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Fatal familial insomnia (FFI) in Basque country. Clinical manifestations, polysomnographic patterns and pathologic findings in three cases
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Abstracts / Sleep Medicine 14S (2013) e93–e164
Daytime peripheral temperature changes during MWT and MSLT M. Guaita a, A. Martinez b, J. Madrid b, M. Rol b, M. Salamero c, J. Santamaria a a Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clínic. IDIBAPS, Universitiy of Barcelona, Spain b Chronobiology Lab., Dept of Physiology, Faculty of Biology, University of Murcia, Spain c Clinical Psychology and Psychiatry Service and Multidisciplinary Sleep Disorders Unit, Hospital Clín, Universitiy of Barcelona, Spain
Introduction: Changes in core and peripheral temperature precede sleep onset but there is no information about these changes during the objective tests of excessive daytime sleepiness (EDS). We aimed to measure wrist temperature (WT) during the maintenance of wakefulness test (MWT) and multiple sleep latency test (MSLT) in patients with symptoms of sleep disordered breathing (SDB). Materials and methods: Sixty-four consecutive patients complaining of snoring or breathing pauses during sleep with and without subjective EDS were included for this study. Patients with irregular sleep-wake schedules, sleep deprivation or medical problems during the tests were excluded. After a nocturnal PSG, patients underwent 5 trials of MWT followed by a research version MSLT, every two hours starting at 8:30 am. WT rhythm was analyzed throughout the day with an Ibuttom device (ThermoChronÒ, Data loggers I-button). WT values were obtained during 3 conditions: in a sitting position 15 min before starting the MWT and during the MWT and MSLT naps. Repeated ANOVA of WT values was used with 2 factors (time and condition) and the interaction. Post-hoc least significant difference was calculated between conditions. Pearson’s correlation were performed between means sleep latencies and mean WT values during MWT and MSLT. Results: Fifty-five patients were analyzed. Patient were mostly over weighted adult male (81% male, mean age 52.4 10.2, BMI 29.6 5.4) and they represented a wide spectrum of SDB (mean Apnea–Hypopnea Index 30.5 24,9, range 0.4–90.4). The main results were: (A) WT values during MWT were higher than during MSLT in all naps except in the fourth nap (p range <0.001–0.02). The lowest WT value was detected during the 3rd nap (around midday), in both tests. The interaction between time and condition was significative (F = 23.000, p = 0.003). (B) A negative correlation was found between sleep latency and WT values during MSLT (r = 0.3, p value = 0.04), but not during MWT. Conclusion: We have found measurable changes in peripheral temperature during a clinical protocol of MWT/MSLT. Wrist temperature is higher during MWT than during MSLT. Both tests showed similar patterns of oscillation with a minimum value throughout midday. Finally, WT was significantly higher in patients with the shortest MSLT latencies. Acknowledgements: Study supported by (A) FIS PI07/0318 to M.S., cofinanced by FEDER. (B) RETICEF (RD12/0043/0011), MINECO (BFU2010-21945-C02–01), and INNPACTO (IPT-2011-0833-900000) with FEDER cofounding to J.A.M. http://dx.doi.org/10.1016/j.sleep.2013.11.326
Heart rate variability during the MSLT and MWT in patients with and without excessive daytime sleepiness M. Guaita 1, M. Umberto 2, V. Montserrat 2, P. Caminal 2, M. Salamero 3, J. Salamero 1 1 Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Spain 2 Dept. ESAII, Centre for Biomedical Engineering Research, CIBER-BBN, Universitat Politècnica de Catalunya, Spain 3 Clinical Psychology and Psychiatry Service and Multidisciplinary Sleep Disorders Unit, Hospital Clin, University of Barcelona, Spain
Introduction: Autonomic heart regulation changes during the transition from wakefulness to sleep. Heart rate variability (HRV) can be used to assess the autonomic nervous system function (ANS). We aimed to evaluate ANS in patients with and without excessive daytime sleepiness (EDS) during the maintenance of wakefulness test (MWT) and multiple sleep latency test (MSLT). Materials and methods: From a series of 98 consecutive patients with symptoms of sleep disordered breathing (SDB) studied with 5 trials of MWT followed by a research version MSLT two groups of patients (matched by age and gender) were selected consecutively based on mean sleep latencies: the sleepy group (SG) with 17 patients ( MWT < 20 min and MSLT < 8 min) and the alert group (AG) with 20 patients (AG: MWT > 20 and MSLT > 8 min). For each test, the first 120-s window of RR signals during wakefulness was