[Importance of nocturia and its impact on quality of sleep and quality of life in patient with benign prostatic hyperplasia]. / Importancia de la nocturia y su impacto en la calidad del sueño y en la calidad de vida en el paciente con hiperplasia benigna de próstata.

INTRODUCTION: Nocturia is the main cause of insomnia or sleep interruption in adult men, which has a negative impact on daily activities, quality of life (QoL) and quality of sleep (QoS). The assessment of nocturia and its impact on QoL and QoS in patients suffering from benign prostatic hyperplasia (BPH) has been poor in terms of clinical research, moreover there is a lack of specific methods to assess this impact. OBJECTIVES: The objectives of BPH treatment should include the improvement of patient's QoL by controlling both diurnal and nocturnal symptoms. In order to assess how nocturia affects QoL and also QoS, some specific tools, such as N-QoL questionnaire or the number of Hours of Undisturbed Sleep (HUS), have been recently developed. Therefore, it would be interesting to assess how nocturia reduction due to LUTS/BPH treatment can impact on some objective parameters such as HUS and also how nocturia reduction improves QoS and QoL. This assessment should be developed during the application of pharmacological treatments in clinical practice by means of these specific tools. With the aim of tackling nocturia as an urologic problem in patients with LUTS/BPH, as well as knowing the physiology of sleep and the effect of nocturia on the sleep and QoL, a meeting of expert urologists, that gathered about fifty specialists of all around Spain, was held in Madrid. This article presents the main ideas and concepts exposed in this meeting. CONCLUSIONS: Nocturia is a symptom with a high prevalence in older patients with STUI/BPH. The PreNoc study has showed a Nocturia prevalence in Spain of 83% in patients > or =60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH.

[Gastroesophageal reflux and obstructive sleep apnea syndrome]. / Reflujo gastroesofágico proximal y sindrome de la apnea obstructiva del sueño. Datos preliminares de un estudio prospectivo.

INTRODUCTION: Patients with mild or moderate Sleep Apnea Syndrome (SAS) need wider therapeutic scope options according to their disease severity. AIM: To consider including proton pump inhibitors (PPI) to the therapeutical alternatives of these patients. MATERIAL AND METHODS: A prospective study was designed, among patients with SAS. Nocturnal polysomnography and double channel pHmetry were performed simultaneously. RESULTS: From the 18 patients included in this preliminary phase, in three (16.7%) nocturnal proximal ph monitoring was positive. These 3 patients were treated with PPI during at least 3 months with a very satisfactory outcome in two of them. CONCLUSIONS: Treatment with PPI may be a useful therapeutical alternative in patients with mild to moderate SAS.

The challenge of chronic insomnia: is non-nightly hypnotic treatment a feasible alternative?

The adverse effects of insomnia on health and quality of life are matters receiving increasing attention. Yet, surveys have consistently shown that most people suffering from insomnia do not seek medical help, perhaps, in part, because of a concern of becoming dependent on hypnotic medication. The treatment of chronic insomnia poses a particular dilemma in that continuous hypnotic treatment is restricted in many countries to a maximum of 4 weeks, and behavioural treatment is not readily available. Non-nightly hypnotic treatment of chronic insomnia offers a promising alternative option for the many patients whose symptoms do not necessitate nightly drug intake, allaying fears of psychological dependence on medication and respecting regulatory constraints on hypnotic use while providing patients with adequate symptom relief. The practical feasibility and efficacy of this approach has been demonstrated with zolpidem using various treatment regimens and study designs. So far, six clinical trials have been completed on over 4000 patients. Published results show effective treatment of insomnia without any evidence of either adverse event associated with a discontinuous regimen or increased hypnotic use over the treatment period.

Consensus on drug treatment, definition and diagnosis for insomnia.

