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Soh JH, Kang YJ, Yoon WH, Park CS, Shin HW. Positional Obstructive Sleep Apnea and Periodic Limb Movements During Sleep: A Large Multicenter Study. Clin Exp Otorhinolaryngol 2024; 17:217-225. [PMID: 38693650 PMCID: PMC11375175 DOI: 10.21053/ceo.2024.00034] [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: 01/30/2024] [Accepted: 04/29/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movements during sleep (PLMS) remain unclear. We investigated these relationships with respect to the severity of OSA and explored the underlying mechanisms. METHODS We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography at four clinical centers over a 5-year period, utilizing event-synchronized analysis. We evaluated the periodic limb movement index (PLMI) and the periodic limb movement with arousal index (PLMAI). The impacts of POSA on the PLMI, PLMAI, and PLMS were analyzed in relation to the severity of OSA. RESULTS The mean PLMI, the mean PLMAI, and the prevalence of PLMS were significantly lower in participants with severe OSA compared to the mild and moderate OSA groups. The mean PLMI among those with mild OSA exceeded that of control participants. Furthermore, the mean PLMI (4.8±12.7 vs. 2.6±9.8 events/hr, P<0.001), the mean PLMAI (0.9±3.7 vs. 0.5±3.3 events/hr, P<0.001), and the prevalence of PLMS (11% vs. 5.3%, P<0.001) were higher in patients with POSA than in those with non-positional OSA. This PLMS finding was particularly pronounced among those with severe OSA (odds ratio [OR], 1.554; 95% confidence interval [CI], 1.065-2.267) and was less evident in the mild (OR, 0.559; 95% CI, 0.303-1.030) and moderate (OR, 1.822; 95% CI, 0.995-3.339) groups. CONCLUSION Patients with POSA, especially those with severe OSA, exhibit a comparatively high prevalence of PLMS. In cases involving prominent PLMS, the diagnosis and treatment of POSA and OSA should be considered.
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Affiliation(s)
- Jae Hyun Soh
- Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea
| | | | - Chan-Soon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyun-Woo Shin
- OUaR LaB Inc., Seoul, Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
- Sensory Organ Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Barateau L, Baillieul S, Andrejak C, Bequignon É, Boutouyrie P, Dauvilliers Y, Gagnadoux F, Geoffroy PA, Micoulaud-Franchi JA, Montani D, Monaca C, Patout M, Pépin JL, Philip P, Pilette C, Tamisier R, Trzepizur W, Jaffuel D, Arnulf I. Guidelines for the assessment and management of residual sleepiness in obstructive apnea-hypopnea syndrome: Endorsed by the French Sleep Research and Medicine Society (SFRMS) and the French Speaking Society of Respiratory Diseases (SPLF). Respir Med Res 2024; 86:101105. [PMID: 38861872 DOI: 10.1016/j.resmer.2024.101105] [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: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/13/2024]
Abstract
Excessive daytime sleepiness (EDS) is frequent among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and can persist despite the optimal correction of respiratory events (apnea, hypopnea and respiratory efforts), using continuous positive airway pressure (CPAP) or mandibular advancement device. Symptoms like apathy and fatigue may be mistaken for EDS. In addition, EDS has multi-factorial origin, which makes its evaluation complex. The marketing authorization [Autorisation de Mise sur le Marché (AMM)] for two wake-promoting agents (solriamfetol and pitolisant) raises several practical issues for clinicians. This consensus paper presents recommendations of good clinical practice to identify and evaluate EDS in this context, and to manage and follow-up the patients. It was conducted under the mandate of the French Societies for sleep medicine and for pneumology [Société Française de Recherche et de Médecine du Sommeil (SFRMS) and Société de Pneumologie de Langue Française (SPLF)]. A management algorithm is suggested, as well as a list of conditions during which the patient should be referred to a sleep center or a sleep specialist. The benefit/risk balance of a wake-promoting drug in residual EDS in OSAHS patients must be regularly reevaluated, especially in elderly patients with increased cardiovascular and psychiatric disorders risks. This consensus is based on the scientific knowledge at the time of the publication and may be revised according to their evolution.
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Affiliation(s)
- Lucie Barateau
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France.
| | - Sébastien Baillieul
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Claire Andrejak
- Pneumology department, CHU Amiens-Picardie, 80054 Amiens, France; UR 4294 AGIR, Picardie Jules-Verne University, Amiens, France
| | - Émilie Bequignon
- ENT and oral maxillofacial surgery department, Intercommunal center Créteil, 94000 Créteil, France; CNRS, ERL 7000, Paris-Est Créteil University, 94010 Créteil, France
| | - Pierre Boutouyrie
- Pharmacology, Inserm PARCC U970, Georges-Pompidou European Hospital, Paris-Cité University, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Sleep and Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac University Hospital, Montpellier, France; Institute of Neurosciences of Montpellier (INM), INSERM, University of Montpellier, France
| | - Frédéric Gagnadoux
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Pierre-Alexis Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 75018 Paris, France; Centre ChronoS, GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014 Paris, France; Université de Paris, NeuroDiderot, Inserm U1141, 75019 Paris, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - David Montani
- Université Paris-Saclay, AP-HP, INSERM UMR_S 999, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Christelle Monaca
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Clinical neurophysiology, sleep disorders unit, U1172 - LilNCog - Lille, neurosciences & cognition, Lille university, Lille CHU, 59000 Lille, France
| | - Maxime Patout
- R3S department, Sleep pathologies unit, University hospital group, AP-HP-Sorbonne university, AP-HP, Pitié-Salpêtrière site, 75013 Paris, France; Inserm, UMRS1158 experimental and clinical respiratory neurophysiology, Sorbonne university, 75005 Paris, France
| | - Jean-Louis Pépin
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Pierre Philip
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; University Sleep medicine unit, Bordeaux CHU, place Amélie-Raba-Léon, Bordeaux, France; SANPSY UMR 6033, Bordeaux University, 33000 Bordeaux, France
| | - Charles Pilette
- Saint-Luc university clinics, Institute for experimental and clinical research (Pneumology unit), UC Louvain, Brussels, Belgium
| | - Renaud Tamisier
- Grenoble-Alpes university, HP2 Inserm laboratory, U1300, Pneumology and Physiology department, CHU Grenoble-Alpes, 38000 Grenoble, France; National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France
| | - Wojciech Trzepizur
- National Competence Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology and Sleep Medicine department, Angers CHU, Angers, France; Inserm 1083, UMR CNRS 6015, MITOVASC, Angers university, 49000 Angers, France
| | - Dany Jaffuel
- Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France; Inserm U1046, physiology and experimental medicine, heart and muscle, Montpellier university, Montpellier, France
| | - Isabelle Arnulf
- National Reference Center for Rare Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, France; Pneumology department, Arnaud-de-Villeneuve hospital, Montpellier CHRU, Montpellier, France
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Chen PY, Lin SY, Wu CS, Hung SH, Chen DHK, Liu WT, Lin YC. An expedited model for identifying potential patients with periodic leg movements. J Sleep Res 2024:e14198. [PMID: 38500205 DOI: 10.1111/jsr.14198] [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: 10/01/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
Periodic leg movements during sleep (PLMS) may have crucial consequences in adults. This study aimed to identify baseline characteristics, symptoms, or questionnaires that could help to identify sleep-disordered breathing patients with significant PLMS. Patients aged 20-80 years who underwent polysomnography for assessing sleep disturbance were included. Various factors such as sex, age, body measurements, symptoms, apnea-hypopnea index (AHI), and sleep quality scales were analysed to determine the presence of PLMS. The study included 1480 patients with a mean age of 46.4 ± 13.4 years, among whom 110 (7.4%) had significant PLMS with a PLM index of 15 or higher. There were no significant differences observed in terms of sex or BMI between patients with and without significant PLMS. However, the odds ratios (OR) for PLMS were 4.33, 4.41, and 4.23 in patients who were aged over 50 years, had insomnia, or had an ESS score of less than 10, respectively. Notably, the OR increased up to 67.89 times in patients who presented with all three risk factors. Our analysis identified significant risk factors for PLMS: age over 50, self-reported insomnia, and lower daytime sleepiness levels. These findings aid in identifying potential PLMS patients, facilitating confirmatory examinations and managing associated comorbidities.