analyzed in the following frequency bands: VLF, <0.04 Hz; LF, 0.04–0.15 Hz; HF, 0.15–0.4 Hz; TB, total-frequency band. ANS activity was described by measures obtained from traditional power spectral analysis (PSA) and from time–frequency representation (TFR). Non-linear measures – Correntropy (CORR) and automutual-information function (AMIF) – were used to describe the RR regularity. Mean values from all day were compared between groups. Cohen’s effect size was calculated to measure the strength of each difference. Finally, a conditional forward logistic regression analysis was performed to find the best discriminatory variables between groups. Results: TFR (in HF and VLF band), AMIF (in all bands) and CORR (in Total band) analysis showed that the SG had higher values than the AG (p range 0.000–0.02) during the MSLT. The strongest differences were found in HF band from TRF and AMIF and in Total band from AMIF and CORR. The best sensitivity (82.4%) and specificity (85%) to distinguish patients with and without sleepiness were achieved with the combination of AMIF and CORR in Total band, respectively. No differences were found in traditional PSA measures. Conclusion: Heart rate variability analysis during the first 2 min of the MSLT while the patient is awake show specific changes in TFR and non-linear measures that differentiate sleepy from non-sleepy patients. Acknowledgements: Study supported by FIS PI07/0318 to MS, cofinanced by FEDER. http://dx.doi.org/10.1016/j.sleep.2013.11.327
Fatal familial insomnia (FFI) in Basque country. Clinical manifestations, polysomnographic patterns and pathologic findings in three cases A. Asencio Guerra a, A. Alvarez Ruiz De Larrinaga a, C. Egea Santaolalla b, J. Durán Cantolla b, E. Alvarez Vadillo a, F. Julián Villaverde c a Hospital Universitario Araba-Txagorritxu, Neurofisiología Clínica, Spain b Hospital Universitario Araba-Txagorritxu, Sleep Unit, Spain c Hospital Universitario Araba-Txagorritxu, Servicio de Neurología, Spain
Introduction: The FFI is a rare prion disease, originated by the mutation D178N in the PRNP gene. It has an autosomal dominant inheritance pattern. Patients characteristically develop progressive insomnia with loss of the normal circadian sleep-activity pattern, inattention, impaired concentration and memory, confusion, hallucinations, motor disturbances (hyperreflexia, dysarthria, myoclonus, ataxia, spasticity), signs of autonomic hyperactivity (increased sweating, tearing, salivation, mild nocturnal hyperthermia, tachycardia, and hypertension). We expose three cases of patients who died with FFI in our hospital.
Abstracts / Sleep Medicine 14S (2013) e93–e164
Materials and methods: We reviewed the medical records of three patients with molecular diagnostic of FFI who died in our hospital, comparing the clinical aspect, polysomnographic patterns and pathologic findings. Results: Clinical characteristics were very similar; patients developed insomnia as a prominent and early complaint, associated with excessive daytime sleepiness, ataxia, diplopia, progressive dysphagia, myoclonus, autonomic hyperactivity, confusion and disorientation. Sleep studies showed significant reduction in total sleep time, disorganization of the structure of sleep, decreased sleep efficiency, reduced slow wave sleep, decrease in the number of spindles and K complexes and presence of irregular, choreiform or stereotypic movements. One patient did not reach REM sleep and showed a slow wave sleep ratio of 72.5%. The pathologic alterations in the patients showed severe atrophy with significant neuronal loss in dorsomedial, and pulvinar thalamic nuclei, reactive astrocytosis, gliosis and vacuolation of the neuropil, more intensely in the mid brain, cerebellum (cortex, vermis and dentate nucleus), striatum and hippocampus. Conclusion: The patients with FFI may exhibit a variety of symptoms and signs. The patients described shared many of the clinical and pathological findings. One patient presented a polysomnographic pattern with a ratio of slow wave sleep 72.5%, rare in the FFI. Acknowledgements: All the people that made possible this study. http://dx.doi.org/10.1016/j.sleep.2013.11.328
Sleep-disordered-breathing in Ehlers–Danlos syndrome genetic model of obstructive sleep apnea) C. Guilleminault 1, M. Primeau 1, H. Chiu 1, K. Yuen 1, D. Leger 2, A. Metlaine 2 1 Stanford University, Sleep Medicine Division, United States 2 Universite Paris-Descartes, Hopital de l’Hotel Dieu, France
(a
