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Diagnosing restless legs syndrome: The patient experience
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Abstracts / Sleep Medicine 14S (2013) e93–e164
sheet. The Montreal Cognitive Assessment Test was used to evaluate the following cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. To assess visuospatial processing, memory and certain executive functions, which are based on the incidental-learning paradigm, the Rey–Osterrieth Complex Figure Test was used. Results: Only nine subjects had information on the ESS, MoCA and CFT scores both at the initial and follow up periods. Of these, seven patients who were able to use CPAP served as the treatment group, while the other two served as the control group. All patients who used CPAP had a notable increase in MoCA scores, from a median score of 24–30. Those who did not use CPAP had no notable change in MoCA score (p = 0.037). Changes in score in both the copy and recall portions of the CFT was statistically significant (p = 0.037). Conclusion: This study conducted in our setting demonstrated that patients with OSA have impairment in different domains of cognitive function. This includes attention, concentration, executive function, visuoconstructional skills, conceptual thinking, language and memory. This study also proved that CPAP improves these cognitive impairments as shown in the improvement of scores in both the MoCA and CFT. Acknowledgements: Neurophysiology and Sleep Disorders Laboratory, Makati Medical Center Department of Neurosciences, Section of Neurology, Makati Medical Center. http://dx.doi.org/10.1016/j.sleep.2013.11.357
Cognitive and behavioral after adenotonsillectomy in apnea syndrome obstructive sleep childhood E. Esteller 1, F. Segarra 2, M. Barceló 3, M. Girabent 4, N. Roure 5, E. Estivill 5 1 Department of Otolaryngology Hospital General de Catalunya, Sociedad Española del Sueño, Spain 2 Clínica del son Estivill, Hospital Universitario Quirón Dexeus and Unidad del Sueño del Hospital Gen, Sociedad Española de Sueño, Spain 3 Child Psychologist, Spain 4 Department of Biostatistics, International University of Catalonia, Spain 5 Clínica del son Estivill, Hospital Universitario Quirón Dexeus, Sociedad Española del Sueño, Spain
Introduction: Adenotonsillectomy is an effective treatment for paediatric obstructive sleep apnea. Your ability to resolve the cognitive and behavioral problems arising is not so clear. Objective: To analyze the evolution of these alterations to a year after surgery. Materials and methods: We studied behavioral and cognitive abnormalities of 45 children with OSA and 30 healthy controls, between 3 and 13 years. Both groups are analyzed using psychological tests, at baseline and one year. Results: Preoperatively, all cognitive and behavioral variables were more affected in the study group than in the control. Attention in 46.7% of cases in the study group and 20% in the control group (p = 0.016), anxiety 60.9% and 40.9% (not significant); Memory 55.6% and 36.7% (p = 0.019); spatial structuring 64.4% and 36.7% (p = 0.017); Hyperactivity 42.9% and 12.5% (p = 0.016) and Attention Deficit 46.4% and 8.3 % (p = 0.003). After one year the study group remains the more affected in all the study variables, although significant differences remain only in spatial structure (31.3% versus 3.3%, p = 0.017) and Attention Deficit (40.5% versus 16.7%, p = 0.031). The percentages of patients who improved at one year are not significantly different in both groups. Conclusion: The cognitive and behavioral disorders of children with sleep apnea are partially resolved with adenotonsillectomy.
