Standard PSG Research Articles

On the relationship between Hypoxic Burden and standard PSG variables for obstructive sleep apnea diagnosis and prediction

On the relationship between Hypoxic Burden and standard PSG variables for obstructive sleep apnea diagnosis and prediction

Deep-Learning Model Based on Convolutional Neural Networks to Classify Apnea-Hypopnea Events from the Oximetry Signal.

Automated analysis of the blood oxygen saturation (SpO2) signal from nocturnal oximetry has shown usefulness to simplify the diagnosis of obstructive sleep apnea (OSA), including the detection of respiratory events. However, the few preceding studies using SpO2 recordings have focused on the automated detection of respiratory events versus normal respiration, without making any distinction between apneas and hypopneas. In this sense, the characteristics of oxygen desaturations differ between obstructive apnea and hypopnea episodes. In this chapter, we use the SpO2 signal along with a convolutional neural network (CNN)-based deep-learning architecture for the automatic identification of apnea and hypopnea events. A total of 398 SpO2 signals from adult OSA patients were used for this purpose. A CNN architecture was trained using 30-s epochs from the SpO2 signal for the automatic classification of three classes: normal respiration, apnea, and hypopnea. Then, the apnea index (AI), the hypopnea index (HI), and the apnea-hypopnea index (AHI) were obtained by aggregating the outputs of the CNN for each subject (AICNN, HICNN, and AHICNN). This model showed a promising diagnostic performance in an independent test set, with 80.3% 3-class accuracy and 0.539 3-class Cohen's kappa for the classification of respiratory events. Furthermore, AICNN, HICNN, and AHICNN showed a high agreement with the values obtained from the standard PSG: 0.8023, 0.6774, and 0.8466 intra-class correlation coefficients (ICCs), respectively. This suggests that CNN can be used to analyze SpO2 recordings for the automated diagnosis of OSA in at-home oximetry tests.

437 Efficacy of a novel oral appliance and the influence of OSA pathophysiological traits on treatment response

Abstract Introduction Oral appliance therapy is a recommended alternative to CPAP for OSA. Approximately 50% of patients have a major reduction in OSA severity but successful treatment outcome remains challenging to predict. Previous prediction methods have focused on clinical variables which have poor predictive value. OSA is recognised as a heterogenous disorder caused by 4 pathophysiological traits. The influence of OSA pathophysiological traits on oral appliance treatment outcome has been explored in recent physiological studies using simplified phenotyping methods. In this preliminary report, we prospectively compared differences in the 4 OSA phenotypes between responders and incomplete responders to a novel oral appliance with built in oral airway using gold standard phenotyping methodology. Methods Data from 22 people with OSA (AHI>10events/h) have been analysed to date. A diagnostic in-laboratory PSG was initially conducted to confirm OSA. A detailed physiology PSG was carried out prior to commencement of oral appliance therapy. For this study night participants were instrumented with standard PSG equipment, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular electrodes inserted perorally into the genioglossus to quantify baseline OSA phenotypic traits. Pcrit was quantified via CPAP dial downs and the non-anatomical traits were quantified from naturally occurring apneas and hypopneas. Participants were then fitted with a next generation novel oral appliance with a built-in oral airway (Oventus O2Vent Optima™) and titrated to at least 75% of maximum mandibular advancement. After acclimatization to therapy, participants were invited to undergo a treatment efficacy PSG. Results Oral appliance therapy reduced the AHI by 52% (21[15,31] vs. 11[7,16] events/h, p<0.001). 46% of participants responded to oral appliance therapy based on the definition of AHI < 10events/h. Preliminary analyses indicated that estimates of baseline upper airway collapsibility tended to be different in responders versus non-responders (responders have less collapsible airways). Conclusion The novel oral appliance reduced OSA severity by 50% with resolution of OSA in half of participants. Baseline pharyngeal collapsibility may be an important physiological predictor of treatment outcome. Support (if any):

Prevalence of Overlap Syndrome. Obstructive Sleep Apnea in Patients with Chronic Obstructive Pulmonary Disease. A study protocol.

