Sleep Disorders (sleep + disorders)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Chronic Headache and Potentially Modifiable Risk Factors: Screening and Behavioral Management of Sleep Disorders

HEADACHE, Issue 1 2008
Jeanetta C. Rains PhD
Sleep-related variables have been identified among risk factors for frequent and severe headache conditions. It has been postulated that migraine, chronic daily headache, and perhaps other forms of chronic headache are progressive disorders. Thus, sleep and other modifiable risk factors may be clinical targets for prevention of headache progression or chronification. The present paper is part of the special series of papers entitled "Chronification of Headache" describing the empirical evidence, future research directions, proposed mechanisms, and risk factors implicated in headache chronification as well as several papers addressing individual risk factors (ie, sleep disorders, medication overuse, psychiatric disorders, stress, obesity). Understanding the link between risk factors and headache may yield novel preventative and therapeutic approaches in the management of headache. The present paper in the special series reviews epidemiological research as a means of quantifying the relationship between chronic headache and sleep disorders (sleep-disordered breathing, insomnia, circadian rhythm disorders, parasomnias) discusses screening for early detection and treatment of more severe and prevalent sleep disorders, and discusses fundamental sleep regulation strategies aimed at headache prevention for at-risk individuals. [source]


Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009
Thomas E. Finucane MD
No abstract is available for this article. [source]


Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009
AGSF, Harrison G. Bloom MD
Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. [source]


Quality Indicators for the Care of Sleep Disorders in Vulnerable Elders

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2007
Jennifer L. Martin PhD
First page of article [source]


Effects of ,1-Blockers for Lower Urinary Tract Symptoms and Sleep Disorders in Patients with Benign Prostatic Hyperplasia

LUTS, Issue 2 2010
Takahiro SAKUMA
Objectives: We evaluated the association of lower urinary tract symptoms (LUTS) and sleep disorders (SD) in patients with benign prostatic hyperplasia (BPH). We also examined improvement of SD following the ,1-blocker therapy for LUTS. Methods: Sixty-eight male patients were enrolled in the study, consisting of 38 cases with LUTS and BPH (BPH group), and 30 men without significant LUTS or BPH (non-BPH group). The degree of LUTS and SD was evaluated by the International Prostate Symptom Score and the Pittsburg Sleep Quality Index (PSQI), respectively. The patients of BPH group then were treated with ,1-blocker for 4 weeks, and were re-examined by all the questionnaires to evaluate the therapeutic efficacies. Results: The correlation analyses showed a significant association of LUTS with SD in BPH group (r = 0.4995, P = 0.0068). Twenty cases (52.6%) in BPH group showed 5.5 or more PSQI scores. Following 4 weeks of ,1-blocker administration, the average PSQI decreased significantly from 6.3 to 4.8 points (P < 0.001). Significant improvement was observed in domains of "sleep quality" and "sleep disturbances" among PSQI (P = 0.0215 and 0.0391, respectively). Moreover, significant association between ,1-blocker induced improvements of nocturia and SD was identified in patients with 5.5 or more PSQI score at baseline (r = 0.445, P = 0.0334). Conclusion: These results suggested that SD is associated with LUTS among BPH patients and therapeutic effects of ,1-blockers on LUTS lead to improvements of SD. [source]


Sleep Disorders: their impact on public health

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2007
Article first published online: 2 AUG 200
No abstract is available for this article. [source]


Subjective daytime sleepiness and its predictors in Finnish adolescents in an interview study

ACTA PAEDIATRICA, Issue 5 2001
O Saarenpää-Heikkilä
The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow-up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi-square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm. Conclusion: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication. [source]


