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Pellitteri G, Versace S, Merlino G, Nilo A, Gigli GL, Valente M. A comprehensive update on the ADMET considerations for α2δ calcium channel ligand medications for treating restless legs syndrome. Expert Opin Drug Metab Toxicol 2024; 20:133-142. [PMID: 38482850 DOI: 10.1080/17425255.2024.2329738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Restless legs syndrome/Willis-Ekbom disease (RLS/WED) is a sleep-related sensory-motor disorder associated with poor sleep quality and impaired daily functioning. In patients affected by chronic RLS/WED, a pharmacological therapy is recommended. International guidelines suggest to start the treatment with a α2δ calcium channel ligand in most cases, unless contraindicated. AREAS COVERED The present review is based on an extensive Internet and PubMed search from 1986 to 2024. Our purpose is to describe the absorption, distribution, metabolism, and toxicology (ADMET) of the α2δ ligands, with common consideration for the therapeutic class, specificities of different compounds, efficacy, and safety in relation to other treatment options. EXPERT OPINION α2δ ligands are quite similar in their ADMET profiles, sharing most of the pharmacokinetics and potential adverse effects. However, we highlight the linear kinetic of gabapentin enacarbil and pregabalin, differently from gabapentin. α2δ ligands are safe and effective for the treatment of RLS/WED. Additional benefits can be obtained in comorbid insomnia, chronic pain syndromes, history of impulse control disorder, and comorbid anxiety. The use of α2δ ligands is associated with poor risk of augmentation. We still need new long-term safe and effective treatments, which could be developed along with our knowledge of RLS/WED pathophysiology.
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Affiliation(s)
- Gaia Pellitteri
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
| | - Salvatore Versace
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Udine, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
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Manconi M, van der Gaag LC, Mangili F, Garbazza C, Riccardi S, Cajochen C, Mondini S, Furia F, Zambrelli E, Baiardi S, Giordano A, Rizzo N, Fonti C, Viora E, D'Agostino A, Cicolin A, Cirignotta F, Aquilino D, Barassi A, Del Giudice R, Fior G, Gambini O, Giordano B, Martini A, Serrati C, Stefanelli R, Scarone S, Canevini M, Fanti V, Stein HC, Marconi AM, Raimondo E, Viglietta E, Santoro R, Simonazzi G, Bianconcini A, Meani F, Piazza N, Filippakos F, Gyr T. Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study. Sleep Med 2024; 113:41-48. [PMID: 37984016 DOI: 10.1016/j.sleep.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.
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Affiliation(s)
- Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University of Bern, Bern, Switzerland.
| | - Linda C van der Gaag
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Francesca Mangili
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Susanna Mondini
- UOC NEUROMET IRCCS Institute of Neurological Sciences Bologna, Italy
| | - Francesca Furia
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Giordano
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Nicola Rizzo
- Division of Obstetrics and Prenatal Medicine, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elsa Viora
- Prenatal Ecography Unit, AOU Città Della Salute e Della Scienza, Dipartimento di Ostetricia e Ginecologia, Torino, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | | | - Daniele Aquilino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Barassi
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Renata Del Giudice
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Fior
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alma Martini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Rossana Stefanelli
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Silvio Scarone
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mariapaola Canevini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Valentina Fanti
- Department of Health Sciences, Università Degli Studi di Milano, Italy
| | | | - Anna Maria Marconi
- Department of Health Sciences, Università Degli Studi di Milano, Italy; Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Erica Raimondo
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Emanuela Viglietta
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Rossella Santoro
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinical Neurologica NeuroMet, Ospedale S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliana Simonazzi
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Alessandra Bianconcini
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Francesco Meani
- Centro di Senologia Della Svizzera Italiana, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Nicoletta Piazza
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Filippos Filippakos
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Thomas Gyr
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
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Turan H, Aşkın Turan S, Butun Z, Kayapınar M. The Prevalence, Severity, and Predictive Factors of Restless Legs Syndrome in Pregnancy. Cureus 2023; 15:e44884. [PMID: 37692184 PMCID: PMC10485731 DOI: 10.7759/cureus.44884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVES The current study aimed to search the prevalence and severity of restless legs syndrome (RLS) in pregnancy according to the three trimesters and predictive factors of RLS in pregnancy based on validated diagnostic tools and a thorough literature review. METHODS The cross-sectional descriptive study included 500 pregnant women without comorbidities who were interviewed face-to-face. Age, height, weight, week of pregnancy, smoking, alcohol, caffeine use, regular exercise, and lab test results from the last visit were all included in the data. Only women satisfying the RLS diagnostic criteria were given the Restless Legs Syndrome Rating Scale. RESULTS The prevalence of RLS was found to be 29.2% with the highest rate in the third trimester (64.4%). In all trimesters, low ferritin (first trimester: p = 0.004; second trimester: p < 0.001; third trimester: p < 0.001), folic acid (first trimester: p = 0.001; second trimester: p < 0.001; third trimester: p < 0.001), vitamin B12 (first trimester: p = 0.003; second trimester: p < 0.001; third trimester: p < 0.001), and hemoglobin (first trimester: p < 0.001; second trimester: p < 0.001; third trimester: p < 0.001) levels were associated with RLS. In the second and third trimesters, low magnesium (p < 0.001 and p < 0.001, respectively) and high creatinine (p = 0.027 and p < 0.001, respectively) levels were associated with RLS. Higher thyroid-stimulating hormone and free T4 levels were associated with RLS in the third trimester but not in the first and second trimesters (median: 2.4 vs. 2.1, p < 0.001; median: 1.5 vs. 1.2, p < 0.001). In the multivariate regression analysis, age (p = 0.034, OR: 1.060, 95% CI: 1.005-1.119), present BMI (p < 0.001, OR: 1.8884, 95% CI: 1.597-2.222), BMI before conception (p < 0.001, OR: 0.607, 95% CI: 0.513-0.718), gravida (p < 0.001, OR: 2.172, 95% CI: 1.547-3.049), low ferritin level (p < 0.001, OR: 6.396, 95% CI: 0.00744-0.010405), low vitamin B12 (p < 0.001, OR: 10.347, 95% CI: 0.00120-0.00176), low folate (p < 0.001, OR: 5.841, 95% CI: 0.00616-0.01240), RLS history before conception (p = 0.013, OR: 4.963, 95% CI: 1.402-17.57), and RLS family history (p < 0.001, OR: 7.914, 95% CI: 0.18760-0.31151) were found to be predictive factors for RLS in pregnancy. CONCLUSION More attention is needed to RLS during pregnancy to prevent or treat this syndrome.
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Affiliation(s)
- Hasan Turan
- Obstetrics and Gynecology, University of Health Sciences, Mersin City Hospital, Mersin, TUR
| | - Suna Aşkın Turan
- Neurology/Pain Management, University of Health Sciences, Mersin City Hospital, Mersin, TUR
| | - Zafer Butun
- Obstetrics and Gynecology/Maternal Fetal Medicine, University of Health Sciences, Eskişehir City Hospital, Eskişehir, TUR
| | - Masum Kayapınar
- Obstetrics and Gynecology/Maternal Fetal Medicine, University of Health Sciences, Mersin City Hospital, Mersin, TUR
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Restless Legs Syndrome and Periodic Limb Movements of Sleep: From Neurophysiology to Clinical Practice. J Clin Neurophysiol 2023; 40:215-223. [PMID: 36872500 DOI: 10.1097/wnp.0000000000000934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
SUMMARY This article summarizes restless legs syndrome (RLS), periodic limb movements of sleep, and periodic limb movement disorder. RLS is a common sleep disorder with a prevalence of 5% to 15% in the general population. RLS can present in childhood, and incidence increases with age. RLS can be idiopathic or secondary to iron deficiency, chronic renal failure, peripheral neuropathy, and medications such as antidepressants (with higher rates for mirtazapine and venlafaxine, while bupropion may reduce symptoms at least in the short term), dopamine antagonists (neuroleptic antipsychotic agents and antinausea medications), and possibly antihistamines. Management includes pharmacologic agents (dopaminergic agents, alpha-2 delta calcium channel ligands, opioids, benzodiazepines) and nonpharmacologic therapies (iron supplementation, behavioral management). Periodic limb movements of sleep are an electrophysiologic finding commonly accompanying RLS. On the other hand, most individuals with periodic limb movements of sleep do not have RLS. The clinical significance of the movements has been argued. Periodic limb movement disorder is a distinct sleep disorder that arises in individuals without RLS and is a diagnosis of exclusion.
