Periodic Movements In Sleep Research Articles

Difference in spectral power density of sleep EEG between patients with simple snoring and those with obstructive sleep apnoea

Patients with simple snoring (SS) often complain of poor sleep quality despite a normal apnoea-hypopnoea index (AHI). We aimed to identify the difference in power spectral density of electroencephalography (EEG) between patients with SS and those with obstructive sleep apnoea (OSA). We compared the absolute power spectral density values of standard EEG frequency bands between the SS (n = 42) and OSA (n = 129) groups during the non-rapid eye movement (NREM) sleep period, after controlling for age and sex. We also analysed partial correlation between AHI and the absolute values of the EEG frequency bands. The absolute power spectral density values in the beta and delta bands were higher in the OSA group than in the SS group. AHI also positively correlated with beta power in the OSA group as well as in the combined group (OSA + SS). In conclusion, higher delta and beta power during NREM sleep were found in the OSA group than in the SS group, and beta power was correlated with AHI. These findings are microstructural characteristics of sleep-related breathing disorders.

Respiratory-Related Leg Movements of Sleep Are Associated With Serotonergic Antidepressants But Not Bupropion.

Respiratory-related leg movements (RRLMs) may contribute to the cardiovascular risk associated with obstructive sleep apnea (OSA). Selective serotonin reuptake inhibitors (SSRIs), but not bupropion, increase periodic leg movements in sleep. This study examines whether patients with OSA using SSRIs have more RRLMs than those taking bupropion or no antidepressant. Patients with an apnea-hypopnea index (AHI) of at least 10 events/h during a full-night diagnostic study or split-night study, who were taking bupropion (n = 32), an SSRI (n = 31), or no antidepressant (n = 31), were selected from a database of prestudy questionnaires. RRLMs were scored according to World Association of Sleep Medicine 2016 standards. Patients using SSRIs had significantly greater overall RRLM% (defined as the percentage of respiratory events associated with a leg movement, including apneas, hypopneas, and respiratory effort-related arousals), RRLM index, and periodic limb movement index relative to patients using bupropion and control patients. The difference between the RRLM% in the SSRI and bupropion groups was limited to patients undergoing split-night studies, and that of the SSRI and control groups was limited to patients undergoing full-night diagnostic studies. The greater number of RRLMs and PLMs in the SSRI group may contribute to treatment-emergent insomnia often seen with SSRI use. Fragmented sleep and elevated autonomic nervous system activation associated with increased RRLMs in patients with OSA taking SSRIs might also limit the tolerability of antidepressant treatment, as well as increase the risk for cardiovascular disease.

Protocolo terapéutico de las alteraciones del sueño en el anciano

Complaints about the quality of sleep in older have a high prevalence due to various factors: sleep physiological changes that occur with aging, primary sleep disorders, secondary disorders to pathologies, treatments or psychosocial factors of the elderly, and poor sleep hygiene. They are associated with high subjective stress, increased risk of falls and raise the possibility of long-term care, institutionalization and impaired quality of life and functional cognitive ability. In this paper we analyze the main sleep disorders in the elderly, especially focusing on the primary sleep disorders such as insomnia, sleep apnea, restless leg syndrome, periodic movements of sleep, circadian rhythm disorder, the disorder of REM sleep behavior and hypersomnia, both pharmacological and therapeutic measures and otherwise, we have at our disposal.

Cell Transplantation: A Future Therapy for Narcolepsy?

Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep-onset rapid eye movement (REM) sleep periods. Narcolepsy is now identified to be a neurodegenerative disease, as there is a massive loss of neurons containing the neuropeptide, hypocretin/orexin. Orexin neurons are solely located in the hypothalamus, particularly in its perifornical, dorsomedial and lateral portions. Orexin fibers widely project throughout the brain and generally have excitatory effects on their postsynaptic cells. Patients with narcolepsy have a severe reduction in the levels of orexins in the cerebrospinal fluid, a finding consistent with orexin neuronal loss. Experimental models have been generated in order to study the physiology of the orexin system and narcolepsy. The discovery of orexin deficiency in narcolepsy is redefining the clinical entity of narcolepsy and offering novel diagnostic procedures. This article reviews the current understanding of narcolepsy and discusses the opportunity to explore the potential use of transplants as a therapeutical tool in order to treat narcolepsy.

α‐Melanocyte stimulating hormone and adrenocorticotropic hormone: An alternative approach when thinking about restless legs syndrome?

