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Bruni O, Angriman M, Miano S, DelRosso LM, Spruyt K, Mogavero MP, Ferri R. Individualized approaches to pediatric chronic insomnia: Advancing precision medicine in sleep disorders. Sleep Med Rev 2024; 76:101946. [PMID: 38735089 DOI: 10.1016/j.smrv.2024.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/25/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
The manifestations of chronic insomnia undergo age-related changes. In younger infants and children, behavioral insomnia emerges as the most prevalent form and typically responds to behavioral interventions. However, distinct clusters of clinical presentations suggest the presence of various phenotypes, potentially implicating the primary involvement of specific neurotransmitters. These conceptualizations, coupled with genetic studies on pleiotropy and polygenicity, may aid in identifying individuals at risk of persistent insomnia into adulthood and shed light on novel treatment options. In school-age children, the predominant presentation is sleep-onset insomnia, often linked with nighttime fears, anxiety symptoms, poor sleep hygiene, limit-setting issues, and inadequate sleep duration. The manifestations of insomnia in adolescence correlate with the profound changes occurring in sleep architecture, circadian rhythms, and homeostatic processes. The primary symptoms during adolescence include delayed sleep onset, sleep misperception, persistent negative thoughts about sleep, and physiological hyperarousal-paralleling features observed in adult insomnia. An approach centered on distinct presentations may provide a framework for precision-based treatment options. Enhanced comprehension of insomnia's manifestations across diverse developmental stages can facilitate accurate assessment. Efforts to subtype insomnia in childhood align with this objective, potentially guiding the selection of appropriate treatments tailored to individual neurobiological, clinical, and familial features.
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Affiliation(s)
- Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Bolzano Hospital, Via Guncina 54, 39100, Bolzano, Italy
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Lourdes M DelRosso
- University of California San Francisco, Fresno, 2625 E. Divisadero St. Fresno, CA, 93721, USA
| | - Karen Spruyt
- Université de Paris, NeuroDiderot Inserm, Academic Hospital Robert Debré Ap-Hp in the Building Bingen, 48 Bd Sérurier, 75019, Paris, France
| | - Maria P Mogavero
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
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De Pieri M, Bueltemann L, Tedone F, Riccardi S, Castelnovo A, Miano S, Manconi M. Clinical and instrumental features in 82 patients with insufficient sleep syndrome. J Sleep Res 2024; 33:e14076. [PMID: 37909272 DOI: 10.1111/jsr.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
Insufficient sleep syndrome possibly represents the worldwide leading cause of daytime sleepiness, but remains poorly recognised and studied. The aim of this case series is to comprehensively describe a cohort of patients with insufficient sleep syndrome. Eighty-two patients were studied concerning demographic and socio-economic features, medical, psychiatric and sleep comorbidities, substance use, sleep symptoms, actigraphy, video-polysomnography, multiple sleep latency tests and treatment. The typical patient with insufficient sleep syndrome is a middle-aged adult (with no difference of gender), employed, who has a family, often carrying psychiatric and neurological comorbidities, in particular headache, anxiety and depression. Other sleep disorders, especially mild sleep apnea and bruxism, were common as well. Actigraphy was a valuable tool in the characterisation of insufficient sleep syndrome, showing a sleep restriction during weekdays, associated with a recovery rebound of night sleep during weekends and a high amount of daytime sleep. An over- or underestimation of sleeping was common, concerning both the duration of night sleep and daytime napping. The average daily sleep considering both daytime and night-time, weekdays and weekends corresponds to the recommended minimal normal duration, meaning that the burden of insufficient sleep syndrome could mainly depend on sleep fragmentation and low quality. Sleep efficiency was elevated both in actigraphy and video-polysomnography. Multiple sleep latency tests evidenced a tendency toward sleep-onset rapid eye movement periods. Our study offers a comprehensive characterisation of patients with insufficient sleep syndrome, and clarifies their sleeping pattern, opening avenues for management and treatment of the disorder. Current options seem not adapted, and in our opinion a cognitive-behavioural psychotherapy protocol should be developed.
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Affiliation(s)
- Marco De Pieri
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Service de psychiatrie adulte, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Switzerland
| | - Linda Bueltemann
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Tedone
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Plazzi G, Pizza F, Lecendreux M, Gringras P, Barateau L, Bruni O, Franco P, Iranzo A, Jennum P, Khatami R, Knudsen-Heier S, Miano S, Nobili L, Partinen M, Reading P, Sonka K, Szakacs A, Zenti M, Kallweit U, Lammers GJ, Dauvilliers Y, Bassetti CLA. Letter to editor. J Sleep Res 2023:e14055. [PMID: 38050449 DOI: 10.1111/jsr.14055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Pizza
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Michel Lecendreux
- Pediatric Sleep Disorders Center, AP-HP, Robert Debre Hospital, Paris, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Paris, France
| | | | - Lucie Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Patricia Franco
- Pediatric Sleep Unit and National Reference Center for Narcolepsy, Mother-Children's Hospital, Hospices Civils de Lyon & U1028, Lyon Neuroscience Research Center (CRNL), University Lyon 1, Lyon, France
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome Lyon, Lyon, France
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Centre, Hospital Clínic Barcelona, Universitat de Barcelona. IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Copenhagen, Denmark
| | - Ramin Khatami
- Center for Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid AG, Barmelweid, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Stine Knudsen-Heier
- Norwegian Center for Neurodevelopmental Disorders and Hypersomnias - NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silvia Miano
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Civic Hospital, Lugano, Switzerland
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
- Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genova, Genoa, Italy
| | - Markku Partinen
- Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
- Helsinki Sleep Clinic, Terveystalo Healthcare, Helsinki, Finland
| | - Paul Reading
- Department of Neurology, The James Cook University Hospital, Middlesbrough, UK
| | - Karel Sonka
- Department of Neurology and Center for Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Attila Szakacs
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Halmstad County Hospital, Halmstad, Sweden
| | - Massimo Zenti
- Associazione Italiana Narcolettici e Ipersonni, Florence, Italy
- European Narcolepsy Alliance for Patients, Bruxells, Belgium
| | - Ulf Kallweit
- Center for Narcolepsy and Hypersomnias, Professorship for Narcolepsy and Hypersomnolence Research, Department of Medicine, University Witten/Herdecke, Witten, Germany
- Center for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Gert J Lammers
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Center, Heemstede, Netherlands
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France
- Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Claudio L A Bassetti
- Medical Faculty, University of Bern, Bern, Switzerland
- Department of Neurology, University Hospital (Inselspital), Bern, Switzerland
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Miano S, Barateau L, De Pieri M, Riccardi S, Thevenin C, Manconi M, Dauvilliers Y. A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele. J Clin Sleep Med 2023; 19:2053-2057. [PMID: 37539640 PMCID: PMC10692923 DOI: 10.5664/jcsm.10748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
STUDY OBJECTIVES We report data collected from 2 reference European sleep centers on a series of patients with narcolepsy with hypocretin-1 deficiency and absence of the human leukocyte antigens (HLA) DQB1*06:02 allele. METHODS Clinical data, HLA DQ markers, and cerebrospinal fluid assessments were collected retrospectively from Caucasian patients with a diagnosis of narcolepsy type 1 with cerebrospinal fluid hypocretin-1 deficiency (< 110 pg/ml) and absence of the HLA DQB1*06:02 allele, with follow-up with at least 1 visit within the last 4 years, consecutively admitted to 2 European sleep centers (Lugano, Switzerland and Montpellier, France). RESULTS Seven patients (3 of 29 patients in Lugano and 4 of 328 in Montpellier) were diagnosed with narcolepsy with hypocretin-1 deficiency and absence of HLA DQB1*06:02 (ie, 2% of patients with narcolepsy type 1). Regarding the HLA-DQB1 genotyping, 4 cases were positive for HLA DQB1*03:01, 1 for DQB1*03:02, and 3 for DQB1*02:01. Three patients had atypical cataplexy and 1 had no cataplexy. Only 2 patients had both a mean sleep latency of less than 8 minutes and more than 2 sleep onset rapid eye movement periods on the Multiple Sleep Latency Test, indicative of a less severe condition. CONCLUSIONS Although rare, this series of 7 cases confirms that hypocretin-deficient narcolepsy should not be excluded in the absence of HLA DQB1*06:02, especially if patients are carriers of other high-risk HLA-DQB1 alleles (DQB1*03:01, *03:02, *02:01). These data support the hypothesis that narcolepsy type 1 is a wider disease spectrum linked to the loss of hypocretin peptide. CITATION Miano S, Barateau L, De Pieri M, et al. A series of 7 cases of patients with narcolepsy with hypocretin deficiency without the HLA DQB1*06:02 allele. J Clin Sleep Med. 2023;19(12):2053-2057.
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Affiliation(s)
- Silvia Miano
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- National Reference Network for Narcolepsy, Montpellier, Institute for Neurosciences of Montpellier (INM), INSERM, University of Montpellier, Montpellier, France
| | - Marco De Pieri
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- General Psychiatry Service, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Silvia Riccardi
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Celine Thevenin
- Département d’Immunologie, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Mauro Manconi
- Sleep Unit, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
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De Pieri M, Manconi M, Riccardi S, Miano S. Central sleep apneas with Cheyne-Stokes breathing in a patient with narcolepsy type 1. Sleep Med 2023; 112:232-233. [PMID: 37924632 DOI: 10.1016/j.sleep.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Affiliation(s)
- M De Pieri
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Thonex, CH, Switzerland; Neurocenter of Southern Switzerland, Sleep Medicine Lugano, CH, Switzerland.
| | - M Manconi
- Neurocenter of Southern Switzerland, Sleep Medicine Lugano, CH, Switzerland; Inselspital University Hospital Bern, Neurology, Bern, CH, Switzerland
| | - S Riccardi
- Neurocenter of Southern Switzerland, Sleep Medicine Lugano, CH, Switzerland
| | - S Miano
- Neurocenter of Southern Switzerland, Sleep Medicine Lugano, CH, Switzerland
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Castelnovo A, Lividini A, Riedner BA, Avvenuti G, Jones SG, Miano S, Tononi G, Manconi M, Bernardi G. Origin, synchronization, and propagation of sleep slow waves in children. Neuroimage 2023; 274:120133. [PMID: 37094626 DOI: 10.1016/j.neuroimage.2023.120133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023] Open
Abstract
STUDY OBJECTIVES Sleep slow wave activity, as measured using EEG delta power (<4 Hz), undergoes significant changes throughout development, mirroring changes in brain function and anatomy. Yet, age-dependent variations in the characteristics of individual slow waves have not been thoroughly investigated. Here we aimed at characterizing individual slow wave properties such as origin, synchronization, and cortical propagation at the transition between childhood and adulthood. METHODS We analyzed overnight high-density (256 electrodes) EEG recordings of healthy typically developing children (N=21, 10.3±1.5 years old) and young healthy adults (N=18, 31.1±4.4 years old). All recordings were preprocessed to reduce artifacts, and NREM slow waves were detected and characterized using validated algorithms. The threshold for statistical significance was set at p=0.05. RESULTS The slow waves of children were larger and steeper, but less widespread than those of adults. Moreover, they tended to mainly originate from and spread over more posterior brain areas. Relative to those of adults, the slow waves of children also displayed a tendency to more strongly involve and originate from the right than the left hemisphere. The separate analysis of slow waves characterized by high and low synchronization efficiency showed that these waves undergo partially distinct maturation patterns, consistent with their possible dependence on different generation and synchronization mechanisms. CONCLUSIONS Changes in slow wave origin, synchronization, and propagation at the transition between childhood and adulthood are consistent with known modifications in cortico-cortical and subcortico-cortical brain connectivity. In this light, changes in slow-wave properties may provide a valuable yardstick to assess, track, and interpret physiological and pathological development.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Althea Lividini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Brady A Riedner
- Center for Sleep and Consciousness, Department of Psychiatry, University of Wisconsin - Madison, Madison, WI, USA
| | - Giulia Avvenuti
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Stephanie G Jones
- Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison(,) Madison, WI, USA
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giulio Tononi
- Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison(,) Madison, WI, USA
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Lucca, Italy.
