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P6. Leg movements during sleep in patients with obstructive sleep apnea
e104
Society Proceedings / Clinical Neurophysiology 123 (2012) e101–e114
P6. Leg movements during sleep in patients with obstructive sleep apnea—S. Fulda a, I. Rusakova a, R. Ferri b, C.L. Bassetti a, I. Pisarenco a, E. Colamartino a, M. Manconi a (a Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland, b Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Troina, Italy) Introduction: Leg movements (LMs) during sleep are frequent in patients with obstructive sleep apnea syndrome (OSAS). Current giudelines distinguish LMs associated with respiratory events from periodic leg movements (PLM), excluding the former when assessing PLM. The aim of the current study was to describe the time structure of global LMs, the relationship between PLM and respiratory related movements (RRM), and the relationship between RRMs and the main respiratory parameters in patients with OSAS. Methods: Retrospective chart review of all patients visiting the sleep lab of the Sleep and Epilepsy Center of the Neurocenter of Southern Switzerland between January 2010 and July 2011, which (1) had undergone full polysomnographic recording, (2) were between 18 and 75 years, (3) had an apnea-hypopnea index >20 and oxygen desaturation index >10 with more than half of all apneas being obstructive and (4) had >15 LMs/h (leg movements index (LMI)). We excluded patients with (1) any medical condition, that could influence LMs or apnea (such as narcolepsy, parasomnias, neurological disorders, renal or heart failure), (2) medication known or suspected to affect LMs (e.g. dopaminergic, benzodiazepines, antidepressants, etc.) and (3) recordings with artefacts of tibialis anterior or flow for more than 20% of the total sleep time. All LMs were scored and classifed as RRM, PLM, or isolated LMs according to WASM-IRLSSG criteria (2006). Intermovement intervals of LMs were analysed with distribution mixture analysis and differences between subjects with and without respiratory-related LMs were explored with non-parameteric tests. Results: Fifty six patients have been included (8F 48 M, 56 ± 12 years). Distribution mixture analysis of intermovement intervals (IMI) of all LMs identified 3 classes of LMs which could be distinguished based on their peak frequencies (Fig. 1). These were around 5 s, 20 s, and 40 s. The latter class (IMIs 40 s) could be traced back to the respiratory-related LMs, while the 20 s peak corresponds to periodic LMs, also found in patients with restless legs syndrome (RLS). LMs with very short IMIs (5 s) are related to wakefullness and arousal. Within the total group, 10 patients had no respiratory LMs (<1/h). Comparison between patients with and without respiratory LMs revealed more severe apnea (higher AHI, ODI), more disturbed sleep (longer sleep latency, more frequent awakenings), and more periodic and non-periodic LMs in patients with respiratory LMs.
Conclusions: Our preliminary results show that respiratory LMs can be distinguished from periodic LMs based on their time structure (IMI). Importantly, respiratory LMs are found predominantly in patients with periodic LMs suggesting a possible shared trait for increased motor activity during sleep. The time structure analysis of LMs may be able provide information on the pathogenesis and meaning of LMs in OSAS patients and might explain the different response of LMs to ventilatory treatment. doi:10.1016/j.clinph.2012.03.056
P7. Importance of mobility for quality of life in patients with multiple sclerosis—C. Vaney a, A. Bienz b, R. Zwicky b, M. Gerber c, M. Traber a (a Center for Medical and Neurological Rehabilitation, Crans-Montana, Switzerland, b Biogen Idec Switzerland AG, Zug, Switzerland, c GEM Clinical Research Consulting, Unterägeri, Switzerland) Introduction: Clinical trials indicate that disease-modifying therapies (DMT) are effective in reducing disease activity and may slow disease progression (Freedman, 2011). Patients judge gait and visual functions as the most valuable (Heesen et al., 2008). The present work explored the impact of patient’s mobility, especially difficulties in walking, as a factor influencing quality of life (QoL) from the perspective of physicians (HCPs). Methods: Between March and July 2011 a survey was conducted amongst 40 Swiss HCPs. The objective was to gain insight on symptoms most frequently reported, impact of walking impairment on QoL, assessment tools, treatment options used, follow-up and monitoring over time. Results: Walking impairment was considered important/very important by 98% HCPs. Regarding the type of walking impairment, the ‘lack of coordination/balance’ was reported most frequently and 14 times as 1st intervention. The impact of walking