Obesity effects on sleep quality with anthropometric and metabolic changes

SUMMARY OBJECTIVE: Obesity is one of the etiological factors of sleep disorders (e.g., obstructive sleep apnea and restless leg syndrome). The aim of this study was to determine the effect of obesity on sleep quality by using the Pittsburgh Quality İndex and Berlin Question are and evaluate the association of sleep with anthropometric and metabolic parameters. METHODS: A total of 76 patients (41 females and 35 males) between the ages of 18 and 70 years with a body mass index >30 kg/m2 were included in this study. Homeostatic model assessment-insulin resistance, hemoglobin A1c, alanine aminotransferase, aspartate transaminase, total cholesterol, low-density lipoprotein, triglyceride, high-density lipoprotein, and thyroid-stimulating hormone levels were analyzed. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index, Berlin Questionnaire, and the Restless Leg Syndrome Questionnaire. RESULTS: A significant correlation was observed between Pittsburgh sleep quality index and body mass index, neck circumference, body fat index, muscle mass, hip and waist circumference, hemoglobin A1c, and homeostatic model assessment-insulin resistance (ps<0.005). The Pittsburgh sleep quality index median (2.5-97.5 percentile) value was 8 (2-18.6) in the patient group and 3.5 (0.1-7.9) in the control group (p<0.0001). Body mass index was found to be the predictor on Pittsburgh sleep quality index (R2=0.162, F=3.726, analysis of variance p=0.008). Notably, 88% (67) and 95% (57) of the poor sleepers were found to be at high risk for obstructive sleep apnea according to Berlin Questionnaire and Pittsburgh Sleep Quality Index, respectively. Also, the frequency of restless leg syndrome was 45% in obese individuals. CONCLUSIONS: We observed a significant correlation between Pittsburgh sleep quality index and the anthropometric and metabolic parameters. Also, the frequency of obstructive sleep apnea and restless leg syndrome was 88% and 45%, respectively, in obese individuals.

Chronic testicular pain cured by low-dose pramipexole: is there an association with restless legs syndrome?

Restless legs syndrome (RLS) is characterized by an urge to move the legs, predominantly at night. About one quarter of the patients with RLS report painful symptoms in the legs. In this case report, the patient presented at the sleep clinic with a chief complaint of insomnia and the classical symptoms of RLS. He also mentioned a chronic testicular pain (CTP). For over a year, the patient had undergone urologic investigation and empiric treatments, with only mild improvement of the testicular pain. After 3 months of therapy with pramipexole, the RLS symptoms and the CTP were no longer present. Finding an etiology for CTP can be challenging and many cases are diagnosed as idiopathic. RLS may be a forgotten and unidentified etiology for CTP in typical urological care. Considering the high prevalence of RLS and CTP, it is relevant to clarify the possible association. CITATION: Tedesco Silva LM, Lenz MCS, Martinez D. Chronic testicular pain cured by low-dose pramipexole: Is there an association with restless legs syndrome? J Clin Sleep Med. 2022;18(5):1467-1469.

Restless legs syndrome in patients on hemodialysis: Polysomnography findings.

INTRODUCTION: Restless legs syndrome (RLS) is a highly prevalent sleep movement disorder usually accompanied by periodic limb movements of sleep (PLMS). The incidence of RLS and PLMS in patients with end-stage renal disease (ESRD) on dialysis is much higher. Clinically, RLS and PLMS can co-occur. We hypothesized that patients with ESRD on dialysis would have a distinct presentation of RLS, with a higher prevalence of PLMS. METHODS: We examined clinical, demographic, biochemical, and polysomnographic characteristics of RLS in patients on dialysis matched to control subjects with normal renal function based on age, sex, body mass index, and frequency of apneas and hypopneas per hour of sleep, defined by the apnea and hypopnea index (AHI), in a proportion of 3:1. Patients with ESRD were on hemodialysis three times per week. Polysomnography was performed overnight in the sleep laboratory. FINDINGS: Patients on dialysis compared to control subjects had a lower amount of N3 sleep (77.6 ± 39.9 minutes vs. 94.8 ± 33.7 minutes, p = 0.037) and REM sleep (55.6 ± 27.5 minutes vs. 74.1 ± 28.4 minutes, p = 0.006), regardless of the presence of RLS. Among the patients on dialysis, those with RLS had higher PLMS. In the control group, patients with RLS had a lower ferritin level, which was not observed in the dialysis group. There was a significant interaction between PLMS and ESRD (p = 0.001), with a higher prevalence of PLMS in patients with ESRD on dialysis in a model adjusted for AHI, sex, arousals, and age. Factors that were associated with PLMS were RLS (p = 0.003), ESRD (p = 0.0001), and AHI (p = 0.041), with an adjusted R2 of 0.321. CONCLUSION: RLS in patients with ESRD on dialysis is independently associated with PLMS, regardless of the severity of sleep apnea, arousals, and age.