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Affiliation(s)
- Po-Yueh Chen
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shang-Yang Lin
- Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | - Chung-Sheng Wu
- Department of Primary Care Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - David Hsin-Kuang Chen
- Department of Medical Education, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Te Liu
- Department of Chest Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chih Lin
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Sleep Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Sato M, Matsui K, Nishimura K, Inoue Y. Coexistence of periodic limb movements during sleep with restless legs syndrome and its association with hypertension in Japanese patients. Sleep Med 2024; 115:187-192. [PMID: 38367361 DOI: 10.1016/j.sleep.2024.02.024] [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: 10/31/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Caucasian patients with restless legs syndrome (RLS) frequently exhibit periodic limb movements during sleep (PLMS), which may increase the risk of hypertension. We evaluated the positivity rate of PLMS and factors associated with positivity in Japanese patients with RLS, and tested whether the complications of PLMS are associated with the presence of hypertension. METHODS We retrospectively investigated polysomnographic data and the presence or absence of hypertension in patients with RLS. Patients with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or those taking antihypertensive medication were categorized as the group with hypertension. RESULTS Among 468 patients, 200 (42.7%) had periodic limb movement index (PLMI) values ≥ 15/h and 108 (23.1%) met the criteria of positivity for hypertension. Multiple logistic regression analysis revealed that only higher age was significantly associated with PLMI values ≥ 15/h. Multiple linear regression analyses of factors associated with an increased PLMI also showed that increased PLMI was significantly correlated with higher age and male sex, but not with the international restless legs scale scores. Multiple logistic regression analysis also revealed that higher age and body mass index, not PLMI values ≥ 15/h, were significantly associated with the presence of hypertension. CONCLUSION The PLMS-positivity rate may be lower in Japanese patients with RLS than in Caucasian patients, and it increases with age and male sex, but not with the severity of the disorder. Furthermore, PLMS complications were not associated with the risk of hypertension in Japanese patients with RLS.
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Affiliation(s)
- Moeko Sato
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kentaro Matsui
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan; Department of Laboratory Medicine, National Center Hospital, National Center of Neurology & Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan; Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology & Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, 4-45-16 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, 4-45-16 Otsuka, Bunkyo-ku, Tokyo, 112-0012, Japan; Department of Somnology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan.
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Cederberg KLJ, Peris Sempere V, Lin L, Zhang J, Leary EB, Moore H, Morse AM, Blackman A, Schweitzer PK, Kotagal S, Bogan R, Kushida CA, Mignot E. Proteomic insights into the pathophysiology of periodic limb movements and restless legs syndrome. Sleep Health 2024; 10:S161-S169. [PMID: 37563071 PMCID: PMC10850434 DOI: 10.1016/j.sleh.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES We used a high-throughput assay of 5000 plasma proteins to identify biomarkers associated with periodic limb movements (PLM) and restless legs syndrome (RLS) in adults. METHODS Participants (n = 1410) of the Stanford Technology Analytics and Genomics in Sleep (STAGES) study had blood collected, completed a sleep questionnaire, and underwent overnight polysomnography with the scoring of PLMs. An aptamer-based array (SomaScan) was used to quantify 5000 proteins in plasma. A second cohort (n = 697) that had serum assayed using a previous iteration of SomaScan (1300 proteins) was used for replication and in a combined analysis (n = 2107). A 5% false discovery rate was used to assess significance. RESULTS Multivariate analyses in STAGES identified 68 proteins associated with the PLM index after correction for multiple testing (ie, base model). Most significantly decreased proteins were iron-related and included Hepcidin (LEAP-1), Ferritin, and Ferritin light chain. Most significantly increased proteins included RANTES, Cathepsin A, and SULT 1A3. Of 68 proteins significant in the base model, 17 were present in the 1300 panel, and 15 of 17 were replicated. The most significant proteins in the combined model were Hepcidin (LEAP-1), Cathepsin A, Ferritin, and RANTES. Exploration of proteins in RLS versus non-RLS identified Cathepsin Z, Heme oxygenase 2 (HO-2), Interleukin-17A (upregulated in the combined cohort), and Megalin (upregulated in STAGES only) although results were less significant than for proteins associated with PLM index. CONCLUSIONS These results confirm the association of PLM with low iron status and suggest the involvement of catabolic enzymes in PLM/RLS.
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Affiliation(s)
- Katie L J Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Vicente Peris Sempere
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ling Lin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Jing Zhang
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Eileen B Leary
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA; Axsome Therapeutics, New York, NY, USA
| | - Hyatt Moore
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Anne M Morse
- Division of Pediatric Sleep Medicine, Geisinger, Danville, PA, USA; Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Adam Blackman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paula K Schweitzer
- Sleep Medicine & Research Center, St. Luke's Hospital, Chesterfield, MO, USA
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Richard Bogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
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Plante DT, Hagen EW, Barnet JH, Mignot E, Peppard PE. Prevalence and Course of Idiopathic Hypersomnia in the Wisconsin Sleep Cohort Study. Neurology 2024; 102:e207994. [PMID: 38165322 DOI: 10.1212/wnl.0000000000207994] [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: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Idiopathic hypersomnia (IH) is a CNS disorder of hypersomnolence of unknown etiology. Due to the requirement for objective sleep testing to diagnose the disorder, there are currently no population-based estimates of the prevalence of IH nor data regarding the longitudinal course of IH in naturalistic settings. METHODS Subjective and objective data from the Wisconsin Sleep Cohort study were used to identify cases with probable IH from participants with polysomnography and multiple sleep latency test data. Demographic, polysomnographic, and symptom-level data were compared between those with and without IH. Longitudinal trajectories of daytime sleepiness among those with IH were assessed to evaluate symptom persistence or remission over time. RESULTS From 792 cohort study participants with available polysomnography and multiple sleep latency test data, 12 cases with probable IH were identified resulting in an estimated prevalence of IH of 1.5% (95% CI 0.7-2.5, p < 0.0001). Consistent with inclusion/exclusion criteria, cases with IH had more severe sleepiness and sleep propensity, despite similar or longer sleep times. Longitudinal data (spanning 12.1 ± 4.3 years) demonstrated a chronic course of sleepiness for most of the cases with IH, though pathologic somnolence remitted in roughly 40% of cases. DISCUSSION These results demonstrate IH is more common in the working population than generally assumed with a prevalence on par with other common neurologic and psychiatric conditions. Further efforts to identify and diagnose those impaired by unexplained daytime somnolence may help clarify the causes of IH and the mechanisms underlying symptomatic remission.