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Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Sleep Med 2023; 19:811-822. [PMID: 36692194 PMCID: PMC10071388 DOI: 10.5664/jcsm.10440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Periodic limb movements during sleep (PLMS) are a frequent finding in restless legs syndrome, but their impact on sleep is still debated, as well the indication for treatment. We systematically reviewed the available literature to describe which drug categories are effective in suppressing PLMS, assessing their efficacy through a meta-analysis, when this was possible. METHODS The review protocol was preregistered on PROSPERO (CRD42021175848), and the systematic search was conducted on and EMBASE (last searched on March 2020). We included original human studies, which assessed PLMS modification on drug treatment with a full-night polysomnography, through surface electrodes on each tibialis anterior muscle. When at least 4 studies were available on the same drug or drug category, we performed a random-effect model meta-analysis. RESULTS Dopamine agonists like pramipexole and ropinirole resulted the most effective, followed by l-dopa and other dopamine agonists. Alpha2delta ligands are moderately effective as well opioids, despite available data on these drugs are much more limited than those on dopaminergic agents. Valproate and carbamazepine did not show a significant effect on PLMS. Clonazepam showed contradictory results. Perampanel and dypiridamole showed promising but still insufficient data. The same applies to iron supplementation. CONCLUSIONS Dopaminergic agents are the most powerful suppressors of PLMS. However, most therapeutic trials in restless legs syndrome do not report objective polysomnographic findings, there is a lack of uniformity in presenting results on PLMS. Longitudinal polysomnographic interventional studies, using well-defined and unanimous scoring criteria and endpoints on PLMS are needed. CITATION Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(4):811-822.
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Affiliation(s)
- Silvia Riccardi
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Raffaele Ferri
- Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Corrado Garbazza
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Regional Hospital of Lugano, Neurocenter of Southern Switzerland, Lugano, Switzerland
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Fulda S, Miano S. Time to rest a hypothesis? Accumulating evidence that periodic leg movements during sleep are not increased in children with attention deficit hyperactivity disorder (ADHD): results of a case-control study and a meta-analysis. Sleep 2023:7069300. [PMID: 36869787 DOI: 10.1093/sleep/zsad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Indexed: 03/05/2023] Open
Abstract
STUDY OBJECTIVES To address the hypothesis that periodic leg movements during sleep (PLMS) are more frequent in children with attention deficit hyperactivity disorder (ADHD) when compared to typically developing (TD) children. To that end we both analyzed PLMS in a recent case-control study and conducted a systematic review and meta-analysis of PLMS frequency in children with ADHD and TD children. METHODS In our case-control study we compared PLMS frequency of 24 children with ADHD (mean age 11 years, 17 male) to that of 22 age matched typically developing (TD) children (mean age 10 years, 12 male). A subsequent meta-analysis included 33 studies that described PLMS frequency in groups of children with ADHD and/or groups of TD children. RESULTS The case-control study did not show any differences in the frequency of PLMS between children with ADHD and TD children, a result that was consistent across a range of different definitions of PLMS, which in turn had a significant and systematic effect on PLMS frequency. The meta-analysis compared the average PLMS indices and the proportion of children with elevated PLMS indices between children with ADHD and TD children and across a number of analyses did not find any meta-analytic results that supported the hypothesis that PLMS are more frequent in children with ADHD. CONCLUSIONS Our results suggest that PLMS are not more frequent in children with ADHD compared to TD children. A finding of frequent PLMS in a child with ADHD should therefore be considered a separate disorder and prompt specific diagnostic and therapeutic strategies.
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Affiliation(s)
- Stephany Fulda
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, EOC, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, EOC, Lugano, Switzerland
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Castelnovo A, Miano S, Ferri R, Raggi A, Maestri M, Bottasini V, Anelli M, Zucconi M, Castronovo V, Ferini-Strambi L, Manconi M. Electrophysiological and Neuropsychological Indices of Cognitive Dysfunction in Patients with Chronic Insomnia and Severe Benzodiazepine Use Disorder. Brain Sci 2023; 13:brainsci13030375. [PMID: 36979185 PMCID: PMC10046290 DOI: 10.3390/brainsci13030375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Benzodiazepine (BDZ) misuse is a growing health problem, with 1–2% of patients under BDZ treatment meeting the criteria for use disorder or dependence. Although BDZ addiction potential has been known for decades, much remains unknown its effects on brain functions. The aim of this study was to assess the neuropsychological and neurophysiological profile of a group of chronic insomniacs taking long-term high doses of benzodiazepine. We recruited 17 consecutive patients admitted to our third-level Sleep Medicine Unit for drug discontinuation (7 males, mean age 49.2 ± 11.2 years, mean education 13.7 ± 3.9 years, mean daily diazepam-equivalent BDZ: 238.1±84.5 mg) and 17 gender/age-matched healthy controls (7 males, mean age 46.8 ± 14.1 years, mean education 13.5 ± 4.5 years). We performed a full neuropsychological evaluation of all subjects and recorded their scalp event-related potentials (Mismatch-Passive Oddball-Paradigm and Active Oddball P300 Paradigm). Patients with chronic insomnia and BDZ use disorder showed a profound frontal lobe executive dysfunction with significant impairment in the cognitive flexibility domain, in face of a preserved working, short and long-term memory. In patients, P300 amplitude tended to be smaller, mainly over the frontal regions, compared to controls. BDZ use disorder has a severe cognitive impact on chronic insomnia patients. Long-term high-dose BDZ intake should be carefully evaluated and managed by clinicians in this specific patient population, especially in relation to risky activities.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute—IRCCS, 94018 Troina, Italy
| | - Alberto Raggi
- Unit of Neurology, G.B. Morgagni–L. Pierantoni Hospital, 47121 Forlì, Italy
| | - Michelangelo Maestri
- Department of Neurosciences, Neurological Clinic, University of Pisa, 56124 Pisa, Italy
| | - Valentina Bottasini
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Matteo Anelli
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marco Zucconi
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Vincenza Castronovo
- Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | | | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Civic Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
- Correspondence: ; Tel.: +41-91-811-68-25
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10
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Miano S, Fanfulla F, Nobili L, Heinzer R, Haba-Rubio J, Berger M, Cereda C, Schmidt M, Manconi M, Bassetti C. SAS CARE 1: Sleep architecture changes in a cohort of patients with Ischemic Stroke/TIA. Sleep Med 2022; 98:106-113. [DOI: 10.1016/j.sleep.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
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11
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Castelnovo A, Lividini A, Bernardi G, Pezzoli V, Foderaro G, Ramelli GP, Manconi M, Miano S. Sleep Power Topography in Children with Attention Deficit Hyperactivity Disorder (ADHD). Children (Basel) 2022; 9:children9020197. [PMID: 35204918 PMCID: PMC8870029 DOI: 10.3390/children9020197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Recent years saw an increasing interest towards sleep microstructure abnormalities in attention-deficit/hyperactivity disorder (ADHD). However, the existing literature on sleep electroencephalographic (EEG) power in ADHD is still controversial, often based on single electrode recordings, and mainly focused on slow wave activity (SWA) during NREM sleep. This study aimed to systematically investigate sleep power topography in all traditional frequency bands, in all sleep stages and across sleep cycles using high-density EEG (HD-EEG). METHOD Thirty drug-naïve children with ADHD (10.5 ± 2.1 years, 21 male) and 23 typically developing (TD) control participants (mean age: 10.2 ± 1.6 years, 13 male) were included in the current analysis. Signal power topography was computed in classical frequency bands during sleep, contrasted between groups and sleep cycles, and correlated with measures of ADHD severity, cognitive functioning and estimated total sleep time. RESULTS Compared to TD subjects, patients with ADHD consistently displayed a widespread increase in low-frequency activity (between 3 and 10 Hz) during NREM sleep, but not during REM sleep and wake before sleep onset. Such a difference involved a wide centro-posterior cluster of channels in the upper SWA range, in Theta, and low-Alpha. Between-group difference was maximal in sleep stage N3 in the first sleep cycle, and positively correlated with average total sleep time. CONCLUSIONS These results support the concept that children with ADHD, compared to TD peers, have a higher sleep pressure and altered sleep homeostasis, which possibly interfere with (and delay) cortical maturation.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3011 Bern, Switzerland
- Correspondence: (A.C.); (S.M.)
| | - Althea Lividini
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy;
| | - Valdo Pezzoli
- Department of Pediatrics, Ospedale Civico, 6900 Lugano, Switzerland; (V.P.); (G.F.)
| | - Giuseppe Foderaro
- Department of Pediatrics, Ospedale Civico, 6900 Lugano, Switzerland; (V.P.); (G.F.)
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, 6500 Bellinzona, Switzerland;
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, 3010 Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Correspondence: (A.C.); (S.M.)