Thirty-four experts and a literature supervisor got together in order to reach a 'consensus' regarding the definition, diagnosis and pharmacological treatment of insomnia. Insomnia is a subjective perception of dissatisfaction with the amount and/or quality of sleep. It includes difficulty in initiating or maintaining sleep or early awakening with inability to fall asleep again. It is associated with complaints of non-restorative sleep and dysfunction of diurnal alertness, energy, cognitive function, behaviour or emotional state, with a decrease in quality of life. The diagnosis is based on clinical and sleep history, physical examination and additional tests, although polysomnography is not routinely indicated. Therapy should include treatment of the underlying causes, cognitive and behavioural measures and drug treatment. Hypnotic therapy can be prescribed from the onset of insomnia and non-benzodiazepine selective agonists of the GABA-A receptor complex are the drugs of first choice. It is recommended that hypnotic treatment be maintained in cases where withdrawal impairs the patient's quality of life and when all other therapeutic measures have failed. Experience suggests that intermittent treatment is better than continuous therapy. The available data do not confirm safety of hypnotics in pregnancy, lactation and childhood insomnia. Benzodiazepines are not indicated in decompensated chronic pulmonary disease but no significant adverse effects on respiratory function have been reported with zolpidem and zopiclone in stable mild to moderate chronic obstructive pulmonary disease and in treated obstructive sleep apnoea syndrome. Data for zaleplon are inconclusive. If the patient recovers subjective control over the sleep process, gradual discontinuation of hypnotic treatment can be considered.

[Childhood insomnia due to disorderly habits]. / Insomnio infantil por hábitos incorrectos.

A common disorder in children aged between 6 months and 5 years is childhood insomnia due to disorderly habits. The clinical characteristics of this condition are difficulty in going to sleep on their own and multiple nocturnal wakenings. It occurs in perfectly normal children who are seen to have difficulty in the normalization of their sleep-waking rhythm due to absence or weak application of external synchronizers. The only point on which we can act to enforce synchronization of the sleep-waking circadian rhythm is on the habits related to getting to sleep. To initiate this synchronization of sleep-waking rhythm, it is essential to create a ritual around the action of going to bed. The possibility of the child getting back to sleep during the many physiological wakenings he has during the night depends on this ritual. It is essential that the child be awake when he leaves the bedroom. The child must learn to go to sleep with external elements which are associated with sleep, and during the physiological wakenings during the night, he will reclaim the circumstances which he associates with sleep. If the child goes to sleep on his own, he will go back to sleep on his own when he wakes at night; but if he has gone to sleep in someone's arms or 'has been put to sleep' by rocking, he will want the arms or rocking again. Once the routine is completed, the parents will leave the room and should follow a pattern of waiting time, increasing his progressively, following techniques for the modification of conduct until the child manages to get to sleep on his own.

[The use of ropinirol ++ as a treatment for restless leg syndrome]. / Uso de ropinirol como tratamientodel síndrome de piernas inquietas.

INTRODUCTION: Restless legs is an unpleasant sensation in the calves that occurs when the individual is sitting or laying down, with an irresistible urge to move the legs. It has been know as a cause of insomnia. We have been using various drugs with a variety of effectiveness. Levodopa is now considered the drug of choice but drug tolerance is likely to develop the risk of drug dependence. Recently, a new drug was developed by Smithkline Beecham called ropinirol which principal indication is the treatment of initial phase of Parkinson's disease. PATIENTS AND METHODS: Base on the idea of the efficacy de la levodopa in patients with restless legs we administered 0.25 mg of ropinirol at bedtime to 15 of our patients diagnosed with restless legs syndrome. None of them had received positive results using the classic treatments during more than five years since they had developed this syndrome. Before the treatment was begun, we discontinued any medications relating to this illness. RESULTS: Beneficial effects were observed after the first administration and has continued until this time, 12 months after the initial treatment. Efficacy was measure by using sleep questionnaires (Spiegel). With only a pill (0.25 mg) at the moment of laying down at bedtime reports a clear improvement in the symptoms, including reducing the periodic leg movements. CONCLUSION: That improvements continue without any secondary side effects and without appearing to have built up any tolerance for the medication. Further research is needed to investigate the long term efficacy and side effects of this new treatment, but at this moment is a valuable and satisfactory tool to treat restless legs syndromes.

[The efficacy of ropinirole in the treatment of chronic insomnia secondary to restless legs syndrome: polysomnography data]. / Eficacia del ropinirol como tratamiento del insomnio crónico secundario al síndrome de piernas inquietas: datos polisomnográficos.