Introduction: Investigation of presence of sleep-disorderedbreathing (SDB) and its cause in Ehlers–Danlos-(ED) Syndrome patients. ED is a genetic disorder characterized by cartilaginous defects including the nasal-maxillary cartilages. Materials and methods: Retrospective series of 34 ED patients presenting to a sleep medicine clinic with complaints of fatigue and poor sleep, evaluated using clinical history, physical examination, polysomnography (PSG) and in a subgroup with anterior rhinometry. Prospective clinical investigation of 9 ED patients followed in a specialized medical ED clinic. Results: All sleep clinic patients had SDB on PSG. SDB included sleep-apnea and hypopnea but also flow limitation; there was an inverse relationship between age of subjects and amount of flow limitation versus apnea–hypopnea during sleep but clinical complaints were similar independent of abnormal polysomnographic finding. Of the subgroup of patients on whom nasal rhinometry was obtained, increased nasal resistance was noted relative to normative values. Nasal CPAP importantly improved symptoms of patients. ED patients in medical clinic presented symptoms and clinical signs of SDB but were never referred for evaluation of SDB. Conclusion: In ED patients, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. ED patients are at particular risk for SDB due to genetically related cartilage defects causing these patients to develop facial structures known to cause SDB. ED may be a genetic model for obstructive sleep apnea because of abnormalities of oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation. http://dx.doi.org/10.1016/j.sleep.2013.11.329
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The clinical and polysomnographic differences associated with hypertension in the patients that have OSA symptoms and the effect of OSA on hypertension B. Gulbay, T. Acican, F. Ciftci, M. Erdemir Isik, Z. Onen Ankara University School of Medicine, Department of Pulmonary Disease, Turkey
Introduction: It has been well known that obstructive sleep apnea (OSA) and hypertension (HT) are closely related. We compared the effect of HT on the clinical and polysomnographic findings on patients who received polysomnography testing for suspicion of OSA. Materials and methods: The polysomnographic data of 158 consecutive patients that underwent a sleep study were retrospectively assessed in two groups in respect of HT history. Results: There were 66 patients (26F/38 M) with HT and 92 patients (27F/65 M) who did not have an HT history. The patients with HT were older and more obese (respectively; p = 0.000, 0.008). OSA [apnea hypopnea index (AHI) >5/sa] was diagnosed in 50 patients (76%) with HT. This rate was 68% (62) in the normotensive patients. Although not statistically significant, HT was 1.5 times greater in patients with OSA (RR = 1.51). Between the two groups, except witnessed apnea and sweating [these symptoms were more in the hypertensive patients (p = 0.015, 0.019)], there were no differences in other OSA symptoms and sleep stages (p>0.05). Although not statistically significant, in the patients with HT the total sleep time was lower and the AHI was higher. It was determined that the 54% of hypertensive patients had high ESS score (ESS > 10), the same rate was 43% in the normotensive patients. In the patients with HT, the average oxygen saturation at sleep was lower (p = 0.003) and the rate of systemic disease was higher. Conclusion: Although HT was more frequent in the patients with OSA, it was also found that the HT is related to the BMI that is a part of metabolic syndrome. It was shown that alone the presence of HT was not an important guide in the diagnosis of OSA. Acknowledgements: We are highly indebted to Ankara University School of Medicine Pulmonary Disease Department for their guidance and constant supervision as well as for providing necessary information regarding the project and also for their support in completing the project. http://dx.doi.org/10.1016/j.sleep.2013.11.330
Periodic limb movements on 713 consecutive video supported polysomnography VPSG I.G. De Gurtubay a, B. Martin b, M. Alonso a, G. Morales a, J. Cascante c, V. Eguia c a Complejo Hospitalario de Navarra, Multidisciplinary Sleep Unit, Neurophysiology, Spain b Complejo Hospitalario de Navarra, Neurophysiology, Spain c Complejo Hospitalario de Navarra, Multidisciplinary Sleep Unit, Pulmonary Medicine, Spain
Introduction: Periodic limb movements during sleep (PLMs) can be an incidental finding, or they can be associated with several sleep disorders. They can even be a biological marker of diseases such as Restless Legs Syndrome (RLS). Materials and methods: 713 adult patients underwent vPSG during 2012. We describe the epidemiology, clinical complaints, sleep diary data, symptoms, suspected diagnosis, associated diseases, vPSG measures, medication management and evolution of those (115) in which pathological PLMs index was reported.