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Heidbreder A, Trenkwalder C, Bachmann CG, Bartl M, Fulda S, Habersack L, Maihöfner C, Mathis J, Muntean L, Schneider B, Stefani A, Paulus J, Young P. Restless Legs Syndrom. SOMNOLOGIE 2023. [DOI: 10.1007/s11818-023-00399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Raggi A, Mogavero MP, DelRosso LM, Ferri R. Clonazepam for the management of sleep disorders. Neurol Sci 2023; 44:115-128. [PMID: 36112279 DOI: 10.1007/s10072-022-06397-x] [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: 07/24/2022] [Accepted: 09/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objectives of this review and meta-analysis of polysomnographic data are those to focus on the clinical use of clonazepam for the management of sleep disorders by re-analyzing clinical trials and randomized clinical trials which have been published in peer-reviewed journals. METHODS A review of the literature including clinical trials and randomized controlled trials was performed in PubMed®, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. A random effects model meta-analysis was then carried out for the four more frequently reported polysomnographic measures: total sleep time, sleep latency, sleep efficiency, and periodic leg movement during sleep (PLMS) index. RESULTS A total of 33 articles were retrieved and screened in full text, of which 18 met the criteria for review; among the latter, nine met the criteria for meta-analysis. The studies included in the review involved patients with insomnia, REM sleep behavior disorder, sleep bruxism, and restless leg syndrome or PLMS which reported, most often, an increase in total sleep time with clonazepam. A clear sleep-promoting effect of clonazepam was found also by meta-analysis. DISCUSSION AND CONCLUSIONS Our results indicate that the pharmacological treatment of sleep disorders with clonazepam must always be personalized according to the type of patient, the risk of addiction and the concomitant presence of respiratory disorders are key factors to take into account. However, in light of the clinical evidence of the few studies in the literature on the different types of disorders, more studies on the use of clonazepam (also in association with first choice treatments) are definitely needed.
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Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, 34 Via Carlo Forlanini, 47121, Forlì, Italy.
| | - Maria Paola Mogavero
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy.,Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Lourdes M DelRosso
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
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Miyazaki A, Takahashi M, Shuo T, Eto H, Kondo H. Determination of optimal 25-hydroxyvitamin D cutoff values for the evaluation of restless legs syndrome among pregnant women. J Clin Sleep Med 2023; 19:73-83. [PMID: 35999809 PMCID: PMC9806781 DOI: 10.5664/jcsm.10270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
STUDY OBJECTIVES Vitamin D deficiency is associated with restless legs syndrome (RLS). However, a cutoff value for serum 25-hydroxyvitamin D (25[OH]D) level associated with RLS has yet to be clearly determined. We evaluated the association between 25(OH)D and RLS in pregnant women. METHODS Data from 203 pregnant women were evaluated using blood samples taken in the third trimester. Liquid chromatography-tandem mass spectrometry and ligand binding assays were used to measure 25(OH)D. RLS was diagnosed based on International Classification of Sleep Disorders, third edition, criteria. The cutoff value for serum 25(OH)D associated with RLS was explored using receiver operating characteristic (ROC) curve and classification and regression tree (CART) analyses. RESULTS The results of liquid chromatography-tandem mass spectrometry (x) and ligand binding assays (y) for serum 25(OH)D in the RLS (n = 35, 17.2%) and non-RLS (n = 168) groups showed a relationship of y = -2.65 + 0.08x . The RLS group showed lower serum 25(OH)D and folate levels. ROC curve and CART analyses revealed cutoff values of 10-12.7 ng/mL and 6.6-7.2 ng/mL for 25(OH)D and folate, respectively. Of the 5 women with RLS symptoms persisting at a moderate-to-severe level after delivery, 4 had 25(OH)D levels < 10 ng/mL and all had folate levels < 6 ng/mL. CONCLUSIONS Vitamin D and folate deficiency were associated with RLS in pregnant women and may be associated with persistent moderate-to-severe postpartum RLS symptomatology; it is essential to examine associations with RLS while accounting for measurement methods and assay systems. CITATION Miyazaki A, Takahashi M, Shuo T, Eto H, Kondo H. Determination of optimal 25-hydroxyvitamin D cutoff values for the evaluation of restless legs syndrome among pregnant women. J Clin Sleep Med. 2023;19(1):73-83.
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Affiliation(s)
- Asuka Miyazaki
- Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Misako Takahashi
- Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takuya Shuo
- Department of Medical Technology and Clinical Engineering, Faculty of Health and Medical Sciences, Hokuriku University, Ishikawa, Japan
| | - Hiromi Eto
- Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hideaki Kondo
- Sleep Center, Social Medical Corporation Shunkaikai, Inoue Hospital, Nagasaki, Japan
- Department of General Medicine, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Ibaraki, Japan
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Kelty E, Terplan M, Orr C, Preen DB. Neonatal outcomes associated with in utero exposure to oxycodone, overall and by trimester of exposure: A retrospective cohort study. THE JOURNAL OF PAIN 2022; 24:617-626. [PMID: 36423793 DOI: 10.1016/j.jpain.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
Oxycodone is commonly used by pregnant women for the treatment of pain. However, the potential risk associated with its use in pregnancy have not been robustly evaluated. The objective of this study was to examine neonatal outcomes associated with prenatal oxycodone exposure. State dispensing records were matched with midwives records to identify women who had been dispensed oxycodone during pregnancy (n=302). A matched comparison group of women who had been prescribed oxycodone prior to pregnancy was also identified (n=604). Hospital, mortality and congenital abnormality data were obtained for each mother-child dyad. Neonatal outcomes were examined for association with any exposure during pregnancy and trimester specific exposure, using generalized linear models. First trimester exposure was not associated with a significant increased risk of congenital anomalies (OR: 1.74 95%CI: 0.78, 3.87). Second trimester exposure to oxycodone was associated with reduction in average length of gestation (aCoef:-0.83, 95%CI: -1.26, -0.41) and birth weight (aCoef:-188, 95%CI: -299, -76). Second trimester exposure was also associated with an increased risk of very preterm birth (<32 weeks) (OR: 5.03, 95%CI: 1.95, 12.98) and admission to the special care nursery (aOR:1.99, 95%CI: 1.30, 3.03). Third trimester exposure to oxycodone was associated with a reduction in average length of gestation (aCoef:-0.33, 95%CI: -0.63, -0.02) compared with the comparison group. The use of oxycodone in pregnancy was not associated with an increased risk of congenital anomalies. However, oxycodone exposure was associated with a short period of gestation, preterm birth, and NAS, which likely contributed to a longer period of hospitalization following birth. PERSPECTIVE: This article assesses the neonatal risks associated with prenatal exposure to oxycodone, providing clinicians and patients with important information on the safety of oxycodone in the treatment of pain in pregnancy.
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McLafferty LP, Spada M, Gopalan P. Pharmacologic Treatment of Sleep Disorders in Pregnancy. Sleep Med Clin 2022; 17:445-452. [PMID: 36150806 DOI: 10.1016/j.jsmc.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pregnancy is a unique physiologic state whose characteristics often predispose women to new-onset sleep disturbances or exacerbations of preexisting sleep disorders. Pregnancy-related factors that can disrupt sleep include heartburn, nocturnal oxytocin secretion, nocturia, and fetal movement. Sleep disorders in pregnancy include insomnia (primary and secondary), restless legs syndrome, and narcolepsy.
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Affiliation(s)
- Laura P McLafferty
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Thompson Building, Suite 1652, 1020 Sansom Street, Philadelphia, PA 19107, USA.
| | - Meredith Spada
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Priya Gopalan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
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Common Sleep Disorders in Pregnancy. Obstet Gynecol 2022; 140:321-339. [DOI: 10.1097/aog.0000000000004866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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Wong PF, D'Cruz R, Hare A. Sleep disorders in pregnancy. Breathe (Sheff) 2022; 18:220004. [DOI: 10.1183/20734735.0004-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Sleep disturbances are common in pregnancy and affect sleep quality. The maternal body is going through constant physical and physiological changes to adapt to the growing fetus. Sleep disorders may manifest at any point during pregnancy; some may result in adverse maternal or fetal outcomes. A strong clinical suspicion is crucial to identify sleep disorders in pregnancy and their management should be evaluated with a multidisciplinary team approach. In this review, we provide an overview of changes in sleep during pregnancy and summarise the key features of common sleep disorders in pregnancy, including practical tips on their management.Educational aimsTo provide an overview of common sleep disorders in pregnancy and their management options.To highlight the impact of the physiological changes in pregnancy on sleep.To outline the type of sleep studies available to investigate sleep disorders in pregnancy.
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Polo-Kantola P. Sleep disturbances in pregnancy: Why and how should we manage them? Acta Obstet Gynecol Scand 2022; 101:270-272. [PMID: 35238029 DOI: 10.1111/aogs.14325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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Sleep Disturbance in Pregnancy. Sleep Med Clin 2022; 17:11-23. [PMID: 35216757 DOI: 10.1016/j.jsmc.2021.10.002] [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: 11/22/2022]
Abstract
Sleep is vital to life, even when women enter into pregnancy state. Good sleep is important for a healthy pregnancy. Sleep disturbances are common during pregnancy and can be due to the change of pregnancy itself or the results of sleep disorders. There is growing evidence linking sleep disturbances with adverse maternal and fetal outcomes. Differentiation of sleep disorders in order to provide appropriate treatment as well as promoting good sleep for pregnant women is important. A multidisciplinary team to provide sleep care during antenatal period may be needed.