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12
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Miano S, Castelnovo A, Bruni O, Manconi M. Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes. J Sleep Res 2022; 31:e13426. [PMID: 34169594 DOI: 10.1111/jsr.13426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/16/2023]
Abstract
The analysis of sleep microstructure in attention deficit hyperactivity disorder (ADHD) revealed an under-representation of the EEG slow component during NREM sleep. Previous studies either excluded or did not characterize objectively sleep disorders, which notoriously affect sleep architecture. The present study aimed to investigate the cyclic alternating pattern in a real clinical sample of children with ADHD, in whom sleep disorders could be considered. Twenty-seven consecutively enrolled drug-naïve children (mean age, 10.53 years; nine females) and 23 controls (mean age, 10.22 years; 11 females) underwent a full sleep investigation, including attended video-polysomnography. Visual cyclic alternating pattern analysis was performed in a blinded way. Children with ADHD had one or more sleep disorders (a narcolepsy-like phenotype was found in two cases, sleep onset insomnia in three cases, arousal disorder in one case, movement disorder phenotype in six cases and obstructive sleep apnea in 11 cases, and six children had sleep-related epileptiform discharges). Children with ADHD and normal controls showed a similar microstructure with a cyclic alternating pattern rate of about 50%. Children with obstructive sleep apnea had a significantly higher cyclic alternating pattern rate during stage N3. Despite not reaching statistical differences, a lower cyclic alternating pattern rate and A1 index were found in children without epileptic abnormalities/obstructive sleep apnea. Our analysis might allow differentiation of the "primary form" of ADHD associated with a decrease of NREM instability from those forms associated with sleep apnea and epileptic activity.
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Affiliation(s)
- Silvia Miano
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mauro Manconi
- Sleep Medicine Unit, Civic Hospital of Lugano (EOC), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Department of Neurology, Inselspital, University Hospital, Bern, Switzerland.,Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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13
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Ferri R, Sparasci D, Castelnovo A, Miano S, Tanioka K, Tachibana N, Carelli C, Riccitelli GC, Disanto G, Zecca C, Gobbi C, Manconi M. Leg movement activity during sleep in multiple sclerosis with and without restless legs syndrome. J Clin Sleep Med 2022; 18:11-20. [PMID: 34216201 PMCID: PMC8807912 DOI: 10.5664/jcsm.9466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To carry out an analysis of leg movement activity during sleep in a polysomnography dataset of patients with multiple sclerosis (MS) in comparison to idiopathic restless legs syndrome (iRLS) and healthy controls. METHODS In this cross-sectional, observational, instrumental study, 57 patients (males/females: 11/46; mean age 46.2 ± 10.2 years) with a diagnosis of MS underwent a telephone interview assessing the 5 standard diagnostic criteria for RLS and polysomnography. Sleep architecture and leg movement activity during sleep were subsequently compared: 1) 40 patients with MS without RLS (MS-RLS) vs 28 healthy controls; 2) 17 patients with MS with RLS (MS+RLS) vs 35 patients with iRLS; 3) MS+RLS vs MS-RLS. RESULTS MS-RLS and MS+RLS presented increased sleep latency, percentage of sleep stage N1, and reduced total sleep time compared to healthy controls and iRLS, respectively. The periodic limb movements during sleep (PLMS) index was higher in MS-RLS than in healthy controls (P = .035) and lower in MS+RLS compared to iRLS (P = .024). PLMS in MS+RLS were less periodic, less often bilateral, and with shorter single movements compared to the typical PLMS in iRLS. CONCLUSIONS MS is a risk factor for RLS, PLMS, and for a lower sleep quality in comparison to healthy patients. PLMS in MS+RLS are fewer and shorter if compared to iRLS. Our results suggest a dissociation between motor (PLMS) and sensory symptoms (RLS sensory component) in RLS secondary to MS, with possible treatment implications. CITATION Ferri R, Sparasci D, Castelnovo A, et al. Leg movement activity during sleep in multiple sclerosis with and without restless legs syndrome. J Clin Sleep Med. 2022;18(1):11-20.
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Affiliation(s)
- Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Kosuke Tanioka
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Chiara Carelli
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Gianna Carla Riccitelli
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Neuropsychology and Behavioural Neurology Research Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Chiara Zecca
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Claudio Gobbi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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14
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Riccitelli GC, Disanto G, Sacco R, Sparasci D, Sacco L, Castelnovo A, Miano S, Manconi M, Gobbi C, Zecca C. Contribution of sleep disturbances to fatigue in multiple sclerosis: a prospective study using clinical and polysomnographic parameters. Eur J Neurol 2021; 28:3139-3146. [PMID: 34143510 PMCID: PMC8457159 DOI: 10.1111/ene.14984] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023]
Abstract
Background and purpose Fatigue is amongst the most frequent and disabling symptoms of multiple sclerosis and a close relation between fatigue and sleep quality has been hypothesized. In this study the contribution of sleep disturbances measured by clinical and polysomnographic parameters to fatigue in multiple sclerosis was investigated. Methods This was a prospective instrumental study performed at the Neurocenter of Southern Switzerland. Demographic data and clinical characteristics including fatigue (as measured by the modified fatigue impact scale [MFIS]), neurological disability, psychiatric symptoms, medications and sleep‐related variables were collected at baseline visit and by a home full‐night polysomnography. The associations between sleep‐related variables and the MFIS were tested using partial correlations adjusted by demographic and sleep‐unrelated clinical factors. Results Seventy‐six patients were included in the study, of whom 53 (69.7%) had an MFIS ≥38 points (median 49.5, interquartile range 31.0–62.0). MFIS scores were positively associated with age, neurological disability, symptoms of depression and anxiety, and use of benzodiazepines and selective serotonin reuptake inhibitors. When adjusting for these variables, the presence of restless legs syndrome (RLS) (r = 0.37, p = 0.005) and periodic leg movements index (r = −0.33, p = 0.014) were associated with MFIS. Excessive daytime sleepiness, total sleep time, sleep efficiency, respiratory disturbances, and percentage of time spent in the different sleep stages (N1, N2, N3 and rapid eye movement) were not associated with fatigue. Conclusions Multiple sclerosis patients with a diagnosis of RLS had significantly higher global fatigue scores compared to those without RLS. Future studies should investigate whether medical treatment of RLS can ameliorate fatigue.
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Affiliation(s)
- Gianna C Riccitelli
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Neuropsychology and Behavioral Neurology Research Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giulio Disanto
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Rosaria Sacco
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Leonardo Sacco
- Neuropsychology and Behavioral Neurology Research Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Silvia Miano
- Neuropsychology and Behavioral Neurology Research Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Neurology Department Inselspital, Bern University Hospital, Bern, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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15
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Sparasci D, Ferri R, Castelnovo A, Gobbi C, Zecca C, Riccitelli G, Disanto G, Carelli C, Miano S, Tanioka K, Tachibana N, Manconi M. 519 Restless Legs and Periodic Limb Movements in 86 patients with Multiple Sclerosis. Sleep 2021. [DOI: 10.1093/sleep/zsab072.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The aim of this study was to assess the prevalence of restless legs syndrome (RLS), periodic limb movements during sleep (PLMS) and their overlap in a large population of patients with multiple sclerosis (MS), and to compare clinical and paraclinical findings between patients with and without RLS/PLMS.
Methods
In this cross–sectional, observational, instrumental study, eighty-six patients (M/F: 27/59; mean age 48.0 ± 10.8 years) with a diagnosis of MS underwent a structured telephone interview assessing the five standard diagnostic criteria for RLS. Seventy-six participants underwent Video-polysomnography and Maintenance of Wakefulness Test (MWT). Instrumental and clinical findings were subsequently statistically compared to investigate their association with RLS and PLMS index (PLMSI).
Results
RLS and PLMS (PLMSI ≥15/h) prevalence in patients with MS was of 31.4% and 31.6% respectively. Among patients with RLS, 37.5% had a PLMSI ≥15/h. In the group with PLMS, 37.5% met all diagnostic criteria for RLS. No differences were found between patients with and without RLS (F = 0.99, p = 0.45), and between patients with and without a PLMSI ≥15/hour (F = 0.32 p = 0.94) on the pool of clinical and instrumental variables.
Conclusion
RLS is highly prevalent and severe in patients with MS. The prevalence of PLMS is comparable to the general population. The low percentage of patients with RLS having a high PLMSI, together with the absence of correlation between RLS and female gender and older age, support the existence of a distinct symptomatic form of RLS in MS.
Support (if any):
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16
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Tanioka K, Castelnovo A, Tachibana N, Miano S, Zecca C, Gobbi C, Manconi M. Framing multiple sclerosis under a polysomnographic perspective. Sleep 2021; 43:5602219. [PMID: 31637431 DOI: 10.1093/sleep/zsz232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Multiple sclerosis (MS) is a mainly demyelinating, autoimmune, and disabling neurological disease. In addition to well-known clinically evident symptoms such as coordination or motor problems, increasing attention has been posed to a constellation of less evident symptoms significantly contributing to the clinical impact of MS. Among others, sleep symptoms have been only recently explored. This systematic review summarizes objective sleep findings detected by using polysomnography and their relationship with clinical variables in MS patients. While it is well known that sleep disorders are frequent in MS, objective clinical data are still scarce. Literature based on subjective reports indicate sleep disorders as highly frequent in MS patients; however, objective data are still scarce. New large case-control instrumental investigations are warranted to establish the real objective entity and impact of sleep comorbidities.
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Affiliation(s)
- Kosuke Tanioka
- Department of Neurology, Osaka City General Hospital, Osaka, Japan.,Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Chiara Zecca
- Multiple Sclerosis Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Claudio Gobbi
- Multiple Sclerosis Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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17
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Dietmann A, Wenz E, van der Meer J, Ringli M, Warncke JD, Edwards E, Schmidt MH, Bernasconi CA, Nirkko A, Strub M, Miano S, Manconi M, Acker J, von Manitius S, Baumann CR, Valko PO, Yilmaz B, Brunner AD, Tzovara A, Zhang Z, Largiadèr CR, Tafti M, Latorre D, Sallusto F, Khatami R, Bassetti CLA. The Swiss Primary Hypersomnolence and Narcolepsy Cohort study (SPHYNCS): Study protocol for a prospective, multicentre cohort observational study. J Sleep Res 2021; 30:e13296. [PMID: 33813771 PMCID: PMC8519114 DOI: 10.1111/jsr.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 12/19/2022]
Abstract
Narcolepsy type 1 (NT1) is a disorder with well‐established markers and a suspected autoimmune aetiology. Conversely, the narcoleptic borderland (NBL) disorders, including narcolepsy type 2, idiopathic hypersomnia, insufficient sleep syndrome and hypersomnia associated with a psychiatric disorder, lack well‐defined markers and remain controversial in terms of aetiology, diagnosis and management. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a comprehensive multicentre cohort study, which will investigate the clinical picture, pathophysiology and long‐term course of NT1 and the NBL. The primary aim is to validate new and reappraise well‐known markers for the characterization of the NBL, facilitating the diagnostic process. Seven Swiss sleep centres, belonging to the Swiss Narcolepsy Network (SNaNe), joined the study and will prospectively enrol over 500 patients with recent onset of excessive daytime sleepiness (EDS), hypersomnia or a suspected central disorder of hypersomnolence (CDH) during a 3‐year recruitment phase. Healthy controls and patients with EDS due to severe sleep‐disordered breathing, improving after therapy, will represent two control groups of over 50 patients each. Clinical and electrophysiological (polysomnography, multiple sleep latency test, maintenance of wakefulness test) information, and information on psychomotor vigilance and a sustained attention to response task, actigraphy and wearable devices (long‐term monitoring), and responses to questionnaires will be collected at baseline and after 6, 12, 24 and 36 months. Potential disease markers will be searched for in blood, cerebrospinal fluid and stool. Analyses will include quantitative hypocretin measurements, proteomics/peptidomics, and immunological, genetic and microbiota studies. SPHYNCS will increase our understanding of CDH and the relationship between NT1 and the NBL. The identification of new disease markers is expected to lead to better and earlier diagnosis, better prognosis and personalized management of CDH.
