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Neurology Jun 2017To estimate the placebo and nocebo responses in restless legs syndrome (RLS) and explore their determinants. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To estimate the placebo and nocebo responses in restless legs syndrome (RLS) and explore their determinants.
METHODS
Databases were searched up to October 2015. Randomized, double-blind, placebo-controlled trials of patients with RLS were included if quantitative data were extractable in the placebo arm. Placebo response was defined as the within-group change from baseline, using any scale measuring RLS severity or disability. Nocebo response was defined as the proportion of patients experiencing adverse events in the placebo arm. Random-effects meta-analysis was used to pool data. Statistical heterogeneity was assessed with statistic. Several predetermined subgroup and sensitivity analysis were performed. PROSPERO registration number is CRD42015027992.
RESULTS
We included 85 randomized controlled trials (5,046 participants). Pooled placebo response effect size was -1.41 (95% confidence interval [CI] -1.56 to -1.25, 64 trials, = 88.1%), corresponding to -6.58 points in the International RLS Study Group Scale (IRLS). Pooled nocebo response was 45.36% (95% CI 40.47%-50.29%, 72 trials; = 89.8%). The placebo and nocebo responses were greater in trials with longer duration, evaluating pharmacologic interventions and idiopathic RLS, and in industry-funded and unpublished studies. The placebo response was considerably smaller in objective as compared to subjective outcomes. In addition, the nocebo response increases proportionally with the placebo response, and has the same predictors.
CONCLUSIONS
The magnitude of the placebo response in RLS is above the threshold of minimal clinical important difference, and the frequency of adverse events is also considerable. These results are relevant to inform the design and interpretation of future clinical trials.
Topics: Humans; Placebo Effect; Randomized Controlled Trials as Topic; Restless Legs Syndrome
PubMed: 28490647
DOI: 10.1212/WNL.0000000000004004 -
European Journal of Neurology Jul 2021The coexistence of peripheral neuropathy (PN) and restless legs syndrome (RLS) or Willis-Ekbom disease is relatively frequent, but its prevalence has shown a high... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
The coexistence of peripheral neuropathy (PN) and restless legs syndrome (RLS) or Willis-Ekbom disease is relatively frequent, but its prevalence has shown a high variability across studies. In addition, several reports have shown data suggesting the presence of PN in patients with idiopathic RLS.
METHODS
A search was undertaken using the PubMed, Embase and Web of Science Databases, from 1966 to 6 December 2020, crossing the search term 'restless legs syndrome' with 'neuropathy', 'polyneuropathy' (PNP) and 'peripheral neuropathy', and the references of interest for this topic were identified; a meta-analysis was performed, according to PRISMA guidelines, and a calculation of pooled prevalences, where appropriate, was made using standard methods.
RESULTS
Restless legs syndrome has been reported in 5.2%-53.7% of patients with PN (average 21.5%; 95% confidence interval 18.6%-24.5%), and PN has been reported in 0%-87.5% of patients with RLS (average 41.8%; 95% confidence interval 39.9%-43.6%), both being significantly more frequent than in controls. The heterogeneity across studies could be due to differences in the diagnostic criteria used for both RLS and PN. RLS is a frequent clinical complaint in patients with PN of different aetiologies, mainly diabetic PN, uraemic PNP, familial amyloid PNP, Charcot-Marie-Tooth disease and chronic dysimmune inflammatory PNP. Recent neurophysiological findings suggest the presence of small sensory fibre loss in patients diagnosed with idiopathic RLS, but it remains to be determined whether RLS associated with small sensory fibre loss and idiopathic RLS are different clinical entities.
CONCLUSIONS
Future studies including clinical and neurophysiological assessment and skin biopsy involving a large series of patients with PN and RLS are needed for a better understanding of the association between these two entities.
Topics: Amyloid Neuropathies, Familial; Charcot-Marie-Tooth Disease; Diabetic Neuropathies; Humans; Polyneuropathies; Restless Legs Syndrome
PubMed: 33772991
DOI: 10.1111/ene.14840 -
The Journal of Prosthetic Dentistry Mar 2018Ceramic restorations are popular because of their excellent optical properties. However, failures are still a major concern, and dentists are confronted with the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
Ceramic restorations are popular because of their excellent optical properties. However, failures are still a major concern, and dentists are confronted with the following question: is sleep bruxism (SB) associated with an increased frequency of ceramic restoration failures?
PURPOSE
The purpose of this systematic review and meta-analysis was to assess whether the presence of SB is associated with increased ceramic restoration failure.
