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Neurocognitive function in patients with idiopathic restless legs syndrome (IRLS) before and after treatment with dopamino-agonist
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Abstracts / Sleep Medicine 14S (2013) e93–e164
the duration of NREM and REM sleeps, suvorexant induced longer durations of NREM sleep as compared with both vehicle- and C1m-administered groups. When compounds were injected at ZT0, C1m did not show significant changes in sleep/wakefulness states in light period, whereas suvorexant slightly but significantly increased sleep amount. We also found that C1m did not significantly affect the amount of REM sleep, while suvorexant remarkably increased it. Conclusion: We suggest that OX1R-mediated pathway plays an important role in suppression of REM sleep. Acknowledgements: This study was supported by the Cabinet Office, Government of Japan through its funding Program for Next Generation World-Leading Researchers. Authors thank Takeda Pharmaceutical Company for providing us the C1m. We also thank Dr. Tatsuhiko Fujimoto for valuable discussion. http://dx.doi.org/10.1016/j.sleep.2013.11.261
Prevalence of restless legs syndrome in chronic liver diseases case-control study C. Falup-Pecurariu 1, F. Coman 2, G. Moraru 2, R. Alexandru 3 1 Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania 2 Department of Gastroenterology, Emergency University County Hospital, Brasov, Romania 3 Faculty of Medicine, Transilvania University, Brasov, Romania
Introduction: Background: restless legs syndrome (RLS) is affecting the quality of sleep and is encountered in many diseases. There are few data on the prevalence of restless legs syndrome (RLS) in chronic liver diseases (CLD). The purpose of this pilot study was to assess the prevalence and clinical features of RLS in chronic liver diseases patients in a case-control study. Materials and methods: Prospective study on 90 patients with chronic liver diseases and 90 healthy volunteers, age and sex matched. RLS was diagnosed using the criteria of the International RLS Study Group, severity by International RLS Study Group Rating Scale. For quality of sleep and depression assessment we used Restless Legs Syndrome Quality of Life instrument, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale. Results: 35/90 (38.88%) patients with chronic liver diseases fulfilled the 4 criteria for RLS vs.11/90 (12,22%) in the control group (p < 0.05). There was a correlation between poor quality of sleep and presence of RLS. In the RLS positive group there was a higher prevalence of insomnia. Conclusion: RLS symptoms have a high prevalence in chronic liver disease and affect quality of sleep. http://dx.doi.org/10.1016/j.sleep.2013.11.262
High prevalence of restless legs syndrome in systemic lupus erythematosus C. Falup-Pecurariu 1, L. Duca 1,2, M. Moarcas 2 1 Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania 2 Department of Neurology, County Emergency University Hospital, Brasov, Romania
Introduction: Background: data regarding the sleep dysturbancies in systemic lupus erytematosous (SLE) are scarce. Objective: the
aim of this study is to determine the prevalence of restless legs syndrome (RLS) and sleep dysturbancies in systemic lupus erythematosus. Materials and methods: prospective study on consecutive patients with SLE. We used a standardized questionnaire with face-to-face interview. RLS diagnosed were based on the criteria of the RLS Study Group. The severity of RLS was assessed by Restless Legs Syndrome Rating Scale and quality of life by Restless Legs Syndrome Quality of Life Instrument. Sleep was assesed by Pittsburg Sleep Quality Index and Epworth Sleepiness Scale. The patients had to choose from a list of terms which described the sensations in their legs. Results: 42 patients with SLE (40 women) were included in the study, mean age 53.43 ± 22.69 years (limits 21–78). 17 patients (40.47%) met the criteria for RLS. Six patients describe frequency of occuring of RLS in 6–7 nights per week, 4 in 4–5, 3 in 1–3 nights, 2 in 2–4 times per month and 2 patients one time per month. Multivariate analyses showed that risk factors for RLS were age and disease duration. Severe insomnia was reported by 15 patients (35.71%). Conclusion: the prevalence of RLS is high is SLE. The severity of disease is high and occurs in 58% more than 4 nights per week. http://dx.doi.org/10.1016/j.sleep.2013.11.263
