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Cross-sectional study on relationships between hypertension and insomnia
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Abstracts / Sleep Medicine 14S (2013) e165–e238
Results: For the SLE cohort (mean age 44.0 7.8 years; mean disease duration 15.5 7.8 years, in disease remission) poor sleep quality resulted in 62.2% SLE patients versus 39.6% of H group (p < 0.01) Insomnia was observed in 29.7% SLE vs 22.6% H patients: respectively 26.4% SLE patients had difficulties in initiating sleep vs 25.7% H patients and 62.2% vs 22.9 % (p < 0.001) had difficulties in maintaining sleep and/or early morning awakening. A depressive disorder was present in 35.1% of SLE vs 13.3% H patients (p < 0.001) while an anxiety disorder was more common in H patients, with a prevalence of 35.8% vs 16.2% SLE (p < 0.01).Regression analysis in unadjusted model showed a higher risk for having poor sleep quality in SLE vs H (OR. 2.5 [Cl 1.21–5.16]). After adjusting for confounding factors (BMI, SAS, BDI), only depression accounted for poor sleep quality in SLE (OR. 6.9 [Cl 1.07–23.6]). Poor sleep quality was not related to corticosteroid therapy (p = ns) while it was related to immunosuppressive therapy (mycophenolate p < .05, azathioprine p < .05). Neither disease duration and activity or SLE organ damage was related to the presence of poor sleep quality (p = ns). Conclusion: In this cohort of SLE women, insomnia and poor sleep quality were common. Especially poor sleep quality, difficulties in maintaining sleep and/or early morning awakening were more common in SLE than in H patients. In addition, depression was highly prevalent in SLE and was a major determinant of poor sleep quality.In addition poor sleep quality may be related to immunosuppressive therapy. These data highlight the importance of investigating sleep disorders, depressive symptoms and the role of therapy in SLE patients. Acknowledgements: L. Carli, L. Ghiadoni. http://dx.doi.org/10.1016/j.sleep.2013.11.548
Metacognition selectively defines primary insomnia L. Palagini 1,2, A. Piarulli 3,4, E. Lai 1,5, E. Cheli 1,6, C. Espie 7,8, A. Gemignani 1,5 1 University of Pisa, Italy 2 Department of Clinical and Experimental Medicine, PsychiatricUnit, University of Pisa, Italy 3 Scuola Superiore S. Anna, Pisa, Italy 4 PERCRO Lab, Scuola Superiore Sant’Anna, Pisa, Italy 5 Department of Clinical and Experimental Medicine, Pisa, Italy 6 Department of Clinical and Experimental Medicine, University of Pisa, Italy 7 University of Oxford, UK 8 Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute,University of Oxford, UK
Introduction: Metacognitive beliefs and associated actions seem to be a stigma of primary insomnia. Indeed mental activity of primary insomniacs during the night is mainly devoted to generate thought control strategies, including reappraisal, worry and thought suppression. These strategies, in turn, induce a vicious cycle, maintaining insomnia. Our aim is to identify whether metacognitive aspects are a specific mental pattern of primary insomnia or an aspecific correlate of sleep alterations. Materials and methods: We have studied 24 primary insomniacs (test group), 24 snorers, complaining nocturnal awakenings without diagnosis of obstructive sleep apnea syndrome (control group), and 20 healthy controls (sham group). Quality of sleep was assessed by Pittsburgh Sleep Quality Index (PSQI), while metacognitive aspects by means of Metacognitions Questionnaire – Insomnia (MCQI). Total score of both indices were log-transformed and tested for normality (Lilliefors test). PSQI scores were normally distributed whereas for MCQI scores the null hypothesis was rejected. On this basis, PSQI was submitted to analysis of variance with group as a 3 level
between factor (test, control and sham groups) while MCQI to Kruskal–Wallis test with group as a between factor. Parametric post hocs were conducted applying unpaired t-tests with Sidak correction whereas non-parametric ones through Mann–Whitney test with Sidak correction. Results: For both tests a significant group effect (p < 0.001) was found. PSQI discriminates primary insomniacs from normal sleeper, but not from snorers, instead MCQI discriminates primary insomniacs from both normal sleepers and snorers. All described post hocs are highly significant (p < 0.001). Conclusion: These preliminary results allowed us to draw two main conclusions: (i) metacognitive aspects selectively characterize mental activity of primary insomniacs; (ii) MCQI, with respect to PSQI, showed higher sensitivity in defining primary insomniacs. In conclusion, the promising psychometric properties of MCQI will help to develop a specific metacognitive model of primary insomnia. Acknowledgements: Dr. A.Agrimi, Dr. D.Menicucci.
