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Slonkova J, Togtokhjargal A, Revendova KZ, Bartos V, Hanzlikova P, Volny O. Hypocretin-1/orexin-A, sleep and excessive daytime sleepiness in patients with nonconvulsive status epilepticus: A cross-sectional cohort study. Sleep Med 2024; 119:192-200. [PMID: 38701718 DOI: 10.1016/j.sleep.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Nonconvulsive status epilepticus (NCSE) manifests as a change in mental status without a coma (NCSE proper) or comatose NCSE. Hypocretin-1/orexin-A (H/O) is involved in alertness and sleep maintenance. Sleep impairment and excessive daytime sleepiness (EDS) have a negative impact on cognitive functions and activities of daily living (ADL). METHODS Patients meeting the NCSE criteria underwent cerebrospinal fluid and brain magnetic resonance imaging examinations, polysomnographies (PSG), multiple latency sleep tests (MSLT), and completed Epworth Sleepiness Scale (ESS). Montreal Cognitive Assessment was used to evaluate cognitive functions, and the Barthel Index was used to assess ADL in the acute phase (V1) and three months follow-up (V2). RESULTS From May 2020 to May 2023, we enrolled 15 patients, eight (53.3 %) women, with a median age of 69 (14) years. The median H/O CSF concentration was 250 (63.6) pg/ml; however, only three CSF samples (20 %) decreased below the borderline concentration of 200 pg/ml. Fourteen out of 15 patients (93.3 %) completed the PSG study. The median of wakefulness after sleep onset was 167 (173.5) min, sleep efficiency (SE) was 62.9 (63) %, sleep latency (SL) was 6 (32) min, REM sleep was 2.85 (7.2) %, and REM first episode latency was 210.5 (196.5) minutes. The medians of the stages N1 NREM were 4.65 (15) %, N2 NREM 68.4 (29.9) %, and N3 NREM 21.8 (35.5) %. MSLT mean latency was 7.7 (12.6) minutes. A significant negative correlation exists between H/O CSF concentrations and the stage N1 NREM (rs = -0.612, p = 0.02), and the proportion of cumulative sleep time with oxygen saturation below 90 % in total sleep time (TST) t90 (rs = -0.57, p = 0.03). MSLT had significant negative correlation with TST (rs = -0.5369, p = 0.0478), with SE (rs = -0.5897, p = 0.0265), with apnea-hypopnea index (rs = -0.7631, p = 0.0002) and with deoxygenation index (rs = -0.8009, p = 0.0006). A positive correlation exists between MSLT and SL (rs = 0.6284, p = 0.0161) and between ESS and t90 (rs = 0.9014, p = 0.0004). The correlation between H/O CSF concentrations and EDS, cognitive performance, and ADL was not proved. CONCLUSIONS Patients after NCSE exhibited sleep impairment and excessive daytime sleepiness. Hypocretin-1/orexin-A concentrations decreased only in 20 % of these cases.
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Affiliation(s)
- Jana Slonkova
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic.
| | | | - Kamila Zondra Revendova
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic
| | - Vladimir Bartos
- University Hospital Ostrava, Institute of Laboratory Medicine, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Biomedical Sciences, Ostrava, Czech Republic
| | - Pavla Hanzlikova
- University Hospital Ostrava, Institute of Radiodiagnostics, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Imaging Methods, Ostrava, Czech Republic
| | - Ondrej Volny
- University Hospital Ostrava, Department of Neurology, Ostrava, Poruba, Czech Republic; University of Ostrava Faculty of Medicine, Department of Clinical Neurosciences, Ostrava, Czech Republic
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Nepožitek J, Dostálová S, Věchetová G, Sieger T, Forejtová Z, Nováková L, Galušková K, Milata M, Varga Z, Tanaka H, Růžička E, Šonka K, Edwards M, Serranová T. Sleepiness and comorbid sleep disorders in functional motor disorders: a comparative study with central hypersomnia. J Sleep Res 2024; 33:e14098. [PMID: 37967854 DOI: 10.1111/jsr.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 11/17/2023]
Abstract
Sleep symptoms, including excessive sleepiness, are frequently reported by patients with functional motor disorders (FMD). We aimed to classify the comorbid sleep disorders in FMD, and to investigate the relationship between subjective sleepiness and objective measures of hypersomnia, comparing them with data from people with central hypersomnia. A total of 37 patients (mean [SD] age 46.4 [11.2] years) with clinically definite FMD, and 17 patients (mean [SD] age 41.1 [11.6] years) with central hypersomnia underwent structured medical and sleep history, neurological examination, polysomnography, multiple sleep latency test (MSLT), and questionnaires assessing sleepiness, fatigue, and depression. In all, 23 patients with FMD (62%) reported excessive daytime sleepiness. Evidence of specific sleep disorders was identified in our cohort, with 35% having restless legs syndrome; 49% obstructive sleep apnea; and 8% periodic limb movements in sleep; however, the presence of these disorders was not correlated with subjective sleepiness. Patients with FMD with self-reported sleepiness reported higher fatigue (p = 0.002), depression (p = 0.002), and had longer sleep latencies in the MSLT (p < 0.001) compared to the patients with central hypersomnia. No correlation was found between subjective and objective sleepiness in either group. Fatigue positively correlated with self-reported sleepiness in patients with FMD (p < 0.001). This study did not find objective correlates of increased sleepiness in patients with FMD. While sleep abnormalities were found to be common in FMD, they were not correlated with self-reports of excessive sleepiness. Positive correlations between self-reported sleepiness and fatigue support the current unified model of non-motor symptoms in FMD.
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Affiliation(s)
- Jiří Nepožitek
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Gabriela Věchetová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University, Prague, Czech Republic
| | - Zuzana Forejtová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lucia Nováková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolína Galušková
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Milata
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Zsóka Varga
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Hiroki Tanaka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karel Šonka
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Mark Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Cousin C, Di Maria J, Hartley S, Vaugier I, Delord V, Bensmail D, Prigent H, Léotard A. Predictive factors and screening strategy for obstructive sleep apnea in patients with advanced multiple sclerosis. Mult Scler Relat Disord 2024; 86:105608. [PMID: 38614056 DOI: 10.1016/j.msard.2024.105608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) screening questionnaires have been evaluated in Multiple Sclerosis (MS) but not yet validated in patients with advanced disease. The aim of this study is to identify OSA predictive factors in advanced MS and to discuss screening strategies. METHODS Oximetry data from 125 patients were retrospectively derived from polysomnographic reports. Univariate and multivariate analysis were used to determine predictive factors for OSA. A two-level screening model was assessed combining the oxygen desaturation index (ODI) and a method of visual analysis. RESULTS multivariate analysis showed that among the clinical factors only age and snoring were associated with OSA. Usual predictive factors such as sleepiness, Body mass index (BMI) or sex were not significantly associated with increased Apnea Hypopnea Index (AHI). The ODI was highly predictive (p < 0.0001) and correctly identified 84.1 % of patients with moderate OSA and 93.8 % with severe OSA. The visual analysis model combined with the ODI did not outperform the properties of ODI used alone. CONCLUSION As the usual clinical predictors are not associated with OSA in patients with advanced MS, questionnaires developed for the general population are not appropriate in these patients. Nocturnal oximetry seems a pertinent, ambulatory and accessible method for OSA screening in this population.
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Affiliation(s)
- C Cousin
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; Unité de recherche clinique Paris Saclay Ouest, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - J Di Maria
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - S Hartley
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - I Vaugier
- Centre d'investigation clinique 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | | | - D Bensmail
- « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France; Service de médecine physique et de réadaptation, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - H Prigent
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France
| | - A Léotard
- Service de Physiologie et d'Explorations Fonctionnelles, AP-HP, Hôpital Raymond Poincaré, Garches, France; « End:icap » U1179 Inserm, UVSQ-Université Paris-Saclay, 78000, Versailles, France; Sleep Lab Initiative In PMR group (SLIIP), France.
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Stanyte A, Podlipskyte A, Alonderis A, Macijauskiene J, Burkauskas J, Steibliene V. Relationship between subjective and objective fatigue and sleep characteristics in individuals with anxiety and mood disorders: An exploratory study. Physiol Behav 2024; 274:114429. [PMID: 38065423 DOI: 10.1016/j.physbeh.2023.114429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Fatigue and sleep disturbances are important symptoms of anxiety and mood disorders (AMD). Studies about the relationship between these variables usually rely on self-report assessments. Therefore, the aim of our exploratory study was to investigate the independent correlations between subjective and objective fatigue and sleep characteristics in individuals with AMD. METHODS In sum, 233 individuals with AMD attending a stress-related disorders day care unit (78.5 % females, mean age 39.0 years old) participated in a cross-sectional study. Participants completed the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Multidimensional Fatigue Inventory-20, and Pittsburgh Sleep Quality Index self-report questionnaires, as well as an exercise capacity workload test for assessing objective fatigue and polysomnography monitoring for evaluation of sleep structure. RESULTS In individuals with AMD, exercise capacity workload was associated with lower percent of stage 1 sleep (β = - 0.17, p = 0.006), REM latency (β = -0.13, p = 0.042), and wake after sleep onset (β = -0.12, p = 0.039). General fatigue was associated with a higher percent of body movements (β = 0.12, p = 0.047), as well as mental fatigue was associated with a higher percent of body movements (β = 0.13, p = 0.029), and a higher score on the PSQI (β = 0.21, p = 0.002). CONCLUSIONS Objective sleep characteristics were associated with objective assessment of fatigue, while subjective sleep quality was associated with subjectively assessed mental fatigue.
