- Email: [email protected]
T-L-107 THE PREVALENCE OF RESTLESS LEGS SYNDROME IN HORMONAL CONTRACEPTIVE USE
Abstracts of 4th International Congress of WASM & 5th Conference of CSS / Sleep Medicine 12, Suppl. 1 (2011) S1–S130
differed significantly for RLS vs. controls except for PLMS. Other standard MRS neurochemical measures neither differed significantly from controls nor correlated with sleep Conclusion: In brain, the Glx signal is mostly ( 80%) glutamate. Increases likely indicate increased glutamate. A primary insomnia study with sleep disruption similar to these RLS patients found reduced GABA with normal glutamate. The glutamate increases, therefore, unlikely result from but rather cause the sleep disruption. If confirmed, this study would provide a missing part of the neurobiological abnormalities of RLS: dopamine, iron and glutamate. Dopamine related to PLMS and sensory symptoms, glutamate related to hyperarousal. Brain iron compromise causes both of these abnormalities in animals. Acknowledgements: Study supported by: NIH grants P01-AG21190, R01NS38704, M01-RR02719.
T-L-107
THE PREVALENCE OF RESTLESS LEGS SYNDROME IN HORMONAL CONTRACEPTIVE USE
Lyla Kamsheh 1 , Ilana Ambrogi 2 , Cherridan Rambally 3 , Hrayr Attarian 2 . 1 University of Chicago, United States; 2 Northwestern University, United States; 3 Methodist Diagnostic Sleep Center, United States Introduction and Objectives: The prevalence of Restless Legs Syndrome (RLS) in pregnancy is around 30%. The etiology, however, of this association is not yet known. Changes in sex hormones are postulated to play a crucial role. We hypothesize that combined hormonal contraceptive therapy (OCP) creates a hormonal environment similar to pregnancy, which may confer a similar increased risk of RLS. The objective of our study is to determine the prevalence rate of RLS among women taking combined hormonal contraceptive therapy compared to controls. Materials and Methods: A survey was distributed to women on the Northwestern Campus of Chicago. The survey included demographic information, contraceptive use history, other medication use, and an International RLS severity index (IRLSS). The prevalence rate of RLS was determined in 145 women taking hormonal contraceptive therapy, who met inclusion criteria and compared to a 169 matched controlled women not taking OCP. Results: A significant relationship between combined OCP use and RLS symptoms was not found (p=0.53). RLS severity between users and nonusers of OCP was not significant either (p=0.2127). OCP users were significantly lighter than non-users (p=0.0040) as were RLS subjects compared with those without RLS (p=0.0015); RLS severity weakly correlated with BMI (R=0.26, p=0.044) as well. Conclusion: These findings suggest that hormonal contraceptive therapy does not increase the risk of developing RLS symptoms and that RLS in pregnancy is not purely due to hormonal changes. Examining a larger sample of women subdividing by estrogen content to determine if there exists a difference between very low vs. low estrogen containing pills and RLS could provide further insight into the hormonal hypothesis. The correlation of higher BMI and RLS has been reported before but the correlation between not using OCPs and increased BMI needs to be perhaps explored further.
S87
patients received placebo. Subjective evaluation of the severity of RLS symptoms was also assessed the morning after each polysomnography. Results: Subjective symptoms were improved by both pramipexole and bromocriptine, with pramipexole inducing the most important improvement. Side effects were preponderant after bromocriptine. Only pramipexole induced a mild reduction in REM sleep and an increase in sleep stage 1. Pramipexole was more effective than bromocriptine in reducing PLMS in patients with a high level of PLMS index at baseline. Typical PLMS (inter-LM intervals 10-40) disappeared completely after pramipexole treatment but persisted, even if reduced, after bromocriptine treatment. Conclusion: This study shows the superior efficacy of a drug targeting D3 receptor subtypes than a drug targeting preferentially D2 subtypes in RLS; establishing the specific target of DA in RLS has scientific relevance and important clinical implications.