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Affiliation(s)
- David T Plante
- From the Department of Psychiatry (D.T.P.), and Department of Population Health Sciences (E.W.H., J.H.B., P.E.P.), University of Wisconsin-Madison; and Stanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Erika W Hagen
- From the Department of Psychiatry (D.T.P.), and Department of Population Health Sciences (E.W.H., J.H.B., P.E.P.), University of Wisconsin-Madison; and Stanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Jodi H Barnet
- From the Department of Psychiatry (D.T.P.), and Department of Population Health Sciences (E.W.H., J.H.B., P.E.P.), University of Wisconsin-Madison; and Stanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- From the Department of Psychiatry (D.T.P.), and Department of Population Health Sciences (E.W.H., J.H.B., P.E.P.), University of Wisconsin-Madison; and Stanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Paul E Peppard
- From the Department of Psychiatry (D.T.P.), and Department of Population Health Sciences (E.W.H., J.H.B., P.E.P.), University of Wisconsin-Madison; and Stanford University Center for Sleep Sciences (E.M.), Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
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Chenini S, Barateau L, Dauvilliers Y. Restless legs syndrome: From clinic to personalized medicine. Rev Neurol (Paris) 2023; 179:703-714. [PMID: 37689536 DOI: 10.1016/j.neurol.2023.08.009] [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] [Indexed: 09/11/2023]
Abstract
Restless legs syndrome (RLS) is a common neurological sensorimotor disorder that impairs sleep, mood and quality of life. RLS is defined by an urge to move the legs at rest that increases in the evening and at night, and is frequently associated with metabolic and cardiovascular diseases. Symptoms frequency, age at RLS onset, severity, familial history and consequences of RLS vary widely between patients. A genetic susceptibility, iron deficiency, dopamine deregulation, and possible hypo-adenosinergic state may play a role in the pathophysiology of RLS. Polysomnographic recordings found often periodic leg movements during sleep and wakefulness in patients with RLS. RLS can be classified as primary or comorbid with major diseases: iron deficiency, renal, neurological, rheumatological and lung diseases. First-line treatments are low-dose dopamine agonists, and alpha-2-delta ligands depending on the clinical context, and second/third line opiates for pharmacoresistant forms of RLS. Augmentation syndrome is a serious complication of dopamine agonists and should be prevented by using the recommended low dose. Despite an increase in knowledge, RLS is still underdiagnosed, poorly recognized, resulting in substantial individual health burden and socioeconomic coast, and education is urgently needed to increase awareness of this disabling disorder.
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Affiliation(s)
- S Chenini
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France.
| | - L Barateau
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases Narcolepsy and Rare Hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, INSERM, Montpellier, France.
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Edelson JL, Schneider LD, Amar D, Brink-Kjaer A, Cederberg KL, Kutalik Z, Hagen EW, Peppard PE, Tempaku PF, Tufik S, Evans DS, Stone K, Tranah G, Cade B, Redline S, Haba-Rubio J, Heinzer R, Marques-Vidal P, Vollenweider P, Winkelmann J, Zou J, Mignot E. The genetic etiology of periodic limb movement in sleep. Sleep 2023; 46:zsac121. [PMID: 35670608 PMCID: PMC10091093 DOI: 10.1093/sleep/zsac121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/12/2022] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Periodic limb movement in sleep is a common sleep phenotype characterized by repetitive leg movements that occur during or before sleep. We conducted a genome-wide association study (GWAS) of periodic limb movements in sleep (PLMS) using a joint analysis (i.e., discovery, replication, and joint meta-analysis) of four cohorts (MrOS, the Wisconsin Sleep Cohort Study, HypnoLaus, and MESA), comprised of 6843 total subjects. METHODS The MrOS study and Wisconsin Sleep Cohort Study (N = 1745 cases) were used for discovery. Replication in the HypnoLaus and MESA cohorts (1002 cases) preceded joint meta-analysis. We also performed LD score regression, estimated heritability, and computed genetic correlations between potentially associated traits such as restless leg syndrome (RLS) and insomnia. The causality and direction of the relationships between PLMS and RLS was evaluated using Mendelian randomization. RESULTS We found 2 independent loci were significantly associated with PLMS: rs113851554 (p = 3.51 × 10-12, β = 0.486), an SNP located in a putative regulatory element of intron eight of MEIS1 (2p14); and rs9369062 (p = 3.06 × 10-22, β = 0.2093), a SNP located in the intron region of BTBD9 (6p12); both of which were also lead signals in RLS GWAS. PLMS is genetically correlated with insomnia, risk of stroke, and RLS, but not with iron deficiency. Pleiotropy adjusted Mendelian randomization analysis identified a causal effect of RLS on PLMS. CONCLUSIONS Because PLMS is more common than RLS, PLMS may have multiple causes and additional studies are needed to further validate these findings.
