Brazilian consensus on guidelines for diagnosis and treatment for restless legs syndrome

Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder-the SEMN study

PURPOSE

This study aimed to (1) evaluate in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) the presence of sleep disorders such as hypersomnia, fatigue, risk of apnea, and the presence of restless legs syndrome/Willis-Ekbom disease (RLS/WED); (2) evaluate quality of sleep in patients with MS and NMOSD; and (3) correlate them with clinical and imaging data.

METHODS

The study was cross-sectional and was carried out in the sector of demyelinating diseases of the neurology service of HUGV-UFAM, Manaus, Brazil, from January 2017 to December 2020.

RESULTS

Our sample consisted of 60 patients, 41 with MS and 19 with NMOSD. We found that patients with MS and NMOSD have poor sleep quality (65%) and hypersomnia (53% in MS; 47% in NMOSD), but low risk of apnea by STOP-BANG. The frequency of RLS/WE found was 14% in MS, and 5% in NMOSD. No correlation existed between sleep quality, number of relapses, and sleep quality for the Expanded Disability Status Scale (EDSS), i.e., fatigue/illness duration.

CONCLUSION

Patients with MS and NMOSD have poor sleep quality, excessive sleepiness, and are at low risk for OSA, yet the frequency of RLS/WED is like that of the general population. There does not seem to be a significant difference between these sleep disorders in these demyelinating diseases of the CNS.

Preliminary short-term outcomes of rapid maxillary expansion on periodic limb movements during sleep in pediatric sleep-disordered breathing

OBJECTIVE

To assess the short-term outcome of rapid maxillary expansion (RME) on periodic limb movement disorder (PLMD) in children with residual snoring after late adenotonsillectomy (AT).

METHODS

This prospective clinical trial included 24 patients treated with rapid maxillary expansion (RME). Participants' inclusion criteria were children with maxillary constriction aged 5-12 years who had AT for more than two years and those whose parents/guardians reported that they still snored ≥4 nights per week. Of which 13 had primary snoring, and 11 had OSA. All patients underwent laryngeal nasofibroscopy evaluation and complete polysomnography. The Quality of life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), the Conners Abbreviated Scale (CAE), and the Epworth Sleep Scale (ESS) were applied before and after palatal expansion.

RESULTS

The OSA 18 domain, PSQ total, CAE, and ESS scores were significantly reduced in both groups (p < 0.001). There was a decrease in PLMS indices. In the total sample, the mean decreased significantly from 4.15 to 1.08. In the Primary Snoring group, the mean decreased from 2.64 to 0.99; in the OSA group, the average decreased significantly from 5.95 to 1.19.

CONCLUSION

This preliminary study suggests that the improvement of PLMS in the OSA group with maxillary constriction is correlated with a favorable neurological impact of the treatment. We suggest a multi-professional approach to the treatment of sleep disorders in children.

Targinact for restless legs syndrome

Idiopathic restless legs syndrome (RLS)--also known as Willis-Ekbom disease--is a neurological condition characterised by an overwhelming urge to move the legs, occurring during rest or inactivity, especially at night. Symptoms are highly variable in frequency and severity, and can affect sleep and quality of life. First-line management includes addressing precipitating or aggravating factors and providing explanation, reassurance and advice on self-help strategies. Drug therapy (e.g. a dopamine agonist) is used for patients with more severe symptoms. In December 2014, the marketing authorisation for a modified-release preparation containing oxycodone and naloxone (Targinact-Napp Pharmaceuticals) was expanded to include use in the treatment of severe to very severe RLS after failure of dopaminergic therapy.(10)Here we review the management of adults with RLS, including the place of oxycodone/naloxone.