Mental Stress and Cardiovascular Health-Part I.

Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual's memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic-pituitary-adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

Obsessive-compulsive personality disorder in rapid eye movement sleep behavior disorder.

Rapid eye movement sleep behavior disorder (RBD) is a common prodromic non-motor symptom of Parkinson's disease (PD). Only few studies have evaluated the personality of RBD patients with conflicting results. Aim of the study was to evaluate the frequency of Personality Disorders (PeDs)in RBD. RBD patients, PD patients and healthy controls (HC) were enrolled. All the enrolled subjects underwent a full neurological examination. Motor symptoms were evaluated with the UPDRS-Motor Examination. PeDs were assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Twenty-nine RBD patients [14 men (48.3%); mean age 55.6 ± 11.1], 30 PD patients [17 men (56.7%); mean age 65.7 ± 10.7] and 30 HC [12 men (40%); mean age 65.7 ± 5.4] were enrolled in the study. PD patients had a disease duration of 4.5 ± 4.6 and presented a mean UPDRS-ME score of 26.7 ± 9.4. The most frequent PeDs was the Obsessive-Compulsive one (OCPeD); OCPeD was significantly more frequent in RBD (55.2%) patients than HC (13.3%; p-value < 0.001). No significant differences were found comparing the frequency of OCPeD in RBD patients to that in PD. In the present study, the prevalence of OCPeD in RBD patients was close to that reported in PD patients. Our data could suggest the existence of a common disease-specific RBD-PD personality profile.

Prevalence of isolated RBD in the city of Catania, Italy: a population-based study.

STUDY OBJECTIVES: Few studies have analyzed the prevalence of isolated rapid eye movement sleep behavior disorder (RBD) giving different estimates. Aim of the study was to estimate the prevalence of isolated RBD in the city of Catania. METHODS: A 3-stage design was adopted. Participants attending the offices of general practitioners in the city of Catania were screened with the RBD Single Question Screen questionnaire (Stage I). Positive participants were interviewed by phone and, if suspected of RBD, were invited for clinical examination by a movement disorders specialist and a sleep specialist (Stage II). After the clinical examination, patients diagnosed as probable isolated RBD (pRBD) were invited to undergo a video polysomnography (Stage III) to confirm the diagnosis of definite RBD. RESULTS: A total of 1,524 participants were screened. Of these, 220 (14.4%) screened positive. One hundred forty-three of them were further screened by phone, of whom 75 were suspected RBD. Thirty-six patients were diagnosed as pRBD, giving a prevalence of 2.36% (95% confidence interval, 1.71-3.25). Twelve pRBD agreed to a video polysomnography and, of these, 4 were diagnosed as definite RBD, giving a prevalence of 0.26% (95% confidence interval, 0.07-0.67). Prevalence adjusted by nonparticipants was 3.48% (95% confidence interval, 2.67-4.52) and 1.18% (95% confidence interval, 0.45-1.37) for pRBD and definite RBD, respectively. CONCLUSIONS: Prevalence of both pRBD and definite RBD in Italy is comparable to the estimates reported in literature, confirming that isolated RBD has a low prevalence in the general population. CITATION: Cicero CE, Giuliano L, Sgroi R, et al. Prevalence of isolated RBD in the city of Catania, Italy: a population-based study. J Clin Sleep Med. 2021;17(11):2241-2248.