INTRODUCTION: Following the line of our earlier investigations, we made an open pilot study using a polysomnograph to objectively show the efficacy of Ropinirole in the treatment of chronic insomnia secondary to the restless legs syndrome (RLS). PATIENTS AND METHODS: We did polysomnograph studies on 5 patients with the characteristics of primary RLS, according to the criteria of the International Group for the study of RLS, who had had chronic insomnia for over 5 years. We used Spiegel's questionnaires to show subjective improvement. RESULTS: The following parameters were significant between the first night (without treatment) and the second night (with 0.25 mg of Ropinirole) and between night 30 without (treatment) and night 31 (with 0.25 mg of Ropinirole). The results were expressed as average values for the 5 patients with their respective standard deviations. Efficiency of sleep: 62.62% +/- 11.31 as compared with 82.82% +/- 8.80, p = 0.010. After 30 days: 64.88% +/- 17.17 against 88.75% +/- 2.09, p = 0.014. Total time asleep: 295' +/- 51.76 against 397.7 +/- 38.50, p = 0.006. After 30 days: 294.6' +/- 87.40 against 391' +/- 22.38, p = 0.025. Number of periodic movements: 91 +/- 33.59 against 30.8 +/- 35.56, p = 0.011. After 30 days: 189.8 +/- 99.79 against 36.2 +/- 21.56, p = 0.013. All patients had subjective improvement in the parameters of Spiegel's test (p = 0.0005). CONCLUSIONS: The improvement in efficiency of sleep seen on polisomnography, total time slept and reduction in periodic limb movements were statistically significant. The subjective improvement described was also confirmed by Spiegel's questionnaire.

[Pharmacological treatment of insomnia in children with neurological disorders]. / Tratamiento farmacológico del insomnio en niños con alteraciones neurológicas.

INTRODUCTION: Insomnia is usual, and a serious problem in children with neurological disorders. Few studies have been made of this and above all there are no guide lines or suggestions as to how to treat these problems. The difficulty is made worse by the different characteristics of the insomnia and of the affected children themselves. Poor sleeping is associated with other pathology of the patient (mental retardation, convulsions, etc.). DEVELOPMENT: We have revised the different modes of treatment, particularly pharmacological, which are available today. Guidelines as to how to handle this symptom are suggested. We also include a list of some drug reactions which may cause symptoms related to sleep (insomnia, excessive sleepiness or nightmares).

[The use of olanzapine in sleep disorders. An open trial with nine patients]. / Uso de olanzapina en los trastornos del sueño. Estudio abierto con nueve pacientes.

INTRODUCTION: The impossibility of treating patients with sleep disorders adequately means that, as specialists, we have to look for new pharmacological treatments and for this reason we examined the information in the paper by Salin Pascual (1999) about the increase in deep sleep when olanzapine is used as an antipsychotic drug. CASE REPORTS: We decided to use this medication in six females and three males who were suffering from different sleep disorders that conditioned their chronic insomnia. The dosages of olanzapine used ranged from 2.5 and 10 mg in a single dose. The clinical history and progress were used to elaborate the results and conclusions. The result was positive in eight of the nine patients, five who were administered the medication as monotherapy and three as polytherapy. CONCLUSION: The population studied is insufficient to prove the effectiveness of the drug, but the fact that in eight of our patients the treatment clearly improved their symptoms leads us to think that this line of research must be continued.

[Restless legs syndrome in a patient with amputation of both legs]. / Síndrome de piernas inquietas en un paciente con amputación de ambas piernas.

INTRODUCTION: We present the case of a patient who, after amputation of both legs, suffered restless legs syndrome (RLS). This syndrome is characterised by a feeling of agitation in the legs and an overwhelming need to move them. CASE REPORT: A 62-year-old male patient who visited because of sleep onset and maintenance insomnia. The aetiology of the insomnia was interpreted as being an anxiety-dysthymic syndrome, which improved with suitable medication. Five months later, the patient returned with the same symptoms (onset insomnia). On questioning the patient again, we noticed that he displayed clear symptoms of RLS, despite the absence of both lower limbs. The clinical features were resolved with the administration of ropinirole. CONCLUSIONS: We do not know of any similar cases, but the scarce amount of knowledge available about RLS makes it likely that many patients with amputations present this problem without any proper diagnosis.

