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Townsend LTJ, Anderson KN, Boeve BF, McKeith I, Taylor JP. Sleep disorders in Lewy body dementia: Mechanisms, clinical relevance, and unanswered questions. Alzheimers Dement 2023; 19:5264-5283. [PMID: 37392199 DOI: 10.1002/alz.13350] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/03/2023]
Abstract
In Lewy body dementia (LBD), disturbances of sleep and/or arousal including insomnia, excessive daytime sleepiness, rapid eye movement (REM) sleep behavior disorder, obstructive sleep apnea, and restless leg syndrome are common. These disorders can each exert a significant negative impact on both patient and caregiver quality of life; however, their etiology is poorly understood. Little guidance is available for assessing and managing sleep disorders in LBD, and they remain under-diagnosed and under-treated. This review aims to (1) describe the specific sleep disorders which occur in LBD, considering their putative or potential mechanisms; (2) describe the history and diagnostic process for these disorders in LBD; and (3) summarize current evidence for their management in LBD and consider some of the ongoing and unanswered questions in this field and future research directions.
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Affiliation(s)
- Leigh T J Townsend
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kirstie N Anderson
- Regional Sleep Service, Newcastle-upon-Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Zolfaghari S, Yao CW, Wolfson C, Pelletier A, Postuma RB. Sleep Disorders and Future Diagnosis of Parkinsonism: A Prospective Study Using the Canadian Longitudinal Study on Aging. J Parkinsons Dis 2021; 12:257-266. [PMID: 34744049 DOI: 10.3233/jpd-212796] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Earlier detection of parkinsonism, specifically during its prodromal stage, may be key to preventing its progression. Previous studies have produced contradictory results on the association between sleep symptoms and prodromal parkinsonism. OBJECTIVE We conducted a prospective study within the Canadian Longitudinal Study on Aging (CLSA) to determine whether self-reported symptoms of insomnia, somnolence, apnea, and restless legs syndrome predate the diagnosis of parkinsonism after three years of follow-up. METHODS At baseline, amongst other information, participants completed a questionnaire for difficulty initiating or maintaining sleep, daytime somnolence, snoring or stopping breathing during sleep, and symptoms of restless legs syndrome. After 3 years of follow-up, baseline responses from participants who self-reported a new diagnosis of parkinsonism (cases) were compared to those who did not (controls). For each case, 10 controls were individually matched by age, sex, education, BMI, caffeine, smoking, and alcohol. Binary unconditional logistic regression models were used to estimate the association between sleep symptoms and new-onset parkinsonism, adjusting for age, sex, education, BMI, smoking, alcohol, and caffeine. RESULTS We identified 58 incident-parkinsonism cases and 580 matched controls (65.5%male, mean age = 69.60, SD = 8.0). Baseline symptoms of sleep-onset insomnia (12.1%vs. 13.0%, Adjusted OR[95%CI] = 0.87[0.32,2.33]), sleep-maintenance insomnia (24.1%vs. 20.2%, AOR = 1.01[0.46,2.20]), daytime somnolence (8.6%vs. 7.4%, AOR = 1.11[0.37,3.39]), obstructive sleep apnea (27.3%vs. 26.2%, AOR = 0.84[0.40,1.79]), and restless leg syndrome (20.6%vs. 9.9%, AOR = 1.34[0.42,4.25]) were similar among those who developed parkinsonism and those who did not. CONCLUSION Symptoms of insomnia, somnolence, apnea, and restless legs did not predate a new diagnosis of parkinsonism over 3 years.