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Vlasie A, Trifu S, Lupuleac C, Kohn B, Cristea M. Restless legs syndrome: An overview of pathophysiology, comorbidities and therapeutic approaches (Review). Exp Ther Med 2021; 23:185. [PMID: 35069866 PMCID: PMC8764906 DOI: 10.3892/etm.2021.11108] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrei Vlasie
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Simona Trifu
- Department of Clinical Neurosciences, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Cristiana Lupuleac
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Bianca Kohn
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Mihai Cristea
- Department of Morphological Sciences, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
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Restless legs syndrome during pregnancy: an overview. SOMNOLOGIE 2021. [DOI: 10.1007/s11818-021-00337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Prevalence of Restless Legs Syndrome and its Symptoms among Patients with Spinal Disorders. J Clin Med 2021; 10:jcm10215001. [PMID: 34768519 PMCID: PMC8584868 DOI: 10.3390/jcm10215001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable sensations in the legs. The purpose of this study was to evaluate the symptoms of RLS in patients with spinal disorders and the impact of RLS on the clinical outcomes of lumbar spinal stenosis (LSS). The records of 278 patients (age range 65–92 years) with spinal disorders who visited our outpatient clinic were reviewed. We used a survey to identify subjects with RLS based on the International RLS Study Group diagnostic criteria. We further recorded patient characteristics, surgical outcomes, sleeping time, mental health condition, and the occurrence of leg cramps. Thirty-two patients (11.5%) met the criteria for RLS. The prevalence of anxiety (46.9% vs. 26.6%, p = 0.023) and leg cramps (90.6% vs. 73.2%, p = 0.030) was higher in patients with RLS than in those without. RLS was present in 12.3% of LSS patients. The visual analog scale score for lower back pain before surgery and at the final follow-up was significantly higher in LSS patients with RLS than in those without. However, the Japanese Orthopaedic Association (JOA) score, JOA score improvement ratio, and VAS score for leg numbness were not significantly different between the groups.
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Franco B, Mota DS, Daubian-Nosé P, Rodrigues NDA, Simino LADP, de Fante T, Bezerra RMN, Manchado Gobatto FDB, Manconi M, Torsoni AS, Esteves AM. Iron deficiency in pregnancy: Influence on sleep, behavior, and molecular markers of adult male offspring. J Neurosci Res 2021; 99:3325-3338. [PMID: 34651324 DOI: 10.1002/jnr.24968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/17/2021] [Accepted: 08/31/2021] [Indexed: 12/14/2022]
Abstract
Iron restriction during pregnancy can lead to iron deficiency and changes in the dopaminergic system in the adulthood of offspring, and restless legs syndrome (RLS) is closely related to these changes. Objectives: Analyze whether iron restriction during pregnancy would cause changes in the behavior, sleep, and dopaminergic system of the male offspring. In addition, we aimed to assess whether exercise would be able to modulate these variables. The pregnant rats (Wistar) were divided into four groups with different concentrations of iron in the diet: standard (St), supplementation (Su), restriction since weaning (R1), and restriction only during pregnancy (R2). After birth, the offspring were assigned to their respective groups according to the dams diet (St, Su, R1, and R2) and distributed into sedentary (SD) and exercised (EX) (for 8 weeks of training), reaching eight groups of offspring (O): OSt SD, OSt EX, OSu SD, OSu EX, OR1 SD, OR1 EX, OR2 SD, and OR2 EX. Sleep, behavior, and analysis of key genes of dopaminergic system (D2, DAT) were performed after 8 weeks. The results for trained offspring that the mother received supplementation diet were the most expressive, with increased freezing and the OR1 SD group showed an increase in DAT protein content. These changes may have been due to the association between the dams diet during pregnancy and the practice of exercise by the offspring. The different concentrations of iron during pregnancy caused changes in the offspring, however, they were not associated with fetal programming in the context of RLS.
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Affiliation(s)
- Beatriz Franco
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Diego Silva Mota
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
| | - Paulo Daubian-Nosé
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
| | | | | | - Thaís de Fante
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
| | | | - Fúlvia de Barros Manchado Gobatto
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Campinas, Brazil.,Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | | | - Andrea Maculano Esteves
- Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Campinas, Brazil.,Faculdade de Ciências Aplicadas, Universidade Estadual de Campinas, Limeira, Brazil
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18
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Kadıoğlu N, Sert UY, Sariaslan SG, Mursel K, Celen S. Sleep Disorders in Pregnancy, Influencing Factors and Quality of Life. Z Geburtshilfe Neonatol 2021; 226:34-40. [PMID: 34311492 DOI: 10.1055/a-1519-7517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM In our study, the frequency of sleep disturbances in pregnancy, the reasons underlying the low quality of sleep, clinical factors, and the effects on quality of life were investigated. METHODS The study was planned as a prospective study and included 189 pregnant women. Clinical features, laboratory results, socio-demographic status, obstetric and medical anamnesis were evaluated. The Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, the Berlin Questionnaire, Beck Depression Inventory, SF-36 quality-of-life questionnaire, and restless leg syndrome (RLS) diagnosis criteria were used for data collection. RESULTS We investigated sleep disorders in 110 pregnant women (58.2%). A history of premenstrual syndrome and patients with hyperemesis gravidarum, obstructive sleep apnea syndrome, Vitamin B12 deficiency, and higher TSH levels in the laboratory were found to be associated with sleep disorders. Sleep disorders and daytime sleepiness were associated with depression, physical and social functioning, pain, and disturbance in general health perception. The number of pregnant women who had two or more RLS complaints was 84 (44%). CONCLUSION The results of our study show that sleep disorders in pregnancy can be managed with easily applicable methods according to the risk factors and related problems.
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Affiliation(s)
- Nezaket Kadıoğlu
- Department of Obstetrics and Gynecology, University of Yuksek ihtisas, Ankara, Turkey
| | - Umit Yasemin Sert
- Department of Obstetrics and Gynecology, Ankara City Hospital, Cankaya, Ankara
| | | | - Konul Mursel
- Department of Obstetrics and Gynecology, Lokman Hekim Hospital, Ankara, Turkey
| | - Sevki Celen
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Education and Research Hospital, Ankara, Turkey
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Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW. The Management of Restless Legs Syndrome: An Updated Algorithm. Mayo Clin Proc 2021; 96:1921-1937. [PMID: 34218864 DOI: 10.1016/j.mayocp.2020.12.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023]
Abstract
Restless legs syndrome (RLS) is a common disorder. The population prevalence is 1.5% to 2.7% in a subgroup of patients having more severe RLS with symptoms occurring 2 or more times a week and causing at least moderate distress. It is important for primary care physicians to be familiar with the disorder and its management. Much has changed in the management of RLS since our previous revised algorithm was published in 2013. This updated algorithm was written by members of the Scientific and Medical Advisory Board of the RLS Foundation based on scientific evidence and expert opinion. A literature search was performed using PubMed identifying all articles on RLS from 2012 to 2020. The management of RLS is considered under the following headings: General Considerations; Intermittent RLS; Chronic Persistent RLS; Refractory RLS; Special Circumstances; and Alternative, Investigative, and Potential Future Therapies. Nonpharmacologic approaches, including mental alerting activities, avoidance of substances or medications that may exacerbate RLS, and oral and intravenous iron supplementation, are outlined. The choice of an alpha2-delta ligand as first-line therapy for chronic persistent RLS with dopamine agonists as a second-line option is explained. We discuss the available drugs, the factors determining which to use, and their adverse effects. We define refractory RLS and describe management approaches, including combination therapy and the use of high-potency opioids. Treatment of RLS in pregnancy and childhood is discussed.
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Affiliation(s)
- Michael H Silber
- Center for Sleep Medicine and Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Mark J Buchfuhrer
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian B Koo
- Department of Neurology, Yale University, New Haven, CT
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Ospedale Civico, and Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - John W Winkelman
- Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Cambridge, MA
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20
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Jahani Kondori M, Kolla BP, Moore KM, Mansukhani MP. Management of Restless Legs Syndrome in Pregnancy and Lactation. J Prim Care Community Health 2021; 11:2150132720905950. [PMID: 32054396 PMCID: PMC7025421 DOI: 10.1177/2150132720905950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Restless legs syndrome (RLS) affects about 20% of all pregnant women. RLS symptoms are usually moderate to severe in intensity during pregnancy and can result in insomnia, depression, and other adverse outcomes. Although iron deficiency has been implicated as a potential etiological factor, other mechanisms can also play a role. Nonpharmacologic methods are the primary recommended form of treatment for RLS in pregnancy and lactation. Iron supplementation may be considered when the serum ferritin is low; however, several patients are unable to tolerate iron or have severe symptoms despite oral iron replacement. Here, we describe a case of severe RLS in pregnancy and illustrate the dilemmas in diagnosis and management. We review the literature on the prevalence, diagnosis, course, possible underlying pathophysiologic mechanisms and complications of RLS in pregnancy. We describe current best evidence on the efficacy, and safety of nonpharmacologic therapies, oral and intravenous iron supplementation, as well as other medication treatments for RLS in pregnancy and lactation. We highlight gaps in the literature and provide a practical guide for the clinical management of RLS in pregnancy and during breastfeeding.