Neurocognitive function in patients with idiopathic restless legs syndrome (IRLS) before and after treatment with dopaminoagonist L. Ferini Strambi, S. Marelli, A. Galbiati, L. Giarolli, A. Oldani, M. Zucconi San Raffaele Scientific Institute, Dept of Clinical Neurosciences, Sleep Disorders Center, Italy
Introduction: RLS patients frequently report insomnia, characterized by difficultly falling asleep and frequent nocturnal awakenings. Daytime consequences such as fatigue, irritability, impaired concentration, depressed mood are frequently reported. Some authors observed cognitive deficit in tests used to assess executive functions similar to those observed in healthy subjects undergoing acute sleep deprivation. To assess cognitive functions, quality of life, sleep quality, anxiety and depressive symptoms in iRLS patients at baseline (BL) compared to age matched normal control (Ctrl), and to assess changes in iRLS after 3 months of treatment with a dopamine agonist drug at low doses. Materials and methods: We evaluate 20 iRLS (F 60%) with severe RLS (mean IRLSRS 26, mean age 46.80 ± 10.10) and 15 Ctrl matched on age and gender. All patients were evaluated with PSG at baseline (BL) and after 3 months of treatment (FU). Neurocognitive functions (global cognitive profile, memory, attention and executive functions, comprehension and language), daytime sleepiness (ESS), anxiety (STAY), depression (BDI), quality of life (SF-36) and quality of sleep (PSQI) were assessed at BL and FU. Results: 18 iRLS completed the study. The PSG showed at BL a reduced TST, SWS%, SE%, an increase in SL, WASO, n° awakenings and PLMI. PLMI decreased significantly after 3 months of treatment. Almost all iRLS’s cognitive domains at BL showed significantly lower scores compared to Ctrl: in particular short term memory, verbal long term memory, executive functions, attention, language production resulted significantly improved (p < 0.005) after treatment. Moreover iRLS at BL showed significantly lower scores at EES, PSQI and SF-36 (p < 0.05) than Ctrl. At FU we observed a statistically significant overall improvement in the cognitive domains as well as in ESS, PSQI, SF-36, BDI (p < 0.005). Only the semantic fluency test and the anxiety did not show any significant improvement.
Abstracts / Sleep Medicine 14S (2013) e93–e164
Conclusion: Our results on cognitive functions are in agreement with literature data on sleep deprivation. Our data showed that cognitive functions impaired at BL when compared to Ctrl significantly improved after 3-months pharmacological treatment reaching the scores of healthy subjects. Moreover, results about quality of life, daytime sleepiness and quality of sleep showed a significant improvement over time. Future studies on iRLS may confirm the involvement of the same cortical network involved in experimental sleep deprivation condition. Acknowledgements: We thanks RLS patients for their availability in detailing their sleep and ill history. We thanks the sleep technicians for hard work. http://dx.doi.org/10.1016/j.sleep.2013.11.264
One year monitoring of nocturnal periodic breathing at the antarctic pole H. Fernandez 1, N. Pattyn 2, O. Mairesse 1,2, R. Meeusen 1,2, E. Mcdonald-Nethercott 1,2, X. Neyt 1,2 1 University of Brussels, Human Physiology & Sportsmedicine, Belgium 2 Royal Military Academy, LIFE Dept., Belgium
Introduction: At altitudes above 2.500 m, ventilation in healthy subjects commonly shows an oscillatory behavior with alternating periods of hyperventilation followed by apneas or hypopneas. This breathing pattern, called periodic breathing (PB), seems to prevail at altitudes above 5533 m. Although PB has been extensively observed, there are still aspects regarding the adaptation to high altitude that remain unknown. To address the influence of altitude on the respiratory system during longer periods of time, nocturnal periodic breathing was monitored at a constant equivalent altitude of 3659 m over the course of 12 months. Materials and methods: The investigation took place at the Concordia station, in the framework of the European Space Agency’s Life Science campaign, during the 2012 winter over. 13 healthy male participants were monitored using a wireless polysomnography (BioRadio, Clevemed Inc.). None of them had significant