MATERIAL AND METHODS
Observational studies and clinical trials that evaluated the short- and long-term survival rate of ceramic restorations in SB participants were selected. Sleep bruxism diagnostic criteria must have included at least 1 of the following: questionnaire, clinical evaluation, or polysomnography. Seven databases, in addition to 3 nonpeer-reviewed literature databases, were searched. The risk of bias was assessed by using the meta-analysis of statistics assessment and review instrument (MAStARI) checklist.
RESULTS
Eight studies were included for qualitative synthesis, but only 5 for the meta-analysis. Three studies were categorized as moderate risk and 5 as high risk of bias. Clinical and methodological heterogeneity across studies were considered high. Increased hazard ratio (HR=7.74; 95% confidence interval [CI]=2.50 to 23.95) and odds ratio (OR=2.52; 95% CI=1.24 to 5.12) were observed considering only anterior ceramic veneers. Nevertheless, limited data from the meta-analysis and from the restricted number of included studies suggested that differences in the overall odds of failure concerning SB and other types of ceramic restorations did not favor or disfavor any association (OR=1.10; 95% CI=0.43 to 2.8). The overall quality of evidence was considered very low according to the GRADE criteria.
CONCLUSIONS
Within the limitations of this systematic review, the overall result from the meta-analysis did not favor any association between SB and increased odds of failure for ceramic restorations.
Topics: Ceramics; Dental Restoration Failure; Humans; Sleep Bruxism
PubMed: 28967401
DOI: 10.1016/j.prosdent.2017.07.005 -
Nephrology, Dialysis, Transplantation :... Sep 2022Restless legs syndrome (RLS) is common among patients with end-stage kidney disease (ESKD) and is associated with poor outcomes. Several recently published studies had... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Restless legs syndrome (RLS) is common among patients with end-stage kidney disease (ESKD) and is associated with poor outcomes. Several recently published studies had focused on pharmacological and non-pharmacological treatments of RLS, but an updated meta-analysis has not been conducted.
METHODS
The study population was adult ESKD patients on dialysis with RLS. Randomized controlled trials (RCTs) were selected. The primary outcome was reduction in RLS severity. The secondary outcomes were improvement in sleep quality and treatment-related adverse events. Frequentist standard network meta-analysis (NMA) and additive component NMA were performed. The evidence certainty was assessed using the Confidence in NMA (CINeMA) framework.
RESULTS
A total of 24 RCTs with 1252 participants were enrolled and 14 interventions were compared. Cool dialysate produced the largest RLS severity score reduction {mean difference [MD] 16.82 [95% confidence interval (CI) 10.635-23.02]} and a high level of confidence. Other potential non-pharmacological interventions include intradialytic stretching exercise [MD 12.00 (95% CI 7.04-16.97)] and aromatherapy massage [MD 10.91 (95% CI 6.96-14.85)], but all with limited confidence of evidence. Among the pharmacological interventions, gabapentin was the most effective [MD 8.95 (95% CI 1.95-15.85)], which also improved sleep quality [standardized MD 2.00 (95% CI 0.47-3.53)]. No statically significant adverse events were detected.
CONCLUSIONS
The NMA supports that cool dialysate is appropriate to treat patients with ESKD and RLS. Gabapentin is the most effective pharmacological intervention and also might improve sleep quality. Further parallel RCTs with sufficient sample sizes are required to evaluate these potential interventions and long-term effects.
Topics: Adult; Dialysis Solutions; Gabapentin; Humans; Kidney Failure, Chronic; Network Meta-Analysis; Renal Dialysis; Restless Legs Syndrome
PubMed: 34612498
DOI: 10.1093/ndt/gfab290 -
Journal of Neurology Apr 2024Anti-IgLON5 disease is a rare but potentially reversible cause of cognitive impairment, sleep disturbances, dysautonomia, and movement disorders. It is an autoimmune... (Review)
Review
BACKGROUND
Anti-IgLON5 disease is a rare but potentially reversible cause of cognitive impairment, sleep disturbances, dysautonomia, and movement disorders. It is an autoimmune encephalitis which, due to its insidious onset, could mimic neurodegenerative disorders, and multiple symptoms overlap with those seen in dementia with Lewy bodies (DLB). We hypothesized that the symptomatology and findings in patients with anti-IgLON5 disease overlapped with that of DLB.
OBJECTIVES
To assess the commonality of features in anti-IgLON5 disease and DLB and identify potential red flags for anti-IgLON5 disease in patients undergoing diagnostic evaluation for DLB.
METHODS
We searched in MEDLINE, Web of Science, and Embase from inception on December the 8th, 2022 with the search term "IgLON5". We performed a systematic review of case reports and case series of anti-IgLON5 disease, and two reviewers independently extracted data on symptoms and findings. Frequencies of symptoms were compared with consensus criteria for DLB.