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21
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Bae H, Cho YW, Kim KT, Allen RP, Earley CJ. Randomized, placebo-controlled trial of ferric carboxymaltose in restless legs syndrome patients with iron deficiency anemia. Sleep Med 2021; 84:179-186. [PMID: 34157632 DOI: 10.1016/j.sleep.2021.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/20/2021] [Accepted: 05/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intravenous ferric carboxymaltose (FCM) has been shown to be efficacious in treating restless legs syndrome (RLS) symptoms in non-anemic patients. The aim of this study was to evaluate the effectiveness of FCM in treating RLS symptoms in patients who also had an iron deficiency anemia (IDA). METHODS This is a randomized, double-blinded, placebo-controlled study. Subjects with RLS and IDA were enrolled. Subjects received an infusion of either 1500 mg FCM or placebo in Phase I. The primary outcomes were a change-from-baseline at week six on the International Restless Legs Syndrome Study Group scale (IRLS). Phase II of the study involved long-term (52 weeks) follow-up, for those who responded to treatment in the prior phase, with the potential for further treatment if symptoms returned. RESULTS We enrolled 29 RLS patients with IDA (15 FCM and 14 placebo). At week six post-infusion, FCM compared to placebo group showed significant improvement from baseline in IRLS score (-13.47 ± 7.38 vs. 1.36 ± 3.59). Among secondary outcome variables, quality of sleep showed significant improvement from baseline in the FCM group. 61% of subjects remained off RLS medications at the Phase II, week-52 endpoint. There were no serious adverse events observed in the study. CONCLUSION The study showed significant efficacy and safety of FCM 1500 mg treatment both in the short term (6 weeks) and long term (52 weeks) in RLS patients with IDA.
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Affiliation(s)
- Hyoeun Bae
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea.
| | - Keun Tae Kim
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Richard P Allen
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Christopher J Earley
- Department of Neurology, Johns Hopkins University, Hopkins Bayview Medical Center, Baltimore, MD, USA
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22
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Yoshimura C, Arima H, Amagase H, Takewaka M, Nakashima K, Imaoka C, Miyanaga N, Obama H, Fujita M, Ando SI. Idiopathic and secondary restless legs syndrome during pregnancy in Japan: Prevalence, clinical features and delivery-related outcomes. PLoS One 2021; 16:e0251298. [PMID: 33974646 PMCID: PMC8112660 DOI: 10.1371/journal.pone.0251298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 04/23/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to investigate prevalence of idiopathic and secondary restless legs syndrome (RLS) according to pregnancy trimester, and its effects on delivery-related outcomes among pregnant women in Japan. Methods This was a single-center, prospective observational study. One hundred eighty-two consecutive pregnant women participated in the study from June 2014 to March 2016. Participants were interviewed and examined in the second and third trimesters of pregnancy and 1 month after delivery. At each term, RLS was identified by a research assistant and then specialist in sleep medicine based on the diagnostic criteria of the International Restless Legs Syndrome Study Group. Delivery-related data was collected from medical charts. RLS was classified as idiopathic RLS, which originally existed before the index pregnancy, or secondary RLS, which newly appeared during the index pregnancy. Results The prevalence of RLS was 4.9% (idiopathic 3.3%, secondary 1.6%) in the second trimester, 5.0% (idiopathic 0.0%, secondary 5.0%) in the third trimester, and 0.6% (idiopathic 0.0%, secondary 0.6%) after delivery. Prolonged labor, emergency Cesarean section, and arrest of labor tended to be more frequent in idiopathic and/or second RLS (all p<0.05). Conclusions The prevalence of RLS during pregnancy was 4–5% and decreases after delivery in current Japan. The presence of RLS was associated with an increase in some delivery-related outcomes. Early detection and treatment of RLS during pregnancy may be beneficial to safe delivery for pregnant women.
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Affiliation(s)
- Chikara Yoshimura
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
- Faculty of Medicine, Department of Respiratory Medicine, Fukuoka University, Fukuoka, Japan
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan
- * E-mail:
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | | | | | | | | | | | | | - Masaki Fujita
- Faculty of Medicine, Department of Respiratory Medicine, Fukuoka University, Fukuoka, Japan
| | - Shin-ichi Ando
- Sleep Apnea Center, Kyushu University Hospital, Fukuoka, Japan
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Management of Parkinson’s disease and other movement disorders in women of childbearing age: Part 2. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Tuna Oran N, Yuksel E, Ruzgar S. Prevalence of restless leg syndrome and effects on quality of life during pregnancy. Sleep Breath 2021; 25:2127-2134. [PMID: 33566234 DOI: 10.1007/s11325-021-02311-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/30/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Restless leg syndrome (RLS) is a movement disorder which constitutes the most common and major risk group during pregnancy. The purpose of this study was to determine prevalence and severity of RLS during pregnancy and to investigate the effect of RLS on quality of life in pregnant women. METHODS This cross-sectional study was conducted in antenatal clinics of four different public hospitals. Data collected were pregnancy assessment form, RLS diagnostic criteria form, RLS severity scale, and SF-12 quality of life scale. RESULTS Among 718 pregnant women, mean age was 28.3±5.9 years (range 19 to 45). According to the diagnostic criteria of RLS, RLS prevalence was 22% (n=159). Of the 159 women with RLS, 41% had moderate severity and 40% had severe RLS. Prevalence of RLS in pregnant women increased with gestational week, working time during pregnancy, weight before pregnancy, total weight gain during pregnancy, and pre-pregnancy body mass index. Physical health scores, physical functioning scores, pain scores, emotional role difficulty scores, and social function scores were significantly lower in the pregnant women with RLS than without RLS (p <0.05). CONCLUSIONS Approximately one-fifth of the pregnant women had RLS, mostly in the third trimester, and the severity of RLS was predominantly moderate and severe. Pregnant women with RLS had poorer quality of life than pregnant women without RLS.
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Affiliation(s)
- Nazan Tuna Oran
- Department of Midwifery, Faculty of Health Sciences, Ege University, Bornova, 35100, Izmir, Turkey
| | - Esma Yuksel
- Department of Midwifery, Faculty of Health Sciences, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Sebnem Ruzgar
- Department of Midwifery, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
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Lu Q, Zhang X, Wang Y, Li J, Xu Y, Song X, Su S, Zhu X, Vitiello MV, Shi J, Bao Y, Lu L. Sleep disturbances during pregnancy and adverse maternal and fetal outcomes: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101436. [PMID: 33571887 DOI: 10.1016/j.smrv.2021.101436] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
Sleep disturbances are highly prevalent in pregnancy and are frequently overlooked as a potential cause of significant morbidity. The association between sleep disturbances and pregnancy outcomes remains largely controversial and needs to be clarified to guide management. To evaluate the association between sleep disturbances and maternal complications and adverse fetal outcomes, we performed a systematic search of PubMed, Embase and Web of Science for English-language articles published from inception to March 6, 2020, including observational studies of pregnant women with and without sleep disturbances assessing the risk of obstetric complications in the antenatal, intrapartum or postnatal period, and neonatal complications. Data extraction was completed independently by two reviewers. We utilized the Newcastle-Ottawa Scales to assess the methodological quality of included studies and random-effect models to pool the associations. A total of 120 studies with 58,123,250 pregnant women were included. Sleep disturbances were assessed, including poor sleep quality, extreme sleep duration, insomnia symptoms, restless legs syndrome, subjective sleep-disordered breathing and diagnosed obstructive sleep apnea. Significant associations were found between sleep disturbances in pregnancy and a variety of maternal complications and adverse fetal outcomes. Overall sleep disturbances were significantly associated with pre-eclampsia (odds ratio = 2.80, 95% confidence interval: 2.38-3.30), gestational hypertension (1.74, 1.54-1.97), gestational diabetes mellitus (1.59, 1.45-1.76), cesarean section (1.47, 1.31-1.64), preterm birth (1.38, 1.26-1.51), large for gestational age (1.40, 1.11-1.77), and stillbirth (1.25, 1.08-1.45), but not small for gestational age (1.03, 0.92-1.16), or low birth weight (1.27, 0.98-1.64). Sleep disturbances were related to higher morbidities in pregnant women who are 30 y or older and overweight before pregnancy. The findings indicate that sleep disturbances, which are easily ignored and treatable for both pregnant women and clinical services, deserve more attention from health care providers during prenatal counseling and health care services.
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Affiliation(s)
- Qingdong Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Xiaoyan Zhang
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yunhe Wang
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Jinqiao Li
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Yingying Xu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China
| | - Xiaohong Song
- Department of Obstetrics and Gynecology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Sizhen Su
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Ximei Zhu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China.
| | - Yanping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing 100191, China; School of Public Health, Peking University, Beijing 100191, China.
| | - Lin Lu
- Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing 100191, China; Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100191, China.