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Affiliation(s)
- Agne Stanyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania.
| | - Aurelija Podlipskyte
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Audrius Alonderis
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Jurate Macijauskiene
- Department of Geriatrics, Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
| | - Vesta Steibliene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga - Kaunas, Lithuania
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Verhoef VTR, Smolders KCHJ, Remmelswaal L, Peeters G, Overeem S, de Kort YAW. Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders. Clocks Sleep 2024; 6:24-39. [PMID: 38247883 PMCID: PMC10801535 DOI: 10.3390/clockssleep6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.
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Affiliation(s)
- Vaida T. R. Verhoef
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Karin C. H. J. Smolders
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Lysanne Remmelswaal
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Geert Peeters
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
| | - Sebastiaan Overeem
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Yvonne A. W. de Kort
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
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Alissa N, Rehan R, Al-Sharman A, Latrous M, Aburub AS, El-Salem K, Morris L, Khalil H. Cognitive status and sleep quality can explain the fear of falling and fall history in people with Parkinson's disease. Int J Rehabil Res 2023; 46:338-343. [PMID: 37581294 DOI: 10.1097/mrr.0000000000000596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Fear of falling (FOF) is highly prevalent in people with Parkinson's disease (PwPD) and contributes to high fall risk. Studies reporting on the relationship between falls, FOF, and non-motor factors such as cognitive function and sleep quality in Parkinson's disease are limited. This study aimed to investigate (1) the relationship of cognitive function and sleep quality with FOF, and history of falls in PwPD; (2) differences in cognitive function and sleep quality between Parkinson's disease fallers and non-fallers; and (3) a cut-off score for cognitive function and sleep quality to discriminate Parkinson's disease fallers from non-fallers. Fifty PwPD were assessed for FOF [Falls Efficacy Scale-International (FES-I)], cognition [Montréal Cognitive Assessment (MOCA)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], and falls history. The MOCA is significantly associated with FES-I scores ( R2 = 0.429, P < 0.0001). Both MOCA ( P = 0.012) and PSQI ( P = 0.027) were associated with falls history even after adjusting for confounding factors (age, sex, L-dopa use, Parkinson's disease severity). Both MOCA and PSQI scores were able to distinguish fallers from non-fallers with cut-off scores of 15.5 and 7.5, respectively. Although our findings revealed that both cognitive function and sleep quality are important factors influencing falls and FOF in PwPD, it remains to be determined if addressing cognitive impairments and poor sleep quality may favorably impact balance before integrating such screenings into fall prevention programs.
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Affiliation(s)
- Nesreen Alissa
- Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Reem Rehan
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Physical Therapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mariem Latrous
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Ala' S Aburub
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Physiotherapy, Israa University, Amman
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Linzette Morris
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hanan Khalil
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Weinrich JO, Saliger J, Eschweiler M, Karbe H, Kalbe E, Nielsen J. The Relationship between Diurnal Measures of Tonic Alertness and Self-Reported Fatigue in Persons with Multiple Sclerosis-A Retrospective Data Analysis. Arch Clin Neuropsychol 2023; 38:1610-1622. [PMID: 37253664 DOI: 10.1093/arclin/acad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE Fatigue in multiple sclerosis (MS) is common, burdensome, and usually assessed by self-report measures. This retrospective data analysis of the twice-daily Alertness test (Test battery of Attentional Performance) examined the extent to which this assessment procedure is associated with MS-related fatigue. METHOD Two-hundred and thirteen German inpatients (136 women) aged 18-69 years with predominantly relapsing MS (72.8%) were included. Based on reaction time (RT) differences between morning tonic alertness (8:30-11:00 a.m.) and afternoon tonic alertness (3:00-4:30 p.m.), patients were divided into an "improver," "maintainer," or "decliner" group. Multinomial logistic regression (MLR) was calculated to predict the likelihood of belonging to one of these performance groups, taking into account cognitive fatigue (Fatigue Scale of Motor and Cognition, FSMCcog), disease severity (Expanded Disability Status Scale, EDSS), depression (Center for Epidemiologic Studies Depression Scale, CES-D), gender, and tonic alertness (a.m.). RESULTS The final MLR model (R2 = .30) included tonic alertness (a.m.) (<.001), FSMCcog (.008), EDSS (.038), CES-D (.161), and gender (.057). Using this model, correct assignment to alertness performance groups was 56.8%. Tonic alertness (p.m.) demonstrated the greatest potential for differentiation among the three performance groups (<.001). CONCLUSIONS These results show a relationship between subjective fatigue and tonic alertness. However, other variables also contribute to this association, suggesting that the RT differences between twice-daily measures of tonic alertness is not related to increased subjective fatigue in a substantial number of pwMS, which diminishes the diagnostic value. Further studies including relevant variables such as sleepiness are urgently needed.
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Affiliation(s)
- Jonas O Weinrich
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, Waldstr. 2-10, 53177 Bonn, Germany
| | - Jochen Saliger
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, Waldstr. 2-10, 53177 Bonn, Germany
| | - Mareike Eschweiler
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, Waldstr. 2-10, 53177 Bonn, Germany
| | - Hans Karbe
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, Waldstr. 2-10, 53177 Bonn, Germany
| | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Germany
| | - Jörn Nielsen
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Center Godeshoehe GmbH, Waldstr. 2-10, 53177 Bonn, Germany
- Department of Medical Psychology | Neuropsychology and Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne 50937, Germany
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Dubessy AL, Arnulf I. Sleepiness in neurological disorders. Rev Neurol (Paris) 2023; 179:755-766. [PMID: 37598089 DOI: 10.1016/j.neurol.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
Sleepiness is a frequent and underrecognized symptom in neurological disorders, that impacts functional outcomes and quality of life. Multiple and potentially additive factors might contribute to sleepiness in neurological disorders, including sleep quality alterations, circadian rhythm disorders, drugs, and sleep disorders including sleep apnea or central disorders of hypersomnolence. Physician awareness of the possible symptoms of hypersomnolence, and associated causes is of crucial importance to allow proper identification and treatment of underlying causes. This review first provides a brief overview on clinical aspects of excessive daytime sleepiness, and diagnosis tools, then examines its frequency and mechanisms in various neurological disorders, including neurodegenerative disorders, multiple sclerosis, autoimmune encephalitis, epilepsy, and stroke.
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Affiliation(s)
- A-L Dubessy
- Saint Antoine Hospital, Assistance publique des Hôpitaux de Paris (AP-HP), Paris, France.
| | - I Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France; National Reference Network for Orphan Diseases: Narcolepsy and Rare Hypersomnias, Paris, France
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Angioni D, Raffin J, Ousset PJ, Delrieu J, de Souto Barreto P. Fatigue in Alzheimer's disease: biological basis and clinical management-a narrative review. Aging Clin Exp Res 2023; 35:1981-1989. [PMID: 37395951 DOI: 10.1007/s40520-023-02482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Fatigue is a common symptom in neurodegenerative diseases and is associated with decreased cognitive performances. A full knowledge of the causes and physiopathological pathways leading to fatigue in Alzheimer's disease could help treating this symptom and obtain positive effects on cognitive functions. OBJECTIVES To provide an overview of the clinical conditions and the biological mechanisms leading to fatigue in Alzheimer's disease patients. To review the recent advances on fatigue management and describe the landscape of future possibilities. METHODS We performed a narrative review including all type of studies (e.g. cross-sectional and longitudinal analysis, reviews, clinical trials). RESULTS We found very few studies considering the symptom fatigue in Alzheimer's disease patients. Populations, designs, and objectives varied across studies rendering comparability across studies difficult to perform. Results from cross-sectional and longitudinal analysis suggest that the amyloid cascade may be involved in the pathogenesis of fatigue and that fatigue may be a prodromal manifestation of Alzheimer's disease. Fatigue and neurodegeneration of Alzheimer's disease could share common brain signatures (i.e. hippocampal atrophy and periventricular leukoaraiosis). Some mechanisms of aging (i.e. inflammation, mitochondrial dysfunction, telomere shortening) may be proposed to play a common underlying role in Alzheimer's disease neurodegeneration and muscle fatigability. Considering treatments, donepezil has been found to reduce cognitive fatigue in a 6-week randomized controlled study. Fatigue is frequently reported as an adverse event in patients treated by anti-amyloid agents in clinical trials. CONCLUSION The literature is actually inconclusive about the main causes of fatigue in Alzheimer's disease individuals and its potential treatments. Further research is needed to disentangle the role of several components such as comorbidities, depressive symptoms, iatrogenic factors, physical decline and neurodegeneration itself. Given the clinical relevance of this symptom, it seems to be important to systematically assess fatigue by validated tools in Alzheimer's disease clinical trials.
