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Neurophysiological evaluation of spinal excitability in patients affected by primitive restless legs syndrome
Abstracts / Sleep Medicine 14S (2013) e93–e164
(78.38%) vs 71 (62.28%), p = 0.07; heart failure 14 (87.5%) vs 86 (63.7%), p = 0.06; sleep suffocation 57 (73.08%) vs 43 (58.9%), p = 0.07. Receiver operating characteristics (ROC) analysis reveals statistic significance for: age (p < 0.01, AUC = 0.69, cut-off = 49 years), neck circumference (p < 0.01, AUC = 0.67, cut-off = 44 cm), abdominal circumference (p < 0.01, AUC = 0.70, cut-off = 112 cm), BMI (p < 0.01, AUC = 0.70, cut-off = 32.03 kg/m2), glycemia (p = 0.03, AUC = 0.59, cut-off = 93 mg/dl), supine AHI position (p = 0.03, AUC = 0.59, cut-off = 48 events/h), medium O2 saturation (p < 0.01, AUC = 0.70, cut-off <95%), oxygen desaturation index (p < 0.01, AUC = 0.63, cut-off = 17.88 ) and ESS (p = 0.03, AUC = 0.59, cut-off = 8). Multivariate analysis on logistic model on body mass index, neck circumference, age, abdominal circumference, glycemia, desaturation index, heart failure, medium O2saturation, snoring, sleep restless, sleep suffocation, supine AHI position and ESS retains only body mass index, neck circumference and age. Conclusion: 1. Arterial hypertension from OSAS is significantly influenced by body mass index, neck circumference and age. 2. An increase of BMI by 1 kg/m2 would entail the risk of hypertension by 2.4%. An increase of 1 cm neck circumference would entail the risk of hypertension by 0.6%. An increase in age by 10 years would entail the risk of hypertension by 7.8%. http://dx.doi.org/10.1016/j.sleep.2013.11.216
Neurophysiological evaluation of spinal excitability in patients affected by primitive restless legs syndrome P. Congiu 1, G. Milioli 2, G. Gioi 1, P. Tacconi 3, M. Fantini 4, M. Puligheddu 1 1 Sleep Disorder Center, University of Cagliari, Italy 2 Sleep Disorder Center, University of Parma, Italy 3 Neurology UOC, University of Cagliari, Italy 4 Dip di Neuroscienze, University of Torino, Italy
Introduction: Restless legs syndrome (RLS) is a frequent pathology, yet underrated and underestimated, affecting inasmuch as 5–10% of the population as a whole. However the pathophysiology has not been completely understood. The dopaminergic system has certainly a primary role, and some studies have highlighted a condition of spinal hyper-excitability. The aim of our study is to explore this hypothesis throughout the electrophysiological evaluation of the spinal and peripheral nervous system in primitives RLS patients. Materials and methods: Among the patients affected by primitive RLS admitted to our Sleep Centerlab, we selected 15 women, and compared them with 17 control subjects of the same sex and age. All subjects had undergone ENG evaluation to exclude any secondary causes of lower limb paresthesia and to evaluate spinal excitability. According to a previous study, we considered two parameters which can be easily extracted from the routine tests normally carried out in the neurophysiopathology labs, the duration of F waves (FWD) of the Internal Popliteal (IPN) and ulnar nerves, and the relationship between FWD and the duration of the corresponding CMAP (CMAPD). Results: None of the subjects (RLS and controls) included in our study presented alterations in the nerve conduction velocity. Compared to the control group, significantly higher values were found in the RLS patients for the FWD/CMAPD ratio average (p < 0.001 test Mann–Whitney) and for the FWD average for both nerves ulnar (p < 0.05 unpaired t-test) and IPN (p < 0.01 unpaired t-test). Conclusion: The results of our study confirm the absence of peripheral involvement in primitive RLS, while they indicate a spinal motorneuronal hyper-excitability, which seems widespread, as both IPN and ulnar nerve stimulation indicators are altered. Such condi-
e101
tion could be due mainly to an alteration of the modulation in the interneuronal system. Presently, RLS diagnosis is based exclusively on clinical criteria. The FWD/CMAPD ratio can help to shed light on the pathogenesis of RLS, and can be used as an instrumental diagnostic indicator, easily obtainable and useful especially in cases of lower leg discomfort at night of unclear interpretation. Acknowledgements: The authors would like to thank Prof. F. Marrosu and Dr. M. Fraschini, University of Cagliari, Italy, and Prof. L. Parrino, University of Parma, Italy, for their important contribution. http://dx.doi.org/10.1016/j.sleep.2013.11.217
Sleep breathing disorders screening in chilean miners J. Santin, P. Moya, P. Contreras, E. Pincheira Centro Médico del Sueño, Pontificia Universidad Catolica de Chile, Chile