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Mondello S, Kobeissy FH, Mechref Y, Zhao J, El Hayek S, Zibara K, Moresco M, Plazzi G, Cosentino FII, Ferri R. Searching for Novel Candidate Biomarkers of RLS in Blood by Proteomic Analysis. Nat Sci Sleep 2021; 13:873-883. [PMID: 34234594 PMCID: PMC8243594 DOI: 10.2147/nss.s311801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/28/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We performed comparative proteomic analyses of blood of patients with RLS and healthy individuals aiming to identify potential biomarker and therapeutic target candidate for RLS. PATIENTS AND METHODS Blood serum samples from 12 patients with a clinical diagnosis of RLS (8 females and 4 males, with a mean age of 68.52 years) and 10 healthy controls (5 females and 5 males, with a mean age of 67.61 years) underwent proteomic profiling by liquid chromatography coupled with tandem mass spectrometry. Pathway analysis incorporating protein-protein interaction networks was carried out to identify pathological processes linked to the differentially expressed proteins. RESULTS We quantified 272 proteins in patients with RLS and healthy controls, of which 243 were shared. Five proteins - apolipoprotein C-II, leucine-rich alpha-2-glycoprotein 1, FLJ92374, extracellular matrix protein 1, and FLJ93143 - were substantially increased in RLS patients, whereas nine proteins - vitamin D-binding protein, FLJ78071, alpha-1-antitrypsin, CD5 antigen-like, haptoglobin, fibrinogen alpha chain, complement factor H-related protein 1, platelet factor 4, and plasma protease C1 inhibitor - were decreased. Bioinformatics analyses revealed that these proteins were linked to 1) inflammatory and immune response, and complement activation, 2) brain-related development, cell aging, and memory disorders, 3) pregnancy and associated complications, 4) myocardial infarction, and 5) reactive oxygen species generation and subsequent diabetes mellitus. CONCLUSION Our findings shed light on the multifactorial nature of RLS and identified a set of circulating proteins that may have clinical importance as biomarkers and therapeutic targets.
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Affiliation(s)
- Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Firas H Kobeissy
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yehia Mechref
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jingfu Zhao
- Department of Chemistry and Biochemistry, Texas Tech University, Lubbock, TX, 79409, USA
| | - Samer El Hayek
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Kazem Zibara
- Department of Biology, Faculty of Sciences-I, PRASE, DSST, Lebanese University, Beirut, Lebanon
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
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Hu S, He X, Zhang Y, Hu S, He F, Zhao F, Zhang Q, Liu T, Wang C. Effectiveness and safety of massage in the treatment of restless legs syndrome: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e23239. [PMID: 33235081 PMCID: PMC7710177 DOI: 10.1097/md.0000000000023239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Restless legs syndrome (RLS), known as a kind of neurological disease, is prevalent but easy to be ignored. Studies have demonstrated that massage therapy can effectively reduce the symptoms of patients with RLS and improve their quality of life. However, the efficacy of massage therapy for RLS is still controversial. Therefore, this protocol aims to evaluate the reliability of massage therapy in treating RLS in a thorough way. METHODS We will search relevant randomized controlled trials from Chinese Biomedical Literature Database, Chongqing VIP, CNKI, Wanfang, Web of Science, Cochrane Library, PubMed, and EMBASE, when publication status and language are not considered and the time limit ends with September 6, 2020. Two experienced researchers will use RevMan V.5.3 software to perform the selection of literature, data collection, data analysis and synthesis separately. Besides, the quality of trials involved in this study will be measured with the Cochrane bias risk assessment tool. RESULTS This protocol will be applied to carry out a systematic evaluation of the massage therapy purposed to treat RLS for its effectiveness and safety. CONCLUSION The review will provide a credible evidence suggesting whether massage therapy is a reliable intervention for RLS. INPLASY REGISTRATION NUMBER INPLASY202090038.
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Affiliation(s)
- Shasha Hu
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Xingwei He
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yajing Zhang
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Songfeng Hu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Fan He
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Fenfen Zhao
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Qin Zhang
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Tingping Liu
- College of Acupuncture-Moxibustion and Tuina, Jiangxi University of Traditional Chinese Medicine
| | - Changkang Wang
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Abstract
Restless legs syndrome (RLS), with a lifetime prevalence of up to 10%, is a frequent neurological disease and the most common movement disorder in sleep. A compulsive urge to move the legs with sensory symptoms and sleep disturbances can significantly impair the quality of life. Furthermore, RLS frequently occurs as a comorbidity to various internal and neurological diseases. It is diagnosed clinically based on the five essential diagnostic criteria. For treatment, an iron deficiency should first be excluded. Drugs approved for the treatment of RLS include dopaminergics (L-DOPA/benserazide) and dopamine agonists as well as oxycodone/naloxone, as a second-line treatment in severe cases. Augmentation as a deterioration of symptoms is a clinically defined complication of high-dose dopaminergic treatment, requiring special management strategies. Due to its high prevalence of up to 25%, RLS plays also an important role in the care of pregnant women.
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Restless-legs-Syndrom: ein Update. SOMNOLOGIE 2020. [DOI: 10.1007/s11818-020-00283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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García-Ramos R, Santos-García D, Alonso-Cánovas A, Álvarez-Sauco M, Ares B, Ávila A, Caballol N, Carrillo F, Escamilla Sevilla F, Freire E, Gómez Esteban JC, Legarda I, López Manzanares L, López Valdés E, Martínez-Torres I, Mata M, Pareés I, Pascual-Sedano B, Martínez Castrillo JC, Mir P. Management of Parkinson's disease and other movement disorders in women of childbearing age: Part 2. Neurologia 2020; 36:159-168. [PMID: 32980194 DOI: 10.1016/j.nrl.2020.05.012] [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: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Many diseases associated with hyperkinetic movement disorders manifest in women of childbearing age. It is important to understand the risks of these diseases during pregnancy, and the potential risks of treatment for the fetus. OBJECTIVES This study aims to define the clinical characteristics and the factors affecting the lives of women of childbearing age with dystonia, chorea, Tourette syndrome, tremor, and restless legs syndrome, and to establish guidelines for management of pregnancy and breastfeeding in these patients. RESULTS This consensus document was developed through an exhaustive literature search and a discussion of the content by a group of movement disorder experts from the Spanish Society of Neurology. CONCLUSIONS We must evaluate the risks and benefits of treatment in all women with hyperkinetic movement disorders, whether pre-existing or with onset during pregnancy, and aim to reduce effective doses as much as possible or to administer drugs only when necessary. In hereditary diseases, families should be offered genetic counselling. It is important to recognise movement disorders triggered during pregnancy, such as certain types of chorea and restless legs syndrome.
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Affiliation(s)
- R García-Ramos
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, Madrid, España.
| | - D Santos-García
- Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | | | - M Álvarez-Sauco
- Hospital General Universitario de Elche, Elche, Alicante, España
| | - B Ares
- Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España
| | - A Ávila
- Consorci Sanitari Integral, Hospital General de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España; Consorci Sanitari Integral, Hospital Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - N Caballol
- Consorci Sanitari Integral, Hospital Sant Joan Despí Moisés Broggi, Sant Joan Despí, Barcelona, España
| | - F Carrillo
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | - F Escamilla Sevilla
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario Virgen de las Nieves, Granada, España
| | - E Freire
- Hospital General Universitario de Elche, Elche, Alicante, España; Hospital IMED Elche, Elche, Alicante, España
| | | | - I Legarda
- Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | | | - E López Valdés
- Instituto de Investigación Sanitaria San Carlos (IdISCC), Hospital Clínico San Carlos, Madrid, España
| | | | - M Mata
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - I Pareés
- Hospital Universitario Ramón y Cajal, Madrid, España; Hospital Rúber Internacional, Madrid, España
| | - B Pascual-Sedano
- Estudios de Ciencias de la Salud, Hospital Santa Creu i Sant Pau, Barcelona, España; Universitat Oberta de Catalunya (UOC), Barcelona, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España
| | | | - P Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España; Hospital Rúber Internacional, Madrid, España
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Guay A, Houle M, O'Shaughnessy J, Descarreaux M. Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review. J Manipulative Physiol Ther 2020; 43:930-941. [PMID: 32900545 DOI: 10.1016/j.jmpt.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this scoping review is to outline the current evidence regarding the management of restless legs syndrome (RLS) with nonpharmacologic approaches. To categorize the efficacy of conservative approaches in reducing symptoms of RLS, we have identified and summarized the current data regarding diagnostic criteria and relevant outcome measures, to inform future research and to guide clinical practice. METHODS A scoping review was conducted using the National Center for Biotechnology Information; EBSCO; the Manual, Alternative and Natural Therapy Index System; the Cumulative Index to Nursing & Allied Health Literature; and Scopus. All literature related to RLS was extracted, screened, and reviewed based on titles and abstract contents. The authors then extracted data from the 24 admissible studies, that is, the ones about manual therapy, exercises, and alternative treatments for RLS. The Physiotherapy Evidence Database scale was used to rate the methodological quality of the included randomized controlled trials by 2 independent readers. RESULTS In the 24 articles fulfilling the selection criteria, there was a consistent trend in the findings showing positive results in lowering RLS symptom severity. Most clinical studies based their diagnosis on the International Restless Legs Syndrome Study Group diagnostic criteria; the International Restless Legs Syndrome Study Group rating scale was the most often used outcome measure. The efficacy of exercise, yoga, massage, acupuncture, traction straight leg raise, cryotherapy, pneumatic compression devices, whole-body vibration, transcranial and transcutaneous stimulation, and near-infrared lights showed different effects on RLS symptom severity, and the level of evidence was evaluated. CONCLUSION Our results showed clinically significant effects for exercises, acupuncture, pneumatic compression devices, and near-infrared light. Short-lasting effects were identified with whole-body cryotherapy, repetitive transcranial stimulation, and transcutaneous stimulation. More studies are necessary to investigate efficacy of yoga, massage, traction straight leg raise, and whole-body vibration. No adverse effects were identified for moderate-intensity exercise, yoga, massage, and pneumatic compression devices.
