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Jensen SM, Friborg O, Mellgren SI, Müller KI, Bergvik S, Arntzen KA. Health-Related Quality of Life in FKRP-Related Limb-Girdle Muscular Dystrophy R9. J Neuromuscul Dis 2024; 11:59-74. [PMID: 37927270 PMCID: PMC10789334 DOI: 10.3233/jnd-221629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Limb-girdle muscular dystrophy R9 (LGMDR9) is a chronic progressive hereditary muscle disease, related to the Fukutin Related Protein (FKRP) gene, that may cause major disabilities, cardiomyopathy, and ventilatory failure. Knowledge of how LGMDR9 affects health-related quality of life (HRQoL) is relevant in treatment and care. OBJECTIVE To investigate HRQoL in the Norwegian LGMDR9 population over 14 months and relation to fatigue and sleep quality. METHODS Participants (16+ years) of the Norwegian LGMDR9 cohort study completed two HRQoL measures, i.e., Individualized Neuromuscular Quality of Life questionnaire (INQoL) and the 36-item Short Form (SF-36) at baseline, 8, and 14 months and measures of fatigue and sleep quality at 9 months. RESULTS HRQoL response rate was 84/90 (75 c.826 C > A homozygotes and nine c.826 C > A compound heterozygotes). Compared to Norwegian normative data, all SF-36 domain scores were impaired (p≤0.006) except mental health in males (p = 0.05) and pain scores. During 14 months, perceived muscle weakness and the INQoL index (disease burden) worsened in c.826 C > A homozygotes. Compound heterozygotes reported more dysphagia and physical difficulties than homozygotes and showed a tendency towards worsening in weakness over time but some improvement on the INQoL index. Homozygous females reported generally poorer HRQoL and a higher burden than males. The INQoL index was related to perceived muscle weakness and fatigue, and fatigue to myalgia and mental distress. The prevalence of fatigue and poor sleep was 40% and 49%, respectively. CONCLUSIONS The 14-month follow-up period shows a worsening of perceived weakness and burden in c.826 C > A homozygotes, which can then be expected. The prevalence and impact of fatigue indicate a need for awareness and treatment of fatigue. Myalgia and mental distress are potential targets in the treatment of fatigue, which future studies need to establish. Sleep issues and gender-specific care needs also require attention in LGMDR9.
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Affiliation(s)
- Synnøve M. Jensen
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway (UNN), Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Oddgeir Friborg
- Department of Psychology, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Svein Ivar Mellgren
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway (UNN), Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Kai Ivar Müller
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway (UNN), Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
- Department of Neurology, Sørlandet Hospital Trust, Kristiansand, Norway
| | - Svein Bergvik
- Department of Psychology, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Kjell Arne Arntzen
- National Neuromuscular Centre Norway and Department of Neurology, University Hospital of North Norway (UNN), Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
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Zhuparris A, Maleki G, Koopmans I, Doll RJ, Voet N, Kraaij W, Cohen A, van Brummelen E, De Maeyer JH, Groeneveld GJ. Smartphone and Wearable Sensors for the Estimation of Facioscapulohumeral Muscular Dystrophy Disease Severity: Cross-sectional Study. JMIR Form Res 2023; 7:e41178. [PMID: 36920465 PMCID: PMC10131943 DOI: 10.2196/41178] [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: 07/28/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy (FSHD) is a progressive neuromuscular disease. Its slow and variable progression makes the development of new treatments highly dependent on validated biomarkers that can quantify disease progression and response to drug interventions. OBJECTIVE We aimed to build a tool that estimates FSHD clinical severity based on behavioral features captured using smartphone and remote sensor data. The adoption of remote monitoring tools, such as smartphones and wearables, would provide a novel opportunity for continuous, passive, and objective