impairment on the ability to work was considered important/very important by 83% of HCPs, on social contacts by 75% and on family life by 73%. Walking impairment was reported through HCPs observation in 36 cases and through asking by HCP in 24 cases but primary reporting by the patient in 19 cases. The most frequently used tool to assess walking impairment was EDSS reported by 93% of HCPs. Physiotherapy was the most frequent help for walking impairment and was reported 38 times, in 53% as 1st priority. The involvement of physiotherapist was considered important/very important by 78% of HCPs. New treatment options were considered to be important/very important by 83% of HCPs. Forty three percentage of HCPs were not aware of new drugs for patients with walking impairment. Conclusions: The majority of Swiss HCPs have an awareness of walking impairment – most often reported as ‘lack of coordination/balance’ – as a primary concern. It impacts on the ability to work, affects social contacts and family life and consequently QoL. However, as patients raised this issue in nearly 50% of the cases, assessing walking impairment on a systematic basis does not occur in clinical practice. Walking impairment was assessed with EDSS, which is not easily performed. As drugs for patients with walking impairment are in development, it raises the need for tests such as Timed 25-Foot Walk (Coleman et al., 2012) in clinical practice especially as it is validated and simple to apply. References
Fig. 1. Distribution mixture analysis intermovement interval distribution of all LMs
Coleman CI, Sobieraj DM, Marinucci LN. Minimally important clinical difference of the Timed 25-Foot Walk Test: results from a randomized controlled trial in patients with multiple sclerosis. Curr Med Res Opin 2012;28:49–56. Freedman MS. Long-term follow-up of clinical trials of multiple sclerosis therapies. Neurology 2011;76(Suppl. 1):S26–34.
Society Proceedings / Clinical Neurophysiology 123 (2012) e101–e114
P6. Leg movements during sleep in patients with obstructive sleep apnea—S. Fulda a, I. Rusakova a, R. Ferri b, C.L. Bassetti a, I. Pisarenco a, E. Colamartino a, M. Manconi a (a Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland, b Sleep Research Centre, Department of Neurology I.C., Oasi Institute (IRCCS), Troina, Italy) Introduction: Leg movements (LMs) during sleep are frequent in patients with obstructive sleep apnea syndrome (OSAS). Current giudelines distinguish LMs associated with respiratory events from periodic leg movements (PLM), excluding the former when assessing PLM. The aim of the current study was to describe the time structure of global LMs, the relationship between PLM and respiratory related movements (RRM), and the relationship between RRMs and the main respiratory parameters in patients with OSAS. Methods: Retrospective chart review of all patients visiting the sleep lab of the Sleep and Epilepsy Center of the Neurocenter of Southern Switzerland between January 2010 and July 2011, which (1) had undergone full polysomnographic recording, (2) were between 18 and 75 years, (3) had an apnea-hypopnea index >20 and oxygen desaturation index >10 with more than half of all apneas being obstructive and (4) had >15 LMs/h (leg movements index (LMI)). We excluded patients with (1) any medical condition, that could influence LMs or apnea (such as narcolepsy, parasomnias, neurological disorders, renal or heart failure), (2) medication known or suspected to affect LMs (e.g. dopaminergic, benzodiazepines, antidepressants, etc.) and (3) recordings with artefacts of tibialis anterior or flow for more than 20% of the total sleep time. All LMs were scored and classifed as RRM, PLM, or isolated LMs according to WASM-IRLSSG criteria (2006). Intermovement intervals of LMs were analysed with distribution mixture analysis and differences between subjects with and without respiratory-related LMs were explored with non-parameteric tests. Results: Fifty six patients have been included (8F 48 M, 56 ± 12 years). Distribution mixture analysis of intermovement intervals (IMI) of all LMs identified 3 classes of LMs which could be distinguished based on their peak frequencies (Fig. 1). These were around 5 s, 20 s, and 40 s. The latter class (IMIs 40 s) could be traced back to the respiratory-related LMs, while the 20 s peak corresponds to periodic LMs, also found in patients with restless legs syndrome (RLS). LMs with very short IMIs (5 s) are related to wakefullness and arousal. Within the total group, 10 patients had no respiratory LMs (<1/h). Comparison between patients with and without respiratory LMs revealed more severe apnea (higher AHI, ODI), more disturbed sleep (longer sleep latency, more frequent awakenings), and more periodic and non-periodic LMs in patients with respiratory LMs.