Introduction: Chronic obstructive pulmonary disease (COPD) and Obstructive sleep apnea (OSA) cause an inflammatory response and hypoxia. Patients who have both conditions have increased morbidity and mortality. Overlap syndrome between OSA and COPD is important but under-recognised. Objectives: We aimed to determine the prevalence and severity of overlap syndrome in patients with COPD through the overnight standard polysomnography. Methods/Design: A consecutive single-center cross-sectional study will be performed. The design, conduct and report of this study followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The sample will be of convenience, recruited consecutively with respiratory complaints that seek care in a private clinic specializing in pulmonology in the city of Cascavel, in the state of Paraná, from September 2016 to July 2017. All subjects will be submitted to the same evaluation protocol described subsequently. Initially will be collected data on baseline demographic, anthropometric and clinical aspects, including body mass index, neck, hip and waist circumferences, respiratory and cardiac rates, peripheral blood pressure, and BODE index. After this phase of the study, patients will perform lung function tests through petismography, sleep studies using the standard overnight PSG, and respond to the Berlin and Pittsburgh questionnaires, and Epworth Sleepiness Scale.

Effects of new PLM scoring rules on PLM rate in relation to sleep and resting wake for RLS and healthy controls.

This study evaluates the differences in periodic leg movement (PLM) rates for Restless Legs Syndrome (RLS) and healthy controls when using the updated PLM scoring criteria developed by IRLSSG in 2016 versus the prior PLM scoring criteria developed by IRLSSG in 2006. Four major problems with the prior standards had been objectively identified, i.e. minimum inter-movement interval should be 10 not 5s, non-PLM leg movements should end any preceding PLM sequence, a leg movement (LM) can be any length > 0.5s, and a PLM should be a persisting movement not a couple or a series of closely spaced, very brief events. Each of these led to including, erroneously, various random leg movements as PLM. Correcting these problems was expected to increase specificity, reducing the number of PLM detected, particularly in situations producing relatively more random leg movements, e.g. wake vs. sleep and controls without PLMD vs. RLS patients. This study evaluated the putative benefits of the updated, 2016-scoring criteria. The LMs from 42 RLS patients and 30 age- and gender-matched controls were scored for PLMS and PLMW from standard all-night PSG recordings using both 2006 and 2016 WASM criteria. The results confirmed that that the 2016 compared to the 2006 criteria generally decreased the PLM rates with particularly large decreases for the conditions with more random non-PLM events, e.g. wake times and normal healthy controls. This supported the view that the new criteria succeeded in increasing the specificity of PLM detection. Moreover, the changes in PLM rates were generally small for the conditions with relatively few random LM, e.g. RLS and sleep. Thus the bulk of existing PLMS research does not require reconsideration of results, with possible exception of special situations with relatively more random leg movements than periodic leg movements, e.g. wake, healthy normals and children.

Expert-level automated sleep staging of long-term scalp electroencephalography recordings using deep learning.

Develop a high-performing, automated sleep scoring algorithm that can be applied to long-term scalp electroencephalography (EEG) recordings. Using a clinical dataset of polysomnograms from 6,431 patients (MGH-PSG dataset), we trained a deep neural network to classify sleep stages based on scalp EEG data. The algorithm consists of a convolutional neural network for feature extraction, followed by a recurrent neural network that extracts temporal dependencies of sleep stages. The algorithm's inputs are four scalp EEG bipolar channels (F3-C3, C3-O1, F4-C4, and C4-O2), which can be derived from any standard PSG or scalp EEG recording. We initially trained the algorithm on the MGH-PSG dataset and used transfer learning to fine-tune it on a dataset of long-term (24-72 h) scalp EEG recordings from 112 patients (scalpEEG dataset). The algorithm achieved a Cohen's kappa of 0.74 on the MGH-PSG holdout testing set and cross-validated Cohen's kappa of 0.78 after optimization on the scalpEEG dataset. The algorithm also performed well on two publicly available PSG datasets, demonstrating high generalizability. Performance on all datasets was comparable to the inter-rater agreement of human sleep staging experts (Cohen's kappa ~ 0.75 ± 0.11). The algorithm's performance on long-term scalp EEGs was robust over a wide age range and across common EEG background abnormalities. We developed a deep learning algorithm that achieves human expert level sleep staging performance on long-term scalp EEG recordings. This algorithm, which we have made publicly available, greatly facilitates the use of large long-term EEG clinical datasets for sleep-related research.

