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Chen HC, Hsu NW, Lin CH. Different dimensions of daytime sleepiness predicted mortality in older adults: Sex and muscle power-specific risk in Yilan Study, Taiwan. Sleep Med 2024; 113:84-91. [PMID: 37995473 DOI: 10.1016/j.sleep.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES This study aimed to investigate the relationship between daytime sleepiness and mortality risk among older adults. The moderating effects of sex and physical function were examined. METHODS This 9-year follow-up study was conducted with community-dwelling individuals aged ≥65 years. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). Exploratory factor analysis (EFA) was used to examine the ESS factors. Handgrip strength was measured to assess physical function, and the highest quartile was defined as good muscle power. Cox regression analysis was used to estimate the 9-year all-cause mortality risk. The interaction terms were examined to evaluate their moderating effect. RESULTS In total, 2588 individuals participated in the study. The EFA explored two factors: the passive factor (PF) and the active factor (AF). After controlling for various covariates, the cutoff-defined daytime sleepiness (ESS≥11), total raw scores, and factor scores of the ESS all failed to predict mortality risk. The 3-way interaction terms showed statistical significance in terms of [sex × PF × muscle power (p = 0.03)] but not for [sex × AF × muscle power (p = 0.11)]. Specifically, PF predicted mortality risk in women with good muscle power (hazard ratio (HR): 1.48; 95 % confidence interval (CI): 1.04-2.10), which is female-specific. In contrast, AF predicted mortality risk only in men with good muscle power (HR: 1.35; 95 % CI: 1.02-1.78). CONCLUSIONS The ESS-measured daytime sleepiness in older adults is multidimensional. The mortality risk for each dimension was determined based on sex and physical function.
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Affiliation(s)
- Hsi-Chung Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine & Community Medicine Center, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Public Health Bureau, Yilan County, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
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Ali E, Shaikh A, Yasmin F, Sughra F, Sheikh A, Owais R, Raheel H, Virk HUH, Mustapha JA. Incidence of adverse cardiovascular events in patients with insomnia: A systematic review and meta-analysis of real-world data. PLoS One 2023; 18:e0291859. [PMID: 37733726 PMCID: PMC10513332 DOI: 10.1371/journal.pone.0291859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Insomnia is a prevalent sleeping disorder associated with increasing cardiovascular (CV) mortality and morbidity. However, data incorporating recent clinical studies evaluating these outcomes is scarce. Hence, we aimed to investigate the association of insomnia with CV mortality, myocardial infarction (MI), all-cause mortality, and incidence of CV disease by conducting the first-ever meta-analysis of real-world data evaluating these CV outcomes. MEDLINE and Scopus databases were queried till August 2022 to identify studies comparing prespecified outcomes in patients with and without insomnia. The primary outcomes were CV mortality and myocardial infarction, while secondary outcomes included all-cause mortality, and CV-disease incidence. All data were pooled using an inverse-variance weighted random-effects model, and results were reported as relative risks (RRs) and p-values. 21 studies were analyzed. Risks for CV mortality and MI were significantly higher in patients with insomnia (RR 1.53, p<0.01, and RR 1.48, p = 0.03, respectively). The risk for all-cause mortality and CV disease incidence was also significantly higher in insomnia patients (RR 1.14, p = 0.03, and RR 1.31, p<0.01, respectively). Individuals with insomnia experience a higher risk of long-term mortality, MI, and incidence of CV disease.
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Affiliation(s)
- Eman Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Yasmin
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Fatima Sughra
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ayesha Sheikh
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Owais
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hamna Raheel
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Jihad A. Mustapha
- Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
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Cluster analysis of clinical phenotypic heterogeneity in obstructive sleep apnea assessed using photoplethysmography. Sleep Med 2023; 102:134-141. [PMID: 36641931 DOI: 10.1016/j.sleep.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/15/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND We evaluated heterogeneity in clinical phenotypes among patients with obstructive sleep apnea syndrome (OSAHS) using photoplethysmography (PPG) in cluster analysis. METHODS All enrolled patients underwent polysomnography (PSG) monitoring while wearing a PPG device. Pulse wave signals were recorded with a modified pulse oximetry probe in the PPG device. The pulse wave-derived cardiac risk composite parameter (CRI) and eight derived signal parameters were used to assess OSAHS phenotype. We defined a high cardiovascular risk OSAHS group (CRI ≥0.5) and low cardiovascular risk OSAHS group (CRI <0.5). K-means clustering was performed for analysis of clinical phenotype heterogeneity in OSAHS by combining the CRI and its derived signals. RESULTS The OSAHS group had high cardiovascular risk for sex, age, body mass index, systolic and diastolic blood pressure, apnea hypopnea index, and obstructive arousal index and higher risk of developing hypertension, diabetes, and cerebrovascular comorbidities. The low cardiovascular risk OSAHS group had higher blood oxygen levels. Three clinical phenotypes were identified in CRI clustering: 1) typical OSAHS with high risk of hypertension (characterized by middle age, obesity, hypertension with severe OSAHS); 2) older women and mild OSAHS; 3) older men and mild OSAHS. Three subtypes were obtained based on the eight cardiac risk-derived parameters: 1) hypoxia combined with decreased pulse wave amplitude variation; 2) decreased vascular pulse wave amplitude combined with decreased pulse frequency; 3) arrhythmia combined with hypoxia. CONCLUSIONS Establishing OSAHS clinical phenotypes with the CRI and derived parameters using PPG may help in establishing multi-dimensional assessment of cardiovascular risk in OSAHS.
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The Association between Hypertension and Insomnia: A Bidirectional Meta-Analysis of Prospective Cohort Studies. Int J Hypertens 2022; 2022:4476905. [PMID: 36618449 PMCID: PMC9815923 DOI: 10.1155/2022/4476905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Studies on bidirectional associations between hypertension and insomnia are inconclusive. The purpose of this meta-analysis was to systematically review and summarize the current evidence from epidemiological studies that evaluated this relationship. Materials and Methods PubMed, Embase, China National Knowledge Infrastructure (CNKI), Wan Fang, and VIP databases were searched for studies published up to May 2021. Prospective cohort studies that reported the relationship between hypertension and insomnia in adults were included. Data were extracted or provided by the authors according to the prevalence rate, incidence rate, unadjusted or adjusted odds ratio (OR), and 95% confidence interval (CI). Heterogeneity was assessed by I2 statistics. ORs were pooled by using random-effects models. Results A total of 23 prospective studies were identified. Twenty cohort studies recorded OR-adjusted value with the outcome for hypertension (OR = 1.11, 95% CI: 1.07-1.16; I2 = 83.9%), and three cohort studies reported OR-adjusted value with the outcome for insomnia (OR = 1.20, 95%CI: 1.08-1.32; I2 = 35.1%). Subgroup analysis showed that early morning awakening and composite insomnia were significantly associated with hypertension. Conclusions The result indicates a possible bidirectional association between hypertension and insomnia. Early identification and prevention of insomnia in hypertension patients are needed, and vice versa.
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Silva LAS, Amaral MMD, Grassi V, Palmeira ALR. Chronic insomnia disorder as risk factor for stroke: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1159-1166. [PMID: 36577416 PMCID: PMC9797278 DOI: 10.1055/s-0042-1755227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Stroke is one of the main causes of mortality worldwide. Nonetheless, there are still risk factors that have not been fully elucidated, such as chronic insomnia disorder. OBJECTIVE To evaluate the association between chronic insomnia disorder and the risk of stroke in adults, through a systematic review. METHODS Multiple studies available in the Embase, Lilacs, and Medline platforms were evaluated in English, Spanish, French, and Portuguese. The selection of papers was restricted to those that had investigated the association between chronic insomnia disorder and stroke in adults, regardless of gender or nationality, without a previous history of stroke. The data was extracted with the Cochrane Effective Practice and Organization of Care (EPOC) form. The risk of bias was evaluated by the EPOC Risk of bias tool. RESULTS A total of 138 articles were identified. After a detailed evaluation with the eligibility criteria, four articles were included in the present systematic review. Three of them recognized the association between chronic insomnia disorder and stroke. The comparative analysis was limited, since the studies used distinct insomnia classifications. Regarding the risk of bias, the analysis displayed an important risk in the selection and allocation of participants, besides the use of own insomnia diagnosis criteria, disrespecting chronology and factors indicated by already established classifications. CONCLUSIONS There is not enough data to determine that chronic insomnia disorder is a risk factor for stroke. The present study points out the existence of a possible relationship between insomnia disorder and stroke, suggesting that further studies adopt standardized criteria and instruments.