Abstracts / Sleep Medicine 14S (2013) e93–e164
Daytime peripheral temperature changes during MWT and MSLT M. Guaita a, A. Martinez b, J. Madrid b, M. Rol b, M. Salamero c, J. Santamaria a a Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clínic. IDIBAPS, Universitiy of Barcelona, Spain b Chronobiology Lab., Dept of Physiology, Faculty of Biology, University of Murcia, Spain c Clinical Psychology and Psychiatry Service and Multidisciplinary Sleep Disorders Unit, Hospital Clín, Universitiy of Barcelona, Spain
Introduction: Changes in core and peripheral temperature precede sleep onset but there is no information about these changes during the objective tests of excessive daytime sleepiness (EDS). We aimed to measure wrist temperature (WT) during the maintenance of wakefulness test (MWT) and multiple sleep latency test (MSLT) in patients with symptoms of sleep disordered breathing (SDB). Materials and methods: Sixty-four consecutive patients complaining of snoring or breathing pauses during sleep with and without subjective EDS were included for this study. Patients with irregular sleep-wake schedules, sleep deprivation or medical problems during the tests were excluded. After a nocturnal PSG, patients underwent 5 trials of MWT followed by a research version MSLT, every two hours starting at 8:30 am. WT rhythm was analyzed throughout the day with an Ibuttom device (ThermoChronÒ, Data loggers I-button). WT values were obtained during 3 conditions: in a sitting position 15 min before starting the MWT and during the MWT and MSLT naps. Repeated ANOVA of WT values was used with 2 factors (time and condition) and the interaction. Post-hoc least significant difference was calculated between conditions. Pearson’s correlation were performed between means sleep latencies and mean WT values during MWT and MSLT. Results: Fifty-five patients were analyzed. Patient were mostly over weighted adult male (81% male, mean age 52.4 10.2, BMI 29.6 5.4) and they represented a wide spectrum of SDB (mean Apnea–Hypopnea Index 30.5 24,9, range 0.4–90.4). The main results were: (A) WT values during MWT were higher than during MSLT in all naps except in the fourth nap (p range <0.001–0.02). The lowest WT value was detected during the 3rd nap (around midday), in both tests. The interaction between time and condition was significative (F = 23.000, p = 0.003). (B) A negative correlation was found between sleep latency and WT values during MSLT (r = 0.3, p value = 0.04), but not during MWT. Conclusion: We have found measurable changes in peripheral temperature during a clinical protocol of MWT/MSLT. Wrist temperature is higher during MWT than during MSLT. Both tests showed similar patterns of oscillation with a minimum value throughout midday. Finally, WT was significantly higher in patients with the shortest MSLT latencies. Acknowledgements: Study supported by (A) FIS PI07/0318 to M.S., cofinanced by FEDER. (B) RETICEF (RD12/0043/0011), MINECO (BFU2010-21945-C02–01), and INNPACTO (IPT-2011-0833-900000) with FEDER cofounding to J.A.M. http://dx.doi.org/10.1016/j.sleep.2013.11.326
Heart rate variability during the MSLT and MWT in patients with and without excessive daytime sleepiness M. Guaita 1, M. Umberto 2, V. Montserrat 2, P. Caminal 2, M. Salamero 3, J. Salamero 1 1 Neurology Service and Multidisciplinary Sleep Disorders Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Spain 2 Dept. ESAII, Centre for Biomedical Engineering Research, CIBER-BBN, Universitat Politècnica de Catalunya, Spain 3 Clinical Psychology and Psychiatry Service and Multidisciplinary Sleep Disorders Unit, Hospital Clin, University of Barcelona, Spain
Introduction: Autonomic heart regulation changes during the transition from wakefulness to sleep. Heart rate variability (HRV) can be used to assess the autonomic nervous system function (ANS). We aimed to evaluate ANS in patients with and without excessive daytime sleepiness (EDS) during the maintenance of wakefulness test (MWT) and multiple sleep latency test (MSLT). Materials and methods: From a series of 98 consecutive patients with symptoms of sleep disordered breathing (SDB) studied with 5 trials of MWT followed by a research version MSLT two groups of patients (matched by age and gender) were selected consecutively based on mean sleep latencies: the sleepy group (SG) with 17 patients ( MWT < 20 min and MSLT < 8 min) and the alert group (AG) with 20 patients (AG: MWT > 20 and MSLT > 8 min). For each test, the first 120-s window of RR signals during wakefulness was analyzed in the following frequency bands: VLF, <0.04 Hz; LF, 0.04–0.15 Hz; HF, 0.15–0.4 Hz; TB, total-frequency band. ANS activity was described by