Sleep disorders: a sometimes forgotten cause of nonepileptic spells

We present a patient with spells of loss of awareness in which the initial diagnostic consideration was partial epilepsy. The patient underwent video-EEG long-term monitoring which raised suspicion of nonepileptic events, but could not exclude simple partial seizures. A failed therapeutic trial with antiepileptic medication and adverse events prompted reevaluation of the case. Sleep studies, including polysomnography and multiple sleep latency testing (MSLT), confirmed a sleep disorder, i.e., narcolepsy, which responded to specific therapy with resolution of the spells.     

Recurrent nightmares and disorders of arousal in temporal lobe epilepsy

Sleep is known to be severely altered in temporal lobe epilepsy (TLE). Furthermore, sleep deprivation is one of the key factors contributing to cognitive deficits and drug resistance in TLE. In the past, “non-ictal” parasomnias, as well as parasomnia-like nocturnal episodes ultimately diagnosed as seizures, have been documented in epileptic patients. However, recurrence of possibly “ictal” parasomnias in TLE has not been adequately appreciated. Through questionnaires and diaries distributed to TLE patients and their families in a tertiary center for epilepsy, 20 out of 168 patients seen in the last 2 years have been identified as, probands and extensively recorded during sleep. Patients presented with confusional arousals were 16, 14 with nightmares, and 2 with sleep walking episodes. Episodes (25) corresponding to clinical or subclinical seizures have been video-polygraphically recorded in 10/20 patients. Therapy optimization, pharmacological or surgical, resolved the episodes in 17/20 patients. A better seizure control with improved quality of life can be achieved by increasing and extending the practice of nocturnal recording in TLE patients.     

Sleep disorders and chronic kidney disease

Sleep disorders have a profound and well-documented impact on overall health and quality of life in the general population. In patients with chronic disease, sleep disorders are more prevalent, with an additional morbidity and mortality burden. The complex and dynamic relationship between sleep disorders and chronic kidney disease (CKD) remain relatively little investigated. This article presents an overview of sleep disorders in patients with CKD, with emphasis on relevant pathophysiologic underpinnings and clinical presentations. Evidence-based interventions will be discussed, in the context of individual sleep disorders, namely sleep apnea, insomnia, restless leg syndrome and excessive daytime sleepiness. Limitations of the current knowledge as well as future research directions will be highlighted, with a final discussion of different conceptual frameworks of the relationship between sleep disorders and CKD.     

Rapid eye movement sleep behaviour disorder in women with Parkinson’s disease is an underdiagnosed entity

Rapid eye movement sleep behavior disorder (RBD) is common in Parkinson’s disease (PD). Little information exists about RBD in women with PD. The aim of this study was to determine the clinical expression of RBD in women with PD and note any differences in women with PD with and without RBD. One hundred fifty-six patients with PD were recruited. There were 37 women with PD and probable RBD was diagnosed using the RBD Screening Questionnaire. Other scales included Pittsburgh Sleep Quality Index, Parkinson’s Disease Sleep Scale, Epworth Sleep Scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. Probable RBD was diagnosed in 10 women with PD (27%). Most often (70%) RBD occurred after the onset of parkinsonian symptoms. Women with probable RBD were older, had shorter duration of PD symptoms, lower tremor score, and higher axial signs score. They had insomnia (80% versus non-probable RBD patients 44%, p = 0.019), and poor sleep quality with excessive daytime sleepiness. Anxiety and depression were common in women with probable RBD. Episodes were brief and confined to vocalization and simple limb movements. No injury to self or bed partners was noted. Women with PD have fewer fights and less aggressive dream enacting behaviour than men, but suffer from significant disturbed sleep, and levels of anxiety and depression.     

快动眼睡眠相关阻塞性睡眠呼吸暂停低通气综合征的睡眠监测特点

目的探讨与快动眼（rapid eye movement,REM）睡眠期密切相关的阻塞性睡眠呼吸暂停低通气综合征（OSAHS）,即REMOSAHS患者的临床及睡眠监测特点。方法回顾在我院进行多道睡眠图（PSG）监测诊断为OSAHS的患者,根据REM睡眠期呼吸暂停低通气指数（AHIREM）和慢动眼睡眠期（non-rapid eye movement,NREM）呼吸暂停低通气指数（AHINREM）将其分为两组,AHIREM/AHINREM〉2为REMOSAHS组,AHIREM/AHINREM≤2为NREMOSAHS组,比较REMOSAHS与NREMOSAHS临床睡眠监测指标的差异。结果 159例OSAHS患者中,REMOSAHS占19.5%,其中男性占58.1%,女性占41.9%;REMOSAHS组与NREMOSAHS组年龄比较差异具有显著性[（34.9±13.5）岁vs（39.6±9.6）岁];两组体块指数（BMI）比较,差异无显著性[（28.1±2.5）kg/m2vs（28.8±3.4）kg/m2];两组总睡眠呼吸暂停低通气指数（AHITST）比较,差异具有显著性[（32.2±29.8）次/hvs（53.0±27.5）次/h]。结论 REMOSAHS女性与男性发病率相近,且年龄较轻,病情较轻。     

发作性睡病与异态睡眠的诊治

本文目的是探讨发作性睡病与异态睡眠的诊断与治疗.发作性睡病被漏诊和误诊的几率较高,危害较大,共患异态睡眠比例高.文章从发作性睡病临床特征、REM睡眠的作用、发作性睡病与异态睡眠(睡眠瘫痪、睡眠幻觉、快眼动睡眠期行为障碍)共病特征及治疗这四个方面进行了讨论.