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Sleep Medicine Nov 2020It is hypothesized that vitamin D deficiency, and calcium/phosphate imbalance could be involved in the pathophysiology of restless leg syndrome (RLS). This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is hypothesized that vitamin D deficiency, and calcium/phosphate imbalance could be involved in the pathophysiology of restless leg syndrome (RLS). This systematic review and meta-analysis of observational studies were carried out to reach a firm conclusion regarding the possible association between vitamin D, calcium and phosphorous levels with RLS in end-stage renal disease (ESRD) patients, other comorbidities and healthy population.
METHODS
PubMed, Scopus, ISI Web of Science, and Cochrane's library were systematically searched up to June 2020. Quality assessment of the included observational studies was performed using Newcastle-Ottawa Quality Assessment Scale. Statistical analyses were done using STATA 11.2. A P-value <0.05 were considered statistically significant.
RESULTS
A total of 36 studies involving 9590 participants were included in this systematic review and meta-analysis. We found that serum vitamin D level is significantly lower (WMD -3.39 ng/mL; 95% CI, -5.96 to -0.81; P = 0.010; I = 86.2%) and phosphorous (SMD 0.19; 95% CI, 0.04-0.34; P = 0.011; I = 83.6%) is significantly higher in RLS individuals compared to the non-RLS individuals. However, the mean difference of serum calcium was not significant in comparison between RLS and control groups (SMD -0.01; 95% CI, -0.19 to 0.18; P = 0.957; I = 89.2%).
CONCLUSION
Results revealed a significant association between serum vitamin D and phosphorous with RLS. However, further prospective cohort studies and clinical trials are needed for better understanding of the relationship between these variables.
Topics: Calcium; Humans; Observational Studies as Topic; Prospective Studies; Restless Legs Syndrome; Vitamin D; Vitamin D Deficiency
PubMed: 32950014
DOI: 10.1016/j.sleep.2020.08.022 -
Sleep Medicine Reviews Aug 2017Restless legs syndrome (RLS) is a relatively common neurological disorder in childhood, although it is usually overlooked due to the atypical presentation in children... (Review)
Review
Restless legs syndrome (RLS) is a relatively common neurological disorder in childhood, although it is usually overlooked due to the atypical presentation in children and associated comorbid conditions that may affect its clinical presentation. Here, we aimed to perform, for the first time, a systematic review of studies reporting the association between RLS in children and adolescents (<18 y) and somatic or neuropsychiatric conditions. We searched for peer-reviewed studies in PubMed, Ovid (including PsycINFO, Ovid MEDLINE, and Embase), Web of Knowledge (Web of Science, Biological abstracts, BIOSIS, FSTA) through November 2015, with no language restrictions. We found 42 pertinent studies. Based on the retrieved studies, we discuss the association between RLS and a number of conditions, including growing pains, kidney disease, migraine, diabetes, epilepsy, rheumatologic disorders, cardiovascular disease, liver and gastrointestinal disorders, and neuropsychiatric disorders (e.g., attention deficit hyperactivity disorder (ADHD), depression, and conduct disorder). Our systematic review provides empirical evidence supporting the notion that RLS in children is comorbid with a number of somatic and neuropsychiatric conditions. We posit that the awareness on comorbid diseases/disorders is pivotal to improve the diagnosis and management of RLS and might suggest fruitful avenues to elucidate the pathophysiology of RLS in children.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Comorbidity; Early Diagnosis; Humans; Nocturnal Myoclonus Syndrome; Polysomnography; Restless Legs Syndrome
PubMed: 27519964
DOI: 10.1016/j.smrv.2016.06.008 -
The Journal of Evidence-based Dental... Mar 2022To evaluate the levels of salivary cortisol in adults and children diagnosed with bruxism. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the levels of salivary cortisol in adults and children diagnosed with bruxism.
METHODS
A search strategy was developed using the following terms: "cortisol", "bruxism" and "sleep bruxism". These were searched in databases: Medline, Embase, Scopus, Cochrane, Web of Science, LILACS and gray literature, for studies published until May 2020.