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Affiliation(s)
- Jacob L Edelson
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Logan D Schneider
- Stanford/VA Alzheimer’s Research Center, Palo Alto, CA 94603, USA
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - David Amar
- Stanford Department of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Andreas Brink-Kjaer
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Katie L Cederberg
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Zoltán Kutalik
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne 1010, Switzerland
- Swiss Institute of Bioinformatics, Lausanne 1015, Switzerland
| | - Erika W Hagen
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI 53726, USA
| | - Paul E Peppard
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Population Health Sciences, Madison, WI 53726, USA
| | | | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo 04021002, Brazil
| | - Daniel S Evans
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
| | - Katie Stone
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, USA
| | - Greg Tranah
- California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA
| | - Brian Cade
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 102115, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 102115, USA
| | - Jose Haba-Rubio
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Raphael Heinzer
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne 1011, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Center Munich (HMGU) Technical University of Munich, 81675 Munich, Germany
- School of Medicine, Institute of Human Genetics Synergy, Cluster of Neuroscience Munich, 52246 Munich, Germany
| | - James Zou
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Palo Alto, CA 94603, USA
| | - Emmanuel Mignot
- Stanford Department of Psychiatry and Behavioral Medicine, Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Palo Alto, CA 94603, USA
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9
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Spektor ED, Koberskaya NN, Shashkova EV, Poluektov MG. [Periodic limb movements in sleep and cerebral small vessel disease progression: a prospective cohort study]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:69-75. [PMID: 37276001 DOI: 10.17116/jnevro202312305269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the predictive role of periodic limb movements in sleep (PLMS) in cerebral small vessel disease (cSVD) progression rate. MATERIAL AND METHODS Fifty patients with cSVD, aged 60-75 y.o., were enrolled. The study protocol included MRI assessment of white matter hyperintensities (WMH), nocturnal actigraphy and cognitive assessment. Depending on the PLMS, the main (PLM index ≥15) and the control (PLM index <15) groups were formed. The second visit was carried out in one year follow-up period, the examination consisted of brain MRI and cognitive assessment under the same protocol. ANCOVA was performed to determine if PLMS influence the degree of MRI- and neuropsychological changes. RESULTS A significant effect of PLMS on the increase in the volume of WMH was revealed, both in the form of an increase in the index by more than 15 movements per hour (p=0.03), and quantitatively in the form of a connection with the index value (p=0.048). The influence of PLMS on the progression of cognitive dysfunction has not been found, however, it has been shown that the presence of PLMS is associated with lesions in the deep white matter (r=0.42, p<0.0001), and the results of neuropsychological tests are associated with lesions in the periventricular and juxtacortical WMH (p < 0.05 for each test). CONCLUSION PLMS predict WMH progression in cSVD.
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Affiliation(s)
- E D Spektor
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - N N Koberskaya
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E V Shashkova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M G Poluektov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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10
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Lee SA, Im K, Yang HR, Kim HJ. Sex Differences in Excessive Daytime Sleepiness Among Patients With Obstructive Sleep Apnea. J Clin Neurol 2022; 18:351-357. [PMID: 35589322 PMCID: PMC9163937 DOI: 10.3988/jcn.2022.18.3.351] [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: 09/14/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE To identify sex differences in daytime sleepiness associated with apnea severity and periodic limb movements during sleep (PLMS) in subjects with obstructive sleep apnea (OSA). METHODS This study used the Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI), and Sleep Hygiene Index (SHI) in logistic regression analyses with interaction terms. Severe OSA, excessive daytime sleepiness (EDS), and PLMS were defined as an apnea-hypopnea index of ≥30, an ESS score of ≥11, and a periodic limb movements index of >15, respectively. RESULTS The 1,624 subjects with OSA (males, 79.1%) comprised 45.3%, 38.2%, and 16.4% with severe OSA, EDS, and PLMS, respectively. Multiple logistic regression without interaction terms showed that sex, severe OSA, and PLMS were not significantly associated with EDS. However, significant interactions were noted between sex and severe OSA and PLMS in EDS in both crude and adjusted models (all p values<0.05). In the adjusted model, severe OSA was associated with EDS in males (p=0.009) but not in females. PLMS were more likely to be associated with EDS in females (p=0.013), whereas PLMS were less likely to be associated with EDS in males (p=0.041). The models were adjusted by the BDI score, SHI, and presence of medical comorbidities. CONCLUSIONS There are significant sex differences in subjective daytime sleepiness in subjects with severe OSA and PLMS. Severe OSA and PLMS may influence daytime sleepiness more in males and females, respectively.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha-Rin Yang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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11
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Kim H, Yang KI, Sunwoo JS, Park J, Heo NH, Kim JH, Hong SB. Association between Self-Perceived Periodic Limb Movement during Sleep and Excessive Daytime Sleepiness Depend on Restless Leg Symptoms in Korean Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084751. [PMID: 35457617 PMCID: PMC9024923 DOI: 10.3390/ijerph19084751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023]
Abstract
Although periodic limb movement during sleep (PLMS) and restless legs syndrome (RLS) are common in children and adolescents, they are relatively overlooked as a target of treatment. PLMS has been evaluated as having a lower clinical significance than RLS. This study examined the relationship of socio-behavioral factors of PLMS in Korean adolescents and checked whether PLMS is associated with excessive daytime sleepiness (EDS), depending on whether restless legs symptoms accompany it. In a cross-sectional study, 25,789 adolescents between 12 and 18 years of age (15.76 ± 1.73 years; female 51.49%) were evaluated using an online survey. Various self-report questionnaires were used to assess PLMS and RLS symptoms, EDS, sleep habits, and various socio-behavioral factors. The prevalence of self-perceived PLMS and restless legs symptoms were 903 (3.50%) and 1311 (5.08%), respectively. Of the 1311 participants, 399 had self-perceived PLMS. The odds ratios (ORs) for self-perceived PLMS in participants with restless legs symptoms were: males (OR = 1.528; 95% CI: 1.145–2.040), usually/always experienced apnea apnea (OR, 3.006; 95% CI, 1.954–4.624), increased proneness to Internet addiction (OR = 1.013; 95% CI: 1.001–1.025), sometimes/often consuming coffee (OR = 1.312; 95% CI: 1.015–1.695), EDS (OR = 0.826; 95% CI: 0.488–1.398), and perceived insufficient sleep (OR = 1.143; 95% CI: 0.835–1.565). The male gender, witness apnea, consuming coffee, and being prone to Internet addiction were identified as factors significantly associated with self-perceived PLMS in participants with restless legs symptoms. However, EDS and insufficient sleep were associated with self-perceived PLMS in the absence of restless legs symptoms.
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Affiliation(s)
- Hyeyun Kim
- Department of Neurology, International St. Mary’s Hospital, College of Medicine, Catholic Kwandong University, Incheon 22711, Korea;
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University, College of Medicine, Cheonan Hospital, Cheonan 31151, Korea;
- Correspondence: (K.I.Y.); (S.B.H.); Tel.: +82-41-570-2290 (K.I.Y.); +82-2-3410-3592 (S.B.H.); Fax: +82-41-592-3810 (K.I.Y.); +82-2-3410-0052 (S.B.H.)
| | - Jun-Sang Sunwoo
- Department of Neurology, Kangbuk Samsung Hospital, Seoul 03181, Korea;
| | - Jongkyu Park
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University, College of Medicine, Cheonan Hospital, Cheonan 31151, Korea;
| | - Nam Hun Heo
- Clinical Trial Center, Department of Biostatics, Soonchunhyang University, Cheonan 31151, Korea;
| | - Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University, Seoul 07804, Korea;
| | - Seung Bong Hong
- Department of Neurology, Samsung Medical Center, Samsung Advanced Institute for Health Sciences & Technology, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea
- Correspondence: (K.I.Y.); (S.B.H.); Tel.: +82-41-570-2290 (K.I.Y.); +82-2-3410-3592 (S.B.H.); Fax: +82-41-592-3810 (K.I.Y.); +82-2-3410-0052 (S.B.H.)
