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Basquin L, Maruani J, Leseur J, Mauries S, Bazin B, Pineau G, Henry C, Lejoyeux M, Geoffroy PA. Study of the different sleep disturbances during the prodromal phase of depression and mania in bipolar disorders. Bipolar Disord 2024. [PMID: 38653574 DOI: 10.1111/bdi.13429] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. METHODS Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. RESULTS Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. CONCLUSION This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.
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Affiliation(s)
- Louise Basquin
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
| | - Julia Maruani
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Jeanne Leseur
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Sibylle Mauries
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | | | - Guillaume Pineau
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
| | - Chantal Henry
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
- Université de Paris, Paris, France
| | - Michel Lejoyeux
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- NeuroDiderot, Inserm, FHU I2-D2, Université Paris Cité, Paris, France
- GHU Paris - Psychiatrie & Neurosciences, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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Šonka K, Feketeová E, Nevšímalová S, Horvat EM, Příhodová I, Dostálová S, Galušková K, Milata M, Bušková J, Susta M. Idiopathic hypersomnia years after the diagnosis. J Sleep Res 2024; 33:e14011. [PMID: 37572055 DOI: 10.1111/jsr.14011] [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: 05/08/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Little attention has been paid to the long-term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow-up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence.
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Affiliation(s)
- Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Feketeová
- Department of Neurology, Faculty of Medicine, University of P.J. Šafárik and University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Soňa Nevšímalová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eszter Maurovich Horvat
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Iva Příhodová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolína Galušková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Milata
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jitka Bušková
- National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Susta
- St. Elisabeth University, Bratislava, Slovak Republic
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Tang SH, Min J, Zhang X, Uwah E, Griffis HM, Cielo CM, Fiks AG, Mindell JA, Tapia IE, Williamson AA. Incidence of pediatric narcolepsy diagnosis and management: evidence from claims data. J Clin Sleep Med 2024. [PMID: 38450539 DOI: 10.5664/jcsm.11104] [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] [Indexed: 03/08/2024]
Abstract
STUDY OBJECTIVES To characterize the incidence of pediatric narcolepsy diagnosis, subsequent care, and potential sociodemographic disparities in a large US claims database. METHODS Merative MarketScan insurance claims (n=12,394,902) were used to identify youth (6-17 years) newly diagnosed with narcolepsy (ICD-10 codes). Narcolepsy diagnosis and care 1-year post-diagnosis included polysomnography (PSG) with Multiple Sleep Latency Test (MSLT), pharmacological care, and clinical visits. Potential disparities were examined by insurance coverage and child race and ethnicity (Medicaid-insured only). RESULTS The incidence of narcolepsy diagnosis was 10:100,000, primarily type 2 (69.9%). Most diagnoses occurred in adolescents with no sex differences, but higher rates in Black versus White youth with Medicaid. Two-thirds had a prior sleep disorder diagnosis and 21-36% had other co-occurring diagnoses. Only half (46.6%) had a PSG with MSLT (± 1-year post-diagnosis). Specialty care (18.9% pulmonary, 26.9% neurology) and behavioral health visits were rare (34.4%), although half were prescribed stimulant medications (51.0%). Medicaid-insured were 86% less likely than commercially insured youth to have any clinical care and 33% less likely to have a PSG with MSLT. CONCLUSIONS Narcolepsy diagnoses occurred in 0.01% of youth, primarily during adolescence, and at higher rates for Black versus White children with Medicaid. Only half had evidence of a diagnostically required PSG with MSLT, underscoring potential misdiagnosis. Many patients had co-occurring conditions, but specialty and behavioral health care were limited. Results suggest misdiagnosis, underdiagnosis, and limited narcolepsy treatment, as well as possible insurance-related disparities. Results highlight the need to identify determinants of evidence-based pediatric narcolepsy diagnosis and management.
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Affiliation(s)
- Si Hao Tang
- Drexel University College of Medicine, Philadelphia, PA
| | - Jungwon Min
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Xuemei Zhang
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Christopher M Cielo
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Jodi A Mindell
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- University of Miami, Miller School of Medicine, Miami, FL
| | - Ignacio E Tapia
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- University of Miami, Miller School of Medicine, Miami, FL
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- The Ballmer Institute, University of Oregon, Portland, OR
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Jeantin L, Gales A, Berzero G, Leu S, Proust J, Giry M, Valyraki NE, Birzu C, Alentorn A, Vidailhet M, Psimaras D, Arnulf I. Hypersomnia in anti-glutamic acid decarboxylase 65 (GAD65) associated neurological syndromes: A pilot study. Eur J Neurol 2024; 31:e16125. [PMID: 37922501 DOI: 10.1111/ene.16125] [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: 08/10/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND AND PURPOSE Despite their detrimental impact on the quality of life in autoimmune encephalitis, sleep disorders have not been investigated in anti-glutamic acid decarboxylase (GAD65) associated neurological syndromes. METHODS Six consecutive adult patients diagnosed with anti-GAD65-associated neurological syndromes (four with limbic encephalitis and two with stiff-person syndrome) and 12 healthy controls were enrolled. Participants underwent sleep interviews and sleep studies including night-time video-polysomnography, followed by five daytime multiple sleep latency tests (MSLTs, to assess propensity to fall asleep) and an 18 h bed rest polysomnography (to assess excessive sleep need). RESULTS Patients reported the need for daily naps and that their cognition and quality of life were altered by sleepiness, but they had normal scores on the Epworth sleepiness scale. Compared with controls, sleep latencies during the MSLT were shorter in the patient group (median 5.8 min, interquartile range [IQR] 4.5, 6.0 vs. 17.7 min, IQR 16.3, 19.7, p = 0.001), and the arousal index was reduced (2.5/h, IQR 2.3, 3.0 vs. 22.3/h, IQR 13.8, 30.0, p = 0.002), although total sleep time was similar between groups (621 min, IQR 464, 651 vs. 542.5 min, IQR 499, 582, p = 0.51). Remarkably, all six patients had MSLT latencies ≤8 min, indicating severe sleepiness. No parasomnia or sleep-disordered breathing was detected. CONCLUSION Central hypersomnia is a relevant characteristic of anti-GAD65-associated neurological syndromes.
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Affiliation(s)
- Lina Jeantin
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Ana Gales
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Giulia Berzero
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Smaranda Leu
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Jérémy Proust
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Marine Giry
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Nefeli Eirini Valyraki
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Cristina Birzu
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Agusti Alentorn
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Marie Vidailhet
- Movement Disorder Unit, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dimitri Psimaras
- Neuro-Oncology Unit, Neurology Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Isabelle Arnulf
- Sleep Disorders Unit, R3S Department, Pitié-Salpêtrière Hospital, AP-HP Sorbonne University, Paris, France
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Shimada Y, Oda Y, Shibata S, Hirose Y, Sasaki T. Successful Challenge With Brexpiprazole for Idiopathic Hypersomnia in a Patient With Bipolar Disorder: A Case Report. Cureus 2024; 16:e53182. [PMID: 38420100 PMCID: PMC10901582 DOI: 10.7759/cureus.53182] [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] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
We describe a 32-year-old Japanese female with hypersomnia and bipolar disorder. She had developed hypersomnia and sleep attacks in her teens. She was misdiagnosed with narcolepsy at a neurology department and then received methylphenidate (MPH) for many years. After giving birth, she developed postpartum depression and suffered from mood swings and irritability. Following 10-year treatment with methylphenidate, she experienced MPH-induced psychosis when she was in a manic state. Her psychosis improved rapidly with the cessation of methylphenidate. Furthermore, brexpiprazole treatment ameliorated her manic symptoms and hypersomnolence. Post-discharge, she was diagnosed with idiopathic hypersomnia based on nocturnal polysomnography and a multiple sleep latency test. This case indicates that brexpiprazole as a serotonin dopamine activity modulator might provide therapeutic effects against not only the patient's manic symptoms but also idiopathic hypersomnia.
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Affiliation(s)
- Yuka Shimada
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Yasunori Oda
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Shintaro Shibata
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Yuki Hirose
- Department of Psychiatry, Chiba University Graduate School of Medicine, Chiba, JPN
| | - Tsuyoshi Sasaki
- Department of Child Psychiatry, Chiba University Hospital, Chiba, JPN
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Schneider LD, Morse AM, Strunc MJ, Lee-Iannotti JK, Bogan RK. Long-Term Treatment of Narcolepsy and Idiopathic Hypersomnia with Low-Sodium Oxybate. Nat Sci Sleep 2023; 15:663-675. [PMID: 37621721 PMCID: PMC10445641 DOI: 10.2147/nss.s412793] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Narcolepsy and idiopathic hypersomnia are chronic conditions that negatively affect alertness, mental and physical energy, functioning, and quality of life (QoL). Calcium, magnesium, potassium, and sodium oxybates (low-sodium oxybate; LXB) is an oxybate formulation with 92% less sodium than sodium oxybate (SXB; a treatment for narcolepsy) and the same active moiety. LXB is approved in the US for treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age or older with narcolepsy, and idiopathic hypersomnia in adults. In Phase 3 clinical trials, LXB exhibited a safety profile consistent with that of SXB in narcolepsy. Besides continued efficacy in treating symptoms, potential benefits of long-term LXB treatment include flexible optimization of dosing and regimen, improvement of QoL and functioning, weight loss, and (relative to SXB in narcolepsy) health benefits of reduced sodium content. Dosing of LXB is twice nightly (for narcolepsy) or once or twice nightly (for idiopathic hypersomnia) based on patient characteristics and response, and individualized titration can be leveraged over the long term as a patient's life circumstances change. Patients with narcolepsy transitioning from SXB initiate LXB at the same dose, and most patients require no further changes to achieve similar efficacy and tolerability. Improvements in functioning and QoL with LXB treatment could have cascading positive effects in multiple domains, particularly in younger patients. In clinical trials, LXB was associated with weight loss in both narcolepsy (in which obesity is a well-established comorbidity) and idiopathic hypersomnia, only occasionally leading participants to be underweight. As both narcolepsy and idiopathic hypersomnia are associated with increased risk of cardiometabolic and cardiovascular comorbidities, limiting medication-related sodium intake with LXB may have significant health benefits, although this has not yet been verified prospectively due to the prolonged follow-up required. LXB is a promising long-term treatment for narcolepsy and idiopathic hypersomnia.
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Affiliation(s)
- Logan D Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anne Marie Morse
- Janet Weis Children’s Hospital, Geisinger Medical Center, Danville, PA, USA
| | - Michael J Strunc
- The Center for Pediatric Sleep Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA, USA
| | - Joyce K Lee-Iannotti
- Department of Neurology, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Richard K Bogan
- Department of Pulmonology, University of South Carolina School of Medicine, Columbia, SC, USA
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Stevens J, Schneider LD, Husain AM, Ito D, Fuller DS, Zee PC, Macfadden W. Impairment in Functioning and Quality of Life in Patients with Idiopathic Hypersomnia: The Real World Idiopathic Hypersomnia Outcomes Study (ARISE). Nat Sci Sleep 2023; 15:593-606. [PMID: 37551277 PMCID: PMC10404411 DOI: 10.2147/nss.s396641] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/13/2023] [Indexed: 08/09/2023] Open
Abstract
Purpose Idiopathic hypersomnia is a debilitating neurologic sleep disorder characterized by excessive daytime sleepiness, sleep inertia, and prolonged sleep. Its impact on patients' quality of life and daily functioning has not been fully elucidated. The Real World Idiopathic Hypersomnia Outcomes Study (ARISE) evaluated the daily functioning, relationships, cognition, emotional well-being, and productivity/employment of participants with idiopathic hypersomnia. Patients and Methods ARISE was a US-based virtual cross-sectional survey comprising multiple patient-reported outcome measures (Functional Outcomes of Sleep Questionnaire, short version [FOSQ-10], Quality of Life in Neurological Disorders [Neuro-QoL] Social Roles and Stigma domains, British Columbia Cognitive Complaints Inventory [BC-CCI], Patient Health Questionnaire [PHQ-9], and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Participants were adults 21-65 years of age with idiopathic hypersomnia. Data were analyzed for all participants and for subgroups with/without long sleep time (LST; self-reported sleep ≥11 hours in 24 hours). Results Of 75 participants enrolled, most were female (81.3%) and the mean (SD) age was 34.1 (10.7) years. Participants' scores on the FOSQ-10 (mean [SD] score: 10.7 [2.8]) and the Neuro-QoL Social Roles (43.4 [4.2]) and Stigma (57.3 [5.9]) domains reflected impairments in daily functioning and quality of life. More than half of participants reported moderate to severe cognitive complaints (BC-CCI; 62.7%) and moderate to severe depressive symptoms (PHQ-9; 66.7%). Scores on the WPAI:SHP showed substantial impairments in absenteeism, presenteeism, overall work productivity, and overall regular daily activity (mean percent [SD]: 12.3 [23.6], 47.6 [22.7], 51.4 [24.7], and 64.0 [21.9], respectively). These considerable impairments were found in participants with and without LST. Conclusion ARISE participants with idiopathic hypersomnia demonstrated poor quality of life and impaired functioning across multiple symptom domains.