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Affiliation(s)
| | - Mateus Molin do Amaral
- Universidade do Vale do Taquari, Centro de Ciências Médicas, Lajeado, Brazil.,Address for correspondence Mateus Molin do Amaral
| | - Vanise Grassi
- Universidade do Vale do Taquari, Centro de Ciências Médicas, Lajeado, Brazil.
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Cavaillès C, Berr C, Helmer C, Gabelle A, Jaussent I, Dauvilliers Y. Complaints of daytime sleepiness, insomnia, hypnotic use, and risk of dementia: a prospective cohort study in the elderly. Alzheimers Res Ther 2022; 14:12. [PMID: 35057850 PMCID: PMC8780361 DOI: 10.1186/s13195-021-00952-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/20/2021] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Sleep disturbances are common in elderly and occur frequently in dementia. The impact of excessive daytime sleepiness (EDS), insomnia complaints, sleep quality, and hypnotics on the risk of all-cause dementia, Alzheimer disease (AD), and dementia with vascular component (DVC) remains unclear, as does the association between sleep profile and plasma β-amyloid levels.
Methods
Analyses were carried out on 6851 participants aged 65 years and over randomly recruited from three French cities and free of dementia at baseline. A structured interview and self-questionnaire assessed sleep complaints (EDS, insomnia complaints, sleep quality) and medications at baseline. Incident cases of dementia were diagnosed systematically over a 12-year period. Multivariate Cox models were used to estimate the risk of dementia associated with the sleep complaints considered individually and globally. Plasma β-amyloid levels were measured by an xMAP-based assay technology in 984 subjects.
Results
After adjustment for socio-demographic characteristics, lifestyle, APOE-ε4, cardiovascular factors, and depressive status, EDS had a higher risk of all-cause dementia (HR = 1.21; 95%CI = [1.01–1.46]) and DVC (HR = 1.58; 95%CI = [1.07–2.32]) but not AD. Persistent use of hypnotics increased the risk for all-cause dementia, specifically AD (HR = 1.28; 95%CI = [1.04–1.58]), but not DVC. No association was found for insomnia complaints and sleep quality taken as individual factors or combined with EDS on the risk of dementia. No association was found between β-amyloid, sleep complaints, and incident dementia.
Conclusions
The results suggest a deleterious role of EDS and hypnotics on dementia. Further studies are required to elucidate the mechanisms involved in these associations and whether its management can prevent the risk of dementia.
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7
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Jin X, Chen H, Li Y, Xu W, Chen X, Tian L, Teng W. Association between daytime napping and stroke: A dose-response meta-analysis. J Sleep Res 2021; 30:e13366. [PMID: 33870591 DOI: 10.1111/jsr.13366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
Daytime napping is common in many regions around the world and has been an important part of people's daily life. Daytime napping has attracted increasing attention in recent years. Thus, we conducted a meta-analysis to evaluate the relationship between daytime napping and stroke, and help reduce the risk of stroke by improving living habits. The Embase, PubMed, Web of Science and PsycINFO databases were searched for cohort studies published before October 2020 and eight eligible studies with 524,408 participants and 5,875 stroke cases were included in the final analysis. The pooled relative risk (RR) of stroke was 1.47 (95% confidence interval [CI]: 1.24-1.74; p < .001) with significant heterogeneity (I2 = 58%, p for heterogeneity = 0.02). However, the heterogeneity decreased when the study in which adjusting for sleep duration and stratifying the results based on sleep duration was not performed was excluded (RR: 1.38; 95% CI: 1.19-1.60, I2 = 44%, p for heterogeneity = 0.10). In dose-response analysis, the linear trend indicated that for every 10-min increase in daytime napping, the risk of stroke increased by 3%. Further well-designed large studies are needed to explore the effects of daytime napping on stroke and the underlying biological mechanisms.
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Affiliation(s)
- Xiaolin Jin
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hanze Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yuru Li
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wenying Xu
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinxin Chen
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Weiyu Teng
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
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8
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Jaussent I, Morin CM, Ivers H, Dauvilliers Y. Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study. Sleep 2021; 43:5586812. [PMID: 31608404 DOI: 10.1093/sleep/zsz249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). METHODS Participants were recruited in 2007-2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score >10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. RESULTS Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. CONCLUSIONS EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.
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Affiliation(s)
- I Jaussent
- INSERM, University Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - C M Morin
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - H Ivers
- Department of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Y Dauvilliers
- INSERM, University Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,CHU Montpellier, Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac, Montpellier, France
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9
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Mayer G, Happe S, Evers S, Hermann W, Jansen S, Kallweit U, Muntean ML, Pöhlau D, Riemann D, Saletu M, Schichl M, Schmitt WJ, Sixel-Döring F, Young P. Insomnia in neurological diseases. Neurol Res Pract 2021; 3:15. [PMID: 33691803 PMCID: PMC7944611 DOI: 10.1186/s42466-021-00106-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/13/2022] Open
Abstract
Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia - namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems.This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia.The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.
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Affiliation(s)
- Geert Mayer
- Neurologische Abteilung der Hephata-Klinik, Schimmelpfengstrasse 6, 34613, Schwalmstadt-Treysa, Germany.
- Neurologische Abteilung der Philipps-Universität Marburg, Mamburg, Germany.
| | - Svenja Happe
- Klinik Maria Frieden, Klinik für Neurologie, Am Krankenhaus 1, 48291, Telgte, Germany
| | - Stefan Evers
- Krankenhaus Lindenbrunn, Abteilung Neurologie, Lindenbrunn 1, 31863, Coppenbrügge, Germany
| | - Wiebke Hermann
- Klinik und Poliklinik für Neurologie und Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Sabine Jansen
- Deutsche Alzheimer Gesellschaft e.V. Selbsthilfe Demenz, Friedrichstr. 236, 10969, Berlin, Germany
| | - Ulf Kallweit
- Klin. Schlaf- und Neuroimmunologie, Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - Maria-Lucia Muntean
- Paracelsus Elena Klinik, Schanzenstr. 85 Dr. med Dieter Pöhlau, 34130, Kassel, Germany
- DRK Kamillus Klinik, Hospitalstr. 6, 53567, Asbach, Germany
| | - Dieter Pöhlau
- DRK Kamillus Klinik, Hospitalstr. 6, 53567, Asbach, Germany
| | - Dieter Riemann
- Psychiatrische Universitätsklinik Freiburg, Hauptstraße 5, 79104, Freiburg, Germany
| | - Michael Saletu
- LKH - Graz II, Standort Süd, Wagner Jauregg Platz 1, A-8053, Graz, Austria
| | | | - Wolfgang J Schmitt
- Universitätsklinik für Psychiatrie und Psychotherapie, Murtenstrasse 21, 3008, Bern, Switzerland
| | | | - Peter Young
- Neurologische Klinik Reithofpark, Reithof 1, 83075, Bad Feilnbach, Germany
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10
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Jennum PJ, Plazzi G, Silvani A, Surkin LA, Dauvilliers Y. Cardiovascular disorders in narcolepsy: Review of associations and determinants. Sleep Med Rev 2021; 58:101440. [PMID: 33582582 DOI: 10.1016/j.smrv.2021.101440] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Narcolepsy type 1 (NT1) is a lifelong disorder of sleep-wake dysregulation defined by clinical symptoms, neurophysiological findings, and low hypocretin levels. Besides a role in sleep, hypocretins are also involved in regulation of heart rate and blood pressure. This literature review examines data on the autonomic effects of hypocretin deficiency and evidence about how narcolepsy is associated with multiple cardiovascular risk factors and comorbidities, including cardiovascular disease. An important impact in NT1 is lack of nocturnal blood pressure dipping, which has been associated with mortality in the general population. Hypertension is also prevalent in NT1. Furthermore, disrupted nighttime sleep and excessive daytime sleepiness, which are characteristic of narcolepsy, may increase cardiovascular risk. Patients with narcolepsy also often present with other comorbidities (eg, obesity, diabetes, depression, other sleep disorders) that may contribute to increased cardiovascular risk. Management of multimorbidity in patients with narcolepsy should include regular assessment of cardiovascular health (including ambulatory blood pressure monitoring), mitigation of cardiovascular risk factors (eg, cessation of smoking and other lifestyle changes, sleep hygiene, and pharmacotherapy), and prescription of a regimen of narcolepsy medications that balances symptomatic benefits with cardiovascular safety.
