- Email: [email protected]
Sleep related rhythmic movements and periodic limb movements in schizophrenia: a clinical case
e234
Abstracts / Sleep Medicine 14S (2013) e165–e238
on increasing drug dosages, but without a precise clue of the mechanisms of such variability. Genetic polymorphisms of cytochrome P450 (CYP450) are involved in drug metabolism and known to be responsible for the interindividual variability of drug response in different population groups. We genotyped CYP450 genes, CYP3A4 and CYP3A5, involved in the metabolism of two common NC drugs (i.e. modafinil (Mod), a wake promoting agent, and venlafaxine (Ven), a noradrenaline- serotonine reuptake inhibitor). Moreover, we genotyped the glycoprotein-P ABCB1(P-gp), also called multidrug resistance protein 1, a transmembrane efflux pump. Finally, genotypes were correlated with Mod and Ven efficacy and dosage, to provide a clue for the interindividual variability in clinical response of NC patients. Materials and methods: 45 Caucasian NC patients (28 males, mean age 4220 y.o.), on chronic therapy with Mod alone or Mod plus Ven underwent blood withdrawal for genetic analysis. Mod and Ven efficacy was empirically scored by a sleep expert (1 = full, 2 = mild, 3 = low efficacy). Multiplex PCR was used for CYP3A4, CYP3A5 and P-gp loci amplification, followed by enzymatic purification, minisequencing reaction, and capillary electrophoresis typing. Results: Out of 45 patients 17 were on Mod alone (38%), 28 on Mod plus Ven (62%). No significant correlation was found between CYP3A4/CYP3A5 genotypes and Mod or Ven efficacy or dosage. The CGC/TTT P- gp-haplotype (wild type/mutated allele), corresponding to a decreased activity, showed a significant correlation with an increased Mod efficacy (p = 0.017). CGC/TTT haplotype was also the most represented in NC, according to general Caucasian population frequency distribution. Conclusion: This is the first attempt to correlate the interindividual variability of drug response to Mod and Ven in NC patients with the genotypes of proteins involved in their metabolism and transport. An increased Mod efficacy resulted to be related to a partially decreased activity of P-gp (partially mutated haplotype), suggesting that the Mod efficacy may be related to the intracellular permanence of Mod, consequent to damaged cell efflux. Acknowledgements: We thank the patients of the Italian Narcolepsy Association (AIN) for the precious collaboration. http://dx.doi.org/10.1016/j.sleep.2013.11.564
Sleep related rhythmic movements and periodic limb movements in schizophrenia: a clinical case P. Porcacchia, F. Mora Granizo, G. Botebol Benhamou Servicio de Neurofisiología, UGC de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Introduction: Schizophrenic patients may present sleep troubles that classically include abnormality of circadian rhythm, a reduction of sleep efficiency and the electroencephalogram’s finding of reduced sleep spindles. Nevertheless we do not know the prevalence of other sleep related conditions in these patients, such as rhythmic and/or periodic limb movements. Materials and methods: We describe a nocturnal, laboratory based, video-polysomnography (PSG) of a 36 years-old man, with a diagnosis of schizophrenia 14 years before. During his childhood he presented sleep related rhythmic movement (head banging) that progressively disappeared when he was a teenager. He was remitted to our laboratory with a clinical suspect of parasomnia, for presenting in the last months limb and arm movements, usually at the beginning of the sleep. His medications include Risperidone, Biperiden and Clorazepate. Results: The PSG showed a reduction of sleep efficiency and the presence of polymorphic periodic and rhythmic movements during
sleep. Rhythmic movements took place during the awakening and N1, with the patient in the supine position and consisted of a rhythmic external rotation of the hip (usually the left) with flexed knee. Three types of periodic movement were detected: typical limb movements with dorsal extension of the foot; forearm extension, with adduction and internal rotation of the arm; a fast extensionflexion of the forearm, as rubbing the hand together with the abdominal wall and frequently correlated with arousals. Conclusion: The unusual association of typical and atypical periodic movement during sleep as well as sleep related rhythmic movements suggest a possible relation with the psychiatric condition and/ or the medication of the patient. Acknowledgements: Clinical staff. http://dx.doi.org/10.1016/j.sleep.2013.11.565