measures obtained from traditional power spectral analysis (PSA) and from time–frequency representation (TFR). Non-linear measures – Correntropy (CORR) and automutual-information function (AMIF) – were used to describe the RR regularity. Mean values from all day were compared between groups. Cohen’s effect size was calculated to measure the strength of each difference. Finally, a conditional forward logistic regression analysis was performed to find the best discriminatory variables between groups. Results: TFR (in HF and VLF band), AMIF (in all bands) and CORR (in Total band) analysis showed that the SG had higher values than the AG (p range 0.000–0.02) during the MSLT. The strongest differences were found in HF band from TRF and AMIF and in Total band from AMIF and CORR. The best sensitivity (82.4%) and specificity (85%) to distinguish patients with and without sleepiness were achieved with the combination of AMIF and CORR in Total band, respectively. No differences were found in traditional PSA measures. Conclusion: Heart rate variability analysis during the first 2 min of the MSLT while the patient is awake show specific changes in TFR and non-linear measures that differentiate sleepy from non-sleepy patients. Acknowledgements: Study supported by FIS PI07/0318 to MS, cofinanced by FEDER. http://dx.doi.org/10.1016/j.sleep.2013.11.327
Fatal familial insomnia (FFI) in Basque country. Clinical manifestations, polysomnographic patterns and pathologic findings in three cases A. Asencio Guerra a, A. Alvarez Ruiz De Larrinaga a, C. Egea Santaolalla b, J. Durán Cantolla b, E. Alvarez Vadillo a, F. Julián Villaverde c a Hospital Universitario Araba-Txagorritxu, Neurofisiología Clínica, Spain b Hospital Universitario Araba-Txagorritxu, Sleep Unit, Spain c Hospital Universitario Araba-Txagorritxu, Servicio de Neurología, Spain
Introduction: The FFI is a rare prion disease, originated by the mutation D178N in the PRNP gene. It has an autosomal dominant inheritance pattern. Patients characteristically develop progressive insomnia with loss of the normal circadian sleep-activity pattern, inattention, impaired concentration and memory, confusion, hallucinations, motor disturbances (hyperreflexia, dysarthria, myoclonus, ataxia, spasticity), signs of autonomic hyperactivity (increased sweating, tearing, salivation, mild nocturnal hyperthermia, tachycardia, and hypertension). We expose three cases of patients who died with FFI in our hospital.
Abstracts / Sleep Medicine 14S (2013) e93–e164
Materials and methods: We reviewed the medical records of three patients with molecular diagnostic of FFI who died in our hospital, comparing the clinical aspect, polysomnographic patterns and pathologic findings. Results: Clinical characteristics were very similar; patients developed insomnia as a prominent and early complaint, associated with excessive daytime sleepiness, ataxia, diplopia, progressive dysphagia, myoclonus, autonomic hyperactivity, confusion and disorientation. Sleep studies showed significant reduction in total sleep time, disorganization of the structure of sleep, decreased sleep efficiency, reduced slow wave sleep, decrease in the number of spindles and K complexes and presence of irregular, choreiform or stereotypic movements. One patient did not reach REM sleep and showed a slow wave sleep ratio of 72.5%. The pathologic alterations in the patients showed severe atrophy with significant neuronal loss in dorsomedial, and pulvinar thalamic nuclei, reactive astrocytosis, gliosis and vacuolation of the neuropil, more intensely in the mid brain, cerebellum (cortex, vermis and dentate nucleus), striatum and hippocampus. Conclusion: The patients with FFI may exhibit a variety of symptoms and signs. The patients described shared many of the clinical and pathological findings. One patient presented a polysomnographic pattern with a ratio of slow wave sleep 72.5%, rare in the FFI. Acknowledgements: All the people that made possible this study. http://dx.doi.org/10.1016/j.sleep.2013.11.328
Sleep-disordered-breathing in Ehlers–Danlos syndrome genetic model of obstructive sleep apnea) C. Guilleminault 1, M. Primeau 1, H. Chiu 1, K. Yuen 1, D. Leger 2, A. Metlaine 2 1 Stanford University, Sleep Medicine Division, United States 2 Universite Paris-Descartes, Hopital de l’Hotel Dieu, France
(a