medical antecedents. Data collection was programmed through the whole campaign with a periodicity of six weeks and one habituation night. All recordings were analyzed by a professional sleep technician. Results: PB was present at a clinically significant level during the whole campaign (AHI = 65.4 ± 14.55). Over time, PB does not seem to show a clear trend, with subjects having both episodes of increasing and decreasing PB levels. Conclusion: There seems to be a controversy regarding the acclimatization mechanism to hypobaric hypoxia and the quantification of PB during the adaptation. Previous studies have reported an increase of periodic breathing during acclimatization to hypoxia, whereas others reported decreases or even no changes. However, previous investigations have observed this process of adaptation only over several days to weeks. Our results show that adaptation of respiration to moderate altitude is a process that might last more than several months. Stable inter-individual differences suggest the existence of responders and non-responders. Acknowledgement: This work was funded under ESA/PRODEX funding through the Neuropole project. http://dx.doi.org/10.1016/j.sleep.2013.11.265
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Is there a correlation between of the epworth sleepiness scale and the CPAP adherence? J. Piña Fernandez 1, A. Mochon Doña 1, P. Cuellar Raya 2, J. Cebrian Gallardo 2 1 VitalAire, Agencia Sanitaria Costa del Sol, Respiratory Nurse, Spain 2 Agencia Sanitaria Costa del Sol, Neumology, Spain
Introduction: The aim of this study is determinate if there is a correlation between the adherence to the cpap treatment and the epworth scale. We have an specific protocol for the adherence in our sleep nurse consultation. Materials and methods: We studied a cohort of patients with Obstructive Sleep Apnea that begins the treatment with cpap between January and December 2012. Scope: 2nd Level Hospital (reference population 340,458 habitants). Variables: Sex, age,pathology, Epworth Scale, Apnea Hipoapnea Index ( IAH ), Hours of daily use of cpap and Pressure of treatment. Results: We analyzed 183 patients ( CI 95 % ).Sex: Male (142) 75%,Women (41)23%. Epworth Scale <10: Mean age 57 ± 25; Mean IAH 43 ± 33; Mean hours of daily use of CPAP 5 ± 3 h; mean pressure of treatment 83 ccH2O. Epworth Scale >10: Mean age 55 ± 20; Mean IAH 43.532; Mean hours of daily use of CPAP 5.5;± 3 h; mean pressure of treatment 8 ± 3 ccH2O. Conclusion: The similars results obtained in the two groups studies shows that the Epworth Scale is not a predictor of the correct use of the CPAP treatment. The epworth scale results are very subjective.There are many factors that influence the correct adherence to the cpap treatment that we don’t measure in our study, probably the interface ( mask ) has an important role in the adherence. Acknowledgement: To the Agencia Sanitaria Costa del Sol and the sleep nurse consultation of the Hospital. http://dx.doi.org/10.1016/j.sleep.2013.11.266
The OSA patient in a specific sleep nurse department J. Piña Fernandez 1, A. Mochon Doña 2, P. Cuellar Raya 3, J. Cebrian Gallardo 3 1 VitalAire, Agencia Sanitaria Costa del Sol, respiratory Nurse, Spain 2 VitalAire, Agencia Sanitaria Costa del Sol, Nurse, Spain 3 Agencia Sanitaria Costa del Sol, Neumology, Spain
Introduction: The purpose was to describe the assistance process implemented in the hospital and how to handle patients suspected of having OSA referred to the sleep disorder nursing department until the starting of treatment, establishing a monitoring procedure for assuring correct compliance with the treatment. Materials and methods: When the patient came to the hospital for the first visit with the pneumologist and there is a suspicion of OSA, a sleep test is ordered (poligraphy- Stardust™ 2 by RESPIRONICSÓ). The patient returns to the pneumologist in 3 months (more or less). The sleep test request also goes to the sleep department nurse when the patient was scheduled for the test. The test is performed at home, and the patient comes to the sleep department nurse and is instructed by the nurse through a talk and a practical demonstration of how to perform the poligraphy at home. On the following day, the information is downloaded and analyzed by the sleep nurse. When the patient has the next appointment with the pneumologist the result of the study is given to the patient and if there is a positive for OSA, the CPAP is implemented by the sleep nurse the same day
