- Email: [email protected]
Comorbidity between epilepsy and parasomnia
Abstracts/Sleep Medicine 16 (2015) S2–S199
deformities. Again, concomitant recording of polysomnography and Rigiscan was performed. Of the four episodes of penile tumescence during sleep period, later two events were during REM sleep periods, and ended with awakening due to penile pain. Therapy with Escitalporam, amitriptyline and propranolol was subsequently tried, but with only minimal improvement of symptoms. Results: According to the diagnostic criteria in internal classification of sleep disorders (ICSD-2), the each patient was diagnosed to have chronic, severe SRPE. Decreased sleep efficiency (83% and 69%) found on polysomnography was partly contributed to awakening due to penile pain, suggesting presence of sleep disturbance in these patients. Conclusion: Despite a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile pain, because SRPE can be diagnosed with its specific clinical features and confirmed with polysomnography accompanied with Rigiscan. http://dx.doi.org/10.1016/j.sleep.2015.02.162
Trauma associated sleep disorder: A proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares and REM without atonia in trauma survivors V. Mysliwiec 1, B. O’reilly 2, J. Polchinski 2, H. Kwon 2, A. Germain 3, B. Roth 2 1 65th Medical Brigade, US Army Meddac, USA 2 Madigan Army Medical Center, USA 3 University of Pittsburgh School of Medicine, USA
Introduction: Disruptive nocturnal behaviors (DNB) and nightmares are common symptoms reported by individuals with traumatic event exposure. Although these symptoms are often attributed to post-traumatic nightmares there are clinical features that suggest this is a unique parasomnia as nightmares do not have DNB as part of their diagnostic criteria. Materials and methods: Case series of four active duty US soldiers with exposure to traumatic events. Patients presented with nocturnal symptoms of DNB and nightmares. Clinical evaluation and attended overnight polysomnogram were performed on each patient. REM without atonia (RWA) was scored by SINBAR criteria. All patients received standard of care treatment for comorbid sleep disorders. Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient’s traumatic experiences. Evidence of autonomic hyperactivity was either reported by night sweats or tachycardia in REM. RWA occurred in all patients with an elevated EMG activity index mean of 20.9% for the four patients. One patient had DNB and a nightmare captured during REM sleep. All patients had clinical improvement with decreased DNB and nightmares with combined therapy of their comorbid sleep disorders and prazosin. Conclusion: We propose trauma associated sleep disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings and treatment responses of patients with DNB, nightmares and REM without atonia after trauma. Patients appear to have improvement with treatment of their comorbid sleep disorders along with prazosin. http://dx.doi.org/10.1016/j.sleep.2015.02.163
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Parasomnias among shift workers In Norway S. Waage 1, N. Magerøy 2, B. Moen 3, S. Pallesen 4, B. Bjorvatn 1 1 University of Bergen and Norwegian Competence Center for Sleep Disorders, Norway 2 Department of Occupational Medicine, Haukeland University Hospital, Norway 3 Department of Global Public Health and Primary Care, University of Bergen, Norway 4 Department of Psychosocial Science, University of Bergen, Norway
Introduction: Shift work is associated with sleep problems and impaired health. Parasomnias are undesirable physical events or experiences that occur during entry into sleep, during sleep or arousals from sleep, and are divided into two major groups, non-rapid eye movement (NREM) sleep-related parasomnias and REM sleeprelated parasomnias. Materials and methods: Data were collected from an on-going longitudinal cohort study “SUrvey of Shift work, Sleep and Health (SUSSH)” that was initiated in 2008/2009, with annually followups. Data were collected by questionnaires, posted along with a prepaid envelope for return. Initially, a sample of 5400 nurses was randomly selected from the Norwegian Nurses Organization’s membership roll which includes most of the nurses in Norway. This study presents findings from the fourth data collection (wave 4) that took place in 2012, including 2198 