http://dx.doi.org/10.1016/j.sleep.2013.11.549
Cross-sectional study on relationships between hypertension and insomnia L. Palagini 1,2, A. Piarulli 3,4, M. Bergamasco 3,4, R. Bruno 1,5, L. Ghiadoni 1,5, A. Gemignani 1,6 1 University of Pisa, Italy 2 Clinical and Experimental Medicine, PsychiatricUnit, University of Pisa, Italy 3 Scuola Superiore S. Anna, Pisa, Italy 4 PERCRO Lab, Scuola Superiore Sant’Anna, Pisa, Italy 5 Clinical and Experimental Medicine, Hypertension Unit, University of Pisa 6 Pathology Department University of Pisa, Italy
Introduction: Hypertension (HT) and insomnia seem to be associated but, to date, only few studies have described this relationship. Insomnia seems to represent an independent factor influencing the negative outcome of HT while other studies indicate, although nonconsistently, a possible negative influence of anxiety/depression on HT.Objective of this study is to determine relationships between insomnia and HT, taking into account also anxiety/depression factors. Materials and methods: In this cross-sectional cohort study, 270 consecutive essential hypertensive patients were recruited at the Outpatient Hypertension Unit, University of Pisa, Italy. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Perceived Stress Scale (PSS), Self-Rating Anxiety Scale (SAS) and State-Trait Anxiety Inventory (STAI-Y2) were administered to all subjects. Patients with Sleep-Disordered Breathing were excluded. Possible associations between HT, insomnia and anxiety/depression factors were evaluated using a statistical approach based on Principal Components Analysis (PCA). Results: After varimax rotation, PCA allowed us identifying two principal components which explain 35% and 24% of variance respectively: 1) PC1, named Insomnia Factor, includes PSQI 1, 2, 3, 4, 5 factors, ISI, and sleep duration (SD) (SD is negatively correlated with PC1 while the other parameters are positively correlated); PC2, named Anxiety/Depression Factor, includes PSQI 6 and 7 components, BDI, SAS, STAI and PSS (all positively correlated with PC2). The study of clinical degree of HT allowed us disentangling Non Resistant HT patients (NRHT, No: 230; 51% males) from Resistant HT patients (RHT, No: 40; 51% females). Thus, Kruskal–Wallis test with Resistant HT as between factor has been computed on both PC1 and PC2. RHT patients showed significantly higher Insomnia Factor (PC1) values than NRHT ones (p < 0.01). No significant
Abstracts / Sleep Medicine 14S (2013) e165–e238
difference has been detected for Anxiety/Depression Factor (PC2). Interestingly, differences identified for the Insomnia Factor show a gender effect: RHT females show significantly higher values with respect to NRHT ones, while no significant difference (p < 0.15) is apparent for males. Conclusion: These preliminary results allowed us to draw two main conclusions: (i) insomnia and anxiety/depression status are independent factors in modulating HT; (ii) insomnia is significantly associated with resistance to treatment in hypertensive women, independently of any other psychological confounders.In conclusion, the promising results of this study will help to develop specific therapeutic strategies towards Resistant Hypertension, which should include hypnotic treatment. Acknowledgements: Elisa Lai, Carolina De Bernardo. http://dx.doi.org/10.1016/j.sleep.2013.11.550
Sleep quality in drug resistant epilepsy patients I. Alvarez Guerrico, B. Garcia Parra, P. Lluis, I. Royo, F.M. Isabel, R. Rocamora Hospital del Mar
Introduction: Sleep and psychiatric disorders are frequent comorbidities in patients with epilepsy. Sleep quality is affected by anxiety or depressive conditions which worsen the seizures control. Reciprocally, epilepsy itself determines sleep disturbances, although mechanisms are not well known. The aim of our study was to evaluate sleep quality in patients admitted to the Epilepsy Monitoring Unit (EMU) of our centre for diagnostic purposes. Parameters to be considered were gender, age, epilepsy type, antiepileptic drug (AED) therapy, anxious and depressive scores and quality of life index. Materials and methods: 92 Patients over 18 years-old with drug resistant epilepsy were analysed. The day of admission at EMU, all patients completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Quality of Life in Epilepsy Inventory (QOLIE-10). Patients with pseudoseizures were excluded. Univariate and multivariate linear regression models were calculated to assess variables