Sleep-related rhythmic movement disorder in adults - A systematic review with a case report.

Sleep-related rhythmic movement disorder is characterised by stereotyped and repetitive rhythmic movements involving large muscle groups during sleep with frequencies between 0.5 and 2 Hz. Most of the published studies on sleep-related rhythmic movement disorder have focussed on children. Therefore, we performed a systematic review on this topic focussing on the adult population. The review is followed by a case report. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A total of seven manuscripts (n = 32 individuals) were included in the review. The clinical manifestation of body or head rolling predominated in the majority of included cases (53.13% and 43.75%, respectively). In n = 11 (34.37%) cases, a combination of rhythmic movements was observed. The literature review also revealed a wide spectrum of co-morbidities: insomnia, restless leg syndrome, obstructive sleep apnea, ischaemic stroke, epilepsy, hypertension, alcohol and drug dependency, mild depression, and diabetes mellitus. The case report presented a 33-year-old female who was referred to the sleep laboratory due to a suspicion of sleep bruxism and obstructive sleep apnea. Although the patient was initially suspected of having obstructive sleep apnea and sleep bruxism, after conducting video-polysomnography she met the criteria for sleep-related rhythmic movement disorder as she presented body rolling, which were surprisingly most evident during the rapid eye movement sleep stage. In summary, the prevalence of sleep-related rhythmic movement disorder among adults has not been determined yet. The present review and case report is a good starting point for discussion regarding rhythmic movement disorder in adults and further research on this topic.

The clinical characteristic of catathrenia: a new look at an old issue-a systematic review of existing literature.

STUDY OBJECTIVES: The International Classification of Sleep Disorders categorized catathrenia as a respiratory disorder, but there are doubts whether episodes appear during rapid eye movement (REM) sleep or the non-rapid eye movement (NREM), their duration, and symptoms. The main objectives were to identify the most common features and relations of catathrenia. METHODS: PubMed, Embase, and Web of Science were searched according to the PRISMA 2020 guidelines. The Joanna Briggs Institute and the ROBINS-I tools were chosen to assess the risk of bias. RESULTS: A total of 288 records were identified, 31 articles were included. The majority of the studies had a moderate risk of bias. 49.57% of episodes occurred during the NREM sleep, while 46% took place during REM. In 60.34% females, catathrenia was more common in the NREM, while in 59.26% of males was in REM sleep (p < 0.05). Females and obese individuals were found to have shorter episodes (p < 0.05). Age was inversely correlated with minimal episodes duration (r = - 0.34). The continuous positive airway pressure (CPAP) therapy was inversely correlated with the maximal episode duration (r = - 0.48). CONCLUSIONS: Catathrenia occurs with similar frequency in both genders. The most frequent symptoms embraced groaning, awareness of disturbing bedpartners, and daytime somnolence-not confirmed by the Epworth Sleepiness Scale. The episodes occur more frequently in NREM than in REM sleep. Catathrenia may be considered as a sex-specific condition. The effects of CPAP treatment leading to shortening episodes duration, which may indicate the respiratory origin of catathrenia.

The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023.

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).

Night work as a stressor: The role of sleep reactivity to stress in the relationship between night work and insomnia.

Sleep reactivity to stress is a predisposition to experience sleep disturbances in response to stress. The present study aimed to examine the potential moderating role of sleep reactivity to stress in the relationship between the number of night shifts per month as a stressor and insomnia symptoms. A total of 188 shift-working physicians completed a short questionnaire about work schedule, the Ford Insomnia Response to Stress and the Insomnia Severity Index. Sleep reactivity to stress was a significant moderator of the effect of number of nights worked in the last month on insomnia symptoms. At low and medium sleep reactivity to stress the relationship between the number of night shifts per month and insomnia symptoms was positive and significant. At high sleep reactivity to stress the relationship was no longer significant. The results show that with low and medium sleep reactivity to stress, the more night shifts a person works per month, the more severe insomnia symptoms they will report. With high sleep reactivity to stress even a low number of night shifts per month will lead to a deterioration of sleep. This is important for identifying those who are more vulnerable to adverse consequences of working in the shift system, and the knowledge of workers' sleep reactivity to stress may help in providing targeted interventions.