monitoring of FSHD symptom severity outside the clinic. METHODS In total, 38 genetically confirmed patients with FSHD were enrolled. The FSHD Clinical Score and the Timed Up and Go (TUG) test were used to assess FSHD symptom severity at days 0 and 42. Remote sensor data were collected using an Android smartphone, Withings Steel HR+, Body+, and BPM Connect+ for 6 continuous weeks. We created 2 single-task regression models that estimated the FSHD Clinical Score and TUG separately. Further, we built 1 multitask regression model that estimated the 2 clinical assessments simultaneously. Further, we assessed how an increasingly incremental time window affected the model performance. To do so, we trained the models on an incrementally increasing time window (from day 1 until day 14) and evaluated the predictions of the clinical severity on the remaining 4 weeks of data. RESULTS The single-task regression models achieved an R2 of 0.57 and 0.59 and a root-mean-square error (RMSE) of 2.09 and 1.66 when estimating FSHD Clinical Score and TUG, respectively. Time spent at a health-related location (such as a gym or hospital) and call duration were features that were predictive of both clinical assessments. The multitask model achieved an R2 of 0.66 and 0.81 and an RMSE of 1.97 and 1.61 for the FSHD Clinical Score and TUG, respectively, and therefore outperformed the single-task models in estimating clinical severity. The 3 most important features selected by the multitask model were light sleep duration, total steps per day, and mean steps per minute. Using an increasing time window (starting from day 1 to day 14) for the FSHD Clinical Score, TUG, and multitask estimation yielded an average R2 of 0.65, 0.79, and 0.76 and an average RMSE of 3.37, 2.05, and 4.37, respectively. CONCLUSIONS We demonstrated that smartphone and remote sensor data could be used to estimate FSHD clinical severity and therefore complement the assessment of FSHD outside the clinic. In addition, our results illustrated that training the models on the first week of data allows for consistent and stable prediction of FSHD symptom severity. Longitudinal follow-up studies should be conducted to further validate the reliability and validity of the multitask model as a tool to monitor disease progression over a longer period. TRIAL REGISTRATION ClinicalTrials.gov NCT04999735; https://www.clinicaltrials.gov/ct2/show/NCT04999735.
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Affiliation(s)
| | - Ghobad Maleki
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
| | | | - Robert J Doll
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
| | - Nicoline Voet
- Department of Rehabilitation, Rehabilitation Center Klimmendaal, Nijmegen, Netherlands
| | - Wessel Kraaij
- Leiden Institute of Advanced Computer Science, Leiden University, Leiden, Netherlands
| | - Adam Cohen
- Centre for Human Drug Research (CHDR), Leiden, Netherlands
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Mahon N, Glennon JC. The Bi-directional Relationship Between Sleep and Inflammation in Muscular Dystrophies: A Narrative Review. Neurosci Biobehav Rev 2023; 150:105116. [PMID: 36870583 DOI: 10.1016/j.neubiorev.2023.105116] [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: 06/07/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Muscular dystrophies vary in presentation and severity, but are associated with profound disability in many people. Although characterised by muscle weakness and wasting, there is also a very high prevalence of sleep problems and disorders which have significant impacts on quality of life in these individuals. There are no curative therapies for muscular dystrophies, with the only options for patients being supportive therapies to aid with symptoms. Therefore, there is an urgent need for new therapeutic targets and a greater understanding of pathogenesis. Inflammation and altered immunity are factors which have prominent roles in some muscular dystrophies and emerging roles in others such as type 1 myotonic dystrophy, signifying a link to pathogenesis. Interestingly, there is also a strong link between inflammation/immunity and sleep. In this review, we will explore this link in the context of muscular dystrophies and how it may influence potential therapeutic targets and interventions.