Alpha-melanocyte stimulating hormone (alpha-MSH) and adrenocorticotropic hormone (ACTH) possess properties suggesting that they may be involved in the pathogenesis of restless legs syndrome (RLS). We sought to determine if alpha-MSH and ACTH when administered centrally in rat recapitulate features reminiscent of RLS: increased activity, sleep fragmentation, and periodic movements during sleep. Rats were instrumented with electroencephalography, electromyography, and intracerebral cannulae and recorded for the measurement of sleep, periodic movements, and behavior following intracerebroventricular administration of alpha-MSH, ACTH, or saline. Studied behavior included grooming, locomotion, and rearing during wake and limb movements during sleep. Vigilance states included active wake (AW), quiet wake (QW), slow wave sleep I (SWSI), slow wave sleep II (SWSII), and paradoxical sleep (PS). All rats received normal saline acting as their own controls. Different rats received alpha-MSH in doses of 0.05, 0.5, 1.0, 2.0, and 6.0 microg or ACTH in doses of 0.5, 1.0, and 2.0 microg. Administered alpha-MSH caused an increase in waking behavior and prolongation of sleep latency, while ACTH stimulated waking behavior and fragmented sleep, yielding more AW and less SWSII and PS. Both hormones increased periodic movements during sleep. When administered centrally in rat, alpha-MSH and ACTH stimulate motor activity in wake, cause changes in sleep architecture, and increase periodic movements in sleep. These melanocortin hormones may play a role in the pathogenesis of RLS.

Can chronic neuroleptic treatment promote sleep disturbances in elderly schizophrenic patients?

It has been proposed that sleep disturbances, especially reduced delta sleep, are related to a poor outcome in schizophrenia. To determine whether long-term treatment with neuroleptics can promote sleep disturbances by increasing the risk of a nocturnal myoclonus syndrome (NMS) (=periodic movements in sleep) related insomnia, we performed all-night polysomnography in 10 chronically ill schizophrenic patients who had been under neuroleptic therapy for a mean of 27 years. NMS-related insomnia was detected in all 10 patients. Potential pathophysiological relationships between long-term neuroleptic therapy and NMS occurrence are discussed. Our findings suggest that long-term administration of neuroleptics favours the appearance of insomnia.

Sleep in peri-menopausal and post-menopausal women.

Despite the fact that a large number of women report sleep disturbances associated with peri-menopausal and post-menopausal periods, there is a surprising lack of literature related to this issue. In fact, there has not been enough work in this area to even definitively establish whether there is a sleep disorder that is specifically related to these life-stage changes. Herein we review the available literature which suggests that insomnia may be directly linked to the changes that occur during the peri/post-menopausal periods. This insomnia appears to be due to night sweats caused by the hormonal changes which occur and which lead to an increase in arousals. Persistence of insomnia symptoms after adequate hormone replacement therapy may indicate that behavioral conditioning of the insomnia initially triggered by the night sweats may have occurred. Alternatively, such an insomnia in a peri/post-menopausal woman could be due to unresolved grief related to going through menopause or could reflect an independent sleep disorder, such as periodic movements of sleep, sleep apnea, depression, anxiety, etc. Whereas menopausal changes do not directly lead to an increase in sleep apnea they seemingly contribute to an increased risk for this disorder. In view of these considerations, we provide guidelines for the proper diagnosis and treatment of peri/post-menopausal women with sleep complaints.

Abnormal movements in sleep as a post-polio sequelae.

Nearly two-thirds of polio survivors report abnormal movements in sleep, with 52% reporting that their sleep is disturbed by these movements. Sleep studies were performed in seven polio survivors to document objectively abnormal movements in sleep. Two patients demonstrated generalized random myoclonus, with brief contractions and even ballistic movements of the arms and legs, slow repeated grasping movements of the hands, slow flexion of the arms, and contraction of the shoulder and pectoral muscles. Two other patients demonstrated periodic movements in sleep with muscle contractions and ballistic movements of the legs, two had periodic movements in sleep plus restless legs syndrome, and one had sleep starts involving only contraction of the arm muscles. Abnormal movements in sleep occurred in Stage II sleep in all patients, in Stage I in some patients, and could significantly disturb sleep architecture even though patients were totally unaware of muscle contractions. Poliovirus-induced damage to the spinal cord and brain is presented as a possible cause of abnormal movements in sleep. The diagnosis of post-polio fatigue, evaluation of abnormal movements in sleep, and management of abnormal movements in sleep using benzodiazepines or dopamimetic agents are described.