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Affiliation(s)
- Davide Angioni
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
| | - Jeremy Raffin
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Pierre-Jean Ousset
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Julien Delrieu
- Gérontopôle of Toulouse, Toulouse University Hospital (CHU Toulouse), Toulouse, France
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Rani S, Shelyag S, Angelova M. Patterns of sedentary behaviour in adults with acute insomnia derived from actigraphy data. PLoS One 2023; 18:e0291095. [PMID: 37733680 PMCID: PMC10513233 DOI: 10.1371/journal.pone.0291095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Sleep disorders, such as insomnia, have been associated with extended periods of inactive, sedentary behaviour. Many factors contribute to insomnia, including stress, irregular sleep patterns, mental health issues, inadequate sleeping schedules, diseases, neurological disorders and prescription medications. OBJECTIVES Identification of the patterns of sedentary time and its duration in adults with acute insomnia and healthy controls to determine the statistically significant sedentary bouts; comparison of the sedentary behaviour patterns in acute insomnia adults with healthy controls. METHODS We investigate the daytime actigraphy data and identify temporal patterns of inactivity among adults with acute insomnia and healthy adults. Seven days of actigraphy data were utilised to calculate sedentary time and bouts of variable duration based on a threshold of activity counts (<100 counts per minute). Statistical analysis was applied to investigate sedentary bouts and total sedentary time during weekdays and weekend. A logistic regression model has been used to determine the significance of sedentary bouts. RESULTS We found that individuals with acute insomnia accumulate a significant amount of their sedentary time in medium (6-30 minutes and 31-60 minutes) and longer (more than 60 minutes) duration bouts in comparison to healthy adults. Furthermore, a low p value for total sedentary time (2.54 ⋅ 10-4) association with acute insomnia supports the finding that acute insomnia individuals are significantly more engaged in sedentary activities compared to healthy controls. Also, as shown by the weekend vs weekday analysis, the physical and sedentary activity patterns of acute insomnia adults demonstrate higher variability during the weekdays in comparison to the weekend. CONCLUSION The results of the present study demonstrate that adults with acute insomnia spend more time in low-intensity daily physical activities compared to healthy adults.
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Affiliation(s)
- Sunita Rani
- School of IT, Deakin University, Melbourne, Victoria, Australia
| | - Sergiy Shelyag
- School of IT, Deakin University, Melbourne, Victoria, Australia
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Maia Angelova
- School of IT, Deakin University, Melbourne, Victoria, Australia
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Zawadka-Kunikowska M, Rzepiński Ł, Cieślicka M, Klawe JJ, Tafil-Klawe M. Association between Daytime Sleepiness, Fatigue and Autonomic Responses during Head-Up Tilt Test in Multiple Sclerosis Patients. Brain Sci 2023; 13:1342. [PMID: 37759943 PMCID: PMC10526123 DOI: 10.3390/brainsci13091342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
We aimed to assess dynamic changes in hemodynamic and autonomic function in response to the head-up tilt test (HUTT) in patients with multiple sclerosis (MS) compared to healthy controls (HCs) and evaluate its relationship with the patients' reported daytime sleepiness and fatigue symptoms. A total of 58 MS patients and 30 HCs were included in the analysis. Fatigue and sleepiness were evaluated using the Chalder Fatigue Scale (CFQ) and the Epworth Sleepiness Scale (ESS), respectively. Hemodynamic response, baroreflex sensitivity, heart rate variability, and systolic and diastolic blood pressure (BP) variability (SBPV, DBPV) parameters were calculated at rest, and in response to the HUTT. The MS patients displayed attenuated BP responses coupled with a more pronounced decrease in cardiac index as well as a reduced increase in the low frequency (LFnu) of DBPV (p = 0.021) and the sympathovagal ratio (p = 0.031) in the latter-phase orthostatic challenge compared to HCs. In MS patients, the ESS score showed no correlation with CFQ or clinical disease outcomes, but exhibited a moderate correlation with LFnu of BPVrest. Fatigue and disease variants predicted blood pressure response to HUTT. These findings underscore the importance of subjective daytime sleepiness and fatigue symptoms and their role in blood pressure regulation in MS patients.
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Affiliation(s)
- Monika Zawadka-Kunikowska
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Łukasz Rzepiński
- Sanitas–Neurology Outpatient Clinic, Dworcowa 110, 85-010 Bydgoszcz, Poland;
- Department of Neurology, 10th Military Research Hospital and Polyclinic, 85-681 Bydgoszcz, Poland
| | - Mirosława Cieślicka
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
| | - Jacek J. Klawe
- Department of Hygiene, Epidemiology, Ergonomy and Postgraduate Education, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland;
| | - Małgorzata Tafil-Klawe
- Department of Human Physiology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland; (M.C.); (M.T.-K.)
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12
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Ludwig B, Deckert M, Krajnc N, Keritam O, Macher S, Bsteh G, Zulehner G, Thurnher M, Berger T, Seidel S, Willinger U, Rommer P. Reported neurological symptoms after severe acute respiratory syndrome coronavirus type 2 infection: A systematic diagnostic approach. Eur J Neurol 2023; 30:2713-2725. [PMID: 37306533 DOI: 10.1111/ene.15923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Following increasing demands of patients with suspected neurological symptoms after infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), the Department of Neurology at the Medical University of Vienna established a new outpatient clinic to systematically assess, diagnose, and document neurological complaints potentially associated with a prior SARS-CoV-2 infection. METHODS The data presented here include prospectively collected 156 outpatients from May 2021 to April 2022. Patients underwent semistandardized interviewing about symptoms with reported onset after SARS-CoV-2 infection, neurological examination, and comprehensive diagnostic workup. RESULTS Reported new onset symptoms after infection included fatigue (77.6%), subjective cognitive impairment (72.4%), headache (47.7%), loss of smell and/or taste (43.2%), and sleep disturbances (42.2%). Most patients had a mild coronavirus disease (COVID-19) disease course (84%) and reported comorbidities (71%), of which the most frequent were psychiatric disorders (34%). Frequency of symptoms was not associated with age, sex, or severity of COVID-19 course. A comprehensive diagnostic workup revealed no neurological abnormalities in the clinical examination, or electrophysiological or imaging assessments in the majority of patients (n = 143, 91.7%). Neuropsychological assessment of a subgroup of patients (n = 28, 17.9%) showed that cognitive impairments in executive functions and attention, anxiety, depression, and somatization symptoms were highly common. CONCLUSIONS In this systematic registry, we identified fatigue, cognitive impairment, and headache as the most frequently reported persisting complaints after SARS-CoV-2 infection. Structural neurological findings were rare. We also suspect a link between the growing burden of the COVID-19 pandemic on personal lives and the increase in reported neurological and psychiatric complaints.
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Affiliation(s)
- Birgit Ludwig
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Matthias Deckert
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Omar Keritam
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gudrun Zulehner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Majda Thurnher
- Section of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
- Rehabilitation Clinic Pirawarth, Bad Pirawarth, Austria
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria
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13
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Thangaleela S, Sivamaruthi BS, Kesika P, Mariappan S, Rashmi S, Choeisoongnern T, Sittiprapaporn P, Chaiyasut C. Neurological Insights into Sleep Disorders in Parkinson's Disease. Brain Sci 2023; 13:1202. [PMID: 37626558 PMCID: PMC10452387 DOI: 10.3390/brainsci13081202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Parkinson's disease (PD) is a common multidimensional neurological disorder characterized by motor and non-motor features and is more prevalent in the elderly. Sleep disorders and cognitive disturbances are also significant characteristics of PD. Sleep is an important physiological process for normal human cognition and physical functioning. Sleep deprivation negatively impacts human physical, mental, and behavioral functions. Sleep disturbances include problems falling asleep, disturbances occurring during sleep, abnormal movements during sleep, insufficient sleep, and excessive sleep. The most recognizable and known sleep disorders, such as rapid-eye-movement behavior disorder (RBD), insomnia, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), sleep-related breathing disorders (SRBDs), and circadian-rhythm-related sleep-wake disorders (CRSWDs), have been associated with PD. RBD and associated emotional disorders are common non-motor symptoms of PD. In individuals, sleep disorders and cognitive impairment are important prognostic factors for predicting progressing neurodegeneration and developing dementia conditions in PD. Studies have focused on RBD and its associated neurological changes and functional deficits in PD patients. Other risks, such as cognitive decline, anxiety, and depression, are related to RBD. Sleep-disorder diagnosis is challenging, especially in identifying the essential factors that disturb the sleep-wake cycle and the co-existence of other concomitant sleep issues, motor symptoms, and breathing disorders. Focusing on sleep patterns and their disturbances, including genetic and other neurochemical changes, helps us to better understand the central causes of sleep alterations and cognitive functions in PD patients. Relations between α-synuclein aggregation in the brain and gender differences in sleep disorders have been reported. The existing correlation between sleep disorders and levels of α-synuclein in the cerebrospinal fluid indicates the risk of progression of synucleinopathies. Multidirectional approaches are required to correlate sleep disorders and neuropsychiatric symptoms and diagnose sensitive biomarkers for neurodegeneration. The evaluation of sleep pattern disturbances and cognitive impairment may aid in the development of novel and effective treatments for PD.