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12
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Mieno Y, Hayashi M, Hirochi M, Ikeda A, Kako H, Ina T, Maeda Y, Maeda S, Inoue T, Souma T, Watanabe T, Horiguchi T, Gotoh Y, Niwa Y, Yamatsuta K, Morikawa S, Sakakibara Y, Okamura T, Uozu S, Goto Y, Isogai S, Fujita S, Fukumoto J, Hosoda N, Imaizumi K. Availability of Home sleep apnea test equipment LS-140 on a comparison with Polysomnography. FUJITA MEDICAL JOURNAL 2022; 8:17-24. [PMID: 35233343 PMCID: PMC8874914 DOI: 10.20407/fmj.2020-014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The prevalence of obstructive sleep apnea (OSA) in Japan is 9% among males and 3% among females. Up to 2.5 million patients are estimated to suffer from the disease, but limited number of facilities are capable of carrying out polysomnography (PSG), leaving more than 80% of these individuals are undiagnosed. In recent years, the development of new portable sleep monitoring (PMs) devices has been remarkable. We evaluate the correlation between the results of the LS-140 PMs device (Fukuda Denshi Tech Co. Ltd.), released in 2017, and those of PSG. METHODS We obtained contemporaneous data from the same patients by equipping 58 patients with PMs (LS-140) devices while they underwent PSG. Our primary outcome was Case 2 of the intraclass correlation coefficient (ICC), i.e., the ICC (2.1). And we used a Bland-Altman analysis to compare the apnea-hypopnea index (AHI) given by PSG and the respiratory event index (REI) given by LS-140 and examined the sensitivity and specificity of the REI relative to the AHI in the diagnosis of OSA. We also carried out the same comparison but in terms of the presence or absence of periodic limb movements (PLMs). RESULTS The ICC (2.1) between The REI and the AHI was 0.944, a rather high value (p<0.0001). The mean difference between AHI and REI values was -3.6 (p<0.0001), indicating a negative fixed bias. Sensitivity may decrease in groups with PLMs. CONCLUSION The REI and the AHI are highly correlated, giving LS-140 sufficient diagnostic sensitivity and specificity to screen for OSA.
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Affiliation(s)
- Yuki Mieno
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Masamichi Hayashi
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Mariko Hirochi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ina
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yuri Maeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shingo Maeda
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takahiro Inoue
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tomohide Souma
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Toshikazu Watanabe
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Tomoya Horiguchi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yusuke Gotoh
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yoshikazu Niwa
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Kumiko Yamatsuta
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sayako Morikawa
- Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Sumito Isogai
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shiho Fujita
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Junichi Fukumoto
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Nami Hosoda
- Fujita Health University Clinical Laboratory Center, Toyoake, Aichi, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine Ⅰ, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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13
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McArdle N, Reynolds AC, Hillman D, Moses E, Maddison K, Melton P, Eastwood P. Prevalence of common sleep disorders in a middle-aged community sample. J Clin Sleep Med 2022; 18:1503-1514. [DOI: 10.5664/jcsm.9886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Nigel McArdle
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Amy C. Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine & Public Health, Flinders University, South Australia
| | - David Hillman
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Eric Moses
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart Tasmania
- School of Biological Sciences, University of Western Australia, Crawley, Western Australia
| | - Kath Maddison
- University of Western Australia, School of health sciences, Nedlands, Western Australia
- West Australian Sleep Disorders Research Institute, Nedlands, Western Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart Tasmania
- School of Global and Population Health, University of Western Australia, Nedlands, Western Australia
| | - Peter Eastwood
- Flinders Health and Medical Research Institute (Sleep Health), College of Medicine & Public Health, Flinders University, South Australia
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14
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Drakatos P, Olaithe M, Verma D, Ilic K, Cash D, Fatima Y, Higgins S, Young AH, Chaudhuri KR, Steier J, Skinner T, Bucks R, Rosenzweig I. Periodic limb movements during sleep: a narrative review. J Thorac Dis 2022; 13:6476-6494. [PMID: 34992826 PMCID: PMC8662505 DOI: 10.21037/jtd-21-1353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/20/2021] [Indexed: 01/02/2023]
Abstract
Objective Using narrative review techniques, this paper evaluates the evidence for separable underlying patho-mechanisms of periodic limb movements (PLMs) to separable PLM motor patterns and phenotypes, in order to elucidate potential new treatment modalities. Background Periodic limb movement disorder (PLMD) is estimated to occur in 5–8% of the paediatric population and 4–11% of the general adult population. Due to significant sleep fragmentation, PLMD can lead to functional impairment, including hyperactivity and delayed language development in children, and poor concentration and work performance in adults. Longitudinal data demonstrate that those with PLMD are at greater risk of depression and anxiety, and a 4-fold greater risk of developing dementia. PLMD has been extensively studied over the past two decades, and several key insights into the genetic, pathophysiological, and neural correlates have been proposed. Amongst these proposals is the concept of separable PLM phenotypes, proposed on the basis of nocturnal features such as the ratio of limb movements and distribution throughout the night. PLM phenotype and presentation, however, varies significantly depending on the scoring utilized and the nocturnal features examined, across age, and co-morbid clinical conditions. Furthermore, associations between these phenotypes with major neurologic and psychiatric disorders remain controversial. Methods In order to elucidate potential divergent biological pathways that may help clarify important new treatment modalities, this paper utilizes narrative review and evaluates the evidence linking PLM motor patterns and phenotypes with hypothesised underlying patho-mechanisms. Distinctive, underlying patho-mechanisms include: a pure motor mechanism originating in the spinal cord, iron deficiency, dopamine system dysfunction, thalamic glutamatergic hyperactivity, and a more cortical-subcortical interplay. In support of the latter hypothesis, PLM rhythmicity appears tightly linked to the microarchitecture of sleep, not dissimilarly to the apnoeic/hypopneic events seen in obstructive sleep apnea (OSA). Conclusions This review closes with a proposal for greater investigation into the identification of potential, divergent biological pathways. To do so would require prospective, multimodal imaging clinical studies which may delineate differential responses to treatment in restless legs syndrome (RLS) without PLMS and PLMS without RLS. This could pave the way toward important new treatment modalities.
