Microsubthalamotomy improves sleep in patients affected by advanced Parkinson’s disease

BackgroundDeep brain stimulation of the subthalamic nucleus (STN-DBS) improves sleep in patients affected by Parkinson’s disease (PD). Since microsubthalamotomy (mSTN) shows positive effects on motor symptoms, it could improve sleep in PD patients. Our goals were: to assess the effects of mSTN on sleep in patients affected by advanced PD; and to look for a correlation between sleep and motor features after the neurosurgical procedure.MethodsFifteen patients who underwent bilateral STN-DBS were enrolled. Subjective sleep evaluation was assessed using the Parkinson’s Disease Sleep Scale (PDSS). Data on sleep schedule and presence of restless legs syndrome (RLS) were obtained. Objective sleep features were investigated by polysomnography (PSG). To evaluate the mSTN effect, we compared motor state and sleep features before and after the neurosurgical procedure, before the programmable pulse generator was switched on.ResultsmSTN had beneficial effects on motor state and sleep features. After the surgery, the mean total PDSS score increased from 84.0 ± 25.2 to 115.2 ± 16.6 (P < 0.001). PD patients reported longer total sleep time duration, decreased daytime sleepiness, and improvement in RLS symptoms. PSG data showed an increase in total sleep time and sleep efficiency with a decrease in wakefulness after sleep onset and arousal index. No correlation between motor improvements and sleep features modifications was observed after mSTN.ConclusionsmSTN improves sleep quality and ameliorates several sleep complaints, as well as motor symptoms, in advanced PD patients who have undergone STN-DBS.     

Sleep in essential tremor: a comparison with normal controls and Parkinson's disease patients

BackgroundRecent studies have shed light on non-motor features of ET, such as depressive symptoms and cognitive changes, which might be attributed to pathophysiological changes in the brains of ET patients. Given these brain changes, we explored sleep abnormalities in ET patients.MethodsSleep was assessed using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI) in 120 ET cases, 120 normal controls, and 40 PD cases.ResultsThe mean ± SD (median) ESS score increased from normal controls (5.7 ± 3.7 (5.0)), to ET cases (6.8 ± 4.6 (6.0)), to PD cases (7.8 ± 4.9 (7.0)), test for trend p = 0.03. An ESS score >10 (an indicator of greater than normal levels of daytime sleepiness) was observed in 11 (9.2%) normal controls, compared to 27 (22.5%) ET cases and 10 (25.0%) PD cases (p = 0.008 when comparing all three groups, and p = 0.005 when comparing ET to normal controls). The global PSQI score was 7.8 ± 2.8 (7.5) in controls, 8.0 ± 3.3 (8.0) in ET cases, and 9.9 ± 3.9 (10.0) in PD cases. The ET case–control difference was not significant (p = 0.8), yet in a test for trend, PD cases had the highest PSQI score (most daytime sleepiness), followed by ET (intermediate), and lowest scores in controls (p = 0.02).ConclusionsSome sleep scores in ET were intermediate between those of PD cases and normal controls, suggesting that a mild form of sleep dysregulation could be present in ET.     

Polysomnographic findings, video-based sleep analysis and sleep perception in progressive supranuclear palsy

Objectives: To compare subjective sleep perception, sleep architecture, rapid eye movement (REM) sleep without atonia, and REM sleep behavior disorder (RBD) in patients with progressive supranuclear palsy (PSP) to patients with Parkinson’s disease (PD).Methods: A comparative sleep study using the Parkinson’s Disease Sleep Scale (PDSS), the Mini-Mental State Examination (MMSE), and cardiorespiratory polysomnography on two consecutive nights with synchronized video recording. The study was undertaken in a sleep laboratory in a movement disorder center. Forty patients matched for age and cognition with probable PSP (n = 20, aged 71 ± 8 years, MMSE ? 24 in n = 7) and PD (n = 20, aged 69 ± 5 years, MMSE ? 24 in n = 8).Results: PDSS sum scores showed no difference between PSP and PD. PSP patients had significantly lower sleep efficiency (43.0 ± 15.0%) compared to PD patients (62.8 ± 19.1%) (p < 0.0008). Seventeen PSP patients and 19 PD patients had REM without atonia (RWA). Seven PSP patients and 13 PD patients had clinical RBD. The amount of RWA was lower in PSP (14.5 ± 17.3%) than in PD (44.6 ± 31.3%) (p < 0.0007). Eleven PSP and 11 PD patients were newly identified with sleep-disordered breathing (SDB).Conclusions: Polysomnographically recorded sleep is more severely impaired in PSP than in PD. PDSS ratings do not reflect the poorer sleep quality in PSP, possibly pointing to a specific neuropsychological profile. RWA and RBD are present in both neurodegenerative diseases. So far undetected SDB affects more than half of all patients in this study.     