0164 Evidence Suggesting Early Airway Collapse as Cause of Spontaneous Arousals

Abstract Introduction Spontaneous arousals can occur in response to a number of stimuli like noise, movement, hypoxia, or airway obstruction. Some arousals occur “spontaneously” and in individuals donning a hyper-arousable phenotype, spontaneous arousals can dominate the sleep architecture. While arousal mechanisms for some stimuli have been well described, there is a profound lack of knowledge to explain spontaneous arousals. During clinical testing of a device that was designed by SleepMethods, Inc. to anticipate obstructive sleep apnea events by the ability to sense minute airway caliber changes, it was noted, incidentally that the device would signal impeding airway collapse but a spontaneous arousal followed the signal before an obstructive airway event ever developed. This phenomenon was observed many times within and between subjects, suggesting the possibility that very early airway changes are causing “spontaneous arousals” Methods Ten adults (7M;3F) aged 18-80y/o (avg. 54.7y/o) with a known AHI ≥ 15/hr (avg. AHI = 42.6/hr) underwent 1 overnight PSG recording while wearing the device. Patients were required to forego their usual CPAP therapy on the night of study in efforts to expose the device to an adequate number of total obstructive events (defined as apneas and hypopneas; RERAs and snores were excluded). Standard PSG analysis was performed. Scoring rules were applied to determine whether signals were true/false positives and/or true/false negatives based on pre-clinical data showing anticipation accuracy for up to 45 seconds prior to an obstructive airway event. Signals designed to herald obstructive events were noted, incidentally, appearing prior to spontaneous arousals. Results Preliminary results suggest that early phases of airway collapse, as the airway progresses from patency to clinically significant obstruction, are causing EEG arousals which, by current standards, are considered “spontaneous”. Because these findings were incidental to another primary purpose of the clinical study, data analysis is in early stages but currently suggesting at least an associative relationship. Conclusion If final data analysis shows statistically significant correlation between early airway collapse and “spontaneous arousals”, it may have tremendous implications for patients with hyper-arousability, insomnia, and/or pathologically elevated spontaneous arousal indices by proposing therapies aimed at airway patency maintenance. Support N/A

1074 Fear Reactivity And Sleep In Trauma-Exposed Males And Females With And Without PTSD

Abstract Introduction Sleep disturbance is considered central to mechanisms of PTSD development and maintenance, and fear learning protocols have been used as laboratory models to understand PTSD disease mechanisms. Some research indicates that fear learning may influence subsequent sleep, especially REM sleep, and that sleep may influence subsequent extinction. In this study, we examined the relationship of startle reactivity during conditioning and later extinction with objectively-measured sleep in PTSD-positive and negative subjects. Methods These analyses were performed as part of a larger study of PTSD and sleep. Thirty-four (34) trauma-exposed male and female participants with and without PTSD completed a fear-potentiated startle conditioning procedure at 9:45am, followed by a PSG-monitored nap (13:30-15:30), followed by an extinction protocol at 4:30pm. All visits were preceded by an adaptation nap visit at least 7 days prior. Eye-blink EMG was used to measure startle reactivity. Mixed-model analyses were performed in SPSS. Results PTSD-positive subjects had higher REM sleep duration (p<.05) and a trend towards shorter REM sleep latency (p=.06). There were no other group or sex effects on standard PSG sleep parameters. During conditioning, PTSD-positive status was associated with higher startle reactivity across stimulus types (p<.01), driven by increased reactivity in PTSD-positive vs. PTSD-negative females. A PTSD x sex interaction effect on startle reactivity showed the opposite effect in males (p<.01). Higher startle reactivity during conditioning predicted longer sleep latency during the subsequent nap (p<.05), but reactivity during conditioning and extinction did not otherwise show a relationship to standard PSG sleep measures. Conclusion These findings are consistent with previous research indicating REM sleep abnormalities as well as heightened fear responses in PTSD. While the observed relationship between higher startle and longer sleep latency is consistent with studies indicating that stress affects subsequent sleep, further research in larger samples is needed to understand causal mechanisms and to advance our understanding of sleep-PTSD mechanisms. Support VA Career Development Award-5IK2CX000871-05