Sick leave duration as a potential marker of functionality and disease severity in depression.

Objective: To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression.Methods: Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic.Results: Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity.Conclusions: Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression. Key pointsDepression in the working population and depression-related sick leave have a profound economic impact on societyDepression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditionsA wide variety of pharmacological and non-pharmacological treatments and work-based interventions have been shown to be effective in reducing depression-related sick leave duration and/or facilitating return to workIn terms of pharmacological intervention, recent real-world evidence has shown that patients treated with antidepressant monotherapy are able to recover their working life faster than those treated with combination therapyAlthough depression-related sick leave duration has been shown to correlate with severity of depressive symptoms, it is not a viable outcome measure of depression severity on its own, but could be used as secondary outcome alongside more formal clinician- and patient-rated severity measuresDepression-related sick leave duration may, however, represent a viable outcome for measuring functionality in depression.

Sleep among primary care physicians-Association with overtime, night duties and strategies to counteract poor sleep quality.

Physicians belong to the risk group for sleep disorders as a result of work related stress, excessive working time, large amount of on-call duties and shift work. Poor sleep quality of healthcare providers threatens not only their safety, but also the safety of their patients. This study examines if there are any differences in how working either long hours or at night duties relates to self-reported sleep time, sleep quality and daytime sleepiness in primary care physicians. We analyzed data from a survey research of 807 participants. Respondents were divided into four groups based on their reported work hours per week and number of nights on duty per month. Overtime was associated with shorter sleep time and worse subjective sleep quality even when compared with that of participants who work on night duties. All investigated groups of participants reported short sleep latencies which suggests that sleep debt is a common problem in this population. Surprisingly in the case of poor sleep quality participants rarely used recommended methods like regular physical activity or specialist advice. The most frequently reported answer was that they do nothing to improve sleep and every third participants uses hypnotics to do that. These results suggest that primary care physicians despite being at high risk for sleep disorders due to working overtime and at night, pay less attention to their sleep quality and do not use recommended strategies to improve it.

Melatonin as a Potential Adjuvant Treatment for COVID-19 beyond Sleep Disorders.

Melatonin is registered to treat circadian rhythm sleep-wake disorders and insomnia in patients aged 55 years and over. The essential role of the circadian sleep rhythm in the deterioration of sleep quality during COVID-19 confinement and the lack of an adverse effect of melatonin on respiratory drive indicate that melatonin has the potential to be a recommended treatment for sleep disturbances related to COVID-19. This review article describes the effects of melatonin additional to its sleep-related effects, which make this drug an attractive therapeutic option for treating patients with COVID-19. The preclinical data suggest that melatonin may inhibit COVID-19 progression. It may lower the risk of the entrance of the SARS-CoV-2 virus into cells, reduce uncontrolled hyper-inflammation and the activation of immune cells, limit the damage of tissues and multiorgan failure due to the action of free radicals, and reduce ventilator-induced lung injury and the risk of disability resulting from fibrotic changes within the lungs. Melatonin may also increase the efficacy of COVID-19 vaccination. The high safety profile of melatonin and its potential anti-SARS-CoV-2 effects make this molecule a preferable drug for treating sleep disturbances in COVID-19 patients. However, randomized clinical trials are needed to verify the clinical usefulness of melatonin in the treatment of COVID-19.

Attitudes Towards ECT: A Survey of Polish Mental Health Professionals.