associated with PSQI. Results: Patients evaluated at EMU showed a lower sleep quality on PSQI (6.79 3.81, cut-off value of 5). Also the quality of life measured by QOLIE-10 (normal index < 21) was reduced (26.71 8.17). Significant differences in PSQI according to gender (F = 52; M = 40), age (39 12 years) or epilepsy form (generalized = 9; temporal = 55; frontal = 13; occipital = 7; other = 8) were not found. Correlations between sleep quality and antiepileptic therapy could not be established. The univariate analysis showed a positive correlation between PSQI and depression and anxiety scores. Nevertheless, the multivariate analysis established a stronger correlation between PSQI and HADS-anxiety index (8.45 4.14). Conclusion: Patients with drug resistant epilepsy have reduced sleep quality and quality of life. Anxiety seems to be the most important condition over sleep quality in pharmacoresistant epilepsy patients. In order to establish correlations between sleep disturbances and epilepsy form or AED therapy, new clinical trials should be developed. Acknowledgements: Epilepsy Monitoring Unit Team, Hospital del Mar. http://dx.doi.org/10.1016/j.sleep.2013.11.551
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Sleep difficulties in Parkinson’s disease M. Partinen 1, A. Ylikoski 1, K. Martikainen 2 1 Vitalmed Research Center, Helsinki Sleep Clinic 2 The Finnish Parkinson Association
Introduction: Insomnia is often complained by patients with Parkinson’s disease (PD). We studied occurrence of different complaints of insomnia, fatigue and sleepiness. Materials and methods: The base populations consisted of 1447 patients with Parkinson’s disease. A structured questionnaire was sent. 649 subjects were included (55.7% men). Mean age was 68.1 y (SD 8.5). Average duration of PD was 5.9 y (SD 4.9). The questions were derived from the Basic Nordic Sleep Questionnaire. Results: Occurrence of complaints on at least three nights/days per week were: difficulties falling asleep 16.6%, nocturnal awakenings 77.5%, early morning awakenings 37.8%, fatigue 43.4%, tiredness 52%, sleepiness 44.4%, snoring 38.8%, nocturnal breathing pauses (apnea) noted by others 6.8%, bruxism 2.9%, waking up to urinate at least once at night 70.3%. Of all 11.7% woke up at least thrice and 41.1% woke up at least twice per night to urinate. Altogether 47.5% complained of chronic insomnia lasting for at least one month. Using the Rimon Depression Scale 24.8% were depressive and using the WHO-5 scale (WHO-5 < 28) the respective figure was 11.9%. Using the Marburg RBD scale 36.7% had at least 6/10 points. The mean ESS score was 8.2 (SD 4.9). ESS was >10 in 30.5% of the responders. Previous restless legs syndrome had been diagnosed in 5% of all but 17% fulfilled the IRLS criteria for RLS. Conclusion: The most common sleep complaints are nocturnal awakenings and nocturia while bruxism and difficulties falling asleep were less frequent. RLS had been rarely diagnosed despite of the complaints. Acknowledgements: This study was supported by the Finnish Parkinson Foundation. http://dx.doi.org/10.1016/j.sleep.2013.11.552
Pharmacogenetic inhibition of the subcoeruleus region influences rem sleep and cataplexy in narcoleptic mice K. Sanghera, J. Kim, J. Peever University of Toronto, Canada
Introduction: Cataplexy – the sudden involuntary loss of skeletal muscle tone – is a defining feature of narcolepsy. A longstanding, but untested, hypothesis is that cataplexy results from intrusion of REM sleep paralysis into wakefulness. This hypothesis is built on the assumption that cataplexy and REM sleep paralysis share a common neural mechanism. The current study aimed to determine if cataplexy is influenced by direct manipulation of REM sleep circuitry. We did this by pharmacogenetically inhibiting cells in the subcoeruleus – a region important for REM paralysis – while monitoring REM sleep and cataplexy in narcoleptic mice. Materials and methods: Virally-mediated transduction of hM4DGi/o was bilaterally targeted to the subcoeruleus (Sub-C) in hypocretin knockout mice (n = 7). Standard electrophysiological (i.e., EEG/ EMG) and behavioural criteria were used to characterize cataplexy and REM sleep. Intraperitoneal administration of clozapine-n-oxide (CNO, 10 mg/kg) was used to inhibit Sub-C cells expressing hM4DGi/o. Saline injections served as controls for CNO administration. Histological and immunohistochemistry were used to verify hM4D-Gi/o expression in the left/right Sub-C.