Identification and treatment of sleep problems in the elderly.

For many adults, changes in sleep occur with aging. An estimated 15 million elderly, or 50% of older Americans, experience some sleep problem. The elderly complain that their sleep is more fragmented and that as they have gotten older, they experience more daytime sleepiness. Laboratory studies have confirmed these complaints. Research has shown that it is not the need for sleep that decreases with age, but rather the ability to sleep. Circadian rhythm disturbances, sleep disorders such as sleep disordered breathing and periodic movements in sleep, medical illness, medication use, and impaired cognitive functioning all contribute to poor sleep and decreased daytime alertness. In institutionalized elderly, sleep is even more disturbed and disrupted. With careful assessment, many of these problems can be addressed and treated, and sometimes cured.

Home assessment of sleep disorders by portable monitoring.

Ambulatory home monitoring has been employed for a number of applications. Portable sleep/wake recorders are useful for assessment of the hypersomnias, circadian sleep/wake disorders, parasomnias, and periodic movements in sleep. Wrist actigraphy can usefully approximate sleep versus wake state during 24 h and has been used for monitoring insomnia, circadian sleep/wake disturbances, and periodic limb movement disorder. Home monitoring of cardiopulmonary parameters can be employed for detection and follow-up of sleep-disordered breathing (sleep apnea, upper airway resistance syndrome). The techniques available for portable monitoring, although valuable, do not replace traditional in-laboratory polysomnography for full assessment of a sleep disorder.

Restless Legs Syndrome

Restless legs syndrome is characterized by unpleasant, deep-seated paresthesias in the legs and sometimes the arms. These sensations occur at rest and are relieved by movement. Sleep disturbance is common. Many patients also have periodic movements of sleep. Mild symptoms of restless legs occur in up to 5% of the population. Restless legs syndrome is idiopathic in most patients, but it may be the presenting feature of iron deficiency and is also common in uremia, pregnancy, diabetes mellitus, rheumatoid arthritis, and polyneuropathy. Treatment of the underlying cause, when possible, usually relieves the symptoms. For patients with severe symptoms, levodopa, bromocriptine mesylate, opioids, carbamazepine, clonazepam, and clonidine hydrochloride have proved to be effective.

The relationship between headaches and sleep disturbances.

The relationship between headaches and sleep disturbances is complex and difficult to analyze. Both symptoms may have causal relations, or may be associated in the same patient with mutual reinforcements. We studied 25 patients presenting with morning or nocturnal headaches. Standard headache diagnosis and polysomnography were performed. After polysomnography, the diagnoses were reevaluated. The main headache entities were cluster, chronic paroxysmal hemicrania, migraine, tension, combined headache, and chronic substance abuse headache. For each group, headache, sleep data, and changes in diagnosis are discussed. The diagnosis was changed in 13 patients; the final diagnoses were periodic movements of sleep, fibromyalgia syndrome, and obstructive sleep apnea. The diagnoses of cluster headache and chronic paroxysmal hemicrania were not modified by polysomnography. The migraine and tension headache groups had a relative male preponderance, and the diagnosis was changed in approximately half of the patients. This was also observed in combined headaches. Patients who had chronic substance abuse headaches had mainly insomnia, which in some cases, was relieved by stopping medication. Data were also analyzed in terms of simple models linking headache and sleep disturbances. Such an approach allowed the identification of several modes of mutual interaction. In summary, morning or nocturnal headaches are frequent indicators of a sleep disturbance and their presence might justify polysomnography, and the use of simple clinical models may be useful for understanding the complex relationship between headache and sleep.