0708 A Study To Determine Efficacy Of A Device In Anticipating Obstructive Sleep Apnea Events

Abstract Introduction Current treatment options for obstructive sleep apnea pose multiple challenges ranging from issues with therapy adherence (i.e. PAP) to partial effectiveness (i.e. MAD) or invasiveness (i.e. implantable nerve stimulation devices). SleepMethods, Inc. designed a device that proposed to solve these issues. It consisted of two integrated mechanisms; one to anticipate the development of an obstructive event and the other to deliver therapeutic intervention to abort the process of airway collapse before it ensued. A clinical trial was conducted to test the efficacy of the system designed to anticipate obstructive sleep apnea events. Methods Ten adults (7M;3F) aged 18-80y/o (avg. 54.7y/o) with a known AHI ≥ 15/hr (avg. AHI = 42.6/hr) underwent 1 overnight PSG recording while wearing the device. Patients were required to forego their usual CPAP therapy on the night of study in efforts to expose the device to an adequate number of total obstructive events (defined as apneas and hypopneas; RERAs and snores were excluded). Standard PSG analysis was performed. Scoring rules were applied to determine whether signals were true/false positives and/or true/false negatives based on pre-clinical data showing anticipation accuracy for up to 45 seconds prior to an obstructive airway event. Results Preliminary results suggest the device functions with 96.9% sensitivity and about 67.1% PPV. Data analysis is ongoing to determine specificity, statistical significance, etc. Conclusion The device has shown promise in pre-clinical and clinical trials to accurately and consistently anticipate airway collapse; a possible breakthrough in designing more targeted therapies aimed at aborting obstructive sleep apnea events before they ensue to a clinically significant degree. Support N/A

0098 The Role of Sleep in Novel Category Learning in Infancy

Abstract Introduction A growing body of research suggests that sleep has an important role in consolidating newly learnt information and generalising this knowledge to novel instances (e.g. Djonlagic et al., 2009). The effects of sleep on early categorisation abilities haven’t been investigated so far and thus the aim of this study is to examine the role of sleep in formation of category representations. Two experiments were conducted. Experiment 1 set out to determine 4-months-old infants’ ability to form novel visual categories when category formation test immediately followed learning. Experiment 2 investigated the impact of sleep on category consolidation by testing category formation after a 2 hours delay. Methods Both experiments employed eye-tracking familiarisation-novelty-preference paradigm. In Experiment 1, infants were familiarised with a set of exemplars from a novel category. Immediately after the familiarisation phase, infants’ category formation was tested and their looking references were used as an index of category learning. Experiment 2 tested consolidation of the newly acquired categories by introducing a delay between the familiarisation and the test phase. Half of the participants took a nap during the delay, whereas the other half remained awake. Polysomnography was recorded using a standard PSG protocol. Sleep stages were scored according to the AASM guidelines, and sleep spindles were detected using an adapted algorithm for children. Results Results of the Experiment 1 revealed that infants were able to learn novel visual categories when category formation was tested immediately after learning suggesting therefore that infants are able to extract relevant information and generalise to novel instances. Preliminary results of Experiment 2 (data analysis ongoing) suggested that infants who napped performed better than infants who stayed awake. Conclusion The present study suggests that infants are able to rapidly form novel categories, and that consolidation of this knowledge is shaped by the activity following learning. Support N/A

Indicators of REM without atonia from standard PSG scoring

Indicators of REM without atonia from standard PSG scoring

Quantitative electroencephalography measures in rapid eye movement and nonrapid eye movement sleep are associated with apnea-hypopnea index and nocturnal hypoxemia in men.

Quantitative electroencephalography (EEG) measures of sleep may identify vulnerability to obstructive sleep apnea (OSA) sequelae, however, small clinical studies of sleep microarchitecture in OSA show inconsistent alterations. We examined relationships between quantitative EEG measures during rapid eye movement (REM) and non-REM (NREM) sleep and OSA severity among a large population-based sample of men while accounting for insomnia. All-night EEG (F4-M1) recordings from full in-home polysomnography (Embletta X100) in 664 men with no prior OSA diagnosis (age ≥ 40) were processed following exclusion of artifacts. Power spectral analysis included non-REM and REM sleep computed absolute EEG power for delta, theta, alpha, sigma, and beta frequency ranges, total power (0.5-32 Hz) and EEG slowing ratio. Apnea-hypopnea index (AHI) ≥10/h was present in 51.2% (severe OSA [AHI ≥ 30/h] 11.6%). In mixed effects regressions, AHI was positively associated with EEG slowing ratio and EEG power across all frequency bands in REM sleep (all p < 0.05); and with beta power during NREM sleep (p = 0.06). Similar associations were observed with oxygen desaturation index (3%). Percentage total sleep time with oxygen saturation <90% was only significantly associated with increased delta, theta, and alpha EEG power in REM sleep. No associations with subjective sleepiness were observed. In a large sample of community-dwelling men, OSA was significantly associated with increased EEG power and EEG slowing predominantly in REM sleep, independent of insomnia. Further study is required to assess if REM EEG slowing related to nocturnal hypoxemia is more sensitive than standard PSG indices or sleepiness in predicting cognitive decline.