Abstracts / Sleep Medicine 14S (2013) e93–e164
the duration of NREM and REM sleeps, suvorexant induced longer durations of NREM sleep as compared with both vehicle- and C1m-administered groups. When compounds were injected at ZT0, C1m did not show significant changes in sleep/wakefulness states in light period, whereas suvorexant slightly but significantly increased sleep amount. We also found that C1m did not significantly affect the amount of REM sleep, while suvorexant remarkably increased it. Conclusion: We suggest that OX1R-mediated pathway plays an important role in suppression of REM sleep. Acknowledgements: This study was supported by the Cabinet Office, Government of Japan through its funding Program for Next Generation World-Leading Researchers. Authors thank Takeda Pharmaceutical Company for providing us the C1m. We also thank Dr. Tatsuhiko Fujimoto for valuable discussion. http://dx.doi.org/10.1016/j.sleep.2013.11.261
Prevalence of restless legs syndrome in chronic liver diseases case-control study C. Falup-Pecurariu 1, F. Coman 2, G. Moraru 2, R. Alexandru 3 1 Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania 2 Department of Gastroenterology, Emergency University County Hospital, Brasov, Romania 3 Faculty of Medicine, Transilvania University, Brasov, Romania
Introduction: Background: restless legs syndrome (RLS) is affecting the quality of sleep and is encountered in many diseases. There are few data on the prevalence of restless legs syndrome (RLS) in chronic liver diseases (CLD). The purpose of this pilot study was to assess the prevalence and clinical features of RLS in chronic liver diseases patients in a case-control study. Materials and methods: Prospective study on 90 patients with chronic liver diseases and 90 healthy volunteers, age and sex matched. RLS was diagnosed using the criteria of the International RLS Study Group, severity by International RLS Study Group Rating Scale. For quality of sleep and depression assessment we used Restless Legs Syndrome Quality of Life instrument, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale. Results: 35/90 (38.88%) patients with chronic liver diseases fulfilled the 4 criteria for RLS vs.11/90 (12,22%) in the control group (p < 0.05). There was a correlation between poor quality of sleep and presence of RLS. In the RLS positive group there was a higher prevalence of insomnia. Conclusion: RLS symptoms have a high prevalence in chronic liver disease and affect quality of sleep. http://dx.doi.org/10.1016/j.sleep.2013.11.262
High prevalence of restless legs syndrome in systemic lupus erythematosus C. Falup-Pecurariu 1, L. Duca 1,2, M. Moarcas 2 1 Department of Neurology, Faculty of Medicine, Transilvania University, Brasov, Romania 2 Department of Neurology, County Emergency University Hospital, Brasov, Romania
Introduction: Background: data regarding the sleep dysturbancies in systemic lupus erytematosous (SLE) are scarce. Objective: the
aim of this study is to determine the prevalence of restless legs syndrome (RLS) and sleep dysturbancies in systemic lupus erythematosus. Materials and methods: prospective study on consecutive patients with SLE. We used a standardized questionnaire with face-to-face interview. RLS diagnosed were based on the criteria of the RLS Study Group. The severity of RLS was assessed by Restless Legs Syndrome Rating Scale and quality of life by Restless Legs Syndrome Quality of Life Instrument. Sleep was assesed by Pittsburg Sleep Quality Index and Epworth Sleepiness Scale. The patients had to choose from a list of terms which described the sensations in their legs. Results: 42 patients with SLE (40 women) were included in the study, mean age 53.43 ± 22.69 years (limits 21–78). 17 patients (40.47%) met the criteria for RLS. Six patients describe frequency of occuring of RLS in 6–7 nights per week, 4 in 4–5, 3 in 1–3 nights, 2 in 2–4 times per month and 2 patients one time per month. Multivariate analyses showed that risk factors for RLS were age and disease duration. Severe insomnia was reported by 15 patients (35.71%). Conclusion: the prevalence of RLS is high is SLE. The severity of disease is high and occurs in 58% more than 4 nights per week. http://dx.doi.org/10.1016/j.sleep.2013.11.263