RESULTS
We obtained a total of six primary studies, involving 854 participants, who met the criteria and were included in the present study. The analysis cortisol levels shows a significant difference favourable to the control group 1.10 (95% CI: 0.68-1.53), showing that patients with bruxism have higher values of salivary cortisol. Heterogeneity of I² = 4% (P = .31).
CONCLUSIONS
It was concluded that despite the different methodologies adopted for the collection and analysis of salivary content, this review found significant results of higher levels of salivary cortisol in adult patients with bruxism.
Topics: Adult; Child; Humans; Hydrocortisone; Sleep Bruxism
PubMed: 35219468
DOI: 10.1016/j.jebdp.2021.101634 -
Journal of Oral Rehabilitation May 2019The purpose of this systematic review was to evaluate the association between sleep bruxism (SB) and anxiety symptoms in adults.
BACKGROUND
The purpose of this systematic review was to evaluate the association between sleep bruxism (SB) and anxiety symptoms in adults.
METHODS
A systematic review was performed and studies assessing SB by means of questionnaires, clinical examination and/or polysomnography (PSG), and validated questionnaires to assess anxiety, were included. Search strategies were developed for seven main electronic databases. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and confidence in cumulative evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation criteria.
RESULTS
Eight cross-sectional studies were included, of which five were judged with low and three with moderate risk of bias. No association with SB was observed in three studies that investigated generic levels of anxiety, while other two papers that evaluated generic anxiety levels through the State-Trait Anxiety Inventory (STAI) found a positive association with probable and definite SB in both STAI-1 and STAI-2 subscales. Only one study evaluated dental anxiety in particular and an association with probable SB was observed regarding very anxious or extremely anxious scores. Two studies assessed specific symptoms of anxiety using the panic-agoraphobic spectra evaluation (PAS-SR) questionnaire. Significantly higher PAS-SR total scores were observed in both studies with regard to SB. No study with definitive assessment of SB was identified.
CONCLUSION
Current literature is controversial regarding an association between SB and generic symptoms of anxiety in adults. It seems that some specific symptoms of the anxiety disorders spectrum might be associated with probable SB.
Topics: Anxiety; Cross-Sectional Studies; Humans; Polysomnography; Risk Factors; Sleep Bruxism; Surveys and Questionnaires
PubMed: 30805947
DOI: 10.1111/joor.12785 -
Journal of Oral & Facial Pain and...To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?
AIMS
To answer the question: among observational studies, is there any association between primary headaches and bruxism in adults?
MATERIALS AND METHODS
A systematic review of observational studies was performed. The search was performed in seven main databases and three gray literature databases. Studies in which samples were composed of adult patients were included. Primary headaches were required to be diagnosed by the International Classification of Headache Disorders. Any diagnostic method for bruxism was accepted. Risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tool and the Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI) tool. Associations were analyzed by calculating odds ratios (OR) in Review Manager 5.3 software. The evidence certainty was screened by Grading of Recommendations Assessment, Development, and Evaluation criteria.
RESULTS
Of the 544 articles reviewed, 5 met the inclusion criteria for qualitative analysis. The included studies evaluated both awake and sleep bruxism, as well as tension-type headaches and migraines as primary headaches. Among two migraine studies, one showed an OR of 1.79 (95% CI: 0.96 to 3.33) and another 1.97 (95% CI: 1.5 to 2.55). On the other hand, among three tension-type headache studies, there was a positive association only with awake bruxism, with an OR of 5.23 (95% CI: 2.57 to 10.65). All included articles had a positive answer for more than 60% of the risk of bias questions. The evidence certainty varied between low and very low. Due to high heterogeneity among the studies, it was impossible to perform a meta-analysis.
CONCLUSION
Patients with awake bruxism have from 5 to 17 times more chance of having tension-type headaches. Sleep bruxism did not have any association with tension-type headache, and the association with migraines is controversial.
Topics: Adult; Bruxism; Headache; Humans; Migraine Disorders; Observational Studies as Topic; Odds Ratio; Sleep Bruxism; Tension-Type Headache
PubMed: 34129658
DOI: 10.11607/ofph.2745 -
Journal of Clinical Sleep Medicine :... Apr 2023Periodic limb movements during sleep (PLMS) are a frequent finding in restless legs syndrome, but their impact on sleep is still debated, as well the indication for... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVES
Periodic limb movements during sleep (PLMS) are a frequent finding in restless legs syndrome, but their impact on sleep is still debated, as well the indication for treatment. We systematically reviewed the available literature to describe which drug categories are effective in suppressing PLMS, assessing their efficacy through a meta-analysis, when this was possible.