Introduction: Sleep Breathing Disorders (SBD) constitute a risk factor for workplace accidents whose consequences have cost in human lives and environmental damage. Since they can be aggravated in high altitude its identification in mining workers is crucial. Objectives: to establish the relation between a screening practiced with night pulse oximetry, and Epworth and Berlin questionnaires in patients clinically suspicious of SDB and polysomnography results, performed in a high altitude chilean mine setting. Materials and methods: A group of 100 consecutive mining workers had an all-night oxymetry done at their work place, (a 2600 meters high camp); those with abnormal oximetries had a PSG performed at the same setting, as part of a ’’Prevention of fatigue and sleep disorders’’ program. They also answered the Epworth scale and Berlin questionnaire. Results: 78% of the workers had abnormal oxymetries and in 74 of them (94%) the PSG showed sleep apnea of different severity; in 24 of these patients (32%) it was related to posture. The average Epworth score was 4.28 while for the Berlin questionnaire it was 2.27. Conclusion: All nigh oximetry is a reliable predictor of SDB as shown by the PSG in chilean high altitude mine workers. SBD is highly prevalent in these type of patients. Epworth and Berlin questionnaires failed to suggest hypersomnolence or SDB; it is speculated that this latter finding can be explained by workers fear to lose their jobs if they recognize the presence of hypersomnolence or witnessed apneas. Acknowledgement: We thank technical personnel support for this research. http://dx.doi.org/10.1016/j.sleep.2013.11.218
Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis F. Cornette 1, A. Ogna 1, V. Forni 2, M. Burnier 2, R. Heinzer 1 1 Center for Investigation and Research in Sleep (CIRS), CHUV, Switzerland 2 Department of Nephrology and Hypertension, CHUV, Switzerland
Introduction: Sleep disordered breathing (SDB) is a common finding in chronic hemodialysis (CHD) patients. Two recent American studies investigated the prevalence of SDB in patients with different degree of chronic kidney disease and reported a prevalence of 26– 57%. The purpose of this study is to evaluate the prevalence of SDB and to evaluate the predictive value of Berlin questionnaire, hemod-
(78.38%) vs 71 (62.28%), p = 0.07; heart failure 14 (87.5%) vs 86 (63.7%), p = 0.06; sleep suffocation 57 (73.08%) vs 43 (58.9%), p = 0.07. Receiver operating characteristics (ROC) analysis reveals statistic significance for: age (p < 0.01, AUC = 0.69, cut-off = 49 years), neck circumference (p < 0.01, AUC = 0.67, cut-off = 44 cm), abdominal circumference (p < 0.01, AUC = 0.70, cut-off = 112 cm), BMI (p < 0.01, AUC = 0.70, cut-off = 32.03 kg/m2), glycemia (p = 0.03, AUC = 0.59, cut-off = 93 mg/dl), supine AHI position (p = 0.03, AUC = 0.59, cut-off = 48 events/h), medium O2 saturation (p < 0.01, AUC = 0.70, cut-off <95%), oxygen desaturation index (p < 0.01, AUC = 0.63, cut-off = 17.88 ) and ESS (p = 0.03, AUC = 0.59, cut-off = 8). Multivariate analysis on logistic model on body mass index, neck circumference, age, abdominal circumference, glycemia, desaturation index, heart failure, medium O2saturation, snoring, sleep restless, sleep suffocation, supine AHI position and ESS retains only body mass index, neck circumference and age. Conclusion: 1. Arterial hypertension from OSAS is significantly influenced by body mass index, neck circumference and age. 2. An increase of BMI by 1 kg/m2 would entail the risk of hypertension by 2.4%. An increase of 1 cm neck circumference would entail the risk of hypertension by 0.6%. An increase in age by 10 years would entail the risk of hypertension by 7.8%. http://dx.doi.org/10.1016/j.sleep.2013.11.216
Neurophysiological evaluation of spinal excitability in patients affected by primitive restless legs syndrome P. Congiu 1, G. Milioli 2, G. Gioi 1, P. Tacconi 3, M. Fantini 4, M. Puligheddu 1 1 Sleep Disorder Center, University of Cagliari, Italy 2 Sleep Disorder Center, University of Parma, Italy 3 Neurology UOC, University of Cagliari, Italy 4 Dip di Neuroscienze, University of Torino, Italy