Neurocognitive function in patients with idiopathic restless legs syndrome (IRLS) before and after treatment with dopaminoagonist L. Ferini Strambi, S. Marelli, A. Galbiati, L. Giarolli, A. Oldani, M. Zucconi San Raffaele Scientific Institute, Dept of Clinical Neurosciences, Sleep Disorders Center, Italy
Introduction: RLS patients frequently report insomnia, characterized by difficultly falling asleep and frequent nocturnal awakenings. Daytime consequences such as fatigue, irritability, impaired concentration, depressed mood are frequently reported. Some authors observed cognitive deficit in tests used to assess executive functions similar to those observed in healthy subjects undergoing acute sleep deprivation. To assess cognitive functions, quality of life, sleep quality, anxiety and depressive symptoms in iRLS patients at baseline (BL) compared to age matched normal control (Ctrl), and to assess changes in iRLS after 3 months of treatment with a dopamine agonist drug at low doses. Materials and methods: We evaluate 20 iRLS (F 60%) with severe RLS (mean IRLSRS 26, mean age 46.80 ± 10.10) and 15 Ctrl matched on age and gender. All patients were evaluated with PSG at baseline (BL) and after 3 months of treatment (FU). Neurocognitive functions (global cognitive profile, memory, attention and executive functions, comprehension and language), daytime sleepiness (ESS), anxiety (STAY), depression (BDI), quality of life (SF-36) and quality of sleep (PSQI) were assessed at BL and FU. Results: 18 iRLS completed the study. The PSG showed at BL a reduced TST, SWS%, SE%, an increase in SL, WASO, n° awakenings and PLMI. PLMI decreased significantly after 3 months of treatment. Almost all iRLS’s cognitive domains at BL showed significantly lower scores compared to Ctrl: in particular short term memory, verbal long term memory, executive functions, attention, language production resulted significantly improved (p < 0.005) after treatment. Moreover iRLS at BL showed significantly lower scores at EES, PSQI and SF-36 (p < 0.05) than Ctrl. At FU we observed a statistically significant overall improvement in the cognitive domains as well as in ESS, PSQI, SF-36, BDI (p < 0.005). Only the semantic fluency test and the anxiety did not show any significant improvement.
Abstracts / Sleep Medicine 14S (2013) e93–e164
Conclusion: Our results on cognitive functions are in agreement with literature data on sleep deprivation. Our data showed that cognitive functions impaired at BL when compared to Ctrl significantly improved after 3-months pharmacological treatment reaching the scores of healthy subjects. Moreover, results about quality of life, daytime sleepiness and quality of sleep showed a significant improvement over time. Future studies on iRLS may confirm the involvement of the same cortical network involved in experimental sleep deprivation condition. Acknowledgements: We thanks RLS patients for their availability in detailing their sleep and ill history. We thanks the sleep technicians for hard work. http://dx.doi.org/10.1016/j.sleep.2013.11.264
One year monitoring of nocturnal periodic breathing at the antarctic pole H. Fernandez 1, N. Pattyn 2, O. Mairesse 1,2, R. Meeusen 1,2, E. Mcdonald-Nethercott 1,2, X. Neyt 1,2 1 University of Brussels, Human Physiology & Sportsmedicine, Belgium 2 Royal Military Academy, LIFE Dept., Belgium
Introduction: At altitudes above 2.500 m, ventilation in healthy subjects commonly shows an oscillatory behavior with alternating periods of hyperventilation followed by apneas or hypopneas. This breathing pattern, called periodic breathing (PB), seems to prevail at altitudes above 5533 m. Although PB has been extensively observed, there are still aspects regarding the adaptation to high altitude that remain unknown. To address the influence of altitude on the respiratory system during longer periods of time, nocturnal periodic breathing was monitored at a constant equivalent altitude of 3659 m over the course of 12 months. Materials and methods: The investigation took place at the Concordia station, in the framework of the European Space Agency’s Life Science campaign, during the 2012 winter over. 13 healthy male participants were monitored using a wireless polysomnography (BioRadio, Clevemed Inc.). None of them had significant medical antecedents. Data collection was programmed through the whole campaign