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Tidsskrift For Den Norske Laegeforening... Oct 2009Sleep disorders are common in the elderly, and may lead to substantially impaired quality of life. Many of these disorders are not diagnosed or treated. This article... (Review)
Review
BACKGROUND
Sleep disorders are common in the elderly, and may lead to substantially impaired quality of life. Many of these disorders are not diagnosed or treated. This article covers treatment options and characteristics of common sleep disorders in the elderly.
MATERIAL AND METHODS
The article is based on the authors' own research and clinical experience, and on articles identified through non-systematic searches in Pubmed.
RESULTS
Many somatic and psychological complaints are associated with sleep disorders; depression is the most common comorbid diagnosis.
INTERPRETATION
A thorough assessment of the patient's sleep pattern is crucial before treatment is instigated. Pharmacological intervention is the most common treatment, but serious side effects are common and there is a high risk of addiction. Effective non-pharmacological interventions are available, also for the elderly.
Topics: Aged; Disorders of Excessive Somnolence; Humans; Parasomnias; Quality of Life; Restless Legs Syndrome; Sleep; Sleep Apnea Syndromes; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Snoring
PubMed: 19823206
DOI: 10.4045/tidsskr.08.0403 -
Praxis 2022
Topics: Continuous Positive Airway Pressure; Humans; Polysomnography; Sleep Apnea, Central
PubMed: 35673838
DOI: 10.1024/1661-8157/a003856 -
Sleep Mar 2015To evaluate the frequency, determinants and sleep characteristics of lucid dreaming in narcolepsy.
OBJECTIVE
To evaluate the frequency, determinants and sleep characteristics of lucid dreaming in narcolepsy.
SETTINGS
University hospital sleep disorder unit.
DESIGN
Case-control study.
PARTICIPANTS
Consecutive patients with narcolepsy and healthy controls.
METHODS
Participants were interviewed regarding the frequency and determinants of lucid dreaming. Twelve narcolepsy patients and 5 controls who self-identified as frequent lucid dreamers underwent nighttime and daytime sleep monitoring after being given instructions regarding how to give an eye signal when lucid.
RESULTS
Compared to 53 healthy controls, the 53 narcolepsy patients reported more frequent dream recall, nightmares and recurrent dreams. Lucid dreaming was achieved by 77.4% of narcoleptic patients and 49.1% of controls (P < 0.05), with an average of 7.6±11 vs. 0.3±0.8 lucid dreams/ month (P < 0.0001). The frequency of cataplexy, hallucinations, sleep paralysis, dyssomnia, HLA positivity, and the severity of sleepiness were similar in narcolepsy with and without lucid dreaming. Seven of 12 narcoleptic (and 0 non-narcoleptic) lucid dreamers achieved lucid REM sleep across a total of 33 naps, including 14 episodes with eye signal. The delta power in the electrode average, in delta, theta, and alpha powers in C4, and coherences between frontal electrodes were lower in lucid than non-lucid REM sleep in spectral EEG analysis. The duration of REM sleep was longer, the REM sleep onset latency tended to be shorter, and the percentage of atonia tended to be higher in lucid vs. non-lucid REM sleep; the arousal index and REM density and amplitude were unchanged.
CONCLUSION
Narcolepsy is a novel, easy model for studying lucid dreaming.
Topics: Adolescent; Adult; Arousal; Case-Control Studies; Cataplexy; Dreams; Dyssomnias; Female; Hallucinations; Humans; Interviews as Topic; Male; Mental Recall; Narcolepsy; Self Report; Sleep Paralysis; Sleep Stages; Sleep, REM; Young Adult
PubMed: 25348131
DOI: 10.5665/sleep.4516 -
Sleep Medicine Reviews Aug 2011Based on 339 cases this review identifies, quantifies and compares 4 clinical forms of recurrent hypersomnia (1) Kleine-Levin syndrome (KLS) (239 cases), (2)... (Review)
Review
Based on 339 cases this review identifies, quantifies and compares 4 clinical forms of recurrent hypersomnia (1) Kleine-Levin syndrome (KLS) (239 cases), (2) Kleine-Levin syndrome without compulsive eating (KLS WOCE) (54 cases), (3) Menstrual related hypersomnia (MRH) (18 cases) and Recurrent hypersomnia with comorbidity (RHC) (28 cases). A second part of the review considers the main current issues on recurrent hypersomnia: the predisposing factors, including a window on family cases; the pathophysiology based on clinical patterns, neuroimaging data, neuropathological examinations and cerebrospinal fluid (CSF) hypocretin-1 measurements; the issues of recurrence and of a possible disruption of the circadian timing system; the relationships between recurrent hypersomnia and mood disorders; and a note on the atypical Kleine-Levin syndrome. The main outcomes of this study are a clear nosologic distinction of the different forms of recurrent hypersomnia, the finding that the prevalence of familial cases of KLS is in the same range as in narcolepsy, the suggestion of the possible involvement of a large set of cortical and subcortical structures in recurrent hypersomnia and some clues in favour of a relationship between recurrent hypersomnia and mood disorders.
Topics: Adolescent; Adult; Age of Onset; Child; Disorders of Excessive Somnolence; Female; Humans; Male; Time Factors; Young Adult
PubMed: 20970360
DOI: 10.1016/j.smrv.2010.08.001 -
Anesthesiology Mar 2023
Topics: Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 36473092
DOI: 10.1097/ALN.0000000000004433 -
Revista de Neurologia Jan 2009Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower... (Review)
Review
INTRODUCTION
Restless legs syndrome (RLS) is a movement disorder with a neurological origin that manifests in the form of sensory-motor symptoms which are located mainly in the lower limbs.