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Affiliation(s)
- Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Julia van der Meer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Maya Ringli
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Ellen Edwards
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado A Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | | | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Jens Acker
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | | | | | - Philip O Valko
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Bahtiyar Yilmaz
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.,Maurice Müller Laboratories, Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Andreas-David Brunner
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Athina Tzovara
- Institute of Computer Science, University of Bern, Bern, Switzerland.,Department of Neurology, Sleep Wake Epilepsy Center, NeuroTec, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Zhongxing Zhang
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Carlo R Largiadèr
- Department of Clinical Chemistry, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mehdi Tafti
- Department of Biomedical Science, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Federica Sallusto
- Institute of Microbiology, ETH Zurich, Zurich, Switzerland.,Institute for Research in Biomedicine, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
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18
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Sparasci D, Ferri R, Castelnovo A, Miano S, Tanioka K, Tachibana N, Carelli C, Riccitelli G, Disanto G, Zecca C, Gobbi C, Manconi M. Restless Legs Syndrome and Periodic Limb Movements in 86 patients with Multiple Sclerosis. Sleep 2021; 44:6171204. [PMID: 33720378 DOI: 10.1093/sleep/zsab066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/15/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To assess the frequency of restless legs syndrome (RLS), periodic limb movements during sleep (PLMS) and their overlap in a large sample of patients with multiple sclerosis (MS). To compare clinical and paraclinical findings among four sub-groups of patients: RLS-/PLMS- (patients without RLS and PLMS), RLS+/PLMS- (patients with RLS and without PLMS), RLS-/PLMS (patients without RLS and with PLMS), RLS+/PLMS+ (patients with both RLS and PLMS). METHODS In this cross-sectional, observational, instrumental study, eighty-six patients (M/F: 27/59; mean age 48.0 ± 10.8 years) with a diagnosis of MS underwent a telephone interview assessing the five standard diagnostic criteria for RLS. Seventy-six participants underwent polysomnography (PSG) and maintenance of wakefulness test. Instrumental and clinical findings were subsequently statistically compared to investigate their association with RLS and PLMS index (PLMSI). RESULTS RLS and PLMS (PLMSI ≥15/h) frequency in patients with MS was of 31.4% and 31.6% respectively. Among patients with RLS, 37.5% had a PLMSI ≥15/h. RLS-/PLMS+ group showed higher wake after sleep onset (p = 0.01), stage shifts per hour (p = 0.03), increased stage N1 (p = 0.03) and reduction in stage N3 (p = 0.01) compared to RLS-/PLMS-. RLS had no influence on clinical and PSG parameters (p = 0.45). CONCLUSIONS RLS is highly frequent in patients with MS. The frequency of PLMS is comparable to the general population. The low percentage of patients with RLS having a high PLMSI, together with the absence of correlation between RLS and female gender and older age, support the existence of a distinct symptomatic form of RLS in MS.
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Affiliation(s)
- Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Kosuke Tanioka
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Naoko Tachibana
- Division of Sleep Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Chiara Carelli
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Gianna Riccitelli
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Giulio Disanto
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Chiara Zecca
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Claudio Gobbi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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19
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Castelnovo A, Loddo G, Provini F, Miano S, Manconi M. Mental Activity During Episodes of Sleepwalking, Night Terrors or Confusional Arousals: Differences Between Children and Adults. Nat Sci Sleep 2021; 13:829-840. [PMID: 34188578 PMCID: PMC8232850 DOI: 10.2147/nss.s309868] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE/BACKGROUND Night terrors, sleepwalking and confusional arousals are behavioral manifestations of incomplete awakenings from sleep. According to international diagnostic criteria, these behaviors occur in the absence of any mental experience, or in the presence of very limited cognition or dream imagery (eg, a single visual scene). The aim of this study was to systematically and retrospectively investigate the mental content associated with sleep terrors and/or sleepwalking in both children and adults. PATIENTS AND METHODS Forty-five consecutive patients referred for a diagnosis of disorders of arousal (DOA) of all subtypes (sleepwalking/sleep terrors/confusional arousals) (25 adults: 30 ± 6 y, 15 females; 20 children: 10 ± 3 y, 6 females) underwent a detailed semi-structured interview about the mental content associated with their nocturnal episodes. The interview was comprehensive of specific questions about their subjective recall rate, several content details (characters, emotions, actions and setting/context), and hallucinatory or dissociative experiences during clinical episodes. Patients' reports were classified for complexity (Orlinsky scale) and content (Hall and Van de Castle categories). RESULTS More than two-third of the children (n = 14) could not recall any mental activity associated with their episodes, whereas more than two-third (n = 16) of the adults recalled at least one mental experience. Half of the adult patients (n = 8) estimated that a specific mental content was subjectively present around 50% or more of the times. Seven adults and one child described clear and vivid hallucinatory experiences of "dreamed" objects or characters projected onto their real home environment, in the absence of any reality testing. Five adults and two children described one or more dissociative experiences. The content of the collected reports was dominated by dynamic actions acted out from a self-perspective, often with apprehension and in response to misfortune and danger, in a home-setting environment. CONCLUSION These results suggest that current diagnostic criteria are tailored around the typical presentation of DOA in children, and do not always fit to adult patients with DOA. Furthermore, they support the concept that consciousness may reemerge in DOA patients during clinical episodes, in a peculiar dissociated, psychotic-like form.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Giuseppe Loddo
- Department of Primary Care, Azienda USL di Bologna, Bologna, Italia
| | - Federica Provini
- IRCSS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italia
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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20
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Bernasconi C, Ott SR, Fanfulla F, Miano S, Horvath T, Seiler A, Cereda CW, Brill AK, Young P, Nobili L, Manconi M, Bassetti CLA. SAS CARE 2 - a randomized study of CPAP in patients with obstructive sleep disordered breathing following ischemic stroke or transient ischemic attack. Sleep Med X 2020; 2:100027. [PMID: 33870178 PMCID: PMC8041126 DOI: 10.1016/j.sleepx.2020.100027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
Objective/background The benefit of Continuous Positive Airway Pressure (CPAP) treatment following ischemic stroke in patients with obstructive sleep-disordered breathing (SDB) is unclear. We set out to investigate this open question in a randomized controlled trial as part of the SAS-CARE study. Patients/methods. Non-sleepy patients (ESS < 10) with ischemic stroke or transient ischemic attack (TIA) and obstructive SDB (AHI ≥ 20) 3 months post-stroke were randomized 1:1 to CPAP treatment (CPAP+) or standard care. Primary outcome was the occurrence of vascular events (TIA/stroke, myocardial infarction/revascularization, hospitalization for heart failure or unstable angina) or death within 24 months post-stroke. Secondary outcomes included Modified Rankin Scale (mRS) and Barthel Index. Results Among 238 SAS-CARE patients 41 (17%) non-sleepy obstructive SDB patients were randomized to CPAP (n = 19) or standard care (n = 22). Most patients (80%) had stroke and were males (78%), mean age was 64 ± 7 years and mean NIHSS score 0.6 ± 1.0 (range: 0–5). The primary endpoint was met by one patient in the standard care arm (a new stroke). In an intent-to treat analysis disregarding adherence, this corresponds to an absolute risk difference of 4.5% or an NNT = 22. mRS and Barthel Index were stable and similar between arms. CPAP adherence was sufficient in 60% of evaluable patients at month 24. Conclusion No benefit of CPAP started three months post-stroke was found in terms of new cardio- and cerebrovascular events over 2 years. This may be related to the small size of this study, the mild stoke severity, the exclusion of sleepy patients, the delayed start of treatment, and the overall low event rate. No benefit of CPAP started 3 months post-stroke was found. A sufficient CPAP compliance was observed over 2 years in 60% of patients. Studies of CPAP in mild stroke need to be large and include long-term outcomes.
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Affiliation(s)
- C Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - S R Ott
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Pulmonary and Sleep Medicine, St. Claraspital, Basel, Switzerland
| | - F Fanfulla
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - S Miano
- Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - T Horvath
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - A Seiler
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - C W Cereda
- Stroke Center EOC, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - A-K Brill
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Young
- University Hospital Münster, Department of Neurology, Münster, Germany
| | - L Nobili
- Department of Neurology, Ospedale Niguarda, Milano, Italy.,DINOGMI, University of Genoa, Genoa, Italy
| | - M Manconi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep Medicine, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - C L A Bassetti
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
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21
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Castelnovo A, Turner K, Rossi A, Galbiati A, Gagliardi A, Proserpio P, Nobili L, Terzaghi M, Manni R, Ferini Strambi L, Manconi M, Miano S, Zambrelli E, Paola Canevini M. Behavioural and emotional profiles of children and adolescents with disorders of arousal. J Sleep Res 2020; 30:e13188. [PMID: 32909647 DOI: 10.1111/jsr.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/03/2020] [Accepted: 08/12/2020] [Indexed: 11/27/2022]
Abstract
Disorders of arousals are common sleep disorders characterized by complex motor behaviours that arise episodically out of slow-wave sleep. Psychological distress has long been associated with disorders of arousal, but this link remains controversial, especially in children and adolescents. The aim of this multi-centre study was to characterize behavioural and emotional problems in a sample of children/adolescents with disorders of arousal, and to explore their relationship with the severity of nocturnal episodes. The parents of 41 children/adolescents with a diagnosis of disorders of arousal (11.5 ± 3.3 years old, 61% males) and of a group of 41 age- and gender-matched control participants filled in the Child Behavior Checklist, along with the Sleep Disturbance Scale for Children and the Paris Arousal Disorders Severity Scale. Multilevel t-tests revealed significantly higher total scores and sub-scores of the Child Behavior Checklist for the patient group compared with the control group. Thirty-four percent of the patients obtained pathological total scores, and 12% of them borderline scores. The severity of emotional/behavioural problems in the patient group was positively correlated with the severity of the nocturnal episodes. Interestingly, children/adolescents with disorders of arousal also obtained higher excessive daytime sleepiness and insomnia symptoms sub-scores at the Sleep Disturbance Scale for Children. These results confirmed the hypothesis that behavioural/emotional problems are surprisingly common in children/adolescents with disorders of arousal. Further studies are warranted to investigate the causal relationship between pathological manifestations, subtler sleep abnormalities, and diurnal emotional/behavioural problems in children/adolescents with disorders of arousal.
