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Expert Review of Neurotherapeutics Apr 2011In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth... (Review)
Review
In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleep-disordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attention-deficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.
Topics: Attention Deficit Disorder with Hyperactivity; Child; Comorbidity; Female; Humans; Male; Nocturnal Myoclonus Syndrome; Restless Legs Syndrome; Sleep Apnea Syndromes; Sleep Wake Disorders
PubMed: 21469929
DOI: 10.1586/ern.11.7 -
Respirology (Carlton, Vic.) Jan 2017Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in... (Review)
Review
Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.
Topics: Continuous Positive Airway Pressure; Humans; Sleep Apnea, Central; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 27797160
DOI: 10.1111/resp.12927 -
Australian Journal of General Practice Sep 2023Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse... (Review)
Review
BACKGROUND
Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse daytime function, mental health and physical health than patients with either disorder alone. General practitioners may face unique challenges in the assessment and management of this prevalent and debilitating condition.
OBJECTIVE
This article aims to provide an overview of the prevalence, consequences, assessment and management of patients with comorbid insomnia and sleep apnoea in Australian general practice.
DISCUSSION
Patients with either insomnia or sleep apnoea should be assessed for both conditions. Treatments for both disorders should be offered to patients with both conditions. The recommended treatment for insomnia is cognitive behavioural therapy, whereas the recommended first-line treatment for moderate and severe obstructive sleep apnoea is lifestyle/weight management advice (where relevant) and continuous positive airway pressure therapy.
Topics: Humans; Australia; General Practitioners; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders
PubMed: 37666781
DOI: 10.31128/AJGP-12-22-6648 -
Fukushima Journal of Medical Science Aug 2017Sleep-disordered breathing (SDB) is frequently observed in patients with heart failure (HF), and complex pathologic conditions exist between both conditions. In this... (Review)
Review
Sleep-disordered breathing (SDB) is frequently observed in patients with heart failure (HF), and complex pathologic conditions exist between both conditions. In this review article, we describe the characteristics of SDB complicated with HF, the prognostic impact of SDB in HF patients, and the favorable effects of positive airway pressure in HF patients with SDB.
Topics: Heart Failure; Humans; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 28740027
DOI: 10.5387/fms.2017-13 -
Journal of Cardiology Aug 2012Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA,... (Review)
Review
Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from upper airway collapse, whereas CSA arises from reductions in central respiratory drive. In patients with OSA, blood pressure is frequently elevated as a result of sympathetic nervous system overactivation. The generation of exaggerated negative intrathoracic pressure during obstructive apneas further increases left ventricular (LV) afterload, reduces cardiac output, and may promote the progression of HF. Intermittent hypoxia and post-apneic reoxygenation cause vascular endothelial damage and possibly atherosclerosis and consequently coronary artery disease and ischemic cardiomyopathy. CSA is also characterized by apnea, hypoxia, and increased sympathetic nervous activity and, when present in HF, is associated with increased risk of death. In patients with HF, abolition of coexisting OSA by continuous positive airway pressure (CPAP) improves LV function and may contribute to the improvement of long-term outcomes. Although treatment options of CSA vary compared with OSA treatment, CPAP and other types of positive airway ventilation improve LV function and may be a promising adjunctive therapy for HF patients with CSA. Since HF remains one of the major causes of mortality in the industrialized countries, the significance of identifying and managing sleep apnea should be more emphasized to prevent the development or progression of HF.
Topics: Heart Failure; Humans; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 22824295
DOI: 10.1016/j.jjcc.2012.05.013 -
Acta Medica Portuguesa 2008Restless legs syndrome (RLS) is a chronic sensorimotor disorder, with a negative impact in the quality of life and sleep architecture. Despite its reported high... (Review)
Review
Restless legs syndrome (RLS) is a chronic sensorimotor disorder, with a negative impact in the quality of life and sleep architecture. Despite its reported high prevalence, remains under-recognized and under-treated. The diagnosis is based on the presence of four essential criteria, three supportive clinical features, and other three associated features. The primary or idiopathic RLS is the most common presentation form, but it is very important to exclude other RLS secondary forms and other differential diagnosis. The physiopathology of the idiopathic RLS remains unclear, however changes in the dopamine pathway have been proposed, and justifies the use of dopaminergic agents as first line treatment. Iron therapy, opioids, anti-epileptics (gabapentin) and benzodiazepines are others non-dopaminergic options of treatment in selected patients.
