Primary Sleep Disorders Research Articles

An Ayurveda approach for managing Geriatric Sleep Disturbances: A Comprehensive Review

Background: Ageing is defined as the progressive deterioration in structure and function of the body organs. In Ayurveda literature ageing (Jara) has been given importance since Vedic period as the natural, progressive phenomenon. In Ayurveda, Sleep (Nidra) is one of the Upasthambha (Sub-Pillar) which is essential for overall health. Ageing causes multiple changes in sleep patterns, and various diseases can further disrupt sleep. Ayurveda describes the physiological increase of Vata Dosha in old age which causes Vata Prakopa in body leading to degeneration of Dhatu (Dhatukshaya) which alter the sleep patterns. Aim: The paper aims to review common sleep disturbances seen in ageing and their prevention and management through Ayurveda. The study discusses various patterns of sleep during ageing and their possible management through Ayurveda. Primary sleep disorders common in the geriatric population such as; insomnia, obstructive sleep apnea, restless leg syndrome, circadian rhythm sleep-wake disorder was discussed and their management through Ayurveda was reviewed. The selection of Ayurvedic treatment and procedures which nourishes Dhatu and pacify Vata Dosha are effective in managing sleep disturbances. Result: The study finds that Vatashamak Chikitsa, regulation of Agni, Dincharya, Ritucharya, Vegdharan, use of Rasayana, Panchakarma, Yogasana are beneficial for the management of sleep disturbances. Conclusion: Sleep disturbances are common in ageing and can be managed efficiently through Ayurveda.

Hypnosis: An aid in working with patients with narcolepsy

ABSTRACT Narcolepsy is a primary neurological sleep disorder characterized by excessive daytime sleepiness, and in a majority of patients, cataplexy, which is sudden muscle weakness brought on by strong emotion. While often thought of as an adult condition, narcolepsy can be present at any age and may occur as often as 1 in 2000 individuals. Regardless of age, its effects are far-reaching, resulting in missed school or work days, poor school or work performance and all associated ramifications. In children and young-adults, narcolepsy can masquerade for years as anxiety, depression, attention deficit disorder and even bipolar disorder, thus delaying diagnosis. Most patients diagnosed with narcolepsy receive significant benefit from standard medication. In addition to medication, however, this article describes promising roles for clinical hypnosis in the care of young patients with narcolepsy, including through teaching them how to have more control over their sleepiness and the emotions that can induce cataplexy, while minimizing side effects that can occur when using narcolepsy medication.

Phenotyping sleep disturbances in ADHD and identifying harmonised outcome measures

AbstractAttention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD in children and adolescents is primarily centred on daytime functioning and the associated impairment of academic performance, although disrupted and restless sleep have been frequently reported in individuals with ADHD. Further, it has been recognised that sleep disorders not only intensify existing ADHD symptoms but in some cases can also mimic ADHD symptoms in the paediatric population with primary sleep disorders. Under the title ‘The blind spot: sleep as a child’s right issue?’, professionals from diverse disciplines, including medicine and social sciences as well as individuals with an interest in ADHD and sleep medicine, including laypeople, have initiated a unifying discourse. The objective of this discourse is to improve our understanding of the diagnosis and treatment of ADHD and disruptive behaviours and to develop personalised and precision medicine. Research has shown that the existing, primarily descriptive and categorical diagnostic systems do not capture the heterogeneous nature of youth with attentional and behavioural difficulties and the phenotypic expressions thereof, including nighttime behaviours and sleep. New strategies for clinical phenotyping and the exploration of patient-reported behaviours are necessary to expand our understanding and develop personalised treatment approaches. In this position paper, we outline gaps in the clinical care of ADHD and related sleep disturbances, review strategies for closing these gaps to meet the needs of individuals with ADHD, and suggest a roadmap for escaping the one-size-fits-all approach that has characterised ADHD treatment algorithms to date.

СИНДРОМ ДЕФИЦИТА ВНИМАНИЯ С ГИПЕРАКТИВНОСТЬЮ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ

Attention deficit hyperactivity disorder (ADHD) is one of the most widespread forms of neurodevelopmental disorders. Modern clinical criteria for the ADHD diagnosis, issues of differential diagnosis in the pediatric practitioner’s routine (with asthenic syndrome in somatic diseases, primary sleep disorders, fetal alcohol syndrome, thyroid diseases) are described in the Article. The data of recent studies on the ADHD pathogenesis mechanisms are discussed as well. ADHD requires comprehensive treatment approach. The results of a multicenter randomized double-blind placebo-controlled clinical trial on the efficiency and safety of the new domestically produced medication, “Prospecta,” in the treatment of ADHD in children are presented.