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Affiliation(s)
- Joanne Stevens
- Global Medical Affairs, Jazz Pharmaceuticals, Philadelphia, PA, USA
| | - Logan D Schneider
- Stanford University Sleep Medicine Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Aatif M Husain
- Duke University Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wayne Macfadden
- Global Medical Affairs, Jazz Pharmaceuticals, Philadelphia, PA, USA
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Zolfaghari S, Cyr M, Pelletier A, Postuma RB. Effects of Season and Daylight Savings Time Shifts on Sleep Symptoms: Canadian Longitudinal Study on Aging. Neurology 2023:WNL.0000000000207342. [PMID: 37137725 DOI: 10.1212/wnl.0000000000207342] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/09/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There has been conflicting evidence regarding the association between seasonal changes and daylight-savings time and sleep disorders. This topic is of current particular interest, as the United States and Canada are considering the elimination of seasonal clock changes. The aim of this study is to compare sleep symptoms among participants who were interviewed in different seasons, and before/after the transition into daylight saving time (DST) and standard time (ST). METHODS 30,097 people aged 45-85 years taking part in the Canadian Longitudinal Study on Aging (CLSA) were studied. Participants completed a questionnaire on sleep duration, satisfaction, sleep-onset insomnia, sleep-maintenance insomnia, and hypersomnolence symptoms. Sleep disorders were compared between participants who were interviewed during different seasons and at different times of the year (DST/ST). Data was analyzed using Chi Square, ANOVA, binary logistic, and linear regression tests. RESULTS Among participants interviewed in different seasons, we found no difference in dissatisfaction with sleep, sleep-onset, sleep-maintenance, and hypersomnolence. Those interviewed in summer had slightly shorter sleep duration compared to winter (6.76±1.2 vs. 6.84±1.3 hours). Participants interviewed one week before versus one week after DST transition showed no difference in sleep symptoms, except for a 9-minute decrease in sleep duration a week after transition. However, those who were interviewed a week after transition to ST compared to a week before reported more dissatisfaction with sleep (28% vs. 22.6%, adjusted odds ratio [95%CI]=1.34 [1.02,1.76]), higher sleep-onset insomnia (7.1% vs. 3.3%, AOR=2.26 [1.19,4.27]), higher sleep-maintenance insomnia (12.9% vs. 8.2%, AOR=1.64 [1.02,2.66]), and more hypersomnolence with adequate sleep (7.3% vs. 3.6%, AOR=2.08 [1.14,3.79]. DISCUSSION We found small seasonal variations in sleep duration but no difference in other sleep symptoms. The transition from DST to ST was associated with a transient increase in sleep disorders.
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Affiliation(s)
- Sheida Zolfaghari
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mariève Cyr
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Amélie Pelletier
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Ronald B Postuma
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
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Wescott DL, Franzen PL, Hasler BP, Miller MA, Soehner AM, Smagula SF, Wallace ML, Hall MH, Roecklein KA. Elusive hypersomnolence in seasonal affective disorder: actigraphic and self-reported sleep in and out of depressive episodes. Psychol Med 2023; 53:1313-1322. [PMID: 37010222 PMCID: PMC10071357 DOI: 10.1017/s003329172100283x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hypersomnolence has been considered a prominent feature of seasonal affective disorder (SAD) despite mixed research findings. In the largest multi-season study conducted to date, we aimed to clarify the nature and extent of hypersomnolence in SAD using multiple measurements during winter depressive episodes and summer remission. METHODS Sleep measurements assessed in individuals with SAD and nonseasonal, never-depressed controls included actigraphy, daily sleep diaries, retrospective self-report questionnaires, and self-reported hypersomnia assessed via clinical interviews. To characterize hypersomnolence in SAD we (1) compared sleep between diagnostic groups and seasons, (2) examined correlates of self-reported hypersomnia in SAD, and (3) assessed agreement between commonly used measurement modalities. RESULTS In winter compared to summer, individuals with SAD (n = 64) reported sleeping 72 min longer based on clinical interviews (p < 0.001) and 23 min longer based on actigraphy (p = 0.011). Controls (n = 80) did not differ across seasons. There were no seasonal or group differences on total sleep time when assessed by sleep diaries or retrospective self-reports (p's > 0.05). Endorsement of winter hypersomnia in SAD participants was predicted by greater fatigue, total sleep time, time in bed, naps, and later sleep midpoints (p's < 0.05). CONCLUSION Despite a winter increase in total sleep time and year-round elevated daytime sleepiness, the average total sleep time (7 h) suggest hypersomnolence is a poor characterization of SAD. Importantly, self-reported hypersomnia captures multiple sleep disruptions, not solely lengthened sleep duration. We recommend using a multimodal assessment of hypersomnolence in mood disorders prior to sleep intervention.
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Affiliation(s)
| | - Peter L. Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brant P. Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Megan A. Miller
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, WA
| | - Adriane M. Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stephen F. Smagula
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith L. Wallace
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Statistics, University of Pittsburgh, Pittsburgh PA
| | - Martica H. Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Center for the Neural Basis of Behavior, University of Pittsburgh, Pittsburgh, PA
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10
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Phan K, Pamidi S, Gomez YH, Gorgui J, El-Messidi A, Gagnon R, Kimoff RJ, Abenhaim HA, Daskalopoulou SS. Sleep-disordered breathing in high-risk pregnancies is associated with elevated arterial stiffness and increased risk for preeclampsia. Am J Obstet Gynecol 2022; 226:833.e1-833.e20. [PMID: 34863697 DOI: 10.1016/j.ajog.2021.11.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Impaired vascular function is a central feature of pathologic processes preceding the onset of preeclampsia. Arterial stiffness, a composite indicator of vascular health and an important vascular biomarker, has been found to be increased throughout pregnancy in those who develop preeclampsia and at the time of preeclampsia diagnosis. Although sleep-disordered breathing in pregnancy has been associated with increased risk for preeclampsia, it is unknown if sleep-disordered breathing is associated with elevated arterial stiffness in pregnancy. OBJECTIVE This prospective observational cohort study aimed to evaluate arterial stiffness in pregnant women, with and without sleep-disordered breathing and assess the interaction between arterial stiffness, sleep-disordered breathing, and preeclampsia risk. STUDY DESIGN Women with high-risk singleton pregnancies were enrolled at 10 to 13 weeks' gestation and completed the Epworth Sleepiness Score, Pittsburgh Sleep Quality Index, and Restless Legs Syndrome questionnaires at each trimester. Sleep-disordered breathing was defined as loud snoring or witnessed apneas (≥3 times per week). Central arterial stiffness (carotid-femoral pulse wave velocity, the gold standard measure of arterial stiffness), peripheral arterial stiffness (carotid-radial pulse wave velocity), wave reflection (augmentation index, time to wave reflection), and hemodynamics (central blood pressures, pulse pressure amplification) were assessed noninvasively using applanation tonometry at recruitment and every 4 weeks from recruitment until delivery. RESULTS High-risk pregnant women (n=181) were included in the study. Women with sleep-disordered breathing (n=41; 23%) had increased carotid-femoral pulse wave velocity throughout gestation independent of blood pressure and body mass index (P=.042). Differences observed in other vascular measures were not maintained after adjustment for confounders. Excessive daytime sleepiness, defined by Epworth Sleepiness Score >10, was associated with increased carotid-femoral pulse wave velocity only in women with sleep-disordered breathing (Pinteraction=.001). Midgestation (first or second trimester) sleep-disordered breathing was associated with an odds ratio of 3.4 (0.9-12.9) for preeclampsia, which increased to 5.7 (1.1-26.0) in women with sleep-disordered breathing and hypersomnolence, whereas late (third-trimester) sleep-disordered breathing was associated with an odds ratio of 8.2 (1.5-39.5) for preeclampsia. CONCLUSION High-risk pregnant women with midgestational sleep-disordered breathing had greater arterial stiffness throughout gestation than those without. Sleep-disordered breathing at any time during pregnancy was also associated with increased preeclampsia risk, and this effect was amplified by hypersomnolence.
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11
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Duis J, Pullen LC, Picone M, Friedman N, Hawkins S, Sannar E, Pfalzer AC, Shelton AR, Singh D, Zee PC, Glaze DG, Revana A. Diagnosis and management of sleep disorders in Prader-Willi syndrome. J Clin Sleep Med 2022; 18:1687-1696. [PMID: 35172921 PMCID: PMC9163612 DOI: 10.5664/jcsm.9938] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clinical experience and a growing body of evidence suggest that sleep disturbances are common in people with Prader-Willi syndrome (PWS). PWS is a rare neuroendocrine disorder characterized by early hypotonia and feeding difficulties; developmental delays; endocrinopathies; and behavioral concerns, especially rigidity, anxiety, and behavioral outbursts. PWS is also characterized by decreased resting energy expenditure and transition to hyperphagia and obesity. We propose that, for many people with PWS, clinical diagnosis and management of sleep disorders is an unmet need. We present current information to suggest disordered sleep is a significant burden for individuals with PWS and often overlooked. While central and obstructive sleep apnea are more widely recognized in PWS, other sleep disorders have increasingly gained recognition, including hypersomnia, narcolepsy-like phenotypes, and insomnia. Sleep disorders can impact behavior, cognition, and quality of life and health for individuals with PWS. Our goal is to bring sleep disorders to the forefront of therapeutic intervention for patients with PWS. This paper presents a review of the literature and recommendations for clinical practice based on published research and our clinical experience as sleep specialists, geneticists, psychiatrists, pediatricians, otolaryngologists, and pulmonologists with extensive experience with this patient population. We recommend that management of sleep be considered an integral part of successful medical management of PWS. Further research concerning sleep problems in PWS is urgently needed to develop best practices and work toward a consensus statement for medical management to meet the needs of people with PWS. CITATION Duis J, Pullen LC, Picone M, et al. Diagnosis and management of sleep disorders in Prader-Willi syndrome. J Clin Sleep Med. 2022;18(6):1687-1696.
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Affiliation(s)
- Jessica Duis
- Section of Genetics and Inherited Metabolic Diseases, Section of Pediatrics Special Care Clinic, Prader-Willi Syndrome Multidisciplinary Clinic, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Address correspondence to: Jessica Duis, MD, MS, Assistant Professor of Pediatrics and Genetics, Section of Genetics and Inherited Metabolic Diseases, Section of Pediatrics Special Care Clinic, Director, Prader-Willi Syndrome Multidisciplinary Clinic, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E 16th Ave, Aurora, CO 80045; Tel: (303) 724-2370;
| | | | | | - Norman Friedman
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephen Hawkins
- Breathing Institute, Children’s Hospital Colorado, Aurora, Colorado
| | - Elise Sannar
- Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Deepan Singh
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, New York
| | - Phyllis C. Zee
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel G. Glaze
- The Children’s Sleep Center, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Amee Revana
- Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
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12
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Shoukat U, Glick DR, Chaturvedi S, Diaz-Abad M. Images: polysomnographic findings of nystagmus caused by a midbrain hemorrhagic stroke. J Clin Sleep Med 2022; 18:1479-1482. [PMID: 35082024 PMCID: PMC9059607 DOI: 10.5664/jcsm.9896] [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: 06/04/2021] [Revised: 10/18/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022]
Abstract
Brainstem strokes can present with an array of ophthalmologic findings depending on the location of the lesion. Eye movements are recorded on electrooculogram during polysomnography for sleep staging. We present the case of a patient with a dorsal midbrain hemorrhagic stroke and nystagmus with distinct findings on the electrooculogram during polysomnography. These eye movements from nystagmus differed in many aspects (frequency and amplitude) from the classic findings of other eye movements recorded during different stages of sleep. These polysomnography findings have not been reported in the setting of midbrain stroke. Future studies comparing nystagmus in multiple sleep stages in stroke patients would be of interest. CITATION Shoukat U, Glick DR, Chaturvedi S, Diaz-Abad M. Images: Polysomnographic findings of nystagmus caused by a midbrain hemorrhagic stroke. J Clin Sleep Med. 2022;18(5):1479-1482.