RESULTS
We included 57 studies with 127 individual case reports of anti-IgLON5 disease (mean age 63 years at diagnosis, median symptom duration 2 years). Cognitive dysfunction was reported in 45% of cases, REM-sleep behavioral disorder in 15%, and 14% had parkinsonism. Respiratory insufficiency was reported in 37%, and bulbar symptoms in 67%.
CONCLUSIONS
We found a significant overlap between anti-IgLON5 disease and DLB. We propose that anti-IgLON5 disease should be considered in young patients with DLB with chorea, gaze palsy, early dysphagia, or prominent respiratory symptoms. Our study contributes to the emerging knowledge on symptoms and biomarkers in anti-IgLON5 disease.
Topics: Humans; Middle Aged; Lewy Body Disease; Cognitive Dysfunction; Sleep Apnea, Obstructive; REM Sleep Behavior Disorder; Sleep Wake Disorders; Encephalitis; Hashimoto Disease
PubMed: 38195895
DOI: 10.1007/s00415-023-12145-8 -
Archives of Oral Biology Feb 2018This systematic review was performed to determine the risk factors related to bruxism in children. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review was performed to determine the risk factors related to bruxism in children.
DESIGN
This systematic review was conducted with reporting in agreement to the PRISMA statement and according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a systematic search of seven online databases, with the last search updated on 1st October 2016. The seven databases were Pubmed, Embase, Cochrane Library database, Web of Science, CNKI, CBM, and WF. The included trial type were RCT, cohort studies, and case-control studies, and bruxism symptoms were assessed by questionnaires and examinations. Eighteen out of the 5637 initially identified studies met the inclusion and exclusion criteria.
RESULTS
gender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache, biting, cheeks tonus, perioral musculature participation, conduct problems, peer problems, emotional symptoms, mental health problems, birth weight, occupation of family head, maternal marital status, hyperactivity, family income seemed to have statistical significance from the present systematic review and meta-analysis.
CONCLUSIONS
The risk factors related to bruxism were as follows: Male, gene, mixed position, moves a lot, anxiety, the nervous, psychological reactions, responsibility, secondhand smoke, snore loudly, restless sleep, sleep with light on, noise in room, "sleep hours, ≤8h", headache, objects biting, conduct problems, peer problems, emotional symptoms and mental health problems.
Topics: Child; Humans; Risk Factors; Sleep Bruxism
PubMed: 29149621
DOI: 10.1016/j.archoralbio.2017.11.004 -
Journal of Oral & Facial Pain and...To investigate the associations between temporomandibular disorders (TMDs) and sleep disorders in adult subjects.
AIMS
To investigate the associations between temporomandibular disorders (TMDs) and sleep disorders in adult subjects.
METHODS
The PubMed, Embase, Evidence-Based Medicine Reviews, and ProQuest Dissertations & Theses databases were searched for studies published in English up to September 2019. Unpublished/gray literature and reference lists of identified articles were also examined. Inclusion criteria were male and female adults, presence or absence of a TMD based on the RDC/TMD or DC/TMD criteria, presence or absence of a sleep disorder according to the International Classification of Sleep Disorders, and any of the following study designs: cross-sectional, case-control, or longitudinal. Methodologic quality assessment was conducted using the National Heart, Lung, and Blood Institute quality assessment tools.
RESULTS
Twenty-two studies (11 cross-sectional, 9 case-control, 1 prospective cohort, and 1 mixed design) met the inclusion criteria. TMDs were assessed independently in relation to sleep bruxism (SB), obstructive sleep apnea (OSA), and sleep quality (SQ). All studies but one assessed TMDs using the RDC/TMD criteria. The relation between the TMD and the different sleep disorders was conflicting for SB and positive for OSA and SQ. Five studies were of good quality, and 17 were of fair quality.
CONCLUSIONS
The evidence is inconclusive regarding the relationship between TMDs and SB and insufficient regarding the relationship with OSA. There is consistently fair evidence to support an association between TMD and SQ. This study highlights the need for higher-quality longitudinal studies to clarify the association between TMDs and sleep disorders.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Male; Prospective Studies; Sleep Bruxism; Sleep Wake Disorders; Temporomandibular Joint Disorders
PubMed: 33730126
DOI: 10.11607/ofph.2780 -
Systematic Reviews Feb 2014Identifying patients with increased risk of suicidal behaviors is a constant challenge and concern for clinicians caring for patients with psychiatric conditions. We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Identifying patients with increased risk of suicidal behaviors is a constant challenge and concern for clinicians caring for patients with psychiatric conditions. We conducted a systematic review to assess the association between suicidal behaviors and sleep disturbances in psychiatric patients.