Patient accessibility and utilization of behavioral sleep medicine referrals in an academic center.

Behavioral sleep medicine (BSM) is a subspecialty that combines behavioral psychology and sleep medicine specialties. The objective of this study was to analyze referral patterns to a BSM clinic. The three specific aims were: (1) describe factors that predict referral acceptance, (2) identify barriers to attending initial appointment, and (3) describe variables associated with the number of visits attended. Retrospective chart reviews were conducted as part of a quality improvement project by this study team's clinical setting. Adults over 21 years of age who were referred to a behavioral sleep medicine clinic in an urban Midwestern academic healthcare system between 2014-2019 were included in this study. Sleep medicine was the main referral source for BSM patients (74.2%), followed by internal medicine (9.3%) and neurology/psychiatry (7.3%). Thirty-eight percent of patients did not schedule an appointment after a referral for BSM was initiated. Younger age, longer distance from clinic, commercial insurance and out of network insurance were all significantly greater for non-schedulers. Eighty-three percent of patients did attend the initial intake session with BSM providers. Older age was associated with lower likelihood of not attending scheduled BSM appointments. Patient characteristics of older age, closer distance from clinic, and in network insurance coverage were found to significantly increase the likelihood of BSM scheduling, while younger age, Black race and not getting a primary sleep disorder diagnosis (versus a diagnosis of Insomnia Disorder) and shorter days from referral to appointment were associated with an increased likelihood of not attending the scheduled BSM treatment engagement.

Can Improving Postoperative Sleep Speed Up Surgical Recovery?

Sleep disturbance is common during recovery after surgical procedures and may have an important effect on mortality, and quality of life. Sleep restriction/deprivation, including decreased quantity and continuity, is common in patients who are patients and persons with acute and chronic illnesses. Age, gender, illness, primary sleep disorders, environment, and medical treatment factors are thought to influence sleep throughout the preoperative period, hospitalization, and recovery. Resulting sleep pattern disturbances include decreases in circadian patterning, continuity, duration, and perceived (subjective) sleep quality. This article synthesizes sleep disturbance in patients who have undergone surgery and highlights sleep strategies to improve faster surgical recovery.

Effects of Modifiable Activity-Related Health Behaviors on the Sleep-Pain Relationship in Adolescents

Poor sleep and chronic pain are commonly related in adolescents. Only 5% of adolescents meet recommendations for physical activity and screen time, both of which impact the experience of sleep and pain disturbances. Research is needed to better understand the sleep-pain relationship in adolescents and to identify potential protective factors, such as activity-related health behaviors. This study examined sleep, behaviors that influence activity (i.e., physical activity, screen time), and their interaction as predictors of pain in a sleep-disordered sample of 105 adolescents aged 12–18 presenting for polysomnography. A hierarchical multiple linear regression was conducted to examine these relationships. Consistent with hypotheses, worse insomnia predicted worse pain. However, other activity-related health behaviors did not influence this relationship, ps > .05. Findings suggest that sleep should be the focus of treatment for adolescents with primary sleep disorders to prevent the onset or exacerbation of pain.

A Comparative Study of Architecture and Quality of Sleep among Juvenile Myoclonic Epilepsy Patients and Healthy Individuals Attending Tertiary Care Hospital in Central India


 
 
 
 Background and Objective: Primary sleep disorders are common in patients with epilepsy. Seizures, epileptiform discharges, and antiepileptic drugs alter the sleep architecture of patients with juvenile myoclonic epilepsy (JME). We evaluated sleep architecture and its quality in these patients.
 Materials and Methods: Thirty patients with JME (11 men and 19 women with mean age of 21.10 ± 4.55 years) and 30 healthy controls underwent overnight polysomnography (PSG). Sleep quality and daytime sleepiness were assessed using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively.
 Results: Myoclonus and generalized tonic-clonic seizures (GTCS) were present in all patients with JME, while absence seizures were in 13.3%. Sleep deprivation was the most frequent precipitating factor for seizures (56.6%) followed by fatigue, sound, and photic stimulation. Patients with JME reported a statistically significant drop in sleep efficiency (P<0.001) with prolonged sleep onset latency (P<0.001). There was prolongation in the N1 stage of non-rapid eye movement (NREM) sleep (P=0.002), and reduction in the N2 stage of NREM (P<0.001) and rapid eye movement (REM) sleep (P<0.001). The median PSQI score was higher in patients with JME, suggesting poor sleep quality (P<0.001), and the daytime sleepiness was not different as indicated by the similar median ESS score (P=0.033).
 Conclusion: Our results suggest a significant alteration in the sleep architecture of patients with JME with reduced sleep efficiency and poor sleep quality. The possible role of the disease itself is suggested for these alterations as a simi- lar trend was also observed in drug naïve patients.
 