[Adverse effects of continuous positive airway pressure therapy and its relation to the nose]. / Efectos adversos derivados del tratamiento con nCPAP y su relación con la nariz.

The main problem in the treatment of obstructive sleep apnea syndrome (OSAS) with nasal continuous airway pressure (nCPAP) is the lack of compliance. One of the most important reasons for no compliance is the adverse effects of this treatment. We analyse, prospectively, 182 patients treated with nCPAP in order to show the relationship between previous nasal problems and adverse effects of nCPAP. Sixty percent of the population developed one o more side effects. Of this group, 69% showed nasal septum deviation at first examination in front of 31% that did not showed this problem (p = 0.001). In the group of patients with nasal side effects we observed an increase of compliance in 80% of patients treated medically and in 89% of those treated by a septoplasty. We demonstrate that the adverse effects of nCPAP are related to previous nasal problems and, also, that treatment of those problems can achieve an increase in compliance to nCPAP therapy.

[Neurocognitive and behavioral disturbances after adenotonsillectomy in obstructive sleep apnea syndrome]. / Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño.

INTRODUCTION: Adenotonsillectomy is an effective treatment for sleep-disordered breathing in children, but its ability to resolve neurocognitive issues, is not clear. OBJECTIVE: To analyze the outcomes of cognitive and behavioral disorders after one year of adenotonsillectomy. METHOD: We studied the behavioral and cognitive abnormalities in 45 children with obstructive sleep apnea and 30 healthy controls, aged 3 to 13 years. Psychological tests were performed in both groups at baseline and at 12 months. RESULTS: Preoperatively, all cognitive and behavioral disturbances were higher in the study group than in the control group: attention in 46.7% of cases in the study group versus 20% in the control group (P=.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=.003). After one year we observed more disturbances in all variables in the study group. However, significant differences remained only in spatial structure (31.3% versus 3.3%, P=.017), and attention deficit (40.5% versus 16.7%, P=.031). The percentages of patients that improved in one year were not significantly different between both groups. CONCLUSION: Behavioral and cognitive disturbances in children with sleep apnea were partially resolved following adenotonsillectomy. Improvements in the cognitive and behavioral variables did not differ significantly from those the normal evolution of the individual, and were independent of the resolution of respiratory disorders.

[Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study]. / Impacto de la nocturia en la calidad del sueño en pacientes con síntomas del tracto urinario inferior sugestivos de hiperplasia benigna de la próstata. Estudio NocSu.

INTRODUCTION: Nocturia is one of the main symptoms associated to BPH, causing significant sleep disturbances, including sleep interruptions. Such sleep interruptions may significantly impair quality of life. MATERIALS AND METHODS: A multicenter, observational, cross-sectional, epidemiological study was conducted in patients with LUTS/BPH aged 60 years or over. In the study visit, demographic and clinical data were collected and quality of sleep questionnaires (MOS-Sleep Scale and COS) were administered. RESULTS: Among the total 249 patients recruited, 205 had nocturia (82.3%) and 44 (17.7%) had no nocturia. All patients should have an I-PSS score ?13, and patients with mild symptoms were therefore excluded (62.9% had moderate and 37.1% severe symptoms). Patients with nocturia were seen to have more sleep problems than those without nocturia (more sleep disturbances, less sleep adequacy, more daily sleepiness, greater concern about their social and occupational functioning, etc). DISCUSSION: Patients with nocturia reported a worse quality of sleep than patients with LUTS/BPH but no nocturia. Nocturia resulted in frequent sleep interruptions, causing malaise and diurnal fatigue in affected patients. Use of therapeutic approaches to relieve or eliminate this undesirable effect may lead to an improvement in sleep quality and quality of life in BPH patients.

[Considerations on neonatal epileptic encephalopathies apropos of a personal case]. / Considérations sur les encéphalopathies épileptiques néonatales à propos d'une observation personnelle.