Effect of pramipexole on RLS symptoms and sleep: a randomized, double-blind, placebo-controlled trial

BackgroundPatients with Restless Legs Syndrome (RLS) often seek treatment because of sleep problems related to nocturnal symptoms. Our goal was to test the ability of pramipexole to improve sleep in RLS patients and to reconfirm its efficacy for primary RLS symptoms.MethodsAdults with moderate or severe RLS were randomized to receive placebo or pramipexole (flexibly titrated from 0.25 to 0.75 mg), 2–3 h before bedtime for 12 weeks. The co-primary outcome measures were change in Medical Outcomes Study (MOS) sleep disturbance score and International RLS Study Group Rating Scale (IRLS) score at 12 weeks.ResultsThe intent-to-treat population included 357 patients: 178 received pramipexole and 179 received placebo. At 12 weeks, the adjusted mean change from baseline was greater for pramipexole (vs. placebo) for IRLS score (−13.4 ± 0.7 vs. −9.6 ± 0.7) and MOS sleep disturbance score (−25.3 ± 1.5 vs. −16.8 ± 1.5) (p ⩽ 0.0001; ANCOVA). Responder rates (clinical and patient global impression and IRLS) were also significantly higher in the pramipexole group. RLS-QOL score was improved over placebo at Week 12 (p < 0.01) as were MOS sleep adequacy (p = 0.0008) and quantity (p = 0.08) scores. Nine percent of patients in each group withdrew because of adverse events.ConclusionsPramipexole is effective and well-tolerated for RLS and related sleep disturbance.     

Tef polymorphism is associated with sleep disturbances in patients with Parkinson's disease

ObjectiveCircadian mechanisms play an important role in the regulation of sleep. A circadian clock-controlled gene, Tef, has been suggested to be associated with depressive symptoms, restless legs syndrome, and slow wave sleep in patients with sleep disorders. The present study sought to explore the association between Tef and sleep disturbances in patients with Parkinson’s disease (PD).MethodsThree hundred and ninety-two unrelated patients with PD were recruited for this study. All of them completed the PD Sleep Scale (PDSS) and other clinical and demographic assessments. rs738499, a single nucleotide polymorphism of the Tef gene, was genotyped by polymerase chain reaction-restriction fragment length polymorphism.ResultsMean total PDSS scores were 111.5 (standard deviation [SD] 23.0) in the TT genotype and 122.2 (SD 18.2) in the TG+GG genotypes (P < 0.01). Significant differences were found between genotypes (TT vs TG+GG) for 14 item scores (all P < 0.05). Total and item scores displayed negative associations with the TT genotype (all P < 0.05) except Item 2 (P = 0.178). Linear regression adjusted for gender, duration, depression and disease severity showed that the polymorphism could explain 0.9% of the variance in PDSS scores.ConclusionsThese preliminary results suggest that the TT genotype in Tef rs738499 is associated with sleep disturbances in PD. Depression and disease severity are the main contributors to these findings, but rs738499 itself is an independent risk factor.     