Periodic Leg Movements (PLM): Their Relationship to Sleep Stages

We investigated the characteristics of periodic leg movements (PLM) during nocturnal sleep and wakefulness in 13 drug-free patients presenting with the restless legs syndrome (RLS, n = 9) or with isolated PLM (n = 4). Eight-hour polygraphic sleep recordings included the electromyogram (EMG) of both tibialis anterior muscles. Scoring of leg movements was done according to established criteria for periodic movements in sleep, but movements occurring during episodes of wakefulness were scored as well. Twelve out of 13 patients had PLM during wakefulness, including three subjects not affected by RLS. The frequency of periodic movements in sleep (PMS) per hour of total sleep time was significantly lower than the frequency of PLM (including movements during wakefulness) per hour of polygraphic recording. Movement indices based on PMS alone underestimated the relative frequency of PLM particularly in patients with high amounts of wakefulness (> 20%). All features of PLM clearly differed between sleep stages. Relative frequency of movements, their duration and their arousing effect decreased along the nonrapid eye movement (NREM) sleep stages, whereas the intermovement interval increased. During rapid eye movement (REM) sleep the duration of movements was shortest and the intermovement interval was longest. The results presented suggest that the processes underlying PLM are most active at the transition from wakefulness to sleep and considerably attenuated during deep NREM sleep and even more during REM sleep. We suggest including movements during wakefulness in routine PLM scoring to get a more complete picture of the disturbance.

Dopamine D2 receptor alteration in patients with periodic movements in sleep (nocturnal myoclonus).

Periodic movements in sleep (PMS) can cause severe sleep disturbances. We investigated the central dopamine D2 receptor density in patients with PMS with 123I-IBZM and single photon emission tomography (SPET). In PMS there was a lower 123I-IBZM binding in the basal ganglia compared to the control group. The results indicate a loss of central D2 receptors in PMS.

Plasma renin activity and sleep-wake structure of narcoleptic patients and control subjects under continuous bedrest.

In order to determine if renin release would be affected by a dysfunction of the circadian and ultradian organization of sleep, 24-hour profiles of plasma renin activity (PRA) concomitant with sleep stages were established in 10 normal subjects and nine narcoleptic patients, with 10-minute blood sampling intervals. Mean PRA levels were similar in control subjects and narcoleptic patients. Individual 24-hour profiles revealed that the previously described association between renin oscillations and sleep stage alternations was preserved. Increased PRA release was observed during the transition from rapid eye movement (REM) sleep or waking periods to nonrapid eye movement (NREM) sleep, and REM sleep occurred as PRA levels were decreasing. Thus, PRA curves exactly reflected the irregularities and disturbances in the sleep structure of the narcoleptic patients. The 24-hour PRA profiles of the patients did not show the general upward trend during nighttime sleep, which is probably induced in the control subjects by the repetitive recurrence of longer episodes of undisturbed NREM sleep. Because of marked sleep fragmentation in the patients, the duration of NREM sleep was often insufficient to allow for the occurrence of a significant PRA increase. Because sleep onset REM (SOREM) episodes, characteristic of narcolepsy, are not preceded by NREM sleep and its associated increase in PRA, no relative PRA decline occurred during this type of REM sleep. In conclusion, the 24-hour PRA profiles of the narcoleptic patients reflected exactly their sleep stage distribution, confirming previous findings that PRA oscillations appear to be inseparable from the NREM-REM sleep cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment [RETIRED

Polysomnography and measurements of physiologic sleepiness (MSLT/MWT) have been established as effective and safe in identifying many sleep/wake disorders, and have identified and defined a number of specific conditions such as SDB, narcolepsy, idiopathic CNS hypersomnia, periodic movements of sleep, and the REM sleep behavior disorder. The performance of these studies requires specialized equipment and accommodations. This technology, coupled with other clinical information and appropriate medical tests, particularly in experienced hands, is valuable in the diagnosis, classification, and treatment of patients with sleep disorders.

Sleep-Related Eating Disorders: Polysomnographic Correlates of a Heterogeneous Syndrome Distinct from Daytime Eating Disorders