Introduction: Restless legs syndrome (RLS) is a frequent pathology, yet underrated and underestimated, affecting inasmuch as 5–10% of the population as a whole. However the pathophysiology has not been completely understood. The dopaminergic system has certainly a primary role, and some studies have highlighted a condition of spinal hyper-excitability. The aim of our study is to explore this hypothesis throughout the electrophysiological evaluation of the spinal and peripheral nervous system in primitives RLS patients. Materials and methods: Among the patients affected by primitive RLS admitted to our Sleep Centerlab, we selected 15 women, and compared them with 17 control subjects of the same sex and age. All subjects had undergone ENG evaluation to exclude any secondary causes of lower limb paresthesia and to evaluate spinal excitability. According to a previous study, we considered two parameters which can be easily extracted from the routine tests normally carried out in the neurophysiopathology labs, the duration of F waves (FWD) of the Internal Popliteal (IPN) and ulnar nerves, and the relationship between FWD and the duration of the corresponding CMAP (CMAPD). Results: None of the subjects (RLS and controls) included in our study presented alterations in the nerve conduction velocity. Compared to the control group, significantly higher values were found in the RLS patients for the FWD/CMAPD ratio average (p < 0.001 test Mann–Whitney) and for the FWD average for both nerves ulnar (p < 0.05 unpaired t-test) and IPN (p < 0.01 unpaired t-test). Conclusion: The results of our study confirm the absence of peripheral involvement in primitive RLS, while they indicate a spinal motorneuronal hyper-excitability, which seems widespread, as both IPN and ulnar nerve stimulation indicators are altered. Such condi-
e101
tion could be due mainly to an alteration of the modulation in the interneuronal system. Presently, RLS diagnosis is based exclusively on clinical criteria. The FWD/CMAPD ratio can help to shed light on the pathogenesis of RLS, and can be used as an instrumental diagnostic indicator, easily obtainable and useful especially in cases of lower leg discomfort at night of unclear interpretation. Acknowledgements: The authors would like to thank Prof. F. Marrosu and Dr. M. Fraschini, University of Cagliari, Italy, and Prof. L. Parrino, University of Parma, Italy, for their important contribution. http://dx.doi.org/10.1016/j.sleep.2013.11.217
Sleep breathing disorders screening in chilean miners J. Santin, P. Moya, P. Contreras, E. Pincheira Centro Médico del Sueño, Pontificia Universidad Catolica de Chile, Chile
Introduction: Sleep Breathing Disorders (SBD) constitute a risk factor for workplace accidents whose consequences have cost in human lives and environmental damage. Since they can be aggravated in high altitude its identification in mining workers is crucial. Objectives: to establish the relation between a screening practiced with night pulse oximetry, and Epworth and Berlin questionnaires in patients clinically suspicious of SDB and polysomnography results, performed in a high altitude chilean mine setting. Materials and methods: A group of 100 consecutive mining workers had an all-night oxymetry done at their work place, (a 2600 meters high camp); those with abnormal oximetries had a PSG performed at the same setting, as part of a ’’Prevention of fatigue and sleep disorders’’ program. They also answered the Epworth scale and Berlin questionnaire. Results: 78% of the workers had abnormal oxymetries and in 74 of them (94%) the PSG showed sleep apnea of different severity; in 24 of these patients (32%) it was related to posture. The average Epworth score was 4.28 while for the Berlin questionnaire it was 2.27. Conclusion: All nigh oximetry is a reliable predictor of SDB as shown by the PSG in chilean high altitude mine workers. SBD is highly prevalent in these type of patients. Epworth and Berlin questionnaires failed to suggest hypersomnolence or SDB; it is speculated that this latter finding can be explained by workers fear to lose their jobs if they recognize the presence of hypersomnolence or witnessed apneas. Acknowledgement: We thank technical personnel support for this research. http://dx.doi.org/10.1016/j.sleep.2013.11.218
Prevalence and predictors of sleep disordered breathing in patients undergoing chronic ambulatory intermittent hemodialysis F. Cornette 1, A. Ogna 1, V. Forni 2, M. Burnier 2, R. Heinzer 1 1 Center for Investigation and Research in Sleep (CIRS), CHUV, Switzerland 2 Department of Nephrology and Hypertension, CHUV, Switzerland
Introduction: Sleep disordered breathing (SDB) is a common finding in chronic hemodialysis (CHD) patients. Two recent American studies investigated the prevalence of SDB in patients with different degree of chronic kidney disease and reported a prevalence of 26– 57%. The purpose of this study is to evaluate the prevalence of SDB and to evaluate the predictive value of Berlin questionnaire, hemod-