The improvements obtained in the variables did not differ significantly in the normal evolution of the children and are independent of the resolution of respiratory disorders. http://dx.doi.org/10.1016/j.sleep.2013.11.358
Correlation between clinical and polysomnography respiratory disorders in children sleep E. Esteller 1, F. Segarra 2, M. Girabent 3, J. Albares 4, N. Roure 4, E. Estivill 4 1 Department of Otolaryngology of Hospital General de Catalunya and Universitat Internacional de Catal, Sociedad Española del Sueño, Spain 2 Clínica del son Estivill, Hospital Univesitario Quirón Dexeus and Unidad del sueño del Hospital Gene, Sociedad Española del Sueño, Spain 3 Department of Biostatistics, International University of Catalonia, Spain 4 Clínica del son Estivill, Hospital Univesitario Quirón Dexeus, Sociedad Española del Sueño, Spain
Introduction: Although polysomnography is the diagnostic test for excellence in sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments, both for and against, is the lack of correlation between objective values and symptomatology. Objective: To evaluate the correlation between clinical and apnea hypopnea index in our work environment. Materials and methods: We compared statistically the preoperative clinic and apnea hypopnea index of 170 children with sleep-disordered breathing undergoing polysomnography. We also evaluated the correlation to postoperative level, with a subgroup of 80 children undergoing adenotonsillectomy with one year follow-up polysomnography. Results: At preoperative level only the degree of tonsillar hypertrophy showed significant correlation with apnea–hypopnea index. The postoperative evidence for change in apnea-hypopnea index: 38.1% of children improve and for children with parents in the group with persistent polysomnography 66.7% showed disease resolution (p = 0.023). It also showed a post-opertive snoring improvement, assessed by visual analog scale. The average VAS score dropped 5 points in the persistent group and 6.1 in the group with resolution of the disease (p = 0.047). Conclusion: Despite the limited correlation between clinical and polysomnography, especially in the preoperative condition, the data ultimately documented subjective–objective correlation. Efforts should be made to obtain objective parameters that provide a higher level of correlation. http://dx.doi.org/10.1016/j.sleep.2013.11.359
Diagnosing restless legs syndrome: the patient experience J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to determine the total time between onset of symptoms and getting the diagnosis RLS, members of RLS patient organizations in Europe and North America were asked to supply this information. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS Patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0 %) could be analyzed. Questions were
Abstracts / Sleep Medicine 14S (2013) e93–e164
asked on age, gender, heredity, affected body parts, symptom severity, sick leave, disablement, diagnosis, current and previous RLS treatment, co-morbidity treatment and sleep disorders. With regard to diagnosis, patients were asked to indicate when their symptoms began, how many years it took before they were diagnosed with RLS, and how many doctors they visited before the diagnosis was made. Results: The majority of RLS respondents (75%) were between 60 and 89 years old (average 69.7, SD 12, range 12–102). Female:male ratio was 68:32. 47% reported a family history of RLS: 1st degree parents 36% and children 22% with RLS. 52% of the respondents visited more than 1 doctor before they were diagnosed with RLS. The average number of visits before diagnosis was 2.4, range 1– 50, SD 2.8 (note: maximum of 50 visits for one respondent) Years from first symptom to diagnosis: average 15.6, SD 15.7, range 0–73 (69% of the respondents had to wait more than two years for a correct diagnosis.) Conclusion: The authors conclude that physicians should be better educated about RLS in order to significantly decrease the many unnecessary consultations, misdiagnoses and long-term untreated suffering. If this were to be achieved, the total saving on health care cost would be 1.1 visits less per RLS patient. Extrapolated to 3% of the general population, this would result in a significant reduction in social costs and work time lost. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known.
http://dx.doi.org/10.1016/j.sleep.2013.11.360
Sick leave and absence from work due to restless legs syndrome J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to assess the impact of RLS on their working life, members of RLS patient organizations were asked to provide information on the total time they had to spend at home due to their RLS symptoms – RLS only, no other illness. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0%) could be analyzed. Questions were asked on a variety of topics, among which sick leave and disabllity benefit. Results: Sick leave 165 respondents (4.0%) are/have been on sick leave due to RLS. Symptoms in sick leave respondents compared to 3942 respondents not on sick leave are more severe (range 0–40). Average without treatment 24.58 (21.27), SD 9.08 (8.75), p 0.000022. Average with treatment 12.96 (9.70), SD 8.50 (7.00), p 0.000028. Time from onset to diagnosis was shorter for sick leave respondents. Average 13.16 (15.61) years (SD 13.07 (15.74) p 0.0232). Treatment of sick leave respondents is not optimal. Dopamine agonists were given in only 68.5% (72.3%) of cases, antiepileptics in 16.4% (13.9%). Sick leave respondents showed a higher use of antidepressants: 23.0% (17.5%), p 0.00017. Disability insurance benefit – DIB 75 (1.8%) of all respondents receive DIB due to RLS. Symptoms in DIB respondents compared to 4032 respondents not on DIB are more severe (range 0–40). Average without treatment 25.90 (21.31), SD 9.39 (8.76), p 0.00018. Average with treatment 13.29 (9.77), SD 9.14 (7.05), p 0.0046. Time from onset to diagnosis was longer for DIB respondents: average 16.53 (15.49), SD 16.01 (15.64), p 0.592. Treatment of DIB respondents is not optimal: Dopa-