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Affiliation(s)
- Panagis Drakatos
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Dhun Verma
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK
| | - Katarina Ilic
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Diana Cash
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,BRAIN, Imaging Centre, CNS, King's College London, London, UK
| | - Yaqoot Fatima
- Institute for Social Science Research, University of Queensland, Brisbane, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
| | - Allan H Young
- School of Academic Psychiatry, King's College London, London, UK
| | - K Ray Chaudhuri
- King's College London and Parkinson's Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Joerg Steier
- Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK.,Faculty of Life and Sciences Medicine, King's College London, London, UK
| | - Timothy Skinner
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark.,La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Romola Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.,The Raine Study, University of Western Australia, Perth, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' Hospital, GSTT NHS, London, UK
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15
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Foldager J, Peppard PE, Hagen EW, Stone KL, Evans DS, Tranah GJ, Sørensen H, Jennum P, Mignot E, Schneider LD. Genetic risk for subjective reports of insomnia associates only weakly with polygraphic measures of insomnia in 2,770 adults. J Clin Sleep Med 2022; 18:21-29. [PMID: 34170227 PMCID: PMC8807892 DOI: 10.5664/jcsm.9468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES Subjective insomnia complaints and objective sleep changes are mostly studied outside of clinical trial studies. In this study, we tested whether 240 genetic variants associated with subjectively reported insomnia were also associated with objective insomnia parameters extracted from polysomnographic recordings in three studies. METHODS The study sample (total n = 2,770) was composed of the Wisconsin Sleep Cohort (n = 1,091) and the Osteoporotic Fractures in Men (n = 1,026) study, two population-based studies, and the Stanford Sleep Cohort, a sleep center patient-based sample (n = 653). Seven objective polysomnographic features related to insomnia defined outcome variables, with each variant allele serving as predictor. Meta-regression was performed, accounting for common confounders as well as variance differences between studies. Additionally, a normalized genetic risk score was generated for each subject to serve as a predictor variable in separate linear mixed models assessing objective insomnia features. RESULTS After correction for multiple testing, single-nucleotide polymorphisms associated with subjective insomnia were not significantly associated with 6 of 7 objective sleep measures. Only periodic limb movement index was significantly associated with rs113851554 (MEIS1), as found in previous studies. The normalized genetic risk score was only weakly associated with arousal index and duration of wake after sleep onset. CONCLUSIONS Our findings suggest that subjective insomnia does not have a strong genetic signature mapping onto objective (polysomnographic) sleep variables. CITATION Foldager J, Peppard PE, Hagen EW, et al. Genetic risk for subjective reports of insomnia associates only weakly with polygraphic measures of insomnia in 2,770 adults. J Clin Sleep Med. 2022;18(1):21-29.
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Affiliation(s)
- Jonathan Foldager
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark,Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Paul E. Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Erika W. Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
| | - Katie L. Stone
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Daniel S. Evans
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Gregory J. Tranah
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Helge Sørensen
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Logan D. Schneider
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California,Stanford/VA Alzheimer’s Research Center, Palo Alto, California,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, California,Address correspondence to: Logan Schneider, MD, Stanford/VA Alzheimer’s Research Center, 3801 Miranda Ave, Building 4, 1st Floor, C-141, Palo Alto, CA 94304;
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16
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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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17
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Periodic limb movements during sleep are associated with poor health-related quality of life in patients with obstructive sleep apnea. Sleep Breath 2021; 26:1045-1052. [PMID: 34405323 DOI: 10.1007/s11325-021-02469-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The clinical significance of the comorbidity of periodic limb movements during sleep (PLMS) in sleep-disordered breathing remains unclear. This study aimed to determine whether or not the presence of PLMS is related to depressed mood and poor quality of life in subjects with obstructive sleep apnea (OSA). METHODS We defined PLMS as a periodic leg movement index of > 15/h. Scores for the Medical Outcomes Study Short Form Health Survey and Beck Depression Inventory were assessed with multiple logistic or linear regression analyses. RESULTS Of 1370 subjects with OSA, a prevalence of PLMS was 14.1%. Older age, men, and obesity were positively associated with PLMS. PLMS occurred in 17%, 15%, and 12% of mild, moderate, and severe subjects with OSA, respectively. Severe OSA was less likely to be associated with PLMS than mild OSA. PLMS negatively correlated with physical and mental component summary scores of the health survey but not with Beck Depression Inventory scores after controlling for confounding variables. PLMS were significantly associated with poor sleep architecture on polysomnography. However, the relationship between PLMS and disturbed sleep was no longer significant after adjusting for age. CONCLUSIONS Health-related quality of life, including physical and mental health but not depressive symptoms, was worse in subjects with OSA and PLMS than in those without PLMS.
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18
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Lee SA, Lee YS, Cho CW, Yang HR, Im K. Different scoring rules for respiratory event-related leg movements: effects on the prevalence of periodic limb movements during sleep and their association with depressive symptoms in patients with obstructive sleep apnea. Sleep Med 2021; 85:204-210. [PMID: 34358757 DOI: 10.1016/j.sleep.2021.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We compared the prevalence of periodic leg movements during sleep (PLMS) according to two different scoring rules of the American Academy of Sleep Medicine (AASM) 2012 and World Association of Sleep Medicine (WASM) 2016 and determined their association with depressed mood in patients with obstructive sleep apnea (OSA). METHODS PLMS, defined as a periodic leg movements index of >15, were diagnosed on a diagnostic and continuous positive airway pressure (CPAP) titration polysomnography using the AASM 2012 and WASM 2016 rules. The Beck Depression Inventory (BDI) and Epworth Sleepiness Scale (ESS) were used, and multiple regression analyses were performed. RESULTS Among 160 OSA patients, the proportion with PLMS scored by the WASM 2016 criteria was significantly higher than that scored by the AASM 2012 criteria in a diagnostic study (20.6% vs. 16.3%, respectively; P = 0.016) but not in CPAP titration study and only in patients with severe OSA. In adjusted models, PLMS were positively associated with BDI scores and a BDI of ≥10 on both diagnostic and CPAP titration studies when scored by the WASM 2016. By contrast, when scored by the AASM 2012, PLMS were associated with BDI scores (but not BDI of ≥10) only in a CPAP titration study. CONCLUSIONS There are significant differences in the prevalence of PLMS and their association with depressed mood depending on the scoring rules in patients with OSA. The current AASM scoring criteria underestimate the prevalence of PLMS, and PLMS are more likely associated with depressed mood according to the WASM scoring criteria.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Yong-Seok Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheon-Woong Cho
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ha-Rin Yang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kayeong Im
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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19