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Affiliation(s)
- Umer Shoukat
- University of Maryland Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Danielle R. Glick
- University of Maryland Sleep Disorders Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Seemant Chaturvedi
- Department of Neurology and Stroke Program, University of Maryland School of Medicine, Baltimore, Maryland
| | - Montserrat Diaz-Abad
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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13
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Kelly MR, Zeidler MR, DeCruz S, Oldenkamp CL, Josephson KR, Mitchell MN, Littner M, Ancoli-Israel S, Badr MS, Alessi CA, Martin JL. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med 2022; 18:161-170. [PMID: 34310278 PMCID: PMC8807926 DOI: 10.5664/jcsm.9528] [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] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To evaluate the clinical utility of actigraphy as compared with sleep questionnaires prior to the Multiple Sleep Latency Test (MSLT) in a sleep disorders clinic population. METHODS Twenty-eight clinically referred participants (mean age: 42.3 ± 18.8 years) completed the study protocol. On day 1, participants completed the following questionnaires: Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (affect, vigor), Patient Health Questionnaire, and Multidimensional Fatigue Symptom Inventory-Short Form. On days 1-8, participants wore an actigraph and completed a sleep diary to assess mean nighttime and mean daytime total sleep time and sleep efficiency or sleep percentage. On day 9, participants repeated the ESS and completed an MSLT. Correlations assessed mean MSLT sleep-onset latency (MSLT-SOL) vs actigraphy, sleep diary, and questionnaires. Chi-square analyses assessed abnormal MSLT-SOL (≤ 8 minutes) or daytime sleepiness (ESS ≥ 10) and referral question (ie, sleep-disordered breathing vs hypersomnolence disorder). RESULTS Mean MSLT-SOL was correlated with nighttime total sleep time assessed via both actigraphy and diary, but not with questionnaires. Significant correlations emerged for ESS score on day 1 vs 9, actigraphy vs sleep diary mean nighttime total sleep time, and PSQI vs mean sleep diary sleep efficiency. There was no significant relationship between mean MSLT-SOL and referral question. CONCLUSIONS Our finding that total sleep time measured by actigraphy was associated with MSLT-SOL suggests it is useful in informing the interpretation of MSLT findings; however, it does not appear to be a viable substitute for MSLT for the measurement of objective sleepiness in clinical settings. CITATION Kelly MR, Zeidler MR, DeCruz S, et al. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med. 2022;18(1):161-170.
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Affiliation(s)
- Monica R. Kelly
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michelle R. Zeidler
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California,Veterans Affairs Greater Los Angeles Healthcare System, Division of Pulmonary Medicine, North Hills, California
| | - Sharon DeCruz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Caitlin L. Oldenkamp
- Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Karen R. Josephson
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michael N. Mitchell
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michael Littner
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - M. Safwan Badr
- Wayne State University, Detroit, Michigan,John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Cathy A. Alessi
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jennifer L. Martin
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California,Address correspondence to: Jennifer L. Martin, PhD, VA Sepulveda Ambulatory Care Center, 16111 Plummer Street (11E), North Hills, CA 91343;
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14
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Thorpy MJ, Arnulf I, Foldvary-Schaefer N, Morse AM, Šonka K, Chandler P, Hickey L, Chen A, Black J, Sterkel A, Chen D, Bogan RK, Dauvilliers Y. Efficacy and Safety of Lower-Sodium Oxybate in an Open-Label Titration Period of a Phase 3 Clinical Study in Adults with Idiopathic Hypersomnia. Nat Sci Sleep 2022; 14:1901-1917. [PMID: 36320423 PMCID: PMC9618250 DOI: 10.2147/nss.s369122] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/09/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the efficacy and safety of lower-sodium oxybate (LXB; Xywav®) during the open-label titration and optimization period (OLT) and stable-dose period (SDP) in a clinical study for the treatment of idiopathic hypersomnia. PATIENTS AND METHODS Data were collected during treatment titration and optimization in a phase 3 randomized withdrawal trial in adults (18-75 years of age) with idiopathic hypersomnia who took LXB treatment (once, twice, or thrice nightly, administered orally) in the OLT (10-14 weeks), followed by the 2-week, open-label SDP. Endpoints included the Epworth Sleepiness Scale (ESS), Idiopathic Hypersomnia Severity Scale (IHSS), Patient Global Impression of Change, Clinical Global Impression of Change, Functional Outcomes of Sleep Questionnaire (FOSQ)-10, and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP). RESULTS The safety population included 154 participants; the modified intent-to-treat population comprised 115 participants. During open-label treatment, mean (SD) ESS scores improved (decreased) from 15.7 (3.8) at baseline to 6.1 (4.0) at end of SDP, and IHSS scores improved (decreased) from 31.6 (8.3) to 15.3 (8.5). Improvements were also observed during OLT in each individual IHSS item and in FOSQ-10 and WPAI:SHP scores. Thirty-five (22.7%) participants discontinued during OLT and SDP, 22 (14.3%) due to treatment-emergent adverse events (TEAEs) during OLT and SDP. The most frequent TEAEs in the first 4 weeks were nausea, headache, dizziness, and dry mouth; TEAE incidence decreased throughout OLT and SDP (weeks 1-4, n = 87 [56.5%]; weeks 13-16, n = 39 [31.7%]). CONCLUSION During open-label treatment with LXB, participants showed clinically meaningful improvements in idiopathic hypersomnia symptoms and in quality of life and functional measures. TEAE incidence declined over LXB titration and optimization.
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Affiliation(s)
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital and Sorbonne University, Paris, France
| | - Nancy Foldvary-Schaefer
- Cleveland Clinic Sleep Disorders Center, Department of Neurology, Lerner College of Medicine, Cleveland, OH, USA
| | | | - Karel Šonka
- Department of Neurology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | | | - Abby Chen
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Jed Black
- Jazz Pharmaceuticals, Palo Alto, CA, USA.,Stanford University Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | | | - Dan Chen
- Formerly Jazz Pharmaceuticals, Palo Alto, CA, USA
| | - Richard K Bogan
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Yves Dauvilliers
- Sleep and Wake Disorders Centre, Department of Neurology, Gui de Chauliac Hospital, Montpellier, France.,University of Montpellier, INSERM Institute Neuroscience Montpellier (INM), Montpellier, France
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15
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Mainieri G, Montini A, Nicotera A, Di Rosa G, Provini F, Loddo G. The Genetics of Sleep Disorders in Children: A Narrative Review. Brain Sci 2021; 11:1259. [PMID: 34679324 PMCID: PMC8534132 DOI: 10.3390/brainsci11101259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/31/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Sleep is a universal, highly preserved process, essential for human and animal life, whose complete functions are yet to be unravelled. Familial recurrence is acknowledged for some sleep disorders, but definite data are lacking for many of them. Genetic studies on sleep disorders have progressed from twin and family studies to candidate gene approaches to culminate in genome-wide association studies (GWAS). Several works disclosed that sleep-wake characteristics, in addition to electroencephalographic (EEG) sleep patterns, have a certain degree of heritability. Notwithstanding, it is rare for sleep disorders to be attributed to single gene defects because of the complexity of the brain network/pathways involved. Besides, the advancing insights in epigenetic gene-environment interactions add further complexity to understanding the genetic control of sleep and its disorders. This narrative review explores the current genetic knowledge in sleep disorders in children, following the International Classification of Sleep Disorders-Third Edition (ICSD-3) categorisation.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (G.M.); (A.M.)
| | - Angelica Montini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (G.M.); (A.M.)
| | - Antonio Nicotera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, “Gaetano Barresi” University of Messina, 98124 Messina, Italy; (A.N.); (G.D.R.)
| | - Gabriella Di Rosa
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, “Gaetano Barresi” University of Messina, 98124 Messina, Italy; (A.N.); (G.D.R.)
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40138 Bologna, Italy; (G.M.); (A.M.)
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
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16
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Abstract
STUDY OBJECTIVES The Maintenance of Wakefulness Test (MWT) is used to objectively evaluate an individual's ability to remain awake; however, microsleeps are not included in the assessment. We aimed to determine if microsleep data prior to sleep onset assisted in interpretation of ability to maintain wakefulness across a range of typical patient groups. METHODS Forty-eight patients referred for overnight polysomnography and subsequent MWT were included. Patients were divided into 3 groups (treated obstructive sleep apnea [OSA], untreated OSA, or treated idiopathic hypersomnia or narcolepsy) based on prior medical diagnosis. Demographics, clinical characteristics, polysomnography, and MWT variables, including frequency, distribution, duration, and latency of microsleeps were compared between groups. RESULTS Microsleeps were observed in MWT trials significantly more frequently in patients with treated idiopathic hypersomnia/narcolepsy over the course of the day (0.34 ± 0.06 vs 0.07 ± 0.02 microsleeps/min; P < .001) and in patients with untreated OSA toward the end of the day (0.31 ± 0.06 vs 0.05 ± 0.02 microsleeps/min; P < .001) compared to the group with treated OSA. Microsleeps were often observed in series and earlier in patients with treated idiopathic hypersomnia/narcolepsy (10.9 ± 1.6 minutes) and those with untreated OSA (16.2 ± 2.7 minutes) compared to the group with treated OSA (24.9 ± 3.0 minutes; P < .05), and, if taken into consideration, would increase the proportion of patients demonstrating inability to maintain wakefulness by 33% and 22%, respectively. CONCLUSIONS MWT performance varies significantly across patient groups. Microsleep analysis prior to sleep onset may be a more sensitive measure of patient daytime wakefulness than sleep latency alone and should be considered in MWT assessment. CITATION Anniss AM, Young A, O'Driscoll DM. Microsleep assessment enhances interpretation of the Maintenance of Wakefulness Test. J Clin Sleep Med. 2021;17(8):1571-1578.
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Affiliation(s)
- Angela M Anniss
- Department of Respiratory and Sleep Medicine, Eastern Health, Box Hill, Victoria, Australia
| | - Alan Young
- Department of Respiratory and Sleep Medicine, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
| | - Denise M O'Driscoll
- Department of Respiratory and Sleep Medicine, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
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17
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Miller JN, Kruger A, Moser DJ, Gutmann L, van der Plas E, Koscik TR, Cumming SA, Monckton DG, Nopoulos PC. Cognitive Deficits, Apathy, and Hypersomnolence Represent the Core Brain Symptoms of Adult-Onset Myotonic Dystrophy Type 1. Front Neurol 2021; 12:700796. [PMID: 34276551 PMCID: PMC8280288 DOI: 10.3389/fneur.2021.700796] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/26/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults, and is primarily characterized by muscle weakness and myotonia, yet some of the most disabling symptoms of the disease are cognitive and behavioral. Here we evaluated several of these non-motor symptoms from a cross-sectional time-point in one of the largest longitudinal studies to date, including full-scale intelligence quotient, depression, anxiety, apathy, sleep, and cerebral white matter fractional anisotropy in a group of 39 adult-onset myotonic dystrophy type 1 participants (27 female) compared to 79 unaffected control participants (46 female). We show that intelligence quotient was significantly associated with depression (P < 0.0001) and anxiety (P = 0.018), but not apathy (P < 0.058) or hypersomnolence (P = 0.266) in the DM1 group. When controlling for intelligence quotient, cerebral white matter fractional anisotropy was significantly associated with apathy (P = 0.042) and hypersomnolence (P = 0.034), but not depression (P = 0.679) or anxiety (P = 0.731) in the myotonic dystrophy type 1 group. Finally, we found that disease duration was significantly associated with apathy (P < 0.0001), hypersomnolence (P < 0.001), IQ (P = 0.038), and cerebral white matter fractional anisotropy (P < 0.001), but not depression (P = 0.271) or anxiety (P = 0.508). Our results support the hypothesis that cognitive deficits, hypersomnolence, and apathy, are due to the underlying neuropathology of myotonic dystrophy type 1, as measured by cerebral white matter fractional anisotropy and disease duration. Whereas elevated symptoms of depression and anxiety in myotonic dystrophy type 1 are secondary to the physical symptoms and the emotional stress of coping with a chronic and debilitating disease. Results from this work contribute to a better understanding of disease neuropathology and represent important therapeutic targets for clinical trials.