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGillUniversity, Montreal, Quebec, Canada.,ResearchInstitute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Chun W Yao
- Integrated Program in Neuroscience, McGillUniversity, Montreal, Quebec, Canada.,ResearchInstitute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Christina Wolfson
- ResearchInstitute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatisticsand Occupational Health, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Neurology andNeurosurgery, McGill University, Montreal, Quebec, Canada
| | - Amelie Pelletier
- ResearchInstitute of the McGill University Health Centre, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacrä-Coeur de Monträal, Montreal, Quebec
| | - Ronald B Postuma
- ResearchInstitute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Neurology andNeurosurgery, McGill University, Montreal, Quebec, Canada.,Centre for Advanced Research in Sleep Medicine, Hôpital du Sacrä-Coeur de Monträal, Montreal, Quebec
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Rodríguez-Almagro D, Achalandabaso-Ochoa A, Obrero-Gaitán E, Osuna-Pérez MC, Ibáñez-Vera AJ, Lomas-Vega R. Sleep Alterations in Female College Students with Migraines. Int J Environ Res Public Health 2020; 17:E5456. [PMID: 32751117 DOI: 10.3390/ijerph17155456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Background: Many factors are thought to potentially trigger migraines, among which sleep disturbances are one of the most frequently reported. Both sleep disorders and migraines affect more women than men. This study aims to analyze sleep alterations in young adult women with migraines and how they are related to the presence, frequency, intensity, and disability of migraines in this population. Methods: Fifty-one female university students with physician-diagnosed migraines and 55 healthy female university students completed surveys assessing demographic information and frequency, intensity, and disability of migraines and sleep quality variables. Results: No differences in sleep quality were found between migraine subjects and healthy women (p = 0.815), but women with migraines presented higher daytime somnolence (p = 0.010), greater sleep disruptions (p = 0.002), and decreased sleep adequacy (p = 0.019). The presence of a migraine was significantly related to daytime somnolence (p = 0.003) and sleep disruptions (p = 0.021). Migraine-related disability was associated with sleep disruptions (p = 0.002), snoring (p = 0.016), and a decreased quantity of sleep (p = 0.040). Migraine frequency was related to sleep disturbance (p = 0.003) and snoring (p < 0.001). The intensity of migraines was associated with sleep disruptions (p = 0.004). Conclusions: Our results suggest a relationship between migraines and sleep alterations.
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Abstract
BACKGROUND Sleep may underlie psychiatric symptoms in young children. However, not many studies have reported on sleep and its associations with symptoms in young child psychiatric patients. OBJECTIVES To assess the amount and quality of sleep and how sleep associates with psychiatric symptoms in young child psychiatric patients. Furthermore, we evaluated how sleep and daytime somnolence differed in patients and their age- and gender-matched controls. METHOD The sample consisted of 139 3- to 7-year-old child psychiatric outpatients and 139 age- and gender-matched controls from community. We evaluated sleep and daytime somnolence with the Sleep Disturbance Scale for Children in all children and psychiatric symptoms with Child Behaviour Checklist (CBCL) in the patient group. Family background information was collected from the patients. RESULTS Of the patients, 31.6% had a significant sleep problem and 14.4% slept too little. The most typical sleep problems were restless sleep (31.7%), morning tiredness (21.6%) and difficulties getting to sleep at night (18.7%). All types of sleep problems were associated with CBCL total, internalising and externalising problems (all p-values < .01). We observed a strong association between all types of sleep problems and emotionally reactive subscale ( p-value < .001). Furthermore, parent-reported sleep problems increased significantly the risk of having high scores on total (odds ratio (OR) = 5.3, 95% confidence interval (CI) = [2.2, 12.6], p < .001), external (OR = 3.7, 95%, CI = [1.6, 8.5], p < .01) and internal (OR = 2.5, 95% CI = [1.1, 5.5], p < .05) scores after controlling for age, gender, family structure and parent's educational level. Even mild sleep disturbance increased the intensity of psychiatric symptoms. Compared to controls, patients slept less ( p < .001) and had significantly more frequent restless sleep, nightmares and morning and daytime somnolence. CONCLUSION Sleep problems and too little sleep are prevalent in young child psychiatric patients, and they relate strongly to the intensity of psychiatric symptoms. Identification and treatment of sleep problems should be a routine part of the treatment plan for young child psychiatric patients. The results emphasise the need for assessing sleep in young child psychiatric patients, as treating the sleep problem may reduce psychiatric symptoms.