Introduction: Investigation of presence of sleep-disorderedbreathing (SDB) and its cause in Ehlers–Danlos-(ED) Syndrome patients. ED is a genetic disorder characterized by cartilaginous defects including the nasal-maxillary cartilages. Materials and methods: Retrospective series of 34 ED patients presenting to a sleep medicine clinic with complaints of fatigue and poor sleep, evaluated using clinical history, physical examination, polysomnography (PSG) and in a subgroup with anterior rhinometry. Prospective clinical investigation of 9 ED patients followed in a specialized medical ED clinic. Results: All sleep clinic patients had SDB on PSG. SDB included sleep-apnea and hypopnea but also flow limitation; there was an inverse relationship between age of subjects and amount of flow limitation versus apnea–hypopnea during sleep but clinical complaints were similar independent of abnormal polysomnographic finding. Of the subgroup of patients on whom nasal rhinometry was obtained, increased nasal resistance was noted relative to normative values. Nasal CPAP importantly improved symptoms of patients. ED patients in medical clinic presented symptoms and clinical signs of SDB but were never referred for evaluation of SDB. Conclusion: In ED patients, abnormal breathing during sleep is commonly unrecognized and is responsible for daytime fatigue and poor sleep. ED patients are at particular risk for SDB due to genetically related cartilage defects causing these patients to develop facial structures known to cause SDB. ED may be a genetic model for obstructive sleep apnea because of abnormalities of oral-facial growth. Early recognition of SDB may allow treatment with orthodontics and myofacial reeducation. http://dx.doi.org/10.1016/j.sleep.2013.11.329
e145
The clinical and polysomnographic differences associated with hypertension in the patients that have OSA symptoms and the effect of OSA on hypertension B. Gulbay, T. Acican, F. Ciftci, M. Erdemir Isik, Z. Onen Ankara University School of Medicine, Department of Pulmonary Disease, Turkey
Introduction: It has been well known that obstructive sleep apnea (OSA) and hypertension (HT) are closely related. We compared the effect of HT on the clinical and polysomnographic findings on patients who received polysomnography testing for suspicion of OSA. Materials and methods: The polysomnographic data of 158 consecutive patients that underwent a sleep study were retrospectively assessed in two groups in respect of HT history. Results: There were 66 patients (26F/38 M) with HT and 92 patients (27F/65 M) who did not have an HT history. The patients with HT were older and more obese (respectively; p = 0.000, 0.008). OSA [apnea hypopnea index (AHI) >5/sa] was diagnosed in 50 patients (76%) with HT. This rate was 68% (62) in the normotensive patients. Although not statistically significant, HT was 1.5 times greater in patients with OSA (RR = 1.51). Between the two groups, except witnessed apnea and sweating [these symptoms were more in the hypertensive patients (p = 0.015, 0.019)], there were no differences in other OSA symptoms and sleep stages (p>0.05). Although not statistically significant, in the patients with HT the total sleep time was lower and the AHI was higher. It was determined that the 54% of hypertensive patients had high ESS score (ESS > 10), the same rate was 43% in the normotensive patients. In the patients with HT, the average oxygen saturation at sleep was lower (p = 0.003) and the rate of systemic disease was higher. Conclusion: Although HT was more frequent in the patients with OSA, it was also found that the HT is related to the BMI that is a part of metabolic syndrome. It was shown that alone the presence of HT was not an important guide in the diagnosis of OSA. Acknowledgements: We are highly indebted to Ankara University School of Medicine Pulmonary Disease Department for their guidance and constant supervision as well as for providing necessary information regarding the project and also for their support in completing the project. http://dx.doi.org/10.1016/j.sleep.2013.11.330
Periodic limb movements on 713 consecutive video supported polysomnography VPSG I.G. De Gurtubay a, B. Martin b, M. Alonso a, G. Morales a, J. Cascante c, V. Eguia c a Complejo Hospitalario de Navarra, Multidisciplinary Sleep Unit, Neurophysiology, Spain b Complejo Hospitalario de Navarra, Neurophysiology, Spain c Complejo Hospitalario de Navarra, Multidisciplinary Sleep Unit, Pulmonary Medicine, Spain
Introduction: Periodic limb movements during sleep (PLMs) can be an incidental finding, or they can be associated with several sleep disorders. They can even be a biological marker of diseases such as Restless Legs Syndrome (RLS). Materials and methods: 713 adult patients underwent vPSG during 2012. We describe the epidemiology, clinical complaints, sleep diary data, symptoms, suspected diagnosis, associated diseases, vPSG measures, medication management and evolution of those (115) in which pathological PLMs index was reported.