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Affiliation(s)
- Jacob N Miller
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Alison Kruger
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - David J Moser
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Laurie Gutmann
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ellen van der Plas
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Timothy R Koscik
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Sarah A Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peggy C Nopoulos
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.,Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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18
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Plante DT, Cook JD, Prairie ML. Multimodal assessment increases objective identification of hypersomnolence in patients referred for multiple sleep latency testing. J Clin Sleep Med 2021; 16:1241-1248. [PMID: 32267229 DOI: 10.5664/jcsm.8470] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The multiple sleep latency test (MSLT) has limitations when evaluating disorders of hypersomnolence with unknown etiology. Alternative measures of hypersomnolence may objectively identify pathology in patients with complaints of daytime sleepiness that may not be captured by the MSLT alone. This study evaluated the impact of a multimodal hypersomnolence assessment relative to MSLT in patients with unexplained hypersomnolence. METHODS Seventy-five patients with unexplained hypersomnolence were included in the analyzed sample. Polysomnography was performed without prescribed wake time, and the psychomotor vigilance task and pupillographic sleepiness test were completed between MSLT nap opportunities. Presence or absence of hypersomnolence for each assessment was defined using a priori cutpoints. Proportions of patients identified as hypersomnolent using the multimodal assessment relative to MSLT alone were evaluated, as well as the sensitivity and specificity of ancillary hypersomnolence measures relative to MSLT as a gold standard. RESULTS The multimodal assessment more than doubled the proportion of patients identified as having objective deficits relative to MSLT ≤ 8 minutes alone. The combination of excessive sleep duration, lapses on the psychomotor vigilance task, and impairments on the pupillographic sleepiness test also had perfect sensitivity in identifying all patients identified as sleepy by the MSLT across 3 different MSLT cutpoints (5, 8, and 10 minutes). CONCLUSIONS These data demonstrate the insufficiency of the MSLT as a singular tool to identify objective pathology in persons with unexplained hypersomnolence. Further efforts to refine and standardize multimodal assessments will likely improve diagnostic acumen and research into the causes of these disorders.
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Affiliation(s)
- David T Plante
- Department of Psychiatry, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jesse D Cook
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin
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19
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Plante DT, Papale LA, Madrid A, Cook JD, Prairie ML, Alisch RS. PAX8/PAX8-AS1 DNA methylation levels are associated with objective sleep duration in persons with unexplained hypersomnolence using a deep phenotyping approach. Sleep 2021; 44:6305146. [PMID: 34145460 DOI: 10.1093/sleep/zsab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2020] [Revised: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Patients with unexplained hypersomnolence have significant impairment related to daytime sleepiness and excessive sleep duration, the biological bases of which are poorly understood. This investigation sought to examine relationships between objectively measured hypersomnolence phenotypes and epigenetic modification of candidate hypersomnolence genes to advance this line of inquiry. METHODS Twenty-eight unmedicated clinical patients with unexplained hypersomnolence were evaluated using overnight ad libitum polysomnography, multiple sleep latency testing, infrared pupillometry, and the psychomotor vigilance task. DNA methylation levels on CpG sites annotated to 11 a priori hypersomnolence candidate genes were assessed for statistical association with hypersomnolence measures using independent regression models with adjusted local index of significance (aLIS) P-value threshold of 0.05. RESULTS Nine CpG sites exhibited significant associations between DNA methylation levels and total sleep time measured using ad libitum polysomnography (aLIS p-value < .05). All nine differentially methylated CpG sites were annotated to the paired box 8 (PAX8) gene and its related antisense gene (PAX8-AS1). Among these nine differentially methylated positions was a cluster of five CpG sites located in the body of the PAX8 gene and promoter of PAX8-AS1. CONCLUSIONS This study demonstrates that PAX8/PAX8-AS1 DNA methylation levels are associated with total sleep time in persons with unexplained hypersomnolence. Given prior investigations that have implicated single nucleotide polymorphisms in PAX8/PAX8-AS1 with habitual sleep duration, further research that clarifies the role of DNA methylation levels on these genes in the phenotypic expression of total sleep time is warranted.
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Affiliation(s)
| | | | - Andy Madrid
- Department of Neurological Surgery, Madison, WI.,Neuroscience Training Program, University of Wisconsin - Madison, Madison, WI
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Saida IB, Saad HB, Zghidi M, Ennouri E, Ettoumi R, Boussarsar M. Artery of Percheron Stroke as an Unusual Cause of Hypersomnia: A Case Series and a Short Literature Review. Am J Mens Health 2021; 14:1557988320938946. [PMID: 32618485 PMCID: PMC7336829 DOI: 10.1177/1557988320938946] [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] [Indexed: 12/19/2022] Open
Abstract
The thalamus and the mesencephalon have a complex blood supply. The artery of
Percheron (AOP) is a rare anatomical variant. Occlusion of this artery may lead
to bithalamic stroke with or without midbrain involvement. Given its broad
spectrum of clinical features, AOP stroke is often misdiagnosed. Usually, it
manifests with the triad of vertical gaze palsy, memory impairment, and coma. In
this article, we report three cases of bilateral thalamic strokes whose clinical
presentations were dominated by a sudden onset of hypersomnia. We also reviewed
last 5 years’ publications related to the AOP strokes in males presenting
sleepiness or equivalent terms as a delayed complication. The AOP stroke may
present a diagnostic challenge for clinicians which should be considered in the
differential diagnosis of hypersomnia.
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Affiliation(s)
- Imen Ben Saida
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Maroua Zghidi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Emna Ennouri
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Radhouane Ettoumi
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Mohamed Boussarsar
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia.,Research Laboratory N° LR12SP09, Heart Failure, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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21
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Evangelista E, Rassu AL, Barateau L, Lopez R, Chenini S, Jaussent I, Dauvilliers Y. Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording. Sleep 2021; 44:6010320. [PMID: 33249509 DOI: 10.1093/sleep/zsaa264] [Citation(s) in RCA: 14] [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] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/19/2020] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording. METHODS A total of 266 drug-free subjects (201 women; mean age: 26.5 years [16.08; 60.87]) underwent 32-h bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19 h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score >10) and EQS (≥9 h/24 h per week). RESULTS Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, Epworth sleepiness scale, EQS, and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder. CONCLUSIONS Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia, and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.
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Affiliation(s)
- Elisa Evangelista
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Anna Laura Rassu
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France
| | - Lucie Barateau
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Régis Lopez
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Sofiène Chenini
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
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22
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Fronczek R, Arnulf I, Baumann CR, Maski K, Pizza F, Trotti LM. To split or to lump? Classifying the central disorders of hypersomnolence. Sleep 2021; 43:5810298. [PMID: 32193539 PMCID: PMC7420691 DOI: 10.1093/sleep/zsaa044] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 12/17/2019] [Revised: 03/10/2020] [Indexed: 01/20/2023] Open
Abstract
The classification of the central disorders of hypersomnolence has undergone multiple iterations in an attempt to capture biologically meaningful disease entities in the absence of known pathophysiology. Accumulating data suggests that further refinements may be necessary. At the 7th International Symposium on Narcolepsy, a group of clinician-scientists evaluated data in support of keeping or changing classifications, and as a result suggest several changes. First, idiopathic hypersomnia with long sleep durations appears to be an identifiable and meaningful disease subtype. Second, idiopathic hypersomnia without long sleep time and narcolepsy without cataplexy share substantial phenotypic overlap and cannot reliably be distinguished with current testing, and so combining them into a single disease entity seems warranted at present. Moving forward, it is critical to phenotype patients across a wide variety of clinical and biological features, to aid in future refinements of disease classification.
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Affiliation(s)
- Rolf Fronczek
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Sleep-Wakecentre SEIN, Heemstede, The Netherlands
| | - Isabelle Arnulf
- Sorbonne University, National Reference Center for Rare Hypersomnia, Pitie-Salpetriere Hospital, Paris, France
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kiran Maski
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, Boston, MA
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, GA
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23
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Rosenberg R, Baladi M, Bron M. Clinically relevant effects of solriamfetol on excessive daytime sleepiness: a posthoc analysis of the magnitude of change in clinical trials in adults with narcolepsy or obstructive sleep apnea. J Clin Sleep Med 2021; 17:711-717. [PMID: 33226332 DOI: 10.5664/jcsm.9006] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the clinical relevance of solriamfetol in treating excessive daytime sleepiness in participants with narcolepsy or obstructive sleep apnea (OSA). METHODS This posthoc analysis includes data from two 12-week, randomized phase 3 studies in participants with narcolepsy or OSA treated with once-daily placebo or solriamfetol 37.5 mg (OSA only), 75 mg, 150 mg, or 300 mg. Excessive daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS) at baseline and at week 12. Cumulative distribution function plots were generated using a last-observation-carried-forward approach to determine the percentage of participants who achieved ESS scores ≤ 10, within the normal range, and the percentage who achieved a reduction (improvement) in ESS ≥ 25% relative to baseline. Safety was also assessed. RESULTS In narcolepsy (n = 231), 30.5%-49.2% of participants treated with solriamfetol (across doses) reported ESS scores ≤ 10 and 44.1%-62.7% achieved a ≥ 25% decrease from baseline in ESS scores at week 12, compared with 15.5% and 27.6%, respectively, of placebo recipients. In OSA (n = 459), 51.8%-73.0% of participants treated with solriamfetol (across doses) reported ESS scores ≤ 10 and 50.0%-81.9% achieved a ≥ 25% decrease from baseline in ESS scores at week 12, compared with 37.7% and 36.8%, respectively, of placebo recipients. Results were generally dose-dependent, with more responders at higher solriamfetol doses. Common treatment-emergent adverse events (≥ 5% of solriamfetol recipients in either study) were headache, nausea, decreased appetite, nasopharyngitis, dry mouth, and anxiety. CONCLUSIONS A greater percentage of participants treated with solriamfetol achieved normal ESS scores (≤ 10) or clinically meaningful improvements on the ESS compared with those receiving placebo. The safety profile was similar between participants with narcolepsy and those with OSA. CLINICAL TRIAL REGISTRATIONS Registry: ClinicalTrials.gov. Names: TONES 2 and TONES 3. URLs: https://www.clinicaltrials.gov/ct2/show/NCT02348593 and https://www.clinicaltrials.gov/ct2/show/NCT02348606. Identifiers: NCT02348593, NCT02348606. Registry: European Union Drug Regulating Authorities Clinical Trials. Names: TONES 2 and TONES 3. URL: https://www.eudract.ema.europa.eu. Identifiers: EudraCT 2014-005487-15, EudraCT 2014-005514-31.
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Affiliation(s)
- Russell Rosenberg
- NeuroTrials Research, Inc., Atlanta, Georgia.,Atlanta School of Sleep Medicine, Atlanta, Georgia
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24
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Abstract
Objective/Background: Dysfunctional sleep-related cognitions (SRCs) have been demonstrated in both insomnia and depression, but have not been evaluated in patients experiencing depression with co-occurring hypersomnolence. Given the prominence of maladaptive thinking in depression with comorbid insomnia, dysfunctional SRCs may also exist in depressed persons experiencing hypersomnolence. Identifying potentially maladaptive SRCs may assist development of cognitive-behavioral strategies to alleviate hypersomnolence and its related impairment, particularly when comorbid with depression. Participants: Twenty-two unmedicated persons with major depressive disorder (MDD) with comorbid hypersomnolence (MDD+/HYP+), as well as age- and sex-matched persons with MDD without hypersomnolence (MDD+/HYP-) and healthy controls (HC). Methods: Participants completed the Dysfunctional Beliefs and Attitudes About Sleep-16-item (DBAS-16) and underwent overnight polysomnography. Groups were compared across clinical and sleep domains, as well as DBAS-16 global, subscale, and individual item scores. Additional analyses evaluated DBAS-16 components while controlling for depression severity. Results: Groups significantly differed across all collected sleep and mood metrics consistent with diagnostic classification. MDD+/HYP+ DBAS-16 global score was significantly elevated, relative to HC, and was comparable to MDD+/HYP-. A DBAS-16 global score significant group effect was maintained while controlling for depression symptom severity, however only individual DBAS-16 items related to quantity and quality of sleep demonstrated particular relevance to MDD+/HYP+ compared to other groups. Conclusions: Results suggest potentially maladaptive SRCs in MDD+/HYP+. Further efforts are needed to clarify whether these beliefs and attitudes about sleep in persons with hypersomnolence are in fact dysfunctional, as well as identify relevant content for development of a novel hypersomnolence-related SRC metric.