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Affiliation(s)
- Hanna Huhdanpää
- 1 Laboratory of Developmental Psychopathology, Children's Hospital/Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Liisa Klenberg
- 2 Department of Psychology and Logopedics, University of Helsinki, Finland
| | - Hannu Westerinen
- 3 Department of Child Psychiatry, Helsinki University Hospital, Finland
| | - Tuija Fontell
- 3 Department of Child Psychiatry, Helsinki University Hospital, Finland
| | - Eeva T Aronen
- 1 Laboratory of Developmental Psychopathology, Children's Hospital/Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Finland
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Tsapanou A, Gu Y, O’Shea D, Eich T, Tang MX, Schupf N, Manly J, Zimmerman M, Scarmeas N, Stern Y. Daytime somnolence as an early sign of cognitive decline in a community-based study of older people. Int J Geriatr Psychiatry 2016; 31:247-55. [PMID: 26081795 PMCID: PMC5381157 DOI: 10.1002/gps.4318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 02/25/2015] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. We hypothesized that daytime somnolence predicts subsequent cognitive decline. METHODS This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. We used generalized estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. RESULTS Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = -0.143, p = 0.047) and longitudinally (B = -0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = -0.003, p = 0.021). CONCLUSIONS Our findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population.
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Affiliation(s)
- Angeliki Tsapanou
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Yian Gu
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Deirdre O’Shea
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Teal Eich
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ming-Xin Tang
- The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,Department of Biostatistics, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Nicole Schupf
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jennifer Manly
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Molly Zimmerman
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Nikolaos Scarmeas
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA,National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA,The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA,The Division of Epidemiology, Joseph P. Mailman School of Public Health, Columbia University, New York, NY, USA
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Abstract
BACKGROUND Nonmotor symptoms in dystonia are increasingly recognized to impair the quality of life. The primary objective of this study was to determine the prevalence of fatigue and sleep disturbances in dystonia and to ascertain their impact on quality of life using standardized questionnaires. METHODS Dystonia patients presenting to a Botulinum toxin clinic were prospectively administered Fatigue Severity Scale (FSS), Multidimensional Fatigue Inventory (MFI), Epworth Sleepiness Scale (ESS) and Parkinson's Disease Sleep Scale (PDSS) for assessment of fatigue and sleep disturbances. Health-related Quality of life (HRQOL) was determined using MOS SF-36 scale and depressive symptoms were assessed using the Beck Depression Inventory II. RESULTS Ninety-one patients with dystonia participated (66 women, 25 men, mean age 60 ± 17 years). Nine subjects had generalized dystonia, 18 segmental dystonia and 64 had focal dystonia. Moderate to severe fatigue was present in 43% of the cohort (FSS), excessive daytime somnolence in 27% (ESS) and other sleep disturbances in 26% (PDSS). FSS and MFI scores correlated significantly with HRQOL even when controlled for depression and sleep disturbances. Excessive daytime somnolence and nocturnal sleep disturbances correlated significantly with the HRQOL; however, these effects were not seen for daytime somnolence when controlled for depression. Psychometric testing found adequate reliabilities and convergent validities for both fatigue and sleep scales. CONCLUSION Fatigue and sleep disturbances revealed high prevalence rates in this large, first of its dystonia study. They negatively impacted the quality of life even when controlled for comorbid depression.
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Affiliation(s)
- A Wagle Shukla
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - R Brown
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
| | - K Heese
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
| | - J Jones
- c 3 Department of Clinical Health Psychology , University of Florida , Gainesville , FL , USA
| | - R L Rodriguez
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - I M Malaty
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - M S Okun
- a 1 Department of Neurology , University of Florida , Gainesville , FL , USA
| | - B M Kluger
- b 2 Department of Neurology , University of Colorado , Aurora , CO , USA
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Simuni T, Caspell-Garcia C, Coffey C, Chahine LM, Lasch S, Oertel WH, Mayer G, Högl B, Postuma R, Videnovic A, Amara AW, Marek K. Correlates of excessive daytime sleepiness in de novo Parkinson's disease: A case control study. Mov Disord 2015; 30:1371-81. [PMID: 26095202 DOI: 10.1002/mds.26248] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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: 12/30/2014] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study was undertaken to determine the frequency and correlates of excessive daytime sleepiness in de novo, untreated Parkinson's disease (PD) patients compared with the matched healthy controls. METHODS Data were obtained from the Parkinson's Progression Markers Initiative, an international study of de novo, untreated PD patients and healthy controls. At baseline, participants were assessed with a wide range of motor and nonmotor scales, including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Excessive daytime sleepiness was assessed based on the Epworth Sleepiness scale (ESS), with a cutoff of 10. RESULTS Four hundred twenty-three PD subjects and 196 healthy controls were recruited into the study. Mean ESS (min, max) score was 5.8 (0, 20) for the PD subjects and 5.6 (0, 19) for healthy controls (P = 0.54). Sixty-six (15.6%) PD subjects and 24 (12%) healthy controls had ESS of at least 10 (P = 0.28). No difference was seen in demographic characteristics, age of onset, disease duration, PD subtype, cognitive status, or utilization of sedatives between the PD sleepiness-positive versus the negative group. The sleepiness-positive group had higher MDS-UPDRS Part I and II but not III scores, and higher depression and autonomic dysfunction scores. Sleepiness was associated with a marginal reduction of A-beta (P = 0.05) but not alpha-synuclein spinal fluid levels in PD. CONCLUSIONS This largest case control study demonstrates no difference in prevalence of excessive sleepiness in subjects with de novo untreated PD compared with healthy controls. The only clinical correlates of sleepiness were mood and autonomic dysfunction. Ongoing longitudinal analyses will be essential to further examine clinical and biological correlates of sleepiness in PD and specifically the role of dopaminergic therapy.