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Affiliation(s)
- Niamh Mahon
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey C Glennon
- School of Medicine, University College Dublin, Dublin, Ireland; UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
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Hoffmann HM, Malo-Juvera V, Statland JM. Self-reported reduced sleep quality and excessive daytime sleepiness in facioscapulohumeral muscular dystrophy. Muscle Nerve 2022; 66:487-494. [PMID: 35893768 PMCID: PMC9489670 DOI: 10.1002/mus.27688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS Facioscapulohumeral muscular dystrophy (FSHD) causes weakness and secondary associations, such as respiratory complications and pain, that can be linked to abnormal sleep patterns. Limited studies have focused on sleep in FSHD. The purpose of this study was to identify the prevalence of, and clinical features associated with, self-reported lowered sleep quality (SQ) and excessive daytime sleepiness (DS) in a large group of participants with FSHD. METHODS We conducted a prospective survey of individuals with self-reported FSHD enrolled in the FSHD Society Registry. The survey consisted of demographic and clinical characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale. Descriptive statistics were evaluated, and associations between clinical characteristics and SQ and DS were explored using one-way analysis of variance tests. Small effect size was identified as 0.01 ≥ η2 > 0.06, medium was 0.06 ≥ η2 > 0.14, and large was 0.14 ≥ η2 . RESULTS Six hundred ninety individuals responded to the survey, equally distributed between men and women, and spanning the age range from under 12 to 74 years of age or older. Sixty-six percent of the respondents showed reduced SQ (PSQI > 5) (n = 392; 95% confidence interval [CI], 62.4-70.0), and 15% showed excessive DS (>10) (n = 89; 95% CI, 12.2-17.9). There was a significant association between SQ and DS. Nocturnal pain had a large significant effect on lowering SQ (P < .001, η2 = 0.192). Factors including age and gender had minor effects on SQ. DISCUSSION Physicians should monitor sleep quality of patients with FSHD as a routine part of care, with special attention to potentially modifiable factors. Future research should address the physiological effects of pain in sleep.
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Affiliation(s)
| | | | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Objective and subjective measures of sleep in men with Muscular Dystrophy. PLoS One 2022; 17:e0274970. [PMID: 36137167 PMCID: PMC9499246 DOI: 10.1371/journal.pone.0274970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Despite poor sleep quality being recognised in Duchenne Muscular Dystrophy, reports from milder forms of Muscular Dystrophy (MD), and accompanied associations with quality of life (QoL), pain and fatigue, remain limited however. Methods Adult males (n = 15 Beckers MD (BMD), n = 12 Limb-Girdle MD (LGMD), n = 12 Fascioscapulohumeral (FSHD), n = 14 non-MD (CTRL)) completed assessments of body composition (Bio-electrical impedance), sleep (7-day 24-hour tri-axial accelerometer, Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index, QoL (SF36-v2), pain (Visual analogue scale), fatigue (Modified Fatigue Index Scale) and functional assessments (Brookes and Vignos). Results FSHD and BMD reported worse sleep than CTRL on the PSQI. FSHD scored worse than CTRL on the Insomnia Severity Index (P<0.05). 25–63% and 50–81% of adults with MD reported poor sleep quality using the Insomnia Severity Index and PSQI, respectively. Accelerometery identified no difference in sleep quality between groups. Associations were identified between sleep measures (PSQI global and insomnia severity) with mental or physical QoL in LGMD, BMD and FSHD. Multiple regression identified associations between sleep impairment and fatigue severity (all MDs), body composition (BMD & LGMD), upper and lower limb function (LGMD, FSHD) and age (FSHD). Conclusions 25–81% of men with MD, depending on classification, experience sleep impairment, using self-report sleep measures. Whilst BMD and FSHD showed worse sleep outcomes than CTRL, no group difference was observed between LGMD and CTRL, however all groups showed associations with sleep impairment and higher levels of fatigue. These findings, and associations with measures of health and wellbeing, highlight an area for further research which could impact QoL in adults with MD.
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Vega RDL, Miró J, Esteve R, Ramírez-Maestre C, López-Martínez AE, Jensen MP. Sleep disturbance in individuals with physical disabilities and chronic pain: The role of physical, emotional and cognitive factors. Disabil Health J 2019; 12:588-593. [PMID: 31076226 DOI: 10.1016/j.dhjo.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 04/15/2019] [Accepted: 04/23/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. OBJECTIVE The aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities. METHODS Participants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (Mage = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses. RESULTS After controlling for age and sex, the predictors explained an additional 7-16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%. CONCLUSIONS Consistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.
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Affiliation(s)
- Rocío de la Vega
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS and Research Center for Behavior Assessment (CRAMC), Department of Psychology and Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Rosa Esteve
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, Spain
| | | | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Abstract
Introduction We present a case of facioscapulohumeral muscular dystrophy (FSHD) with a diaphragm paralysis as the primary cause of ventilatory failure. FSHD is an autosomal dominant inherited disorder with a restricted pattern of weakness. Although respiratory weakness is a relatively unknown in FSHD, it is not uncommon. Methods We report on the clinical findings of a 68-year old male who presented with severe dyspnea while supine. Results Supplementing our clinical findings with laboratory, electrophysiological and radiological performances led to the diagnosis of diaphragm paralysis. Arterial blood gas in sitting position without supplemental oxygen showed a mild hypercapnia. His sleep improved after starting non-invasive ventilation and his daytime sleepiness disappeared. Discussion We conclude that in patients with FSHD who have symptoms of nocturnal hypoventilation, an adequate assessment of the diaphragm is recommended. This is of great importance as we know that nocturnal hypoventilation can be treated effectively by non-invasive ventilation.