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Affiliation(s)
- Jesse David Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin,Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meredith Ellen Rumble
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kieulinh Michelle Tran
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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25
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Ekimova IV, Guzeev MA, Simonova VV, Pastukhov YF. [Age-related differences in sleep disturbances in rat models of preclinical Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:26-33. [PMID: 33076642 DOI: 10.17116/jnevro202012009226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the changes in temporal characteristics of sleep-wake cycle, which can serve as non-motor manifestations of an early stage of Parkinson's disease (PD), using the model of preclinical PD in rats of two age groups. MATERIAL AND METHODS A prolonged (up to 21 days) model of preclinical PD in middle-aged (7-8 month) and aged (19-20 month) rats was created. The model was based on cumulative inhibition of proteasomal system of the brain caused by intranasal administration of lactacystin, a specific proteasome inhibitor. Polysomnographic data were recorded daily using telemetric Dataquest A.R.T. System (DSI, USA) in unrestrained animals. RESULTS AND CONCLUSION Aging was accompanied with increased sleepiness during the active (dark) phase of the day (as was implied by a two-fold increase in the total time of drowsiness) and with 1.5-fold growth of light sleep during the inactive phase of the day. A common feature of sleep disturbances in the model of preclinical PD in both middle-aged and aged rats was hypersomnia during the active phase of the day. It was suggested to be similar to the excessive daytime sleepiness in humans. Hypersomnolence was more pronounced in aged rats because it added to sleepiness developing with aging. In both age groups, the model of preclinical PD was also associated with a decrease in EEG delta power during slow-wave sleep. It is considered dangerous because it might represent the decrease in protein synthesis rate and the weakening of restorative processes in neurons, occurring with the prolonged inhibition of proteasomal system of the brain. Sleep disturbances, identified the model of preclinical PD in rats of different age, may be recommended for clinical validation as low-cost early signs indicating the initial stage of PD.
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Affiliation(s)
- I V Ekimova
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, St-Petersburg, Russia
| | - M A Guzeev
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, St-Petersburg, Russia
| | - V V Simonova
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, St-Petersburg, Russia
| | - Yu F Pastukhov
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences, St-Petersburg, Russia
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Hamilton KE, Shelton CM, Wheless J, Phelps SJ. Persistent Hypersomnolence Following Clobazam in a Child With Epilepsy and Undiagnosed CYP2C19 Polymorphism. J Pediatr Pharmacol Ther 2020; 25:320-327. [PMID: 32461746 DOI: 10.5863/1551-6776-25.4.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe an 11-year-old female who presented with severe hypersomnolence after receiving 1 week of modest doses of clobazam (CLB). In reviewing the above case, we considered that the hypersomnolence could be related to a pharmacodynamic, pharmacokinetic, or pharmacogenomic issue associated with CLB or to a combination of these factors. Although serum concentrations of CLB and its active metabolite are sensitive to factors that affect cytochrome-dependent metabolism, drug-drug interactions were omitted as a cause of the hypersomnolence. Subsequent DNA analysis of the cytochrome P450 2C19 gene revealed the patient as *2/*2 genotype with poor metabolizer enzyme activity. Because genetic testing of all patients treated with CLB is currently not practical, CLB dose/concentration ratios and pharmacokinetic drug-drug interaction impact models may be indicated. Genetic testing should be considered when an adverse effect suggests the possibility of a polymorphism important to drug metabolism.
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Plante DT, Cook JD, Barbosa LS, Goldstein MR, Prairie ML, Smith RF, Riedner BA. Establishing the objective sleep phenotype in hypersomnolence disorder with and without comorbid major depression. Sleep 2020; 42:5373060. [PMID: 30854559 DOI: 10.1093/sleep/zsz060] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/25/2019] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES To clarify whether hypersomnolence disorder is associated with a specific sleep phenotype and altered neurophysiological function in persons with and without hypersomnolence disorder and major depressive disorder (MDD). METHODS Eighty-three unmedicated persons with and without hypersomnolence disorder and/or MDD underwent ad libitum high-density EEG polysomnography. Clinical and sleep architecture variables were compared between groups. Topographic patterns of slow-wave activity (SWA) relative to healthy controls were compared, with correlations between topographic SWA and daytime sleepiness assessed. Reductions in SWA in hypersomnolence disorder were mapped to specific cortical areas using source localization. RESULTS Regardless of the presence or absence of comorbid MDD, persons with hypersomnolence disorder had increased sleep duration relative to both controls and persons with MDD without hypersomnolence. Participants with hypersomnolence disorder also demonstrated reduced bilateral centroparietal low-frequency activity during nonrapid eye movement sleep relative to controls, a pattern not observed in persons with MDD but without hypersomnolence. SWA in these regions was negatively correlated with subjective measures of daytime sleepiness. Source localization demonstrated reductions in SWA in the supramarginal gyrus, somatosensory, and transverse temporal cortex in participants with hypersomnolence disorder. CONCLUSIONS Hypersomnolence disorder is characterized by increased sleep duration with normal sleep continuity, regardless of the presence or absence of comorbid depression. Reduced local SWA may be a specific neurophysiological finding in hypersomnolence disorder. Further research is warranted to elucidate the mechanisms through which these cortical changes are related to clinical complaints of daytime sleepiness.
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Affiliation(s)
- David T Plante
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI.,Department of Psychology, University of Wisconsin - Madison, Madison, WI
| | - Jesse D Cook
- Department of Psychology, University of Wisconsin - Madison, Madison, WI
| | - Leonardo S Barbosa
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI
| | | | - Michael L Prairie
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI
| | - Richard F Smith
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI
| | - Brady A Riedner
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI
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Mokhlesi B, Temple KA, Tjaden AH, Edelstein SL, Nadeau KJ, Hannon TS, Manchanda S, Sam S, Barengolts E, Utzschneider KM, Ehrmann DA, Van Cauter E. The association of sleep disturbances with glycemia and obesity in youth at risk for or with recently diagnosed type 2 diabetes. Pediatr Diabetes 2019; 20:1056-1063. [PMID: 31486162 PMCID: PMC7199716 DOI: 10.1111/pedi.12917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/22/2019] [Revised: 08/19/2019] [Accepted: 09/03/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Poor sleep may increase obesity and type 2 diabetes (T2D) risk in youth. We explored whether subjective sleep duration, sleep quality, or risk for obstructive sleep apnea (OSA) are associated with glycemia, body mass index (BMI), or blood pressure (BP) in overweight/obese youth. METHODS Two-hundred and fourteen overweight/obese youth of 10 to 19 years of age at risk for or recently diagnosed with T2D who were screened for the Restoring Insulin Secretion (RISE) Study had a 2-hour oral glucose tolerance test (OGTT) and completed a Cleveland Adolescent Sleepiness questionnaire and a Sleep Disturbances Scale questionnaire. Independent associations between sleep variables and measures of glycemia, BMI, and BP were evaluated with regression models. RESULTS The multiethnic cohort was 67% female, 14.1 ± 2.1 years, and BMI 35.9 ± 6.5 kg/m2 . Habitual sleep duration <8 hours was reported in 74%. Daytime sleepiness was reported in 51%, poor sleep quality in 26%, and 30% had high obstructive sleep apnea (OSA) risk. Daytime sleepiness was associated with higher HbA1c (0.2%, P = .02) and 2-hour glucose (13.6 mg/dL, P < .05). Sleep duration, sleep quality, and OSA risk were not associated with the evaluated outcomes. Poor sleep quality and OSA risk were associated with higher BMI (2.9 kg/m2 , P = .004 and 2.83 kg/m2 , P < .003, respectively). CONCLUSIONS In overweight/obese youth with or at risk for T2D, daytime sleepiness was associated with higher HbA1c. In addition, poor sleep quality and OSA risk were associated with higher BMI. These findings support intervention studies aimed at improving sleep quality in obese youth.
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Affiliation(s)
| | | | - Ashley H. Tjaden
- George Washington University Biostatistics Center (RISE Coordinating Center), Rockville, Maryland
| | - Sharon L. Edelstein
- George Washington University Biostatistics Center (RISE Coordinating Center), Rockville, Maryland
| | - Kristen J. Nadeau
- University of Colorado Anschutz Medical Campus/Children’s Hospital Colorado, Denver, Colorado
| | | | | | - Susan Sam
- University of Chicago, Chicago, Illinois
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29
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Forscher EC, Prairie ML, Cook JD, Notermann SL, Plante DT. Utility of the Compensatory Tracking Task for Objective Differentiation of Hypersomnolence in Depression: A High-Density EEG Investigation. Sleep Vigil 2019; 3:49-56. [PMID: 32864560 PMCID: PMC7453740 DOI: 10.1007/s41782-019-00062-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/31/2019] [Accepted: 04/22/2019] [Indexed: 06/11/2023]
Abstract
Hypersomnolence is a common and debilitating symptom in mood disorders. However, objective differentiation of excessive daytime sleepiness (EDS) from non-EDS in depression has not yet been achieved. This study compared performance on the Compensatory Tracking Task (CTT) and concurrently-recorded high-density (hd)EEG theta power in 22 patients with major depressive disorder (MDD) and co-occurring EDS against 22 age- and sex-matched patients with MDD but no EDS, as well as 22 age- and sex-matched healthy controls. Though depressed hypersomnolent participants endorsed feeling sleepier than depressed non-hypersomnolent and healthy control participants prior to starting the CTT, no group differences in CTT performance were observed. Average hdEEG theta power was higher during periods of high error on the CTT compared to periods of low error, but did not differ between the groups. Though the CTT still holds promise as an objective neurobehavioral measure, these results do not indicate a capability to differentiate EDS from non-EDS in mood disorders.
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Affiliation(s)
- Emily C Forscher
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Psychiatry, Madison, WI
- Department of Psychology, University of Wisconsin-Madison, Madison, WI
| | - Michael L Prairie
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - Jesse D Cook
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Psychiatry, Madison, WI
- Department of Psychology, University of Wisconsin-Madison, Madison, WI
| | - Sydney L Notermann
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Psychiatry, Madison, WI
| | - David T Plante
- University of Wisconsin-Madison School of Medicine and Public Health, Department of Psychiatry, Madison, WI
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Kazemeini E, Braem MJ, Moorkens G, Balina S, Kastoer C, Op de Beeck S, Vanderveken OM, Dieltjens M. Scoring of Hypersomnolence and Fatigue in Patients With Obstructive Sleep Apnea Treated With a Titratable Custom-Made Mandibular Advancement Device. J Clin Sleep Med 2019; 15:623-628. [PMID: 30952225 DOI: 10.5664/jcsm.7728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/13/2018] [Accepted: 01/09/2019] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES The objective of this study was to measure fatigue and hypersomnolence in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device (MAD), using Epworth Sleepiness Scale (ESS) for hypersomnolence and Checklist Individual Strength questionnaire (CIS20R) for fatigue. METHODS This was a single-center, prospective cohort study. A total of 58 patients with OSA filled out ESS and CIS20R questionnaires at baseline and after 3 months of MAD treatment. A total of 39 full datasets were collected. Statistical analysis for reliability of the questionnaires, comparison between baseline and 3-month follow-up, correlation between the changes in the values of the two questionnaires, and changes in apnea-hypopnea index (AHI) were performed. RESULTS CIS20R showed excellent reliability in this patient group at baseline and 3-month follow-up (Cronbach α = .97), ESS showed a marginally good reliability (Cronbach α = .82). The CIS20R (82/140) expressed high levels of fatigue at baseline, and ESS showed a normal level of daytime sleepiness. AHI, ESS, and CIS20R were significantly reduced under MAD treatment. A significant correlation between ESS and CIS20R was observed. No significant correlation between any of the questionnaires and the change in AHI was found. CONCLUSIONS The CIS20R questionnaire results showed a high level of fatigue in the patients with OSA, and the questionnaire can be used to evaluate changes in fatigue due to MAD treatment after 3 months. The ESS failed to show similar characteristics. Therefore, a combination of ESS for hypersomnolence with CIS20R for fatigue is proposed for the follow-up of patients with OSA treated with MAD.
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Affiliation(s)
- Elahe Kazemeini
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Marc J Braem
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Greta Moorkens
- Department of Internal Medicine, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Sowjanya Balina
- Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Chloé Kastoer
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Sara Op de Beeck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Olivier M Vanderveken
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Marijke Dieltjens
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Cook JD, Eftekari SC, Leavitt LA, Prairie ML, Plante DT. Optimizing Actigraphic Estimation of Sleep Duration in Suspected Idiopathic Hypersomnia. J Clin Sleep Med 2019; 15:597-602. [PMID: 30952223 DOI: 10.5664/jcsm.7722] [Citation(s) in RCA: 15] [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: 08/02/2018] [Accepted: 01/08/2019] [Indexed: 12/25/2022]
Abstract
STUDY OBJECTIVES To determine the optimal Actiwatch 2 setting configuration for the estimation of total sleep time (TST) in persons with suspected idiopathic hypersomnia. METHODS Thirty-three patients with a diagnosis of idiopathic hypersomnia (28 female; mean age = 33.7 ± 10.5) underwent ad libitum polysomnography with concurrent use of the Actiwatch 2. Actiwatch 2 sleep-wake activity threshold (SWAT; Low, Medium, and High) and sleep immobility onset and offset (SIOO; 5, 10, 15, 20, 25, and 30 epoch) duration were modified during data processing. The resultant 18 unique setting combinations were subsequently evaluated using Bland-Altman and epoch comparison analyses to determine optimal settings relative to polysomnography. RESULTS Low SWAT + 25 Epoch SIOO displayed the least divergence from polysomnography (mean difference 3.4 minutes). Higher SWAT and lower SIOO increased sensitivity and accuracy, but at the expense of reducing specificity and the ability to accurately estimate TST. CONCLUSIONS These results demonstrate that actigraphic settings should be carefully considered when estimating sleep duration. The Low + 25 Epoch configuration is indicated as most optimal for estimating TST in persons with suspected idiopathic hypersomnia. COMMENTARY A commentary on this article appears in this issue on page 539.