BACKGROUND: Although the efficacy of electroconvulsive therapy (ECT) has been well established, the utilization rate of ECT has decreased in Poland in recent years. One of the main reasons could be the negative attitude towards ECT in the community and by mental health professionals. The aim of this study was to assess the knowledge about and attitudes toward ECT in Polish mental health professionals including psychiatrists and non-physicians: nurses, psychologists, social workers. SUBJECTS AND METHODS: Psychiatrists and other mental health professionals in two large Polish hospitals were approached to participate in the survey by completing a 28-item questionnaire. The specific hospitals have been selected due to the fact that they were located in the same province of Poland (Mazowsze), had similar catchment area and profile, provided similar mental health services with only one exception; one offered ECT while the other did not. Of the 185 questionnaires that had been distributed, 165 were completed yielding a response rate of 89.19%. The study population consists of 85 psychiatrists and trainees and 80 non-physicians. RESULTS: Psychiatrists did not differ from other mental health professionals with respect to the knowledge and attitudes toward ECT. However, there were significant differences in the attitude (9.1±3.8 vs 7.1±3.3; p<0.001) and knowledge (5.9±3.8 vs 2.8±4.1; p<0.001) scores between those professionals, who have ever worked in a psychiatric ward where they could observe ECT sessions and those who have not had such an opportunity. CONCLUSIONS: Frequent witnessing of ECT sessions seems to be the most effective educational intervention to change negative attitudes towards ECT.

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment.

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.

Automatic artefact detection in single-channel sleep EEG recordings.

Quantitative electroencephalogram analysis (e.g. spectral analysis) has become an important tool in sleep research and sleep medicine. However, reliable results are only obtained if artefacts are removed or excluded. Artefact detection is often performed manually during sleep stage scoring, which is time consuming and prevents application to large datasets. We aimed to test the performance of mostly simple algorithms of artefact detection in polysomnographic recordings, derive optimal parameters and test their generalization capacity. We implemented 14 different artefact detection methods, optimized parameters for derivation C3A2 using receiver operator characteristic curves of 32 recordings, and validated them on 21 recordings of healthy participants and 10 recordings of patients (different laboratory) and considered the methods as generalizable. We also compared average power density spectra with artefacts excluded based on algorithms and expert scoring. Analyses were performed retrospectively. We could reliably identify artefact contaminated epochs in sleep electroencephalogram recordings of two laboratories (healthy participants and patients) reaching good sensitivity (specificity 0.9) with most algorithms. The best performance was obtained using fixed thresholds of the electroencephalogram slope, high-frequency power (25-90 Hz or 45-90 Hz) and residuals of adaptive autoregressive models. Artefacts in electroencephalogram data can be reliably excluded by simple algorithms with good performance, and average electroencephalogram power density spectra with artefact exclusion based on algorithms and manual scoring are very similar in the frequency range relevant for most applications in sleep research and sleep medicine, allowing application to large datasets as needed to address questions related to genetics, epidemiology or precision medicine.

Effects of cognitive remediation therapy versus other interventions on cognitive functioning in schizophrenia inpatients.

Computerised cognitive remediation therapy (CCRT) has been shown to improve cognitive function in individuals with schizophrenia beyond effects of other forms of therapy. However, results vary between studies, and most are aimed at individuals who are living in the community. Very few studies have investigated its efficacy in psychiatric wards in order to assess whether or not this is a suitable site to start the therapy. This study evaluated CCRT efficacy among schizophrenia inpatients who received a broad range of therapeutic interventions in a psychiatric ward. A randomised controlled trial of CCRT versus an active control in 66 young inpatients with a diagnosis of schizophrenia was conducted. The intervention lasted for 6 weeks and its efficacy was assessed with the composite score of the MATRICS Consensus Cognitive Battery. Both groups improved similarly in cognitive function and psychopathological symptoms. However, the CCRT group improved more than the controls in negative symptoms. This result shows that providing a drill and practice cognitive remediation to inpatients does not produce benefits for cognitive functioning substantially greater than other forms of therapy provided in a ward, but it is more efficient in reduction of negative symptoms. Our results suggest that CRT might be considered as a promising intervention for reducing negative symptoms in schizophrenia individuals.