Sleep and Headache Disorders: Clinical Recommendations for Headache Management

HEADACHE, Issue 2006
Jeanetta C. Rains PhD
Clinical practice points were drawn from a review of sleep and headache disorders published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Sleep as well as psychiatric disorders tend to become prevalent in more complex and severe headache patterns and regulation of sleep and mood may favorably impact headache threshold; (2) Specific headache patterns, irrespective of headache diagnosis, are suggestive of a potential sleep disorder (eg, "awakening" or morning headache, chronic daily headache); (3) Sleep disorders most implicated with headache include obstructive sleep apnea, primary insomnia, and circadian phase abnormalities, and treatment of such sleep disorders may improve or resolve headache; (4) Inexpensive screening tools (eg, sleep history interview, headache/sleep diary, validated questionnaires, prediction equations) aid identification of patients warranting polysomnography; and (5) Pharmacologic and behavioral therapies are effective in the regulation of sleep and are compatible with usual headache care. [source]


Sleep in adolescence: a review of issues for nursing practice

JOURNAL OF CLINICAL NURSING, Issue 13 2009
Tamara Vallido
Aims and objectives., The aim of this review was to explore the literature to determine what is known about adolescent sleep, the causes and consequences of disturbed sleep in adolescence and the implications this has for nursing practice. Background., Sleep disorders are relatively common in young people. Disturbed sleep can be both a cause and a result of ill health and if recognised can indicate psychosocial, psychological or physical difficulties. Design., Literature review. Methods., Searching of key electronic databases. Results., Disturbed sleep in adolescents has several potential consequences, including daytime sleepiness, reduced academic performance and substance use/abuse. However, despite its significance and frequency, sleep disturbance is an area of adolescent health that is almost entirely unaddressed within the nursing literature. Conclusion., Nursing has a role to play in assisting adolescents and their families to recognise the importance of sleep to the general health and well-being of young people. Relevance to clinical practice., There is a need for nursing to develop tools to assess sleep in adolescent clients and non-pharmaceutical interventions to assist adolescents achieve optimum sleep and rest. Nurses may also contribute to educating adolescents and their families regarding the importance of good sleep hygiene. [source]


The quality of sleep in patients with coeliac disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2010
F. Zingone
Aliment Pharmacol Ther 2010; 32: 1031,1036 Summary Background, Coeliac disease is a chronic disease with a various clinical presentation, including anxiety and depression. Aim, To investigate the quality of sleep in coeliac disease. Methods, The participants were coeliacs at diagnosis; coeliacs on a gluten-free diet at follow-up and healthy volunteers. Participants completed the Pittsburgh Sleep Quality Index (PSQI), SF36, Zung and Fatigue scales and State-Trait Anxiety Inventory (STAI). Results, The PSQI score was higher in coeliacs at diagnosis and in a gluten-free diet than in healthy volunteers (P < 0.001). A gluten-free diet did not improve the PSQI score (P = 0.245) in coeliac disease. The other test scores were similar between coeliacs at diagnosis and those on a gluten-free diet, whereas significant differences were found between coeliacs and volunteers. PSQI score was inversely associated with the quality of the physical (r = ,0.327, P = 0.002) and mental (r = ,0.455, P < 0.001) component scores. The sleep quality scores were related to depression (r = 0.633, P < 0.001), fatigue (r = 0.377, P < 0.001), state anxiety (r = 0.484, P < 0.001) and trait anxiety (r = 0.467, P < 0.001). Conclusions, Sleep disorders are common in coeliac disease not only at diagnosis but also during treatment with a gluten-free diet. Sleep disorders are related to depression, anxiety and fatigue, and inversely related to quality of life scale scores. [source]


Beneficial effect of transcranial magnetic stimulation on sleep in Parkinson's disease,