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Affiliation(s)
- Jesse D Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sahand C Eftekari
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lydia A Leavitt
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael L Prairie
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David T Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Abstract
STUDY OBJECTIVES To validate Ullanlinna Narcolepsy Scale (UNS) as a screening tool for narcolepsy in a clinical population and to compare it with Swiss Narcolepsy Scale (SNS) and Epworth Sleepiness Scale (ESS). METHODS UNS questionnaires of 267 participants visiting Helsinki Sleep Clinic were analyzed. The diagnoses of the participants were narcolepsy type 1 (NT1, n = 89), narcolepsy type 2 (NT2, n = 10), other hypersomnias (n = 24), sleep apnea (n = 37), restless legs syndrome or periodic limb movement disorder (n = 56), and other sleep-related disorders (n = 51). In addition, ESS and SNS scores in a subset of sample (total N = 167) were analyzed and compared to UNS. RESULTS Mean UNS score in NT1 was 22.0 (95% confidence interval [CI] = 20.4 to 23.6, range 9-43), which was significantly higher than in other disorders, including NT2 (mean 13.7, 95% CI = 10.3 to 17.1, range 7-21, p = .0013). Sensitivity and specificity of UNS in separating NT1 from other disorders were 83.5% and 84.1%, respectively. Positive and negative predictive values were 82.5% and 85.1%, respectively. Sensitivities of SNS and ESS in NT1 were 77.2% and 88.6%, and specificities 88.6% and 45.5%, respectively. There were no differences in receiver operating characteristic curves between UNS and SNS. UNS had moderate negative correlation with hypocretin-1 levels (rs = -.564, p < .001), and mean sleep latency in multiple sleep latency test (rs= -.608, p < .001). CONCLUSIONS UNS has high specificity and sensitivity for NT1 in a sleep clinic setting. UNS scores below 9 strongly suggest against the diagnosis of narcolepsy.
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Affiliation(s)
- Tomi Sarkanen
- Department of Neurology, Tampere University Hospital, Tampere, Finland
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Anniina Alakuijala
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Partinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
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Alomar M, Almeneessier AS, Olaish AH, Alshiban A, Alomar A, BaHammam AS. Immune-mediated comorbidities in Saudi patients with narcolepsy. Nat Sci Sleep 2019; 11:35-43. [PMID: 31118849 PMCID: PMC6507108 DOI: 10.2147/nss.s195650] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/16/2019] [Indexed: 01/27/2023] Open
Abstract
Background: Autoimmunity has been proposed as a cause of narcolepsy. A few studies have assessed comorbid autoimmune diseases in patients with narcolepsy, with conflicting results; however, no study has assessed autoimmune diseases in Arab narcolepsy patients. This study aimed to assess the coexistence of immune-mediated conditions such as allergies, autoimmune diseases, and autoinflammatory diseases in patients with narcolepsy type 1 (with cataplexy) (NT1) and narcolepsy type 2 (without cataplexy) (NT2). Methods: Personal and family history of autoimmune/autoinflammatory and allergic disorders was collected using a questionnaire in 80 consecutive Saudi patients with narcolepsy (46 NT1 and 24 NT2), who were diagnosed according to the International Classification of Sleep Disorders, Third Edition. The control group comprised 222 adults from the general population. Results: Comorbid autoimmune/autoinflammatory diseases were reported by 21.4% of the NT1 patients, and 12.2% of the controls, with no significant difference between cases and controls in a model adjusted for confounding covariates. However, allergic disorders were significantly more prevalent among NT1 patients. Both comorbid autoimmune/autoinflammatory and allergic disorders were significantly more prevalent among NT2 patients compared to controls. No differences in demographic and clinical characteristics were detected between narcolepsy patients with and without autoimmune/autoinflammatory diseases. Conclusion: NT1 is not associated with increased comorbid autoimmune diseases in the studied sample of Saudi patients. However, autoimmune diseases are associated with NT2, and allergic disorders are associated with both NT1 and NT2. These findings suggest the existence of dysregulation in the immune system of narcolepsy patients that requires further research.
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Affiliation(s)
- Majed Alomar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aljohara S Almeneessier
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Family and Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Awad H Olaish
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman Alshiban
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alomar
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, King Saud University, Riyadh, Saudi Arabia
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Cook JD, Eftekari SC, Dallmann E, Sippy M, Plante DT. Ability of the Fitbit Alta HR to quantify and classify sleep in patients with suspected central disorders of hypersomnolence: A comparison against polysomnography. J Sleep Res 2018; 28:e12789. [PMID: 30407680 DOI: 10.1111/jsr.12789] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 08/20/2018] [Revised: 09/19/2018] [Accepted: 10/10/2018] [Indexed: 01/18/2023]
Abstract
Measuring sleep duration and early onset rapid eye movement sleep (REMS) is critical in the assessment of suspected central disorders of hypersomnolence (CDH). Current multi-sensor activity trackers that integrate accelerometry and heart rate are purported to accurately quantify sleep time and REMS; however, their utility in suspected CDH has not been established. This investigation aimed to determine the ability of a current, multi-sensor tracker, Fitbit Alta HR (FBA-HR), to quantify and classify sleep in patients with suspected CDH relative to polysomnography (PSG). Forty-nine patients (46 female; mean age, 30.3 ± 9.84 years) underwent ad libitum PSG with concurrent use of the FBA-HR. FBA-HR sleep variable quantification was assessed using Bland-Altman analysis. FBA-HR all sleep (AS), light sleep (LS; PSG N1 + N2), deep sleep (DS; PSG N3) and REMS classification was evaluated using epoch-by-epoch comparisons. FBA-HR-detected sleep-onset rapid eye movement periods (SOREMPs) were compared against PSG SOMREMPs. FBA-HR displayed significant overestimation of total sleep time (11.6 min), sleep efficiency (1.98%) and duration of deep sleep (18.2 min). FBA-HR sensitivity and specificity were as follows: AS, 0.96, 0.58; LS, 0.73, 0.72;DS, 0.67, 0.92; REMS, 0.74, 0.93. The device failed to detect any nocturnal SOREMPs. Device performance did not differ appreciably among diagnostic subgroups. These results suggest FBA-HR cannot replace EEG-based measurements of sleep and wake in the diagnostic assessment of suspected CDH, and that improvements in device performance are required prior to adoption in clinical or research settings.
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Affiliation(s)
- Jesse D Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sahand C Eftekari
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Erika Dallmann
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Megan Sippy
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David T Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Abstract
The occlusion of the artery of Percheron (AOP) is a rare condition that causes bilateral thalamic ischemic stroke with or without midbrain involvement. It happens as a result of an anatomical variant of the diencephalic irrigation, in which the thalamic paramedian arteries arise from a common trunk from the posterior cerebral artery (PCA), which generates a clinical syndrome characterized by bilateral vertical gaze palsy, memory impairment and hypersomnia. In this case, we report a 62-year-old woman admitted to the emergency room with altered mental status, mainly somnolence. On physical examination, she was somnolent, apathetic and with no motor deficit. Magnetic resonance imaging (MRI) of the brain demonstrated bilateral thalamic hyperintensities and midbrain involvement in diffusion-weighted imaging (DWI) and T2 sequences, suggesting occlusion of the AOP. Bilateral thalamic infarction due to this anatomical variant is an entity with a low prevalence, and its diagnosis can be delayed because of the wide spectrum of clinical signs.
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Affiliation(s)
- Miguel A Garcia-Grimshaw
- Internal Medicine, Hospital General De Tijuana, Universidad Autonoma De Baja California, Campus Mexicali, Tijuana, MEX
| | - Mariana Peschard-Franco
- School of Medicine, Instituto Tecnológico Y De Estudios Superiores De Monterrey, Monterrey, MEX
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Cook JD, Prairie ML, Plante DT. Ability of the Multisensory Jawbone UP3 to Quantify and Classify Sleep in Patients With Suspected Central Disorders of Hypersomnolence: A Comparison Against Polysomnography and Actigraphy. J Clin Sleep Med 2018; 14:841-848. [PMID: 29734975 DOI: 10.5664/jcsm.7120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 08/08/2017] [Accepted: 02/16/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the ability of a multisensory fitness tracker, the Jawbone UP3 (JB3), to quantify and classify sleep in patients with suspected central disorders of hypersomnolence. METHODS This study included 43 patients who completed polysomnography (PSG) and a Multiple Sleep Latency Test (MSLT) with concurrent wrist-worn JB3 and Actiwatch 2 (AW2) recordings for comparison. Mean differences in nocturnal sleep architecture variables were compared using Bland-Altman analysis. Sensitivity, specificity, and accuracy were derived for both devices relative to PSG. Ability of the JB3 to detect sleep onset rapid eye movement periods (SOREMPs) during MSLT naps was also quantified. RESULTS JB3 demonstrated a significant overestimation of total sleep time (39.6 min, P < .0001) relative to PSG, but performed comparably to AW2. Although the ability of the JB3 to detect epochs of sleep was relatively good (sensitivity = 0.97), its ability to distinguish light, deep, and REM sleep was poor. Similarly, the JB3 did not correctly identify a single SOREMP during any MSLT nap opportunity. CONCLUSIONS The JB3 did not accurately quantify or classify sleep in patients with suspected central disorders of hypersomnolence, and was particularly poor at identifying REM sleep. Thus, this device cannot be used as a surrogate for PSG or MSLT in the assessment of patients with suspected central disorders of hypersomnolence.
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Affiliation(s)
- Jesse D Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael L Prairie
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David T Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Ludwig B, Smith S, Heussler H. Associations Between Neuropsychological, Neurobehavioral and Emotional Functioning and Either Narcolepsy or Idiopathic Hypersomnia in Children and Adolescents. J Clin Sleep Med 2018; 14:661-674. [PMID: 29609710 DOI: 10.5664/jcsm.7066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/24/2017] [Accepted: 01/05/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Narcolepsy and idiopathic hypersomnia are chronic neurological sleep disorders characterized by hypersomnolence or excessive daytime sleepiness. This review aims to systematically examine the scientific literature on the associations between narcolepsy and idiopathic hypersomnia and their effect on intellectual functioning, academic achievement, behavior, and emotion. METHODS Published studies that examined those associations in children and adolescents were included. Studies in which children or adolescents received a clinical diagnosis, and in which the associated function was measured with at least one objective instrument were included. Twenty studies published between 1968 and 2017 were eligible for inclusion in this review. RESULTS There does not appear to be a clear association between intellectual functioning and narcolepsy or idiopathic hypersomnia; however, limited research is an obstacle to obtaining generalizability. The variability in results from studies investigating associations between academic achievement and these two hypersomnolence disorders suggests that further research using standardized and validated assessment instruments is required to determine if there is an association. Behavior and emotion appear to be significantly affected by narcolepsy. Only two studies included populations of children and adolescents with idiopathic hypersomnia. CONCLUSIONS Further research using larger populations of children and adolescents with narcolepsy or idiopathic hypersomnia while utilizing standardized and validated instruments is required, because the effect of these conditions of hypersomnolence varies and is significant for each individual.