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Key Words
- Chronic respiratory failure
- DUX4, double homeobox
- Diaphragm paralysis
- FSHD, facioscapulohumeral muscular dystrophy
- FVC, forced vital capacity
- Facioscapulohumeral muscular dystrophy
- HCO3, bicarbonate
- NIPPV, non-invasive positive pressure ventilation
- Non invasive positive pressure ventilation
- PSG, polysomnography
- Sleep
- SpO2, oxygen saturation
- kPa, kilopascal
- pH, acidity level
- paCO2, partial pressure of arterial carbon dioxide
- paO2, partial pressure of arterial oxygen
- tcpCO2, transcutaneous carbon dioxide
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Subjective sleep quality in stable neuromuscular patients under non-invasive ventilation. Sleep Med 2014; 15:1259-63. [DOI: 10.1016/j.sleep.2014.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/07/2014] [Accepted: 06/05/2014] [Indexed: 11/22/2022]
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Salort-Campana E, Nguyen K, Lévy N, Pouget J, Attarian S. Diagnostic clinique et moléculaire de la myopathie facioscapulo-humérale de type 1 (FSHD1) en 2012. Rev Neurol (Paris) 2013; 169:573-82. [DOI: 10.1016/j.neurol.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/10/2013] [Accepted: 07/15/2013] [Indexed: 01/20/2023]
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Della Marca G, Sancricca C, Losurdo A, Di Blasi C, De Fino C, Morosetti R, Broccolini A, Testani E, Scarano E, Servidei S, Mirabella M. Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis. Clin Neurophysiol 2013; 124:1615-21. [DOI: 10.1016/j.clinph.2013.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 12/13/2022]
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Della Marca G, Frusciante R, Vollono C, Iannaccone E, Dittoni S, Losurdo A, Testani E, Gnoni V, Colicchio S, Di Blasi C, Erra C, Mazza S, Ricci E. Pain and the Alpha-Sleep Anomaly: A Mechanism of Sleep Disruption in Facioscapulohumeral Muscular Dystrophy. PAIN MEDICINE 2013; 14:487-97. [DOI: 10.1111/pme.12054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Recommendations for the management of facioscapulohumeral muscular dystrophy in 2011. Rev Neurol (Paris) 2012; 168:910-8. [PMID: 22551571 DOI: 10.1016/j.neurol.2011.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 11/09/2011] [Accepted: 11/29/2011] [Indexed: 12/19/2022]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a neuromuscular disease, characterized by an autosomal dominant mode of inheritance, facial involvement, and selectivity and asymmetry of muscle involvement. In general, FSHD typically presents before age 20 years. Usually, FSHD muscle involvement starts in the face and then progresses to the shoulder girdle, the humeral muscles and the abdominal muscles, and then the anterolateral compartment of the leg. Disease severity is highly variable and progression is very slow. About 20% of FSHD patients become wheelchair-bound. Lifespan is not shortened. The diagnosis of FSHD is based on a genetic test by which a deletion of 3.3kb DNA repeats (named D4Z4 and mapping to the subtelomeric region of chromosome 4q35) is identified. The progressive pattern of FSHD requires that the severity of symptoms as well as their physical, social and psychological impact be evaluated on a regular basis. A yearly assessment is recommended. Multidisciplinary management of FSHD--consisting of a combination of genetic counselling, functional assessment, an assessment by a physical therapist, prescription of symptomatic therapies and prevention of known complications of this disease--is required. Prescription of physical therapy sessions and orthopedic appliances are to be adapted to the patient's deficiencies and contractures.
