Persistent combined type sleep-related rhythmic movement disorder into adolescence: a case report.

Sleep-related rhythmic movement disorder is characterized by repetitive, stereotyped, rhythmic movements of large muscle groups, primarily occurring at the onset of sleep and during sleep. Common in infancy and early childhood, its persistence into adolescence or adulthood is rare. Combined type is rare. This article reviews and analyzes the diagnosis and treatment of a case with combined type sleep-related rhythmic movement disorder persisting for 15 years aimed at enhancing the level of diagnosis and treatment of the disorder, and reducing misdiagnosis and missed diagnosis. CITATION: Zhao Y, Wang F, Wang X, Zhao W, Liu Z. Persistent combined type sleep-related rhythmic movement disorder into adolescence: a case report. J Clin Sleep Med. 2024;20(8):1391-1394.

Quality of sleep in patients with nocturnal leg cramps and validity of a single-item measure of cramp-related sleep disturbance: an observational study.

OBJECTIVE: Only a few studies have addressed the impact of nocturnal leg cramps on sleep quality. We investigated the association between nocturnal leg cramps and sleep disturbance using the Pittsburgh Sleep Quality Index (PSQI), and assessed the criterion validity of a single-item daily measure of cramp-related sleep disturbance. METHODS: In this prospective observational study conducted in Western Switzerland from January 2015 to June 2016, 20 primary care physicians recruited up to 20 consecutive patients aged >50 years. During a 2-week period, patients recorded on a daily basis the number of cramps and their level of sleep disturbance using a single item measure (10-point visual analogue scale from 0 to 10). They also completed the PSQI questionnaire on day 14. Patients were considered as “poor sleepers” if the PSQI score was >5/21. The criterion validity of the single-item measure (averaged over the 2-week period) was assessed using Spearman’s rank correlation coefficient to determine the correlation with the PSQI. RESULTS: 129 patients participated (women 67%, mean age 70 years). The single-item and the PSQI mean scores were 2.6/10 (standard deviation 2.5) and 6.1/21 (SD 3.9), respectively. Being a “poor sleeper” (47% of patients) was not statistically significantly associated with patients’ characteristics and number of cramps. The averaged single-item measure was not correlated with the PSQI score (Spearman’s rank correlation 0.08, p-value 0.51). CONCLUSIONS: In this primary care sample, poor sleep quality was not associated with suffering from a higher number of nocturnal cramps, and a single-item mean score was not a valid instrument to screen for sleep disturbance among these patients.

Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method.

BACKGROUND: A substantial proportion of people using cannabis report using it to improve sleep. Yet, little research exists on the associations between the timing of cannabis use and sleep. This study examines the time elapsed between cannabis use and sleep start time and its association with two of the main indicators of sleep continuity: (1) sleep onset latency (SOL) and (2) number of awakenings (NOA) throughout the night. METHODS: Each morning, for 7 consecutive days, daily cannabis users (n = 54) reported on the timing of previous night's cannabis use and sleep indicators on their smartphones. Mixed effects models examined the relations of within- and between-subjects' time elapsed between previous night cannabis use and sleep start time, with (1) SOL and (2) NOA. RESULTS: Within subjects, shorter time elapsed between cannabis use and sleep start time was associated with shorter SOL (ß = 0.519, p = 0.010), but not NOA (ß = -0.030, p = 0.535). Furthermore, between individuals, the time gap between the previous night cannabis use and sleep start time was not associated with SOL or NOA (p > 0.05). CONCLUSIONS: It is possible that cannabis use proximal to bedtime is associated with shorted sleep onset latency but not nighttime awakenings. Cannabis users should be informed about both the potential sleep aid effects of cannabis and its limitations. Pending further evidence of the effects of cannabis on sleep, cannabis users experiencing sleep problems should be provided with evidence-based alternatives to improve sleep, e.g., pharmacological and behavioral treatments.

Sleep-related rhythmic movements and rhythmic movement disorder beyond early childhood.