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Lee SA, Kim SJ, Lee SY, Kim HJ. Clinical characteristics of periodic limb movements during sleep categorized by continuous positive airway pressure titration polysomnography in patients with obstructive sleep apnea. Sleep Breath 2021; 26:251-257. [PMID: 33973111 DOI: 10.1007/s11325-021-02387-z] [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] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The presence of periodic limb movements during sleep (PLMS) varies among patients with obstructive sleep apnea (OSA) undergoing treatment with continuous positive airway pressure (CPAP). The factors associated with this variation are unknown. METHODS PLMS were defined as a periodic leg movements index of > 15/h. Patients with OSA and PLMS were categorized into four groups depending on diagnostic and CPAP titration polysomnography (PSG). A multinomial logistic regression analysis was performed using a non-PLMS group as the reference category. RESULTS This study included 861 patients with OSA who underwent a full-night CPAP titration PSG. The proportions of the subjects with PLMS on both PSGs (persistent PLMS), those with CPAP-emergent PLMS, and those with CPAP-resolved PLMS were 12.9%, 9.2%, and 3.9%, respectively. Compared with the non-PLMS group, the persistent group was more likely to be of older age and male sex and has a higher body mass index and restless legs syndrome (RLS). Patients in the CPAP-emergent group were also older and more likely to have RLS as well as more severe apnea. Patients in the CPAP-resolved group were more likely to be women, of older age, have a higher body mass index, but less severe apnea. CONCLUSIONS PLMS elicited by CPAP are more likely to occur in older patients with more severe sleep apnea and comorbid RLS, whereas OSA patients in which PLMS resolve after CPAP are more likely to be women and have milder sleep apnea. Persistent PLMS share clinical characteristics with PLMS in general population.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Soo Jeong Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - So Young Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
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20
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Hermann W, Flemming T, Brandt MD, Langner S, Reichmann H, Storch A. Asymmetry of Periodic Leg Movements in Sleep (PLMS) in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:255-266. [PMID: 31609696 DOI: 10.3233/jpd-191667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Periodic limb movements in sleep (PLMS) are repetitive movements usually of the legs strongly associated with Restless-legs syndrome (RLS), which appear more frequently in males, older age and other sleep disturbances, such as sleep-disordered breathing (SDB). Patients with Parkinson's disease (PD) suffer from various sleep disturbances including REM sleep behavior disorder, RLS and PLMS. Although a dopaminergic pathophysiology of PLMS is discussed, no systematic data on PLMS side-to-side distribution in PD and its correlation with asymmetry of motor symptoms are available. OBJECTIVE This study aimed at elucidating PLMS asymmetry in correlation to that of motor symptoms in PD compared to SDB and RLS. METHODS Cross-sectional, retrospective analysis of two polysomnography (PSG) recordings per patient scoring PLMS separately for both legs. RESULTS Of 105 patients (44 PD, 44 age- and sex-matched SDB and 17 RLS patients) PLMS measures (number of PLM, PLM-Index, PLM-arousal index) showed significant side-to-side differences in all disease entities in both PSGs (P < 0.001; Wilcoxon rank test). PLM-Index asymmetry (PLM-I difference of >5/h between both sides) was observed less frequently in PD (34% of patients) compared to RLS (77% , P < 0.05) and SDB (59% , P < 0.05; χ2 test). In asymmetric PD patients, predominant side of PLMS was more stable than in SDB and RLS comparing the two PSGs, but we did not detect an agreement between PLMS predominant side with that of motor symptoms in PD patients. CONCLUSIONS Only the minority of PD patients shows asymmetric PLMS distribution with relatively high night-to-night stability but no correlation with motor symptom asymmetry.
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Affiliation(s)
- Wiebke Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
| | - Theresa Flemming
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Moritz D Brandt
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Simona Langner
- Interdisciplinary Sleep Centre, Departments of Neurology and Internal Medicine I, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock, Rostock, Germany
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21
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Krøigård T, Beier CP. Falls caused by severe restless legs syndrome with persistent periodic limb movements during sleep and wakefulness. Sleep Med 2020; 74:78-80. [PMID: 32841848 DOI: 10.1016/j.sleep.2020.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Thomas Krøigård
- Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Christoph P Beier
- Department of Neurology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Lim DC, Mazzotti DR, Sutherland K, Mindel JW, Kim J, Cistulli PA, Magalang UJ, Pack AI, de Chazal P, Penzel T. Reinventing polysomnography in the age of precision medicine. Sleep Med Rev 2020; 52:101313. [PMID: 32289733 PMCID: PMC7351609 DOI: 10.1016/j.smrv.2020.101313] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
For almost 50 years, sleep laboratories around the world have been collecting massive amounts of polysomnographic (PSG) physiological data to diagnose sleep disorders, the majority of which are not utilized in the clinical setting. Only a small fraction of the information available within these signals is utilized to generate indices. For example, the apnea-hypopnea index (AHI) remains the primary tool for diagnostic and therapeutic decision-making for obstructive sleep apnea (OSA) despite repeated studies showing it to be inadequate in predicting clinical consequences. Today, there are many novel approaches to PSG signals, making it possible to extract more complex metrics and analyses that are potentially more clinically relevant for individual patients. However, the pathway to implement novel PSG metrics/analyses into routine clinical practice is unclear. Our goal with this review is to highlight some of the novel PSG metrics/analyses that are becoming available. We suggest that stronger academic-industry relationships would facilitate the development of state-of-the-art clinical research to establish the value of novel PSG metrics/analyses in clinical sleep medicine. Collectively, as a sleep community, it is time to reinvent how we utilize the polysomnography to move us towards Precision Sleep Medicine.
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Affiliation(s)
- Diane C Lim
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States.
| | - Diego R Mazzotti
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Kate Sutherland
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Jesse W Mindel
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Jinyoung Kim
- University of Pennsylvania School of Nursing, Philadelphia, PA, United States
| | - Peter A Cistulli
- Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department Respiratory and Sleep Medicine, Royal North Shore Hospital, Australia
| | - Ulysses J Magalang
- Division of Pulmonary, Critical Care and Sleep Medicine, The Ohio State University, Wexner Medical Center, United States
| | - Allan I Pack
- Division of Sleep Medicine/Department of Medicine, University of Pennsylvania, United States
| | - Philip de Chazal
- Charles Perkins Centre and School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, Australia
| | - Thomas Penzel
- Center for Sleep Medicine, Charite Universitätsmedizin, Berlin, Germany; Saratov State University, Saratov, Russia
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23
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Berger M, Hirotsu C, Haba-Rubio J, Betta M, Bernardi G, Siclari F, Waeber G, Vollenweider P, Marques-Vidal P, Heinzer R. Risk factors of excessive daytime sleepiness in a prospective population-based cohort. J Sleep Res 2020; 30:e13069. [PMID: 32412149 DOI: 10.1111/jsr.13069] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023]
Abstract
Although excessive daytime sleepiness is commonly evaluated in clinical and research settings using the Epworth Sleepiness Scale, few studies have assessed the factors associated with its incidence in the general population. We prospectively investigated the predictors of incident and persistent excessive daytime sleepiness in 2,751 subjects (46.1% men, mean age 56.0 ± 9.8 years) from the CoLaus-PsyCoLaus population-based cohort (Lausanne, Switzerland) over 5 years. Participants completed the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, and underwent a full clinical evaluation at baseline and 5 years afterwards. Ambulatory polysomnography was performed at baseline in a sub-sample of 1,404 subjects. Among the 2,438 subjects without excessive daytime sleepiness (Epworth Sleepiness Scale ≤ 10) at baseline, the 5-year incidence of excessive daytime sleepiness was 5.1% (n = 124). Multivariate logistic regression revealed that male sex, depressive symptoms, reported poor sleep quality and moderate to severe obstructive sleep apnea were independent predictors of incident excessive daytime sleepiness, while older age, moderate coffee consumption, periodic leg movement during sleep and hypertension were independent protective factors. Stratified analysis according to sex and age showed some distinctive associations. Among the 313 patients with excessive daytime sleepiness at baseline, 137 (43.8%) had persistent excessive daytime sleepiness 5 years later. Our findings provide new insights into the predictors of incident excessive daytime sleepiness, but interventional studies are needed to understand the impact of treating these risk factors on the incidence of excessive daytime sleepiness.