METHODS
The review protocol was preregistered on PROSPERO (CRD42021175848), and the systematic search was conducted on and EMBASE (last searched on March 2020). We included original human studies, which assessed PLMS modification on drug treatment with a full-night polysomnography, through surface electrodes on each tibialis anterior muscle. When at least 4 studies were available on the same drug or drug category, we performed a random-effect model meta-analysis.
RESULTS
Dopamine agonists like pramipexole and ropinirole resulted the most effective, followed by l-dopa and other dopamine agonists. Alpha2delta ligands are moderately effective as well opioids, despite available data on these drugs are much more limited than those on dopaminergic agents. Valproate and carbamazepine did not show a significant effect on PLMS. Clonazepam showed contradictory results. Perampanel and dypiridamole showed promising but still insufficient data. The same applies to iron supplementation.
CONCLUSIONS
Dopaminergic agents are the most powerful suppressors of PLMS. However, most therapeutic trials in restless legs syndrome do not report objective polysomnographic findings, there is a lack of uniformity in presenting results on PLMS. Longitudinal polysomnographic interventional studies, using well-defined and unanimous scoring criteria and endpoints on PLMS are needed.
CITATION
Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. . 2023;19(4):811-822.
Topics: Humans; Restless Legs Syndrome; Dopamine Agonists; Nocturnal Myoclonus Syndrome; Movement; Dopamine Agents
PubMed: 36692194
DOI: 10.5664/jcsm.10440 -
Sleep Medicine Dec 2023Augmentation of restless legs syndrome (RLS) is an iatrogenic side effect induced by dopaminergic agents, and it is a major cause of therapeutic failure. Iron deficiency... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Augmentation of restless legs syndrome (RLS) is an iatrogenic side effect induced by dopaminergic agents, and it is a major cause of therapeutic failure. Iron deficiency is a risk factor for RLS, but its effects on the development of RLS augmentation are unclear. This meta-analysis aimed to elucidate the association between serum ferritin and RLS augmentation.
METHODS
We searched the PubMed, Cochrane Library, Embase, ClinicalKey, ScienceDirect, and ProQuest databases for studies comparing the serum ferritin levels of patients with augmented RLS and nonaugmented RLS. A meta-analysis based on a random-effects model was conducted. Levodopa equivalent dose (LED), International Restless Legs Study Group Severity Rating Scale (IRLS), and serum hemoglobin levels were also analyzed.
RESULTS
Six observational studies fulfilled the eligibility criteria of this meta-analysis. A total of 220 RLS patients with augmentation and 687 RLS patients without augmentation were included. The results revealed that augmented RLS was significantly associated with low serum ferritin levels (p = 0.002), high LEDs (p = 0.026), and nonsignificantly associated with high IRLS scores (p = 0.227).
CONCLUSIONS
A low serum ferritin level is associated with RLS augmentation. For patients with RLS who are iron deficient, iron supplements can not only relieve their fundamental RLS symptoms but also lower the risk of RLS augmentation. Moreover, non-dopminergic agents should be considered as the first-line treatment for patients with persistent low serum ferritin levels or those with moderate to severe RLS to prevent augmentation.