MOVEMENT DISORDERS, Issue 6 2009
Karin D. van Dijk MD
Abstract Sleep disorders are common in Parkinson's disease (PD) and have profound negative influences on quality of life. Sleep structure in healthy participants can be changed by repetitive transcranial magnetic stimulation (rTMS), but this has never been studied systematically in PD. Therefore, we characterized sleep in PD patients and examined effects of rTMS using a combination of actigraphy and a pressure sensitive pad. Thirteen PD patients received 5 Hz rTMS over the motor or parietal cortex. Actigraphic sleep estimates were obtained before, during and after rTMS, as well as compared with 8 healthy, age-matched controls. Motor symptoms and mood were evaluated before and after rTMS. Mixed-model regression analyses indicated that PD patients slept shorter (350 ± 17 vs. 419 ± 24 min., P = 0.02), more fragmented (fragmentation index 41 ± 4 vs. 22 ± 2, P = 0.0004) and had a lower sleep efficiency (77 ± 2 vs. 86 ± 2%, P = 0.002) and longer nocturnal awakenings (3.4 ± 0.2 vs. 2.3 ± 0.2 min., P = 0.003) than healthy controls. rTMS over the parietal, but not over the motor cortex improved sleep fragmentation (P = 0.0002) and sleep efficiency (P = 0.0002) and reduced the average duration of nocturnal awakenings (P = 0.02). No change of motor symptoms or mood was observed. Disturbed sleep in PD patients may partly be reversed by parietal rTMS, without affecting motor symptoms or mood. © 2009 Movement Disorder Society [source]


Sleep disorders and gastrointestinal symptoms: chicken, egg or vicious cycle?

NEUROGASTROENTEROLOGY & MOTILITY, Issue 2 2009
M. Maneerattanaporn
No abstract is available for this article. [source]


Diagnostic pitfalls in children with sleep disorders: two cases with hypersomnia

ACTA PAEDIATRICA, Issue 12 2008
Kutluhan Yilmaz
Abstract Sleep disorders are common in children, yet several clinical pitfalls give rise to the unrecognition or improper management of those children. Here, we present diagnostic difficulties in two adolescents with narcolepsy and Kleine,Levin syndrome. The first patient was a 12-year-old girl who had been given Na-valproate for nearly a year because hypersomnia was initially perceived as unconsciousness periods of epileptic spells, and later attributed to the antiepileptic drug. The other patient was a 14-year-old boy who had been managed as a specific psychiatric disorder for several months despite the characteristic symptoms of Kleine,Levin syndrome (hypersomnia, hyperphagia, hypersexuality, behavioural and cognitive dysfunction). Both cases emphasize that sleep disorders could be manifested with various clinics and that there are several diagnostic challenges in children. Conclusion: Sleep medicine needs to be given larger role in both training curriculum and post-graduate education for paediatricians. [source]


A prospective 10-year study on children who had severe infantile colic

ACTA PAEDIATRICA, Issue 2005
Francesco Savino
Abstract Aim: To evaluate the association between infantile colic and gastrointestinal, allergic and psychological disorders in childhood. Methods: A prospective study was conducted on 103 infants aged 31,87 d. After 10 y, between 2001 and 2003, the children were recalled and a paediatrician evaluated the selected disorders by anamnesis, medical examination, laboratory tests and parent interviews. Results: Of the 103 infants enrolled, 96 completed the study. There was an association between infantile colic and recurrent abdominal pain (p=0.001) and allergic disorders: allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy (p<0.05). Sleep disorders, fussiness, aggressiveness and feelings of supremacy are more frequent in children who suffered from colic during early infancy (p<0.05). A family history of gastrointestinal diseases and atopic diseases was significantly higher in infants with colic than in controls (p<0.05). Conclusion: Susceptibility to recurrent abdominal pain, allergic and psychological disorders in childhood may be increased by infantile colic. Our findings confirm that severe infantile colic might be the early expression of some of the most common disorders in childhood. [source]


Subjective daytime sleepiness and its predictors in Finnish adolescents in an interview study