METHODS
A systematic literature search of Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycInfo, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, and Scopus was conducted using earliest inclusive dates to 28 June 2013. Eligible studies were comparative observational studies that reported sleep disturbances in psychiatric patients and the outcome of interest (any type of suicidal behaviors). Pairs of reviewers extracted descriptive data, study quality, and outcomes. Odds ratios (OR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. Newcastle-Ottawa scale was used to critically appraise study quality.
RESULTS
Nineteen studies met the inclusion criteria. Compared to those without sleep disturbances, patients with psychiatric diagnoses and co-morbid sleep disturbances were significantly more likely to report suicidal behaviors (OR = 1.99, 95% CI 1.72, 2.30, P <0.001). The association was also demonstrated across several psychiatric conditions including depression (OR = 3.05, 95% CI 2.07, 4.48, P <0.001), post-traumatic stress disorder (PTSD) (OR = 2.56, 95% CI 1.91, 3.43, P <0.001), panic disorder (OR = 3.22, 95% CI 1.09, 9.45, P = 0.03), and schizophrenia (OR = 12.66, 95% CI 1.40, 114.44, P = 0.02). In subgroup analysis based on the type of sleep disorder, we also found suicidal behavior to be significantly associated with the presence of insomnia, parasomnias, and sleep-related breathing disorders, but not hypersomnias.
CONCLUSIONS
This systematic review and meta-analysis suggests that in patients with psychiatric diagnoses, sleep disturbances are associated with the increased risk of suicidal behaviors.
Topics: Humans; Mental Disorders; Risk Factors; Sleep Wake Disorders; Suicide
PubMed: 24568642
DOI: 10.1186/2046-4053-3-18 -
Journal of Oral & Facial Pain and...To evaluate the association between sleep bruxism (SB) and quality of life (QoL) in the general population.
AIMS
To evaluate the association between sleep bruxism (SB) and quality of life (QoL) in the general population.
METHODS
A systematic review was conducted, and studies were included with no restrictions regarding age, gender, or language. SB and general health-related QoL and/or oral health-related QoL (OHRQoL) measures in the included studies needed to be based on validated tools. The databases searched were Google Scholar, LILACS, OpenGrey, ProQuest, PubMed, Science Direct, Scopus, and Web of Science. Quality of evidence was evaluated using the Joanna Briggs Institute critical appraisal checklists and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.
RESULTS
Fourteen studies met the inclusion criteria. Ten studies were published in English, and four in Portuguese. All studies evaluating the association of SB with health-related QoL showed no statistical significance when overall scores were considered. The overall quality of evidence was considered very low due to high heterogeneity among the studies. SB seemed not to be associated with health-related QoL, but did have a negative impact on some characteristics of OHRQoL.
CONCLUSION
There is insufficient scientific evidence to support or disprove the association between SB and QoL/OHRQoL in the general population.
Topics: Humans; Oral Health; Quality of Life; Sleep Bruxism
PubMed: 33290440
DOI: 10.11607/ofph.2687 -
Sleep Medicine Reviews Aug 2018Pregnant women are more likely to be affected by restless legs syndrome (RLS) than the general population. Restless legs syndrome during pregnancy is associated with... (Meta-Analysis)
Meta-Analysis Review
Pregnant women are more likely to be affected by restless legs syndrome (RLS) than the general population. Restless legs syndrome during pregnancy is associated with adverse maternal and fetal outcomes. Currently unknown is the worldwide and regional prevalence of RLS in pregnant women. We performed a meta-analysis to provide a full profile of the prevalence of RLS during pregnancy. A systematic search of the PubMed, Medline, EMBASE, and Web of Science databases was performed to identify studies that were published up to April 2017, followed by random-effects meta-analyses. A total of 196 articles were identified, among which 27 longitudinal and cross-sectional observational studies with 51,717 pregnant subjects were included in the analysis. The pooled overall prevalence of RLS across all three trimesters was 21%. According to the regional classification of the World health organization, the prevalence of RLS during pregnancy in the European Region, Western Pacific Region, Eastern Mediterranean Region, and Region of the Americas was 22%, 14%, 30%, and 20%, respectively. The regional prevalence in the African Region and South-East Asia Region was not assessed because of insufficient data. We also analyzed the prevalence of RLS in the first, second, and third trimesters of pregnancy, and the rates of RLS were 8%, 16%, and 22%, respectively. We also found that the high prevalence of RLS decreased to 4% after delivery. No publication bias was found in these analyses. The findings emphasize the high occurrence of RLS during pregnancy. Future studies should examine the effects of RLS during pregnancy on maternal and fetal outcomes.
Topics: Female; Global Health; Humans; Pregnancy; Pregnancy Complications; Prevalence; Restless Legs Syndrome; Surveys and Questionnaires
PubMed: 29169861
DOI: 10.1016/j.smrv.2017.10.003