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Affiliation(s)
- Anna Castelnovo
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Katherine Turner
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Alessandro Rossi
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
| | - Andrea Galbiati
- Department of Neurology, Sleep Disorders Center, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Alessandra Gagliardi
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Centre Cantonal de l'Autisme, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland
| | - Paola Proserpio
- Claudio Munari Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy
| | - Lino Nobili
- Department of Neuroscience - Rehabilitation-Ophthalmology - Genetics - Child and Maternal Health (DINOGMI), University of Genoa, Italy.,Child Neuropsychiatry, IRCCS G. Gaslini Institute, Genoa, Italy
| | - Michele Terzaghi
- Unit of Sleep Medicine and Epilepsy, IRCCS Istituto Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Manni
- Unit of Sleep Medicine and Epilepsy, IRCCS Istituto Mondino Foundation, Pavia, Italy
| | - Luigi Ferini Strambi
- Department of Neurology, Sleep Disorders Center, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Maria Paola Canevini
- Department of Health Sciences, University of Milan, Milan, Italy.,Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
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22
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Ott SR, Fanfulla F, Miano S, Horvath T, Seiler A, Bernasconi C, Cereda CW, Brill AK, Young P, Nobili L, Manconi M, Bassetti CLA. SAS Care 1: sleep-disordered breathing in acute stroke an transient ischaemic attack - prevalence, evolution and association with functional outcome at 3 months, a prospective observational polysomnography study. ERJ Open Res 2020; 6:00334-2019. [PMID: 32577418 PMCID: PMC7293990 DOI: 10.1183/23120541.00334-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/24/2020] [Indexed: 12/27/2022] Open
Abstract
Sleep-disordered breathing (SDB) is frequent in patients with acute stroke. Little is known, however about the evolution of SDB after stroke. Most of our knowledge stems from smaller cohort studies applying limited cardiopulmonary sleep recordings or from cross-sectional data collected in different populations. This study aims to determine prevalence, type and intra-individual evolution of SDB based on full-night polysomnography (PSG) in acute stroke and 3 months thereafter. Furthermore, we aimed to identify predictors of SDB in the acute and chronic phase and to evaluate associations between SDB and functional outcome at 3 months (M3). A total of 166 patients with acute cerebrovascular events were evaluated by full PSG at baseline and 105 again at M3. The baseline prevalence of SDB (apnoea–hypopnoea index (AHI)>5·h−1) was 80.5% and 25.4% of the patients had severe SDB (AHI>30·h−1). Obstructive sleep apnoea was more prevalent than central sleep apnoea (83.8% versus 13%). Mean±SD AHI was 21.4±17.6·h−1and decreased significantly at M3 (18±16.4·h−1; p=0.018). At M3, 91% of all patients with baseline SDB still had an AHI>5·h−1 and in 68.1% the predominant type of SDB remained unchanged (78.9% in obstructive sleep apnoea and 44.4% in central sleep apnoea). The only predictors of SDB at baseline were higher age and body mass index and in the chronic phase additionally baseline AHI. Baseline AHI was associated with functional outcome (modified Rankin score >3) at M3. The high prevalence of SDB in acute stroke, its persistence after 3 months, and the association with functional outcome supports the recommendation for a rapid SDB screening in stroke patients. The high prevalence of SDB in acute stroke, its persistence after 3 months and its association with functional outcome support the recommendation for rapid SDB screening in stroke patientshttps://bit.ly/3bFWqV7
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Affiliation(s)
- Sebastian R Ott
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Pulmonary and Sleep Medicine, St Claraspital, Basel, Switzerland.,These authors contributed equally
| | - Francesco Fanfulla
- Neurocentre of Southern Switzerland, Lugano, Switzerland.,Sleep Medicine Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy.,These authors contributed equally
| | - Silvia Miano
- Neurocentre of Southern Switzerland, Lugano, Switzerland
| | - Thomas Horvath
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Seiler
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Carlo W Cereda
- Neurocentre of Southern Switzerland, Lugano, Switzerland
| | - Anne-Kathrin Brill
- Dept of Pulmonary Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Peter Young
- Dept of Neurology, University Hospital Münster, Münster, Germany
| | - Lino Nobili
- Dept of Neurology, Ospedale Niguarda, Milan, Italy.,Dept of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genoa, Italy
| | - Mauro Manconi
- Neurocentre of Southern Switzerland, Lugano, Switzerland.,Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake-Epilepsy Center, Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Dept of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.,Dept of Neurology, Sechenow University, Moscow, Russia
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23
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Castelnovo A, Amato N, Riccardi S, Pereno M, Miano S, Manconi M. 1271 High-Density EEG Correlates During Confusional Arousals in a Child With a Long-Lasting History Of Sleepwalking. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleepwalking belongs to a family of disorders (Disorders of Arousal - DOA) that are thought to derive from incomplete arousals out of Non Rapid Eye Movement (NREM) sleep. At yet, our knowledge about the specific neural dynamics occurring during clinical episodes is limited and relies on one SPECT case study, four stereo-EEG case reports/series and one single high-density electro-encephalography (hdEEG) case report. We herein describe a single case captured by hdEEG.
Report of Case
We collected two consecutive sleep recordings (using a 256-channel hdEEG coupled with standard video-polysomnography) of a non-medicated, otherwise healthy, 13-year-old male, with a history of recurrent daily sleepwalking episodes. We visually identified 17 behavioral events during sleep stage 3 and divided them into two groups: clear clinical episodes (n = 7) and simple movements associated with burst of delta waves (n = 10). Source power topography in the delta range (1-4 Hz) was computed using LORETA. Source images during selected episodes were compared to 30 second-windows of baseline stage 3 sleep. Comparisons were performed using statistical non-parametric mapping with supra-threshold cluster tests. Events were associated with an increase of delta power over the right frontopolar prefrontal cortex (rPFC) / Broadman area 10 (BA10) at their onset. This finding was clearly observable even when considering only clear-cut events, followed by the involvement of the right dorsolateral and medial prefrontal cortex / BA9 and of the left superior temporal gyrus/ BA 22.
Conclusion
We were able to replicate a recently published case report by our group, where we highlighted the putative role of rPFC and PFC and prefronto-temporal circuit in DOA episodes. Intriguingly, we observed a lateralization of this effect, with a prominent right frontal involvement. Novel research has shown a physiological asymmetry in the generation of large slow waves between the two hemispheres. An increased right-left unbalance might prime behavioral episodes in DOA patients.
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Affiliation(s)
- A Castelnovo
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
| | - N Amato
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
| | - S Riccardi
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
| | - M Pereno
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
| | - S Miano
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
| | - M Manconi
- Sleep Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, SWITZERLAND
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Miano S, Amato N, Foderaro G, Pezzoli V, Ramelli GP, Toffolet L, Manconi M. Sleep phenotypes in attention deficit hyperactivity disorder. Sleep Med 2019; 60:123-131. [PMID: 30377038 DOI: 10.1016/j.sleep.2018.08.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/27/2018] [Accepted: 08/06/2018] [Indexed: 01/17/2023]
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Miano S, Amato N, Garbazza C, Abbafati M, Foderaro G, Pezzoli V, Ramelli GP, Manconi M. Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder. Sleep 2019; 42:5540162. [DOI: 10.1093/sleep/zsz167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/28/2019] [Indexed: 02/04/2023] Open
Abstract
Abstract
Study Objectives
Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea–hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD.
Materials and Methods
The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed.
Results
At scalp topography, the focus of SWA was observed over the centro–parietal–occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01).
Conclusions
Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.