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Curcio G, Tempesta D, Scarlata S, Marzano C, Moroni F, Rossini PM, Ferrara M, De Gennaro L. Validity of the Italian Version of the Pittsburgh Sleep Quality Index (PSQI). Neurol Sci 2012; 34:511-9. [PMID: 22526760 DOI: 10.1007/s10072-012-1085-y] [Citation(s) in RCA: 374] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 03/27/2012] [Indexed: 02/08/2023]
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Paus S, Gross J, Moll-Müller M, Hentschel F, Spottke A, Wabbels B, Klockgether T, Abele M. Impaired sleep quality and restless legs syndrome in idiopathic focal dystonia: a controlled study. J Neurol 2011; 258:1835-40. [DOI: 10.1007/s00415-011-6029-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 02/24/2011] [Accepted: 03/24/2011] [Indexed: 11/24/2022]
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Romigi A, Izzi F, Pisani V, Placidi F, Pisani LR, Marciani MG, Corte F, Panico MB, Torelli F, Uasone E, Vitrani G, Albanese M, Massa R. Sleep disorders in adult-onset myotonic dystrophy type 1: a controlled polysomnographic study. Eur J Neurol 2011; 18:1139-45. [PMID: 21338442 DOI: 10.1111/j.1468-1331.2011.03352.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sleep disturbances and excessive daytime somnolence are common and disabling features in adult-onset myotonic dystrophy type 1 (DM1). METHODS Our study used questionnaires, ambulatory polysomnography and the multiple sleep latency test to evaluate sleep-wake cycle and daytime sleepiness in unselected adult-onset DM1 patients. We recruited 18 patients affected by adult-onset DM1 and 18 matched controls. RESULTS Sleep efficiency was <90% in 16/18 patients, and it was significantly reduced when compared with controls. Reduced sleep efficiency was associated with abnormal respiratory events (5/18 patients) and/or periodic limb movements (11/18 patients). The Periodic Limb Movement Index was significantly increased in DM1 versus controls. A significantly lower mean MSLT sleep latency was detected in DM1 versus controls, but it did not reach pathological levels. CONCLUSIONS Our controlled study demonstrated sleep alterations in unselected consecutive DM1 patients. Periodic limb movements in sleep are commonly associated with sleep disturbance in adult-onset DM1, and it may represent a marker of CNS neurodegenerative processes in DM1.
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Affiliation(s)
- A Romigi
- Neurophysiopathology Department, Sleep Medicine Centre, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy.
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Della Marca G, Frusciante R, Dittoni S, Vollono C, Buccarella C, Iannaccone E, Rossi M, Scarano E, Pirronti T, Cianfoni A, Mazza S, Tonali PA, Ricci E. Sleep disordered breathing in facioscapulohumeral muscular dystrophy. J Neurol Sci 2009; 285:54-8. [PMID: 19501370 DOI: 10.1016/j.jns.2009.05.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 05/05/2009] [Accepted: 05/13/2009] [Indexed: 11/18/2022]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is one of the most frequent forms of muscular dystrophy. The aims of this study were: 1) to evaluate the prevalence of sleep disordered breathing (SDB) in patients with FSHD; 2) to define the sleep-related respiratory patterns in FSHD patients with SDB; and 3) to find the clinical predictors of SDB. Fifty-one consecutive FSHD patients were enrolled, 23 women, mean age 45.7+/-12.3 years (range: 26-72). The diagnosis of FSHD was confirmed by genetic tests. All patients underwent medical and neurological evaluations, subjective evaluation of sleep and full-night laboratory-based polysomnography. Twenty patients presented SDB: 13 presented obstructive apneas, four presented REM related oxygen desaturations and three showed a mixed pattern. Three patients needed positive airways pressure. SDB was not related to the severity of the disease. Body mass index, neck circumference and daytime sleepiness did not allow prediction of SDB. In conclusion, the results suggest a high prevalence of SDB in patients with FSHD. The presence of SDB does not depend on the clinical severity of the disease. SDB is often asymptomatic, and no clinical or physical measure can reliably predict its occurrence. A screening of SDB should be included in the clinical assessment of FSHD.
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Affiliation(s)
- Giacomo Della Marca
- Department of Neurosciences, Catholic University, Policlinico Universitario A. Gemelli L.go A. Gemelli, 8, 00168 Rome, Italy.
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