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Affiliation(s)
- Beris Ludwig
- University of Queensland, Queensland, Australia.,Mater Research Institute, University of Queensland, Queensland, Australia
| | - Simon Smith
- University of Queensland, Queensland, Australia
| | - Helen Heussler
- University of Queensland, Queensland, Australia.,Mater Research Institute, University of Queensland, Queensland, Australia.,Respiratory and Sleep Medicine Department, Lady Cilento Hospital, Queensland, Australia
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Taylor DJ, Wilkerson AK, Pruiksma KE, Williams JM, Ruggero CJ, Hale W, Mintz J, Organek KM, Nicholson KL, Litz BT, Young-McCaughan S, Dondanville KA, Borah EV, Brundige A, Peterson AL. Reliability of the Structured Clinical Interview for DSM-5 Sleep Disorders Module. J Clin Sleep Med 2018; 14:459-464. [PMID: 29458705 PMCID: PMC5837848 DOI: 10.5664/jcsm.7000] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 10/05/2017] [Revised: 11/15/2017] [Accepted: 12/13/2017] [Indexed: 01/16/2023]
Abstract
STUDY OBJECTIVES To develop and demonstrate interrater reliability for a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Sleep Disorders (SCISD). METHODS The SCISD was designed to be a brief, reliable, and valid interview assessment of adult sleep disorders as defined by the DSM-5. A sample of 106 postdeployment active-duty military members seeking cognitive behavioral therapy for insomnia in a randomized clinical trial were assessed with the SCISD prior to treatment to determine eligibility. Audio recordings of these interviews were double-scored for interrater reliability. RESULTS The interview is 8 pages long, includes 20 to 51 questions, and takes 10 to 20 minutes to administer. Of the nine major disorders included in the SCISD, six had prevalence rates high enough (ie, n ≥ 5) to include in analyses. Cohen kappa coefficient (κ) was used to assess interrater reliability for insomnia, hypersomnolence, obstructive sleep apnea hypopnea (OSAH), circadian rhythm sleep-wake, nightmare, and restless legs syndrome disorders. There was excellent interrater reliability for insomnia (1.0) and restless legs syndrome (0.83); very good reliability for nightmare disorder (0.78) and OSAH (0.73); and good reliability for hypersomnolence (0.50) and circadian rhythm sleep-wake disorders (0.50). CONCLUSIONS The SCISD is a brief, structured clinical interview that is easy for clinicians to learn and use. The SCISD showed moderate to excellent interrater reliability for six of the major sleep disorders in the DSM-5 among active duty military seeking cognitive behavioral therapy for insomnia in a randomized clinical trial. Replication and extension studies are needed. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Comparing Internet and In-Person Brief Cognitive Behavioral Therapy of Insomnia; Identifier: NCT01549899; URL: https://clinicaltrials.gov/ct2/show/NCT01549899.
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Affiliation(s)
- Daniel J. Taylor
- Department of Psychology, The University of North Texas, Denton, Texas
| | - Allison K. Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kristi E. Pruiksma
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jacob M. Williams
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Camilo J. Ruggero
- Department of Psychology, The University of North Texas, Denton, Texas
| | - Willie Hale
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
| | - Jim Mintz
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Karin L. Nicholson
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | - Brett T. Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Stacey Young-McCaughan
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Katherine A. Dondanville
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Elisa V. Borah
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- School of Social Work, University of Texas at Austin, Austin, Texas
| | - Antoinette Brundige
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alan L. Peterson
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
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Sidhu M, Brady L, Tarnopolsky M, Ronen GM. Clinical Manifestations Associated With the N-Terminal-Acetyltransferase NAA10 Gene Mutation in a Girl: Ogden Syndrome. Pediatr Neurol 2017; 76:82-85. [PMID: 28967461 DOI: 10.1016/j.pediatrneurol.2017.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Ogden syndrome is a rare X-linked disorder caused by pathogenic variants in the NAA10 gene. This syndrome, reported in just over 20 children, has been associated with dysmorphic features, failure to thrive, developmental impairments, hypotonia, and cardiac arrhythmias. PATIENT DESCRIPTION We describe a 14-year-old girl who presented in infancy with hypotonia, global developmental delay, and dysmorphic features. She later developed autism spectrum disorder, epileptic encephalopathy, extrapyramidal signs, early morning lethargy with hypersomnolence, and hypertension with left ventricular hypertrophy. Magnetic resonance imaging showed a thin corpus callosum and progressive white matter loss. Whole exome sequencing identified a de novo pathogenic variant in the NAA10 gene (c.247C>T, p.R83C). Much of her early presentation was in keeping with what has been previously described with Ogden syndrome. CONCLUSIONS We have identified additional evolving neurological impairments in this, to date, oldest documented girl with Ogden syndrome. We recommend screening patients with Ogden syndrome for these newly identified features of early life trajectories to guide management.
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Affiliation(s)
- Mandeep Sidhu
- Division of Pediatric Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Brady
- Department of Pathology (Genetics), McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Mark Tarnopolsky
- Departments of Pediatrics and Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabriel M Ronen
- Division of Pediatric Neurology, McMaster University, Hamilton, Ontario, Canada.
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Plante DT, Cook JD, Goldstein MR. Objective measures of sleep duration and continuity in major depressive disorder with comorbid hypersomnolence: a primary investigation with contiguous systematic review and meta-analysis. J Sleep Res 2017; 26:255-265. [PMID: 28145043 PMCID: PMC5435536 DOI: 10.1111/jsr.12498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/10/2016] [Accepted: 12/13/2016] [Indexed: 12/13/2022]
Abstract
Hypersomnolence plays an important role in the presentation, treatment and course of mood disorders. However, there has been relatively little research that examines objective measures of sleep duration and continuity in patients with depression and hypersomnolence, despite the use of these factors in sleep medicine nosological systems. This study compared total sleep time and efficiency measured by naturalistic actigraphic recordings followed by ad libitum polysomnography (PSG; without prescribed wake time) in 22 patients with major depressive disorder and co-occurring hypersomnolence against age- and sex-matched healthy sleeper controls. The major depressive disorder and co-occurring hypersomnolence group demonstrated significantly longer sleep duration compared with healthy sleeper controls quantified by sleep diaries, actigraphy and ad libitum PSG. No between-group differences in sleep efficiency (SE), latency to sleep or wake after sleep onset were observed when assessed using objective measures. To further contextualize these findings within the broader scientific literature, a systematic review was performed to identify other comparable investigations. A meta-analysis of pooled data demonstrated patients with mood disorders and co-occurring hypersomnolence have significantly greater sleep duration and similar SE compared with healthy controls when assessed using ad libitum PSG. These results suggest current sleep medicine nosology that distinguishes hypersomnia associated with psychiatric disorders primarily as a construct characterized by low SE and increased time in bed may not be accurate. Future studies that establish the biological bases hypersomnolence in mood disorders, as well as clarify the accuracy of nosological thresholds to define excessive sleep duration, are needed to refine the diagnosis and treatment of these disorders.
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Affiliation(s)
- David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jesse D. Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Kosky CA, Bonakis A, Yogendran A, Hettiarachchi G, Dargan PI, Williams AJ. Urine Toxicology in Adults Evaluated for a Central Hypersomnia and How the Results Modify the Physician's Diagnosis. J Clin Sleep Med 2016; 12:1499-1505. [PMID: 27568897 DOI: 10.5664/jcsm.6276] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/08/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Drugs and psychoactive substances can cause sleepiness and when undetected, may lead to over diagnosis of central hypersomnias. We performed urine drug testing using gas chromatography-mass spectrometry in adults undergoing multiple sleep latency testing (MSLT) for a suspected central hypersomnia. We examined how the drug test results modified the treating physician's diagnosis. METHODS One hundred eighty-six consecutive patients with a suspected central hypersomnia who underwent clinical assessment, MSLT and urine drug testing by gas chromatography-mass spectrometry were retrospectively studied. Physicians made a diagnosis after clinical assessment and MSLT and were initially blinded to the urine drug test results. RESULTS A third of patients assessed for subjective hypersomnia had a positive urine drug test for a substance affecting sleep. Opioids, cannabis, and amphetamines were the commonest drugs detected. Using MSLT, 35 (18.8%) of 186 patients had objective hypersomnia that may have been due to a drug or substance. Drugs or substances may have confounded the MSLT in 11 (20.1%) of 53 patients who fulfilled diagnostic criteria for idiopathic hypersomnia, and 12 (52%) of 23 of those who fulfilled diagnostic criteria for narcolepsy without cataplexy. Of the 75 positive urine drug samples, 61 (81%) were substances or medications not revealed in the physician interview. The treating physician had not suspected drugs or substances as a possible cause of objective hypersomnia in 34 (97%) of the 35 patients. CONCLUSIONS Drugs and psychoactive substances can confound the results of the MSLT and when undetected could lead to over diagnosis of central hypersomnias.
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Affiliation(s)
- Christopher A Kosky
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Western Australia.,Sleep Disorders Centre Guys' Hospital, London, UK
| | - Anastasios Bonakis
- Sleep Disorders Centre Guys' Hospital, London, UK.,National and Kapodistrian University of Athens, 2nd Neurological Unit, Attiko Hospital, Greece
| | - Arthee Yogendran
- West Australian Sleep Disorders Research Institute, Sir Charles Gairdner Hospital, Perth, Western Australia.,Sleep Disorders Centre Guys' Hospital, London, UK
| | - Gihan Hettiarachchi
- Sleep Disorders Centre Guys' Hospital, London, UK.,Medway Maritime Hospital, Gillingham, UK
| | - Paul I Dargan
- Clinical Toxicology, Guy's and St Thomas' Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, United Kingdom
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Trotti LM, Saini P, Koola C, LaBarbera V, Bliwise DL, Rye DB. Flumazenil for the Treatment of Refractory Hypersomnolence: Clinical Experience with 153 Patients. J Clin Sleep Med 2016; 12:1389-1394. [PMID: 27568889 DOI: 10.5664/jcsm.6196] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 02/02/2016] [Accepted: 06/27/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Patients with central disorders of hypersomnolence sometimes do not achieve satisfactory symptom control with currently available wake-promoting medications. Based on the finding that the cerebrospinal fluid from some patients with hypersomnolence demonstrates potentiation of gamma-aminobutyric acid (GABA)-A receptors in excess of that of controls, a finding that reverses with flumazenil, we initiated prescribing compounded flumazenil to carefully selected, treatment-refractory hypersomnolent patients. METHODS This retrospective chart review evaluated the first 153 consecutive patients treated with transdermal and/or sublingual flumazenil by physicians at our center from 2013 through January 2015. RESULTS Patients were 35.5 y old (± 14.4) and 92 (60.1%) were women. Mean Epworth Sleepiness Scale scores prior to flumazenil were 15.1 (± 4.5) despite prior or current treatment with traditional wake-promoting therapies. Symptomatic benefit was noted by 96 patients (62.8%), with a mean reduction in Epworth Sleepiness Scale score of 4.7 points (± 4.7) among responders. Of these, 59 remained on flumazenil chronically, for a mean of 7.8 mo (± 6.9 mo). Female sex and presence of reported sleep inertia differentiated flumazenil responders from nonresponders. Adverse events were common, but often did not result in treatment discontinuation. Serious adverse events included a transient ischemic attack and a lupus vasculopathy, although whether these events occurred because of flumazenil administration is unknown. CONCLUSIONS This chart review demonstrates that sublingual and transdermal flumazenil provided sustained clinical benefit to 39% of patients with treatment-refractory hypersomnolence. Prospective, controlled studies of this GABA-A receptor antagonist for the treatment of hypersomnolence are needed. COMMENTARY A commentary on this article appears in this issue on page 1321.
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Affiliation(s)
- Lynn Marie Trotti
- Emory University School of Medicine, Sleep Center and Department of Neurology, Atlanta, GA
| | - Prabhjyot Saini
- Emory University School of Medicine, Sleep Center and Department of Neurology, Atlanta, GA.,Emory University Rollins School of Public Health, Atlanta, GA
| | - Catherine Koola
- Emory University Rollins School of Public Health, Atlanta, GA
| | - Vincent LaBarbera
- Emory University School of Medicine, Sleep Center and Department of Neurology, Atlanta, GA
| | - Donald L Bliwise
- Emory University School of Medicine, Sleep Center and Department of Neurology, Atlanta, GA
| | - David B Rye
- Emory University School of Medicine, Sleep Center and Department of Neurology, Atlanta, GA
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Plante DT, Finn LA, Hagen EW, Mignot E, Peppard PE. Subjective and Objective Measures of Hypersomnolence Demonstrate Divergent Associations with Depression among Participants in the Wisconsin Sleep Cohort Study. J Clin Sleep Med 2016; 12:571-8. [PMID: 26888592 DOI: 10.5664/jcsm.5694] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 10/28/2015] [Accepted: 11/25/2015] [Indexed: 01/12/2023]
Abstract
STUDY OBJECTIVES To examine associations of depression with habitual sleep duration, daytime sleepiness, and objective sleep propensity in a nonclinical population. METHODS Data from adults participating in the Wisconsin Sleep Cohort Study were utilized in analyses. There were 1,287 adults (3,324 observations) who were used in the analysis of subjective hypersomnolence measures; 1,155 adults (2,981 observations) were used in the analysis of objective sleep propensity assessed by the multiple sleep latency test (MSLT). Repeated-measures logistic regression estimated associations between presence of depression (defined as modified Zung Self-Rating Depression Scale ≥ 50 or use of antidepressant medications) and three primary hypersomnolence measures: subjective excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] ≥ 11), self-reported sleep duration ≥ 9 h/d, and objective sleep propensity (MSLT mean sleep latency < 8 min). RESULTS After adjusting for age, sex, body mass index, chronic medical conditions, sedative hypnotic medication use, caffeine, tobacco, and alcohol use, sleep disordered breathing, as well as insomnia and sleep duration when appropriate, estimated odd ratios (95% confidence interval) for depression were: 1.56 (1.31,1.86) for ESS ≥ 11; 2.01 (1.49, 2.72) for habitual sleep time ≥ 9 h; and 0.76 (0.63-0.92) for MSLT mean sleep latency < 8 min. CONCLUSIONS Our results demonstrate divergent associations between subjective and objective symptoms of hypersomnolence and depression, with subjective sleepiness and excessive sleep duration associated with increased odds of depression, but objective sleep propensity as measured by the MSLT associated with decreased odds of depression. Further research is indicated to explain this paradox and the impact of different hypersomnolence measures on the course of mood disorders. COMMENTARY A commentary on this article appears in this issue on page 467.