Studies were done on a newborn with tonic status seizures beginning at 15 days old to his death at 3 months of age. The clinical features were: (1) important psychomotor retardation; (2) tonic seizures consisting of flexion or extension of the upper limbs and head, ocular revulsion, facial cyanosis and respiration troubles. The seizure mean duration was from 4 to 6 sec. The seizures appeared sometimes isolated, sometimes in bursts with an increasing frequency but not related to the nycthemeral cycle. In the EEG there appears a 'burst-suppression' pattern which persists continuously whether the patient was asleep or awake. The clinical and electroencephalographic findings suggest Ohtahara's syndrome. Some considerations are made about the clinical, electroencephalographic and aetiologic findings of the several epileptic encephalopathies with suppression bursts in the newborn.

[Electroencephalographic study of a case of neonatal herpes encephalitis (author's transl)]. / Etude électro-encéphalographique d'un cas d'encéphalite herpétique néo-natale.

This report describes the serial E.E.G. changes occurring over 6 weeks in a particularly interesting case of neonatal herpes encephalitis commencing on the 13th day of life. Atypical periodic complexes occurred briefly on the fifteenth day and disappeared on the 21st day. These focal complexes were less characteristic than those seen in the older child or adult. On the 27th day E.E.G. activity disappeared contrasting with the preservation of organised sleep recognised by polygraph studies using ocular movement, respiration and chin tonus. At 2 months the child no longer was conscious, E.E.G. activity totally absent but sleep organisation persisted with intense ocular motility.

[Electroencephalographic morphology of seizures in full-term newborn infants]. / Morphologie électroencephalographique des crises du nouveau-né à terme.

e studied the morphology of the electrical discharges of 63 newborns who presented an electrical or electro-clinical status of known aetiology. The seizures have been classified as: discharges of beta, alpha, theta and delta frequencies; discharges of diphasic spikes; discharges of "saw waves"; positive spikes or slow waves, burst-suppressions and extremely polymorph discharges. We confirm the existing opinion in the current literature that the discharges are really changeable and polymorphic, are modified during seizure and vary in morphology, voltage, frequency and polarity. A typical or characteristic pattern of the seizures of newborn does not exist although theta and delta frequencies are predominant. A correlation between voltage, frequency and duration of the electrical discharge seems to exist; the higher the frequency of the electrical discharge, the lower is its voltage and its duration and vice versa. The cortical immaturity of the newborn plays an important role in the morphological changes of the electrical discharges.

[Episodes of apnea in an infant: unusual forms of epileptic seizures]. / Episodes d'apnée chez un nourrisson: formes inhabituelles de crises comitiales.

The authors report the observation of an infant who begins at the age of 7 months to present episodes of epileptic apnea with cyanosis, lost of consciousness, hypotony and sometimes ocular revulsion and distal myoclonia. From their onset there are several a day, more frequent during sleep than when awake. From the EEG point of view they are characterized by a 5-7 c/sec large and diffuse rhythm. The infant also presents epileptic myoclonias, tonic and partial seizures. She has a very slight evolutive encephalopathy, disclosed at the age of 4 months by a psychomotor retardation. No etiology has been proved. The CT scan shows during the evolution a cortico-subcortical atrophy. Every type of seizure was very resistant to different treatments. The apneas disappeared after ACTH therapy. The authors demonstrate the epileptic nature of these apneas which are very rarely observed after the neonatal period.

[Comb-like rhythm: an EEG pattern peculiar to leucinosis]. / "Ritmos en peine": un patrón EEG propio de la leucinosis.

EEG and clinical aspects of a newborn baby with maple syrup urine disease are presented. EEG shows in central areas "Comb-like rhytms" with pseudo-periodic background activity. These patterns seem peculiar to maple syrup urine disease according to Trottier et al. (1975). EEG findings may suggest screening for aminoacids.

[Developmental study of the paroxysmal tracing in the full term neonate (author's transl)]. / Etude évolutive du tracé paroxystique chez le nouveau-né a terme.

The development of the paroxysmal trace was studied in 13 full term neonates having presented with severe neonatal anoxia. The paroxysmal tracings according to the definition given by by Monod and Dreyfus-Brisac changed between the 10th and 15th days, the bursts of waves being more polymorphic and closer together but the paroxysmal component persisted. Further groups of anterior slow waves symmetrical and limited to the mid temporal region appeared. These patterns disappeared between the 2nd and 3rd month to make way for generalised spikes and resembling hypsarrhythmia beyond the third month.