 
 

Primary Headaches and Sleep Disorders: Review of Literature about Comorbidity in Children and Adolescents

Sleep disorders and primary headaches are frequent health problems in childhood, and they are often comorbid in an individual, linked by a mutual and complex relationship. This comorbidity is frequent and well documented, but the available literature is usually biased in favor of one aspect or another, mainly depending on the expertise of the authors. The aim of this article is to review existing literature on the comorbidity between primary headaches and sleep disorders in pediatric age and summarize the heterogeneous results. Our findings, involving a total of 12 studies and 16.474 subjects aged 2–18 years, indicate a bidirectional and strong relationship between headache and sleep disorders in childhood, with multiple associations between headache features and sleep disturbances. This can be explained by many common pathophysiologic pathways. Improving sleep quality could help to reduce migraine intensity and disability and vice versa.

Gender medicine and sleep disorders: from basic science to clinical research.

Several pivotal differences in sleep and sleep disorders are recognized between women and men. This is not only due to changes in hormonal balance during women's reproductive life, such as in pregnancy and menopause. Women are more likely to report insomnia and non-specific symptoms of apneas, such as fatigue or mood disturbance, compared to men. Thus, it is important for clinicians and researchers to take sex and gender differences into account when addressing sleep disorders in order to acknowledge the biology unique to women. We present a narrative review that delves into the primary sleep disorders, starting from basic science, to explore the impact of gender differences on sleep and the current status of research on women's sleep health.

Restless Sleep Disorder as a New Primary Sleep Disorder in Children and Adolescents

Restless sleep is a frequent complaint clinically and often associated with specific sleep or medical conditions. Recently, restless sleep disorder (RSD) has been identified as a new pediatric sleep disorder with core features of restless sleep and frequent large muscle movements during sleep, which are not explained by other conditions. Based on the medical literature and expert clinical experience, the task force developed a consensus diagnostic criteria for RSD and scoring large muscle group movements in children aged 6–18 years. Eight essential criteria of RSD include a complaint of restless sleep, observed large body movements during sleep, video-polysomnographic documentation of ≥5 large body movements/hour, occurrence at least thrice weekly for at least 3 months, clinically significant impairment, and differentiation from other conditions that may secondarily cause restless sleep. There is evidence to support a pathophysiology based on iron deficiency, sleep instability, and increased sympathetic activation, and treatment options include oral or intravenous iron supplementation. This review describes the key features of RSD, potential pathophysiology, and current treatment options to help diagnose patients with RSD, which has been overlooked.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Sleep Related Rhythmic Movement Disorder in older children and adults and their association with comorbid conditions – experience from two centres and literature review

Sleep related rhythmic movement disorders (SRRMD) are highly prevalent among infants and children and tend to disappear into adolescence and adulthood. However, few reports have identified patients who had rhythmic movements at wake-sleep transition persisting into adulthood. This is a case series of SRRMD diagnosed on video-polysomnography from retrospective chart review of patients, who were 6 years or older, seen in Sleep Neurology clinics in two centres by the senior author, over a 10 years period. In addition, an updated review of all papers published on the topic, since year 2000 is being reported. A total of nine patients (2 females) with SRRMD were included in this series with age ranging between 9 and 62 years. Five patients had comorbid primary sleep disorders and four others had associated neurodevelopmental disorders. Association with other primary sleep disorders like sleep apnea and restless legs syndrome and relief with treatment of the latter, has been highlighted.

Ropinirole patch treatment of nocturnal violent tremor in Parkinson's disease

AbstractParkinson's disease (PD) patients experience nocturnal movement linked to primary sleep disorders. We describe a patient with PD who presented with unusual nocturnal tremor. Frequent, violent tremor during sleep is unusual but can occur in PD, and treatment is likely to be difficult. Nocturnal tremor may result from the on–off phenomenon and can be successfully treated using a long‐acting ropinirole patch.