ACTA PAEDIATRICA, Issue 5 2001
O Saarenpää-Heikkilä
The purpose of this study is to evaluate the predictors of subjective daytime sleepiness (SDS) and its chronicity in adolescents. Two groups of adolescents (107 with SDS and 107 without SDS) from our first questionnaire study were invited to an interview after 3 y. A follow-up questionnaire had been sent to them one year earlier. The interview included questions about sleep, daytime sleepiness, living habits, physical and mental health, and progress at school. The adolescents were also examined clinically. Interviews were conducted with 66 out of 107 subjects with SDS and 64 out of 107 without SDS (age range 12 to 19 y). In this interview 42 out of the 130 adolescents had SDS. A total of 20 adolescents reported SDS in both questionnaire studies and in the interview (chronic SDS). In a multivariate analysis (logistic regression) sleep disorders, frequent medication and depressive emotions were significantly associated with SDS. Chronic SDS was connected in a bivariate analysis (Pearson's chi-square) with excessive night waking, difficulty in falling asleep, dreaming, frequent medication, frequent alcohol drinking, and irregular breakfast eating, and in our previous studies also with delayed sleep rhythm. Conclusion: Sleep disorders and health problems were more common causes of SDS than undesirable living habits. However, alcohol drinking and delayed sleep rhythm were associated with chronic SDS in addition to sleep disorders and medication. [source]


Prevalence of Sleep Disordered Breathing in a Heart Failure Program

CONGESTIVE HEART FAILURE, Issue 5 2004
Robin J. Trupp MSN
Recent data show that a high percentage of patients with systolic left ventricular dysfunction have sleep-disordered breathing (SDB), contributing to the incidence of morbidity and mortality in heart failure. This study examines the prevalence of sleep disorders in stable heart failure patients regardless of ejection fraction. On three consecutive days in a heart failure clinic, all patients were asked to participate in a screening for SDB. This screening involved the placement of an outpatient device (ClearPath, Nexan, Inc., Alpharetta, GA), which collects thoracic impedance, oxyhemoglobin saturation, and 2-lead electrocardiogram data. Sixteen patients (42%) had moderate or severe SDB, and 22 patients (55%) had mild or no significant SDB. Fourteen of the 16 patients with moderate or severe SDB subsequently received treatment by confirming SDB and the continuous positive airway pressure in a sleep lab. Forty-two percent of patients with stable heart failure presenting to a heart failure clinic screened positive for SDB, despite receiving optimal standard of care. [source]


Orexin receptor subtype activation and locomotor behaviour in the rat

ACTA PHYSIOLOGICA, Issue 3 2010
W. K. Samson
Abstract Aim:, Orexin-producing neurones, located primarily in the perifornical region of the lateral hypothalamus, project to a wide spectrum of brain sites where they influence numerous behaviours as well as modulating the neuroendocrine and autonomic responses to stress. While some of the actions of orexin appear to be mediated via the type 1 receptor, some are not, including its action on the release of one stress hormone, prolactin. We describe here the ability of orexin to increase locomotor behaviours and identify the importance of both receptor subtypes in these actions. Methods:, Rats were tested for their behavioural responses to the central activation of both the type 1 (OX1R) and type 2 (OX2R) receptor (ICV orexin A), compared to OX2R activation using a relatively selective OX2R agonist in the absence or presence of an orexin receptor antagonist that possesses highest affinity for OX1R. Results:, Increases in locomotor activity were observed, effects which were expressed by not only orexin A, which binds to both the OX1R and the OX2R receptors, but also by the relatively selective OX2R agonist [(Ala11, Leu15)-orexin B]. Furthermore, the OX1R selective antagonist only partially blocked the action of orexin A on most locomotor behaviours and did not block the actions of [(Ala11, Leu15)-orexin B]. Conclusion:, We conclude that orexin A exerts its effects on locomotor behaviour via both the OX1R and OX2R and that agonism or antagonism of only one of these receptors for therapeutic purposes (i.e. sleep disorders) would not provide selectivity in terms of associated behavioural side effects. [source]


Melatonin therapy for circadian rhythm sleep disorders in children with multiple disabilities: what have we learned in the last decade?