Purinergic Receptors in Neurological Diseases With Motor Symptoms: Targets for Therapy.

Since proving adenosine triphosphate (ATP) functions as a neurotransmitter in neuron/glia interactions, the purinergic system has been more intensely studied within the scope of the central nervous system. In neurological disorders with associated motor symptoms, including Parkinson's disease (PD), motor neuron diseases (MND), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Huntington's Disease (HD), restless leg syndrome (RLS), and ataxias, alterations in purinergic receptor expression and activity have been noted, indicating a potential role for this system in disease etiology and progression. In neurodegenerative conditions, neural cell death provokes extensive ATP release and alters calcium signaling through purinergic receptor modulation. Consequently, neuroinflammatory responses, excitotoxicity and apoptosis are directly or indirectly induced. This review analyzes currently available data, which suggests involvement of the purinergic system in neuro-associated motor dysfunctions and underlying mechanisms. Possible targets for pharmacological interventions are also discussed.

Excessive daytime somnolence is associated with hypoglycemia in adult Latinos with type 2 diabetes mellitus.

OBJECTIVE: This study aimed to determine the frequency of sleep disorders in hypoglycemic diabetic patients and possible relationships with scores of sleep disorders and restless legs syndrome in mestizo population in Guayaquil, Ecuador. METHODS: A multicenter, cross-sectional study conducted at an outpatient endocrinology clinic in urban and rural Ecuador regions, included 290 participants with type 2 diabetes mellitus with severe hypoglycemic episodes, completed, validated, and culturally adapted sleep questionnaires to assess daytime sleepiness, risk of sleep apnea and restless legs syndrome. Logistic regression analysis was conducted to identify factors associated with severe hypoglycemia. RESULTS: The prevalence of EDS was 56.8%, RLS prevalence of 46.2%, and 38.6% prevalence of high risk Berlin score. Multivariate logistic regression indicated hypoglycemic T2DM in the range of 56-75 years old were more likely to have high ESS (p 0.0001). CONCLUSION: A high prevalence of sleep disorders in diabetic Latinos living in Ecuador was evidenced. The presence of somnolence in patients older than 56 years and high HbA1c levels should alert the clinician for the occurrence of hypoglycemic episodes.

Frequencia dos disturbios de sono em mulheres na pos-menopausa com sobrepeso/obesidade / Frequency of sleep disturbances in overweight/obese postmenopausal women

OBJETIVOS: Avaliar a frequência dos distúrbios do sono, como apneia obstrutiva do sono, síndrome das pernas inquietas e insônia, em pacientes na pós-menopausa com sobrepeso/obesidade no ambulatório de distúrbios do sono no climatério. MÉTODOS: Foram selecionadas 34 pacientes na pós-menopausa, e os seguintes critérios de inclusão foram adotados: idade entre 50 e 70 anos, mínimo de 12 meses de amenorreia, Índice de Massa Corporal igual ou superior a 25 kg/m2, pacientes com queixas relacionadas ao sono e que tivessem sido submetidas a pelo menos uma polissonografia. As pacientes responderam a seis questionários sobre características do sono e sintomas do climatério e uso de medicações. Foram aferidos o peso e a altura em balança padronizada e as medidas das circunferências do abdome e do quadril. Para a análise estatística, o teste do χ2 foi utilizado para variáveis qualitativas, e o teste t de Student, para análise das variáveis quantitativas. RESULTADOS: A média de idade foi de 60,3 anos, o Índice de Massa Corporal médio de 31,6, o tempo de pós-menopausa médio de 11,6 anos e o Índice Menopausal de Kupperman médio de 19. Da amostra, 85,2% apresentou relação cintura/quadril igual ou superior a 0,8; metade apresentou escore igual ou superior a 9 na Escala de Epworth; 68% apresentou distúrbio do sono de acordo com o índice de Pittsburgh e 68% dos casos foram classificados como de alto risco para apneia do sono pelo Questionário Berlin. Na polissonografia, 70,5% apresentou eficiência do sono menor que 85%; 79,4% com latência do sono menor que 30 min; 58,8% com latência para sono REM menor que 90 min e 44,1% com apneia leve. Comparando os grupos, houve associação linear média entre IMC e IAH e relação ...