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Affiliation(s)
- Alexe Guay
- Département des Sciences de l'Activité Physique, University of Quebec at Trois-Rivieres, Trois-Rivières, Québec, Canada
| | - Mariève Houle
- Département des Sciences de l'Activité Physique, University of Quebec at Trois-Rivieres, Trois-Rivières, Québec, Canada
| | - Julie O'Shaughnessy
- Département de Chiropratique, University of Quebec at Trois-Rivieres, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Département des Sciences de l'Activité Physique, University of Quebec at Trois-Rivieres, Trois-Rivières, Québec, Canada.
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Sheng L, Zhao P, Ma H, Qi L, Yi Z, Shi Y, Zhong J, Shi H, Dai Z, Pan P. Gray matter alterations in restless legs syndrome: A coordinate-based meta-analysis. Medicine (Baltimore) 2020; 99:e21374. [PMID: 32702936 PMCID: PMC7373538 DOI: 10.1097/md.0000000000021374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Voxel-based morphometry (VBM) is an objective structural magnetic resonance imaging (MRI) technique which allows researchers to investigate group-level differences in regional gray matter (GM) volume or density over the whole brain. In the last decade, VBM studies in restless leg syndrome (RLS) have exhibited inconsistent and conflicting findings. METHODS Studies will be identified through a computerized literature search of the following databases: PubMed, Web of Science, and Embase until October 1, 2018 and updated on March 1, 2020. This protocol will be performed in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). In addition, we will follow the recent guidelines and recommendations for coordinate-based meta-analysis (CBMA). This CBMA will be performed with the seed-based d mapping with permutation of subject images (SDM-PSI) software. RESULTS This CBMA will offer the latest evidence of GM alterations in RLS. CONCLUSIONS To our knowledge, this will be the first CBMA that pooled VBM findings in RLS. This quantitative evidence of GM alterations will characterize brain morphometry of RLS. PROSPERO REGISTRATION NUMBER CRD42018117014.
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Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan
| | | | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan
| | - Liang Qi
- The Affiliated Huai’an Hospital of Xuzhou Medical University, Second People's Hospital of Huai’an City, Huai’an
| | | | | | | | | | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, P.R. China
| | - PingLei Pan
- Department of Central Laboratory
- Department of Neurology
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Steinweg K, Nippita T, Cistulli PA, Bin YS. Maternal and neonatal outcomes associated with restless legs syndrome in pregnancy: A systematic review. Sleep Med Rev 2020; 54:101359. [PMID: 32805557 DOI: 10.1016/j.smrv.2020.101359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
Restless legs syndrome (RLS) affects one in five pregnant women. This review aims to synthesise evidence regarding gestational RLS and its consequences on pregnant women and neonates. Search of Embase, MEDLINE, PsycINFO, Maternity and Infant Care and Scopus was conducted in July 2018 using MeSH headings and keywords for 'restless legs syndrome' and 'pregnancy' or 'birth'. Our search identified 16 eligible studies from 12 countries published between 2004 and 2018 concerning gestational RLS and one or more maternal, delivery or neonatal outcomes. The most consistent associations were observed between gestational RLS and increased risks of gestational hypertension, pre-eclampsia, and peripartum depression. There were mixed findings for caesarean delivery, preterm birth and low birth weight, with the majority reporting no association with gestational RLS. Gestational RLS was not associated with postpartum haemorrhage, gestational diabetes, fetal distress, or low Apgar scores. Future research is needed to investigate whether effective treatment of RLS can mitigate these potential harms. Validated methods for diagnosing RLS in pregnancy would support research in this growing field.
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Affiliation(s)
- Kate Steinweg
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tanya Nippita
- Sydney Medical School Northern, University of Sydney, NSW, Australia; Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW, Australia; Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Peter A Cistulli
- Sydney Medical School Northern, University of Sydney, NSW, Australia; Sleep Research Group, Charles Perkins Centre, University of Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Yu Sun Bin
- Sydney Medical School Northern, University of Sydney, NSW, Australia; Sleep Research Group, Charles Perkins Centre, University of Sydney, NSW, Australia.
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Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless Legs Syndrome across the Lifespan: Symptoms, Pathophysiology, Management and Daily Life Impact of the Different Patterns of Disease Presentation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3658. [PMID: 32456058 PMCID: PMC7277795 DOI: 10.3390/ijerph17103658] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
Restless legs syndrome is a common but still underdiagnosed neurologic disorder, characterized by peculiar symptoms typically occurring in the evening and at night, and resulting in sleep disruption and daily functioning impairment. This disease can affect subjects of all age ranges and of both sexes, manifesting itself with a broad spectrum of severity and deserving special attention in certain patient categories, in order to achieve a correct diagnosis and an effective treatment. The diagnosis of restless legs syndrome can be challenging in some patients, especially children and elderly people, and an effective treatment might be far from being easy to achieve after some years of drug therapy, notably when dopaminergic agents are used. Moreover, the pathophysiology of this disorder offers an interesting example of interaction between genetics and the environment, considering strong iron metabolism involvement and its interaction with recognized individual genetic factors. Therefore, this syndrome allows clinicians to verify how lifespan and time can modify diagnosis and treatment of a neurological disorder.
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Affiliation(s)
- Giuseppe Didato
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Roberta Di Giacomo
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Giuseppa Jolanda Rosa
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
- Neurology Unit, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Ambra Dominese
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Marco de Curtis
- Clinical and Experimental Epileptology and Sleep Disorders Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, 20133 Milan, Italy; (R.D.G.); (G.J.R.); (A.D.); (M.d.C.)
| | - Paola Lanteri
- Neurophysiopathology Unit, Foundation IRCCS Carlo Besta Neurological Institute, 20133 Milan, Italy;
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Zhu XY, Wu TT, Wang HM, Li X, Ni LY, Chen TJ, Qiu MY, Shen J, Liu T, Ondo WG, Wu YC. Correlates of Nonanemic Iron Deficiency in Restless Legs Syndrome. Front Neurol 2020; 11:298. [PMID: 32425874 PMCID: PMC7205016 DOI: 10.3389/fneur.2020.00298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/30/2020] [Indexed: 01/23/2023] Open
Abstract
Objective: Iron deficiency anemia (IDA) is a well-known cause of secondary restless legs syndrome (RLS). Iron deficiency without anemia (IDNA) is insidious, and its association with RLS is less evaluated. We investigate prevalence and features of IDNA in a consecutive cohort of patients with RLS. Methods: We included sequential primary RLS patients and RLS patients with IDA. We also recruited age- and gender-matched healthy controls. RLS mimics and other comorbidities were carefully excluded. Results: One-hundred and ninety-six RLS patients without anemia, 26 RLS patients with IDA, and 63 controls were included. 42.3% of RLS patients without anemia had iron deficiency. Women were much more susceptible for IDNA with a relative risk of 5.51 (p < 0.0001). Women with IDNA and RLS had younger age both at interview and at RLS onset compared to women with RLS without iron deficiency (NID) (P < 0.01). IDNA RLS patients showed a tendency to higher risk of severe/very severe tiredness or sleepiness during the day as compared to NID RLS patients. Furthermore, IDNA RLS patients had longer duration of RLS (P < 0.01 in men, P < 0.05 in women) and younger age at onset (only in men, P < 0.05) compared to IDA RLS patients. Conclusion: IDNA is frequent in RLS and iron deficiency may be severe despite a normal hemoglobin level. Women are at much higher risk for IDNA, and IDNA in women presents some specific clinical features. Features of IDNA RLS are different from IDA RLS. Regular screening of peripheral iron parameters even in patients with normal blood counts is recommended for timely optimal management.