nurses. The nurses reported (no/ yes) whether they had experienced different parasomnias (confusional arousal, sleepwalking, sleep terror, sleep related eating, sleep related violence, sexsomnia, nightmare, dream enactment) during the last 3 months (less than once a month; 1–3 times a month; weekly or more often). Results: The prevalence of the different parasomnias ranged from 0.3% (injured somebody else during sleep) to 42.4% (nightmare) among day workers only, from 0.0% (sleep related eating; injured yourself during sleep) to 46.8% (nightmare) among night workers only, from 0.7% (sleep related eating; injured somebody else during sleep) to 54.7% (nightmare) among two shift workers and from 0.6% (injured yourself during sleep) to 53.7% (nightmare) among three shift workers. In all work schedules nightmare was the most common parasomnia. Nurses working a two shift schedule (including day and evening) and three shift schedule (including day, evening and night) showed higher prevalence for nearly all parasomnias compared with nurses working day only and night only schedules, but statistical significance was seen only for confusional arousal and nightmares. There were no apparent differences between day only and night only schedules. Conclusion: To conclude, nurses working rotational shift work schedules reported more confusional arousal and nightmares compared with nurses working daytime only. Most likely this findings can be attributed to circadian rhythm misalignment and sleep deprivation caused by shift work. http://dx.doi.org/10.1016/j.sleep.2015.02.164
Comorbidity between epilepsy and parasomnia H. Yilmaz 1, A. Kisabay 1, M. Batum 2, B. Oktan 1 1 Celal Bayar University School of Medicine, Department of Neurology, Section of Epilepsy and Sleep Disorders, Manisa, Turkey 2 Usak Public Hospital, Turkey
Introduction: The relationship between parasomnia and epilepsy are complex and little is known about the comorbidity of
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Abstracts/Sleep Medicine 16 (2015) S2–S199
parasomnia and epileptic seizures. We here aimed to investigate patients to reveal the comorbidity of epilepsy and parasomnia. Materials and methods: We retrospectively investigated all patients who was evaluated by video EEG polysomnograpy in our epilepsy and sleep disorders unit last 5 years. The diagnosis of epilepsy was made on clinical and electrophysiological findings. The diagnosis of parasomnia was made according to criteria of International Classification of sleep disorders and video EEG PSG findings. Results: A total of 114 male (62%) and 71 female (38%) patients were investigated. We have seen that only 81 patients (44%) of 185 patients were true diagnosed as epilepsy parasomnia comorbidity. Conclusion: Parasomnias and epileptic seizures can coexist in the same subject making the differential diagnosis of these conditions particularly challenging. A greater awareness, among clinicians, of the comorbidities between sleep disorders and epilepsy may help to prevent misdiagnosis and mistreatment. http://dx.doi.org/10.1016/j.sleep.2015.02.165
Change in the severity of apnea immediately after modified cautery assisted palatal stiffening operation N. Abdul Rashid 1, M. Mat Baki 2, N. Tajudin 2, M. Maaya 2, A. Mohamed 2 1 Universiti Putra Malaysia, Malaysia 2 Universiti Kebangsaan Malaysia, Malaysia
Introduction: Obstructive Sleep Apnea (OSA) is a risk factor for perioperative morbidity and mortality but evidence in the medical literature for postoperative complications requiring intensive care have been inconsistent. Postoperative observation in an intensive care setting may be shrewd but may not be necessary for all patients undergoing upper airway surgery. Materials and methods: A prospective cross-sectional study was carried out to observe the change in the severity of OSA in adult patients with mild to severe OSA who had undergone modified Cautery Assisted Palatal Stiffening Operation (CAPSO) with adjunct procedures. Their preoperative and immediate postoperative Level III polysomnography results were compared. The results were obtained from a four-channel unattended ambulatory device (Watch PAT100 by Itamar Medical, Israel). The patients were also observed for difficult intubation following induction of general anesthesia pre-operatively, as well as for airway compromise, cardiovascular events and any surgical complications in the immediate post-operative period in the recovery bay and intensive care unit. Results: Forty patients were recruited but only 21 completed the study. There were 19 male patients and 2 females. The median age was 32.5 years (9.8) (mean value of 34.9 ± 7.8) with the youngest at 24 years and oldest at 53 years. The median body mass index (BMI) was 29.0 (8.2) (mean value of 30 ± 4.5) where the lowest index was 23.2 and the highest was 37.5. 