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2004
James E Jan MD FRCP(C)
First page of article [source]


Psychopathological changes and quality of life in hepatitis C virus-infected, opioid-dependent patients during maintenance therapy

ADDICTION, Issue 4 2009
Arne Schäfer
ABSTRACT Aims To examine among maintenance patients (methadone or buprenorphine) with and without hepatitis C virus (HCV) infection (i) the frequency of psychopathological symptoms at baseline and 1-year follow-up; (ii) the association between antiviral interferon (IFN) treatment and psychopathological symptoms; and (iii) to explore whether IFN therapy has an effect on 1-year outcome of maintenance treatment. Design Naturalistic prospective longitudinal cohort design. Setting A total of 223 substitution centres in Germany. Participants A nationally representative sample of 2414 maintenance patients, namely 800 without and 1614 with HCV infection, of whom 122 received IFN therapy. Measures HCV infection (HCV+/HCV - ), IFN (IFN+/IFN - ) treatment status and clinical measures. Diagnostic status and severity (rated by clinician), psychopathology (BSI,Brief Symptom Inventory) and quality of life (EQ-5D,EuroQol Group questionnaire). Findings HCV+ patients revealed indications for a moderately increased psychopathological burden and poorer quality of life at baseline and follow-up compared to HCV - patients. HCV+ patients showed a marked deterioration over time only in the BSI subscale somatization (P = 0.002), and the frequency of sleep disorders almost doubled over time (12.8% at baseline; 24.1% at follow-up; P < 0.01). IFN treatment, received by 10% of HCV+ patients, did not impair efficacy or tolerability of maintenance therapy and was associated overall with neither increased psychopathological burden nor reduced quality of life. Conclusions Findings suggest no increased risk among HCV+ patients on maintenance therapy for depressive or other psychopathological syndromes. In our patient sample, IFN treatment was not associated with increased psychopathological burden, reduced quality of life or poorer tolerability and efficacy of maintenance treatment. [source]


Paroxysmal Motor Disorders of Sleep: The Clinical Spectrum and Differentiation from Epilepsy

EPILEPSIA, Issue 11 2006
Christopher P. Derry
Summary:, The diagnosis of paroxysmal events in sleep represents a significant challenge for the clinician, with the distinction of nocturnal epilepsy from nonepileptic sleep disorders often the primary concern. Diagnostic error or uncertainty is not uncommon in this situation, particularly with respect to nocturnal frontal lobe epilepsy (NFLE), which has a variable and often unusual presentation. Such errors can be minimized if the range of nonepileptic disorders with motor activity in sleep is fully appreciated. Here we review these disorders, before discussing the important clinical and electrographic features that allow their accurate differentiation from seizures. Particular emphasis is placed on the differentiation of nocturnal frontal lobe epilepsy from non,rapid eye movement (NREM) arousal disorders and other parasomnias. The value of recording episodes with video EEG polysomnography is discussed. [source]


Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2003
O. Resta
Abstract Background, In the 1970s and 80s it was believed that obstructive sleep apnea (OSA) was primarily a disease of men. The present study was addressed to evaluate the effect of gender and menopause on the prevalence and the characteristics of OSA and on anthropometric, clinical, respiratory and polysomnographic data in a population of obese individuals. Patients and methods, A total of 230 obese subjects (BMI , 30 kg m,2), 148 women and 82 men, aged 16,75 years, were recruited and evaluated for general and anthropometric parameters, respiratory function, sleep-related symptoms and sleep disorders of breathing. Results, Respiratory disturbance index (RDI) and the prevalence of OSA were lower in women than in men (P < 0·001 and P < 0·001, respectively). Among subjects < 55 years, neck circumference, percentage of predicted normal neck circumference (PPNC), waist-to-hip ratio (WHR), PaCO2, RDI and the prevalence of OSA were lower in female subjects (P = 0·05, P < 0·05, P < 0·001, P < 0·01 and P < 0·01, respectively). BMI, neck circumference, PPNC, WHR, RDI and the prevalence of OSA were higher in postmenopausal compared with premenopausal women (P < 0·01, P < 0·01, P < 0·01, P < 0·01 and P < 0·01, respectively). Conclusions, Our study demonstrates that (i) the male dominance regarding the prevalence and the severity of OSA disappears in men older than 55 years, and (ii) menopause seems to play a pivotal role in modulating both the presence and the degree of sleep disorder. [source]


Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke)

EUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007
P. Jennum
A task force to develop guidelines for diagnostic evaluation and treatment of sleep disorders in degenerative neurologic disorders and stroke was initiated by the European Federation of Neurological Societies (EFNS). The aims were to provide evidence-based recommendations in the management of sleep disorders associated with degenerative neurologic disorders and stroke. Neurological patients often have significant sleep disorders like sleep-related breathing disorders (SBD), insomnia, sleep-related motor and rapid eye movement behavioral disorders affecting nocturnal sleep and daytime function. A polysomnography (PSG) is usually a diagnostic minimum for the diagnoses of the most commonly reported sleep disorders in patients with neurologic diseases. A full video-PSG/video-EEG-PSG should be considered in patients with nocturnal motor and/behavior manifestations. Respiratory polygraphy has a moderate sensitivity and specificity in the diagnosis of SBD without neurologic diseases, but its value in patients with neurologic diseases has not been evaluated. Oximetry has a poor sensitivity-specificity for the identification of SDB. Continuous and bi-level positive airway pressure devices are the most effective treatment of SDB in patients with neurologic diseases. There is a need for further studies focusing on the diagnostic procedures and treatment modalities in patients with sleep disorders and degenerative neurologic diseases and stroke. [source]


Measuring fatigue in patients with Parkinson's disease , the Fatigue Severity Scale

EUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2002
K. Herlofson
The objective was to compare the prevalence and severity of fatigue in patients with Parkinson's disease (PD) with that in two control groups, one consisting of randomly chosen control subjects of the same age and sex distribution and the other consisting of patients with coxarthrosis waiting to receive total hip replacement. We also explored the possible correlation of demographic and clinical data to the presence and severity of fatigue. Sixty-six patients with PD, 131 randomly chosen controls and 79 patients with coxarthrosis, waiting to receive total hip replacement, were evaluated for fatigue. Patients and controls with a depressive mood disorder or cognitive impairment had been excluded from the study. Fatigue was measured by the Fatigue Severity Scale (FSS). For the patients with PD the mean total FSS score was 4.1, compared with 2.7 amongst the randomly chosen control group and 2.9 in the group consisting of patients with coxarthrosis. Fifty per cent of the patients with PD had a mean total FSS score of 4 or higher, compared with 25% in both of the two control groups. There was no correlation between pain, presence of self-reported nocturnal sleep disorders or duration of PD and fatigue. The patients with fatigue did have a more advanced disease, measured both by Unified Parkinson's Disease Rating Scale score and Hoehn and Yahr stage. Although the univariate analyses indicated that more severe parkinsonism was correlated to the symptom, the multivariate analysis showed that none of the studied variables were significant explanatory factors for fatigue. Fatigue is a common symptom in patients with PD without depression or dementia. The study indicates that fatigue is an independent symptom of the disease without relation to other motor or non-motor symptoms. [source]


Sleep and the metabolic syndrome

EXPERIMENTAL PHYSIOLOGY, Issue 1 2007
Robert Wolk
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. [source]


Chronic Headache and Potentially Modifiable Risk Factors: Screening and Behavioral Management of Sleep Disorders

HEADACHE, Issue 1 2008
Jeanetta C. Rains PhD
Sleep-related variables have been identified among risk factors for frequent and severe headache conditions. It has been postulated that migraine, chronic daily headache, and perhaps other forms of chronic headache are progressive disorders. Thus, sleep and other modifiable risk factors may be clinical targets for prevention of headache progression or chronification. The present paper is part of the special series of papers entitled "Chronification of Headache" describing the empirical evidence, future research directions, proposed mechanisms, and risk factors implicated in headache chronification as well as several papers addressing individual risk factors (ie, sleep disorders, medication overuse, psychiatric disorders, stress, obesity). Understanding the link between risk factors and headache may yield novel preventative and therapeutic approaches in the management of headache. The present paper in the special series reviews epidemiological research as a means of quantifying the relationship between chronic headache and sleep disorders (sleep-disordered breathing, insomnia, circadian rhythm disorders, parasomnias) discusses screening for early detection and treatment of more severe and prevalent sleep disorders, and discusses fundamental sleep regulation strategies aimed at headache prevention for at-risk individuals. [source]