INTRODUCTION: Sleep-related rhythmic movements (SRRMs) are common in young children and become less prevalent with increasing age. When SRRMs significantly interfere with sleep and/or affect daytime functioning, potentially resulting in injury, rhythmic movement disorder (SRRMD) is diagnosed. OBJECTIVE: The aim of our study was to assess clinical comorbidities, types of SRRMs, sleep stage/wakefulness distribution during night, and age-dependence of these parameters. MATERIAL AND METHODS: In sum, 45 patients (age range 1-26 years, mean age 10.56 ± 6.4 years, 29 men) were clinically examined for SRRMs or SRRMD. Nocturnal polysomnography (PSG) was recorded in 38 patients. To evaluate clinical and sleep comorbidity, the cohort of 38 patients was divided according to age into four groups: (1) younger than 5 years (N = 7), (2) 5-9 years (N = 12), (3) 10-14 years (N = 11), and (4) ≥ 15 years (N = 8). RESULTS: A clear relationship between perinatal risk factors and developmental disorders (attention deficit hyperactivity disorder - ADHD, specific learning disability) was found which extended population prevalence at least five times. A total of 62 recordings were evaluated in 38 patients; SRRMs were found in PSG in 31 of 38 patients (82%). No age-dependent correlation between type of SRRMs and sleep stage/wakefulness distribution during the night was observed. However, when all recordings were correlated together, rolling stereotypes occurred more frequently in REM sleep, and rocking stereotypes in superficial NREM sleep. CONCLUSION: Developmental disorders and perinatal risk factors were connected with SRRMs and SRRMD in children and young adults. Rolling movements were significantly associated with REM stage and rocking stereotypes with superficial NREM sleep, independent of age.

Objectively confirmed prevalence of sleep-related rhythmic movement disorder in pre-school children.

OBJECTIVE: Childhood sleep-related rhythmic movement disorder (RMD) (ie, sleep-related repetitive movements involving large muscle groups) can impair sleep quality, cause local injury, and disturb household members. Previous parental reports indicate prevalence rates in children under three years of age between 5.5 and 67%. We studied the prevalence of RMD with objective home videosomnography. METHODS: Parents of 707 children having their one-year routine health check (357 male), 740 children having their two-year health check (395 male), and 17 children of unknown age (nine male), were asked if their child showed sleep-related rhythmic movements. If telephone interview confirmed likely RMD, parents completed a standardised clinical questionnaire and three nights of home videosomnography. RESULTS: At the one-year health check, 31/707 possible cases of RMD were identified [maximal prevalence: 4.38%; 95% CI (2.81, 5.89)] compared to 11/740 at the two-year check [maximal prevalence: 1.49%, 95% CI (0.61, 2.36)]. Of 42 possible cases, nine had resolved; 14 were uncontactable, or did not wish to participate, and four did not complete the study protocol. In four of 10 remaining one-year olds and four of five remaining two-year olds parental report was objectively confirmed by videosomnography. Minimal prevalence based on objective observation was therefore 0.28% [95% CI (0.08, 1.30)] at one-year check and 0.41% [95% CI (0.08, 1.24)] at two-year check. CONCLUSIONS: Prevalence of RMD in a large population of infants and toddlers was lower than previously reported (maximum prevalence 2.87%, minimum prevalence 0.34%). It is important to confirm parental report using objective measures.

Sexsomnia as a Defense in Repeated Sex Crimes.

Sexsomnia and related sexual behaviors during sleep may be diagnosed in individuals accused of sex crimes. Although sexsomnia is now formally recognized in the DSM-5, the variable presentation of such behaviors and the possibility of malingering in medicolegal situations can cause challenges for forensic evaluators and legal professionals alike. Review of the literature reveals a paucity of cases involving allegations of repeated incidents due to abnormal sexual behaviors or experiences in sleep. It is important for experts involved in such cases to understand how the courts have responded to sexsomnia defenses involving diverse alleged incidents. The authors review the case law and discuss methods of examining evaluees with suspected sexsomnia in cases of alleged sexual assault.

Restless legs syndrome and nocturnal leg cramps: a review and guide to diagnosis and treatment.

Restless legs syndrome (RLS) and nocturnal leg cramps (NLCs) are common disorders affecting 7.0% and 24.1% of the population in some European countries, respectively. Patients suffering from RLS experience uncomfortable nocturnal sensations in the legs with the urge to move that dissipates while moving. NLC is characterized by abrupt muscle contraction, most often in the gastrocnemius or foot muscles, which occurs at night and may result in significant sleep disturbances. The diagnosis of these disorders has presented a challenge to health care providers because of symptom overlap with other sensory and motor disturbances with nocturnal predominance. Treatment options and approaches are lacking, partially because of our currently incomplete understanding of the pathophysiological mechanisms underlying these conditions. We reviewed the medical literature to provide a comprehensive assessment of RLS and NLC with a focus on improved diagnostic accuracy and treatment approaches.

Nocturnal leg symptoms are not associated with specific patterns of superficial venous insufficiency.