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Affiliation(s)
- Subramanian Thangaleela
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
| | - Bhagavathi Sundaram Sivamaruthi
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
- Office of Research Administration, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Periyanaina Kesika
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
- Office of Research Administration, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Subramanian Rashmi
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
| | - Thiwanya Choeisoongnern
- Neuropsychological Research Laboratory, Neuroscience Research Center, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok 10110, Thailand
| | - Phakkharawat Sittiprapaporn
- Neuropsychological Research Laboratory, Neuroscience Research Center, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok 10110, Thailand
| | - Chaiyavat Chaiyasut
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
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14
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Romigi A, Caccamo M, Testa F, Ticconi D, Cappellano S, Di Gioia B, Vitrani G, Rosenzweig I, Centonze D. Muscle atonia index during multiple sleep latency test: A possible marker to differentiate narcolepsy from other hypersomnias. Clin Neurophysiol 2023; 149:25-31. [PMID: 36870217 DOI: 10.1016/j.clinph.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/15/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The complexity and delay of the diagnosis of narcolepsy require several diagnostic tests and invasive procedures such as lumbar puncture. Our study aimed to determine the changes in muscle tone (atonia index, AI) at different levels of vigilance during the entire multiple sleep latency test (MSLT) and each nap in people with narcolepsy type 1 (NT1) and 2 (NT2) compared with other hypersomnias and its potential diagnostic value. METHODS Twenty-nine patients with NT1 (11 M 18F, mean age 34.9 years, SD 16.8) and sixteen with NT2 (10 M 6F, mean age 39 years, SD 11.8) and 20 controls with other hypersomnias (10 M, 10F mean age 45.1 years, SD 15.1) were recruited. AI was evaluated at different levels of vigilance (Wake and REM sleep) in each nap and throughout the MSLT of each group. The validity of AI in identifying patients with narcolepsy (NT1 and NT2) was analyzed using receiver operating characteristic (ROC) curves. RESULTS AI during wakefulness (WAI) was significantly higher in the narcolepsy groups (NT1 and NT2 p < 0.001) compared to the hypersomniac group. AI during REM sleep (RAI) (p = 0.03) and WAI in nap with sudden onsets of REM sleep periods (SOREMP) (p = 0.001) were lower in NT1 than in NT2. The ROC curves showed high AUC values for WAI (NT1 0.88; Best Cut-off > 0.57, Sensitivity 79.3 % Specificity 90 %; NT2 0.89 Best Cut-off > 0.67 Sensitivity 87.5 % Specificity 95 %; NT1 and NT2 0.88 Best Cut-off > 0.57 Sensitivity 82.2 % Specificity 90 %) in discriminating subjects suffering from other hypersomnias. RAI and WAI in nap with SOREMP showed a poor AUC value (RAI AUC: 0.7 Best cutoff 0.7 Sensitivity 50 % Specificity 87.5 %; WAI in nap before SOREMP AUC: 0.66, Best cut-off < 0.82 sensitivity 61.9 % and specificity 67.35 %) differentiating NT1 and NT2. CONCLUSIONS WAI may represent an encouraging electrophysiological marker of narcolepsy and suggests a vulnerable tendency to dissociative wake / sleep dysregulation lacking in other forms of hypersomnia. SIGNIFICANCE AI during wakefulness may help distinguish between narcolepsy and other hypersomnias.
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Affiliation(s)
- A Romigi
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy.
| | - M Caccamo
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - F Testa
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - D Ticconi
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - S Cappellano
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - B Di Gioia
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - G Vitrani
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
| | - I Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK
| | - D Centonze
- IRCCS Neuromed Istituto Neurologico Mediterraneo, Sleep Medicine Center, Via Atinense 18, Pozzilli, IS, Italy
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15
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Ferraris C, Ronga I, Pratola R, Coppo G, Bosso T, Falco S, Amprimo G, Pettiti G, Lo Priore S, Priano L, Mauro A, Desideri D. Usability of the REHOME Solution for the Telerehabilitation in Neurological Diseases: Preliminary Results on Motor and Cognitive Platforms. SENSORS (BASEL, SWITZERLAND) 2022; 22:9467. [PMID: 36502170 PMCID: PMC9740672 DOI: 10.3390/s22239467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
The progressive aging of the population and the consequent growth of individuals with neurological diseases and related chronic disabilities, will lead to a general increase in the costs and resources needed to ensure treatment and care services. In this scenario, telemedicine and e-health solutions, including remote monitoring and rehabilitation, are attracting increasing interest as tools to ensure the sustainability of the healthcare system or, at least, to support the burden for health care facilities. Technological advances in recent decades have fostered the development of dedicated and innovative Information and Communication Technology (ICT) based solutions, with the aim of complementing traditional care and treatment services through telemedicine applications that support new patient and disease management strategies. This is the background for the REHOME project, whose technological solution, presented in this paper, integrates innovative methodologies and devices for remote monitoring and rehabilitation of cognitive, motor, and sleep disorders associated with neurological diseases. One of the primary goals of the project is to meet the needs of patients and clinicians, by ensuring continuity of treatment from healthcare facilities to the patient's home. To this end, it is important to ensure the usability of the solution by elderly and pathological individuals. Preliminary results of usability and user experience questionnaires on 70 subjects recruited in three experimental trials are presented here.
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Affiliation(s)
- Claudia Ferraris
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, 10129 Turin, Italy
| | - Irene Ronga
- BraIn Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, 10124 Turin, Italy
| | - Roberto Pratola
- Engineering Ingegneria Informatica S.p.A., 00144 Rome, Italy
| | - Guido Coppo
- Synarea Consultants s.r.l., 10153 Turin, Italy
| | - Tea Bosso
- BraIn Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, 10124 Turin, Italy
- Geriatrics Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Sara Falco
- BraIn Plasticity and Behaviour Changes Research Group, Department of Psychology, University of Turin, 10124 Turin, Italy
- Clinical Pyschology Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Gianluca Amprimo
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, 10129 Turin, Italy
- Department of Control and Computer Engineering, Politecnico di Torino, 10129 Turin, Italy
| | - Giuseppe Pettiti
- Institute of Electronics, Computer and Telecommunication Engineering, National Research Council, 10129 Turin, Italy
| | | | - Lorenzo Priano
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 20123 Milan, Italy
- Department of Neurosciences, University of Turin, 10126 Turin, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation, S. Giuseppe Hospital, 20123 Milan, Italy
- Department of Neurosciences, University of Turin, 10126 Turin, Italy
| | - Debora Desideri
- Engineering Ingegneria Informatica S.p.A., 00144 Rome, Italy
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Hsieh PS, Hwang SW, Hwang SR, Hwang JH. Association between various breathing indexes during sleep and the Epworth Sleepiness Scale score in adults. Medicine (Baltimore) 2022; 101:e32017. [PMID: 36482611 PMCID: PMC9726380 DOI: 10.1097/md.0000000000032017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Some breathing indexes during sleep, including the apnea-hypopnea index, oxygen desaturation index, and oxygen saturation during sleep, can be recorded by overnight polysomnography. We aimed to investigate the association of various breathing indexes during sleep with the Epworth Sleepiness Scale (ESS) score in adults. We retrospectively collected the clinical and overnight polysomnography data of 2829 adults aged 20 years or older from November 2011 to June 2017. The association of various breathing indexes during sleep and ESS score was analyzed using univariate and multivariate logistic regression analysis for all adults (20-91 years), and in each sex and of body mass index (<26 kg/m2 vs ≥26 kg/m2). The mean ESS score was 6.2 (standard deviation = 4.3; range = 0-24) for all adults. After adjustment for age, sex, many common diseases, and health-related habits, apnea-hypopnea index, oxygen desaturation index, percentage of oxygen saturation below 90% during sleep, and percentage of oxygen saturation below 85% during sleep were significantly positively associated with ESS score in all adults, whereas mean oxygen saturation during sleep, minimal oxygen saturation during sleep, and awake oxygen saturation during sleep were significantly negatively associated with ESS score in all adults. In subgroup analysis, we found that the association between breathing indexes during sleep and ESS score was similar in both sex, but was significant in subjects of body mass index ≥ 26 kg/m2. All breathing indexes during sleep had significant positive or negative correlation with ESS score in all adults, especially in obese subjects.
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Affiliation(s)
- Pei-Shan Hsieh
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | | | | | - Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * Correspondence: Juen-Haur Hwang, Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 62247, Taiwan (e-mail: )
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17
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Romigi A, D'Aniello A, Caccamo M, Testa F, Vitrani G, Grammaldo L, De Risi M, Casciato S, Cappellano S, Esposito V, Centonze D, Di Gennaro G. Sleep macrostructure and cyclic alternating pattern in patients who underwent surgery for hippocampal sclerosis: A prospective controlled polysomnographic study. Sleep Med 2022; 100:419-426. [PMID: 36244316 DOI: 10.1016/j.sleep.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS) is one of the most common drug-resistant epilepsy. Surgery is currently accepted as an effective and safe therapeutic approach compared to antiseizure medications (ASMs). The study aims to evaluate the effect of surgical treatment of TLE-HS on sleep profile and architecture by subjective and objective evaluation of sleep in basal condition after one month and one year. METHODS Thirteen patients with TLE-HS were recruited to undergo overnight polysomnography and a subjective evaluation of nocturnal sleep utilizing the Pittsburgh Sleep Quality Index (PSQI) and daytime somnolence through the Epworth Sleepiness Scale (ESS) in basal condition (T0), one month (T1) and one year after surgery (T2), respectively. Thirteen healthy controls (HC) matched for age, sex and BMI were recruited. Scoring and analysis of sleep macrostructure and cyclic alternating pattern (CAP) parameters were performed. RESULTS The comparison between patients in basal condition (T0) and HC showed a significant lower sleep efficiency (p = 0.003) and REM percentage (p < 0.001). Regarding CAP, patients at T0 showed higher total CAP rate (p < 0.001), CAP rate in N2 (p < 0.001), higher A3 (%) (p = 0.001), higher mean duration of A1 (p = 0.002), A3 index (p < 0.001), cycle in sequences (p < 0.001), lower B duration (p < 0.001), cycle mean duration (p < 0.001) than HC. Surgery did not induce significant changes in nocturnal macrostructural polysomnographic variables in T1 and T2. Lower CAP rate (T1 vs T0 and T2 vs T0 p < 0.001), CAP rate in N3 (T1 vs T0 and T2 vs T0 p < 0.001), A3 (%) (T1 vs T0 and T2 vs T0 p < 0.001); lower phase A2 index (T1 vs T0 p < 0.001) and A3 index (T1 vs T0 p < 0.001), lower phase A1 index (T2 vs T0 p < 0.001) and cycle in sequences (T2 vs T0 p = 0.002) higher B mean duration (T2 vs T0 p = 0.002). No significant differences were found between T1 and T2 in CAP parameters. CONCLUSION We found a significant NREM sleep instability in patients with TLE-HS compared with HC. In addition, anterior temporal lobectomy (ATL) induced a significant improvement in sleep continuity as evaluated by cyclic alternating pattern already one month later and this effect persisted after one year. ALT seems to restore a more resilient sleeping brain.