O: Other
T-O-109
SLEEP DISORDERS IN PRIMARY SCHOOL CHILDREN IN KERMANSHAH, IRAN
Shapour Karimi. Kermanshah, Iran, Iran Introduction and Objectives: Sleep disorders are common in children; they also have a significant impact on the parents. Few studies in this field have been performed in Iran; hence the present study was carried out in order to determine sleep patterns and the prevalence of sleep disorders in school aged children in Kermanshah. Materials and Methods: This cross sectional study was done on 200 students (100 males and 100 females) of elementary schools in Kermanshah, selected from cluster random samples. The duration of the study was from September 2009 to April 2010, and data was acquired by means of a standard pediatric sleep questionnaire. Results: The prevalence of sleep disorder among subjects was 40.3% (43.3% in males, and 37.3% in females). Sleep patterns during the school days differed significantly from what was observed on Fridays (p=0.000). In addition, there was a significant difference between males and females in terms of duration of sleep on Fridays (p=0.014). Conclusion: Considering the high prevalence of sleep disorders in children, their harmful impact on the development of the nervous system and the child’s learning and psychological health as well as on parental competency, and again bearing in mind the low level of awareness among the general population about sleep hygiene, we strongly recommend educational programs via public media and via meetings with the parents in schools.
T-O-110
A MOBILE SLEEP UNIT IS FEASIBLE AND COST EFFECTIVE
Tiina Aalto 1 , Adel Bachour 2 . 1 Sleep Unit, Finland; 2 Sleep Unit, Finland
T-L-108
WHICH RECEPTOR SUBTYPE IS THE TARGET OF DOPAMINE-AGONISTS IN RESTLESS LEGS SYNDROME?
Mauro Manconi 1 , Raffaele Ferri 2 , Marco Zucconi 3 , Alessandro Oldani 3 , Claudio Bassetti 1 . 1 Sleep and Epilepsy Centre, Neurocenter of the Southern Switzerland, Switzerland; 2 Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Italy; 3 Sleep Disorders Center, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Institute and Ospedale San Raffaele, Italy Introduction and Objectives: The aim of this study was to compare the efficacy of equivalent low dosages of the most selective D3 receptor subtype dopamine-agonist available pramipexole and that of the most selective D2 receptor subtype bromocriptine on restless legs syndrome (RLS) and periodic leg movements during sleep. Materials and Methods: A placebo-controlled prospective investigation was carried out on 45 drug naïve patients with idiopathic RLS. Each patient underwent two consecutive full night polysomnographic studies, the first recording was performed without pre-medication, before the second recording one group received a single oral dose of 0.25 mg pramipexole and a second group a single oral dose of 2.5 mg bromocriptine, the remaining
Introduction and Objectives: Patients with reduced mobility or those during acute hospitalization experience difficulties in moving to the Sleep Unit for a sleep study. We developed a mobile sleep unit where the nurse moves to the patient’s bed-side to conduct the unattended sleep study. We evaluated the feasibility of this approach. Materials and Methods: Patients were referred for suspicion of sleep apnea. We selected patients hospitalized elsewhere and patients with reduced mobility, for a bed-side sleep study. The sleep nurse moved by a public taxi and the sleep device Embletta Gold (Embla, Denver, CO) was sent back by taxi the next day. A clinical and technical evaluation was performed (0 = no signal, 100 = good signal). Results: We studied 23 subjects (12 females), mean age 59 (range 24-83 years) and BMI 31 (20-45 kg/m2 ). Eight patients were hospitalized elsewhere during the time of the study. Seven patients had tetraplegy; three patients exhibited no communication ability. Two studies failed; one because no data was found, and the other due to patient readiness. The failure rate was 8%. The best signal quality was for the ECG channel 100% and the poorest for the oximetry at 83%. The cost for one bed-side sleep study was €340 (€200 for the routine sleep study, €115 for taxi, and €25 for 75 minutes of extra working time for the sleep nurse) and for a technically successful study
differed significantly for RLS vs. controls except for PLMS. Other standard MRS neurochemical measures neither differed significantly from controls nor correlated with sleep Conclusion: In brain, the Glx signal is mostly ( 80%) glutamate. Increases likely indicate increased glutamate. A primary insomnia study with sleep disruption similar to these RLS patients found reduced GABA with normal glutamate. The glutamate increases, therefore, unlikely result from but rather cause the sleep disruption. If confirmed, this study would provide a missing part of the neurobiological abnormalities of RLS: dopamine, iron and glutamate. Dopamine related to PLMS and sensory symptoms, glutamate related to hyperarousal. Brain iron compromise causes both of these abnormalities in animals. Acknowledgements: Study supported by: NIH grants P01-AG21190, R01NS38704, M01-RR02719.