Prevalence of 'poor sleep' among patients with multiple sclerosis: an independent predictor of mental and physical status

BackgroundPatients with multiple sclerosis (MS) report sleep disturbances more frequently than the general population. Besides specific sleep disturbances, many other conditions could impair nocturnal rest in this population. In addition, information regarding the role of disrupted sleep on quality of life (QoL) in MS patients is lacking. This study was performed to bridge this gap.MethodsA total of 120 patients with MS were enrolled into the study. Demographic, socioeconomic and clinical characteristics (clinical course and duration of MS, EDSS score, therapeutic information, presence of pain, presence of sexual and/or bladder dysfunction, localization of demyelinating plaques, and presence of anxiety and depression) were collected. The Pittsburgh Sleep Quality Index (PSQI), the Charlson Comorbidity Index (CCI) and the Italian version of the 36-item Short Form (SF-36) were used to assess quality of sleep, comorbidity and QoL, respectively.ResultsNearly half (47.5%) of MS patients were classified as “poor sleepers,” having significantly higher EDSS (3.1 ± 1.4 vs. 2.3 ± 1.4, p = 0.009) and CCI scores (0.19 ± 0.4 vs. 0.03 ± 0.2, p = 0.009) than “good sleepers.” In addition, pain due to MS was more common among “poor sleepers” (33.3% vs. 17.7%, p = 0.05). Scores for each domain of the SF-36, and the mental component summary (MCS) and physical component summary (PCS) scores were significantly lower in poor sleepers than in good sleepers (p < 0.001 for each score). Of the different variables associated with MCS, the only independent predictors of mental status were: presence of sexual and/or bladder dysfunction and global PSQI score. The independent predictors for physical status (PCS) were age, EDSS score and global PSQI score.ConclusionsPoor sleep is common in patients with MS, representing an independent predictor of QoL. Patients with MS who are poor sleepers should receive immediate assessment and treatment, bearing in mind that, in addition to specific sleep disturbances, other clinical conditions (both related and unrelated to MS) can disrupt nocturnal sleep.     

Sleep disordered breathing in a cohort of patients with sporadic inclusion body myositis

ObjectiveThe aims of the study were: (1) to evaluate subjective sleep quality and daytime sleepiness in patients affected by sporadic inclusion-body myositis (IBM); (2) to define the sleep and sleep-related respiratory pattern in IBM patients.MethodsThirteen consecutive adult patients affected by definite IBM were enrolled, six women and seven men, mean age 66.2 ± 11.1 years (range: 50–80). Diagnosis was based on clinical and muscle biopsy studies. All patients underwent subjective sleep evaluation (Pittsburgh Sleep Quality Index, PSQI and Epworth Sleepiness Scale, ESS), oro-pharingo-esophageal scintigraphy, pulmonary function tests, psychometric measures, anatomic evaluation of upper airways, and laboratory-based polysomnography. Findings in IBM patients were compared to those obtained from a control group of 25 healthy subjects (13 men and 12 women, mean age 61.9 ± 8.6 years).ResultsDisease duration was >10 years in all. Mean IBM severity score was 28.8 ± 5.4 (range 18–36). Dysphagia was present in 10 patients. Nine patients had PSQI scores ? 5; patients had higher mean PSQI score (IBM: 7.2 ± 4.7, Controls: 2.76 ± 1.45, p = 0.005); one patient (and no controls) had EES > 9. Polysomnography showed that IBM patients, compared to controls, had lower sleep efficiency (IBM: 78.8 ± 12.0%, Controls: 94.0 ± 4.5%, p < 0.001), more awakenings (IBM: 11.9 ± 11.0, Controls: 5.2 ± 7.5, p = 0.009) and increased nocturnal time awake (IBM: 121.2 ± 82.0 min., Controls: 46.12 ± 28.8 min., p = 0.001). Seven Patients (and no controls) had polysomnographic findings consistent with sleep disordered breathing (SDB).ConclusionData suggest that sleep disruption, and in particular SDB, might be highly prevalent in IBM.SignificanceData indicate that IBM patients have poor sleep and high prevalence of SDB.     