16 patients were a category ASA physical status 1 under the American Society of Anesthesiologists (ASA) Physical Status classification system while the remaining 5 were in the ASA physical status 2 category. The median preoperative and postoperative apnea hypopnea index remained in the severe category, which were 36.0 (51) (mean value of 43.1 ± 28.9) and 46.8 (40.4) (mean value of 40.3 ± 22.6) (p = 0.77) respectively. The median preoperative and postoperative oxygen desaturation index increased from 17.6 (47.2) (mean value of 30.8 ± 24.8) to 34.8 (36.3) (mean value of 28.9 ± 19.5) (p = 0.73). There was an improvement in the median preoperative and postoperative minimum saturation from 77% (14.5) (mean value of 77% ± 9.8) to 84% (7.5) (mean value of 83% ± 7.5) (p < 0.05). No difficult intubations were observed
and there were no respiratory, cardiovascular and surgical complications in the immediate postoperative period. Conclusion: No worsening of the severity of apnea was observed in the immediate postoperative period in all the study patients with mild to severe OSA who had undergone modified CAPSO with adjunct procedures. Those with ASA physical status 1 and 2 may be safe to be monitored in the general in the immediate postoperative period. http://dx.doi.org/10.1016/j.sleep.2015.02.166
The effect of antihypertensive drugs on heart rate variability and sleep parameters in hypertensive patients L. Ko 1, C. Yang 2, T. Kuo 2 1 Far Eastern Memorial Hospital, Taiwan 2 Sleep Research Center and Institute of Brain Science, National YangMing University, Taiwan
Introduction: Hypertension and insomnia are often coexist. Few studies investigated the impact of antihypertensive agents, such as angiotensin II receptor antagonist (ARB)/angiotensin-converting enzyme inhibitor (ACEi) and calcium channel blocker (CCB) on autonomic function and sleep parameters. Materials and methods: Twenty-seven patients with primary hypertension not under antihypertensive treatment, and 16 and nine patients receiving ARB/ACEi and CCB treatment respectively participated in this study. Forty-eight healthy subjects were recruited as the control group. Their electroencephalogram (EEG), electrocardiogram (ECG), electromyography (EMG), electrooculography (EOG) were recorded with TD1A (a miniature polysomnography) for 24 hours simultaneously. Autonomic function were analyzed with spectral analysis of heart rate variability. The Pittsburgh Sleep Quality Index was assessed in all the subjects recruited. Results: The heart rate variability analysis revealed a decrease in high frequency (HF) power in the ARB/ACEi treatment group compared with the hypertension without treatment group during REM (p = 0.026) and NREM (p = 0.045) sleep stages; the REM latency was lengthened in the ARB/ACEi treatment group compared with the healthy controls and hypertensive without treatment group (p = 0.004 and 0.015, respectively), and the other 14 parameters did not differ significantly among four groups. Hypertensive patients with ARB/ACEi treatment alone had significantly higher total PSQI score compared with healthy controls (p = 0.009), but a trend toward significant difference compared with hypertensive patients without any treatment (p = 0.065). Conclusion: Hypertensive patients with ARB/ACEi treatment alone had subjective poor sleep quality, and altered sleep structure compared with healthy controls and hypertensive patients without treatment. This group of patients also showed attenuated vagal tone during sleep. http://dx.doi.org/10.1016/j.sleep.2015.02.167
What kind of sleep is narcotic sleep? How different cannabinoids induce changes in the EEG of mice and the mechanism behind it O. Malyshevskaya, K. Aritake, Y. Urade International Institute for Integrative Sleep Medicine (WPI-IIIS), Japan
Introduction: Recently, many kinds of synthetic cannabinoids have been spread globally. Acute administration of synthetic cannabinoids