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Affiliation(s)
- Andrea Romigi
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Alfredo D'Aniello
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Marco Caccamo
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Federica Testa
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Giuseppe Vitrani
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Liliana Grammaldo
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Marco De Risi
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sara Casciato
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Simone Cappellano
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Vincenzo Esposito
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Diego Centonze
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Giancarlo Di Gennaro
- Istituto Neurologico Mediterraneo, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
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Baril AA, Beiser AS, DeCarli C, Himali D, Sanchez E, Cavuoto M, Redline S, Gottlieb DJ, Seshadri S, Pase MP, Himali JJ. Self-reported sleepiness associates with greater brain and cortical volume and lower prevalence of ischemic covert brain infarcts in a community sample. Sleep 2022; 45:zsac185. [PMID: 35917199 PMCID: PMC9548673 DOI: 10.1093/sleep/zsac185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES We evaluated if self-reported sleepiness was associated with neuroimaging markers of brain aging and ischemic damage in a large community-based sample. METHODS Participants from the Framingham Heart Study Offspring cohort (n = 468, 62.5 ± 8.7 years old, 49.6%M) free of dementia, stroke, and neurological diseases, completed sleep questionnaires and polysomnography followed by magnetic resonance imaging (MRI), 3 years later on average. We used linear and logistic regression models to evaluate the associations between Epworth Sleepiness Scale (ESS) scores and total brain, cortical and subcortical gray matter, and white matter hyperintensities volumes, and the presence of covert brain infarcts. RESULTS Higher sleepiness scores were associated with larger total brain volume, greater cortical gray matter volume, and a lower prevalence of covert brain infarcts, even when adjusting for a large array of potential confounders, including demographics, sleep profiles and disorders, organic health diseases, and proxies for daytime cognitive and physical activities. Interactions indicated that more sleepiness was associated with larger cortical gray matter volume in men only and in APOE ε4 noncarriers, whereas a trend for smaller cortical gray matter volume was observed in carriers. In longitudinal analyses, those with stable excessive daytime sleepiness over time had greater total brain and cortical gray matter volumes, whereas baseline sleepiness scores were not associated with subsequent atrophy or cognitive decline. CONCLUSION Our findings suggest that sleepiness is not necessarily a marker of poor brain health when not explained by diseases or sleep debt and sleep disorders. Rather, sleepiness could be a marker of preserved sleep-regulatory processes and brain health in some cases.
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Affiliation(s)
- Andrée-Ann Baril
- The Framingham Heart Study, Framingham, MA, USA
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Alexa S Beiser
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Charles DeCarli
- Department of Neurology, University of California, Davis, CA, USA
| | | | - Erlan Sanchez
- Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Marina Cavuoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniel J Gottlieb
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
| | - Matthew P Pase
- The Framingham Heart Study, Framingham, MA, USA
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia
- Harvard T.H. Chan School of Public Health, MA, USA
| | - Jayandra J Himali
- The Framingham Heart Study, Framingham, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, TX, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
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19
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Al-Sharman A, Aldughmi M, Khalil H, AlKhawaldeh H, Siengsukon CF, El-Salem K. Knowledge and attitudes of physiotherapists toward sleep: A survey study. Work 2022; 73:739-746. [DOI: 10.3233/wor-211039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Sleep has been considered as a critical brain state that affects various body functions relevant to physiotherapy (PTs) practice such as motor learning and relearning, pain management, and cognitive function. Despite the importance of sleep for successful rehabilitation outcomes, sleep is often overlooked by PTs. OBJECTIVE: The purpose of this study was to assess the attitude and perception of PTs on the need to assess sleep and provide education about sleep for their patients, as well as the perceived need for PTs to be educated on sleep topics. METHODS: A survey questionnaire to assess physical therapist’s perceptions and attitudes about sleep was utilized in this study. RESULTS: 90 PTs fill out the survey. All respondents agreed that poor sleep is important to people’s health, 93% agreed that PTs should assess patients’ sleep habits and sleep quality and 88% agreed that addressing sleep issues may impact PTs outcomes. The majority did not receive education about sleep during PT education (75%) or following graduation (86%). Most respondents (95%) think PTs should receive education about sleep. CONCLUSIONS: our findings indicated that PTs recognize that sleep impacts their outcomes and patients’ sleep should be assessed, as well as the need to receive education about sleep. Therefore, PT education programs may consider incorporating education about sleep, and the development of continuing education courses is also needed.
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Affiliation(s)
- Alham Al-Sharman
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Mayis Aldughmi
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Hanan Khalil
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Hasan AlKhawaldeh
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Catherine F. Siengsukon
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas, MO, USA
| | - Khalid El-Salem
- Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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20
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Huang Y, Du S, Chen D, Qin Y, Cui J, Han H, Ge X, Bai W, Zhang X, Yu H. The path linking excessive daytime sleepiness and activity of daily living in Parkinson’s disease: the longitudinal mediation effect of autonomic dysfunction. Neurol Sci 2022; 43:4777-4784. [DOI: 10.1007/s10072-022-06081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
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21
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Exploring the management approaches of cytokines including viral infection and neuroinflammation for neurological disorders. Cytokine 2022; 157:155962. [PMID: 35853395 DOI: 10.1016/j.cyto.2022.155962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022]
Abstract
Considerable evidence supports that cytokines are important mediators of pathophysiologic processes within the central nervous system (CNS). Numerous studies have documented the increased production of various cytokines in the human CNS in various neurological and neuropsychiatric disorders. Deciphering cytokine actions in the intact CNS has important implications for our understanding of the pathogenesis and treatment of these disorders. The purpose of this study is to discuss the recent research on treating cytokine storm and amyloids, including stroke, Parkinson's disease (PD), Alzheimer's disease (AD), Huntington's condition, Multi-sclerosis (MS), Amyotrophic Lateral Sclerosis (ALS). Neuroinflammation observed in neurological disorders has a pivotal role in exacerbating Aβ burden and tau hyperphosphorylation, suggesting that stimulating cytokines in response to an undesirable external response could be a checkpoint for treating neurological disorders. Furthermore, the pro-inflammatory cytokines help our immune system through a neuroprotective mechanism in clearing viral infection by recruiting mononuclear cells. This study reveals that cytokine applications may play a vital role in providing novel regulation and methods for the therapeutic approach to neurological disorders and the causes of the deregulation, which is responsible for neuroinflammation and viral infection. However, it needs to be further investigated to clarify better the mechanisms of cytokine release in response to various stimuli, which could be the central point for treating neurological disorders.
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22
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Susta M, Šonka K, Bizik G, Petranek S, Nevsimalova S. Idiopathic Hypersomnia-A Dynamic Simulation Model. Front Neurol 2022; 13:902637. [PMID: 35756941 PMCID: PMC9226714 DOI: 10.3389/fneur.2022.902637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Aims of the study Commonly used approach to illness assessment focuses on the patient's actual state supplemented by binary records of past events and conditions. This research project was designed to explain subjective experience in idiopathic hypersomnia (IH) patients influenced by their clinical symptoms and comorbidities. Material and Methods Forty-three IH patients of both sexes (female 60.5%, male 39.5%) were assessed using a detailed structured examination. The interview covered neurologic, psychiatric, and internal medicine anamnesis, medication past and current, substance abuse, work impairment, detailed sleep-related data, specific sleep medication, and a full-length set of questionnaires including depression, quality of life, sleepiness, anxiety, fatigue, insomnia, and sleep inertia. The data were digitized and imported into statistical software (SPSS by IBM), and dynamic simulation software (Vensim by Ventana Systems Inc.) was used to build a causal loop diagram and stocks and flows diagram as a simulation structure. Results The overall raw data and simulation-based patterns fit at 76.1%. The simulation results also identified the parameters that contribute the most to patients' subjective experience. These included sleep inertia, the refreshing potential of naps, the quality of nocturnal sleep, and the social aspects of the patient's life. Psychiatric disorders influence the overall pattern at a surprisingly low level. The influence of medication has been studied in detail. Although its contribution to the dynamics looks marginal at first sight, it significantly influences the contribution of other variables to the overall patient experience of the disease. Conclusion Even the simplified dynamic structure designed by the research team reflects the real-life events in patients with IH at the acceptable level of 76.1% and suggests that a similar structure plays an important role in the course of the disease. Therapeutic focus on the parameters identified by the model should enhance the patients' subjective experience throughout illness duration and might even turn the progress from negative into positive. Further research is needed to understand the dynamics of idiopathic hypersomnia in greater detail to better understand the causes and design therapeutic approaches to improve patients' quality of life.