Sleep disturbances in Malaysian patients with Parkinson's disease using polysomnography and PDSS

BackgroundSleep disturbances such as sleep fragmentation, sleep disordered breathing (SDB), periodic limb movements (PLM), excessive daytime somnolence (EDS) and insomnia are prevalent in Parkinson's disease (PD). However, studies in the Asian population are limited.MethodsThis was a cross-sectional study involving 46 Malaysians with PD using polysomnography (PSG) and standardized translated Parkinson's disease sleep scale (PDSS). Overnight PSG recordings, UPDRS and PDSS scores, and baseline demographic data were obtained.ResultsData from 44 patients were analysed. Thirty-six patients (81.8%) had PSG-quantified sleep disorders. Twenty-three (52.3%) had sleep fragmentation, 24 (54.6%) had SDB and 14 (32%) had PLM. EDS was present in 9.1%. Insomnia was reported by 31.8%. Patients with sleep fragmentation had significantly higher UPDRS scores and lower PDSS insomnia sub-scores. The UPDRS scores correlated negatively with the TST and sleep efficiency. All patients with EDS had SDB (p = 0.056). The PDSS insomnia sub-items correlated with sleep fragmentation on PSG.Conclusion: The prevalence of sleep disorders based on PSG and PDSS in our PD patients was high, the commonest being sleep fragmentation and SDB, while EDS was the least prevalent. Problem specific sub-items of the PDSS were more accurate in predicting the relevant PSG-related changes compared to the PDSS as a whole.     

Excessive daytime sleepiness and nocturia in women

ObjectiveTo investigate associations between excessive daytime sleepiness and nocturia in women.MethodA total of 488 women aged 18–89 years who underwent screening for cervical cancer at one institution in Florianópolis, Brazil, took part in this investigation. Sleep issues and daytime sleepiness, urinary frequency, and nutritional status were investigated.ResultsThe prevalence of excessive daytime sleepiness was 31.3%. Most of the women reported having nocturia, since 32.4% reported one nocturnal voiding, and 24.3% two or more nocturnal voidings. Higher nocturnal voiding frequency was identified in women who spent longer in bed (P = 0.028) and had worse quality of sleep (P < 0.001), higher daytime sleepiness (P = 0.016) and excess body weight (P < 0.001). A higher prevalence of daytime sleepiness was also observed in those women assumed to have urine leakage (P = 0.006). Women with two or more nocturnal voidings presented 1.58 (CI: 1.06–2.37) higher prevalence of daytime sleepiness independent of time in bed (P = 0.030).ConclusionWomen with at least two nocturnal voidings presented higher prevalence of daytime sleepiness, worse sleep quality, and longer time in bed. Moreover, women with daytime sleepiness presented higher frequency of urine leakage.     

Sleep disordered breathing in patients with primary Sjögren's syndrome: A group controlled study

ObjectivePatients with primary Sjögren’s syndrome (pSS) have higher fatigue levels and also suffer from excessive day time sleepiness. The underlying mechanisms for this are not fully understood. Knowing that these patients have higher salivary surface tension, we postulated that sleep disordered breathing (SDB) would be more common and would be a contributor to these symptoms amongst pSS patients. We investigated the prevalence of SDB in pSS patients and its relationship to their symptoms of fatigue and excessive daytime sleepiness.MethodsThis was an observational study of 28 pSS patients (mean ± SEM age, 58.7 ± 1.9) and 18 healthy subjects (mean ± SEM age, 55.8 ± 3.4) matched for age, sex, and BMI. All the participants underwent an overnight polysomnography. The two groups were compared for fatigue, sleepiness, anxiety, and depression scores, and for the frequency of obstructive apneas and hypopneas during sleep. Correlation analyses were used to explore relationships between sleep study variables and excess sleepiness and fatigue.ResultsFatigue, sleepiness, anxiety and depression symptoms, and sleep onset latency were significantly greater in pSS patients than controls. pSS patients had twice the frequency of obstructive apneas and hypopneas compared with control subjects (median[IQR],18.6/h [10.4–40.1] vs. 9.9/h [6.5–23.4]; p = 0.032) and OSA defined as an apnea–hypopnea index >15 events/h of sleep was more prevalent amongst pSS patients than controls (64% vs. 28%; p = 0.033). While no significant correlations were found between parameters of sleep disordered breathing and sleepiness scores or fatigue scores in the pSS group, CPAP treatment in a small subset of the pSS who were more severely affected by OSA suggested significant symptomatic benefit.ConclusionOSA appears to be increased in pSS and may be a useful therapeutic target to improve the quality of life of these patients.     