deformities. Again, concomitant recording of polysomnography and Rigiscan was performed. Of the four episodes of penile tumescence during sleep period, later two events were during REM sleep periods, and ended with awakening due to penile pain. Therapy with Escitalporam, amitriptyline and propranolol was subsequently tried, but with only minimal improvement of symptoms. Results: According to the diagnostic criteria in internal classification of sleep disorders (ICSD-2), the each patient was diagnosed to have chronic, severe SRPE. Decreased sleep efficiency (83% and 69%) found on polysomnography was partly contributed to awakening due to penile pain, suggesting presence of sleep disturbance in these patients. Conclusion: Despite a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile pain, because SRPE can be diagnosed with its specific clinical features and confirmed with polysomnography accompanied with Rigiscan. http://dx.doi.org/10.1016/j.sleep.2015.02.162
Trauma associated sleep disorder: A proposed parasomnia encompassing disruptive nocturnal behaviors, nightmares and REM without atonia in trauma survivors V. Mysliwiec 1, B. O’reilly 2, J. Polchinski 2, H. Kwon 2, A. Germain 3, B. Roth 2 1 65th Medical Brigade, US Army Meddac, USA 2 Madigan Army Medical Center, USA 3 University of Pittsburgh School of Medicine, USA
Introduction: Disruptive nocturnal behaviors (DNB) and nightmares are common symptoms reported by individuals with traumatic event exposure. Although these symptoms are often attributed to post-traumatic nightmares there are clinical features that suggest this is a unique parasomnia as nightmares do not have DNB as part of their diagnostic criteria. Materials and methods: Case series of four active duty US soldiers with exposure to traumatic events. Patients presented with nocturnal symptoms of DNB and nightmares. Clinical evaluation and attended overnight polysomnogram were performed on each patient. REM without atonia (RWA) was scored by SINBAR criteria. All patients received standard of care treatment for comorbid sleep disorders. Results: DNB ranged from vocalizations, somnambulism to combative behaviors that injured bed partners. Nightmares were replays of the patient’s traumatic experiences. Evidence of autonomic hyperactivity was either reported by night sweats or tachycardia in REM. RWA occurred in all patients with an elevated EMG activity index mean of 20.9% for the four patients. One patient had DNB and a nightmare captured during REM sleep. All patients had clinical improvement with decreased DNB and nightmares with combined therapy of their comorbid sleep disorders and prazosin. Conclusion: We propose trauma associated sleep disorder (TSD) as a unique sleep disorder encompassing the clinical features, PSG findings and treatment responses of patients with DNB, nightmares and REM without atonia after trauma. Patients appear to have improvement with treatment of their comorbid sleep disorders along with prazosin. http://dx.doi.org/10.1016/j.sleep.2015.02.163
S65
Parasomnias among shift workers In Norway S. Waage 1, N. Magerøy 2, B. Moen 3, S. Pallesen 4, B. Bjorvatn 1 1 University of Bergen and Norwegian Competence Center for Sleep Disorders, Norway 2 Department of Occupational Medicine, Haukeland University Hospital, Norway 3 Department of Global Public Health and Primary Care, University of Bergen, Norway 4 Department of Psychosocial Science, University of Bergen, Norway
Introduction: Shift work is associated with sleep problems and impaired health. Parasomnias are undesirable physical events or experiences that occur during entry into sleep, during sleep or arousals from sleep, and are divided into two major groups, non-rapid eye movement (NREM) sleep-related parasomnias and REM sleeprelated parasomnias. Materials and methods: Data were collected from an on-going longitudinal cohort study “SUrvey of Shift work, Sleep and Health (SUSSH)” that was initiated in 2008/2009, with annually followups. Data were collected by questionnaires, posted along with a prepaid envelope for return. Initially, a sample of 5400 nurses was randomly selected from the Norwegian Nurses Organization’s membership roll which includes most of the nurses in Norway. This study presents findings from the fourth data collection (wave 4) that took place in 2012, including 