DEVELOPMENT
We review the epidemiological, pathophysiological, clinical and therapeutic characteristics of this disease, with special emphasis on the diagnostic criteria.
CONCLUSIONS
Diagnosis of RLS is mainly clinical and is based on the criteria established by the National Institutes of Health consensus development conference in 2002. There are specific criteria for special groups (the elderly with cognitive impairment and children) in which it is not possible to determine whether RLS exists or not using the usual diagnostic criteria.
Topics: Clinical Trials as Topic; Dopamine Agents; Humans; Restless Legs Syndrome
PubMed: 19222013
DOI: No ID Found -
Experimental Physiology Jan 2007The metabolic syndrome represents a clustering of several interrelated risk factors of metabolic origin that are thought to increase cardiovascular risk. It is still... (Review)
Review
The metabolic syndrome represents a clustering of several interrelated risk factors of metabolic origin that are thought to increase cardiovascular risk. It is still uncertain whether this clustering results from multiple underlying risk factors or whether it has a single cause. One metabolic abnormality that may underlie several clinical characteristics of the metabolic syndrome is insulin resistance. This review discusses the evidence that sleep disturbances (obstructive sleep apnoea, sleep deprivation and shift work) may independently lead to the development of both insulin resistance and individual clinical components of the metabolic syndrome. The converse may also be true, in that metabolic abnormalities associated with the metabolic syndrome and insulin resistance may potentially exacerbate sleep disorders. The notion that sleep disturbances exert detrimental metabolic effects may help explain the increasing prevalence of the metabolic syndrome and insulin resistance in the general population and may have important implications for population-based approaches to combat the increasing epidemic of metabolic and cardiovascular disease.
Topics: Animals; Dyslipidemias; Dyssomnias; Humans; Hypertension; Insulin Resistance; Metabolic Syndrome; Obesity; Risk Factors; Sleep; Sleep Apnea, Obstructive; Sleep Disorders, Circadian Rhythm; Time Factors
PubMed: 17085678
DOI: 10.1113/expphysiol.2006.033787 -
Journal of Clinical Sleep Medicine :... Jan 2022
Topics: Female; Humans; Polysomnography; Sleep Apnea, Obstructive
PubMed: 34648424
DOI: 10.5664/jcsm.9684 -
Journal of Sleep Research Dec 2023Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an... (Meta-Analysis)
Meta-Analysis Review
Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta-analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full-text records were independently reviewed by at least two authors. Forward- and backward-chain referencing, and hand-searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta-analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges' g = -0.89, 95% confidence interval [CI] -1.35, -0.43). Subgroup meta-analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges' g = -1.19, 95% CI -1.77, -0.61) and treated OSA (four studies, Hedges' g = -0.55, 95% CI -0.75, -0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Cognitive Behavioral Therapy; Sleep; Sleep Apnea, Obstructive; Comorbidity
PubMed: 36872072
DOI: 10.1111/jsr.13847 -
Neurology May 2022Narcolepsy and idiopathic hypersomnia usually begin in early adolescence, but diagnostic delays ranging from 5 to 10 years are common, affecting disease burden. To...
BACKGROUND AND OBJECTIVES
Narcolepsy and idiopathic hypersomnia usually begin in early adolescence, but diagnostic delays ranging from 5 to 10 years are common, affecting disease burden. To improve early identification of these treatable conditions, we developed and validated the Pediatric Hypersomnolence Survey (PHS).
METHODS
Content was developed through literature review, patient focus groups, interviews with experts in the field, and field testing. We then validated the 14-item self-reported survey across 3 hospitals and web recruitment from patient groups. In the validation phase, we recruited a total of 331 participants (patients with narcolepsy type 1 [n = 64], narcolepsy type 2 [n = 34], idiopathic hypersomnia [n = 36], and other sleep disorders [n = 97] and healthy controls [n = 100], ages 8-18 years) to complete the survey. We assessed a range of psychometric properties, including discriminant diagnostic validity for CNS disorders of hypersomnolence using receiver operating characteristic curve analysis and reliability across a 1-week period.
RESULTS
Confirmatory factor analysis indicated a 4-domain solution with good reliability expressed by satisfactory omega values. Across groups, the PHS total score showed appropriate positive correlations with other validated surveys of sleepiness ( = 0.65-0.78, < 0.001) and negative correlations with multiple sleep latency test measures (mean sleep latency: = -0.27, = 0.006; number of sleep-onset REM periods: = 0.26, = 0.007). Compared to controls and patients with other sleep disorders, the area under the curve for participants with narcolepsy or idiopathic hypersomnia was 0.87 (standard error 0.02, 95% CI 0.83-0.91) with high sensitivity (81.3, 95% CI 73.7%-87.5%) and specificity (81.2%, 95 CI 75.1%-86.4%). Test-retest reliability was = 0.87.
DISCUSSION
The PHS is a valid and reliable tool for clinicians to identify pediatric patients with narcolepsy and idiopathic hypersomnia. Implemented in clinical practice, the PHS will potentially decrease diagnostic delays and time to treatment, ultimately reducing disease burden for these debilitating conditions.
CLASSIFICATION OF EVIDENCE
This study provides Class III evidence that the PHS accurately identifies patients with central disorders of hypersomnolence.
Topics: Adolescent; Child; Disorders of Excessive Somnolence; Humans; Idiopathic Hypersomnia; Narcolepsy; Reproducibility of Results; Sleep Latency
PubMed: 35314496
DOI: 10.1212/WNL.0000000000200187