e157
mine agonists were given in 70.7% (72.2%) of cases, antiepileptics in 16.0 % (13.9%). DIB respondents showed a lower use of antidepressants: 9.3% (17.9%), p 0.00008. Despite treatment an overall 2–4% of patents report sick or are on disability benefits because of RLS. Conclusion: The authors conclude that correct and early diagnosis and optimal medical treatment may lead to decreased sick leave as well as disability insurance benefits in severe RLS and thus reduce health care expenditure and increase quality of life for these patients. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known. http://dx.doi.org/10.1016/j.sleep.2013.11.361
Dosing patterns of dopamine agonists for restless legs J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to find out the total consumption of medicines by RLS patients, members of RLS patient organizations in Europe and North America were asked to supply this information. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS Patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0%) could be analyzed. Questions were asked on a variety of topics, including the total daily of the various medicines used. Results: 73% of pramipexole doses and 80% of ropinirole doses reported were in line with internationally approved doses, (<=0.75 mg/day for pramipexole, and <=4.0 mg/day for ropinirole. Respondents in the USA tend to take significantly (p < 0.01) higher total daily doses of the dopamine agonists than do respondents in Europe; mean pramipexole, Europe 0.53 mg, USA 1.05 mg, Ropinirole, Europe 3.06 mg, USA 3.97 mg. There is no difference in respondent satisfaction with treatment in relation to dose. Conclusion: In view of the most recent scientific data on the intake of the dopamine agonists and the current opinion on optimal dosages of these medicines, the study indicates that both medicines are used in abundance, leading to significant over consumption, a much higher risk of augmentation and other side effects, lesser quality of life for these patients, as well as overspending of the healthcare costs worldwide. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known. http://dx.doi.org/10.1016/j.sleep.2013.11.362
Sleep quality and associated factors in residents of a major teaching hospital in Iran S. Jafarpour 1, K. Sadeghniiat-Haghighi 2 1 Occupational Sleep Research Center, Tehran University of Medical Sciences, Iran 2 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Iran
Introduction: Residency is a challenging part of medical training among different specialties.. Long work hours and shift work and
Abstracts / Sleep Medicine 14S (2013) e93–e164
sheet. The Montreal Cognitive Assessment Test was used to evaluate the following cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. To assess visuospatial processing, memory and certain executive functions, which are based on the incidental-learning paradigm, the Rey–Osterrieth Complex Figure Test was used. Results: Only nine subjects had information on the ESS, MoCA and CFT scores both at the initial and follow up periods. Of these, seven patients who were able to use CPAP served as the treatment group, while the other two served as the control group. All patients who used CPAP had a notable increase in MoCA scores, from a median score of 24–30. Those who did not use CPAP had no notable change in MoCA score (p = 0.037). Changes in score in both the copy and recall portions of the CFT was statistically significant (p = 0.037). Conclusion: This study conducted in our setting demonstrated that patients with OSA have impairment in different domains of cognitive function. This includes attention, concentration, executive function, visuoconstructional skills, conceptual thinking, language and memory. This study also proved that CPAP improves these cognitive impairments as shown in the improvement of scores in both the MoCA and CFT. Acknowledgements: Neurophysiology and Sleep Disorders Laboratory, Makati Medical Center Department of Neurosciences, Section of Neurology, Makati Medical Center. http://dx.doi.org/10.1016/j.sleep.2013.11.357
Cognitive and behavioral after adenotonsillectomy in apnea syndrome obstructive sleep childhood E. Esteller 1, F. Segarra 2, M. Barceló 3, M. Girabent 4, N. Roure 5, E. Estivill 5 1 Department of Otolaryngology Hospital General de Catalunya, Sociedad Española del Sueño, Spain 2 Clínica del son Estivill, Hospital Universitario Quirón Dexeus and Unidad del Sueño del Hospital Gen, Sociedad Española de Sueño, Spain 3 Child Psychologist, Spain 4 Department of Biostatistics, International University of Catalonia, Spain 5 Clínica del son Estivill, Hospital Universitario Quirón Dexeus, Sociedad Española del Sueño, Spain
Introduction: Adenotonsillectomy is an effective treatment for paediatric obstructive sleep apnea. Your ability to resolve the cognitive and behavioral problems arising is not so clear. Objective: To analyze the evolution of these alterations to a year after surgery. Materials and methods: We studied behavioral and cognitive abnormalities of 45 children with OSA and 30 healthy controls, between 3 and 13 years. Both groups are analyzed using psychological tests, at baseline and one year. Results: Preoperatively, all cognitive and behavioral variables were more affected in the study group than in the control. Attention in 46.7% of cases in the study group and 20% in the control group (p = 0.016), anxiety 60.9% and 40.9% (not significant); Memory 55.6% and 36.7% (p = 0.019); spatial structuring 64.4% and 36.7% (p = 0.017); Hyperactivity 42.9% and 12.5% (p = 0.016) and Attention Deficit 46.4% and 8.3 % (p = 0.003). After one year the study group remains the more affected in all the study variables, although significant differences remain only in spatial structure (31.3% versus 3.3%, p = 0.017) and Attention Deficit (40.5% versus 16.7%, p = 0.031). The percentages of patients who improved at one year are not significantly different in both groups. Conclusion: The cognitive and behavioral disorders of children with sleep apnea are partially resolved with adenotonsillectomy.