Sertindole: EEG Analysis, Tolerability, and Clinical Efficacy.

INTRODUCTION: One of the common side effects of antipsychotic drugs is excessive sedation. The treatment with antipsychotics often manifests as an increase in slow wave activity in electroencephalography (EEG). The aim of this study was to analyze EEG recordings of patients treated with a non-sedative antipsychotic drug sertindole with regard to its adverse effects and clinical efficacy. PATIENTS AND METHODS: EEG recordings of 45 patients (27 females, mean age 30.1±8.7 years) with schizophrenia were analyzed. EEG recordings were categorized based on abnormalities severity. The clinical efficacy was rated on the Clinical Global Impression Scale. RESULTS: Abnormalities from mild to moderate were found in 29% of the group. Clinical improvement was observed in 80% of patients. Sedation/daytime sleepiness was present in 7% of patients. Other side effects were prolongation of QTc (11%, severe 4%), insomnia (9%), extrapyramidal symptoms (7%), and heart palpitations (2%). CONCLUSIONS: Patients treated with sertindole do not show side effects similar to those found during treatment with other antipsychotic drugs. Increased slow wave activity in EEG and sedation were absent in the majority of the investigated patients.

European guideline for the diagnosis and treatment of insomnia.

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

Effects of Antidepressants on Sleep.

PURPOSE OF REVIEW: The aim of this review article was to summarize recent publications on effects of antidepressants on sleep and to show that these effects not only depend on the kind of antidepressant drugs but are also related to the dose, the time of drug administration, and the duration of the treatment. RECENT FINDINGS: Complaints of disrupted sleep are very common in patients suffering from depression, and they are listed among diagnostic criteria for this disorder. Moreover, midnocturnal insomnia is the most frequent residual symptom of depression. Thus, all antidepressants should normalize sleep. However, at least in short-term treatment, many antidepressants with so-called activating effects (e.g. fluoxetine, venlafaxine) may disrupt sleep, while others with sedative properties (e.g., doxepin, mirtazapine, trazodone) rapidly improve sleep, but may cause problems in long-term treatment due to oversedation.For sleep-promoting action, the best effects can frequently be achieved with a very low dose, administered early enough before bedtime and importantly, always as a part of more complex interventions based on the cognitive-behavioral protocol to treat insomnia (CBT-I). For successful treatment of depression, it is necessary to understand the effects of antidepressants on sleep. Each physician should also be aware that some antidepressants may worsen or induce primary sleep disorders like restless legs syndrome, sleep bruxism, REM sleep behavior disorder, nightmares, and sleep apnea, which may result from an antidepressant-induced weight gain.

The Polish Academic Version of the MATRICS Consensus Cognitive Battery (MCCB): Evaluation of Psychometric Properties.

Work and social functioning in schizophrenia are strongly influenced by cognitive impairment so improving cognition is a priority in the treatment of schizophrenia. Until recently the lack of a widely accepted index of cognitive change for use in schizophrenia was a major obstacle to the development of cognition enhancing treatments. The MATRICS (measurement and treatment research to improve cognition in schizophrenia) consensus cognitive battery (MCCB) was developed as a standard cognitive battery for use in clinical trials of cognition enhancing treatments for schizophrenia and has attracted worldwide interest. To analyze the reliability and validity of a translated and adapted Polish approved academic version of the MCCB. Sixty one patients were assessed at baseline and again after 30 days. The study protocol approximated the MATRICS psychometric and standardization study; the 10 tests that comprise the MCCB were administered to participants. Functioning and psychopathological symptoms were also assessed. Patients and test administrators also assessed the tolerability and practicality of all the cognitive tests. All tests in the battery were found to have high test-retest reliability. All the tests were rated as tolerable and practical by patients and administrators. However practice effects were generally higher in the Polish version of the MCCB than in the original version. Our analysis corroborates previous evidence that the MCCB represents a good tool for assessing cognitive deficits in research studies of schizophrenia also in non-English speaking countries.