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Affiliation(s)
- Silvia Miano
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Ninfa Amato
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Manuel Abbafati
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
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Wolfensberger B, Ferri R, Bianco G, Abbafati M, Miano S, Kaelin‐Lang A, Bassetti CL, Manconi M. From physiological neck myoclonus to sleep related head jerk. J Sleep Res 2019; 28:e12831. [DOI: 10.1111/jsr.12831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Beat Wolfensberger
- Department of Neurology University Hospital Inselspital Bern Switzerland
| | - Raffaele Ferri
- Sleep Research Centre Oasi Research Institute-IRCCS Troina Italy
| | - Giovanni Bianco
- Sleep and Epilepsy Center Neurocenter of the Southern Switzerland Civic Hospital of Lugano Lugano Switzerland
| | - Manuel Abbafati
- Sleep and Epilepsy Center Neurocenter of the Southern Switzerland Civic Hospital of Lugano Lugano Switzerland
| | - Silvia Miano
- Sleep and Epilepsy Center Neurocenter of the Southern Switzerland Civic Hospital of Lugano Lugano Switzerland
| | - Alain Kaelin‐Lang
- Department of Neurology University Hospital Inselspital Bern Switzerland
- Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland
| | | | - Mauro Manconi
- Department of Neurology University Hospital Inselspital Bern Switzerland
- Sleep and Epilepsy Center Neurocenter of the Southern Switzerland Civic Hospital of Lugano Lugano Switzerland
- Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland
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Zubler F, Seiler A, Horvath T, Roth C, Miano S, Rummel C, Gast H, Nobili L, Schindler KA, Bassetti CL. Stroke causes a transient imbalance of interhemispheric information flow in EEG during non-REM sleep. Clin Neurophysiol 2018; 129:1418-1426. [DOI: 10.1016/j.clinph.2018.03.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/21/2018] [Accepted: 03/19/2018] [Indexed: 12/12/2022]
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Miano S, Ninfa A, Casadei A, Manconi M. 0819 A Full Sleep Assessment In Children With Attention Deficit Hyperactivity Disorders (ADHD). Sleep 2018. [DOI: 10.1093/sleep/zsy061.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Miano
- Sleep Centre, Neurocenter of Southern Switzerland, Lugano, SWITZERL
| | - A Ninfa
- Sleep Centre, Neurocenter of Southern Switzerland, Lugano, SWITZERL
| | - A Casadei
- Sleep Centre, Neurocenter of Southern Switzerland, Lugano, SWITZERL
| | - M Manconi
- Sleep Centre, Neurocenter of Southern Switzerland, Lugano, SWITZERL
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Manconi M, Fanfulla F, Ferri R, Miano S, Haba-Rubio J, Heinzer R, Horvath T, Proserpio P, Young P, Moschovitis G, Seiler A, Cereda C, Nobili L, Wiest R, Ott SR, Bassetti CL. Periodic limb movements during sleep in stroke/TIA: Prevalence, course, and cardiovascular burden. Neurology 2018; 90:e1663-e1672. [PMID: 29643080 DOI: 10.1212/wnl.0000000000005471] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/15/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To define the prevalence, time course, and associated factors of periodic limb movements during sleep (PLMS) in patients with ischemic stroke or TIA. METHODS Patients enrolled in the prospective Sleep-Disordered Breathing in Transient Ischemia Attack (TIA)/Ischemic Stroke and Continuous Positive Airway Pressure (CPAP) Treatment Efficacy (SAS-CARE) study underwent a double polysomnographic investigation in the acute and chronic phases after stroke/TIA, together with a MRI brain scan and a 24-hour blood pressure evaluation. The prevalence of PLMS in patients was compared with that in a matched sample of randomly selected healthy controls from the HypnoLaus cohort. One hundred sixty-nine recordings were performed in the acute phase and 191 after 3 months (210 recordings were obtained from the same 105 patients in both phases) and were compared to those of 162 controls. RESULTS The mean number of PLMS per hour and the percentage of participants with a PLMS index >10 and >15 per hour were similar between patients and controls. PLMS remained stable from the acute to the chronic phase after stroke. Factors positively associated with PLMS were age, body mass index, and history of hypertension. Blood pressure over 24 hours and the burden of cerebrovascular damage were similar between the groups with PLMS and without PLMS. CONCLUSIONS PLMS are equally frequent in patients with stroke/TIA and the general population. The absence of higher blood pressure values and of a greater vascular brain damage found in patients with PLMS compared to those without PLMS might be due to a greater use of antihypertensive medication among patients with PLMS, which corresponds to a higher prevalence of previous diagnosis of hypertension in these patients.
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Affiliation(s)
- Mauro Manconi
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland.
| | - Francesco Fanfulla
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Raffaele Ferri
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Silvia Miano
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Josè Haba-Rubio
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Raphael Heinzer
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Thomas Horvath
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Paola Proserpio
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Peter Young
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Giorgio Moschovitis
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Andrea Seiler
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Carlo Cereda
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Lino Nobili
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Roland Wiest
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Sebastian R Ott
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland
| | - Claudio L Bassetti
- From the Sleep and Epilepsy Center (M.M., F.F., S.M., C.C.,), Neurocenter of Southern Switzerland, Civic Hospital of Lugano; Neurology Department Inselspital (M.M., T.H., A.S., C.L.B.), Bern University Hospital, Switzerland; Sleep Medicine Unit (F.F.), Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia; Sleep Research Centre (R.F.), Department of Neurology IC, Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy; Center for Investigation and Research in Sleep (J.H.-R., R.H.), Lausanne University Hospital, Switzerland; C. Munari Center of Epilepsy Surgery (P.P., L.N.), Niguarda Hospital, Milan, Italy; Klinik für Schlafmedizin und Neuromuskuläre Erkrankungen (P.Y.), Universitätsklinikum Münster, Germany; Department of Cardiology (G.M.), Regional Hospital of Lugano, Switzerland; Department of Neuroscience (L.N.), University of Genoa, Italy; University Institute of Diagnostic and Interventional Neuroradiology (R.W.), Inselspital, Bern University Hospital, University of Bern, Switzerland; and Department of Pulmonary Medicine and University of Bern (S.R.O.), Inselspital, University Hospital, Bern, Switzerland.
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Abel F, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Tan HL, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children. Eur Respir J 2017; 50:50/6/1700985. [PMID: 29217599 DOI: 10.1183/13993003.00985-2017] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Abstract
The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms (e.g. snoring) and/or conditions predisposing to SDB (e.g. mandibular hypoplasia) as well as children with SDB and complex conditions (e.g. Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions (e.g. supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.
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Affiliation(s)
- Athanasios G Kaditis
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Francois Abel
- Dept of Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Hui-Leng Tan
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Paediatric Pulmonology Unit, First Dept of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Paediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Chiaro G, Maestri M, Riccardi S, Haba-Rubio J, Miano S, Bassetti CL, Heinzer RC, Manconi M. Sleep-Related Rhythmic Movement Disorder and Obstructive Sleep Apnea in Five Adult Patients. J Clin Sleep Med 2017; 13:1213-1217. [PMID: 28859719 DOI: 10.5664/jcsm.6778] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/06/2017] [Indexed: 01/06/2023]
Abstract
ABSTRACT Sleep-related rhythmic movements (SRRMs) are typical in infancy and childhood, where they usually occur at the wake-to-sleep transition. However, they have rarely been observed in adults, where they can be idiopathic or associated with other sleep disorders including sleep apnea. We report a case series of 5 adults with sleep-related rhythmic movement disorder, 4 of whom had a previous history of SRRMs in childhood. SRRMs mostly occurred in consolidated sleep, in association with pathological respiratory events, predominantly longer ones, especially during stage R sleep, and recovered in 1 patient with continuous positive airway pressure therapy. We hypothesize that sleep apneas may act as a trigger of rhythmic motor events through a respiratory-related arousal mechanism in genetically predisposed subjects.
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Affiliation(s)
- Giacomo Chiaro
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Michelangelo Maestri
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Silvia Riccardi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | | | - Raphaël C Heinzer
- Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.,University Department of Neurology, Inselspital, Bern, Switzerland
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Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, Villa MP, Verhulst SL. Adenotonsillectomy to treat obstructive sleep apnea: Is it enough? Pediatr Pulmonol 2017; 52:699-709. [PMID: 28052557 DOI: 10.1002/ppul.23641] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/07/2016] [Accepted: 11/03/2016] [Indexed: 01/01/2023]
Abstract
Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS),1 improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease. Early recognition and treatment of children with persistent OSAS is required to prevent long-term morbidity. The management of these children is frequently complex and a multidisciplinary approach is required as most of them have additional risk factors for OSAS and comorbidities. In this paper, we first provide an overview of children at risk for persistent disease following adenotonsillectomy. Thereafter, we discuss different diagnostic modalities to evaluate the sites of persistent upper airway obstruction and the currently available treatment options. Pediatr Pulmonol. 2017;52:699-709. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - F Abel
- Department of Paediatric Respiratory and Sleep Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - E Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - M Evangelisti
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - A Kaditis
- First Department of Paediatrics, Pediatric Pulmonology Unit, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - S Miano
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - M P Villa
- University of Rome "La Sapienza" School of Medicine, Rome, Italy.,Regional Sleep Disorders Center, Sant' Andrea Hospital, Rome, Italy
| | - S L Verhulst
- Department of Pediatric Pulmonology, Antwerp University Hospital, University of Antwerp, Belgium
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Chiaro G, Maestri M, Riccardi S, Haba-Rubio J, Miano S, Bassetti CL, Heinzer R, Manconi M. 0737 SLEEP-RELATED RHYTHMIC MOVEMENT DISORDER AND SLEEP APNEA IN FIVE ADULT PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Joosten KF, Larramona H, Miano S, Van Waardenburg D, Kaditis AG, Vandenbussche N, Ersu R. How do we recognize the child with OSAS? Pediatr Pulmonol 2017; 52:260-271. [PMID: 27865065 DOI: 10.1002/ppul.23639] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/12/2016] [Accepted: 10/30/2016] [Indexed: 12/29/2022]
Abstract
Obstructive sleep-disordered breathing includes a spectrum of clinical entities with variable severity ranging from primary snoring to obstructive sleep apnea syndrome (OSAS). The clinical suspicion for OSAS is most often raised by parental report of specific symptoms and/or abnormalities identified by the physical examination which predispose to upper airway obstruction (e.g., adenotonsillar hypertrophy, obesity, craniofacial abnormalities, neuromuscular disorders). Symptoms and signs of OSAS are classified into those directly related to the intermittent pharyngeal airway obstruction (e.g., parental report of snoring, apneic events) and into morbidity resulting from the upper airway obstruction (e.g., increased daytime sleepiness, hyperactivity, poor school performance, inadequate somatic growth rate or enuresis). History of premature birth and a family history of OSAS as well as obesity and African American ethnicity are associated with increased risk of sleep-disordered breathing in childhood. Polysomnography is the gold standard method for the diagnosis of OSAS but may not be always feasible, especially in low-income countries or non-tertiary hospitals. Nocturnal oximetry and/or sleep questionnaires may be used to identify the child at high risk of OSAS when polysomnography is not an option. Endoscopy and MRI of the upper airway may help to identify the level(s) of upper airway obstruction and to evaluate the dynamic mechanics of the upper airway, especially in children with combined abnormalities. Pediatr Pulmonol. 2017;52:260-271. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Koen F Joosten
- Erasmus MC, Pediatric Intensive Care, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Department of Pediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Dick Van Waardenburg
- Pediatric Intensive Care Unit, Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Refika Ersu
- Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
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Miano S, Esposito M, Foderaro G, Ramelli GP, Pezzoli V, Manconi M. Sleep-Related Disorders in Children with Attention-Deficit Hyperactivity Disorder: Preliminary Results of a Full Sleep Assessment Study. CNS Neurosci Ther 2016; 22:906-914. [PMID: 27255788 DOI: 10.1111/cns.12573] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/10/2016] [Accepted: 05/05/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND AND METHODS We present the preliminary results of a prospective case-control sleep study in children with a diagnosis of attention-deficit hyperactivity disorder (ADHD). A deep sleep assessment including sleep questionnaires, sleep habits, a video-polysomnographic recording with full high-density electroencephalography (EEG) and cardiorespiratory polygraphy, multiple sleep latency test, and 1-week actigraphic recording were performed to verify whether children with ADHD may be classified into one of the following five phenotypes: (1) hypoarousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD; (2) delayed sleep onset insomnia; (3) sleep-disordered breathing; (4) restless legs syndrome and/or periodic limb movements; and (5) sleep epilepsy and/or EEG interictal epileptiform discharges. RESULTS Fifteen consecutive outpatients with ADHD were recruited (two female, mean age 10.6 ± 2.2, age range 8-13.7 years) over 6 months. The narcolepsy-like sleep phenotype was observed in three children, the sleep onset insomnia phenotype was observed in one child, mild obstructive sleep apnea was observed in three children, sleep hyperkinesia and/or PLMs were observed in five children, while IEDs and or nocturnal epilepsy were observed in three children. Depending on the sleep phenotype, children received melatonin, iron supplementation, antiepileptic drugs, or stimulants. CONCLUSIONS Our study further highlights the need to design an efficient sleep diagnostic algorithm for children with ADHD, thereby more accurately identifying cases in which a full sleep assessment is indicated.