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Affiliation(s)
- Poul Jørgen Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark.
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy; IRCCS, Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lee A Surkin
- Empire Sleep Medicine, New York, NY, United States
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France; University of Montpellier, INSERM U1061, Montpellier, France
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11
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Chen CY, Chen CL. Recognizable Clinical Subtypes of Obstructive Sleep Apnea After Ischemic Stroke: A Cluster Analysis. Nat Sci Sleep 2021; 13:283-290. [PMID: 33688287 PMCID: PMC7936703 DOI: 10.2147/nss.s301668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Obstructive sleep apnea (OSA) increases risk of stroke recurrence and mortality in ischemic stroke patients. However, equivocal treatment effects warrant further categorization of post-stroke OSA for risk stratification and individualized treatment planning. METHODS The study recruited 232 ischemic stroke patients with moderate-to-severe OSA admitted for inpatient rehabilitation consecutively. Latent class analysis was performed based on sex, age, smoking, daytime sleepiness, depression, obesity, sedative use, atrial fibrillation, diabetes, dyslipidemia, hypertension, recurrent stroke and dysphagia. The augmentation index, a marker of arterial stiffness, was measured by applanation tonometry. RESULTS A three-cluster model provided the best fit. Cluster 1 (n=84, 36.2%) was older in age, predominantly female, with the highest hypopnea index and prevalence of atrial fibrillation. Moreover, patients in Cluster 1 had significantly higher augmentation index than those in Cluster 2. Cluster 2 patients (N=80, 34.5%) were of older age, predominantly male, with the highest prevalence of depression, the lowest prevalence of hypertension and had the most normal body mass index (BMI). Additionally, Cluster 2 had less nocturnal hypoxia as compared to Cluster 3. Cluster 3 (n=68, 29.3%) was the youngest in age, predominantly male, with the highest BMI, cumulative risk score, and prevalence of dyslipidemia of the three clusters. CONCLUSION Post-stroke OSA can be categorized into three clinical phenotypes. Patients in Clusters 1 and 3 both had elevated cardiovascular risk and treatment can be based on their distinct characteristics. Patients in Cluster 2 had relatively lower risk of cardiovascular events and the benefits of OSA treatment requires further study.
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Affiliation(s)
- Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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12
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McKinnon AC, Beath AP, Naismith SL. Relationships between sleep quality, depressive symptoms and MCI diagnosis: A path analysis. J Affect Disord 2019; 256:26-32. [PMID: 31158713 DOI: 10.1016/j.jad.2019.05.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/21/2019] [Accepted: 05/27/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND This study examined the complex relationships between sleep quality, depressive symptoms, and cognitive decline in older adults. We hypothesised that older age, lower education and greater medical comorbidities would each be associated with increased mild cognitive impairment (MCI) diagnosis risk through indirect effects via poorer sleep quality, and greater depressive symptomology. METHODS 540 adults 44 years and over were recruited at the Brain and Mind Centre, Sydney, Australia. Participants underwent comprehensive psychiatric, neuropsychological, and medical assessment. Subjective sleep quality, current depressive symptomatology, and current medical burden were assessed. RESULTS There were significant indirect effects of each of age, comorbidities and education, that operated via both sleep and depression. Younger age, greater comorbidities and fewer years' education each predicted greater chance of MCI diagnosis via poorer sleep and in turn higher depressive symptomatology. Additionally, there was a significant direct effect of older age on MCI. LIMITATIONS The current study is cross-sectional and cannot determine whether poorer sleep quality and greater depressive symptomatology precede or arise as a result of the onset of cognitive decline in later-life. A longitudinal design may allow further explication of these relationships. CONCLUSIONS Both sleep and depression are linked with cognitive decline in older adults, with sleep disturbance appearing to predict depressive symptoms. These findings have implications for the management of MCI. Both greater depression symptomatology and sleep disturbance were shown to predict the risk of MCI diagnosis, with this effect strongest in those that are younger. Improved early detection and treatment of sleep problems in older adults may help prevent depressive symptom manifestation or exacerbation, in turn potentially reducing the risk of subsequent cognitive decline.
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Affiliation(s)
- Andrew C McKinnon
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Australia
| | - Alissa P Beath
- Department of Psychology, Macquarie University, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Australia.
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Abstract
BACKGROUND In this study, we intend to assess the efficacy of zolpidem combined with cognitive-behavioral therapy (CBT) for patients with primary insomnia (PI). METHODS A predefined search strategy will be used to search for associated literature from inception to the July 1, 2019: PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, Google Scholar, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure with no language limitation. In addition, we will also retrieve reference lists of included studies and relevant reviews, as well as the conference proceedings. All randomized controlled trials related to the zolpidem and CBT for PI will be included. Two authors will perform study selection, data collection, and study quality, respectively. We will also apply RevMan 5.3 software for statistical analysis. RESULTS This study will provide a comprehensive overview of the available evidence of the benefits and safety of zolpidem and CBT for PI. Primary outcomes are sleep quality and severity of sleep disorders. Secondary outcomes consist of sleep-onset latency, total sleep duration, sleep efficiency, and frequency and adverse events. CONCLUSION The results of this study will inform clinical and policy decisions regarding the benefits and harm of zolpidem and CBT for patients with PI. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019142796.
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Affiliation(s)
- Ying Song
- Department of Neurology, The Fifth Central Hospital of Tianjin Binhai Hospital of Peking University
| | - Bing Liang
- Department of Characteristic Medical Center, Chinese People's Armed Police Force, Tianjin, China
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14
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Chiaro G, Manconi M. Restless legs syndrome, periodic limb movements during sleep and cardiovascular risk. Auton Neurosci 2019; 220:102554. [PMID: 31331694 DOI: 10.1016/j.autneu.2019.102554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
Multiple mechanisms may modulate an association between restless legs syndrome/Willis-Ekbom disease (RLS/WED) and cardiovascular disease (CVD), including chronic sleep deprivation, intermittent, periodic limb movements in sleep (PLMS)-related autonomic fluctuations and possible autonomic dysfunction intrinsically associated with RLS per se. The purpose of this paper is to review the existing RLS/WED literature focusing on the pathophysiologic evidence for possible associations between RLS/WED and PLMS with CVD and events (CVE). Specific intrinsic dysautonomic aspects of the disease, which may contribute to generating CVD, are separately discussed. The association between RLS/WED and both CV risk factors and CVD still remains elusive. Although several shared pathophysiological causes could explain these possible relationships, the emerging body of literature focusing on these disorders remains controversial. Not only longitudinal population-based studies and meta-analyses, but also more animal models and therapeutic interventions are needed in order to build a sufficiently robust body of evidence on this topic.
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Affiliation(s)
- Giacomo Chiaro
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Biomedical and Neuromotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Neurology, Bern University Hospital, Bern, Switzerland.
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15
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The neurophysiological basis of excessive daytime sleepiness: suggestions of an altered state of consciousness. Sleep Breath 2019; 24:15-23. [PMID: 31140116 DOI: 10.1007/s11325-019-01865-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Excessive daytime sleepiness (EDS) is characterized by difficulty staying awake during daytime, though additional features may be present. EDS is a significant problem for clinical and non-clinical populations, being associated with a range of negative outcomes that also represent a burden for society. Extreme EDS is associated with sleep disorders, most notably the central hypersomnias such as narcolepsy, Kleine-Levin syndrome, and idiopathic hypersomnia (IH). Although investigation of these conditions indicates that EDS results from diminished sleep quality, the underlying cause for this impairment remains uncertain. One possibility could be that previous research has been too narrow in scope with insufficient attention paid to non-sleep-related aspects. Here, we offer a broader perspective in which findings concerning the impact of EDS on cortical functioning are interpreted in relation to current understanding about the neural basis of consciousness. Alterations in the spatial distribution of cortical activity, in particular reduced connectivity of frontal cortex, suggest that EDS is associated with an altered state of consciousness.