Effects of nasal continuous positive airway pressure on panic disorder comorbid with obstructive sleep apnea syndrome

BackgroundsBoth obstructive sleep apnea syndrome (OSAS) and panic disorder (PD) are common disorders that often coexist. Continuous positive airway pressure (CPAP) has been established as the first-line treatment for OSAS. In this study, we examined the efficacy of CPAP on PD comorbid with OSAS by conducting a randomized crossover study using sham CPAP as control.MethodsPD patients (n = 12) with an apnea hypopnea index (AHI) of 20/h or higher completed the study. At baseline, the subjects were asked to write their own records pertaining to the frequency of attacks and their score on the panic disorder severity scale (PDSS), and then they participated in the randomized crossover trial period, which measured optimal CPAP and sham CPAP set at 4 cmH₂O during nighttime sleep for each 4-week assignment.ResultsThe frequency of panic attacks, total PDSS score, and the frequency of alprazolam use for alleviating the attack symptoms were significantly decreased during the optimal CPAP period than during the baseline period and the sham CPAP period. Among the PDSS subitems, the frequency of attacks, panic distress, work impairment, and social impairment showed significant improvements during the optimal pressure period.ConclusionOur results suggest that OSAS contributes to PD aggravation, and a combination of pharmaceutical treatment for PD and OSAS-specific treatments such as CPAP could be recommended for patients with PD comorbid with OSAS.     

Daytime sleepiness and polysomnography in obstructive sleep apnea patients

BackgroundExcessive daytime sleepiness (EDS) is the major complaint in subjects with obstructive sleep apnea syndrome (OSAS). However, EDS is not universally present in all patients with OSAS. The mechanisms explaining why some patients with OSAS complain of EDS whereas others do not are unknown.ObjectiveTo investigate polysomnographic determinants of excessive daytime sleepiness (EDS) in a large multicenter cohort of patients with obstructive sleep apnea (OSAS).MethodsAll consecutive patients with an apnea–hypopnea index greater than 5 h⁻¹ who were evaluated between 2003 and 2005. EDS was assessed using the Epworth Sleepiness Scale (ESS), and patients were considered to have EDS if the ESS was >10.ResultsA total of 1649 patients with EDS ((mean [±SD] Epworth 15 ± 3) and 1233 without EDS (Epworth 7 ± 3) were studied. Patients with EDS were slightly younger than patients without EDS (51 ± 12 vs 54 ± 13 years, p < 0.0001), had longer total sleep time (p < 0.007), shorter sleep latency (p < 0001), greater sleep efficiency (p < 0.0001) and less NREM sleep in stages 1 and 2 (p < 0.007) than those without EDS. Furthermore, patients with EDS had slightly higher AHI (p < 0.005) and arousal index (p < 0.001) and lower nadir oxygen saturation (p < 0.01).ConclusionsPatients with OSAS and EDS are characterized by longer sleep duration and increased slow wave sleep compared to those without EDS. Although patients with EDS showed a mild worsening of respiratory disturbance and sleep fragmentation, these results suggest that sleep apnea and sleep disruption are not the primary determinants of EDS in all of these patients.     