Topics: Humans; Restless Legs Syndrome; Dopamine Agents; Levodopa; Iron; Ferritins; Observational Studies as Topic
PubMed: 37879259
DOI: 10.1016/j.sleep.2023.10.022 -
Sleep Medicine Reviews Oct 2022This systematic review and meta-analysis aimed to investigate depression prevalence and depression-related symptoms among patients with isolated/idiopathic rapid eye... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis aimed to investigate depression prevalence and depression-related symptoms among patients with isolated/idiopathic rapid eye movement sleep behavior disorder (iRBD). We systematically searched online databases (PubMed and Scopus), performed meta-analyses of psychiatric symptoms prevalence using a random-effects model, and calculated 95% prediction intervals (PIs) and I values to evaluate the degree of heterogeneity. We conducted a meta-regression analysis to assess the relationship between psychiatric symptom severity, age at diagnosis, and disease duration from onset of iRBD. We analyzed 31 studies which included 3,576 patients (2,871 men, 80.3%; mean age, 66.6 ± 8.6 years). The pooled depression prevalence was 28.8% (95% CI 23.1-35.2, 95% PI 8.1-65.1, and I = 83.9%). We found a significantly negative correlation between depression-scale scores and disease duration in iRBD (p = 0.012, β = -0.36, R analog = 0.33). Pooled prevalence of apathy and anxiety was 38.4% (95% CI 27.7-50.4, 95% PI 0.02-99.9, and I = 57.8%) and 21.3% (95% CI 15.5-28.5, 95% PI 4.2-62.6, and I = 47.1%), respectively. Few articles on alexithymia were available for meta-analysis. This study confirmed high prevalence of depression, apathy, and anxiety in patients with iRBD.
Topics: Aged; Anxiety; Anxiety Disorders; Depression; Humans; Male; Middle Aged; Prevalence; REM Sleep Behavior Disorder
PubMed: 36150254
DOI: 10.1016/j.smrv.2022.101684 -
Journal of Sleep Research Jun 2023Rapid eye movement (REM) sleep behaviour disorder is a REM sleep parasomnia characterised by the loss of the physiological muscle atonia during REM sleep, resulting in... (Review)
Review
Rapid eye movement (REM) sleep behaviour disorder is a REM sleep parasomnia characterised by the loss of the physiological muscle atonia during REM sleep, resulting in dream enactment behaviours that may cause injuries to patients or their bed partners. The nocturnal motor episodes seem to respond to the dream contents, which are often vivid and violent. These behavioural and oneiric features make the REM sleep behaviour disorder a potential model to study dreams. This review aims to unify the literature about dream recall in REM sleep behaviour disorder as a privileged approach to study dreams, systematically reviewing studies that applied retrospective and prospective experimental designs to provide a comprehensive overview of qualitative and quantitative aspects of dream recall in this REM sleep parasomnia. The present work highlights that the study of dreaming in REM sleep behaviour disorder is useful to understand unique aspects of this pathology and to explore neurobiological, electrophysiological, and cognitive mechanisms of REM sleep and dreaming.
Topics: Humans; Dreams; REM Sleep Behavior Disorder; Retrospective Studies; Prospective Studies; Parasomnias
PubMed: 36316953
DOI: 10.1111/jsr.13768 -
Journal of Orthodontics Jun 2013The aim of the present work was to systematically review the literature and identify all peer-reviewed papers dealing with etiological and risk factors associated with... (Review)
Review
OBJECTIVE
The aim of the present work was to systematically review the literature and identify all peer-reviewed papers dealing with etiological and risk factors associated with bruxism.
DATA SOURCES
Data extraction was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for randomized clinical trials (RCT), controlled clinical trials (CCT) or cohort studies: Cochrane Library, Medline, and Embase from 1980 to 2011. Unpublished literature was searched electronically using ClinicalTrials.gov.
DATA SELECTION
The primary outcome was bruxism etiology. Studies should have a standardized method to assess bruxism.
DATA EXTRACTION
Screening of eligible studies, assessment of the methodological quality and data extraction were conducted independently and in duplicate. Two reviewers inspected the references using the same search strategy and then applied the same inclusion criteria to the selected studies. They used criteria for methodological quality that was previously described in the Cochrane Handbook. Among the 1247 related articles that were critically assessed, one randomized clinical trial, one controlled clinical trial and seven longitudinal studies were included in the critical appraisal. Of these studies, five were selected, but reported different outcomes.
DATA SYNTHESIS
There is convincing evidence that (sleep-related) bruxism can be induced by esophageal acidification and also that it has an important relationship with smoking in a dose-dependent manner. Disturbances in the central dopaminergic system are also implicated in the etiology of bruxism.
Topics: Bruxism; Cohort Studies; Controlled Clinical Trials as Topic; Databases, Bibliographic; Humans; Randomized Controlled Trials as Topic; Risk Factors; Sleep Bruxism
PubMed: 23794697
DOI: 10.1179/1465313312Y.0000000021