Prevalence of Insomnia among Medical Staff during the Epidemic Prevention and Control: A Perspective on Health Behavior

Objectives: In this study, we investigated the sleep status of medical personnel in selected regions of China during the pandemic years of 2020 to 2022; we also considered their health behavior (HB). Methods: We used a random sampling method to select medical personnel for data collection in Shandong Province and its surrounding areas. For assessment instruments we used the General Situation Questionnaire, Pittsburgh Sleep Quality Index Inventory (PSQI), Self-Assessment Scale for Anxiety (SAS), and Self-Assessment Scale for Depression (SDS). Results: A total of 621 medical personnel participated, with a mean PSQI score of 11.37±3.79. The overall detection rate of insomnia was 88.73%, with 16.79% indicating severe insomnia. The primary sleep disorder among medical staff was daytime dysfunction, followed by difficulty falling asleep, poor sleep quality, and sleep efficiency. Various factors including age, education, position/title, abnormal menstruation, working age, income, night shift, and work intensity significantly influenced sleep quality. Advanced age, higher education, higher position/title, abnormal menstruation, working night shift, and higher work intensity emerged as risk factors; having longer working years was protective. Income was a compound factor affecting sleep. Conclusion: Increasing attention to the sleep situation of medical personnel is crucial, as these factors may impact their HB.

An intriguing case of episodic hypersomnolence- Kleine–Levin syndrome, a diagnosis often missed

ABSTRACT A sleep disorder is characterised by alteration in normal pattern of sleep enough to interfere with the normal functioning of an individual. Sleep disorders are broadly classified as primary sleep disorders such as dyssomnias, hypersomnia and parasomnias and secondary due to medical and mental disorders such as anxiety or substance abuse. We report the case of a 12-year-old boy who presented to us with episodic hypersomnolence, hyperphagia and behavioural abnormalities and was initially managed as epilepsy at another hospital. He was subsequently diagnosed as primary sleep disorder, Kleine–Levin syndrome. We also describe the diagnostic approach to such a case and the crucial role of functional brain imaging in it.

The therapeutic potential of opioids in narcolepsy type 1: A systematic literature review and questionnaire study

ObjectiveNarcolepsy type 1 is a primary sleep disorder caused by deficient hypocretin transmission leading to excessive daytime sleepiness and cataplexy. Opioids have been suggested to increase the number of hypocretin-producing neurons. We aimed to assess opioid use and its self-reported effect on narcolepsy type 1 symptom severity through a literature review and questionnaire study. MethodsWe systematically reviewed literature on opioid use in narcolepsy. We also recruited 100 people with narcolepsy type 1 who completed an online questionnaire on opioid use in the previous three years. The main questionnaire topics were the indication for use, and the possible effects on narcolepsy symptom severity. Structured follow-up interviews were conducted when opioid use was reported. ResultsThe systematic literature review mainly showed improvements in narcolepsy symptom severity. Recent opioid use was reported by 16/100 questionnaire respondents, who had used 20 opioids (codeine: 7/20, tramadol: 6/20, oxycodone: 6/20, fentanyl: 1/20). Narcolepsy symptom changes were reported in 11/20. Positive effects on disturbed nocturnal sleep (9/20), excessive daytime sleepiness (4/20), hypnagogic hallucinations (3/17), cataplexy (2/18), and sleep paralysis (1/13) were most pronounced for oxycodone (4/6) and codeine (4/7). ConclusionsOpioids were relatively frequently used compared to a similarly young general Dutch sample. Oxycodone and, to a lesser extent, codeine were associated with self-reported narcolepsy symptom severity improvements. Positive changes in disturbed nocturnal sleep and daytime sleepiness were most frequently reported, while cataplexy effects were less pronounced. Randomised controlled trials are now needed to verify the potential of opioids as therapeutic agents for narcolepsy.