The nightly administration of sodium oxybate results in significant reduction in the nocturnal sleep disruption of patients with narcolepsy

BackgroundPrevious studies indicate that nightly sodium oxybate administration reduces nocturnal sleep disruption in narcolepsy. The present study provided an opportunity to further characterize these sleep-related effects in patients with narcolepsy during treatment with sodium oxybate as monotherapy or in combination with modafinil.MethodsThis double-blind, placebo-controlled study enrolled 278 patients with narcolepsy taking modafinil 200–600 mg daily for the treatment of excessive daytime sleepiness (EDS). Following a baseline polysomnogram (PSG) and Maintenance of Wakefulness Test (MWT), patients were randomized to receive treatment with: (1) placebo, (2) sodium oxybate, (3) modafinil, or (4) sodium oxybate + modafinil. PSGs and MWTs were repeated after 4 and 8 weeks. Other efficacy measures included Epworth Sleepiness Scale scores and daily diary recordings.ResultsAfter 8 weeks, significant changes in sleep architecture among patients receiving sodium oxybate and sodium oxybate/modafinil included a median increase in Stage 3 and 4 sleep (43.5 and 24.25 min, respectively) and delta power and a median decrease in nocturnal awakenings (6.0 and 9.5, respectively). No significant changes in PSG parameters were noted in patients treated with placebo or modafinil alone.ConclusionsIn addition to its established efficacy for the treatment of cataplexy and EDS, nightly sodium oxybate administration significantly reduces measures of sleep disruption and significantly increases slow-wave sleep in patients with narcolepsy.     

Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study

BackgroundMandibular advancement appliances (MAA) are a recognized alternative treatment to continuous positive airway pressure (CPAP) for mild-moderate obstructive sleep apnea syndrome (OSAS). The aim of this study is to assess the efficacy of and subject satisfaction with two MAA in the management of OSAS.MethodsFive women and 11 men (47.9 ± 1.6 years), previously untreated with CPAP, were recruited from a sleep disorders clinic following a polysomnographic diagnosis of mild-moderate OSAS with Respiratory Disturbance Index (RDI) of 9.4 ± 1.1. A randomized single blind cross-over study was completed with both Klearway and Silencer (three months for each study arm). Subjects completed standardized questionnaires on sleep quality, sleepiness and functional outcomes (Functional Outcome Sleep Questionnaire: FOSQ). MAA satisfaction (e.g., comfort) and efficacy (e.g., reduction of respiratory noises, headache) were assessed by subjects and sleep partner.ResultsThe two MAA (Silencer 4.7 ± 0.9 and Klearway 6.5 ± 1.3) significantly reduced the RDI compared to the baseline night (10.0 ± 1.2, respectively p < 0.001 and p < 0.01). The RDI was slightly lower with the Silencer (p ? 0.05) but subjects’ preference for comfort was in favor of the Klearway (Klearway 7.0 ± 0.4 vs Silencer 5.8 ± 0.4, p = 0.04). The Epworth score, FOSQ, respiratory noise and morning headache were also improved following use of both appliances (p ? 0.05 to 0.001).ConclusionAlthough both MAA decreased RDI and subjective daytime sleepiness in a similar manner, the choice between various types of MAA needs to be taken into account when considering the benefit of RDI reduction over the benefit of subject compliance. The long term benefit of increased RDI reduction vs. a better subject compliance needs to be assessed in prospective studies.     

Snoring men with daytime sleepiness drive more than others: A population-based study

ObjectiveTo investigate whether subjects with daytime sleepiness who snore or report witnessed sleep apneas drive more than others.MethodsQuestions on snoring, witnessed sleep apnea, excessive daytime sleepiness and driving distance per year were included in the Northern Sweden component of the WHO, MONICA study. Invited were 10756 subjects aged 25–79 years, randomly selected from the population register.ResultsThere were 7905 (73%) subjects, 3858 men and 4047 women who responded to the questionnaire and attended a visit for a physical examination. Habitually snoring men with daytime sleepiness drove a mean of 22566 (95% CI 18550–26582) km a year, which was significantly more than non-snoring men without excessive daytime sleepiness who drove 17751 (95% CI 17076–18427) km a year, p = 0.02, after adjustments for age, body mass index, smoking and physical activity. Men reporting witnessed sleep apnea and excessive daytime sleepiness also drove more than their counterparts in adjusted analysis, p = 0.01. Women reporting daytime sleepiness and witnessed apnea tended to drive more, while snoring women with daytime sleepiness did not.ConclusionsMen suffering from excessive daytime sleepiness who snore habitually or report witnessed sleep apneas drive significantly more than others.     