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16
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Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women. Sleep Med 2019; 53:94-100. [DOI: 10.1016/j.sleep.2018.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 01/11/2023]
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17
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Jarrin DC, Alvaro PK, Bouchard MA, Jarrin SD, Drake CL, Morin CM. Insomnia and hypertension: A systematic review. Sleep Med Rev 2018; 41:3-38. [PMID: 29576408 DOI: 10.1016/j.smrv.2018.02.003] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 12/16/2017] [Accepted: 02/09/2018] [Indexed: 11/26/2022]
Abstract
Insomnia is a prevalent sleep disorder that is associated with a multitude of health consequences. Particularly, insomnia has been associated with cardiovascular disease and its precursors, such as hypertension and blood pressure (BP) non-dipping. The present systematic review aimed to summarize the evidence on the concurrent and prospective associations between insomnia and hypertension and/or BP. Using electronic search engines (PubMed, SCOPUS, PsycINFO), 5,618 articles published from January 1970 to December 2017 were identified, and 64 met the inclusion criteria (26 to 162,121 participants; age range: 18-100; 46.4% male). Insomnia was based on diagnostic or non-diagnostic criteria. Hypertension was based on self-or physician-reports, antihypertensive medication use, and/or measured BP. Findings indicate that when insomnia is frequent, chronic, and/or accompanied with short sleep duration or objective markers of arousal, there is a strong association with hypertension/BP. Based on limited studies, hypertension did not significantly predict future insomnia in middle-aged adults, but did in older adults. Based on a majority of case-control studies, no differences in BP were found between participants with and without insomnia. Further research is needed to identify putative pathophysiological mechanisms underlying the link between insomnia and hypertension. The impact of insomnia therapy on BP should also be further examined in the future.
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Affiliation(s)
- Denise C Jarrin
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec City, Canada.
| | - Pasquale K Alvaro
- The Institute for Breathing and Sleep, Austin Health, Heidelberg 3084, Victoria, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Marc-André Bouchard
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec City, Canada
| | - Stephanie D Jarrin
- Clinical Science Department, American University of Antigua College of Medicine, Antigua and Barbuda
| | | | - Charles M Morin
- École de psychologie, Université Laval, Québec City, Québec, Canada; Centre d'étude des troubles du sommeil, Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec City, Canada
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18
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Janto K, Prichard JR, Pusalavidyasagar S. An Update on Dual Orexin Receptor Antagonists and Their Potential Role in Insomnia Therapeutics. J Clin Sleep Med 2018; 14:1399-1408. [PMID: 30092886 DOI: 10.5664/jcsm.7282] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 06/05/2018] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES Current pharmacological options for the treatment of insomnia insufficiently meet the needs of all insomnia patients. Approved treatments are not consistently effective in improving sleep onset and sleep maintenance, while also having complicated safety profiles. These limitations highlight the unmet need for additional medications and treatment strategies. Initial research suggests that the dual orexin receptor antagonists (DORAs) may offer an additional pharmaceutical option to treat insomnia in some patients. METHODS We reviewed the existing literature on dual orexin receptor antagonists in PubMed databases using the search terms "orexin receptor antagonist," "almorexant" "filorexant," "lembroexant" and "suvorexant"; searches were limited to English language primary research articles, clinical trials, and reviews. RESULTS Targeting the orexin receptor system for treatment of insomnia offers an additional and alternative pharmacological approach to more common gamma aminobutyric acid agonist sedative hypnotic treatment. Effectiveness is not well established in the current literature; however, the literature does suggest efficacy. Preclinical reports also suggest the potential for treatment in individuals with comorbid Alzheimer disease and insomnia. CONCLUSIONS DORAs offer an additional treatment option for insomnia. More clinical trials are needed to robustly evaluate their safety and effectiveness in several subclasses of individuals with insomnia. Given the published literature, head-to-head comparisons to existing treatment for insomnia are warranted.
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Affiliation(s)
- Kayla Janto
- Department of Psychology, University of St. Thomas, St. Paul, Minnesota
| | | | - Snigdha Pusalavidyasagar
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota
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19
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Daytime Sleepiness in Patients Diagnosed with Sarcoidosis Compared with the General Population. Can Respir J 2018; 2018:6853948. [PMID: 30123391 PMCID: PMC6079447 DOI: 10.1155/2018/6853948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to analyze daytime sleepiness in a sample of patients diagnosed with sarcoidosis. Methods A sample of 1197 German sarcoidosis patients was examined with the Epworth Sleepiness Scale (ESS), the Fatigue Assessment Scale, the Hospital Anxiety and Depression Scale, the Pittsburgh Sleep Quality Index, and the Short-Form Health Survey (SF-8). The patients' ESS mean scores were compared with those obtained from a large general population sample. Results Exactly 50% of the patients reached the criterion (ESS > 10) for excessive daytime sleepiness, compared with only 22.1% in the general population. The effect size for the mean score difference between both samples was d=0.62. The number of affected organs and the number of concomitant diseases proved to be significant independent predictors of daytime sleepiness. Sleepiness was associated with fatigue (r=0.45), anxiety (r=0.23), depression (r=0.28), sleep problems (r=0.23), and detriments in physical (r=-0.29) and mental (r=-0.28) quality of life. Conclusions The issue of excessive daytime sleepiness should be considered in the management of sarcoidosis.
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20
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Ogilvie RP, Lakshminarayan K, Iber C, Patel SR, Lutsey PL. Joint effects of OSA and self-reported sleepiness on incident CHD and stroke. Sleep Med 2018. [PMID: 29530366 DOI: 10.1016/j.sleep.2018.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnea (OSA), and both EDS and OSA have separately been associated with increased risk of cardiovascular disease (CVD), their joint association with CVD risk is unknown. METHODS Among 3874 Sleep Heart Health Study (SHHS) participants without prevalent CVD, moderate to severe OSA was defined by an apnea hypopnea index (AHI) ≥ 15 on an in-home polysomnography. EDS was defined as an Epworth Sleepiness Scale score ≥11. Incident CVD events included total CVD events (coronary heart disease (CHD) and stroke), as well as CHD and stroke separately. Cox proportional hazards models adjusted for age, sex, alcohol, smoking, and body mass index. RESULTS Compared to those with AHI <15, the hazard ratios (95% CI) for the association of moderate-severe OSA (AHI ≥15) were as follows: CVD 1.06 (0.85-1.33); CHD 1.08 (0.85-1.33); and stroke 1.18 (0.75-1.84). Weak associations between EDS and CVD risk = [1.22 (1.01-1.47)] and CHD risk [1.25 (1.02-1.53)] were present, however there were none for stroke risk [1.10 (0.75-1.63)]. When jointly modeled, both AHI ≥15 and EDS (compared with having AHI <15 and no EDS) was associated with HRs of 1.26 (0.91-1.73) for CVD, 1.24 (0.87-1.75) for CHD and 1.49 (0.78-2.86) for stroke. There were no statistically significant interactions between daytime sleepiness and OSA on the multiplicative or additive scales. CONCLUSIONS Having both EDS and moderate-severe OSA was not associated with an increased risk of CVD in the SHHS data.