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Affiliation(s)
- Tanya Simuni
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Lama M Chahine
- The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shirley Lasch
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | | | - Geert Mayer
- Hephata-Klinik, Hephata Hessisches Diakoniezentrum e. V
| | - Birgit Högl
- Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | - Ken Marek
- Institute for Neurodegenerative Disorders, New Haven, CT, USA
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Perez-Lloret S, Videla AJ, Richaudeau A, Vigo D, Rossi M, Cardinali DP, Perez-Chada D. A multi-step pathway connecting short sleep duration to daytime somnolence, reduced attention, and poor academic performance: an exploratory cross-sectional study in teenagers. J Clin Sleep Med 2013; 9:469-73. [PMID: 23674938 DOI: 10.5664/jcsm.2668] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A multi-step causality pathway connecting short sleep duration to daytime somnolence and sleepiness leading to reduced attention and poor academic performance as the final result can be envisaged. However this hypothesis has never been explored. OBJECTIVE To explore consecutive correlations between sleep duration, daytime somnolence, attention levels, and academic performance in a sample of school-aged teenagers. METHODS We carried out a survey assessing sleep duration and daytime somnolence using the Pediatric Daytime Sleepiness Scale (PDSS). Sleep duration variables included week-days' total sleep time, usual bedtimes, and absolute weekday to-weekend sleep time difference. Attention was assessed by d2 test and by the coding subtest from the WISC-IV scale. Academic performance was obtained from literature and math grades. Structural equation modeling was used to assess the independent relationships between these variables, while controlling for confounding effects of other variables, in one single model. Standardized regression weights (SWR) for relationships between these variables are reported. RESULTS Study sample included 1,194 teenagers (mean age: 15 years; range: 13-17 y). Sleep duration was inversely associated with daytime somnolence (SWR = -0.36, p < 0.01) while sleepiness was negatively associated with attention (SWR = -0.13, p < 0.01). Attention scores correlated positively with academic results (SWR = 0.18, p < 0.01). Daytime somnolence correlated negatively with academic achievements (SWR = -0.16, p < 0.01). The model offered an acceptable fit according to usual measures (RMSEA = 0.0548, CFI = 0.874, NFI = 0.838). A Sobel test confirmed that short sleep duration influenced attention through daytime somnolence (p < 0.02), which in turn influenced academic achievements through reduced attention (p < 0.002). CONCLUSIONS Poor academic achievements correlated with reduced attention, which in turn was related to daytime somnolence. Somnolence correlated with short sleep duration.
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Affiliation(s)
- Santiago Perez-Lloret
- Departamento de Docencia e Investigación, Facultad de Ciencias Médicas, Universidad Católica Argentina, Buenos Aires, Argentina.