Over a 5-yr period, 19 adults presented to our sleep disorders center with histories of involuntary, nocturnal, sleep-related eating that usually occurred with other problematic nocturnal behaviors. Mean age (+/- SD) at presentation was 37.4 (+/- 9.1) yr (range 18-54); 73.7% of the patients (n = 14) were female. Mean age of sleep-related eating onset was 24.7 (+/- 12.9) yr (range 5-44). Eating occurred from sleep nightly in 57.9% (n = 11) of patients. Chief complaints included excessive weight gain, concerns about choking while eating or about starting fires from cooking and sleep disruption. Extensive polysomnographic studies, clinical evaluations and treatment outcome data identified three etiologic categories for the sleep-related eating: (a) sleepwalking (SW), 84.2% (n = 16); (b) periodic movements of sleep (PMS), 10.5% (n = 2) and (c) triazolam abuse (0.75 mg hs), 5.3% (n = 1). DSM-III Axis 1 psychiatric disorders (affective, anxiety) were present in 47.4% (n = 9) of the patients, and only two patients had a daytime eating disorder (anorexia nervosa), each in remission for 3-7 yr. Nearly half of all patients fulfilled established criteria for being overweight, based on the body mass index. Onset of sleep-related eating was linked directly to the onset of SW, PMS, triazolam abuse, nicotine abstinence, chronic autoimmune hepatitis, narcolepsy, encephalitis or acute stress. In the SW group, 72.7% (8/11) of patients had nocturnal eating and other SW behavior suppressed by clonazepam (n = 7) and/or bromocriptine (n = 2) treatment. Both patients with PMS likewise responded to treatment with combinations of carbidopa/L-dopa, codeine and clonazepam. Thus, sleep-related eating disorders can generally be controlled with treatment of the underlying sleep disorder.

Disorders of movement and behaviour during sleep (see also page 303)

To outline recently described movement disorders during sleep which are common and poorly recognised. Computer-based literature search up to July 1990 (with the index terms sleep disorders, sleep myoclonus, nocturnal myoclonus, periodic movements in sleep, REM behaviour disorder and parasomnias) supplemented by a manual search through the references of papers obtained by computer search and a manual search through contents of the following journals: Sleep, Sleep Research, Neurology and Brain. There is a group of common and poorly recognised movement disorders during sleep. The patient usually presents complaining of disturbed sleep, daytime somnolence and abnormal nocturnal behaviour. These conditions are susceptible to precise diagnosis and effective treatment.

A Clinical and Polysomnographic Comparison of Neuroleptic-Induced Akathisia and the Idiopathic Restless Legs Syndrome

Neuroleptic-induced akathisia (NIA) is motor restlessness caused by dopamine receptor blocking antipsychotic agents. Nine patients with NIA and 11 patients with idiopathic restless legs syndrome (RLS) were studied polysomnographically. The sleep disturbances were milder in NIA than idiopathic RLS but increased numbers of awakenings and decreased sleep efficiencies were common to both groups. In addition, RLS patients demonstrated prolonged sleep latencies. Periodic movements in sleep (PMS) were present in only 5 of 9 patients with NIA but in all 11 patients with idiopathic RLS. In no NIA patient did we see the multiple, large amplitude, violent, resting myoclonic jerks of the legs that we saw during wakefulness in some of our more severe cases of idiopathic RLS. NIA patients tended to experience inner restlessness and idiopathic RLS patients tended to experience leg paresthesias as an antecedent to motor restlessness. Idiopathic RLS patients had symptoms that were worse at night and in repose far more frequently than patients with NIA. NIA and idiopathic RLS have similarities and differences. Because both NIA and idiopathic RLS are characterized by motor restlessness and sleep disturbances, the pharmacodynamics of antipsychotic medications may give clues as to both the cause and treatment of idiopathic RLS.

Night sleep electroencephalogram power spectral analysis in excessive daytime sleepiness disorders

A group of 53 patients (40 males, 13 females) with mean age of 49 years, ranging from 30 to 70 years, was evaluated in the following excessive daytime sleepiness (EDS) disorders: obstructive sleep apnea syndrome (B4a), periodic movements in sleep (B5a), affective disorder (B2a), functional psychiatric non affective disorder (B2b). We considered all adult patients referred to the Center sequentially with no other distinctions but these three criteria: (a) EDS was the main complaint; (b) right handed; (c) not using psychotropic drugs for two weeks prior to the all-night polysomnography. EEG (C3/A1, C4/A2) samples from 2 to 10 minutes of each stage of the first REM cycle were chosen. The data was recorded simultaneously in magnetic tape and then fed into a computer for power spectral analysis. The percentage of power (PP) in each band calculated in relation to the total EEG power was determined of subsequent sections of 20.4 s for the following frequency bands: delta, theta, alpha and beta. The PP in all EDS patients sample had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage. PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were close to stage 2 levels. In an EDS patients interhemispheric coherence was high in every band and sleep stage. B4a patients sample PP had a tendency to decrease progressively from the slowest to the fastest frequency bands, in every sleep stage; PP distribution in the delta range increased progressively from stage 1 to stage 4; stage REM levels were between stage 1 and stage 2 levels.(ABSTRACT TRUNCATED AT 250 WORDS)