Subjective sleep characteristics associated with anxiety and depression in older adults: a population-based study O. Potvin 1, D. Lorrain 2, G. Belleville 3, S. Grenier 4, M. Préville 2 1 Centre de recherche de l’Institut universitaire en santé mentale de Québec, Québec, Canada 2 Université de Sherbrooke, Sherbrooke, Canada 3 Université Laval, Canada 4 Centre de Recherche de l’Institut Universitaire de gériatrie de Montréal, Canada
Introduction: At the moment, population-based data on the subjective sleep characteristics related to anxiety disorders in older adults are scarce and the few results do not agree with the view proposed by the DSM concerning sleep difficulties related to anxiety. This study examines the subjective sleep characteristics specific to anxiety and depression in older adults. Materials and methods: The sample comprises a random population-based sample of 2393 individuals aged 65 years or older. Anxiety and depression were identified by a structured interview and categorized using DSM-5 criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode (MDE) and depressive episode with insufficient symptoms (DEIS). Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index (PSQI). The association between subjective sleep characteristics and anxiety/depression were assessed using logistic regression adjusted for age, education level, cognitive functioning, subjective health, anxiolytic/sedative/ hypnotic use, antidepressants use, cardiovascular conditions, and the number of chronic diseases. Results: The prevalence of poor sleep (PSQI >5) was 64% in participants with anxiety disorder (Adjusted odds ratio: 2.16, 95% CI: 1.30–3.60) and 55% in participants with unspecified anxiety disorders (1.59, 1.12–2.26) compared to 37% in those without anxiety. Nearly all PSQI subscales were significantly associated with anxiety, but these subscales shared variance and only short sleep duration, sleep disturbance and daytime functioning subscales were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to breathing, coughing/snoring, feeling hot or cold, pain, and bad dreams. The prevalence of poor sleep was 54% in participants with MDE (1.07, 0.70–1.64) and 58% in participants with DEIS (1.70, 1.22–2.36) compared to 36% in those without depression. The use of sleeping medication was the only specific sleep characteristic associated with depression. Conclusion: These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances
Abstracts / Sleep Medicine 14S (2013) e165–e238
on increasing drug dosages, but without a precise clue of the mechanisms of such variability. Genetic polymorphisms of cytochrome P450 (CYP450) are involved in drug metabolism and known to be responsible for the interindividual variability of drug response in different population groups. We genotyped CYP450 genes, CYP3A4 and CYP3A5, involved in the metabolism of two common NC drugs (i.e. modafinil (Mod), a wake promoting agent, and venlafaxine (Ven), a noradrenaline- serotonine reuptake inhibitor). Moreover, we genotyped the glycoprotein-P ABCB1(P-gp), also called multidrug resistance protein 1, a transmembrane efflux pump. Finally, genotypes were correlated with Mod and Ven efficacy and dosage, to provide a clue for the interindividual variability in clinical response of NC patients. Materials and methods: 45 Caucasian NC patients (28 males, mean age 4220 y.o.), on chronic therapy with Mod alone or Mod plus Ven underwent blood withdrawal for genetic analysis. Mod and Ven efficacy was empirically scored by a sleep expert (1 = full, 2 = mild, 3 = low efficacy). Multiplex PCR was used for CYP3A4, CYP3A5 and P-gp loci amplification, followed by enzymatic purification, minisequencing reaction, and capillary electrophoresis typing. Results: Out of 45 patients 17 were on Mod alone (38%), 28 on Mod plus Ven (62%). No significant correlation was found between CYP3A4/CYP3A5 genotypes and Mod or Ven efficacy or dosage. The CGC/TTT P- gp-haplotype (wild type/mutated allele), corresponding to a decreased activity, showed a significant correlation with an increased Mod efficacy (p = 0.017). CGC/TTT haplotype was also the most represented in NC, according to general Caucasian population frequency distribution. Conclusion: This is the first attempt to correlate the interindividual variability of drug response to Mod and Ven in NC patients with the genotypes of proteins involved in their metabolism and transport. An increased Mod efficacy resulted to be related to a partially decreased activity of P-gp (partially mutated haplotype), suggesting that the Mod efficacy may be related to the intracellular permanence of Mod, consequent to damaged cell efflux. Acknowledgements: We thank the patients of the Italian Narcolepsy Association (AIN) for the precious collaboration. http://dx.doi.org/10.1016/j.sleep.2013.11.564