Abstracts / Sleep Medicine 14S (2013) e165–e238
Results: For the SLE cohort (mean age 44.0 7.8 years; mean disease duration 15.5 7.8 years, in disease remission) poor sleep quality resulted in 62.2% SLE patients versus 39.6% of H group (p < 0.01) Insomnia was observed in 29.7% SLE vs 22.6% H patients: respectively 26.4% SLE patients had difficulties in initiating sleep vs 25.7% H patients and 62.2% vs 22.9 % (p < 0.001) had difficulties in maintaining sleep and/or early morning awakening. A depressive disorder was present in 35.1% of SLE vs 13.3% H patients (p < 0.001) while an anxiety disorder was more common in H patients, with a prevalence of 35.8% vs 16.2% SLE (p < 0.01).Regression analysis in unadjusted model showed a higher risk for having poor sleep quality in SLE vs H (OR. 2.5 [Cl 1.21–5.16]). After adjusting for confounding factors (BMI, SAS, BDI), only depression accounted for poor sleep quality in SLE (OR. 6.9 [Cl 1.07–23.6]). Poor sleep quality was not related to corticosteroid therapy (p = ns) while it was related to immunosuppressive therapy (mycophenolate p < .05, azathioprine p < .05). Neither disease duration and activity or SLE organ damage was related to the presence of poor sleep quality (p = ns). Conclusion: In this cohort of SLE women, insomnia and poor sleep quality were common. Especially poor sleep quality, difficulties in maintaining sleep and/or early morning awakening were more common in SLE than in H patients. In addition, depression was highly prevalent in SLE and was a major determinant of poor sleep quality.In addition poor sleep quality may be related to immunosuppressive therapy. These data highlight the importance of investigating sleep disorders, depressive symptoms and the role of therapy in SLE patients. Acknowledgements: L. Carli, L. Ghiadoni. http://dx.doi.org/10.1016/j.sleep.2013.11.548
Metacognition selectively defines primary insomnia L. Palagini 1,2, A. Piarulli 3,4, E. Lai 1,5, E. Cheli 1,6, C. Espie 7,8, A. Gemignani 1,5 1 University of Pisa, Italy 2 Department of Clinical and Experimental Medicine, PsychiatricUnit, University of Pisa, Italy 3 Scuola Superiore S. Anna, Pisa, Italy 4 PERCRO Lab, Scuola Superiore Sant’Anna, Pisa, Italy 5 Department of Clinical and Experimental Medicine, Pisa, Italy 6 Department of Clinical and Experimental Medicine, University of Pisa, Italy 7 University of Oxford, UK 8 Nuffield Department of Clinical Neurosciences/Sleep & Circadian Neuroscience Institute,University of Oxford, UK
Introduction: Metacognitive beliefs and associated actions seem to be a stigma of primary insomnia. Indeed mental activity of primary insomniacs during the night is mainly devoted to generate thought control strategies, including reappraisal, worry and thought suppression. These strategies, in turn, induce a vicious cycle, maintaining insomnia. Our aim is to identify whether metacognitive aspects are a specific mental pattern of primary insomnia or an aspecific correlate of sleep alterations. Materials and methods: We have studied 24 primary insomniacs (test group), 24 snorers, complaining nocturnal awakenings without diagnosis of obstructive sleep apnea syndrome (control group), and 20 healthy controls (sham group). Quality of sleep was assessed by Pittsburgh Sleep Quality Index (PSQI), while metacognitive aspects by means of Metacognitions Questionnaire – Insomnia (MCQI). Total score of both indices were log-transformed and tested for normality (Lilliefors test). PSQI scores were normally distributed whereas for MCQI scores the null hypothesis was rejected. On this basis, PSQI was submitted to analysis of variance with group as a 3 level
between factor (test, control and sham groups) while MCQI to Kruskal–Wallis test with group as a between factor. Parametric post hocs were conducted applying unpaired t-tests with Sidak correction whereas non-parametric ones through Mann–Whitney test with Sidak correction. Results: For both tests a significant group effect (p < 0.001) was found. PSQI discriminates primary insomniacs from normal sleeper, but not from snorers, instead MCQI discriminates primary insomniacs from both normal sleepers and snorers. All described post hocs are highly significant (p < 0.001). Conclusion: These preliminary results allowed us to draw two main conclusions: (i) metacognitive aspects selectively characterize mental activity of primary insomniacs; (ii) MCQI, with respect to PSQI, showed higher sensitivity in defining primary insomniacs. In conclusion, the promising psychometric properties of MCQI will help to develop a specific metacognitive model of primary insomnia. Acknowledgements: Dr. A.Agrimi, Dr. D.Menicucci.