Methodological strategies in using standard PSG in research and practice

Methodological strategies in using standard PSG in research and practice

Sleep EEG Derived From Behind-the-Ear Electrodes (cEEGrid) Compared to Standard Polysomnography: A Proof of Concept Study.

Electroencephalography (EEG) recordings represent a vital component of the assessment of sleep physiology, but the methodology presently used is costly, intrusive to participants, and laborious in application. There is a recognized need to develop more easily applicable yet reliable EEG systems that allow unobtrusive long-term recording of sleep-wake EEG ideally away from the laboratory setting. cEEGrid is a recently developed flex-printed around-the-ear electrode array, which holds great potential for sleep-wake monitoring research. It is comfortable to wear, simple to apply, and minimally intrusive during sleep. Moreover, it can be combined with a smartphone-controlled miniaturized amplifier and is fully portable. Evaluation of cEEGrid as a motion-tolerant device is ongoing, but initial findings clearly indicate that it is very well suited for cognitive research. The present study aimed to explore the suitability of cEEGrid for sleep research, by testing whether cEEGrid data affords the signal quality and characteristics necessary for sleep stage scoring. In an accredited sleep laboratory, sleep data from cEEGrid and a standard PSG system were acquired simultaneously. Twenty participants were recorded for one extended nocturnal sleep opportunity. Fifteen data sets were scored manually. Sleep parameters relating to sleep maintenance and sleep architecture were then extracted and statistically assessed for signal quality and concordance. The findings suggest that the cEEGrid system is a viable and robust recording tool to capture sleep and wake EEG. Further research is needed to fully determine the suitability of cEEGrid for basic and applied research as well as sleep medicine.

A motion-based waveform for the detection of breathing difficulties during sleep

Individuals who suffer from different sleep breathing disorders suffer from a wide range of serious health problems. Unfortunately, the rate of diagnosis is very low, and the existing breathing monitoring techniques are expensive, uncomfortable and time- and labor-intensive. The gold standard PSG is invasive, costly, technically complex and time-consuming. Toward developing a non-contact sleep breathing monitoring system, this study presents a motion-based computer vision approach that aims to detect breathing movements of the sleeping patient from infrared videos and map them into a waveform. The proposed waveform illustrates that each type of breathing difficulty has a specific pattern and hence can be easily distinguished. This facilitates identifying only suspicious periods during which physiological signals will be scored, instead of analyzing the whole signals of 8 h of sleep.

Sleep-Related Arousal Versus General Cognitive Arousal in Primary Insomnia

The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. Cognitive-behavioral treatment for insomnia might benefit from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal.

Comparison of ambulatory and polysomnographic recording of jaw muscle activity during sleep in normal subjects

Clinicians and investigators need a simple and reliable recording device to diagnose or monitor sleep bruxism (SB). The aim of this study was to compare recordings made with an ambulatory electromyographic telemetry recorder (TEL-EMG) with those made with standard sleep laboratory polysomnography with synchronised audio-visual recording (PSG-AV). Eight volunteer subjects without current history of tooth grinding spent one night in a sleep laboratory. Simultaneous bilateral masseter EMG recordings were made with a TEL-EMG and standard PSG. All types of oromotor activity and rhythmic masseter muscle activity (RMMA), typical of SB, were independently scored by two individuals. Correlation and intra-class coefficient (ICC) were estimated for scores on each system. The TEL-EMG was highly sensitive to detect RMMA (0·988), but with low positive predictive value (0·231) because of a high rate of oromotor activity detection (e.g. swallowing and scratching). Almost 72% of false-positive oromotor activity scored with the TEL-EMG occurred during the transient wake period of sleep. A non-significant correlation between recording systems was found (r = 0·49). Because of the high frequency of wake periods during sleep, ICC was low (0·47), and the removal of the influence of wake periods improved the detection reliability of the TEL-EMG (ICC = 0·88). The TEL-EMG is sensitive to detect RMMA in normal subjects. However, it obtained a high rate of false-positive detections because of the presence of frequent oromotor activities and transient wake periods of sleep. New algorithms are needed to improve the validity of TEL-EMG recordings.