2198 nurses. The nurses reported (no/ yes) whether they had experienced different parasomnias (confusional arousal, sleepwalking, sleep terror, sleep related eating, sleep related violence, sexsomnia, nightmare, dream enactment) during the last 3 months (less than once a month; 1–3 times a month; weekly or more often). Results: The prevalence of the different parasomnias ranged from 0.3% (injured somebody else during sleep) to 42.4% (nightmare) among day workers only, from 0.0% (sleep related eating; injured yourself during sleep) to 46.8% (nightmare) among night workers only, from 0.7% (sleep related eating; injured somebody else during sleep) to 54.7% (nightmare) among two shift workers and from 0.6% (injured yourself during sleep) to 53.7% (nightmare) among three shift workers. In all work schedules nightmare was the most common parasomnia. Nurses working a two shift schedule (including day and evening) and three shift schedule (including day, evening and night) showed higher prevalence for nearly all parasomnias compared with nurses working day only and night only schedules, but statistical significance was seen only for confusional arousal and nightmares. There were no apparent differences between day only and night only schedules. Conclusion: To conclude, nurses working rotational shift work schedules reported more confusional arousal and nightmares compared with nurses working daytime only. Most likely this findings can be attributed to circadian rhythm misalignment and sleep deprivation caused by shift work. http://dx.doi.org/10.1016/j.sleep.2015.02.164
Comorbidity between epilepsy and parasomnia H. Yilmaz 1, A. Kisabay 1, M. Batum 2, B. Oktan 1 1 Celal Bayar University School of Medicine, Department of Neurology, Section of Epilepsy and Sleep Disorders, Manisa, Turkey 2 Usak Public Hospital, Turkey
Introduction: The relationship between parasomnia and epilepsy are complex and little is known about the comorbidity of
S66
Abstracts/Sleep Medicine 16 (2015) S2–S199
parasomnia and epileptic seizures. We here aimed to investigate patients to reveal the comorbidity of epilepsy and parasomnia. Materials and methods: We retrospectively investigated all patients who was evaluated by video EEG polysomnograpy in our epilepsy and sleep disorders unit last 5 years. The diagnosis of epilepsy was made on clinical and electrophysiological findings. The diagnosis of parasomnia was made according to criteria of International Classification of sleep disorders and video EEG PSG findings. Results: A total of 114 male (62%) and 71 female (38%) patients were investigated. We have seen that only 81 patients (44%) of 185 patients were true diagnosed as epilepsy parasomnia comorbidity. Conclusion: Parasomnias and epileptic seizures can coexist in the same subject making the differential diagnosis of these conditions particularly challenging. A greater awareness, among clinicians, of the comorbidities between sleep disorders and epilepsy may help to prevent misdiagnosis and mistreatment. http://dx.doi.org/10.1016/j.sleep.2015.02.165
Change in the severity of apnea immediately after modified cautery assisted palatal stiffening operation N. Abdul Rashid 1, M. Mat Baki 2, N. Tajudin 2, M. Maaya 2, A. Mohamed 2 1 Universiti Putra Malaysia, Malaysia 2 Universiti Kebangsaan Malaysia, Malaysia
Introduction: Obstructive Sleep Apnea (OSA) is a risk factor for perioperative morbidity and mortality but evidence in the medical literature for postoperative complications requiring intensive care have been inconsistent. Postoperative observation in an intensive care setting may be shrewd but may not be necessary for all patients undergoing upper airway surgery. Materials and methods: A prospective cross-sectional study was carried out to observe the change in the severity of OSA in adult patients with mild to severe OSA who had undergone modified Cautery Assisted Palatal Stiffening Operation (CAPSO) with adjunct procedures. Their preoperative and immediate postoperative Level III polysomnography results were compared. The results were obtained from a four-channel unattended ambulatory device (Watch PAT100 by Itamar Medical, Israel). The patients were also observed for difficult intubation following induction of general anesthesia pre-operatively, as well as for airway compromise, cardiovascular events and any surgical complications in the immediate post-operative period in the recovery bay and intensive care unit. Results: Forty patients were recruited but only 21 completed the study. There were 19 male patients and 2 females. The median age was 32.5 years (9.8) (mean value of 34.9 ± 7.8) with the youngest at 24 years and oldest at 53 years. The median body mass index (BMI) was 29.0 (8.2) (mean value of 30 ± 4.5) where the lowest index was 23.2 and the highest was 37.5. 