Nocturnal pulse wave attenuation is associated with office blood pressure in a population based cohort

Objective and BackgroundPulse wave amplitude (PWA) derived from the digital vascular bed has been used in sleep studies. The nocturnal attenuation of PWA has been shown to reflect sympathetic activation during sleep. We assessed the relationship between nocturnal PWA attenuation and office blood pressure (BP).MethodsEighty-one subjects (46 men; age 60 ± 7 years; body mass index [BMI] 28.2 ± 4.3 kg/m²; apnea hypopnea index [AHI], 25.4 ± 22.6 events/h; systolic BP 137 ± 15 mmHg; diastolic BP 79 ± 7 mmHg) recruited from a population based cohort underwent simultaneous ambulatory polysomnography (PSG) and peripheral arterial tonometry (PAT) recording. Episodic attenuations of PWA derived from the pulse waveform of the PAT signal were identified and characterized. Generalized least squares regression models were used to identify the associations between median PWA attenuation (PWA.att), office BP and sleep-related disordered breathing.ResultsWe found that the association between PWA.att and office BP was independent of gender, age, BMI, antihypertensive medication, number of attenuation episodes, AHI, oxygen desaturation ?4% index (ODI4) and arousal index. Each 10% increase in PWA.att was associated with increases of 5.0 mmHg systolic BP (P = 0.02) and 3.0 mmHg diastolic BP (P = 0.005). We also found independent relationships between systolic/diastolic BP and BMI (P = 0.0006/0.001), AHI (P = 0.03/0.1) and ODI4 (P = 0.03/0.03).ConclusionsThe degree of PWA attenuation during the night is associated with office BP independent of sleep-disordered breathing. Continuous assessment of PWA during sleep may provide novel insights into cardiovascular physiology and morbidity.     

Sleep and impulsivity in Parkinson's disease

BackgroundImpulsive behavior and poor sleep are important non-motor features of Parkinson's disease (PD) that negatively impact the quality of life of patients and their families. Previous research suggests a higher level of sleep complaints in PD patients who demonstrate impulsive behaviors, but the nature of the sleep disturbances has yet to be comprehensively tested.MethodsConsecutive idiopathic PD patients (N = 143) completed the Minnesota Impulse Disorder Interview and a sleep questionnaire that assessed sleep efficiency, excessive daytime sleepiness, restless legs symptoms, snoring, dreams/nightmares, and nocturia. Patients were also given a Unified Parkinson's Disease Rating Scale motor examination and they completed cognitive testing.ResultsImpulsive PD patients endorsed more sleep complaints than non-impulsive PD patients. The group difference was primarily attributable to poor sleep efficiency (e.g., greater nocturnal awakenings), p < .01, and greater daytime sleepiness, p < .01, in the impulsive PD patients. Interestingly, restless legs symptoms were also greater in the impulsive PD patients, p < .05. The results could not be explained by medications or disease severity.ConclusionsPoor sleep efficiency, restless legs symptoms, and increased daytime sleepiness are associated with impulsivity in PD. Longitudinal studies are needed to determine whether sleep disturbances precede impulsivity in PD.     

Increased frequency of restless legs syndrome in chronic obstructive pulmonary disease patients