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Affiliation(s)
- Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland.
| | - Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe Foderaro
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland
| | - Valdo Pezzoli
- Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
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Kaditis AG, Alonso Alvarez ML, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, Larramona H, Miano S, Narang I, Trang H, Tsaoussoglou M, Vandenbussche N, Villa MP, Van Waardenburg D, Weber S, Verhulst S. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J 2015; 47:69-94. [PMID: 26541535 DOI: 10.1183/13993003.00385-2015] [Citation(s) in RCA: 445] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/11/2015] [Indexed: 12/11/2022]
Abstract
This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h(-1), those with an AHI of 1-5 episodes·h(-1) and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7).
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Affiliation(s)
- Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Luz Alonso Alvarez
- Multidisciplinary Sleep Unit, Pulmonology, University Hospital of Burgos and CIBER of Respiratory Diseases (CIBERES), Burgos Foundation for Health Research, Burgos, Spain
| | - An Boudewyns
- Dept of Otorhinolaryngology Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Emmanouel I Alexopoulos
- Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece
| | - Refika Ersu
- Division of Paediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Koen Joosten
- Erasmus MC, Sophia Children's Hospital, Paediatric Intensive Care, Rotterdam, The Netherlands
| | - Helena Larramona
- Paediatric Pulmonology Unit, Dept of Paediatrics, University Autonoma of Barcelona, Corporacio Sanitaria Parc Tauli, Hospital of Sabadell, Barcelona, Spain
| | - Silvia Miano
- Sleep and Epilepsy Centre, Neurocentre of Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ha Trang
- Paediatric Sleep Centre, Robert Debré University Hospital, EA 7334 REMES Paris-Diderot University, Paris, France
| | - Marina Tsaoussoglou
- Pediatric Pulmonology Unit, First Dept of Paediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | | | - Maria Pia Villa
- Pediatric Sleep Disease Centre, Child Neurology, NESMOS Dept, School of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Rome, Italy
| | - Dick Van Waardenburg
- Paediatric Intensive Care Unit, Dept of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silke Weber
- Dept of Ophthalmology, Otolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University-UNESP, Botucatu, São Paulo, Brazil
| | - Stijn Verhulst
- Dept of Paediatrics, Antwerp University Hospital, Edegem, Belgium
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Vitelli O, Tabarrini A, Miano S, Rabasco J, Pietropaoli N, Forlani M, Parisi P, Villa MP. Impact of obesity on cognitive outcome in children with sleep-disordered breathing. Sleep Med 2015; 16:625-30. [PMID: 25862118 DOI: 10.1016/j.sleep.2014.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the impact of obesity on cognitive impairment, in children with obstructive sleep apnoea (OSA), children with OSA and obesity, and in normal controls. METHODS Thirty-six children with OSA (group 1), 38 children with OSA and obesity (group 2) and 58 normal controls (group 3) were studied. The Total intelligence quotient (T-IQ), Verbal IQ (V-IQ) and the Performance IQ (P-IQ) scores were obtained using the Wechsler Intelligence Scale for Children - Third Edition Revised. All participants' parents filled out the questionnaire containing the attention deficit and hyperactive disorder rating scale to investigate symptoms of hyperactivity and attention deficit. Obese and non-obese children with sleep-disordered breathing (SDB) underwent polysomnography. RESULTS T-QI and P-QI scores were significantly lower in group 2 with higher performance impairment at the subtest compared to other groups. In obese children, V-IQ was significantly correlated with age of onset (r = 0.335, p = 0.05) and duration of SDB (r = -0.362, p = 0.02), while P-IQ and T-IQ were correlated with body mass index (BMI) percentile (r = -0.341, p = 0.03) and respiratory disturbance index (RDI) (r = -0.321, p = 0.05), respectively. RDI and BMI negatively influenced T-IQ in obese children with OSA. No correlation was found between sleep parameters and IQ scores or subtest scores in all groups. CONCLUSIONS Obese children with OSA showed higher cognitive impairment. Obesity has an additive and synergic action with that exerted by OSA, speeding up the onset of complications.
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Affiliation(s)
- Ottavio Vitelli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Alessandra Tabarrini
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Silvia Miano
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano, Switzerland
| | - Jole Rabasco
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Nicoletta Pietropaoli
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Martina Forlani
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Pasquale Parisi
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome
| | - Maria Pia Villa
- Neuroscience, Mental Health and Sense Organs Department, Paediatric Sleep Disorder Centre, Faculty of Medicine and Psychology, La Sapienza' University, Rome.
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Abstract
Because signs of nocturnal seizures can overlap with sleep respiratory events, clinicians can have difficulty distinguishing abnormal events related to sleep disorders from epileptic seizures. We describe the case of a 3-year-old child presenting with ictal electroencephalographic (EEG) activity associated with a particular form of atypical obstructive sleep apnea, characterized by increased respiratory rate, paradoxical breathing, desaturations, and tonic-dystonic posture associated with movement artifacts. Following cardiorespiratory polysomnography, the patient was initially misdiagnosed as having severe obstructive sleep apnea syndrome.
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Affiliation(s)
- Ottavio Vitelli
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Silvia Miano
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Alessandra Tabarrini
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Anna Rita Mazzotta
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Maria Chiara Supino
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Martina Forlani
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
| | - Maria Pia Villa
- Faculty of Medicine and Psychology, Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
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Miano S, Peraita-Adrados R. Pediatric insomnia: clinical, diagnosis, and treatment. Rev Neurol 2014; 58:35-42. [PMID: 24343539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pediatric insomnia is an extrinsic sleep disorder subdivided into two categories: behavioral insomnia and insomnia related to medical, neurological, and psychiatric diseases. This review will cover several types of insomnia, comorbidities and specific pediatric therapies according to clinical characteristics and age. Behavioral insomnia should be differentiated from pediatric insomnia due to medical conditions, mostly occurring during the first year of life. Multiple night awakenings and diurnal hypersomnolence are strong indicators of insomnia due to medical conditions. Insomnia during adolescence and pediatric insomnia associated with psychiatric comorbidity, cognitive disabilities and epilepsy, will be discussed in terms of diagnosis, clinical features and implications for treatment.
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Silverman P, Mazanec S, Gallagher P, Miano S, Lyons JA, Rowehl-Miano W, Daly B. Abstract P6-08-14: Meeting needs and expectations of breast cancer survivors: Learning from patients through a survey method. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-08-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Oncology patients have many needs throughout the care continuum. Identification of the most salient needs is critical in program planning in an environment where resources are limited. Choices for programming should be based on information regarding survivors’ perceived needs and their usage of services provided by the cancer center and in the community. We developed a survey to assess needs of patients seen at our Cancer Center. The purpose of the project was to establish the feasibility of the method in the population, identify needs, use these as a basis to develop programs to meet the needs, and establish a baseline for future needs assessments.
Methods: Previous U.S. cancer patient needs surveys were used as a background to create survey questions for cancer survivors using a quality of life framework. The scope of the survey was expanded based on feedback from Cancer Center leaders and Patent and Family Advisory Committee members. IRB approval was obtained and surveys were mailed to patients seen within 2 years at our sites. After eliciting demographic data, questions sought information about the performance of the cancer team and patient preferences for learning styles and what resources were used. Patients were asked by whom they preferred follow-up care to be given. Specific questions on the physical, emotional, social and spiritual effects of cancer were sought. Breast cancer respondents were compared to respondents with other types of cancer.
Results: 1005 of 2750 (37%) mailed surveys were returned; 518 (51.5%) were from breast cancer survivors. Of the breast cancer survivors, mean age was 64 (range 30-94); 82% were Caucasian, 15% African-American; 62% were married; 50% were retired; 24% remained on treatment, 14% <2 years, 29% 2-5 years, 33% >5 years after treatment. Slightly more than half used non-hospital (57%) or hospital (54%) resources. Most commonly used non-hospital resource was internet (34%); most commonly used hospital resource was information from the health care team (36%). One year after treatment 90% preferred follow-up care from primary oncology team (vs. primary care physician or other). While there was concordance that “attention to my physical needs” was excellent for 76% and this was “important” for 94%, only 46% rated “attention to my emotional needs” as excellent with this was “important” for 84%. Fear of cancer recurrence was the greatest concern for patients and had not significantly resolved for the respondents >5 years after treatment. Breast cancer patients differed significantly from patients with other types of cancer having less fatigue (p<0.001), more issues with sexual intimacy (p = 0.001), more interest in obtaining genetic counseling (p = 0.001) and more fear of developing a new cancer (p = 0.01).
Conclusions: This method of assessment was feasible (with a project cost of $7000), was completed in two years and can be used as a baseline. As a result of this survey our Cancer Center created an educational print resource describing our supportive oncology programs, implemented an end of treatment distress screening tool piloted with breast cancer patients, and provided staff education regarding patient needs and intervention tools.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-14.
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Affiliation(s)
- P Silverman
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - S Mazanec
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - P Gallagher
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - S Miano
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - JA Lyons
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - W Rowehl-Miano
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
| | - B Daly
- University Hospitals Seidman Cancer Center, Cleveland, OH; Case Western Reserve School of Nursing, Cleveland, OH
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Miano S, Tabarrini A, Vitelli O, Mazzotta A, Del Pozzo M, Rabasco J, Barreto M, Parisi P, Ferretti A, Villa MP. The cooccurrence of interictal discharges and seizures in pediatric sleep-disordered breathing. Epilepsy Behav 2013; 29:508-12. [PMID: 24128933 DOI: 10.1016/j.yebeh.2013.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022]
Abstract
Studies in the literature data have shown that the prevalence of obstructive sleep apnea (OSA) in children with epilepsy is high and that treatment for OSA leads to a reduction in the number of seizures; by contrast, few studies have demonstrated an increased prevalence of interictal epileptiform discharges (IEDs) or epilepsy in children with sleep-disordered breathing (SDB). The aim of the present study was to confirm the high prevalence of IEDs or epilepsy in a large sample of children with SDB and to collect follow-up data. Children were recruited prospectively and underwent their first video-polysomnography (video-PSG) for SDB in a teaching hospital sleep center. Of the 298 children who fulfilled the diagnostic criteria for sleep-disordered breathing, 48 (16.1%) children were found to have IEDs, three of these 48 children were also found to have nocturnal seizures (two females diagnosed with rolandic epilepsy and a male diagnosed with frontal lobe epilepsy). Only 11 subjects underwent a second video-PSG after 6months; at the second video-PSG, the IEDs had disappeared in six subjects, who also displayed a reduced AHI and an increased mean overnight saturation. Thirty-eight of the 250 children without IEDs underwent a second video-PSG after 6months. Of these 250 children, four, who did not display any improvement in the respiratory parameters and were found to experience numerous stereotyped movements during sleep, were diagnosed with nocturnal frontal lobe epilepsy. Our study confirms the high prevalence of IEDs in children with SDB. Follow-up data indicate that they may recede over time, accompanied by an improvement of sleep respiratory parameters.