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Affiliation(s)
- David T Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Laurel A Finn
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Erika W Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Paul E Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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Wang JY, Han F, Dong SX, Li J, An P, Zhang XZ, Chang Y, Zhao L, Zhang XL, Liu YN, Yan H, Li QH, Hu Y, Lv CJ, Gao ZC, Strohl KP. Cerebrospinal Fluid Orexin A Levels and Autonomic Function in Kleine-Levin Syndrome. Sleep 2016; 39:855-60. [PMID: 26943469 DOI: 10.5665/sleep.5642] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. METHODS From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS. Cerebrospinal fluid orexin A levels and diurnal blood pressure were measured in relapse versus remission in a subgroup of patients. RESULTS Presenting symptoms included relapsing or remitting excessive sleepiness-associated parallel complaints of cognitive changes (82%), eating disorders (84%); depression (45%); irritability (36%); hypersexuality (18%); and compulsions (11%). Episodes were 8.2 ± 3.3 days in duration. In relapse, diurnal values for blood pressure and heart rate were lower (P < 0.001). In a subgroup (n = 34), cerebrospinal fluid orexin A levels were ∼31% lower in a relapse versus remission (215.7 ± 81.5 versus 319.2 ± 95.92 pg/ml, P < 0.001); in three patients a pattern of lower levels during subsequent relapses was documented. CONCLUSIONS There are lower orexin A levels in the symptomatic phase than in remission and a fall and rise in blood pressure and heart rate, suggesting a role for orexin dysregulation in KLS pathophysiology.
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Affiliation(s)
- Jing Yu Wang
- Binzhou Medical University Hospital, Shandong Province, China
| | - Fang Han
- Binzhou Medical University Hospital, Shandong Province, China.,Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Song X Dong
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Pei An
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xiao Zhe Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yuan Chang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Xue Li Zhang
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Ya Nan Liu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Han Yan
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Qing Hua Li
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Yan Hu
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Chang Jun Lv
- Binzhou Medical University Hospital, Shandong Province, China
| | - Zhan Cheng Gao
- Department of Pulmonary Medicine, Peking University People's Hospital, Beijing, China
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, OH
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45
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Hwangbo Y, Kim WJ, Chu MK, Yun CH, Yang KI. Habitual Sleep Duration, Unmet Sleep Need, and Excessive Daytime Sleepiness in Korean Adults. J Clin Neurol 2016; 12:194-200. [PMID: 26833986 PMCID: PMC4828566 DOI: 10.3988/jcn.2016.12.2.194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [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: 08/20/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Sleep need differs between individuals, and so the same duration of sleep will lead to sleep insufficiency in some individuals but not others. The aim of this study was to determine the separate and combined associations of both sleep duration and unmet sleep need with excessive daytime sleepiness (EDS) in Korean adults. Methods The participants comprised 2,769 Korean adults aged 19 years or older. They completed questionnaires about their sleep habits over the previous month. The question regarding sleep need was "How much sleep do you need to be at your best during the day?" Unmet sleep need was calculated as sleep need minus habitual sleep duration. Participants with a score of >10 on the Epworth Sleepiness Scale were considered to have EDS. Results The overall prevalence of EDS was 11.9%. Approximately one-third of the participants (31.9%) reported not getting at least 7 hours of sleep. An unmet sleep need of >0 hours was present in 30.2% of the participants. An adjusted multivariate logistic regression analysis revealed a significant excess risk of EDS in the groups with unmet sleep needs of ≥2 hours [odds ratio (OR), 1.80; 95% confidence interval (CI), 1.27–2.54] and 0.01–2 hours (OR, 1.42; 95% CI, 1.02–1.98). However, habitual sleep duration was not significantly related to EDS. Conclusions EDS was found to be associated with unmet sleep need but not with habitual sleep duration when both factors were examined together. We suggest that individual unmet sleep need is more important than habitual sleep duration in terms of the relation to EDS.
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Affiliation(s)
- Young Hwangbo
- Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Won Joo Kim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Hallym University College of Medicine, Anyang, Korea
| | - Chang Ho Yun
- Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea.
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Avis KT, Shen J, Weaver P, Schwebel DC. Psychosocial Characteristics of Children with Central Disorders of Hypersomnolence Versus Matched Healthy Children. J Clin Sleep Med 2015; 11:1281-8. [PMID: 26285115 PMCID: PMC4623126 DOI: 10.5664/jcsm.5186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 07/31/2014] [Accepted: 06/12/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hypersomnia of central origin from narcolepsy or idiopathic hypersomnia (IHS) is characterized by pathological levels of excessive daytime sleepiness (EDS). Central hypersomnia has historically been underdiagnosed and poorly understood, especially with respect to its impact on daytime functioning and quality of life in children. OBJECTIVE Describe the psychosocial adjustment of children treated for narcolepsy or IHS on school performance, quality of life, and physical/extracurricular activities. METHODS Using a matched case control design, we compared child self- and parent-reported data from thirty-three 8- to 16-year-olds with an established diagnosis of narcolepsy or IHS, according to ICSD-2 criteria, to that of 33 healthy children matched by age, race/ethnicity, gender, and household income. Assessments evaluated academic performance, quality of life and wellness, sleepiness, and participation in extracurricular activities. RESULTS Compared to healthy controls, children with central hypersomnia had poorer daytime functioning in multiple domains. Children with hypersomnia missed more days of school and had lower grades than healthy controls. Children with hypersomnia had poorer quality of life by both parent and child report. Children with hypersomnia were significantly sleepier, had higher BMI, and were more likely to report a history of recent injury. Finally, children with hypersomnia engaged in fewer after-school activities than healthy controls. CONCLUSIONS A range of significant psychosocial consequences are reported in children with hypersomnia even after a diagnosis has been made and treatments initiated. Health care professionals should be mindful of the psychosocial problems that may present in children with hypersomnia over the course of treatment.
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Affiliation(s)
| | - Jiabin Shen
- UAB Department of Psychology, Birmingham, AL
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Abstract
ABSTRACT Wilson disease (WD) is an autosomal recessive disorder of copper metabolism resulting in copper accumulation in a number of organs including the liver, brain, and cornea, predominantly leading to hepatic, neurologic, and psychiatric manifestations. An association between WD and sleep problems is not commonly recognized, and sleep complaints are often overlooked. Daytime hypersomnolence is even more rarely reported in this population. We report a case of WD and hypersomnolence objectively confirmed by a multiple sleep latency test (MSLT). Consequently, we suggest that increased awareness, assessment, and treatment of sleep disorders, including daytime sleepiness, may help improve patients' quality of life.
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Affiliation(s)
- Valerie C Amann
- George Washington University, Washington, DC.,Department of Dermatology, University Hospital Zurich, Zürich, Switzerland
| | - Neal K Maru
- Integrated Neurology Services, Alexandria, VA
| | - Vivek Jain
- George Washington University, Pulmonary and Critical Care Medicine, Washington, DC
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Arnulf I, Neutel D, Herlin B, Golmard JL, Leu-Semenescu S, Cochen de Cock V, Vidailhet M. Sleepiness in Idiopathic REM Sleep Behavior Disorder and Parkinson Disease. Sleep 2015; 38:1529-35. [PMID: 26085299 DOI: 10.5665/sleep.5040] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [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: 10/20/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine whether patients with idiopathic and symptomatic RBD were sleepier than controls, and if sleepiness in idiopathic RBD predicted earlier conversion to Parkinson disease. METHODS The Epworth Sleepiness Scale (ESS) and its determinants were compared at the time of a video-polysomnography for an RBD diagnosis in patients with idiopathic RBD, in patients with Parkinson disease, and in controls. Whether sleepiness at time of RBD diagnosis predicted an earlier conversion to neurodegenerative diseases was retrospectively analyzed in the followed-up patients. RESULTS The 75 patients with idiopathic RBD were sleepier (ESS: 7.8 ± 4.6) at the time of RBD diagnosis than 74 age- and sex-matched controls (ESS: 5.0 ± 3.6, P < 0.0001). They reached the levels of 114 patients with Parkinson disease (ESS: 8.7 ± 4.8), whether they had (n = 78) or did not have (n = 36) concomitant RBD. The severity of sleepiness in idiopathic RBD correlated with younger age, but not with sleep measures. Among the 69 patients with idiopathic RBD who were followed up for a median 3 years (1-15 years), 16 (23.2%) developed parkinsonism (n = 6), dementia (n = 6), dementia plus parkinsonism (n = 2), and multiple system atrophy (n = 2). An ESS greater than 8 at time of RBD diagnosis predicted a shorter time to phenoconversion to parkinsonism and dementia, from RBD onset, and from RBD diagnosis (when adjusted for age and time between RBD onset and diagnosis). CONCLUSIONS Sleepiness is associated with idiopathic REM sleep behavior disorder and predicts more rapid conversion to parkinsonism and dementia, suggesting it is an early marker of neuronal loss in brainstem arousal systems.
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Affiliation(s)
- Isabelle Arnulf
- Sorbonne Universities, UPMC Univ Paris 06, Paris, France.,Brain Research Institute (CRICM - UPMC-Paris6), Paris, France.,Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Dulce Neutel
- Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Bastien Herlin
- Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jean-Louis Golmard
- Department of Biostatistics, Salpêtrière Hospital, ER4, Sorbonne Universites, UPMC Univ Paris 06, Paris, France
| | - Smaranda Leu-Semenescu
- Brain Research Institute (CRICM - UPMC-Paris6), Paris, France.,Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Marie Vidailhet
- Sorbonne Universities, UPMC Univ Paris 06, Paris, France.,Brain Research Institute (CRICM - UPMC-Paris6), Paris, France
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Abstract
Narcolepsy is a disabling sleep disorder characterized by daytime hypersomnolence. Those with cataplexy have spells of muscle weakness precipitated by strong emotions, especially laughter or surprise. Cataplexy treatments include antidepressants or a GABA-B agonist, gamma hydroxybutyrate (GHB). GHB is the most effective treatment for cataplexy, but is expensive and can have significant side effects. A recent report of a murine model of narcolepsy-cataplexy suggests R-baclofen has potential efficacy against cataplexy. We report on two narcolepsy patients with multiple daily cataplexy episodes, one of whom had been effectively treated with GHB, but had to discontinue it for unrelated medical reasons. Both subsequently tried baclofen and experienced almost complete resolution of cataplexy. This report suggests baclofen can be an effective treatment for cataplexy in humans and warrants further study.
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Affiliation(s)
- Elliott Kyung Lee
- Department of Psychiatry, Faculty of Medicine, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada ; Royal Ottawa Mental Health Center, Ottawa, ON, Canada
| | - Alan Bruce Douglass
- Department of Psychiatry, Faculty of Medicine, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada ; Royal Ottawa Mental Health Center, Ottawa, ON, Canada
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50
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Abstract
Kleine-Levin syndrome (KLS) is a rare and disabling disorder characterized by recurrent episodes of hypersomnia as well as cognitive and behavioral abnormalities. Sadly, the treatment options are very limited and often ineffective. To our knowledge, there have been no reports in the literature for the use of acetazolamide as a treatment for this disorder. We report the case of a 26-year-old female patient with KLS in whom acetazolamide was used to treat recurrent hypersomnia and cognitive abnormalities. The patient had a dramatic improvement on acetazolamide in both the frequency and severity of her symptoms. The symptoms recurred when acetazolamide was stopped on two occasions and improved with resumption of the drug, leading us to conclude that its therapeutic effect was significant.
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Affiliation(s)
- Blaire Kapson
- Stony Brook Department of Neurology, Stony Brook, NY
| | - Sumiti Nayar
- Stony Brook Department of Neurology, Stony Brook, NY
| | - Rebecca Spiegel
- Stony Brook Department of Neurology, Stony Brook, NY ; Stony Brook University Sleep Disorder Center, Stony Brook, NY
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