BACKGROUND: Certain nocturnal symptoms such as leg cramping (LC) and restless leg symptoms (RLS) are found in patients with venous disease. This study investigates the relationship between nocturnal symptoms and anatomic locations of superficial venous insufficiency. METHODS: A retrospective review of 371 consecutive patients presenting to a venous disease practice over a 1-year period was conducted. Patients underwent comprehensive assessment including standardized duplex scans. Superficial venous disease was classified by anatomic location (great saphenous vein [GSV], small saphenous vein [SSV], tributaries). Information on patient symptoms was obtained from questionnaires and patient interviews. RESULTS: Most patients in the cohort were female (315/371, 85%) with an average age of approximately 56 years. The 56 men had an average age of 63.2. Nearly all patients (92%) had findings of superficial venous reflux with the anatomic site of involvement as follows: GSV (51%), SSV (16%), and tributaries (33%). Thirty-two percent of patients experienced LC and 16% experienced RLS. The patterns of reflux did not differ between patients with nocturnal symptoms compared to those without nocturnal symptoms. Nine percent of patients with nocturnal symptoms had no evidence of venous disease. Of those patients with LC, 76% had reflux in the GSV, 48% had reflux in the SSV, and 92% had reflux in at least one segment of the superficial venous system. Of those patients with RLS, 78% had reflux in the GSV, 35% had reflux in the SSV, and 87% had reflux in at least one segment of the superficial venous system. CONCLUSIONS: No significant difference was detected between patterns of superficial venous reflux in patients with nocturnal symptoms compared to those without nocturnal symptoms. In addition, the presence of nocturnal symptoms does not predict a specific pattern of disease. Future studies are needed to determine whether correction of the main truncal disease is sufficient or if ablation of both the truncal and tributary veins is necessary for alleviation of nocturnal symptoms.

Criteria in diagnosing nocturnal leg cramps: a systematic review.

BACKGROUND: Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder. METHOD: A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps. RESULTS: After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress. CONCLUSION: The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.

[Ictal Speech Manifesting as Sleep Talking: A Case Report].

We present a 28-year-old female patient whose epilepsy started at the age of 19. MRI showed right perisylvian polymicrogyria. She exhibited various seizure symptoms, such as somatosensory aura involving the left leg, dyscognitive seizures, and amnesic seizures. Her mother indicated that the patient sometimes had "sleep talking", which was associated with presence of epileptic seizures of the next day. Long-term video electroencephalography (EEG) revealed that her episodes of "sleep talking" were epileptic events, specifically ictal speech, originating in the right hemisphere. The present case demonstrates the importance of considering "sleep talk" as an epileptic symptom. Careful history taking is fundamental to carry patients with possibly pathological "sleep talk" to the long-term video EEG, which will contribute correct diagnosis and treatment. (Received August 16, 2016; Accepted September 9, 2016; Published February 1, 2017).

A review of nocturnal leg cramps in older people.

Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients.

Bed Partner "Gas-Lighting" as a Cause of Fictitious Sleep-Talking.

A case report highlighting a rare and striking, but perhaps under-recognized, cause of reported sleep-talking to a specialist sleep clinic, involving "gas-lighting" by the bed partner.

Sexsomnia: sleep sex research and its legal implications.

"Sleep sex," also known as sexsomnia, is a sleep disorder characterized by sexual behaviors committed while asleep. There has recently been increased interest in sexsomnia due to controversies arising in legal trials that have been widely publicized in the social and public media. This article attempts to marshal the current information about sexsomnia from the forensic literature and provides an overview of sexsomnia including common features, precipitating factors, prevalence rates, diagnostic procedures, and treatment. As sexsomnia represents a condition in which sexual acts are committed without awareness or intention, this paper also reviews the development of sexsomnia as a legal defense and summarizes Canadian case law on the topic. It provides an overview of the hurdles presented to defense attorneys attempting to utilize the defense and examines popular public notions surrounding the legitimacy of sexsomnia and the possibility of malingering. We conclude that sexsomnia is a legitimate sleep disorder for which case law now exists to support its use in legal defenses based on automatism. The question of whether it is an example of "sane" or "insane" automatism remains to be determined by the courts. Regardless of whether or not sexsomnia is determined to be a mental disorder by the courts, it is now a recognized and well-described sleep disorder that can be safely treated and managed by knowledgeable clinicians.

Differentiating nocturnal leg cramps and restless legs syndrome.

Leg pain and discomfort are common complaints in any primary physician's clinic. Two common causes of pain or discomfort in legs are nocturnal leg cramps (NLC) and restless leg syndrome (RLS). NLC present as painful and sudden contractions mostly in part of the calf. Diagnosis of NLC is mainly clinical and sometimes involves investigations to rule out other mimics. RLS is a condition characterized by the discomfort or urge to move the lower limbs, which occurs at rest or in the evening/night. The similarity of RLS and leg cramps poses the issue of errors in diagnosing and differentiating the two. In this paper we review the pathopysiology of each entity and their diagnosis as well as treatment. The two conditions are then compared to appreciate the differences and similarities. Finally, suggestions are recommended for complete assessment.

Exploding head syndrome.

Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided.