Sleep-wake Disturbances In Patients Research Articles

0991 Dual Therapy to Treat Circadian Rhythm Disturbance in Unique Genetic Mutation of Smith-Magenis Syndrome

Abstract Introduction Smith-Magenis syndrome (SMS) is a rare disorder associated with several genetic mutations. Patients with SMS experience circadian rhythm sleep-wake disorders, which may lead to significant behavioral concerns. A proposed etiology of sleep disturbances is diurnal melatonin secretion. Treatment approaches aim at blocking the abnormal morning secretion of melatonin and providing exogenous melatonin in the evening. Report of case(s) We present a patient with SMS having persistent sleep-wake disturbance despite dual therapy with beta-1 adrenergic antagonist in the morning and over-the-counter melatonin at night. Our patient switched to therapy with beta-1 adrenergic antagonist in the mornings and melatonin receptor agonist, tasimelteon, at night with significant improvement. In addition, our patient has mutations in JAKMIP1 and ZBTB18 genes. ZBTB18 mutation is a novel mutation in the setting of clinical features of SMS. Conclusion To the authors’ knowledge, this is the first case report of successful combination therapy to optimize treatment of sleep-wake disturbances in patients with SMS. Support (if any)

Sleep/Wake Disorders After Sports Concussion: Risks, Revelations, and Interventions.

Sleep-wake disturbances (SWDs) are among the most prevalent, persistent, and often disregarded sequelae of traumatic brain injury. Identification and treatment of SWDs in patients with traumatic brain injury is important and can complement other efforts to promote maximum functional recovery. SWDs can accentuate other consequences of traumatic brain injury, negatively affect mood, exacerbate pain, heighten irritability, and diminish cognitive abilities and the potential for recovery. The risk for sports injuries increases when athletes are sleep deprived. Sleep deprivation increases risk-taking behaviors, predisposing to injuries. SWDs are an independent risk factor for prolonged recovery after sports-related concussion. SWDs following sports-related concussion have been shown to impede recovery, rehabilitation, and return to preinjury activities.

Effects of Deep Brain Stimulation on Sleep-Wake Disturbances in Patients with Parkinson's Disease: A Narrative Review.

Sleep-wake disturbances (SWD) are one of the most common non-motor symptoms in the Parkinson's disease (PD) and can appear in the early stage, even before the onset of motor symptoms. Deep brain stimulation (DBS) is an established treatment for the motor symptoms in patients with advanced PD. However, the effect of DBS on SWD and its specific mechanisms are not widely understood and remain controversial. In addition to the circuit-mediated direct effect, DBS may improve SWD by an indirect effect, such as the resolution of nocturnal motor complications and a reduction of dopaminergic medication. Here, the authors review the recent literatures regarding the impact of DBS on SWD in patients with PD. Furthermore, the selection of the DBS targets and the specific effects of applying DBS to each target on SWD in PD are also discussed.

Non-pharmacological interventions for the treatment of sleep-wake disturbances in patients with cancer

Non-pharmacological interventions for the treatment of sleep-wake disturbances in patients with cancer

Editorial introductions

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Stefan KlöppelStefan KlöppelStefan Klöppel is Director of the University Hospital of Old Age Psychiatry in Bern, Switzerland. Until recently, he has been head of the Freiburg Brain Imaging research unit which is dedicated to MRI research with a clinical focus. After medical school, Stefan Klöppel took positions as clinical research fellow at the Department of Neurology in Hamburg, Germany and at University College London, UK. He finished his specialisation in Psychiatry and Psychotherapy in Freiburg with a clinical focus on old age psychiatry and dementia. His research is focused on neurodegenerative disorders. One aspect is the modification of machine learning techniques to apply them to MRI for an early and accurate diagnosis. These methods are highly flexible and are able to separate patients with a wide range of diseases. More recently, he took interest in non-invasive brain stimulation techniques where he seeks to identify protocols sufficiently robust for the application in clinical routine. He currently combines these stimulation methods with imaging to gain insight into the underlying mechanisms. Claudio L. BassettiClaudio L. BassettiProfessor Claudio L. Bassetti was born and raised in Ticino (Southern Switzerland), is married and father of three boys. He speaks six languages and enjoys history, literature, music, sports, and travelling. Claudio Bassetti received his MD degree from the University of Basel in 1984 and trained in neurology in Bern and Lausanne (FMH degree in 1992). He performed two research fellowships in basic neurophysiology (Basel, 1985–1986) and sleep medicine (Ann Arbor-Michigan, USA, 1995–6). In 1997 he became “Privatdozent” (associate professor) at the University of Bern. In 2000 he was appointed Professor of neurology at the university of Zurich and Director of the neurological outpatient clinics of the university hospital. In 2009 he founded the neurocenter of Southern Switzerland in Lugano which he directed until 2012. Since 2012 he is full professor of neurology at the university of Bern and director of the neurology department at the university hospital. Claudio Bassetti has authored eight books and over 350 scientific publications. His topics of interest include general neurology, sleep, stroke, movement disorders, and translational/animal research. He served as president of the European Neurological Society (ENS, 2013–4), European Sleep Research Society (ESRS, 2008–12) and Swiss Neurological Society (SNG, 2008–12). He was one of the founders and first president of the Swiss Federation of Clinical Neurosocieties (SFCNS, 2009–2013). Currently he is a board member of the Swiss Academy of Medical Sciences (SAMW). Since 2016 he is also Vice-Dean Research of the Medical Faculty-University Bern. Panagiotis BargiotasPanagiotis BargiotasDr Panagiotis Bargiotas is an attending physician at the Department of Neurology and the Sleep-Wake-Epilepsy Center at the University Hospital Bern, Switzerland. He specializes in the interdisciplinary management of patients with sleep-wake disturbances and neurodegenerative disorders. He is currently involved in various clinical trials and preclinical research with main focus on the mechanisms underlying sleep-wake disturbances in patients with Parkinson's disease and especially in the context of deep brain stimulation.

Addressing sleep-wake disturbances in patients with traumatic brain injury

Addressing sleep-wake disturbances in patients with traumatic brain injury

Non-pharmacological interventions for the treatment of sleep-wake disturbances in patients with cancer

Non-pharmacological interventions for the treatment of sleep-wake disturbances in patients with cancer

Improving Sleep-Wake Disturbances in Patients With Cancer

Patients with cancer tend to suffer sleep-wake disturbances at a higher rate than the general population. Insomnia and fatigue should be regarded as a significant patient safety issue, as poor sleep can elevate patients' risks of falls, motor vehicle accidents, and acute infectious illnesses. To alleviate those risks, oncology nurses should be familiar with effective evidence-based practices for assessing and improving patients' sleep quality.

Evaluation of Tentorial Length and Angle in Sleep-Wake Disturbances After Mild Traumatic Brain Injury

The purpose of this study was to determine if there is an association between tentorial length and angle and sleep-wake disturbances in patients with mild traumatic brain injury (TBI). MRI examinations of the brain of 34 consecutive patients with mild TBI with sleep-wake disturbance and 30 patients with mild TBI without sleep-wake disturbance were retrospectively reviewed. The length of the tentorium on a sagittal T1-weighted image (tentorial length) and the angle formed between the tentorium and a line through the foramen magnum (tentorial angle) were measured. Results were correlated with both neuropsychologic testing and any sleep-wake disturbance. No significant difference existed between patients with and without sleep-wake disturbances in terms of age (p=0.44), sex (p=0.13), Immediate Post-Concussion Assessment Cognitive Test total symptom score (p=0.10), verbal memory score (p=0.32), visual memory score (p=0.31), processing speed (p=0.15), or reaction time (p=0.84). Tentorial length in patients with mild TBI with sleep-wake disturbances was significantly longer than patients with mild TBI without sleep-wake disturbances (p<0.01), and tentorial angle was significantly smaller (p<0.01). Tentorial angle was inversely correlated with length of time to recovery (p=0.002), and tentorial length was directly correlated with length of time to recovery (p<0.001). Among patients with mild TBI with similar cognitive function and symptom severity, those with sleep-wake disturbances have significantly longer tentorial length with a flatter angle than do patients with mild TBI without sleep symptoms, with length of time to recovery being directly correlated with tentorial length and indirectly correlated with tentorial angle. Direct impact between the tentorium and the pineal gland during mild TBI may lead to pineal gland injury, disruption of melatonin homeostasis, and sleep-wake disturbances.

Sleep-wake abnormalities in patients with cirrhosis

A considerable proportion of patients with cirrhosis exhibit insomnia, delayed sleep habits, and excessive daytime sleepiness. These have been variously attributed to hepatic encephalopathy and impaired hepatic melatonin metabolism, but the understanding of their pathophysiology remains limited and their treatment problematic. Sleep is regulated by the interaction of a homeostatic and a circadian process. The homeostatic process determines sleep propensity in relation to sleep-wake history, thus the need to sleep increases with the duration of the waking period. The circadian process, which is marked by the 24-hour rhythm of the hormone melatonin, is responsible for the alternation of high/low sleep propensity in relation to dark/light cues. Circadian sleep regulation has been studied in some depth in patients with cirrhosis, who show delays in the 24-hour melatonin rhythm, most likely in relation to reduced sensitivity to light cues. However, while melatonin abnormalities are associated with delayed sleep habits, they do not seem to offer a comprehensive explanation to the insomnia exhibited by these patients. Fewer data are available on homeostatic sleep control: it has been recently hypothesized that patients with cirrhosis and hepatic encephalopathy might be unable, due to excessive daytime sleepiness, to accumulate the need/ability to produce restorative sleep. This review will describe in some detail the features of sleep-wake disturbances in patients with cirrhosis, their mutual relationships, and those, if any, with hepatic failure/hepatic encephalopathy. A separate section will cover the available information on their pathophysiology. Finally, etiological treatment will be briefly discussed.

4272 POSTER Sleep-wake Disturbances in Patients With Cancer and Informal Caregivers – the Added Value of a Dyadic Approach in Their Assessment and Management

Sleep-wake disturbances in patients with cancer and informal caregivers : the added value of a dyadic approach in their assessment and management

Sleep-Wake Disturbances in Patients with Advanced Cancer and Their Family Carers

Sleep disturbance is common in patients with advanced cancer, and their family carers also may suffer from sleep problems. The aims of this study were to determine the prevalence of sleep-wake disturbances in patients with advanced cancer and their carers, to monitor the amount of daytime spent in activity and rest, and to examine the relationship between sleep, physical, and psychological symptoms. This was a prospective, descriptive observational study in patients with advanced incurable cancer and their carers attending a regional cancer center, using subjective (Short Form-36, Epworth Sleepiness Score, Hospital Anxiety and Depression Scale, Memorial Symptom Assessment Scale, and sleep history and diary) and objective (Actiwatch) assessments over a seven-day period. Sixty patients with advanced cancer and their family carers completed the study. Poor sleep was a frequent complaint: 47% of the patients and 42% of the carers reported that they did not sleep well, yet patients reported sleeping an average of 8.2 hours and carers 7.8 hours per night. The objective assessments revealed that although sleep efficiency (SE) was greater than 90% for most patients and carers, sleep fragmentation was high in both groups. Patients and carers who complained of poor sleep were significantly more anxious ( P < 0.001 and <0.05) compared with patients and carers who reported sleeping well. Patients who complained of poor sleep had significantly more pain ( P < 0.05). These results show that a substantial proportion of advanced cancer patients and their carers complained of poor sleep despite reporting “normal” duration of sleep. Objective measurements using Actiwatch revealed good SE but high levels of sleep fragmentation and movement, suggesting that sleep quality may be disturbed. Further work is required to investigate sleep quality and the consequences of poor sleep. In the meantime, health care professionals need to routinely inquire about sleep and consider possible reversible underlying factors, such as pain and anxiety, for those who report sleep disturbance.

C.19.04 Making treatment decisions in depression: balancing efficacy and tolerability among contemporary antidepressant treatment options

Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI—such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.

C.20.02 Effective treatment of schizophrenia across the spectrum of age, severity and symptoms

Sleep-wake disturbances are extremely common after a traumatic brain injury (TBI). The most common disturbances are insomnia (difficulties falling or staying asleep), increased sleep need, and excessive daytime sleepiness that can be due to the TBI or other sleep disorders associated with TBI, such as sleep-related breathing disorder or post-traumatic hypersomnia. Sleep-wake disturbances can have a major effect on functional outcomes and on the recovery process after TBI. These negative effects can exacerbate other common sequelae of TBI—such as fatigue, pain, cognitive impairments, and psychological disorders (eg, depression and anxiety). Sleep-wake disturbances associated with TBI warrant treatment. Although evidence specific to patients with TBI is still scarce, cognitive-behavioural therapy and medication could prove helpful to alleviate sleep-wake disturbances in patients with a TBI.

Sleep-Wake Disturbances and Quality Of Life in Patients With Advanced Lung Cancer

To examine the scope and severity of subjective sleep-wake disturbances in patients with lung cancer and compare them to a group of healthy adults who were similar in age, gender, and race, and to examine the impact of sleep-wake disturbances on measures of health-related quality of life (QOL). Descriptive, comparative. University-based and private urban ambulatory care clinics. 43 patients with advanced non-small cell or small cell lung cancer and 36 healthy adults. All participants were cognitively intact, and none had any known neurologic disorder, polysomnographically diagnosed sleep disorder, mood or anxiety disorders, or cerebral metastasis. Questionnaires, interview, and medical record review. Nocturnal sleep (quality, quantity, and disturbance), daytime sleepiness, and health-related QOL (physical, mental). Patients with lung cancer had poor perceived nocturnal sleep quality and excessive daytime sleepiness that differed significantly from the comparison group. Sleep disturbances in the group with lung cancer were characterized by breathing difficulty, cough, nocturia, and frequent awakenings. Sleep-wake disturbances were significantly associated with poorer health-related QOL after controlling for group. Excessive daytime sleepiness was associated most often with decreases in mental health, whereas poor nocturnal sleep was associated most often with decreases in physical health. Findings suggest that sleep-wake disturbances are common in patients with lung cancer and that the disturbances are significantly associated with health-related QOL. Patients with lung cancer may be at risk for sleep-disordered breathing. The magnitude of nocturnal sleep disturbance and daytime sleepiness identified in this study reinforces the importance of ongoing screening and effective intervention for sleep-wake disturbances in patients with lung cancer.