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Affiliation(s)
- Rachel P Ogilvie
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Conrad Iber
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sanjay R Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota-Twin Cities, Minneapolis, MN, USA
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21
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Gabelle A, Gutierrez LA, Jaussent I, Navucet S, Grasselli C, Bennys K, Marelli C, David R, Andrieu S, Berr C, Vellas B, Dauvilliers Y. Excessive Sleepiness and Longer Nighttime in Bed Increase the Risk of Cognitive Decline in Frail Elderly Subjects: The MAPT-Sleep Study. Front Aging Neurosci 2017; 9:312. [PMID: 29033827 PMCID: PMC5625324 DOI: 10.3389/fnagi.2017.00312] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/12/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: To identify self-reported sleep-wake disturbances that increase the risk of cognitive decline over 1-year follow-up in frail participants. Background: Risk factors for cognitive impairment need to be better identified especially at earliest stages of the pathogenesis. Sleep-wake disturbances may be critical factors to consider and were thus being assessed in this at-risk population for cognitive decline. Methods: Frail elderly participants aged ≥70 years were selected from a subsample of the Multi-domain Alzheimer Preventive Trial (MAPT) for a sleep assessment (MAPT-sleep study) at 18-month follow-up (M18). Sleep-wake disturbances were evaluated using a clinical interview (duration of daytime and nighttime sleep, time in bed, number of naps, and presence of clinically-defined sleep disorders) and numerous validated questionnaires [Epworth Sleepiness Scale for excessive daytime sleepiness (EDS), Insomnia Severity Scale and Berlin Questionnaire]. Cognitive decline was defined as a difference between the MMSE and cognitive composite scores at M24 and M36 that was ranked in the lowest decile. Multivariate logistic regression models adjusted for several potential confounding factors were performed. Results: Among the 479 frail participants, 63 developed MMSE-cognitive decline and 50 cognitive composite score decrease between M24 and M36. Subjects with EDS had an increased risk of MMSE decline (OR = 2.46; 95% CI [1.28; 4.71], p = 0.007). A longer time spent in bed during night was associated with cognitive composite score decline (OR = 1.32 [1.03; 1.71], p = 0.03). These associations persisted when controlling for potential confounders. Patients with MMSE score decline and EDS had more naps, clinically-defined REM-sleep Behavior Disorder, fatigue and insomnia symptoms, while patients with cognitive composite score decline with longer time in bed had increased 24-h total sleep time duration but with higher wake time after onset. Conclusions: The risk of cognitive decline is higher in frailty subjects with EDS and longer nighttime in bed. Early detection of sleep-wake disturbances might help identifying frail subjects at risk of cognitive decline to further propose sleep health strategies to prevent cognitive impairment. http://www.clinicaltrials.gov NCT00672685; Date of registration May, 2nd 2008.
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Affiliation(s)
- Audrey Gabelle
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France.,University of Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1183, Saint Eloi Hospital, Montpellier, France
| | - Laure-Anne Gutierrez
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France
| | - Isabelle Jaussent
- University of Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France
| | - Sophie Navucet
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France
| | - Caroline Grasselli
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France
| | - Karim Bennys
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France
| | - Cécilia Marelli
- Department of Neurology, Memory Research and Resources Center, CHU Montpellier, Montpellier, France
| | - Renaud David
- Department of Psychiatry, Memory Research and Resources Center, CHU Nice, Nice, France
| | - Sandrine Andrieu
- Gérontopôle de Toulouse, Institut National de la Santé et de la Recherche Médicale UMR1027, Toulouse Université III, Toulouse, France
| | - Claudine Berr
- Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Institut National de la Santé et de la Recherche Médicale UMR1027, Toulouse Université III, Toulouse, France
| | - Yves Dauvilliers
- University of Montpellier, Montpellier, France.,Institut National de la Santé et de la Recherche Médicale U 1061, La Colombière Hospital, Montpellier, France.,Department of Neurology, Narcolepsy National Reference Center, Sleep Center, CHU Montpellier, University of Montpellier, Montpellier, France
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22
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Smedinga H, Steyerberg EW, Beukers W, van Klaveren D, Zwarthoff EC, Vergouwe Y. Prediction of Multiple Recurrent Events: A Comparison of Extended Cox Models in Bladder Cancer. Am J Epidemiol 2017; 186:612-623. [PMID: 28525539 DOI: 10.1093/aje/kwx133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/04/2016] [Indexed: 11/12/2022] Open
Abstract
Recurrence of bladder cancer can occur repeatedly in the same patient after treatment of the primary tumor. Models predicting the risk of a next recurrence may inform individualized decision-making on surveillance frequency. We aimed to assess the usefulness of extensions of the Cox proportional hazards model for repeated events in this context. We analyzed 531 Dutch patients with bladder cancer (1990-2012) with information on 7 prespecified predictors at the time of diagnosis of the primary and recurrent tumors. We considered 3 aspects of model variants: how to model time to the repeated events (calendar time, gap time, elapsed time); the number of preceding events (predictor, stratum variable); and the within-subject correlation (ignored in a simple Cox model, robust standard errors in a variance-correction model, random effect in a frailty model). First to fourth recurrences of bladder cancer occurred in 313, 174, 103, and 66 patients, respectively, with median calendar follow-up times of 1.1, 2.5, 3.8, and 4.5 years, respectively. We focused on gap time in the detailed analyses, allowing for clinically meaningful predictions. Variance-correction models may be useful if predictor selection is part of the model development. Frailty models may be useful when within-subject correlation is strong.
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23
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Jawinski P, Kittel J, Sander C, Huang J, Spada J, Ulke C, Wirkner K, Hensch T, Hegerl U. Recorded and Reported Sleepiness: The Association Between Brain Arousal in Resting State and Subjective Daytime Sleepiness. Sleep 2017; 40:3866822. [DOI: 10.1093/sleep/zsx099] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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24
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Cholley-Roulleau M, Chenini S, Béziat S, Guiraud L, Jaussent I, Dauvilliers Y. Restless legs syndrome and cardiovascular diseases: A case-control study. PLoS One 2017; 12:e0176552. [PMID: 28445539 PMCID: PMC5406016 DOI: 10.1371/journal.pone.0176552] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 04/12/2017] [Indexed: 01/18/2023] Open
Abstract
Objective The association between restless legs syndrome (RLS), cardiovascular diseases (CVD) and hypertension is inconsistent. This case-control study examined i) the association between primary RLS, CVD and hypertension by taking into account many potential confounders and ii) the influence of RLS duration, severity and treatment, sleep and depressive symptoms on CVD and hypertension in primary RLS. Methods A standardized questionnaire to assess the RLS phenotype, history of CVD and hypertension, sleep and depressive symptoms, drug intake and demographic/clinical features was sent to the France-Ekbom Patients Association members. A CVD event was defined as a self-reported history of coronary heart disease, heart failure, arrhythmia or stroke. Hypertension was also self-assessed. Current treatment for hypertension and arrhythmia also defined underlying hypertension and arrhythmia. Controls without RLS and without consanguinity were chosen by the patients. Results 487 patients with primary RLS (median age 71 years; 67.4% women) and 354 controls (68 years, 47.7% women) were included. Most of the patients (91.7%) were treated for RLS, especially with dopaminergic agonists. The median age of RLS onset was 45 years. CVD and hypertension were associated with RLS in unadjusted association, but not after adjustment for age, sex and body mass index. Patients with RLS and with CVD and/or hypertension were significantly older, with hypercholesterolemia, sleep apnea and older age at RLS and at daily RLS onset compared with patients without CVD and/or hypertension. No significant difference was found for other RLS features, ferritin levels, daytime sleepiness, insomnia and depressive symptoms. Conclusion Despite some limitations in the design of this study, we found that most of the treated patients for primary RLS had no association with CVD and hypertension after controlling for key potential confounders. Comorbid CVD or hypertension was associated with cardiovascular risk factors, but not with RLS features except for older age at onset.