The improvements obtained in the variables did not differ significantly in the normal evolution of the children and are independent of the resolution of respiratory disorders. http://dx.doi.org/10.1016/j.sleep.2013.11.358
Correlation between clinical and polysomnography respiratory disorders in children sleep E. Esteller 1, F. Segarra 2, M. Girabent 3, J. Albares 4, N. Roure 4, E. Estivill 4 1 Department of Otolaryngology of Hospital General de Catalunya and Universitat Internacional de Catal, Sociedad Española del Sueño, Spain 2 Clínica del son Estivill, Hospital Univesitario Quirón Dexeus and Unidad del sueño del Hospital Gene, Sociedad Española del Sueño, Spain 3 Department of Biostatistics, International University of Catalonia, Spain 4 Clínica del son Estivill, Hospital Univesitario Quirón Dexeus, Sociedad Española del Sueño, Spain
Introduction: Although polysomnography is the diagnostic test for excellence in sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments, both for and against, is the lack of correlation between objective values and symptomatology. Objective: To evaluate the correlation between clinical and apnea hypopnea index in our work environment. Materials and methods: We compared statistically the preoperative clinic and apnea hypopnea index of 170 children with sleep-disordered breathing undergoing polysomnography. We also evaluated the correlation to postoperative level, with a subgroup of 80 children undergoing adenotonsillectomy with one year follow-up polysomnography. Results: At preoperative level only the degree of tonsillar hypertrophy showed significant correlation with apnea–hypopnea index. The postoperative evidence for change in apnea-hypopnea index: 38.1% of children improve and for children with parents in the group with persistent polysomnography 66.7% showed disease resolution (p = 0.023). It also showed a post-opertive snoring improvement, assessed by visual analog scale. The average VAS score dropped 5 points in the persistent group and 6.1 in the group with resolution of the disease (p = 0.047). Conclusion: Despite the limited correlation between clinical and polysomnography, especially in the preoperative condition, the data ultimately documented subjective–objective correlation. Efforts should be made to obtain objective parameters that provide a higher level of correlation. http://dx.doi.org/10.1016/j.sleep.2013.11.359
Diagnosing restless legs syndrome: the patient experience J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to determine the total time between onset of symptoms and getting the diagnosis RLS, members of RLS patient organizations in Europe and North America were asked to supply this information. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS Patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0 %) could be analyzed. Questions were
Abstracts / Sleep Medicine 14S (2013) e93–e164
asked on age, gender, heredity, affected body parts, symptom severity, sick leave, disablement, diagnosis, current and previous RLS treatment, co-morbidity treatment and sleep disorders. With regard to diagnosis, patients were asked to indicate when their symptoms began, how many years it took before they were diagnosed with RLS, and how many doctors they visited before the diagnosis was made. Results: The majority of RLS respondents (75%) were between 60 and 89 years old (average 69.7, SD 12, range 12–102). Female:male ratio was 68:32. 47% reported a family history of RLS: 1st degree parents 36% and children 22% with RLS. 52% of the respondents visited more than 1 doctor before they were diagnosed with RLS. The average number of visits before diagnosis was 2.4, range 1– 50, SD 2.8 (note: maximum of 50 visits for one respondent) Years from first symptom to diagnosis: average 15.6, SD 15.7, range 0–73 (69% of the respondents had to wait more than two years for a correct diagnosis.) Conclusion: The authors conclude that physicians should be better educated about RLS in order to significantly decrease the many unnecessary consultations, misdiagnoses and long-term untreated suffering. If this were to be achieved, the total saving on health care cost would be 1.1 visits less per RLS patient. Extrapolated to 3% of the general population, this would result in a significant reduction in social costs and work time lost. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known.