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Lower EE, Malhotra A, Surdulescu V, Baughman RP. Armodafinil for sarcoidosis-associated fatigue: a double-blind, placebo-controlled, crossover trial. J Pain Symptom Manage 2013; 45:159-69. [PMID: 22917711 PMCID: PMC3678278 DOI: 10.1016/j.jpainsymman.2012.02.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 02/13/2012] [Accepted: 02/20/2012] [Indexed: 11/17/2022]
Abstract
CONTEXT Fatigue has been identified in more than one-half of patients with sarcoidosis. Although fatigue is not synonymous with impaired quality of life, most studies of sarcoidosis identify fatigue as a major cause of impaired quality of life. OBJECTIVES To test the hypothesis that stimulants may have a role in the treatment of fatigued sarcoidosis patients, even without objective evidence of daytime sleepiness. METHODS This was a double-blind, placebo-controlled, crossover study of sarcoidosis patients followed up in one sarcoidosis clinic Sarcoidosis patients with fatigue received either armodafinil or placebo with eight weeks of therapy for each arm and a two week washout period before crossover to the other treatment. Initial armodafinil dose was 150mg and increased to 250mg after four weeks. Patients underwent polysomnography and multiple sleep latency testing (MSLT) the following day. Patients with an apnea/hypopnea index <6/hour received either armodafinil or placebo. Polysomnography with MSLT was repeated after each treatment arm. RESULTS Fifteen patients received the study drug. Fatigue was assessed using the Fatigue Assessment Scale (the lower the score, the less the fatigue) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) (the higher the score, the less the fatigue). After eight weeks of therapy, there was a significant improvement in the Fatigue Assessment Scale during armodafinil treatment (median -4.5, range -20, 5) compared with placebo treatment (median 3.5, range -9, 14, P<0.05) and for the FACIT-F (armodafinil: median 9, range -12, 26 vs. placebo: median -5, range -17, 11, P<0.005). This improvement in fatigue was seen for both those with and without shortened sleep onset latency time during the MSLT. CONCLUSION Armodafinil treatment led to a significant reduction in fatigue in sarcoidosis patients. This effect was seen even in patients who did not have excessive daytime somnolence.
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Affiliation(s)
- Elyse E Lower
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA
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Verma A, Anand V, Verma NP. Sleep disorders in chronic traumatic brain injury. J Clin Sleep Med 2007; 3:357-62. [PMID: 17694723 PMCID: PMC1978305] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVE To examine the spectrum of sleep disorders in patients with chronic traumatic brain injury (TBI) and determine if the severity of sleep disorder is related to severity of chronic TBI. METHODS Patients who underwent evaluation for sleep disorder/s following a TBI were included in this retrospective analysis. Sixty adult patients with TBI (age 20-69 yr; 38 M and 22 F), who presented with sleep-related complaints 3 months to 2 years following TBI, were studied. None had sleep complaints prior to the TBI. Orophrayngeal, chin, and TMJ examinations were considered benign. The severity of injury was assessed by the Global Assessment of Functioning (GAF) scale. Polysomnograms (PSGs) were performed on 54 patients (90%), 28 of whom underwent multiple sleep latency tests (MSLTs) because they scored >11 on the Epworth Sleepiness Scale (ESS). The Beck Depression Inventory (BDI) scale was administered if there was sleep maintenance insomnia, and the Hamilton Anxiety Scale (HAS) was administered if there was sleep onset insomnia. RESULTS The TBI severity was mild in 40%, moderate in 20%, and severe in 40%. The Epworth Sleepiness Scale (ESS) score was elevated (>11) in 52%. Hypersomnia was the presenting complaint in 50%, mostly due to sleep apnea, narcolepsy, and periodic limb movement disorder (PLMD). Insomnia was the presenting complaint in 25%, half with sleep maintenance insomnia and high BDI scores, and the remainder with sleep onset insomnia and high HAS scores. Parasomnia was the presenting complaint in 25%; the most frequent parasomnia was REM behavior disorder (RBD). GAF scores were significantly correlated (p < 0.05) with some of the measures of sleep disruption (stage 1, sleep efficiency, and wake during sleep), but not with others (wake before sleep, stage-shifts, PLMI, PLMA and AHI) on the PSG. Fifty-three percent (15/28) had a mean sleep onset latency <5 minutes, and 32% (9/28), also had two or more sleep onset rapid eye movement periods (SOREMPs) on the MSLT. CONCLUSION The results of this study demonstrate that a full spectrum of common sleep disorders occurs in patients with chronic TBI. The severity of chronic TBI as measured by GAF scores is correlated with some of the measures of sleep disruption but not others, indicating a complex and multifactorial pathogenesis.
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Affiliation(s)
- Arunima Verma
- B.G. Tricounty Neurology and Sleep Clinic, Warren, MI
| | - Vivek Anand
- B.G. Tricounty Neurology and Sleep Clinic, Warren, MI
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