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Affiliation(s)
| | - Sofiene Chenini
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Séverine Béziat
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
| | - Lily Guiraud
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Isabelle Jaussent
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Unité des Troubles du Sommeil, Neurologie, Hôpital Gui-de-Chauliac, Montpellier, France
- Inserm, U1061, Montpellier, France
- Université Montpellier, Montpellier, France
- * E-mail:
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25
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He Q, Zhang P, Li G, Dai H, Shi J. The association between insomnia symptoms and risk of cardio-cerebral vascular events: A meta-analysis of prospective cohort studies. Eur J Prev Cardiol 2017; 24:1071-1082. [PMID: 28359160 DOI: 10.1177/2047487317702043] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Qiao He
- The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China
| | - Peng Zhang
- The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China
| | - Guangxiao Li
- The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China
| | - Huixu Dai
- The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China
| | - Jingpu Shi
- The Department of Clinical Epidemiology, Institute of Cardiovascular Diseases and Center of Evidence Based Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Center of Evidence Based Medicine, Liaoning Province and China Medical University, Shenyang, China
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26
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Sun YJ, Yuan JM, Yang ZM. Effectiveness and safety of moxibustion for primary insomnia: a systematic review and meta-analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:217. [PMID: 27411310 PMCID: PMC4944240 DOI: 10.1186/s12906-016-1179-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary insomnia is a widespread and refractory disease. Moxibustion therapy for insomnia shows some advantages compared with conventional therapies. This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the effectiveness and safety of moxibustion therapy for insomnia. METHODS We conducted a comprehensive literature review of the CENTRAL, PubMed, EMBASE, Web of science, CNKI, VIP, and Wanfang Data databases from their inception to July 2015 for RCTs that compared moxibustion with western medications, oral Chinese medicine, or other methods of traditional Chinese medicine (TCM) in patients with primary insomnia. The primary outcome measure was effective rate and secondary outcome measure was adverse events. Data collection and analysis included risk of bias evaluation, meta-analysis, sensitivity analysis, publication bias and adverse events analysis according to corresponding criteria. RESULTS The study included 22 RCTs (1,971 patients). The quality of the studies was low. The overall meta-analysis demonstrated that moxibustion was more effective for insomnia than western medications, oral Chinese medicine and other TCM therapies (RR = 1.17, 95 % CI 1.12 to 1.23, P < 0.00001). Subgroup analyses demonstrated that moxibustion was more effective for insomnia than western medications (RR = 1.16, 95 % CI 1.09 to 1.24, P < 0.00001), oral Chinese medicine (RR = 1.11, 95 % CI 1.04 to 1.18, P = 0.002), and other TCM therapies (RR = 1.22, 95 % CI 1.15 to 1.30, P < 0.00001). There were no serious adverse effects associated with moxibustion therapy for insomnia, and the rate of adverse events was low. CONCLUSION It is difficult to get the conclusion regarding the effectiveness and safety of moxibustion for primary insomnia due to insufficient evidence, such as the high risk of bias in the included studies, small sample sizes, and few reports on adverse effects. Moxibustion should be considered as a novel therapeutic option for insomnia, and more rigorous clinical trials of moxibustion therapy for insomnia are needed to assess its effects.
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Affiliation(s)
- Yu-Jiao Sun
- />Guangzhou University of Chinese Medicine, No.12, Jichang Road, Bai Yun District, Guangzhou, Guangdong 510405 China
| | - Jia-Min Yuan
- />Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong 510120 China
| | - Zhi-Min Yang
- />Guangdong Hospital of Traditional Chinese Medicine, No.111, Dade Road, Yue Xiu District, Guangzhou, Guangdong 510120 China
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Wannamethee SG, Papacosta O, Lennon L, Whincup PH. Self-Reported Sleep Duration, Napping, and Incident Heart Failure: Prospective Associations in the British Regional Heart Study. J Am Geriatr Soc 2016; 64:1845-50. [PMID: 27351127 PMCID: PMC5031211 DOI: 10.1111/jgs.14255] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives To examine the associations between self‐reported nighttime sleep duration and daytime sleep and incident heart failure (HF) in men with and without preexisting cardiovascular disease (CVD). Design Population‐based prospective study. Setting General practices in 24 British towns. Participants Men aged 60–79 without prevalent HF followed for 9 years (N = 3,723). Measurements Information on incident HF cases was obtained from primary care records. Assessment of sleep was based on self‐reported sleep duration at night and daytime napping. Results Self‐reported short nighttime sleep duration and daytime sleep of longer than 1 hour were associated with preexisting CVD, breathlessness, depression, poor health, physical inactivity, and manual social class. In all men, self‐reported daytime sleep of longer than 1 hour duration was associated with significantly greater risk of HF after adjustment for potential confounders (adjusted hazard ratio (aHR) = 1.69, 95% CI = 1.06–2.71) than in those who reported no daytime napping. Self‐reported nighttime sleep duration was not associated with HF risk except in men with preexisting CVD (<6 hours: aHR = 2.91, 95% CI = 1.31–6.45; 6 hours: aHR = 1.89, 95% CI = 0.89–4.03; 8 hours: aHR = 1.29, 95% CI = 0.61–2.71; ≥9 hours: aHR = 1.80, 905% CI = 0.71–4.61 vs nighttime sleep of 7 hours). Snoring was not associated with HF risk. Conclusion Self‐reported daytime napping of longer than 1 hour is associated with greater risk of HF in older men. Self‐reported short sleep (<6 hours) in men with CVD is associated with particularly high risk of developing HF.
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Affiliation(s)
- S Goya Wannamethee
- Department of Primary Care and Population Health, University College, London, United Kingdom.
| | - Olia Papacosta
- Department of Primary Care and Population Health, University College, London, United Kingdom
| | - Lucy Lennon
- Department of Primary Care and Population Health, University College, London, United Kingdom
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, United Kingdom
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Sander C, Hegerl U, Wirkner K, Walter N, Kocalevent RD, Petrowski K, Glaesmer H, Hinz A. Normative values of the Epworth Sleepiness Scale (ESS), derived from a large German sample. Sleep Breath 2016; 20:1337-1345. [PMID: 27234595 DOI: 10.1007/s11325-016-1363-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Daytime sleepiness is associated with several medical problems. The aim of this paper is to provide normative values for one of the most often used questionnaires measuring daytime sleepiness, the Epworth Sleepiness Scale (ESS). METHODS A large sample of 9711 people from the German general population took part in this study. In addition to the ESS, several other questionnaires were used, and sociodemographic and behavioral factors were recorded. RESULTS Normative values for the ESS are given. According to the generally accepted criterion ESS > 10, 23 % of the sample showed excessive daytime sleepiness. Males reported significantly more daytime sleepiness than females (effect size d = 0.19). In the age range of 40-80 years, a continuous decline of daytime sleepiness was observed. Psychometric properties of the ESS were good. Alcohol intake and nicotine consumption were marginally associated with daytime sleepiness, and obese people reported significantly more sleepiness than people of normal weight (OR = 1.39). CONCLUSIONS The normative tables allow clinicians and researchers to assess the degree of their patients' daytime sleepiness, especially in the upper range of scores.
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Affiliation(s)
- Christian Sander
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Kerstin Wirkner
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Nadja Walter
- Faculty of Sport Science, University of Leipzig, Leipzig, Germany
| | - Rüya-Daniela Kocalevent
- Institute and Policlinic for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
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Berticat C, Thomas F, Dauvilliers Y, Jaussent I, Ritchie K, Helmer C, Tzourio C, Raymond M, Artero S. Excessive daytime sleepiness and antipathogen drug consumption in the elderly: a test of the immune theory of sleep. Sci Rep 2016; 6:23574. [PMID: 26996205 PMCID: PMC4800730 DOI: 10.1038/srep23574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/25/2016] [Indexed: 01/14/2023] Open
Abstract
The evolutionary reasons for sleep remain controversial. The immune theory of sleep suggests that sleep is essential to the immune system, allowing organisms to allocate more energy to their immunity. This hypothesis was tested by exploring the links between excessive daytime sleepiness (EDS) and vulnerability to infectious diseases in a large (n = 9294) cohort of elderly individuals, with information on socio-demographics, daily habits, and medical characteristics. At the two-year and four-year follow-ups, we obtained individual data from the national healthcare insurance about all medications prescribed to the participants between 2001 and 2003 (n = 2865). We found an independent positive association between EDS and the consumption of some anti-pathogen drugs. This relationship was mostly explained by fungal and parasitic infections rather than by viral and bacterial ones. These results, although based on correlations, are consistent with the idea that EDS as a proxy of altered sleep quality/quantity may affect the efficiency of the immune system, and hence vulnerability to infections.
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Affiliation(s)
- Claire Berticat
- Institute of Evolutionary Sciences, University of Montpellier, Montpellier, France. (CNRS UMR 5554, IRD, EPHE)
| | | | - Yves Dauvilliers
- Centre de Référence Maladies Rares Narcolepsie et Hypersomnie Idiopathique, Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac, CHU Montpellier, France.,INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France
| | - Isabelle Jaussent
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France
| | - Karen Ritchie
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France.,Faculty of Medicine, Imperial College, St Mary's Hospital, London, United Kingdom
| | | | - Christophe Tzourio
- INSERM, Neuroepidemiology, UMR897,University of Bordeaux, Bordeaux, France
| | - Michel Raymond
- Institute of Evolutionary Sciences, University of Montpellier, Montpellier, France. (CNRS UMR 5554, IRD, EPHE)
| | - Sylvaine Artero
- INSERM U1061, La Colombière Hospital, University of Montpellier, Montpellier, France
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Grandner MA, Williams NJ, Knutson KL, Roberts D, Jean-Louis G. Sleep disparity, race/ethnicity, and socioeconomic position. Sleep Med 2016; 18:7-18. [PMID: 26431755 PMCID: PMC4631795 DOI: 10.1016/j.sleep.2015.01.020] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 12/26/2022]
Abstract
Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue.