PURPOSE: To evaluate the frequency of sleep disorders, such as obstructive sleep apnea, restless leg syndrome and insomnia in overweight/obese postmenopausal women seen in a climacteric sleep disorders clinic. METHODS: Thirty-four postmenopausal women were selected using the following inclusion criteria: age between 50 and 70 years; at least 12 months of amenorrhea; body mass index (BMI) greater than or equal to 25 kg/m2; and sleep-related complaints with at least one previous polysomnography. Patients provided responses to 6 questionnaires related to sleep characteristics and menopausal symptoms. Weight and height were measured using standardized scales, and abdomen and hip circumferences were also measured. The statistical analyses were performed using the χ2 test for qualitative variables and using Student's t-test for quantitative variables. RESULTS: Patients' characteristics were as follows: mean age of 60.35 years; mean BMI of 31.62; an average of 11.61 postmenopausal years and an average Kupperman Index of 19. A total of 85.2% of the patients had a waist/hip ratio of less than 0.8. The Epworth Scale score was greater than or equal to 9 in 50% of patients; 68% had sleep disturbances according to the Pittsburgh Index, and 68% were classified as high-risk for sleep apnea by the Berlin Questionnaire. On polysomnography, 70.58% of the patients had a sleep efficiency lower than 85%; 79.41% had a sleep latency of less than 30 min; 58.82% had a REM sleep latency of less than 90 min, and 44.11% had mild apnea. When the groups were compared, a linear association was identified between BMI and the AHI average, and a relationship between high BMI and use of drugs for thyroid treatment was found. CONCLUSION: There was a high prevalence of sleep-disordered breathing, initial insomnia, fragmented sleep, and thyroid disorders in the group with higher BMI. .

Restless leg syndrome exacerbated by amytriptiline in a patient with Duchenne Muscular Dystrophy.

We report an unusual case of a Duchenne Muscular Dystrophy(DMD) patient who initiated a restless leg syndrome after the use of amytriptiline. The prescription and use of this medication for patients with persistent neuropathic pain is relatively common, especially for patients with DMD. Normally, this medication is well tolerated, however, we now report the occurrence of an induction or intensification of a restless leg syndrome case in a young patient with DMD, treated with amytriptiline for his chronic pain.

Mortality associated with periodic limb movements during sleep in amyotrophic lateral sclerosis patients / Mortalidade associada aos movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica

OBJECTIVE: To describe the prevalence and severity of periodic limb movements during sleep in amyotrophic lateral sclerosis patients and to explore this fact as a predictor of severity of the condition with respect to mortality. METHODS: In this case-control study, questionnaire and polysomnographic data were analyzed from 35 amyotrophic lateral sclerosis patients. Controls were matched by age, genre, and body mass index. A Kaplan-Meier curve was used to compare the survival time of patients with periodic limb movements of sleep index below or above 5. RESULTS: The number of amyotrophic lateral sclerosis patients with an index greater than five was higher than controls (19 (53%) versus 4 (11%); p<0.0001), and the mean index was higher (23.55±40.07 versus 3.28±8.96; p=0.0009). Earlier mortality was more common in patients with more than five periodic limb movements per hour of sleep than patients with less than five periodic limb movements per hour of sleep (7/19 (37%) versus 1/16 (6%); p=0.04) in this group of patients that had a mean survival of 33 months. CONCLUSIONS: There were more periodic limb movements of sleep in amyotrophic lateral sclerosis patients than in the control population. The higher number of these movements in amyotrophic lateral sclerosis patients correlates with disease severity and may suggest poor survival.