Topics: Algorithms; Humans; Restless Legs Syndrome
PubMed: 19094811
DOI: No ID Found -
The European Respiratory Journal Apr 2022Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining... (Review)
Review
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and ageing is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate ageing and ageing-related processes; ageing may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms ( excessive daytime sleepiness, and defects in memory and cognition), possible physiological consequences of OSA ( accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in ageing. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the aforementioned considerations make it essential to review the interaction of OSA and ageing, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
Topics: Aged; Disorders of Excessive Somnolence; Humans; Obesity; Quality of Life; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 34561285
DOI: 10.1183/13993003.01649-2021 -
Comparative Medicine Apr 2013Problems with sleep affect a large part of the general population, with more than half of all people in the United States reporting difficulties with sleep or... (Review)
Review
Problems with sleep affect a large part of the general population, with more than half of all people in the United States reporting difficulties with sleep or insufficient sleep at various times and about 40 million affected chronically. Sleep is a complex physiologic process that is influenced by many internal and environmental factors, and problems with sleep are often related to specific personal circumstances or are based on subjective reports from the affected person. Although human subjects are used widely in the study of sleep and sleep disorders, the study of animals has been invaluable in developing our understanding about the physiology of sleep and the underlying mechanisms of sleep disorders. Historically, the use of animals for the study of sleep disorders has arguably been most fruitful for the condition of narcolepsy, in which studies of dogs and mice revealed previously unsuspected mechanisms for this condition. The current overview considers animal models that have been used to study 4 of the most common human sleep disorders-insomnia, narcolepsy, restless legs syndrome, and sleep apnea-and summarizes considerations relevant to the use of animals for the study of sleep and sleep disorders. Animal-based research has been vital to the elucidation of mechanisms that underlie sleep, its regulation, and its disorders and undoubtedly will remain crucial for discovering and validating sleep mechanisms and testing interventions for sleep disorders.
Topics: Animals; Disease Models, Animal; Dogs; Female; Male; Mice; Narcolepsy; Rats; Restless Legs Syndrome; Sleep Apnea Syndromes; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders
PubMed: 23582416
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Sep 2009Restless legs syndrome is a common cause of sleep problems; the condition is often associated with periodic limb movement during sleep. The syndrome is probably... (Review)
Review
BACKGROUND
Restless legs syndrome is a common cause of sleep problems; the condition is often associated with periodic limb movement during sleep. The syndrome is probably under-diagnosed and under-treated.
MATERIAL AND METHODS
The article is based on literature identified through a search in PubMed, a review of international recommendations and our own clinical experience.
RESULTS
The restless leg syndrome is common, with a prevalence of about 10 %. Many of these patients are affected by sleep disturbances and have periodic limb movement during sleep (PLMS). Restless legs and the associated sleep disturbances can be effectively treated with dopaminagonists. Because of the augmentation risk, the lowest necessary dose should be maintained. PLMS also occurs in other sleep disorders. Periodic limb movement disorder (PLMD) is defined as PLMS combined with sleep disturbances and/or sleepiness during daytime without a known cause. The clinical relevance of PLMD for sleep disturbances is not clear.
INTERPRETATION
The restless legs syndrome is a common cause of sleep disturbance; good treatment options are available.
Topics: Humans; Nocturnal Myoclonus Syndrome; Polysomnography; Restless Legs Syndrome; Sleep
PubMed: 19844285
DOI: 10.4045/tidsskr.09.0042 -
Sleep Medicine Jul 2023Ulotaront (SEP-363856) is a novel agonist at trace amine-associated receptor 1 and serotonin 5-HT receptors in clinical development for the treatment of schizophrenia.... (Randomized Controlled Trial)
Randomized Controlled Trial
A multicenter, double-blind, placebo-controlled, randomized, Phase 1b crossover trial comparing two doses of ulotaront with placebo in the treatment of narcolepsy-cataplexy.
BACKGROUND
Ulotaront (SEP-363856) is a novel agonist at trace amine-associated receptor 1 and serotonin 5-HT receptors in clinical development for the treatment of schizophrenia. Previous studies demonstrated ulotaront suppresses rapid eye movement (REM) sleep in both rodents and healthy volunteers. We assessed acute and sustained treatments of ulotaront on REM sleep and symptoms of cataplexy and alertness in subjects with narcolepsy-cataplexy.
METHODS
In a multicenter, double-blind, placebo-controlled, randomized, 3-way crossover study, ulotaront was evaluated in 16 adults with narcolepsy-cataplexy. Two oral doses of ulotaront (25 mg and 50 mg) were administered daily for 2 weeks and compared with matching placebo (6-treatment sequence, 3-period, 3-treatment).
RESULTS
Acute treatment with both 25 mg and 50 mg of ulotaront reduced minutes spent in nighttime REM compared to placebo. A sustained 2-week administration of both doses of ulotaront reduced the mean number of short-onset REM periods (SOREMPs) during daytime multiple sleep latency test (MSLT) compared to placebo. Although cataplexy events decreased from the overall mean baseline during the 2-week treatment period, neither dose of ulotaront statistically separated from placebo (p = 0.76, 25 mg; p = 0.82, 50 mg), and no significant improvement in patient and clinician measures of sleepiness from baseline to end of the 2-week treatment period occurred in any treatment group.
CONCLUSIONS
Acute and sustained treatment with ulotaront reduced nighttime REM duration and daytime SOREMPs, respectively. The effect of ulotaront on suppression of REM did not demonstrate a statistical or clinically meaningful effect in narcolepsy-cataplexy.
REGISTRATION
ClinicalTrials.gov identifier: NCT05015673.
Topics: Humans; Cataplexy; Cross-Over Studies; Narcolepsy; Pyrans; Adult
PubMed: 37209427
DOI: 10.1016/j.sleep.2023.04.019