T-L-107
THE PREVALENCE OF RESTLESS LEGS SYNDROME IN HORMONAL CONTRACEPTIVE USE
Lyla Kamsheh 1 , Ilana Ambrogi 2 , Cherridan Rambally 3 , Hrayr Attarian 2 . 1 University of Chicago, United States; 2 Northwestern University, United States; 3 Methodist Diagnostic Sleep Center, United States Introduction and Objectives: The prevalence of Restless Legs Syndrome (RLS) in pregnancy is around 30%. The etiology, however, of this association is not yet known. Changes in sex hormones are postulated to play a crucial role. We hypothesize that combined hormonal contraceptive therapy (OCP) creates a hormonal environment similar to pregnancy, which may confer a similar increased risk of RLS. The objective of our study is to determine the prevalence rate of RLS among women taking combined hormonal contraceptive therapy compared to controls. Materials and Methods: A survey was distributed to women on the Northwestern Campus of Chicago. The survey included demographic information, contraceptive use history, other medication use, and an International RLS severity index (IRLSS). The prevalence rate of RLS was determined in 145 women taking hormonal contraceptive therapy, who met inclusion criteria and compared to a 169 matched controlled women not taking OCP. Results: A significant relationship between combined OCP use and RLS symptoms was not found (p=0.53). RLS severity between users and nonusers of OCP was not significant either (p=0.2127). OCP users were significantly lighter than non-users (p=0.0040) as were RLS subjects compared with those without RLS (p=0.0015); RLS severity weakly correlated with BMI (R=0.26, p=0.044) as well. Conclusion: These findings suggest that hormonal contraceptive therapy does not increase the risk of developing RLS symptoms and that RLS in pregnancy is not purely due to hormonal changes. Examining a larger sample of women subdividing by estrogen content to determine if there exists a difference between very low vs. low estrogen containing pills and RLS could provide further insight into the hormonal hypothesis. The correlation of higher BMI and RLS has been reported before but the correlation between not using OCPs and increased BMI needs to be perhaps explored further.
S87
patients received placebo. Subjective evaluation of the severity of RLS symptoms was also assessed the morning after each polysomnography. Results: Subjective symptoms were improved by both pramipexole and bromocriptine, with pramipexole inducing the most important improvement. Side effects were preponderant after bromocriptine. Only pramipexole induced a mild reduction in REM sleep and an increase in sleep stage 1. Pramipexole was more effective than bromocriptine in reducing PLMS in patients with a high level of PLMS index at baseline. Typical PLMS (inter-LM intervals 10-40) disappeared completely after pramipexole treatment but persisted, even if reduced, after bromocriptine treatment. Conclusion: This study shows the superior efficacy of a drug targeting D3 receptor subtypes than a drug targeting preferentially D2 subtypes in RLS; establishing the specific target of DA in RLS has scientific relevance and important clinical implications.