http://dx.doi.org/10.1016/j.sleep.2013.11.360
Sick leave and absence from work due to restless legs syndrome J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to assess the impact of RLS on their working life, members of RLS patient organizations were asked to provide information on the total time they had to spend at home due to their RLS symptoms – RLS only, no other illness. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0%) could be analyzed. Questions were asked on a variety of topics, among which sick leave and disabllity benefit. Results: Sick leave 165 respondents (4.0%) are/have been on sick leave due to RLS. Symptoms in sick leave respondents compared to 3942 respondents not on sick leave are more severe (range 0–40). Average without treatment 24.58 (21.27), SD 9.08 (8.75), p 0.000022. Average with treatment 12.96 (9.70), SD 8.50 (7.00), p 0.000028. Time from onset to diagnosis was shorter for sick leave respondents. Average 13.16 (15.61) years (SD 13.07 (15.74) p 0.0232). Treatment of sick leave respondents is not optimal. Dopamine agonists were given in only 68.5% (72.3%) of cases, antiepileptics in 16.4% (13.9%). Sick leave respondents showed a higher use of antidepressants: 23.0% (17.5%), p 0.00017. Disability insurance benefit – DIB 75 (1.8%) of all respondents receive DIB due to RLS. Symptoms in DIB respondents compared to 4032 respondents not on DIB are more severe (range 0–40). Average without treatment 25.90 (21.31), SD 9.39 (8.76), p 0.00018. Average with treatment 13.29 (9.77), SD 9.14 (7.05), p 0.0046. Time from onset to diagnosis was longer for DIB respondents: average 16.53 (15.49), SD 16.01 (15.64), p 0.592. Treatment of DIB respondents is not optimal: Dopa-
e157
mine agonists were given in 70.7% (72.2%) of cases, antiepileptics in 16.0 % (13.9%). DIB respondents showed a lower use of antidepressants: 9.3% (17.9%), p 0.00008. Despite treatment an overall 2–4% of patents report sick or are on disability benefits because of RLS. Conclusion: The authors conclude that correct and early diagnosis and optimal medical treatment may lead to decreased sick leave as well as disability insurance benefits in severe RLS and thus reduce health care expenditure and increase quality of life for these patients. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known. http://dx.doi.org/10.1016/j.sleep.2013.11.361
Dosing patterns of dopamine agonists for restless legs J. Jaarsma, S. Sevborn EARLS – European Alliance for Restless Legs Syndrome, The Netherlands
Introduction: In order to find out the total consumption of medicines by RLS patients, members of RLS patient organizations in Europe and North America were asked to supply this information. Materials and methods: A detailed questionnaire was sent to 11,731 members of RLS Patient organizations in Austria, Belgium, Finland, France, Great Britain, Italy, Norway, Spain, Sweden, The Netherlands, Canada and the USA. 4278 questionnaires were returned, of which 4107 (35.0%) could be analyzed. Questions were asked on a variety of topics, including the total daily of the various medicines used. Results: 73% of pramipexole doses and 80% of ropinirole doses reported were in line with internationally approved doses, (<=0.75 mg/day for pramipexole, and <=4.0 mg/day for ropinirole. Respondents in the USA tend to take significantly (p < 0.01) higher total daily doses of the dopamine agonists than do respondents in Europe; mean pramipexole, Europe 0.53 mg, USA 1.05 mg, Ropinirole, Europe 3.06 mg, USA 3.97 mg. There is no difference in respondent satisfaction with treatment in relation to dose. Conclusion: In view of the most recent scientific data on the intake of the dopamine agonists and the current opinion on optimal dosages of these medicines, the study indicates that both medicines are used in abundance, leading to significant over consumption, a much higher risk of augmentation and other side effects, lesser quality of life for these patients, as well as overspending of the healthcare costs worldwide. Acknowledgements: The authors wish to acknowledge the dedication of the thousands of RLS patients worldwide who helped complete this questionnaire and provided us with detailed and accurate information not hitherto known. http://dx.doi.org/10.1016/j.sleep.2013.11.362
Sleep quality and associated factors in residents of a major teaching hospital in Iran S. Jafarpour 1, K. Sadeghniiat-Haghighi 2 1 Occupational Sleep Research Center, Tehran University of Medical Sciences, Iran 2 Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Sciences, Iran
Introduction: Residency is a challenging part of medical training among different specialties.. Long work hours and shift work and