16 patients were a category ASA physical status 1 under the American Society of Anesthesiologists (ASA) Physical Status classification system while the remaining 5 were in the ASA physical status 2 category. The median preoperative and postoperative apnea hypopnea index remained in the severe category, which were 36.0 (51) (mean value of 43.1 ± 28.9) and 46.8 (40.4) (mean value of 40.3 ± 22.6) (p = 0.77) respectively. The median preoperative and postoperative oxygen desaturation index increased from 17.6 (47.2) (mean value of 30.8 ± 24.8) to 34.8 (36.3) (mean value of 28.9 ± 19.5) (p = 0.73). There was an improvement in the median preoperative and postoperative minimum saturation from 77% (14.5) (mean value of 77% ± 9.8) to 84% (7.5) (mean value of 83% ± 7.5) (p < 0.05). No difficult intubations were observed
and there were no respiratory, cardiovascular and surgical complications in the immediate postoperative period. Conclusion: No worsening of the severity of apnea was observed in the immediate postoperative period in all the study patients with mild to severe OSA who had undergone modified CAPSO with adjunct procedures. Those with ASA physical status 1 and 2 may be safe to be monitored in the general in the immediate postoperative period. http://dx.doi.org/10.1016/j.sleep.2015.02.166
The effect of antihypertensive drugs on heart rate variability and sleep parameters in hypertensive patients L. Ko 1, C. Yang 2, T. Kuo 2 1 Far Eastern Memorial Hospital, Taiwan 2 Sleep Research Center and Institute of Brain Science, National YangMing University, Taiwan
Introduction: Hypertension and insomnia are often coexist. Few studies investigated the impact of antihypertensive agents, such as angiotensin II receptor antagonist (ARB)/angiotensin-converting enzyme inhibitor (ACEi) and calcium channel blocker (CCB) on autonomic function and sleep parameters. Materials and methods: Twenty-seven patients with primary hypertension not under antihypertensive treatment, and 16 and nine patients receiving ARB/ACEi and CCB treatment respectively participated in this study. Forty-eight healthy subjects were recruited as the control group. Their electroencephalogram (EEG), electrocardiogram (ECG), electromyography (EMG), electrooculography (EOG) were recorded with TD1A (a miniature polysomnography) for 24 hours simultaneously. Autonomic function were analyzed with spectral analysis of heart rate variability. The Pittsburgh Sleep Quality Index was assessed in all the subjects recruited. Results: The heart rate variability analysis revealed a decrease in high frequency (HF) power in the ARB/ACEi treatment group compared with the hypertension without treatment group during REM (p = 0.026) and NREM (p = 0.045) sleep stages; the REM latency was lengthened in the ARB/ACEi treatment group compared with the healthy controls and hypertensive without treatment group (p = 0.004 and 0.015, respectively), and the other 14 parameters did not differ significantly among four groups. Hypertensive patients with ARB/ACEi treatment alone had significantly higher total PSQI score compared with healthy controls (p = 0.009), but a trend toward significant difference compared with hypertensive patients without any treatment (p = 0.065). Conclusion: Hypertensive patients with ARB/ACEi treatment alone had subjective poor sleep quality, and altered sleep structure compared with healthy controls and hypertensive patients without treatment. This group of patients also showed attenuated vagal tone during sleep. http://dx.doi.org/10.1016/j.sleep.2015.02.167
What kind of sleep is narcotic sleep? How different cannabinoids induce changes in the EEG of mice and the mechanism behind it O. Malyshevskaya, K. Aritake, Y. Urade International Institute for Integrative Sleep Medicine (WPI-IIIS), Japan
Introduction: Recently, many kinds of synthetic cannabinoids have been spread globally. Acute administration of synthetic cannabinoids