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Affiliation(s)
- Marek Susta
- Department of Public Health, St. Elisabeth University, Bratislava, Slovakia
| | - Karel Šonka
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Gustav Bizik
- Department of Psychiatry, Aalborg University, Aalborg, Denmark
| | - Svojmil Petranek
- Health Care Facility, Department of the Interior, Prague, Czechia
| | - Sona Nevsimalova
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
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23
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Wang H, Tang X, Zhou J, Xu Y. Excessive Daytime Sleepiness Is Associated With Non-motor Symptoms of Multiple System Atrophy: A Cross-Sectional Study in China. Front Neurol 2022; 12:798771. [PMID: 35087473 PMCID: PMC8786795 DOI: 10.3389/fneur.2021.798771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Excessive daytime sleepiness (EDS) in multiple system atrophy (MSA) has received scant attention in the literature, thus the present cross-sectional study aimed to investigate the prevalence of EDS and its potential risk factors among Chinese patients with MSA. Methods: A total of 66 patients with MSA (60.6% males) were consecutively recruited. Eighteen patients (27.3%, 13 men) with Epworth Sleepiness Scale score >10 were defined as having EDS. Demographic, motor [Unified Multiple-System Atrophy (UMSARS)] and non-motor symptoms [Non-Motor Symptoms Scale (NMSS)], and sleep parameters [polysomnography (PSG)] were compared between patients with MSA with and without EDS. A logistic regression analysis was used to calculate the risk factors of EDS in patients with MSA. Results: There were no significant differences in age, sex, MSA onset age, disease duration, MSA sub-type, and motor symptom severity between MSA patients with and without EDS. However, compared with the MSA patients without EDS, their counterparts with EDS had higher scores of NMSS (65.3 ± 23.1 vs. 43.4 ± 25.3, P = .0002), Hamilton Anxiety (HAMA) [15.3 (10.3–20.0) vs. 9.5 (3.0–15.0), P = 0.006], Hamilton Depression (HAMD) [13.7 (12.5–17.8) vs. 9.0 (4.0–13.0), P = 0.015], and Fatigue Severity Scale (FSS) [29.8 (17.3–47.8) vs. 18.7 (10.3–21.8), P = 0.040]. Conversely, the patients with EDS had lower score of Mini-Mental State Examination (MMSE) [23.3 (20.3–27.0) vs. 25.7 (22.0–29.0), P = 0.023]. Similarly, there was a significantly lower percentage of N3 sleep (%) [0.3 (0–0) vs. 2.0 (0–0), P = 0.007] and a higher apnea-hypopnea index (AHI/h) [30.5 (14.5–47.8) vs. 19.3 (5.0–28.7), P = 0.034] in patients with EDS. After adjusting for age, sex, disease duration, MSA sub-type, and UMSARS score, the odds ratio (OR) (95% CI) of EDS was higher while increasing scores in FSS [1.06 (1.02–1.11)], HAMA [1.16 (1.04–1.28)], HAMD [1.13 (1.02–1.25)], NMSS [1.04 (1.01–1.07)], and AHI [1.03 (1.00–1.10)]. The OR of EDS was lower while the MMSE score was increasing [0.85 (0.72–1.00)]. Conclusions: The presence and severity of EDS may be significantly associated with the non-motor dysfunction, including fatigue, anxiety, depression, cognitive dysfunction, and sleep-related breathing disorder, but not with the motor dysfunction in MSA.
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Affiliation(s)
- Hui Wang
- Department of Neurology, The Second People's Hospital of Chengdu, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Junying Zhou
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanming Xu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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24
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Zhao J, Kong Q, Wang M, Huang H, Zhou X, Guo Y, Zhang Y, Wu L, Yu Z, Luo X. Association of Excessive Daytime Sleepiness with Cerebral Small Vessel Disease in Community-Dwelling Older Adults. Nat Sci Sleep 2022; 14:765-773. [PMID: 35478722 PMCID: PMC9037722 DOI: 10.2147/nss.s357586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Excessive daytime sleepiness (EDS) and cerebral small vessel disease (CSVD) are common problems among older adults; however, their association is not clear. The present study aimed to investigate the frequency of EDS in CSVD patients and the relationship between EDS and neuroimaging markers of CSVD. PATIENTS AND METHODS We conducted a cross-sectional study among 1076 community-dwelling older adults aged 55-85 years. EDS was measured using the Epworth Sleepiness Scale (ESS), and EDS was defined as an ESS score greater than 10. Binary logistic regression was performed to assess the association between EDS and neuroimaging markers of CSVD. RESULTS Of the 1076 participants (mean age: 65.58 ± 6.46 years, 60.5% female), the prevalence of EDS was 10.0%. EDS was more frequent in participants with CSVD than in the total sample (20.0% vs 10.0%, p <0.001). In fully adjusted models, EDS was significantly correlated with CSVD burden (OR = 1.39, 95% CI 1.16 to 1.68, p <0.001), the severity of white matter hyperintensities (WMH) (OR = 1.33, 95% CI 1.14 to 1.54, p <0.001), and presence of lacunes (OR = 2.47, 95% CI 1.53 to 4.00, p <0.001) but not with the presence of cerebral microbleeds (CMBs) (OR=1.54, 95% CI 0.92 to 2.56, p = 0.099) or severity of enlarged perivascular spaces (EPVS) in basal ganglia (OR = 1.16, 95% CI 0.70 to 1.92, p = 0.564). CONCLUSION We found a high frequency of EDS symptoms in CSVD individuals. Further, EDS was significantly associated with WMH, lacunes, and CSVD burden. Our findings further suggest patients with CSVD may exhibit abnormal sleep-wake patterns.
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Affiliation(s)
- Jing Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Qianqian Kong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xirui Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yinping Guo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Delva M, Delva I, Pinchuk V, Kryvchun A, Purdenko T. PREVALENCE AND PREDICTORS OF FATIGUE IN PATIENTS WITH EPISODIC MIGRAINE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1970-1974. [PMID: 36129080 DOI: 10.36740/wlek202208205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: We studied prevalence, intensity and predictors of fatigue in patient with episodic migraine (EM). PATIENTS AND METHODS Materials and methods: We enrolled in the study 85 patients with EM and 88 healthy subjects. Fatigue was identified according to Fatigue Severity Scale. We recorded socio-demographic factors: gender, age, marital status, formal education level, employment status, smoking. Anxiety and depression symptoms were assessed by Hospital Anxiety and Depression Scale, daytime sleepiness was measured by Epworth scale. The co-morbidities included history of low back pain during last year, arterial hypertension, diabetes mellitus and abdominal obesity. It was analyzed usage of non-steroidal anti-inflammatory drugs, combined analgesics, triptans for abortive migraine treatment. RESULTS Results: Fatigue prevalence in patients with EM was 41,2%, which was significantly higher than in healthy controls (11,4%). Fatigue intensity in episodic migraineurs was 5,7 (4,9-6,8) and did not differ significantly from fatigue intensity in healthy individuals - 4,9 (4,5-5,8). In multivariate logistic regression analysis independent predictors of fatigue were only migraine-related factors (number of migraine headache days per month, headache severity and migraine prodrome presence). There was weak direct correlation between the number of headache migraine days per month and fatigue intensity. CONCLUSION Conclusions: 1. Fatigue prevalence in patients with EM is significantly higher than in healthy controls. 2. In patients with EM fatigue has migraine-related predictors.
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Affiliation(s)
| | - Iryna Delva
- POLTAVA STATE MEDICAL UNIVERSITY, POLTAVA, UKRAINE
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26
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Liu H, Li J, Wang X, Huang J, Wang T, Lin Z, Xiong N. Excessive Daytime Sleepiness in Parkinson's Disease. Nat Sci Sleep 2022; 14:1589-1609. [PMID: 36105924 PMCID: PMC9464627 DOI: 10.2147/nss.s375098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is one of the most common sleep disorders in Parkinson's disease (PD). It has attracted much attention due to high morbidity, poor quality of life, increased risk for accidents, obscure mechanisms, comorbidity with PD and limited therapeutic approaches. In this review, we summarize the current literature on epidemiology of EDS in PD to address the discrepancy between subjective and objective measures and clarify the reason for the inconsistent prevalence in previous studies. Besides, we focus on the effects of commonly used antiparkinsonian drugs on EDS and related pharmacological mechanisms to provide evidence for rational clinical medication in sleepy PD patients. More importantly, degeneration of wake-promoting nuclei owing to primary neurodegenerative process of PD is the underlying pathogenesis of EDS. Accordingly, altered wake-promoting nerve nuclei and neurotransmitter systems in PD patients are highlighted to providing clues for identifying EDS-causing targets in the sleep and wake cycles. Future mechanistic studies toward this direction will hopefully advance the development of novel and specific interventions for EDS in PD patients.
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Affiliation(s)
- Hanshu Liu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jingwen Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xinyi Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Jinsha Huang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tao Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhicheng Lin
- Laboratory of Psychiatric Neurogenomics, McLean Hospital; Harvard Medical School, Belmont, MA, 02478, USA
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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27
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Vaughan CL, Bruno V. What neurologists wish palliative care physicians knew. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:93-104. [PMID: 36055723 DOI: 10.1016/b978-0-323-85029-2.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
As the incidence of neurologic (particularly neurodegenerative) diseases continues to rise, so too will the palliative needs in this patient population. To appropriately care for these patients and families, neurologists and palliative care providers will need to strengthen collaboration. Palliative care providers not formally trained in neurology may feel ill-equipped to manage some of the distinct neuropalliative care needs of these patients. Here, we provide insights into the unique characteristics of patients with neurologic disease and emphasize the relevance of the palliative care skillset in this population to aid the collaboration between palliative care providers and neurologists.