with a periodicity of six weeks and one habituation night. All recordings were analyzed by a professional sleep technician. Results: PB was present at a clinically significant level during the whole campaign (AHI = 65.4 ± 14.55). Over time, PB does not seem to show a clear trend, with subjects having both episodes of increasing and decreasing PB levels. Conclusion: There seems to be a controversy regarding the acclimatization mechanism to hypobaric hypoxia and the quantification of PB during the adaptation. Previous studies have reported an increase of periodic breathing during acclimatization to hypoxia, whereas others reported decreases or even no changes. However, previous investigations have observed this process of adaptation only over several days to weeks. Our results show that adaptation of respiration to moderate altitude is a process that might last more than several months. Stable inter-individual differences suggest the existence of responders and non-responders. Acknowledgement: This work was funded under ESA/PRODEX funding through the Neuropole project. http://dx.doi.org/10.1016/j.sleep.2013.11.265
e119
Is there a correlation between of the epworth sleepiness scale and the CPAP adherence? J. Piña Fernandez 1, A. Mochon Doña 1, P. Cuellar Raya 2, J. Cebrian Gallardo 2 1 VitalAire, Agencia Sanitaria Costa del Sol, Respiratory Nurse, Spain 2 Agencia Sanitaria Costa del Sol, Neumology, Spain
Introduction: The aim of this study is determinate if there is a correlation between the adherence to the cpap treatment and the epworth scale. We have an specific protocol for the adherence in our sleep nurse consultation. Materials and methods: We studied a cohort of patients with Obstructive Sleep Apnea that begins the treatment with cpap between January and December 2012. Scope: 2nd Level Hospital (reference population 340,458 habitants). Variables: Sex, age,pathology, Epworth Scale, Apnea Hipoapnea Index ( IAH ), Hours of daily use of cpap and Pressure of treatment. Results: We analyzed 183 patients ( CI 95 % ).Sex: Male (142) 75%,Women (41)23%. Epworth Scale <10: Mean age 57 ± 25; Mean IAH 43 ± 33; Mean hours of daily use of CPAP 5 ± 3 h; mean pressure of treatment 83 ccH2O. Epworth Scale >10: Mean age 55 ± 20; Mean IAH 43.532; Mean hours of daily use of CPAP 5.5;± 3 h; mean pressure of treatment 8 ± 3 ccH2O. Conclusion: The similars results obtained in the two groups studies shows that the Epworth Scale is not a predictor of the correct use of the CPAP treatment. The epworth scale results are very subjective.There are many factors that influence the correct adherence to the cpap treatment that we don’t measure in our study, probably the interface ( mask ) has an important role in the adherence. Acknowledgement: To the Agencia Sanitaria Costa del Sol and the sleep nurse consultation of the Hospital. http://dx.doi.org/10.1016/j.sleep.2013.11.266
The OSA patient in a specific sleep nurse department J. Piña Fernandez 1, A. Mochon Doña 2, P. Cuellar Raya 3, J. Cebrian Gallardo 3 1 VitalAire, Agencia Sanitaria Costa del Sol, respiratory Nurse, Spain 2 VitalAire, Agencia Sanitaria Costa del Sol, Nurse, Spain 3 Agencia Sanitaria Costa del Sol, Neumology, Spain
Introduction: The purpose was to describe the assistance process implemented in the hospital and how to handle patients suspected of having OSA referred to the sleep disorder nursing department until the starting of treatment, establishing a monitoring procedure for assuring correct compliance with the treatment. Materials and methods: When the patient came to the hospital for the first visit with the pneumologist and there is a suspicion of OSA, a sleep test is ordered (poligraphy- Stardust™ 2 by RESPIRONICSÓ). The patient returns to the pneumologist in 3 months (more or less). The sleep test request also goes to the sleep department nurse when the patient was scheduled for the test. The test is performed at home, and the patient comes to the sleep department nurse and is instructed by the nurse through a talk and a practical demonstration of how to perform the poligraphy at home. On the following day, the information is downloaded and analyzed by the sleep nurse. When the patient has the next appointment with the pneumologist the result of the study is given to the patient and if there is a positive for OSA, the CPAP is implemented by the sleep nurse the same day