Sleep and rheumatic diseases.

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective. BACKGROUND: A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep. Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep. THERAPY: Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD.

[Control of Respiratory Symptoms During Sleep in Patients with Stable Bronchial Asthma]. / Nächtliche Symptomkontrolle bei Patienten mit stabilem Asthma bronchiale.

INTRODUCTION: Awareness of respiratory symptoms during day- and night-time is important for asthma control. Acoustic long-term recording offers a possibility to monitor symptoms objectively. In this prospective observational study frequency of night-time cough and wheezing was evaluated in patients with stable asthma. METHODS: Night-time cough and wheezing were monitored by LEOSound lung sound monitor in 40 patients with stable asthma. Patients did not complain of respiratory problems during day- and nighttime, asthma control test was 23 points on average. FEV1 was 84 ±â€Š15 %; MEF 50 71 ±â€Š27 % and Rtot 0,48 ±â€Š0,18 kPas/l. The age of the patients was 35 ±â€Š11 years. All patients had an antiobstructive and/or anti-inflammatory medication. The present study focuses on description of frequency, severity and characteristics of night-time symptoms like cough and wheezing in patients with stable asthma and tries to depict differences in patients who present cough or wheezing. RESULTS: Wheezing was monitored in 2 of the 40 patients. In the first patient duration of wheezing was 19 min, in the second 55 min. Lung function in patient 1 showed a moderate bronchial obstruction, he was still smoking. Patient 2 was a non-smoker with a significant bronchial obstruction (FEV1 49 %; MEF 50 27 % and Rtot 0,52 kPas/l). In 26 patients there was no coughing, 14 patients had 4 ±â€Š3 (2 - 13) cough epochs during the night. By dividing the collective in two groups differentiated by the presence of cough/ no cough we found no significant differences regarding lung function and ACT-scores. Both patients with night-time wheezing presented low ACT- Scores (20 and 21 points). CONCLUSIONS: Nocturnal wheezing and cough episodes were detectable in 2 respectively 14 patients with stable asthma. Long-term recording of normal and adventitious breath sounds offers a practical opportunity to evaluate night-time cough and wheezing objectively.