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Affiliation(s)
- Mathieu Berger
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Camila Hirotsu
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jose Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Monica Betta
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | | | - Francesca Siclari
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Gerard Waeber
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Raphael Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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24
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Reid-Varley WB, Ponce Martinez C, Khurshid KA. Sleep disorders and disrupted sleep in addiction, withdrawal and abstinence with focus on alcohol and opioids. J Neurol Sci 2020; 411:116713. [PMID: 32087437 DOI: 10.1016/j.jns.2020.116713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/30/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Affiliation(s)
- William-Bernard Reid-Varley
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Caridad Ponce Martinez
- Department of Psychiatry, Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Khurshid A Khurshid
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America; Department of Psychiatry, Massachusetts Lung and Allergy Center, University of Massachusetts, United States of America.
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25
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Lersch F, Jerney P, Kaiser H, Willi C, Steck K, Hight D, Zubler F. Actimetry-Documented Persistent Periodic Limb Movements During EEG-Confirmed Deep General Anesthesia: A Case Report. A A Pract 2020; 14:e01183. [PMID: 32224690 DOI: 10.1213/xaa.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Motor activity during general anesthesia (GA) without neuromuscular blockade is often interpreted as reflecting insufficient anesthesia. Here we present the case of an octogenarian undergoing deep sclerectomy with opioid-sparing electroencephalography (EEG)-guided anesthesia. Periodic leg movements (PLM) appeared during ongoing surgery while the patient's raw EEG displayed a pattern of deep anesthesia, evidenced by burst suppression. Recognizing PLM in the context of opioid-sparing GA is of importance for anesthesiologists, as deep anesthesia is not necessarily associated with a decrease in motor activity.
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Affiliation(s)
| | - Pascal Jerney
- From the Department of Anesthesiology and Pain Medicine
| | - Heiko Kaiser
- From the Department of Anesthesiology and Pain Medicine
| | - Cédric Willi
- From the Department of Anesthesiology and Pain Medicine
| | | | - Darren Hight
- From the Department of Anesthesiology and Pain Medicine
| | - Frédéric Zubler
- Sleep-Wake-Epilepsy-Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Kim HJ, Lee SA. Periodic limb movements during sleep may reduce excessive daytime sleepiness in men with obstructive sleep apnea. Sleep Breath 2020; 24:1523-1529. [DOI: 10.1007/s11325-020-02024-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/21/2020] [Accepted: 01/28/2020] [Indexed: 02/04/2023]
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27
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Gottlieb DJ, Bhatt DL. More Evidence That We Could All Use a Good Night's Sleep. J Am Coll Cardiol 2019; 73:145-147. [PMID: 30654885 DOI: 10.1016/j.jacc.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel J Gottlieb
- VA Boston Healthcare System, Boston, Massachusetts; Brigham and Women's Hospital Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts. https://twitter.com/DLBhattMD
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28
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Garbazza C, Hackethal S. Measuring and interpreting periodic leg movements during sleep: easy does it. Sleep 2019; 42:5535524. [DOI: 10.1093/sleep/zsz155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Sandra Hackethal
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
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29
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Sleep disorders, nocturnal blood pressure, and cardiovascular risk: A translational perspective. Auton Neurosci 2019; 218:31-42. [DOI: 10.1016/j.autneu.2019.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
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30
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Jones SE, van Hees VT, Mazzotti DR, Marques-Vidal P, Sabia S, van der Spek A, Dashti HS, Engmann J, Kocevska D, Tyrrell J, Beaumont RN, Hillsdon M, Ruth KS, Tuke MA, Yaghootkar H, Sharp SA, Ji Y, Harrison JW, Freathy RM, Murray A, Luik AI, Amin N, Lane JM, Saxena R, Rutter MK, Tiemeier H, Kutalik Z, Kumari M, Frayling TM, Weedon MN, Gehrman PR, Wood AR. Genetic studies of accelerometer-based sleep measures yield new insights into human sleep behaviour. Nat Commun 2019; 10:1585. [PMID: 30952852 PMCID: PMC6451011 DOI: 10.1038/s41467-019-09576-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/14/2019] [Indexed: 01/16/2023] Open
Abstract
Sleep is an essential human function but its regulation is poorly understood. Using accelerometer data from 85,670 UK Biobank participants, we perform a genome-wide association study of 8 derived sleep traits representing sleep quality, quantity and timing, and validate our findings in 5,819 individuals. We identify 47 genetic associations at P < 5 × 10-8, of which 20 reach a stricter threshold of P < 8 × 10-10. These include 26 novel associations with measures of sleep quality and 10 with nocturnal sleep duration. The majority of identified variants associate with a single sleep trait, except for variants previously associated with restless legs syndrome. For sleep duration we identify a missense variant (p.Tyr727Cys) in PDE11A as the likely causal variant. As a group, sleep quality loci are enriched for serotonin processing genes. Although accelerometer-derived measures of sleep are imperfect and may be affected by restless legs syndrome, these findings provide new biological insights into sleep compared to previous efforts based on self-report sleep measures.
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Affiliation(s)
- Samuel E Jones
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | | | - Diego R Mazzotti
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, 19104, PA, USA
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, 1011, Switzerland
| | - Séverine Sabia
- Research Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
- INSERM, U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, Paris, 75010, France
| | - Ashley van der Spek
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Jorgen Engmann
- UCL Institute of Cardiovascular Science, Research department of Population Science and Experimental Medicine, Centre for Translational Genomics, 222 Euston Road, London, NW1 2DA, UK
| | - Desana Kocevska
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, 3000 CA, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Jessica Tyrrell
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Robin N Beaumont
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, EX1 2LU, UK
| | - Katherine S Ruth
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Marcus A Tuke
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Seth A Sharp
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Yingjie Ji
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Jamie W Harrison
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Rachel M Freathy
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Anna Murray
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, 3000 CA, The Netherlands
| | - Jacqueline M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02111, USA
- Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, M13 9PL, UK
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, 193 Hathersage Road, Manchester, M13 0JE, UK
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, 3000 CA, The Netherlands
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Boston, MA, 02115, USA
| | - Zoltán Kutalik
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, 1010, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland
| | - Meena Kumari
- ISER, University of Essex, Colchester, Essex, CO4 3SQ, UK
| | - Timothy M Frayling
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Michael N Weedon
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK.
| | - Philip R Gehrman
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, 19104, PA, USA
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, 19104, PA, USA
| | - Andrew R Wood
- Genetics of Complex Traits, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK.
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