http://dx.doi.org/10.1016/j.sleep.2013.11.549
Cross-sectional study on relationships between hypertension and insomnia L. Palagini 1,2, A. Piarulli 3,4, M. Bergamasco 3,4, R. Bruno 1,5, L. Ghiadoni 1,5, A. Gemignani 1,6 1 University of Pisa, Italy 2 Clinical and Experimental Medicine, PsychiatricUnit, University of Pisa, Italy 3 Scuola Superiore S. Anna, Pisa, Italy 4 PERCRO Lab, Scuola Superiore Sant’Anna, Pisa, Italy 5 Clinical and Experimental Medicine, Hypertension Unit, University of Pisa 6 Pathology Department University of Pisa, Italy
Introduction: Hypertension (HT) and insomnia seem to be associated but, to date, only few studies have described this relationship. Insomnia seems to represent an independent factor influencing the negative outcome of HT while other studies indicate, although nonconsistently, a possible negative influence of anxiety/depression on HT.Objective of this study is to determine relationships between insomnia and HT, taking into account also anxiety/depression factors. Materials and methods: In this cross-sectional cohort study, 270 consecutive essential hypertensive patients were recruited at the Outpatient Hypertension Unit, University of Pisa, Italy. Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Beck Depression Inventory (BDI), Perceived Stress Scale (PSS), Self-Rating Anxiety Scale (SAS) and State-Trait Anxiety Inventory (STAI-Y2) were administered to all subjects. Patients with Sleep-Disordered Breathing were excluded. Possible associations between HT, insomnia and anxiety/depression factors were evaluated using a statistical approach based on Principal Components Analysis (PCA). Results: After varimax rotation, PCA allowed us identifying two principal components which explain 35% and 24% of variance respectively: 1) PC1, named Insomnia Factor, includes PSQI 1, 2, 3, 4, 5 factors, ISI, and sleep duration (SD) (SD is negatively correlated with PC1 while the other parameters are positively correlated); PC2, named Anxiety/Depression Factor, includes PSQI 6 and 7 components, BDI, SAS, STAI and PSS (all positively correlated with PC2). The study of clinical degree of HT allowed us disentangling Non Resistant HT patients (NRHT, No: 230; 51% males) from Resistant HT patients (RHT, No: 40; 51% females). Thus, Kruskal–Wallis test with Resistant HT as between factor has been computed on both PC1 and PC2. RHT patients showed significantly higher Insomnia Factor (PC1) values than NRHT ones (p < 0.01). No significant
Abstracts / Sleep Medicine 14S (2013) e165–e238
difference has been detected for Anxiety/Depression Factor (PC2). Interestingly, differences identified for the Insomnia Factor show a gender effect: RHT females show significantly higher values with respect to NRHT ones, while no significant difference (p < 0.15) is apparent for males. Conclusion: These preliminary results allowed us to draw two main conclusions: (i) insomnia and anxiety/depression status are independent factors in modulating HT; (ii) insomnia is significantly associated with resistance to treatment in hypertensive women, independently of any other psychological confounders.In conclusion, the promising results of this study will help to develop specific therapeutic strategies towards Resistant Hypertension, which should include hypnotic treatment. Acknowledgements: Elisa Lai, Carolina De Bernardo. http://dx.doi.org/10.1016/j.sleep.2013.11.550
Sleep quality in drug resistant epilepsy patients I. Alvarez Guerrico, B. Garcia Parra, P. Lluis, I. Royo, F.M. Isabel, R. Rocamora Hospital del Mar
Introduction: Sleep and psychiatric disorders are frequent comorbidities in patients with epilepsy. Sleep quality is affected by anxiety or depressive conditions which worsen the seizures control. Reciprocally, epilepsy itself determines sleep disturbances, although mechanisms are not well known. The aim of our study was to evaluate sleep quality in patients admitted to the Epilepsy Monitoring Unit (EMU) of our centre for diagnostic purposes. Parameters to be considered were gender, age, epilepsy type, antiepileptic drug (AED) therapy, anxious and depressive scores and quality of life index. Materials and methods: 92 Patients over 18 years-old with drug resistant epilepsy were analysed. The day of admission at EMU, all patients completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Quality of Life in Epilepsy Inventory (QOLIE-10). Patients with pseudoseizures were excluded. Univariate and multivariate linear regression models were calculated to