Bridging the Gap between Psychiatry and Neurology: Alzheimer's disease- symptoms beyond memory impairment

It is increasingly recognized that there is significant heterogeneity in phenotype and clinical trajectories in Alzheimer's disease.Up to 25% of Alzheimer's disease (AD) cases do not show the typical neuropathology. Recently subtypes and atypical non-amnestic AD presentations have been formalized in the International Working Group (IWG) clinical diagnosis criteria. Clinical diagnosis of atypical AD has significantly been improved by the availability of biomarkers, including cerebrospinal fluid levels of Aβ42, total tau (t-tau) and phosphorylated tau181 (p-tau), MRI volumetric estimation of hippocampal and medial temporal atrophy, and amyloid brain PET imaging. Special attention will be given to language variant of Alzheimer's disease. A predominant deficit in the language domain is a key feature of primary progressive aphasia but language impairment is commonly present in Alzheimer's disease. International diagnostic criteria for PPA and its three variants (agrammatic, logopenic, semantic) were published in 2011. Since then, studies have investigated the validity of these criteria in classifying patients which includes clinical symptoms, neurocognitive presentations, distinct MRI signatures, and neuropathological differences. In this session special attention will be given of logopenic PPA a syndrome frequently seen in atypical Alzheimer's disease. Even though Alzheimer's disease is most notable for memory impairment, language impairments are also found early in the disease course. Indeed, neuropsychological testing shows changes in confrontation naming and semantic fluency. However, there is an additional body of research that shows that changes in spontaneous language, including idea density, speech quantity, fluency, and tempo can differentiate between normal aging and Alzheimer's disease.A physiologic sleep pattern is essential in the process of memory formation. Inadequate sleep results in cognitive impairment. MCI has an increased rate of sleeping problems compared to healthy people of the same age. In MCI, primary sleep disorders like sleep-disordered breathing, PLMS, RLS, RBD are more common, and also associated with a high rate of progression from MCI to AD. MCI also showed shorter total sleep time (longer in non-amnestic MCI), sleep efficiency, and cyclic alternating pattern. There is increased nighttime behavior. EEG power in amnestic MCI showed a reduction in the power of delta and theta frequency. There is a reduction in fast spindle counts on frontal location. Blunted and delayed onset with a duration of REM sleep reduced. A growing body of evidence supports the hypothesis that people with sleep disorders have a higher risk of developing Alzheimer's disease AD. Insomnia, self-reported sleep disturbances, decline in sleep duration, impaired sleep consolidation, delayed or decreased circadian rhythms and sleep-disordered breathing have been shown to increase AD risk, supporting the hypothesis that a chronically disrupted sleep-wake cycle can drive AD pathogenesis. Associations of sleep disorders and neurodegeneration in Alzheimer's are complex. Its understanding however is crucial for proper AD prevention, diagnosis, as well as management.Psychosis is a core syndrome in other than Alzheimer's disease and neurodegenerative disorders. It is however present in a large percentage of patients with AD. Psychosis most commonly presents as a delusional process and is linked to disruptive behavior, rapid progression, and overall morbidity. Psychotic syndromes in AD are complex but necessary to be diagnosed and managed properly.

Protocolo diagnóstico del insomnio

The complaint of insufficient or nonrestorative sleep is highly prevalent among the general population and leads to frequent medical consultations in search of a treatment. Any physician must have basic knowledge in order to know the normal data for the population, know when a disease is present, and be able to differentiate primary insomnia from insomnia caused by other primary sleep disorders such as obstructive sleep apnea, restless legs syndrome, or other circadian rhythm disorders which have a different treatment approach. This protocol attempts to facilitate this task and clarify any questions about the terminology or definitions of «symptoms of insomnia» and «insomnia disorder» offering enough information to differentiate primary insomnia from other insomnias and thus, for recommending the most effective treatments.

Protocolo diagnóstico de la somnolencia diurna excesiva

Excessive daytime sleepiness (EDS) is a common symptom that indicates the inability to remain alert during the day, an irresistible need to sleep, spontaneous daytime sleep, or prolonged nighttime sleep. EDS is a cause of functional impairment in the school, work, social, or family sphere as well as traffic accidents and cardiovascular risk. Therefore, it must be identified and treated. The most common cause of EDS is sleep deprivation. Other causes are toxic, drug, psychiatric disorders (depression), medical problems (obesity, hypothyroidism), primary sleep disorders (obstructive sleep apneas), or central hypersomnias (type 1 and 2 narcolepsy, idiopathic hypersomnia, or Kleine-Levin syndrome). With a detailed case history, it can be verified whether there is a known and treatable cause, although performing a sleep study is usually necessary to confirm the diagnosis. This document proposes an algorithm for an evaluation in the clinic, indications for additional tests in a sleep laboratory, and the management of these disorders.