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Affiliation(s)
- Silvia Miano
- Neuroscience, Mental Health and Sense Organs Department, Chair of Pediatrics, Sleep Disorder Centre, "La Sapienza" University, Rome, Italy
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Villa MP, Castaldo R, Miano S, Paolino MC, Vitelli O, Tabarrini A, Mazzotta AR, Cecili M, Barreto M. Adenotonsillectomy and orthodontic therapy in pediatric obstructive sleep apnea. Sleep Breath 2013; 18:533-9. [DOI: 10.1007/s11325-013-0915-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 10/29/2013] [Accepted: 11/13/2013] [Indexed: 11/27/2022]
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Miano S, Donfrancesco R, Parisi P, Rabasco J, Mazzotta AR, Tabarrini A, Vitelli O, Villa MP. Case reports of sleep phenotypes of ADHD: from hypothesis to clinical practice. J Atten Disord 2013; 17:565-73. [PMID: 24022016 DOI: 10.1177/1087054713497254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Five sleep ADHD phenotypes have been hypothesized: (a) the hypo-arousal state of the "primary" form of ADHD, (b) the sleep phase advanced disorder, (c) sleep disordered breathing (SDB), (d) restless legs syndrome and/or periodic limb movements disorder (PLMD), and (e) epilepsy. METHOD Five case reports are presented; each child but one underwent video-polysomnography. RESULTS The first case report is an example of ADHD and SDB, with improvement of hypersomnolence after resolution of sleep apnea. The second case shows the impact of delayed sleep onset latency in the pathogenesis of ADHD, and the efficacy of melatonin. The third case report describes the association with PLMD, with amelioration after iron supplementation. The other two cases are examples of ADHD and epilepsy, with clinical improvement after antiepileptic treatment was started. CONCLUSION A diagnostic and therapeutic algorithm should be designed to find the best first-line treatment for ADHD and sleep problems/epilepsy.
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Papoff P, Guelfi G, Cicchetti R, Caresta E, Cozzi DA, Moretti C, Midulla F, Miano S, Cerasaro C, Cascone P. Outcomes after tongue-lip adhesion or mandibular distraction osteogenesis in infants with Pierre Robin sequence and severe airway obstruction. Int J Oral Maxillofac Surg 2013. [PMID: 23978696 DOI: 10.1016/j.ijom.2013.07.747.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
The objective was to review and compare outcomes after tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) in infants with severe breathing difficulties related to Pierre Robin sequence (PRS). A single-centre retrospective (2002-2012) study was carried out; 18 infants with severe breathing difficulties related to PRS resistant to conservative treatment, who underwent TLA or MDO to correct airway obstruction, were enrolled. The primary outcome measures were successful weaning from respiratory support and resumption of full oral feeding. Nine underwent TLA and nine MDO. Eight of the nine infants who underwent MDO and all those treated with TLA were successfully weaned from respiratory support. After discharge, residual respiratory distress was diagnosed more commonly after TLA than after MDO (6/9 vs 1/9, P=0.050). Infants resumed oral feeding sooner after MDO than after TLA (mean days after surgery to full oral feeds 44±24 vs 217±134, P<0.003). The length of hospital stay was longer for infants treated with MDO than for those treated with TLA. The rate of complications was similar. Infants with severe airway obstruction related to PRS can benefit safely from either TLA or MDO. Although MDO lengthens the time to discharge, this option stabilizes airway patency of infants with PRS more efficiently and achieves full oral feeding more rapidly than TLA.
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Affiliation(s)
- P Papoff
- Pediatric Emergency and Intensive Care, Sapienza University of Rome, Umberto I Policlinico, Rome, Italy.
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Correale P, Montagnani F, Miano S, Sciandivasci A, Pascucci A, Petrioli R, Testi W, Tanzini G, Francini G. Biweekly Triple Combination Chemotherapy with Gemcitabine, Oxaliplatin, Levofolinic Acid and 5-Fluorouracil (GOLF) Is a Safe and Active Treatment for Patients with Inoperable Pancreatic Cancer. J Chemother 2013; 20:119-25. [DOI: 10.1179/joc.2008.20.1.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Esposito M, Parisi P, Miano S, Carotenuto M. Migraine and periodic limb movement disorders in sleep in children: a preliminary case-control study. J Headache Pain 2013; 14:57. [PMID: 23815623 PMCID: PMC3704667 DOI: 10.1186/1129-2377-14-57] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/22/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The relationships between sleep and headaches are complex and manifold. About the variety of phenomena that can disrupt the sleep macrostructure and can impact its restorative function, the periodic limb movements disorder (PLMd) can be considered as the most powerful.No studies are known about the role of PLMd in the pathophysiology of migraine in children.Aim of study is to assess the prevalence of PLMd and migraine and their relationship with disability and pain intensity in a pediatric sample, referred for migraine without aura by pediatricians. METHODS After a preliminary sleep habits screening with the Sleep Disturbances Scale for Children, 34 migraine subjects affected by migraine without aura (20 M, 14 F) (mean age 9.08; SD ± 2.28) and 51 volunteers healthy children (28 M, 23 F) (mean age 9.37; SD ± 1.81) accepted to underwent overnight PSG recordings in the Sleep Laboratory of the Clinic of Child and Adolescent Neuropsychiatry, in order to define the macrostructural sleep characteristics and the prevalence of PLMd. Subsequently, the migraineurs sample was studied in order to define the relationship between disability, pain intensity, therapeutical responsiveness and the presence of PLMd. RESULTS In the migraineurs children group, the individuals with PLM pathological index (PLMI ≥ 5) represent the 26.47% of sample and present higher frequency (p < 0.001), intensity (p < 0.001), duration (p = 0.006) and life impairment as scored in the PedMIDAS (p < 0.001) of headache and lower efficacy of prophylactic (p = 0.001) and acute (p = 0.006) pharmacological treatment than MoA children without PLM pathological index. CONCLUSIONS This preliminary study indicates the potential value of the determination of the PLMd signs, and the importance of the PSG evaluation in children affected by migraine, particularly when the clinical and pharmacological management tend to fail in the attacks control.
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Affiliation(s)
- Maria Esposito
- Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Via Sergio Pansini 5 PAD XI, Naples 80131, Italy
| | - Pasquale Parisi
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Via di Grottarossa, 1035-1039, Rome 00189, Italy
| | - Silvia Miano
- Child Neurology, Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Via di Grottarossa, 1035-1039, Rome 00189, Italy
| | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Via Sergio Pansini 5 PAD XI, Naples 80131, Italy
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Miano S, Peraita-Adrados R. [Nocturnal frontal lobe epilepsy is often misdiagnosed as sleep disorders in children: a case series]. Rev Neurol 2013; 56:257-267. [PMID: 23440753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION. We present a series of children who underwent a video-polysomnographic recording at our Sleep and Epilepsy Unit, who received a diagnosis of nocturnal frontal lobe epilepsy (NFLE). AIMS. To describe electroclinical and video polygraphic features of paediatric NFLE that differentiate this condition from other sleep disorders that overlap and mimic the sleep motor and autonomic events of NFLE. PATIENTS AND METHODS. The inclusion criterion was that the patients have their first video-EEG-PSG recording in our laboratory. RESULTS. Twenty-four out of 190 children were diagnosed with NFLE (group 1); while 166 had other sleep disorders (group 2). Among children diagnosed with NFLE, seven were referred for sleep-disordered breathing, seven for parasomnias, two for insomnia, two for hypersomnia, and one for periodic limb movements, while five were referred for epilepsy. In group 1, perinatal history was normal in most cases (21 out of 24) and a familiar history of epilepsy was found in four cases. Sleep-disordered breathing was diagnosed as a comorbid condition in four children. Standard EEG was normal in 21 cases. Interictal EEG showed epileptic discharges in four cases, while ictal EEG was expressed by a rhythmic theta activity preceded by an arousal and/or a short background desynchronization, movement artifacts, and autonomic changes. All seizures, repeated highly stereotyped motor events, were followed by stage shifts and/or a postural change and, by short awakenings. CONCLUSIONS. We found a high percentage of children with NFLE, often misdiagnosed or associated with other sleep disorders, which may be a trigger for nocturnal seizures.
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Affiliation(s)
- Silvia Miano
- Neuroscience, Mental Health and Sense Organs Department, Universita La Sapienza, Roma, Italia.
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Cicchetti R, Cascone P, Caresta E, Papoff P, Miano S, Cerasaro C, Ramieri V, Midulla F, Moretti C. Mandibular distraction osteogenesis for neonates with Pierre Robin sequence and airway obstruction. J Matern Fetal Neonatal Med 2013; 25 Suppl 4:141-3. [PMID: 22958047 DOI: 10.3109/14767058.2012.715011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neonates with Pierre Robin Sequence (PRS) usually present with varying degrees of upper airway obstruction and difficulty feeding. Early treatment is important for such children in order to prevent impaired cognitive development resulting from hypoxemic episodes. Various procedures aimed at widening the pharyngeal space have been proposed, including prone position, tongue-lip adhesion, mandibular traction, non-invasive ventilation and palatal plates. Mandibular distraction osteogenesis (MDO) using external or internal devices has become increasingly popular as an alternative treatment option when other medical or surgical techniques do not prove to be satisfactory. This review summarizes current evidence on the effectiveness of MDO in infants with PRS. Because of a lack of studies comparing this treatment with other procedures, general recommendations cannot be drawn and treatment of infants with PRS still requires individualization.
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Affiliation(s)
- Roberto Cicchetti
- Department of Paediatrics, Paediatric Emergency and Intensive Care, Sapienza University of Rome, Italy
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