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Affiliation(s)
- Xiao-Ying Zhu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting-Ting Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Ming Wang
- Department of Clinical Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Li
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling-Yan Ni
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian-Jiao Chen
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng-Yao Qiu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Shen
- Department of Clinical Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Te Liu
- Geriatric Laboratory, Shanghai Geriatric Institute of Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - William G Ondo
- Department of Neurology, Methodist Neurological Institute, Weill Cornell Medical School, Houston, TX, United States
| | - Yun-Cheng Wu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Le syndrome des jambes sans repos. Rev Med Interne 2020; 41:258-264. [DOI: 10.1016/j.revmed.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022]
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Umeno S, Kato C, Nagaura Y, Kondo H, Eto H. Characteristics of sleep/wake problems and delivery outcomes among pregnant Japanese women without gestational complications. BMC Pregnancy Childbirth 2020; 20:179. [PMID: 32197593 PMCID: PMC7082997 DOI: 10.1186/s12884-020-02868-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
Background Frequently observed sleep/wake problems among pregnant women need comprehensive evaluation. This study was conducted to clarify the sleep/wake problems among pregnant women without gestational complications during the second and third trimester and the effects of sleep/wake problems on delivery outcomes. Methods A total of 88 Japanese pregnant women participated in this study. In their second and third trimester, subjective sleep quality, insomnia severity, excessive daytime sleepiness (EDS), and restless legs syndrome/Willis-Ekbom disease (RLS/WED) were assessed using questionnaires; also, sleep disordered breathing (SDB) was screened using a pulse oximeter. Results From the second to the third trimester, an increasing tendency of sleep/wake problems was observed. During the third trimester, the percentages of women experiencing decreased subjective sleep quality, difficulty maintaining sleep (DMS), EDS, RLS/WED, and 3% oxygen desaturation index (ODI) values ≥5/h were 62.5, 45.5, 48.9, 9.1, and 29.5%, respectively. In a logistic regression analysis for EDS in the third trimester, the adjusted odds ratio (95% confidence interval) of total sleep duration < 6 h, moderate to severe DMS, and 3% ODI values ≥5/h were 3.25 (1.16–9.10), 4.74 (1.60–14.00), and 0.90 (0.28–2.89), respectively. Although short sleep durations, decreased subjective sleep quality, EDS, and SDB did not affect delivery outcomes or the infant’s condition, the percentage of women undergoing cesarean sections in the severe insomnia group was significantly higher (p = 0.008). Conclusions Sleep/wake problems were frequent during pregnancy, especially during the third trimester. EDS among pregnant women was associated with shorter sleep durations and DMS rather than SDB. The effect of factors related to insomnia on delivery outcomes should thus be considered a crucial problem among pregnant Japanese women without gestational complications in clinical practice.
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Affiliation(s)
- Shiho Umeno
- Department of Reproductive Health, Nagasaki University, Institute of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.,Karatsu Red Cross Hospital, 2430 Watada, Karatsu, Saga, 847-8588, Japan
| | - Chiho Kato
- Department of Reproductive Health, Nagasaki University, Institute of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.,Department of Maternal Nursing/Midwifery, Japanese Red Cross College of Nursing, 4-1-3 Hiroo, Shibuya-ku, Tokyo, 150-0012, Japan
| | - Yuki Nagaura
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-820, Japan
| | - Hideaki Kondo
- International Institute for Integrative Sleep Medicine, University of Tsukuba, 1-2 Kasuga, Tsukuba, Ibaraki, 305-8550, Japan.
| | - Hiromi Eto
- Department of Reproductive Health, Nagasaki University, Institute of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
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Daugherty SL, Carter JR, Bourjeily G. Cardiovascular Disease in Women Across the Lifespan: The Importance of Sleep. J Womens Health (Larchmt) 2020; 29:452-460. [PMID: 32096682 DOI: 10.1089/jwh.2020.8331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) and sleep disturbances are both common and associated with significant morbidity and mortality. Compared with men, women are more likely to report insufficient sleep. During the 2018 Research Conference on Sleep and the Health of Women sponsored by the National Heart, Lung, and Blood Institute, researchers in cardiology, integrative physiology and sleep medicine reviewed the current understanding of how sleep and sleep disturbances influence CVD in women across the lifespan. Women may be particularly vulnerable to the negative effects of sleep disturbances at important stages of their life, including during pregnancy and after menopause. The proposed pathways linking sleep disturbances and adverse cardiovascular outcomes in women are numerous and the complex interaction between them is not well understood. Future research focused on understanding the scope of sleep disorders in women, defining the underlying mechanisms, and testing interventions to improve sleep are critical for improving the cardiovascular health of all women.
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Affiliation(s)
- Stacie L Daugherty
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.,Adult and Children Center for Outcomes Research and Delivery Sciences (ACCORDS), University of Colorado School of Medicine, Aurora, Colorado.,Colorado Cardiovascular Outcomes Research Group, Denver, Colorado
| | - Jason R Carter
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan
| | - Ghada Bourjeily
- Divisions of Pulmonary, Critical Care and Sleep Medicine, and Obstetric Medicine, Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Quality improvement and practice-based research in sleep medicine using structured clinical documentation in the electronic medical record. SLEEP SCIENCE AND PRACTICE 2020; 4:1. [PMID: 32395635 PMCID: PMC7213673 DOI: 10.1186/s41606-019-0038-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: We developed and implemented a structured clinical documentation support (SCDS) toolkit within the electronic medical record, to optimize patient care, facilitate documentation, and capture data at office visits in a sleep medicine/neurology clinic for patient care and research collaboration internally and with other centers. Methods: To build our SCDS toolkit, physicians met frequently to develop content, define the cohort, select outcome measures, and delineate factors known to modify disease progression. We assigned tasks to the care team and mapped data elements to the progress note. Programmer analysts built and tested the SCDS toolkit, which included several score tests. Auto scored and interpreted tests included the Generalized Anxiety Disorder 7-item, Center for Epidemiological Studies Depression Scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and the International Restless Legs Syndrome Study Group Rating Scale. The SCDS toolkits also provided clinical decision support (untreated anxiety or depression) and prompted enrollment of patients in a DNA biobank. Results: The structured clinical documentation toolkit captures hundreds of fields of discrete data at each office visit. This data can be displayed in tables or graphical form. Best practice advisories within the toolkit alert physicians when a quality improvement opportunity exists. As of May 1, 2019, we have used the toolkit to evaluate 18,105 sleep patients at initial visit. We are also collecting longitudinal data on patients who return for annual visits using the standardized toolkits. We provide a description of our development process and screenshots of our toolkits. Conclusions: The electronic medical record can be structured to standardize Sleep Medicine office visits, capture data, and support multicenter quality improvement and practice-based research initiatives for sleep patients at the point of care.
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Abstract
Pregnancy is associated with a number of physiologic changes in the body including hormonal, anatomical, and mechanical. These changes alter many physiologic functions including sleep. The literature suggests that a number of women develop changes in duration, pattern, and quality of sleep during pregnancy. In addition, these changes also pave the way for expression of sleep disorders (e.g., insomnia, obstructive sleep apnea, and restless legs syndrome). Change in sleep and appearance of sleep disorders not only influence pregnant women, but also have negative influences on the fetus and outcomes of pregnancy. However, optimal management of these disorders may reverse adverse consequences. In this chapter, risk factors, clinical presentation, and management of insomnia, obstructive sleep apnea, and restless legs syndrome during pregnancy are discussed in view of the available literature.
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Affiliation(s)
- Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, India.
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, India
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Patel A, Khan SS. Restless Legs Syndrome in Women with Comorbid Psychiatric Disease. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20191106-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marshall NS, Serinel Y, Killick R, Child JM, Raisin I, Berry CM, Lallukka T, Wassing R, Lee RW, Ratnavadivel R, Vedam H, Grunstein R, Wong KK, Hoyos CM, Cayanan EA, Comas M, Chapman JL, Yee BJ. Magnesium supplementation for the treatment of restless legs syndrome and periodic limb movement disorder: A systematic review. Sleep Med Rev 2019; 48:101218. [PMID: 31678660 DOI: 10.1016/j.smrv.2019.101218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
Magnesium supplementation is often suggested for restless legs syndrome (RLS) or period limb movement disorder (PLMD) based on anecdotal evidence that it relieves symptoms and because it is also commonly recommended for leg cramps. We aimed to review all articles reporting the effects of magnesium supplementation on changes in RLS and/or PLMD. We conducted a systematic search looking for all relevant articles and then two reviewers read all article titles and abstracts to identify relevant studies. Eligible studies were scored for their quality as interventional trials. We found 855 abstracts and 16 of these could not be definitively excluded for not addressing all aspects of our research question. Seven full-text articles were unlocatable and one was ineligible which left eight studies with relevant data. One was a randomised placebo-controlled trial, three were case series and four were case studies. The RCT did not find a significant treatment effect of magnesium but may have been underpowered. After quality appraisal and synthesis of the evidence we were unable to make a conclusion as to the effectiveness of magnesium for RLS/PLMD. It is not clear whether magnesium helps relieve RLS or PLMD or in which patient groups any benefit might be seen.