Shift Work Sleep Disorder is Associated with an Attenuated Brain Response of Sensory Memory and an Increased Brain Response to Novelty: An ERP study

To study the neurophysiological changes in attention and memory functions in shift work sleep disorder (SWSD), using event-related brain potentials (ERPs). 9 healthy night workers (NW) (mean age = 40 y; SD +/- 8.9 y); 8 night workers meeting diagnostic criteria for SWSD (mean age = 37 y +/- 9.4 y) and 9 healthy day workers (DW) (mean age = 35 y +/- 7.3 y). Using standard PSG the sleep related measures (TIB, TST, SOL, SE, and sleep stage distribution) were obtained prior to EEG/ERP study. Measures of habitual sleep were obtained from 2 week sleep logs and sleepiness was assessed with standardized measures. Using 32-EEG leads the ERPs to 3 types of sounds (novel, duration deviant, and simple tone) were obtained. The mismatch negativity (MMN) reflecting memory processing and P3a-reflecting the shift of involuntary attention were obtained. The statistical comparisons of ERPs and sleep related parameters were performed using repeated measured ANOVAs and t-tests where appropriate. Patients with SWSD had reduced TST and increased WASO relative to healthy workers. ERP results demonstrated significant attenuation of MMN amplitude over frontal regions in SWSD patients relative to NW and DW. In the SWSD patients, the P3a was increased to novelty across frontocentral brain regions with respect to the same locations in healthy controls. The ERP evidence of sensory memory reduction and attentional hyper-reaction to novel sound in conjunction with disturbed sleep suggests the need for more neurophysiological studies in SWSD workers.

Perioperative practical experiences in using a level 2 portable polysomnography

The objective of the study is to test the hypothesis that a level 2 portable sleep device (Embletta X100) is a reliable alternative for standard PSG in surgical patients. After hospital ethics approvals, preoperative patients over 18 years old were recruited. The patients for validation underwent standard PSG and Embletta X100 simultaneously in a sleep laboratory before surgery. The other patients received sleep studies with Embletta X100 perioperatively. The correlation analysis and paired Student t test between variables from Embletta and from standard PSG were used to evaluate the accuracy of Embletta. The quality of PSG recordings with Embletta was summarized. Twenty-one patients completed sleep study on both systems; ten females and ten males, age was 54 ± 11 and BMI was 36 ± 9. There was a significant correlation between the majority of parameters from standard PSG and Embeltta X100 with manual scoring. The inter-rater agreement was substantial to perfect at different AHI cutoffs with a Kappa coefficient of 0.69 to 1. A significant correlation between standard PSG and Embletta X100 with automatic scoring was found only in AHI and a few other parameters. In 385 patients, 1,002 perioperative PSG recordings were carried out with Embletta. Of them, 889(88.7%) were technically good and 90(9%) technically acceptable. Only 23 (2.3%) PSG recordings failed. Embletta X100, installed by a well-trained sleep technician, is a good alternative when standard PSG was not available or impractical. Manual scoring by a certified PSG technologist is the key for reliable results.

Effectiveness of ropinirole for RLS and depressive symptoms in an 11-year-old girl

An 11-year-old girl was referred for an irresistible urge to move her legs associated with uncomfortable sensations. She was diagnosed with definite Restless Legs Syndrome (RLS) according to 2003 NIH criteria. The IRLSSG severity scale score was 31 (very severe). The girl also presented with dysthymic disorder according to DSM-IV criteria, as confirmed by the semi-structured interview Kiddie-SADS-PL. The score on the Children Depression Inventory (CDI) was in the clinical range (21). The total score on the Sleep Disturbance Scale for Children (SDSC) was 100. A standard PSG revealed a periodic limb movement index of 16.5, indicating that the child also presented with Periodic Limb Movements Disorder. The girl was treated with ropinirole (a D2/D3 dopamine agonist). After 3 months of treatment (0.50 mg/day at 8.00 PM), RLS, as well as depressive symptoms, remarkably improved, as suggested by the improvement in the IRLSSG severity and CDI scores (14 and 4, respectively). No side effects were reported. The total score on the SDSC also improved (73). The PLM index did not remarkably change. We strongly recommend double blind, randomized, controlled studies to gain insight into the effective treatment strategies for RLS and depression when they coexist in children.