OBJETIVO:Descrever a prevalência e a severidade dos movimentos periódicos de membros durante o sono nos pacientes com esclerose lateral amiotrófica e explorar isso como um preditor de severidade da doença e mortalidade. MÉTODOS: Estudo caso controle em que foram analisados 35 pacientes por questionários e polissonografia. Os controles foram pareados por idade, gênero, e índice de massa corporal. Uma curva de Kaplan-Meier foi usada para comparar o tempo de sobrevida em pacientes com índice de movimento periódico de membros durante o sono acima e abaixo de 5. RESULTADOS: O número de pacientes com esclerose lateral amiotrófica com índice de movimentos periódicos de membros durante o sono acima de cinco foi maior do que os controles (19 (53%) versus 4 (11%); p<0,0001) e a média do índice de movimentos periódicos de membros durante o sono também foi maior no grupo dos pacientes (23,55±40,07 versus 3,28±8,96; p=0,0009). A mortalidade precoce foi mais comum em pacientes com mais que cinco movimentos durante o sono por hora do que pacientes com menos do que cinco movimentos durante o sono por hora (7/19 (37%) versus 1/16 (6%); p=0,04). Nesse grupo, os pacientes tiveram sobrevida média de 33 meses. CONCLUSÃO:Houve um maior número de movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica do que na população controle. O maior número de movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica foi correlacionado com severidade da doença e pode sugerir menor sobrevida.

Restless legs syndrome: study of prevalence among medical school faculty members / Síndrome das pernas inquietas: estudo de prevalência entre professores do curso de medicina

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25 percent of the subjects evaluated and most were women (62.5 percent). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

O objetivo deste estudo foi analisar a prevalência da síndrome das pernas inquietas (SPI) e suas implicações clínicas em uma amostra envolvendo docentes de um curso de Medicina. Foi realizado um estudo transversal que envolveu 78 docentes do curso de Medicina de uma Universidade do Sul do Brasil. Os indivíduos avaliados responderam um questionário com perguntas epidemiológicas e de diagnóstico para SPI, assim como escalas de sonolência de Epworth e Stanford. Os portadores de SPI responderam questionário de gravidade. As variáveis foram analisadas quanto à significância estatística. Obtivemos uma prevalência de indivíduos portadores de SPI de 10,25 por cento, sendo 62,5 por cento destes do sexo feminino. A existência de sonolência diurna excessiva foi significativamente maior em pacientes portadores da síndrome (p=0,04). Os pacientes portadores de SPI possuíam idade significativamente inferior ao grupo não sindrômico (p=0,02). A SPI mostrou-se bastante prevalente em nossa amostra. A prevalência de sonolência diurna e menos idade mostrou importante relação com esta síndrome, enquanto outros fatores possivelmente relacionados não foram confirmados.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27 percent). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52 percent) and excessive daytime sleepiness in 3 cases (6.8 percent). Fatigue was present in 32 subjects (73 percent) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

A genética dos distúrbios do sono na infância e adolescência: [revisão] / The genetics of sleep disorders in childhood and adolescence: [review]

OBJETIVO: O objetivo deste artigo é revisar a literatura sobre a genética dos distúrbios do sono na infância e adolescência. FONTES DOS DADOS: As palavras-chave "sono" e "genética" foram usadas para pesquisar por artigos publicados nos últimos cinco anos no banco de dados MEDLINE. A seguir, seus resumos foram analisados. A pesquisa também incluiu artigos clássicos, com a primeira descrição dos genes. SÍNTESE DOS DADOS: A recorrência familiar de muitos distúrbios do sono é um achado freqüente, mas loci genéticos foram descobertos para poucos deles. Descrevemos aqui distúrbios do sono transmitidos por herança genética e também aqueles que apresentam altos índices de recorrência familiar, apesar de nenhum gene específico haver sido encontrado. CONCLUSÕES: Apesar da maioria dos distúrbios do sono ainda não terem uma base molecular identificada, técnicas modernas são cada vez mais utilizadas para determinar a contribuição dos genes ao sono e aos seus distúrbios associados. A importância clínica destas descobertas pode estar relacionada com a melhoria de métodos diagnósticos, mas também como alvo para o desenvolvimento de medicações específicas.

OBJECTIVE: To review the literature regarding the genetics of sleep disorders in childhood and adolescence. SOURCES: Articles published in the past 5 years were searched on MEDLINE using the keywords sleep and genetics. Abstracts were then analyzed. Classical articles with the first description of genes were also included. SUMMARY OF THE FINDINGS: We often find familial recurrence in many sleep disorders. However, gene loci were discovered for only a few of them. We describe sleep disorders transmitted by genetic heritance and also those in that, although a gene was not found, familial recurrence is high. CONCLUSION: Although most of the sleep disorders do not have by now an identified molecular basis, modern techniques are being increasingly applied to determine the contribution of genes to sleep and its associated disorders. The clinical importance of these discoveries may relate not only to improving diagnostic methods but also as a target for drug development.