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Affiliation(s)
- Michael A Grandner
- Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Natasha J Williams
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | | | - Dorothy Roberts
- University of Pennsylvania Law School, Philadelphia, PA, USA; Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA; Department of Africana Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
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Hwangbo Y, Kim WJ, Chu MK, Yun CH, Yang KI. Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults. J Clin Neurol 2016; 12:194-200. [PMID: 26833986 PMCID: PMC4828566 DOI: 10.3988/jcn.2016.12.2.194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. Results The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27–2.54] and 0.01–2 hours (OR, 1.42; 95% CI, 1.02–1.98). However, habitual sleep duration was not significantly related to EDS. Conclusions EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.
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Affiliation(s)
- Young Hwangbo
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Won Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Chang Ho Yun
- Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
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Chuang SF, Liao CC, Yeh CC, Lin JG, Lane HL, Tsai CC, Chen TL, Chen T, Shih CC. Reduced risk of stroke in patients with cardiac arrhythmia receiving traditional Chinese medicine: A nationwide matched retrospective cohort study. Complement Ther Med 2016; 25:34-8. [PMID: 27062945 DOI: 10.1016/j.ctim.2015.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 11/04/2015] [Accepted: 12/26/2015] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Patients with cardiac arrhythmia were more likely to develop stroke than general population. The therapeutic effect of traditional Chinese medicine (TCM) on the risk of stroke in patients with cardiac arrhythmia was unknown. The aim of this study is to investigate the risk of stroke in patients with cardiac arrhythmia receiving TCM. METHODS From the one million cohort of the Taiwan's National Health Insurance Research Database, we identified cohort of cardiac arrhythmia included 2029 patients who received TCM treatment in 2000-2004. The matching methods with propensity score was used to select 2029 appropriate control cohort for comparison. Incident events of stroke were identified during the follow-up period at the end of 2010. Cox proportional hazard model was used to calculate adjusted hazard ratios and 95% confidence intervals of stroke associated with TCM treatment. RESULTS During the follow-up period, patients with cardiac arrhythmia who underwent TCM treatment (11.4 per 1000 person-years) had a lower incidence of new-onset stroke than those without TCM treatment (17.7 per 1000 person-years), with an HR of 0.62 (95% CI=0.50-0.78). The association between TCM treatment and decreased new-onset stroke was both significant in women and men. The young patients aged 45-54 years who received TCM had the lowest risk of stroke (HR=0.48, 95% CI=0.27-0.87). CONCLUSIONS Receiving TCM treatment was associated with a lower risk of stroke in patients with cardiac arrhythmia. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, the dose of herbal medicine, and acupuncture points used in treatments.
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Affiliation(s)
- Sun-Fa Chuang
- Department of Biomedical Engineering, National Cheng Kung University, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, USA
| | - Jaung-Geng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hsin-Long Lane
- The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Taiwan
| | - Chin-Chuan Tsai
- The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Taiwan; Department of Chinese medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tainsong Chen
- Department of Biomedical Engineering, National Cheng Kung University, Taiwan
| | - Chun-Chuan Shih
- The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Taiwan; Ph.D Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan.
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Jaussent I, Cristol JP, Stengel B, Ancelin ML, Dupuy AM, Besset A, Helmer C, Ritchie K, Berr C, Dauvilliers Y. Impact of sleep disturbances on kidney function decline in the elderly. Eur Respir J 2015; 47:860-8. [DOI: 10.1183/13993003.01147-2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/03/2015] [Indexed: 11/05/2022]
Abstract
While sleep disturbances are frequent in renal disease patients, no studies have examined prospectively the associations between sleep disturbances and kidney function decline in community-dwelling elderly subjects.Glomerular filtration rates (eGFRs) were estimated at baseline and at 11-year follow-up. A glomerular filtration decline over the follow-up period was defined as a percentage decline greater than or equal to the cut-off value of the highest tertile of kidney function decline (22%) in 1105 subjects. Excessive daytime sleepiness (EDS) and insomnia complaints were self-rated at baseline. Restless legs syndrome (RLS) and its age at onset were assessed at study end-point. An ambulatory polysomnography recording was performed during the follow-up in 277 subjects. Apnoea-hypopnoea index (AHI), periodic limb movements during sleep (PLMS) and total sleep time were analysed.An increased risk of eGFR decline was associated with EDS (OR 1.67, 95% CI 1.18–2.34) and RLS (OR 1.98, 95% CI 1.18–3.30) independently of potential confounders including cardiovascular risk factors. Among insomnia complaints, a borderline association with eGFR decline was found for early morning awakening only. High AHI (≥30 events·h−1) and short total sleep time (<6 h), but not PLMS were linked to eGFR decline in crude associations, but only AHI remained significantly associated after multi-adjustments.EDS, RLS and AHI constitute independent risk factors for kidney glomerular function decline.
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Durán Agüero S, Sánchez Reyes H, Díaz Narváez V, Araya Pérez M. [Dietary factors associated with daytime somnolence in healthy elderly of Chile]. Rev Esp Geriatr Gerontol 2015; 50:270-273. [PMID: 25895703 DOI: 10.1016/j.regg.2015.02.008] [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: 01/28/2015] [Revised: 02/17/2015] [Accepted: 02/18/2015] [Indexed: 06/04/2023]
Abstract
AIM To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. METHODS A total of 1780 independent individuals 60 years and older of both sexes (70.9±7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score>10 was considered drowsiness and scores>15 excessive or severe drowsiness. RESULTS Among the population under 80 years, 5.3% showed ESE score>15 and 26.2% an ESE score>10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score>15 and 32.5% for an ESE score>10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE>10) were age older than 80 years (OR=1.58; 95% CI=1.14 to 2.19) and dinner after 21 hours (OR=1.3; 95% CI=1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR=1.81; 95% CI=1.01 to 3.29). CONCLUSIONS Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness.
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Affiliation(s)
- Samuel Durán Agüero
- Nutrición y Dietética, Facultad de Ciencia de la Salud, Universidad San Sebastián, Concepción, Chile.
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Andrechuk CRS, Ceolim MF. Sonolência diurna excessiva nos pacientes com infarto agudo do miocárdio. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivos: Caracterizar a sonolência diurna em pacientes com infarto agudo do miocárdio e identificar as características sociodemográficas e clínicas associadas à sonolência diurna excessiva nesses pacientes. Métodos: Estudo transversal com 113 pacientes (média de idade 59,7; 70,8% sexo masculino). Utilizou-se um instrumento para caracterização sociodemográfica e clínica e a Escala de Sonolência de Epworth. Resultados: A sonolência diurna excessiva foi identificada em 33 pacientes (29,2%). Aqueles com índice de massa corporal acima de 30kg/m2 e aqueles que evoluíram com piora clínica obtiveram escore superior na Escala de Sonolência Epworth, comparados àqueles com índice de massa corporal inferior a 30kg/m2 e melhora clínica. Os pacientes com 60 anos ou mais, os separados e aqueles com índice de massa corporal superior a 30kg/m2 apresentaram chances maiores de referir sonolência diurna excessiva. Conclusão: Identificar indivíduos com sonolência diurna excessiva deve constituir parte da atuação rotineira do enfermeiro visando à prevenção das doenças cardiovasculares.
