors including pathological gambling, kleptomania, compulsive shopping, and hypersexuality. Criminality, suicidality, and marital discord also were featured. These occurred over a wide range of latencies and l-dopa exposures. This group of Australian RLS patients with ICDs display high levels of impulsivity and is the first to use the BIS-11 questionnaire in this setting. Impulse control disorders can occur over a wide range of dopamine agonist therapy types and dose exposures. Impulse control disorder tendencies may persist, despite withdrawal of dopamine agonists. The emergence of ICDs needs careful consideration in light of their potentially devastating financial, social, and marital consequences.

  5. [Socioeconomic relevance of the idiopathic restless legs syndrome (RLS) in Germany: cost-of-illness study].

    Science.gov (United States)

    Nelles, Sandra; Köberlein, Juliane; Grimm, Christine; Pittrow, David; Kirch, Wilhelm; Rychlik, Reinhard

    2009-05-15

    1.3% of German adults suffer from clinically relevant restless legs syndrome (RLS). A cost-of-illness study was conducted to evaluate the costs for diagnosis and therapy of the idiopathic RLS. A clinical pathway based on expert guidelines was developed. The costs for the 1st year of treatment in idiopathic RLS were calculated with the Markov Model. Relevant published clinical study data were used for the model as well as questioning of physicians. Costs per patient with approved drug treatment are 989.80 Euro for sickness funds and 1,285.26 Euro from the societal perspective. Drug costs are the main cost components for sickness funds and the society with 69% and 61%, respectively. Less than half of the patients continue an L-dopa therapy longer than 1 year. About one quarter of all RLS patients need off-label therapy after the 1st year of treatment. The costs for a guideline-oriented therapy for all patients with clinically relevant RLS in Germany are about 1,135 billion Euro, representing 0.5% of all health-related costs in Germany. Further controlled clinical trials are required to provide evidence for the efficacy of different treatment options including drugs without an approval for RLS and long-term use. Health services research is required for cost-utility analysis, to evaluate the costs of inadequate treatment, and to obtain additional information to improve the resource allocation in RLS treatment.

  6. Linking restless legs syndrome with Parkinson's disease: clinical, imaging and genetic evidence

    Directory of Open Access Journals (Sweden)

    Peeraully Tasneem

    2012-02-01

    Full Text Available Abstract Restless legs syndrome (RLS and Parkinson's disease (PD are both common neurological disorders. There has been much debate over whether an etiological link between these two diseases exists and whether they share a common pathophysiology. Evidence pointing towards a link includes response to dopaminergic agents in PD and RLS, suggestive of underlying dopamine dysfunction in both conditions. The extrastriatal dopaminergic system, in particular altered spinal dopaminergic modulation, may be variably involved in PD patients with RLS symptoms. In addition, there is now evidence that the nigrostriatal system, primarily involved in PD, is also affected in RLS. Furthermore, an association of RLS with the parkin mutation has been suggested. The prevalence of RLS has also been reported to be increased in other disorders of dopamine regulation. However, clinical association studies and functional imaging have produced mixed findings. Conflicting accounts of emergence of RLS and improvement in RLS symptoms after deep brain stimulation (DBS also contribute to the uncertainty surrounding the issue. Among the strongest arguments against a common pathophysiology is the role of iron in RLS and PD. While elevated iron levels in the substantia nigra contribute to oxidative stress in PD, RLS is a disorder of relative iron deficiency, with symptoms responding to replacement therapy. Recent ultrasonography studies have suggested that, despite overlapping clinical features, the mechanisms underlying idiopathic RLS and RLS associated with PD may differ. In this review, we provide a concise summary of the clinical, imaging and genetic evidence exploring the link between RLS and PD.

  7. Comorbidities, medications and depressive symptoms in patients with restless legs syndrome and migraine

    Directory of Open Access Journals (Sweden)

    Karen S. Ferreira

    Full Text Available OBJECTIVE: The pathophysiology of migraine and restless legs syndrome (RLS seems to involve inherited mechanism and dysfunction of the dopaminergic system. Previous articles have shown that the frequency of RLS is higher in migraine patients than in controls. We conducted a study to evaluate comorbidities, medication used and depressive symptoms that can explain the relation between migraine and RLS. METHODS: A case-control study was performed in which patients with migraine (n=72 and a control group without migraine (n=72 were interviewed. Data including RLS diagnosis, depressive symptoms, comorbidities and drugs used were evaluated. RESULTS: There was a significant association between migraine and RLS (p=0.01, but comorbidities such as diabetes, hypertension, anemia and drugs used did not explain this association. Depression scores, as measured by the Beck Depression Inventory, were higher in migraine patients with RLS (p =0.04. CONCLUSION: No specific factors explaining the association between migraine and RLS were found. Symptoms of depression were more frequent in patients with migraine and RLS.

  8. Plantar reflex excitability is increased in the evening in restless legs syndrome patients.

    Science.gov (United States)

    Dafkin, Chloe; Green, Andrew; Olivier, Benita; McKinon, Warrick; Kerr, Samantha

    2017-11-01

    To investigate if diurnal changes in spinal excitability (plantar reflex) occur in restless legs syndrome (RLS) participants compared to healthy matched controls. Thirteen RLS participants and 13 healthy control participants' plantar reflex responses were evaluated in the evening (PM) and t