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Affiliation(s)
- Christina L Vaughan
- Department of Neurology and Medicine, Anschutz Medical Center, University of Colorado, Aurora, CO, United States; Department of Neurology, VA Eastern Colorado Health System, Aurora, CO, United States.
| | - Veronica Bruno
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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28
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Baillieul S, Dekkers M, Brill AK, Schmidt MH, Detante O, Pépin JL, Tamisier R, Bassetti CLA. Sleep apnoea and ischaemic stroke: current knowledge and future directions. Lancet Neurol 2021; 21:78-88. [PMID: 34942140 DOI: 10.1016/s1474-4422(21)00321-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
Sleep apnoea, one of the most common chronic diseases, is a risk factor for ischaemic stroke, stroke recurrence, and poor functional recovery after stroke. More than half of stroke survivors present with sleep apnoea during the acute phase after stroke, with obstructive sleep apnoea being the most common subtype. Following a stroke, sleep apnoea frequency and severity might decrease over time, but moderate to severe sleep apnoea is nevertheless present in up to a third of patients in the chronic phase after an ischaemic stroke. Over the past few decades evidence suggests that treatment for sleep apnoea is feasible during the acute phase of stroke and might favourably affect recovery and long-term outcomes. Nevertheless, sleep apnoea still remains underdiagnosed and untreated in many cases, due to challenges in the detection and prediction of post-stroke sleep apnoea, uncertainty as to the optimal timing for its diagnosis, and a scarcity of clear treatment guidelines (ie, uncertainty on when to treat and the optimal treatment strategy). Moreover, the pathophysiology of sleep apnoea associated with stroke, the proportion of stroke survivors with obstructive and central sleep apnoea, and the temporal evolution of sleep apnoea subtypes following stroke remain to be clarified. To address these shortcomings, the management of sleep apnoea associated with stroke should be integrated into a multidisciplinary diagnostic, treatment, and follow-up strategy.
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Affiliation(s)
- Sébastien Baillieul
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Martijn Dekkers
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland
| | - Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital, University Hospital, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, University Hospital, Bern, Switzerland; Ohio Sleep Medicine Institute, Dublin, OH, USA
| | - Olivier Detante
- Stroke Unit, Neurology Department, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1216, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pépin
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Renaud Tamisier
- Service Universitaire de Pneumologie Physiologie, Grenoble Alpes University Hospital, Grenoble, France; Inserm U1300, Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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Schmidt MH, Dekkers MPJ, Baillieul S, Jendoubi J, Wulf MA, Wenz E, Fregolente L, Vorster A, Gnarra O, Bassetti CLA. Measuring Sleep, Wakefulness, and Circadian Functions in Neurologic Disorders. Sleep Med Clin 2021; 16:661-671. [PMID: 34711389 DOI: 10.1016/j.jsmc.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Neurologic disorders impact the ability of the brain to regulate sleep, wake, and circadian functions, including state generation, components of state (such as rapid eye movement sleep muscle atonia, state transitions) and electroencephalographic microarchitecture. At its most extreme, extensive brain damage may even prevent differentiation of sleep stages from wakefulness (eg, status dissociatus). Given that comorbid sleep-wake-circadian disorders are common and can adversely impact the occurrence, evolution, and management of underlying neurologic conditions, new technologies for long-term monitoring of neurologic patients may potentially usher in new diagnostic strategies and optimization of clinical management.
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Affiliation(s)
- Markus H Schmidt
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Ohio Sleep Medicine Institute, 4975 Bradenton Avenue, Dublin, OH 43017, USA.
| | - Martijn P J Dekkers
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Sébastien Baillieul
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble 38000, France
| | - Jasmine Jendoubi
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Marie-Angela Wulf
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Livia Fregolente
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Albrecht Vorster
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Oriella Gnarra
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Sensory-Motor System Lab, IRIS, ETH Zurich, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Department of Neurology, University of Sechenow, Moscow, Russia
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Nobili L, Beniczky S, Eriksson SH, Romigi A, Ryvlin P, Toledo M, Rosenzweig I. Expert Opinion: Managing sleep disturbances in people with epilepsy. Epilepsy Behav 2021; 124:108341. [PMID: 34619543 DOI: 10.1016/j.yebeh.2021.108341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/21/2022]
Abstract
Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.
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Affiliation(s)
- Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy; Child Neuropsychiatry Unit, Istituto G. Gaslini, Genoa, Italy.
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre and Aarhus University Hospital, Denmark.
| | - Sofia H Eriksson
- Department of Clinical and Experiential Epilepsy, UCL Institute of Neurology, University College London, London, UK.
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences, Vaud University Hospital Center, Lausanne, Switzerland
| | - Manuel Toledo
- Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Kings College London and Sleep Disorders Centre, GSTT NHS Trust, London, UK.
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Zaccara G, Bartolini E, Tramacere L, Lattanzi S. Drugs for patients with epilepsy and excessive daytime sleepiness. Epilepsy Behav 2021; 124:108311. [PMID: 34534876 DOI: 10.1016/j.yebeh.2021.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Excessive daytime sleepiness (EDS) and attentional deficits are often observed in people with epilepsy. They may be the consequence of seizures and subclinical discharges as well as of comorbid conditions as obstructive sleep apnea/hypopnea syndrome (OSAS), attention deficit hyperactivity disorder (ADHD), or other less frequent disorders. Excessive daytime sleepiness may also be caused or worsened by antiseizure medications (ASMs). Several meta-analyses suggested that lamotrigine, lacosamide, and perhaps eslicarbazepine are less sedative than other traditional and new ASMs and, in patients prone to somnolence, might be preferred over ASMs with more sedative properties. In patients with severe EDS and/or ADHD, advantages and risks of a treatment with a psychostimulant need to be considered. Methylphenidate, modafinil, armodafinil, pitolisant, and solriamfetol are authorized for use in ADHD and EDS in patients with narcolepsy and some of them also in OSAS. These agents are off-label for the treatment of EDS associated with epilepsy. They do not have proconvulsant effects, although there are several possible risks for patients with epilepsy. The risks of cardiovascular events and psychiatric symptoms should be carefully evaluated as such disorders can coexist with epilepsy and be triggered by these agents. Finally, combination of psychostimulants with ASMs may be associated with several pharmacokinetic drug-drug interactions.
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Affiliation(s)
| | - Emanuele Bartolini
- USL Centro Toscana, Neurology Unit, Nuovo Ospedale Santo Stefano, Prato, Italy
| | - Luciana Tramacere
- USL Centro Toscana, Neurology Unit, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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32
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Sap-Anan N, Pascoe M, Wang L, Grigg-Damberger MM, Andrews ND, Foldvary-Schaefer N. The Epworth Sleepiness Scale in epilepsy: Internal consistency and disease-related associations. Epilepsy Behav 2021; 121:108099. [PMID: 34102473 DOI: 10.1016/j.yebeh.2021.108099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Epworth Sleepiness Scale (ESS) is the most common instrument for measuring subjective sleep propensity in people with epilepsy but has not yet been validated in this population. STUDY OBJECTIVES We aimed to systematically assess the validity, performance, and internal consistency of the ESS, as well as correlations between the ESS and disease-specific variables and patient-reported outcome measures in a cohort of adults with epilepsy (AWE). METHODS Ninety-five AWE completed sleep and seizure diaries, in-laboratory polysomnography (PSG) and patient-reported outcome measures, including the ESS, Insomnia Severity Index (ISI), and the Beck Depression Inventory (BDI). Demographic information and data from 95 matched controls referred for PSG for suspected obstructive sleep apnea (OSA) was taken from the electronic medical record. Frequencies of high ESS item ratings (item score ≥2) were calculated for each group. Cronbach's α and factor analysis were performed to assess the internal consistency and validity of the ESS within cases and controls. Multivariable linear models were used to assess the association between ESS and predictors of interest, adjusting for demographic and disease-specific variables, including seizure type, frequency, and anti-seizure medication (ASM) therapy. RESULTS While suspected OSA controls had significantly greater mean ESS total scores (9.9 vs 7.9, p = 0.004) and proportion with ESS >10 (42% vs 25%, p = 0.014), there were no significant differences in the severity of item responses, with the exception of "lying down to rest in the afternoon when circumstances permit," for which more controls rated as likely/very likely (79% vs 64%), p = 0.024). AWE with ESS >10 had higher mean standardized ASM dose (2.5 vs 1.7, p = 0.026). All ESS items were significantly correlated with the total score within each group. Cronbach's α was 0.75 for cases and 0.85 for controls, indicating good internal consistency of the ESS for both groups. After adjusting for demographic and sleep characteristics, higher ESS scores were associated with greater insomnia scores on the ISI (p = 0.024) and depressive symptoms on the BDI (p = 0.018). CONCLUSIONS This study provides validity for the use of the ESS in adult populations with epilepsy.
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Affiliation(s)
| | - Maeve Pascoe
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
| | - Lu Wang
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Noah D Andrews
- Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
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Solly EJ, Clough M, Foletta P, White OB, Fielding J. The Psychiatric Symptomology of Visual Snow Syndrome. Front Neurol 2021; 12:703006. [PMID: 34393980 PMCID: PMC8362098 DOI: 10.3389/fneur.2021.703006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: To characterise the psychiatric symptoms of visual snow syndrome (VSS), and determine their relationship to quality of life and severity of visual symptoms. Methods: One hundred twenty-five patients with VSS completed a battery of questionnaires assessing depression/anxiety, dissociative experiences (depersonalisation), sleep quality, fatigue, and quality of life, as well as a structured clinical interview about their visual and sensory symptoms. Results: VSS patients showed high rates of anxiety and depression, depersonalisation, fatigue, and poor sleep, which significantly impacted quality of life. Further, psychiatric symptoms, particularly depersonalisation, were related to increased severity of visual symptoms. The severity/frequency of psychiatric symptoms did not differ significantly due to the presence of migraine, patient sex, or timing of VSS onset (lifelong vs. later onset). Conclusion: Psychiatric symptoms are highly prevalent in patients with VSS and are associated with increased visual symptom severity and reduced quality of life. Importantly, patients with lifelong VSS reported lower levels of distress and milder self-ratings of visual symptoms compared to patients with a later onset, while being equally likely to experience psychiatric symptoms. This suggests that the psychiatric symptoms of VSS are not solely due to distress caused by visual symptoms. While no consistently effective treatments are available for the visual symptomology of VSS, psychiatric symptoms offer an avenue of treatment that is likely to significantly improve patient quality of life and ability to cope with visual symptoms.