Background: Despite complaints of poor sleep being very common in people with chronic obstructive pulmonary disease (COPD), restless legs syndrome (RLS) symptoms have not been extensively investigated in these patients.Objective: To assess the prevalence and severity of RLS in patients with COPD and to investigate the factors potentially associated with RLS.Methods: A total of 87 patients with COPD and 110 controls, matched for age and sex, were evaluated regarding the presence and severity of RLS symptoms. A diagnosis of RLS was made according to the criteria of the International RLS Study Group (IRSLSSG), and severity was assessed by the IRLSSG severity scale. Excessive daytime somnolence was assessed using the Epworth sleepiness scale (ESS).Results: RLS was significantly more frequent in COPD patients than in controls (36.8% vs. 11%; p < 0.001). Compared to controls, COPD patients with RLS showed higher disease severity (mean IRLSSG severity scale score: 20.5 ± 2.8 for COPD, and 18 ± 3.5 for controls; p = 0.016) and more pronounced daytime somnolence (mean ESS score: 11.8 ± 1.1 for COPD, and 8.6 ± 3.6 for controls; p = 0.009). Moreover, compared to those without RLS, COPD patients with RLS showed increased daytime sleepiness (mean ESS score: 11.8 ± 1.1 for COPD/RLS, and 7.3 ± 4 for COPD/non-RLS; p < 0.001) and longer disease duration (11.9 ± 7 years for COPD/RLS, and 8.7 ± 6.9 years for COPD/non-RLS; p = 0.045). Multivariate analysis showed that ESS score was the only factor significantly associated with RLS in COPD patients.Conclusions: RLS is a frequent cause of disabling sleep disturbance in patients with COPD and should be specifically investigated in these patients.     

Disturbed dreaming during the third trimester of pregnancy

ObjectiveThe majority of women develop sleep impairments during pregnancy, but alterations in dream experiences remain poorly understood. This study aimed to assess prospectively and comparatively the recall of dreaming and of disturbed dreaming in late pregnancy.MethodsFifty-seven nulliparous, third-trimester pregnant women (mean age ± SD, 28.7 ± 4.06 years) and 59 non-pregnant controls (mean age ± SD, 26.8 ± 4.21 years) completed demographics and psychological questionnaires. A 14-day prospective home log assessed sleep and dream characteristics and the Sleep Disorders Questionnaire measured retrospective dream and disturbed dream recall.ResultsEven though pregnant and non-pregnant women showed similar prospective dream recall (P = 0.47), pregnant women reported prospectively more bad dreams (P = 0.004). More pregnant women (21%) than non-pregnant women (7%) reported a nightmare incidence exceeding moderately severe pathology (>1/week) (P = 0.03). Pregnant women also reported overall lower sleep quality (P = 0.007) and more night awakenings (P = 0.003). Higher prospective recall of bad dreams (r = −0.40, P = 0.002) and nightmares (r = −0.32, P = 0.001) both correlated with lower sleep quality in pregnant women.ConclusionsLate pregnancy is a period of markedly increased dysphoric dream imagery that may be a major contributor to impaired sleep at this time. Further polysomnographic assessments of pregnant women are needed to clarify relationships between sleep and disturbed dream production in this population.     

Decreased chemosensitivity and improvement of sleep apnea by nocturnal hemodialysis

Background:Sleep apnea occurs in up to 50% of patients with end-stage renal disease and is improved by nocturnal hemodialysis. We hypothesized that its pathogenesis is related to changes in chemoreflex responsiveness.Methods:Twenty-four patients receiving conventional hemodialysis (4 h/day, 3 times/week) had overnight polysomnography and measurement of the ventilatory response to carbon dioxide during isoxic hypoxia and hyperoxia using a modified rebreathing technique. Measurements were repeated following conversion from conventional to nocturnal hemodialysis (8 h/night, 3–6 nights/week). Patients were divided into apneic and non-apneic groups based on apnea–hypopnea index ?15/h at baseline (17 apneics and 7 non-apneics), and the apneic group was further divided into “responders” and “non-responders” based on a significant reduction in AHI at follow-up.Results:Conversion from conventional to nocturnal hemodialysis was associated with a decrease in the ventilatory sensitivity to hypercapnia during hyperoxia in responders (3.2 ± 1.0 vs. 2.3 ± 1.3 L/min/mmHg) but not in non-responders (2.8 ± 1.3 vs. 2.9 ± 1.6 L/min/mmHg). The change in ventilatory sensitivity was correlated with the change in apnea–hypopnea index in all apneic patients (r = .528, p = 0.029).Conclusions:Improvement of sleep apnea following conversion from conventional to nocturnal hemodialysis is associated with a decrease in chemoreflex responsiveness. This finding suggests that increased chemoreflex responsiveness contributes to the pathogenesis of sleep apnea in some patients with end-stage renal disease.