[The stabilizing effect of dehydroepiandrosterone on clinical parameters of metabolic syndrome in patients with schizophrenia treated with olanzapine - a randomized, double-blind trial]. / Stabilizujacy efekt dehydroepiandrosteronu na kliniczne parametry zespolu metabolicznego u pacjentów chorych na schizofrenie leczonych olanzapina - badanie randomizowane z podwójnie slepa próba.

OBJECTIVES: Epidemiological studies have shown that low levels of dehydroepiandrosterone might increase the risk of developing metabolic syndrome. The aim of this study was to evaluate whether dehydroepiandrosterone supplementation in schizophrenic patients treated with olanzapine would influence the anthropometric and biochemical parameters of metabolic syndrome. METHODS: Male schizophrenic patients (no=55) participated in a twelve-week, randomized, double blind, placebo controlled study. They received 100 mg dehydroepiandrosterone (DHEA) or placebo as an augmentation of olanzapine treatment (an average dosage 15 mg/day). Main outcomes of the study were changes in lipid profile, fasting glucose levels, body mass index and waist circumference values. RESULTS: Forty five patients completed the study. There were no major changes in the overall cholesterol value, HDL cholesterol, LDL cholesterol or triglycerides in either group. The results of the repeated measures analysis of the system: fasting glucose level 2x, (at the beginning and end of the study), 2x (the study group and the control group), showed a significant interaction (F =5.7, df= 1.000 p= 0.021). The blood glucose level was decreased in the DHEA group. Furthermore, increases in waist circumference (delta= -1.11, t=-2.87; df=20; p=0.01) and BMI value (delta= -0.48, t=-2.38; df=19; p=0.028) were observed in the placebo group. CONCLUSIONS: Dehydroepiandrosterone supplementation results in stabilization of BMI, waist circumference and fasting glycaemia values in schizophrenic patients treated with olanzapine. To confirm the insulin-like effect of dehydroepiandrosterone, long-term research concentrating on the evaluation of glucose metabolism has to be performed.

[Guidelines for the use of second-generation long-acting antipsychotics]. / Wskazówki do stosowania leków przeciwpsychotycznych II generacji o przedluzonym dzialaniu.

Long-acting injectable antipsychotics constitute a valuable alternative for the treatment of psychotic disorders, mainly schizophrenia. They assure a more stable drug level, improve treatment compliance, and increase the chances for favorable and long-lasting improvement. Additionally, the long-acting second-generation antipsychotics combine the values of long-acting injectable drugs with the values of atypical antipsychotics. Four second generation long-acting antipsychotics have been described: risperidone, olanzapine, aripiprazole and paliperidone. The indications for their use, treatment strategy, tolerance, and potential interactions are discussed.

[Androgens - a common biological marker of sleep disorders and selected sexual dysfunctions?]. / Androgeny - wspólny marker biologiczny zaburzen snu oraz wybranych dysfunkcji seksualnych?

The relationship between sleep disturbances and sexual dysfunctions still remains unclear. The links which indicate the importance of central nervous system and sleep mechanisms in regulations of the endocrine system seem to have bilateral character; the nature of such associations is not fully understood. The aim of the paper is to describe the influence of androgens on the relations between sexual functioning and sleep functions in patients of both sexes. The physiological role of the androgens is described with the emphasis put on the specific action of these hormones in sleep regulation, as well as the mutual relations between the regulatory role of sleep on the sexual apparatus. The newest data suggest that the androgenic hormonal profile is linked to the sleep rhythm, but not to the chronobiological diurnal rhythm in male patients. This may constitute the purpose for further research on the role of androgens in the connections between sexual and sleep disturbances. Up to date there is little known about androgens' role in sleep regulation in women. The influence of sexual activity disturbances as behavioral factors influencing the severity and the persistence of insomnia as well as their position among other factors important for the triggering of insomnia requires further scientific exploration.