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Affiliation(s)
- Emma J Solly
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Paige Foletta
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Owen B White
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
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Koc Okudur S, Soysal P. Excessive Daytime Sleepiness is Associated With Malnutrition, Dysphagia, and Vitamin D Deficiency in Older Adults. J Am Med Dir Assoc 2021; 22:2134-2139. [PMID: 34181909 DOI: 10.1016/j.jamda.2021.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included. METHODS All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores >23.5, 17-23.5, or <17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin B12, vitamin D, and folate deficiencies were also evaluated. The Epworth Sleepiness Scale score of ≥11 points indicated EDS. RESULTS The mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P < .05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P < .05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted. CONCLUSIONS AND IMPLICATIONS There is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.
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Affiliation(s)
- Saadet Koc Okudur
- Department of Geriatric Medicine, Manisa State Hospital, Manisa, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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35
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Höffken O, Haensch CA. Vigilanz und Fahreignung. KLIN NEUROPHYSIOL 2021. [DOI: 10.1055/a-1098-3761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Störungen der Vigilanz können die Fahreignung relevant beeinträchtigen. Sie können vielfältige Ursachen haben und stellen eine der Hauptursachen für Verkehrsunfälle dar. Dieser Artikel benennt die rechtlichen Grundlagen für die Beurteilung der Fahreignung, stellt Testverfahren zur Einschätzung von Vigilanzstörungen vor und erläutert ein praktisches Vorgehen unter Berücksichtigung der gesetzlichen Bestimmungen.
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Sleep quality and daytime sleepiness in epilepsy: Systematic review and meta-analysis of 25 studies including 8,196 individuals. Sleep Med Rev 2021; 57:101466. [PMID: 33838598 DOI: 10.1016/j.smrv.2021.101466] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/26/2022]
Abstract
We sought to gain a better understanding of the relationship between epilepsy and sleep quality and daytime sleepiness by performing a literature search of PubMed for case-control studies that compared patients with epilepsy to controls and reported the Pittsburgh sleep quality index (PSQI) and/or the Epworth sleepiness scale (ESS). Study-specific mean differences in the PSQI and ESS between cases and controls were extracted from the publications and pooled using random-effects meta-analysis. Twenty-five studies (2964 cases, 5232 controls) were included. Fifteen studies reported the PSQI and 24 the ESS. Mean age was 40 years; 50.4% were women. When comparing cases to controls, the pooled mean differences in the PSQI and ESS were 1.27 (95% confidence interval (CI): 0.76, 1.78; P < 0.001; I2: 81.4%) and 0.38 (95% CI: -0.07, 0.84; P = 0.099; I2: 81.0%). Subgroup analyses revealed that mean differences in the ESS were significantly lower in studies with a higher proportion of patients with focal epilepsy (P = 0.004). In this large-scale meta-analysis patients with epilepsy had a higher PSQI, close to the pathological cut-off, compared to controls, but a similar and unremarkable ESS. Further studies are needed to investigate potential effect modifiers, such as specific antiepileptic drugs or seizure frequency.
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Anatomical Covariance Analysis: Detection of Disrupted Correlation Network Related to Clinical Trait Fatigue in Multiple Sclerosis: A Pilot Study. Behav Neurol 2020. [PMID: 32175581 PMCID: PMC7775148 DOI: 10.1155/2020/5807496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fatigue is one of the most distressing symptoms among persons with multiple sclerosis (PwMS). The experience of fatigue is inherently interoceptive, yet no study to date has explicitly investigated the insular cortex (IC) as a primary goal in the experience of fatigue in PwMS. In addition, it is unknown how brain regions such as IC play a role in state or trait fatigue. Objective Assess the involvement of the IC in trait fatigue and state fatigue in PwMS with and without clinical fatigue. Methods Trait and state fatigue, cognitive status, and structural MRI were assessed in 27 PwMS. PwMS were stratified into nonclinical fatigue (nF-MS, FSS ≤ 4.0) (n = 10) and clinical fatigue (F-MS, FSS ≥ 5.0) (n = 10). Voxel-based morphometry analysis (VBM) for the whole sample (n = 20) and for the two groups was performed. Anatomical covariance analysis (ACA) analysis was conducted by selecting different volumes included in the corticostriatal network (CoStN) and analyzing interhemispheric correlations between those volumes to explore the state of the CoStN in both groups. Results In the VBM analysis, when considering the whole sample of PwMS, higher levels of trait fatigue were negatively associated with grey matter (GM) volume in the left dorsal anterior insula (dAI) (rho = −0.647; p = 0.002; R2 = 0.369). When comparing nF-MS versus F-MS, significant differences were found in the left dAI, where the F-MS group showed less GM volume in the left dAI. In the ACA analysis, the F-MS group showed fewer significant interhemispheric correlations in comparison with the Low-FSS group. Conclusions The present results provide support to the interoceptive component of self-reported fatigue and suggest that changes in the relationship between the different anatomical regions involved in the CoStN are present even in nonclinical trait fatigue. Those changes might be responsible for the experience of trait fatigue in PwMS. Future studies with larger samples and multimodal MRI acquisitions should be considered to fully understand the changes in the CoStN and the specific role of the IC in trait fatigue.
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Dacosta-Aguayo R, Wylie G, DeLuca J, Genova H. Changes in plant function and root mycobiome caused by flood and drought in a riparian tree. Behav Neurol 2020; 40:886-903. [PMID: 32175581 PMCID: PMC7775148 DOI: 10.1093/treephys/tpaa031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023] Open
Abstract
Under increasingly harsh climatic conditions, conservation of threatened species requires integrative studies to understand stress tolerance. Riparian Ulmus minor Mill. populations have been massively reduced by Dutch Elm disease (DED). However, resistant genotypes were selected to restore lost populations. To understand the acclimation mechanisms to the succession of abiotic stresses, ramets of five DED-tolerant U. minor genotypes were subjected to flood and subsequently to drought. Physiological and biochemical responses were evaluated together with shifts in root-fungal assemblages. During both stresses, plants exhibited a decline in leaf net photosynthesis and an increase in percentage loss of stem hydraulic conductivity and in leaf and root proline content. Stomatal closure was produced by chemical signals during flood and hydraulic signals during drought. Despite broad similarities in plant response to both stresses, root-mycobiome shifts were markedly different. The five genotypes were similarly tolerant to moderate drought, however, flood tolerance varied between genotypes. In general, flood did not enhance drought susceptibility due to fast flood recovery, nevertheless, different responses to drought after flood were observed between genotypes. Associations were found between some fungal taxonomic groups and plant functional traits varying with flood and drought (e.g. proline, chlorophyll and starch content) indicating that the thriving of certain taxa depends on host responses to abiotic stress.
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Affiliation(s)
- Rosalia Dacosta-Aguayo
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
| | - Glenn Wylie
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, USA
| | - John DeLuca
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, USA
| | - Helen Genova
- Neuropsychology and Neuroscience, Kessler Foundation, 120 Eagle Rock Avenue, Suite 100, East Hanover, New Jersey 07936, USA
- Department of Physical Medicine and Rehabilitation, Rutgers University, New Jersey Medical School, Newark, NJ 07101, USA
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Jo S, Kim HJ, Kim HW, Koo YS, Lee SA. Sex differences in factors associated with daytime sleepiness and insomnia symptoms in persons with epilepsy. Epilepsy Behav 2020; 104:106919. [PMID: 32058302 DOI: 10.1016/j.yebeh.2020.106919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 11/29/2022]
Abstract
Clinical factors associated with daytime sleepiness and insomnia in persons with epilepsy (PWE) were examined in this cross-sectional study of 126 participants (men, 50.8%). Excessive daytime sleepiness (EDS; score of ≥11 on the Epworth Sleepiness Scale (ESS)) was noted in 17.5% of participants (mean score, 6.1 ± 4.2), and moderate-to-severe insomnia (Insomnia Severity Index (ISI) scores of ≥15) was noted in 20.6% (mean score, 7.8 ± 6.4). Linear regression analyses revealed that ESS scores were independently associated with obstructive sleep apnea (OSA; snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and gender (STOP-Bang) score of ≥3), an antiepileptic drug (AED) load of >3, depression (Patient Health Questionnaire-9 (PHQ-9) score of ≥10), female sex, and nocturnal seizures. Insomnia Severity Indices were independently associated with depression and anxiety (Generalized Anxiety Disorder-7 (GAD-7) score of ≥7). Notably, significant sex differences were found. Epworth Sleepiness Scale scores were associated with OSA in men but were associated with depression in women. In addition, anxiety was associated with insomnia in women only. Overall, OSA and depression were the most important significant clinical factors associated with daytime sleepiness and insomnia, respectively. However, there were sex differences for the associations between individual factors and sleep disturbances.
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Affiliation(s)
- Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Seo Koo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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