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Affiliation(s)
- Nathaniel S Marshall
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, Australia.
| | - Yasmina Serinel
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, NSW, Australia
| | - Roo Killick
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia
| | - Julia M Child
- University Library, The University of Sydney, Sydney, Australia
| | - Isabelle Raisin
- University Library, The University of Sydney, Sydney, Australia
| | - Callum M Berry
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Tea Lallukka
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine, Department of Public Health, University of Helsinki, Finland
| | - Rick Wassing
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia
| | - Richard Ww Lee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia
| | - Rajeev Ratnavadivel
- Central Coast Local Health Network, NSW, Australia; Faculty of Health and Medicine, University of Newcastle, Australia
| | - Hima Vedam
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Australia; South Western Sydney Clinical School, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Ron Grunstein
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital Camperdown NSW Australia
| | - Keith Kh Wong
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital Camperdown NSW Australia
| | - Camilla M Hoyos
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth A Cayanan
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Maria Comas
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Julia L Chapman
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia
| | - Brendon J Yee
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital Camperdown NSW Australia
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Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation. Chest 2019; 157:184-197. [PMID: 31622589 DOI: 10.1016/j.chest.2019.09.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/03/2019] [Accepted: 09/21/2019] [Indexed: 12/18/2022] Open
Abstract
Sleep disturbances are common in pregnancy, and sleep disorders may worsen or present de novo in the course of gestation. Managing a pregnant patient is complicated by the risk of teratogenicity, pharmacokinetic changes, and the dynamic nature of pregnancy. Although nonpharmacologic interventions are likely safest, they are often ineffective, and a patient is left dealing with frustrations of the sleep disturbance, as well as the negative outcomes of poor sleep in pregnancy. As with any other condition in pregnancy, management requires an understanding of pregnancy physiology, knowledge of the impact of a given condition on pregnancy or fetal and neonatal outcomes, and an ability to weigh the risk of the exposure to an untreated, or poorly treated condition, against the risk of a given drug. In partnership with the pregnant patient or couple, options for therapy should be reviewed in the context of the impact of the condition on pregnancy and offspring outcomes, while understanding that data (positive or negative) on the impact of therapy on perinatal outcomes are lacking. This article reviews the epidemiology of sleep disorders in pregnancy, general principles of prescribing in pregnancy and lactation, and safety surrounding therapeutic options in pregnancy.
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Wilson S, Anderson K, Baldwin D, Dijk DJ, Espie A, Espie C, Gringras P, Krystal A, Nutt D, Selsick H, Sharpley A. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol 2019; 33:923-947. [PMID: 31271339 DOI: 10.1177/0269881119855343] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This British Association for Psychopharmacology guideline replaces the original version published in 2010, and contains updated information and recommendations. A consensus meeting was held in London in October 2017 attended by recognised experts and advocates in the field. They were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aiming to reach consensus where the evidence and/or clinical experience was considered adequate, or otherwise to flag the area as a direction for future research. A draft of the proceedings was circulated to all speakers for comments, which were incorporated into the final statement.
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Affiliation(s)
- Sue Wilson
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Kirstie Anderson
- 2 Regional Sleep Service, Freeman Hospital, Newcastle Upon Tyne, UK
| | - David Baldwin
- 3 Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Derk-Jan Dijk
- 4 Sleep Research Centre, University of Surrey, Guildford, UK
| | - Audrey Espie
- 5 Psychology Department, NHS Fife, Dunfermline, UK
| | - Colin Espie
- 6 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul Gringras
- 7 Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Krystal
- 8 Psychiatry and Behavioral Science, University of California, San Francisco, CA, USA
| | - David Nutt
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Hugh Selsick
- 9 Royal London Hospital for Integrated Medicine, London, UK
| | - Ann Sharpley
- 10 Department of Psychiatry, University of Oxford, Oxford, UK
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von Manitius S, Flügel D, Gievers Steinlein B, Schnelle M, von Mandach U, Simões‐Wüst AP. Bryophyllum pinnatum in the treatment of restless legs syndrome: A case series documented with polysomnography. Clin Case Rep 2019; 7:1012-1020. [PMID: 31110737 PMCID: PMC6509919 DOI: 10.1002/ccr3.2144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/12/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
Restless legs syndrome may seriously affect patients' sleep and quality of life, but established pharmacological therapy can often have severe side effects. Therefore, new therapeutic approaches such as well-tolerated preparations from the medicinal plant Bryophyllum pinnatum should be considered as alternatives. Their sedative and spasmolytic properties might contribute to improve patients' condition.
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Affiliation(s)
| | - Dominique Flügel
- Department of NeurologyKantonsspital St. GallenSt. GallenSwitzerland
| | | | | | | | - Ana Paula Simões‐Wüst
- Department of ObstetricsZurich University HospitalZurichSwitzerland
- Research DepartmentClinic ArlesheimArlesheimSwitzerland
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Abstract
Anatomical, physiological, psychological and hormonal alterations affect sleep during pregnancy. Sleep appears tobe commonly impaired only after the first trimester. Albeit objective data regarding the reduction of sleep durationand efficiency are not univocal, poor sleep is reported by over half of pregnant women. The reasons underlyingthese complaints are multiple, including lower back pain, gastroesophageal reflux disorder (GERD), increasedmicturition and repositioning difficulties at night. Specific primary sleep disorders whose prevalence drasticallyincreases during pregnancy include obstructive sleep apnea (OSA) and restless legs syndrome (RLS), both relatedto gestational hypertension and gestational diabetes mellitus (GDM). Pre-eclampsia and labor complicationsleading to an increased number of cesarean sections and preterm births correlate with insomnia and OSA inparticular. Post-partum depression (PPD) and impairment of the mother-infant relationship may also be consideredas secondary effects deriving from poor sleep during pregnancy. Recognition and treatment of sleep disordersshould be encouraged in order to protect maternal and fetal health and prevent dire consequences at birth.
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Affiliation(s)
- Rosalia Silvestri
- University of Messina, Department of Clinical and Experimental Medicine, Sleep Medicine Centerof the Neurophysiopathology and Movement Disorders Unit - Messina - Messina - Italy
| | - Irene Aricò
- University of Messina, Department of Clinical and Experimental Medicine, Sleep Medicine Centerof the Neurophysiopathology and Movement Disorders Unit - Messina - Messina - Italy
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Restless Legs Syndrome. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Garbazza C, Manconi M. Management Strategies for Restless Legs Syndrome/Willis-Ekbom Disease During Pregnancy. Sleep Med Clin 2018; 13:335-348. [PMID: 30098751 DOI: 10.1016/j.jsmc.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Restless legs syndrome/Willis-Ekbom disease is a common disorder during pregnancy that may significantly impact on the health of affected women, leading to negative consequences in the short and long term. An accurate diagnosis helps to recognize the syndrome and choose the optimal therapeutic strategy, based on the characteristics and needs of the patient. This article summarizes the main treatment options recommended by the consensus clinical guidelines of the International Restless Legs Syndrome Study Group and provides a short guide to the management of restless leg syndrome during pregnancy in clinical practice.
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Affiliation(s)
- Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Via Tesserete 46, Lugano CH-6903, Switzerland.
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Via Tesserete 46, Lugano CH-6903, Switzerland
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Comorbidities, treatment, and pathophysiology in restless legs syndrome. Lancet Neurol 2018; 17:994-1005. [PMID: 30244828 DOI: 10.1016/s1474-4422(18)30311-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022]
Abstract
Restless legs syndrome, also known as Willis-Ekbom disease, is a common neurological condition whose manifestation is affected by complex environmental and genetic interactions. Restless legs syndrome can occur on its own, mostly at a young age, or with comorbidities such as cardiovascular disease, diabetes, and arterial hypertension, making it a difficult condition to properly diagnose. However, the concept of restless legs syndrome as being two entities, primary or secondary to another condition, has been challenged with genetic data providing further insight into the pathophysiology of the condition. Although dopaminergic treatment was formerly the first-line therapy, prolonged use can result in a serious worsening of symptoms known as augmentation. Clinical studies on pregabalin, gabapentin enacarbil, oxycodone-naloxone, and iron preparations have provided new treatment options, but most patients still report inadequate long-term management of symptoms. Studies of the hypoxic pathway activation and iron deficiency have provided valuable information about the pathophysiology of restless legs syndrome that should now be translated into new, more effective treatments for restless legs syndrome.
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Abstract
Pregnancy often predisposes women to new-onset sleep disturbances, as well as exacerbations of preexisting sleep disorders. The goals of treating perinatal sleep disorders include the promotion of restorative sleep and the benefits it brings to both mother and fetus. The prescribing of any sleep aid in pregnancy must include consideration of the risks and benefits for both the patient and her fetus. Although data on the perinatal use of sleep aids is limited, there may be effects on fetal development, timing and duration of delivery, and postnatal outcomes.
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Affiliation(s)
- Laura P McLafferty
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Thompson Building, Suite 1652, 1020 Sansom Street, Philadelphia, PA 19107, USA.
| | - Meredith Spada
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Priya Gopalan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O'Hara St., Pittsburgh, PA 15213, USA
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