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Lan Y, Wu X, Tan HJ, Wu N, Xing JJ, Wu FS, Zhang LX, Liang FR. Auricular acupuncture with seed or pellet attachments for primary insomnia: a systematic review and meta-analysis. Altern Ther Health Med 2015; 15:103. [PMID: 25886561 PMCID: PMC4425871 DOI: 10.1186/s12906-015-0606-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 03/12/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Primary insomnia is a common health issue in the modern world. We conducted a systematic review of the auricular therapy, aiming to evaluate whether there are advantages of auricular acupuncture with seed or pellet attachments for the treatment of primary insomnia. METHODS A search of relevant literatures was performed on major medical databases, including Medline, Embase, CENTRAL, CBM, CNKI, VIP, Wanfang Data and so on. Risk of bias evaluation, meta-analysis, sensitivity analysis and evidence rating of all extracted information were conducted also. RESULTS A total of 1381 records were identified, with 15 studies deemed eligible for the present review. Meta-analyses were conducted in two comparisons separately: participants received auricular acupuncture were more likely to make an improvement in clinical effective rate (RR = 1.40, 95% CI 1.07 to 1.83), sleep duration (MD = 56.46, 95% CI 45.61 to 67.31), sleep efficiency(MD = 12.86, 95% CI 9.67 to 16.06), global score on PSQI (MD = -3.41, 95% CI -3.93 to -2.89), number of awakenings( MD = -3.27, 95% CI -6.30 to -0.25) and sleep onset latency(MD = -10.35, 95% CI -14.37 to -6.33) when compared to sham auricular acupuncture or placebo; while in auricular acupuncture VS medications comparison, a better effective rate (RR = 1.24, 95% CI 1.15 to 1.34), better sleep efficiency(MD = 21.44, 95% CI 16.30 to 26.58), lower PSQI score (MD = -3.62, 95% CI -4.59 to -2.65) and less adverse effect (RR = 0.11, 95% CI 0.04 to 0.26) can be seen also in auricular acupuncture group. Although these results suggested benefits of auricular acupuncture, the overall quality of evidence rated by the GRADE system was low. CONCLUSION Statistical analyses of the outcomes revealed a positive effect of auricular acupuncture for primary insomnia. Nonetheless, considering the poor methodological quality, insufficient sample size and possible publication bias, current evidence is not yet adequate to provide a strong support for the use of auricular acupuncture in the treatment of primary insomnia. More strictly designed clinical studies will be needed to obtain a more explicit conclusion.
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Zuurbier LA, Luik AI, Leening MJG, Hofman A, Freak-Poli R, Franco OH, Stricker BH, Tiemeier H. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med 2015; 11:117-21. [PMID: 25406270 DOI: 10.5664/jcsm.4454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/09/2014] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality. METHODS This prospective population-based study was conducted in the Rotterdam Study. Of the 3445 eligible persons (mean age 72.0±7.1 years) available for cross-sectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1989 eligible persons (mean age 70.0±5.8 years) were followed for an average of 6.5±0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in relation to sleep quality, assessed by the Pittsburgh Sleep Quality Index. RESULTS No associations between clinical heart failure and sleep quality were observed in cross-sectional analyses. Clinical heart failure predicted a reduction of sleep quality (B = 1.00 points on the Pittsburgh Sleep Quality Index; 95% CI 0.40, 1.60) in longitudinal assessment. This association was driven by the sleep onset latency and sleep quality components of the Pittsburgh Sleep Quality Index. Cardiac dysfunction was not related to sleep quality in cross-sectional or longitudinal analyses. CONCLUSIONS Clinical heart failure, but not cardiac dysfunction measured by echocardiography, increases the risk of poor sleep quality in the general population over time. These findings suggest that clinical manifestations of heart failure negatively affect sleep.
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Affiliation(s)
- Lisette A Zuurbier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rosanne Freak-Poli
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands: Inspectorate for Health Care, The Hague, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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McKinnon A, Terpening Z, Hickie IB, Batchelor J, Grunstein R, Lewis SJG, Naismith SL. Prevalence and predictors of poor sleep quality in mild cognitive impairment. J Geriatr Psychiatry Neurol 2014; 27:204-11. [PMID: 24687189 DOI: 10.1177/0891988714527516] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To investigate the prevalence of and contributors to poor sleep quality in patients with mild cognitive impairment (MCI). METHODS Data were collected for 158 patients meeting the criteria for MCI. Measures included the Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Mini-Mental State Examination. Demographic, lifestyle, medication, and substance use data were also collected. RESULTS A total of 63% of patients with MCI demonstrated sleep disturbance, a significantly higher rate than that of the controls (44%; chi-square = 8.77; P = .003). Depressive symptoms, cognition, antidepressant usage, alcohol consumption, age, and education were identified as significant predictors of self-reported sleep quality in patients with MCI (R(2) = .327, F 6,145 = 11.729, P < .0001). CONCLUSIONS Sleep disturbance occurs in around two-thirds of patients with MCI. Interventions addressing depression, cognition, and substance and medication use may improve sleep quality in MCI.
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Affiliation(s)
- Andrew McKinnon
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Zoe Terpening
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Jennifer Batchelor
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia
| | - Ron Grunstein
- Woolcock Institute of Medical Research, NSW, Australia
| | - Simon J G Lewis
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Clinic, The University of Sydney, Camperdown, NSW, Australia
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Abstract
Insomnia is a common sleep disorder which has been shown to adversely affect outcomes in hospitalized patients. This article reviews the available classes of medications that may be considered in the treatment of insomnia in the hospital setting.
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Affiliation(s)
- Jennifer Kelly
- Clinical Pharmacy Specialist, Residential Rehabilitation Treatment Programs (RRTPs), (A-PRRTP, CWT/TR, DRRTP, G-PRRTP, STARR Programs), Albuquerque, NM
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40
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Jaussent I, Ancelin ML, Berr C, Pérès K, Scali J, Besset A, Ritchie K, Dauvilliers Y. Hypnotics and mortality in an elderly general population: a 12-year prospective study. BMC Med 2013; 11:212. [PMID: 24070457 PMCID: PMC3849429 DOI: 10.1186/1741-7015-11-212] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypnotics are widely used by the elderly, and their impact on mortality remains controversial. The inconsistent findings could be due to methodological limitations, notably the lack of control for underlying sleep symptoms or illness associated with hypnotic use, for example, insomnia symptoms and excessive daytime sleepiness, depression and anxiety. Our objective was to examine the association between the use of hypnotics and mortality risk in a large cohort of community-dwelling elderly, taking into account a wide range of potential competing risks including sociodemographic characteristics, lifestyle, and chronic disorders as well as underlying psychiatric disorders and sleep complaints. METHODS Analyses were carried out on 6,696 participants aged 65 years or older randomly recruited from three French cities and free of dementia at baseline. Adjusted Cox proportional hazards models with delayed entry, and age of the participants as the time scale, were used to determine the association between hypnotic use and 12-year survival. RESULTS At baseline, 21.7% of the participants regularly used at least one hypnotic. During follow-up, 1,307 persons died, 480 from cancer and 344 from cardiovascular disease. Analyses adjusted for study center, age and gender showed a significantly greater risk of all-cause and cardiovascular-related mortality with hypnotics, particularly benzodiazepines, and this increased with the number of hypnotics used. None of these associations were significant in models adjusting for sociodemographic and lifestyle characteristics, chronic disorders including cardiovascular pathologies, sleep and psychiatric disorders. Results remained unchanged when duration of past hypnotic intake or persistent versus intermittent use during follow-up were taken into account. CONCLUSIONS When controlling for a large range of potential confounders, the risk of mortality was not significantly associated with hypnotic use regardless of the type and duration. Underlying psychiatric disorders appear to be the principal confounders of the observed association.
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Affiliation(s)
- Isabelle Jaussent
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
| | - Marie-Laure Ancelin
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
| | - Claudine Berr
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
| | - Karine Pérès
- Inserm, Centre Inserm U897, Bordeaux F-33000, France
- ISPED, Centre Inserm U897, Université Bordeaux, Bordeaux F-33000, France
| | | | - Alain Besset
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
| | - Karen Ritchie
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
- Faculty of Medicine, Imperial College, London, UK
| | - Yves Dauvilliers
- Inserm, U1061, Montpellier F-34000, France
- Université Montpellier 1, Montpellier F-34000, France
- CHU Montpellier, Service de Neurologie, Unité des Troubles du Sommeil, Hôpital Gui-de-Chauliac, Montpellier, France
- Service de Neurologie, Hôpital Gui-de-Chauliac, 80 avenue Augustin Fliche, Montpellier cedex 5 34295, France
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