Conclusions: Our preliminary results show that respiratory LMs can be distinguished from periodic LMs based on their time structure (IMI). Importantly, respiratory LMs are found predominantly in patients with periodic LMs suggesting a possible shared trait for increased motor activity during sleep. The time structure analysis of LMs may be able provide information on the pathogenesis and meaning of LMs in OSAS patients and might explain the different response of LMs to ventilatory treatment. doi:10.1016/j.clinph.2012.03.056
P7. Importance of mobility for quality of life in patients with multiple sclerosis—C. Vaney a, A. Bienz b, R. Zwicky b, M. Gerber c, M. Traber a (a Center for Medical and Neurological Rehabilitation, Crans-Montana, Switzerland, b Biogen Idec Switzerland AG, Zug, Switzerland, c GEM Clinical Research Consulting, Unterägeri, Switzerland) Introduction: Clinical trials indicate that disease-modifying therapies (DMT) are effective in reducing disease activity and may slow disease progression (Freedman, 2011). Patients judge gait and visual functions as the most valuable (Heesen et al., 2008). The present work explored the impact of patient’s mobility, especially difficulties in walking, as a factor influencing quality of life (QoL) from the perspective of physicians (HCPs). Methods: Between March and July 2011 a survey was conducted amongst 40 Swiss HCPs. The objective was to gain insight on symptoms most frequently reported, impact of walking impairment on QoL, assessment tools, treatment options used, follow-up and monitoring over time. Results: Walking impairment was considered important/very important by 98% HCPs. Regarding the type of walking impairment, the ‘lack of coordination/balance’ was reported most frequently and 14 times as 1st intervention. The impact of walking impairment on the ability to work was considered important/very important by 83% of HCPs, on social contacts by 75% and on family life by 73%. Walking impairment was reported through HCPs observation in 36 cases and through asking by HCP in 24 cases but primary reporting by the patient in 19 cases. The most frequently used tool to assess walking impairment was EDSS reported by 93% of HCPs. Physiotherapy was the most frequent help for walking impairment and was reported 38 times, in 53% as 1st priority. The involvement of physiotherapist was considered important/very important by 78% of HCPs. New treatment options were considered to be important/very important by 83% of HCPs. Forty three percentage of HCPs were not aware of new drugs for patients with walking impairment. Conclusions: The majority of Swiss HCPs have an awareness of walking impairment – most often reported as ‘lack of coordination/balance’ – as a primary concern. It impacts on the ability to work, affects social contacts and family life and consequently QoL. However, as patients raised this issue in nearly 50% of the cases, assessing walking impairment on a systematic basis does not occur in clinical practice. Walking impairment was assessed with EDSS, which is not easily performed. As drugs for patients with walking impairment are in development, it raises the need for tests such as Timed 25-Foot Walk (Coleman et al., 2012) in clinical practice especially as it is validated and simple to apply. References
Fig. 1. Distribution mixture analysis intermovement interval distribution of all LMs
Coleman CI, Sobieraj DM, Marinucci LN. Minimally important clinical difference of the Timed 25-Foot Walk Test: results from a randomized controlled trial in patients with multiple sclerosis. Curr Med Res Opin 2012;28:49–56. Freedman MS. Long-term follow-up of clinical trials of multiple sclerosis therapies. Neurology 2011;76(Suppl. 1):S26–34.