Pharmacological Approaches to Managing Migraine and Associated Comorbidities,Clinical Considerations for Monotherapy Versus Polytherapy

HEADACHE, Issue 4 2007
Stephen D. Silberstein MD
Comorbidity is defined as an illness that occurs more frequently in association with a specific disorder than would be found as a coincidental association in the general population. Conditions that are frequently comorbid with migraine include depression, anxiety, stroke, epilepsy, sleep disorders, and other pain disorders. In addition, many common illnesses occur concomitantly (at the same time) with migraine and influence the treatment choice. Migraine management, and especially migraine prevention, can be challenging when patients have comorbid or concomitant illnesses. The objectives of this initiative are to review the literature on managing patients who have migraine and common comorbidities, present additional clinical approaches for care of these difficult patients, and evaluate the areas in which research is needed to establish evidence-based guidelines for the management of migraine with associated comorbid conditions. [source]


Sleep and Headache Disorders: Clinical Recommendations for Headache Management

HEADACHE, Issue 2006
Jeanetta C. Rains PhD
Clinical practice points were drawn from a review of sleep and headache disorders published in the regular issue of Headache (released in tandem with this supplement). The recommendations include: (1) Sleep as well as psychiatric disorders tend to become prevalent in more complex and severe headache patterns and regulation of sleep and mood may favorably impact headache threshold; (2) Specific headache patterns, irrespective of headache diagnosis, are suggestive of a potential sleep disorder (eg, "awakening" or morning headache, chronic daily headache); (3) Sleep disorders most implicated with headache include obstructive sleep apnea, primary insomnia, and circadian phase abnormalities, and treatment of such sleep disorders may improve or resolve headache; (4) Inexpensive screening tools (eg, sleep history interview, headache/sleep diary, validated questionnaires, prediction equations) aid identification of patients warranting polysomnography; and (5) Pharmacologic and behavioral therapies are effective in the regulation of sleep and are compatible with usual headache care. [source]


Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009
AGSF, Harrison G. Bloom MD
Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. [source]


Self-Reported Sleep and Nap Habits and Risk of Falls and Fractures in Older Women: The Study of Osteoporotic Fractures

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006
Katie L. Stone PhD
OBJECTIVES: To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women. DESIGN: Study of Osteoporotic Fractures prospective cohort study. SETTING: Clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, near Pittsburgh, Pennsylvania. PARTICIPANTS: Eight thousand one hundred one community-dwelling Caucasian women aged 69 and older (mean 77.0). MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Fall frequency during the subsequent year was ascertained using tri-annual questionnaire. Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports. RESULTS: Five hundred fifty-three women suffered hip fractures, and 1,938 suffered nonspinal fractures. In multivariate models, women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year (odds ratio=1.32, 95% confidence interval (CI)=1.03,1.69) and were more likely to suffer a hip fracture (hazard ratio (HR)=1.33, 95% CI=0.99,1.78) than women who did not nap daily. Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than (HR=1.26, 95% CI=1.00,1.58) and a similar but nonsignificant increased risk of hip fracture to (HR=1.43, 95% CI=0.95,2.15) those who reported sleeping between 8 and 9 hours. CONCLUSION: Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women. Interventions to improve sleep may reduce their risk of falls and fractures. Future research is needed to determine whether specific sleep disorders contribute to these relationships. [source]


Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly Populations

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005
Sonia Ancoli-Israel PhD
A good night's sleep is often more elusive as we age, because the prevalence of insomnia in older people is high. Insufficient sleep can have important effects on daytime function by increasing the need to nap, reducing cognitive ability including attention and memory, slowing response time, adversely affecting relationships with friends and family, and contributing to a general sense of being unwell. However, rather than aging per se, circadian rhythm shifts, primary sleep disorders, comorbid medical/psychiatric illnesses, and medication use cause sleep difficulties in older people, which psychosocial factors may also affect. Clinicians should ask elderly patients about satisfaction with sleep. Any sleep complaints warrant careful evaluation of contributing factors and appropriate treatment. [source]