Sleep related rhythmic movements and periodic limb movements in schizophrenia: a clinical case P. Porcacchia, F. Mora Granizo, G. Botebol Benhamou Servicio de Neurofisiología, UGC de Neurociencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Introduction: Schizophrenic patients may present sleep troubles that classically include abnormality of circadian rhythm, a reduction of sleep efficiency and the electroencephalogram’s finding of reduced sleep spindles. Nevertheless we do not know the prevalence of other sleep related conditions in these patients, such as rhythmic and/or periodic limb movements. Materials and methods: We describe a nocturnal, laboratory based, video-polysomnography (PSG) of a 36 years-old man, with a diagnosis of schizophrenia 14 years before. During his childhood he presented sleep related rhythmic movement (head banging) that progressively disappeared when he was a teenager. He was remitted to our laboratory with a clinical suspect of parasomnia, for presenting in the last months limb and arm movements, usually at the beginning of the sleep. His medications include Risperidone, Biperiden and Clorazepate. Results: The PSG showed a reduction of sleep efficiency and the presence of polymorphic periodic and rhythmic movements during
sleep. Rhythmic movements took place during the awakening and N1, with the patient in the supine position and consisted of a rhythmic external rotation of the hip (usually the left) with flexed knee. Three types of periodic movement were detected: typical limb movements with dorsal extension of the foot; forearm extension, with adduction and internal rotation of the arm; a fast extensionflexion of the forearm, as rubbing the hand together with the abdominal wall and frequently correlated with arousals. Conclusion: The unusual association of typical and atypical periodic movement during sleep as well as sleep related rhythmic movements suggest a possible relation with the psychiatric condition and/ or the medication of the patient. Acknowledgements: Clinical staff. http://dx.doi.org/10.1016/j.sleep.2013.11.565
Subjective sleep characteristics associated with anxiety and depression in older adults: a population-based study O. Potvin 1, D. Lorrain 2, G. Belleville 3, S. Grenier 4, M. Préville 2 1 Centre de recherche de l’Institut universitaire en santé mentale de Québec, Québec, Canada 2 Université de Sherbrooke, Sherbrooke, Canada 3 Université Laval, Canada 4 Centre de Recherche de l’Institut Universitaire de gériatrie de Montréal, Canada
Introduction: At the moment, population-based data on the subjective sleep characteristics related to anxiety disorders in older adults are scarce and the few results do not agree with the view proposed by the DSM concerning sleep difficulties related to anxiety. This study examines the subjective sleep characteristics specific to anxiety and depression in older adults. Materials and methods: The sample comprises a random population-based sample of 2393 individuals aged 65 years or older. Anxiety and depression were identified by a structured interview and categorized using DSM-5 criteria for phobias, panic disorder, generalized anxiety disorder, unspecified anxiety disorder, major depressive episode (MDE) and depressive episode with insufficient symptoms (DEIS). Subjective sleep characteristics were measured using the Pittsburgh Sleep Quality Index (PSQI). The association between subjective sleep characteristics and anxiety/depression were assessed using logistic regression adjusted for age, education level, cognitive functioning, subjective health, anxiolytic/sedative/ hypnotic use, antidepressants use, cardiovascular conditions, and the number of chronic diseases. Results: The prevalence of poor sleep (PSQI >5) was 64% in participants with anxiety disorder (Adjusted odds ratio: 2.16, 95% CI: 1.30–3.60) and 55% in participants with unspecified anxiety disorders (1.59, 1.12–2.26) compared to 37% in those without anxiety. Nearly all PSQI subscales were significantly associated with anxiety, but these subscales shared variance and only short sleep duration, sleep disturbance and daytime functioning subscales were independently related to anxiety. Within these significant subscales, the main specific sleep complaints associated with anxiety were daytime sleepiness and sleep disturbances related to breathing, coughing/snoring, feeling hot or cold, pain, and bad dreams. The prevalence of poor sleep was 54% in participants with MDE (1.07, 0.70–1.64) and 58% in participants with DEIS (1.70, 1.22–2.36) compared to 36% in those without depression. The use of sleeping medication was the only specific sleep characteristic associated with depression. Conclusion: These results suggest that in older adults, symptoms of short sleep duration, daytime sleepiness and sleep disturbances