O: Other
T-O-109
SLEEP DISORDERS IN PRIMARY SCHOOL CHILDREN IN KERMANSHAH, IRAN
Shapour Karimi. Kermanshah, Iran, Iran Introduction and Objectives: Sleep disorders are common in children; they also have a significant impact on the parents. Few studies in this field have been performed in Iran; hence the present study was carried out in order to determine sleep patterns and the prevalence of sleep disorders in school aged children in Kermanshah. Materials and Methods: This cross sectional study was done on 200 students (100 males and 100 females) of elementary schools in Kermanshah, selected from cluster random samples. The duration of the study was from September 2009 to April 2010, and data was acquired by means of a standard pediatric sleep questionnaire. Results: The prevalence of sleep disorder among subjects was 40.3% (43.3% in males, and 37.3% in females). Sleep patterns during the school days differed significantly from what was observed on Fridays (p=0.000). In addition, there was a significant difference between males and females in terms of duration of sleep on Fridays (p=0.014). Conclusion: Considering the high prevalence of sleep disorders in children, their harmful impact on the development of the nervous system and the child’s learning and psychological health as well as on parental competency, and again bearing in mind the low level of awareness among the general population about sleep hygiene, we strongly recommend educational programs via public media and via meetings with the parents in schools.
T-O-110
A MOBILE SLEEP UNIT IS FEASIBLE AND COST EFFECTIVE
Tiina Aalto 1 , Adel Bachour 2 . 1 Sleep Unit, Finland; 2 Sleep Unit, Finland
T-L-108
WHICH RECEPTOR SUBTYPE IS THE TARGET OF DOPAMINE-AGONISTS IN RESTLESS LEGS SYNDROME?
Mauro Manconi 1 , Raffaele Ferri 2 , Marco Zucconi 3 , Alessandro Oldani 3 , Claudio Bassetti 1 . 1 Sleep and Epilepsy Centre, Neurocenter of the Southern Switzerland, Switzerland; 2 Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Italy; 3 Sleep Disorders Center, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Vita-Salute University, Institute and Ospedale San Raffaele, Italy Introduction and Objectives: The aim of this study was to compare the efficacy of equivalent low dosages of the most selective D3 receptor subtype dopamine-agonist available pramipexole and that of the most selective D2 receptor subtype bromocriptine on restless legs syndrome (RLS) and periodic leg movements during sleep. Materials and Methods: A placebo-controlled prospective investigation was carried out on 45 drug naïve patients with idiopathic RLS. Each patient underwent two consecutive full night polysomnographic studies, the first recording was performed without pre-medication, before the second recording one group received a single oral dose of 0.25 mg pramipexole and a second group a single oral dose of 2.5 mg bromocriptine, the remaining
Introduction and Objectives: Patients with reduced mobility or those during acute hospitalization experience difficulties in moving to the Sleep Unit for a sleep study. We developed a mobile sleep unit where the nurse moves to the patient’s bed-side to conduct the unattended sleep study. We evaluated the feasibility of this approach. Materials and Methods: Patients were referred for suspicion of sleep apnea. We selected patients hospitalized elsewhere and patients with reduced mobility, for a bed-side sleep study. The sleep nurse moved by a public taxi and the sleep device Embletta Gold (Embla, Denver, CO) was sent back by taxi the next day. A clinical and technical evaluation was performed (0 = no signal, 100 = good signal). Results: We studied 23 subjects (12 females), mean age 59 (range 24-83 years) and BMI 31 (20-45 kg/m2 ). Eight patients were hospitalized elsewhere during the time of the study. Seven patients had tetraplegy; three patients exhibited no communication ability. Two studies failed; one because no data was found, and the other due to patient readiness. The failure rate was 8%. The best signal quality was for the ECG channel 100% and the poorest for the oximetry at 83%. The cost for one bed-side sleep study was €340 (€200 for the routine sleep study, €115 for taxi, and €25 for 75 minutes of extra working time for the sleep nurse) and for a technically successful study