assess variables associated with PSQI. Results: Patients evaluated at EMU showed a lower sleep quality on PSQI (6.79 3.81, cut-off value of 5). Also the quality of life measured by QOLIE-10 (normal index < 21) was reduced (26.71 8.17). Significant differences in PSQI according to gender (F = 52; M = 40), age (39 12 years) or epilepsy form (generalized = 9; temporal = 55; frontal = 13; occipital = 7; other = 8) were not found. Correlations between sleep quality and antiepileptic therapy could not be established. The univariate analysis showed a positive correlation between PSQI and depression and anxiety scores. Nevertheless, the multivariate analysis established a stronger correlation between PSQI and HADS-anxiety index (8.45 4.14). Conclusion: Patients with drug resistant epilepsy have reduced sleep quality and quality of life. Anxiety seems to be the most important condition over sleep quality in pharmacoresistant epilepsy patients. In order to establish correlations between sleep disturbances and epilepsy form or AED therapy, new clinical trials should be developed. Acknowledgements: Epilepsy Monitoring Unit Team, Hospital del Mar. http://dx.doi.org/10.1016/j.sleep.2013.11.551
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Sleep difficulties in Parkinson’s disease M. Partinen 1, A. Ylikoski 1, K. Martikainen 2 1 Vitalmed Research Center, Helsinki Sleep Clinic 2 The Finnish Parkinson Association
Introduction: Insomnia is often complained by patients with Parkinson’s disease (PD). We studied occurrence of different complaints of insomnia, fatigue and sleepiness. Materials and methods: The base populations consisted of 1447 patients with Parkinson’s disease. A structured questionnaire was sent. 649 subjects were included (55.7% men). Mean age was 68.1 y (SD 8.5). Average duration of PD was 5.9 y (SD 4.9). The questions were derived from the Basic Nordic Sleep Questionnaire. Results: Occurrence of complaints on at least three nights/days per week were: difficulties falling asleep 16.6%, nocturnal awakenings 77.5%, early morning awakenings 37.8%, fatigue 43.4%, tiredness 52%, sleepiness 44.4%, snoring 38.8%, nocturnal breathing pauses (apnea) noted by others 6.8%, bruxism 2.9%, waking up to urinate at least once at night 70.3%. Of all 11.7% woke up at least thrice and 41.1% woke up at least twice per night to urinate. Altogether 47.5% complained of chronic insomnia lasting for at least one month. Using the Rimon Depression Scale 24.8% were depressive and using the WHO-5 scale (WHO-5 < 28) the respective figure was 11.9%. Using the Marburg RBD scale 36.7% had at least 6/10 points. The mean ESS score was 8.2 (SD 4.9). ESS was >10 in 30.5% of the responders. Previous restless legs syndrome had been diagnosed in 5% of all but 17% fulfilled the IRLS criteria for RLS. Conclusion: The most common sleep complaints are nocturnal awakenings and nocturia while bruxism and difficulties falling asleep were less frequent. RLS had been rarely diagnosed despite of the complaints. Acknowledgements: This study was supported by the Finnish Parkinson Foundation. http://dx.doi.org/10.1016/j.sleep.2013.11.552
Pharmacogenetic inhibition of the subcoeruleus region influences rem sleep and cataplexy in narcoleptic mice K. Sanghera, J. Kim, J. Peever University of Toronto, Canada
Introduction: Cataplexy – the sudden involuntary loss of skeletal muscle tone – is a defining feature of narcolepsy. A longstanding, but untested, hypothesis is that cataplexy results from intrusion of REM sleep paralysis into wakefulness. This hypothesis is built on the assumption that cataplexy and REM sleep paralysis share a common neural mechanism. The current study aimed to determine if cataplexy is influenced by direct manipulation of REM sleep circuitry. We did this by pharmacogenetically inhibiting cells in the subcoeruleus – a region important for REM paralysis – while monitoring REM sleep and cataplexy in narcoleptic mice. Materials and methods: Virally-mediated transduction of hM4DGi/o was bilaterally targeted to the subcoeruleus (Sub-C) in hypocretin knockout mice (n = 7). Standard electrophysiological (i.e., EEG/ EMG) and behavioural criteria were used to characterize cataplexy and REM sleep. Intraperitoneal administration of clozapine-n-oxide (CNO, 10 mg/kg) was used to inhibit Sub-C cells expressing hM4DGi/o. Saline injections served as controls for CNO administration. Histological and immunohistochemistry were used to verify hM4D-Gi/o expression in the left/right Sub-C.