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

INTRODUCCIÓN: La adenoamigdalectomía es un tratamiento eficaz en la apnea obstructiva del sueño. Su capacidad para resolver los problemas cognitivos y conductuales derivados no es tan clara. OBJETIVO: Analizar la evolución de dichas alteraciones a un año de la cirugía. MÉTODO: Se estudian alteraciones de conducta y cognitivas de 45 niños con apnea obstructiva del sueño y 30 controles sanos, entre 3 y 13 años. Ambos grupos son analizados mediante test psicológicos, en el momento basal y pasado un año. RESULTADOS: En el preoperatorio, todas las variables cognitivas y conductuales estaban más afectadas en el grupo de estudio que en el control: atención, en el 46,7% de casos del grupo de estudio y el 20% en el grupo control (p = 0,016); ansiedad, en el 60,9 y el 40,9% (no significativo); memoria, en el 55,6% y el 36,7% (p = 0,019); estructuración espacial, en el 64,4% y el 36,7% (p = 0,017); hiperactividad, en el 42,9% y el 12,5% (p = 0,016), y déficit de atención, en el 46,4% y el 8,3% (p = 0,003). A un año persiste mayor afectación en el grupo de estudio en todas las variables, aunque se mantienen diferencias significativas solo en estructuración espacial (31,3% versus 3,3%; p = 0,017) y déficit de atención (40,5% versus 16,7%; p = 0,031). Los porcentajes de pacientes que mejoran a un año no son significativamente diferentes en ambos grupos. CONCLUSIÓN: Las alteraciones de conducta y cognitivas de los niños con apnea del sueño se resuelven de forma parcial. Las mejoras obtenidas en las variables analizadas no difieren significativamente de la evolución normal del individuo y son independientes de la resolución de sus trastornos respiratorios

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 inboth 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=0.016), anxiety 60.9% versus 40.9% (not significant); memory 55.6% versus 36.7% (P=.019), spatial structuring 64.4% versus 36.7% (P=0.017), hyperactivity 42.9% versus 12.5% (P=.016), and attention deficit 46.4% versus 8.3% (P=0.003). 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=0.031). 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 esolved 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

[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.

Eficacia de la terapia herbal con melisa y valeriana en la deshabituación de benzodiacepinas en pacientes con insomnio primario / Efficacy of herbal therapy with melissa and valerian to treat benzodiazepine dependence in patients with primary insomnia

Introducción. La utilización de benzodiacepinas en pacientes con insomnio es una práctica habitual, y no es infrecuente una cierta inercia terapéutica que puede prolongar su consumo durante meses e incluso años. Aunque sus beneficios a corto plazo son evidentes, su uso prolongado conlleva a menudo un cierto grado de neuroadaptación, por ello disminuir los síntomas de abstinencia durante la retirada es importante para conseguir un mayor éxito en el abandono del fármaco. El uso de la terapia herbal puede ayudar a conseguir dichos objetivos. El objetivo del presente estudio es valorar la eficacia de la combinación valeriana y melisa en la mejoría de dichos síntomas y sobre los parámetros de sueño. Sujetos y métodos Estudio experimental randomizado con existencia de grupo control y sin enmascaramiento, realizado en la Clínica de Sueño Estivill sobre una muestra de 50 pacientes con insomnio primario, en tratamiento con 1 mg de lorazepam entre 6 meses y 2 años anteriores a su entrada en el estudio, que fueron asignados paritariamente a un grupo intervención (GI), que recibió una combinación de 120mg de extracto valeriana y 80 mg de extracto de melisa y a un grupo control (GC) realizándose visitas de seguimiento en consulta y autoregistros semanales para valorar parámetros relacionados con la calidad del sueño y descanso, así como la evolución de la sintomatología asociada más frecuentemente al abandono del fármaco. Resultados. Tras un seguimiento de 90 días, el grupo sometido a terapia herbal presentó una menor proporción de sujetos que manifestaron ansiedad ( GI 59%; GC 77%), irritabilidad ( GI 54%; GC 84%), inquietud (GI 52%; GC 62%) y trastornos del ánimo (GI 43%; GC 64%), así como un menor predominio de formas moderadas o severas en su presentación. Del mismo modo, el grupo tratado experimentó una disminución en el tiempo necesario para conciliar el sueño y de la vigilia intrasueño, así como un mayor tiempo de descanso medio tras la retirada, comparado con el grupo control. Aunque en el grupo tratado existió una mayor proporción de pacientes que manifestaron una mayor calidad en el sueño, y del descanso obtenido, las diferencias observadas no obtuvieron significación estadística. Conclusiones. A pesar de las limitaciones del estudio, los presentes resultados sugieren que la terapia herbal proporciona una mejoría subjetiva de la calidad de ciertos parámetros de sueño y de la presentación y severidad de los síntomas asociados a la retirada de benzodiacepinas en pacientes con insomnio primario, pudiendo constituir una alternativa eficaz en su abordaje (AU)

Introduction. The use of benzodiazepines in patients with insomnia is common practice, and it is not unusual to detect a degree of therapeutic inertia that can prolong the consumption of these agents for months or even years. Although they have clear short-term benefits, prolonged use often leads to a degree of neuroadaptation; it is therefore important to reduce the symptoms of abstinence during withdrawal in order to achieve greater success in the discontinuation of treatment. The use of herbal therapy can help to achieve these aims. The objective of the present study was to evaluate the efficacy of a combination of Valerian and Melissa on the reduction of symptoms of withdrawal and the effect of this combination on sleep parameters. Subjects and methods This was a randomised, controlled, unblinded experimental study performed in the Estevill Sleep Clinic on a sample of 50 patients with primary insomnia and on treatment with 1 mg of lorazepam for between 6 months and 2 years prior to recruitment. Patients were assigned in a 1-to-1 ratio to the intervention group (IG), which received a combination of 120 mg of extract of Valerian and 80 mg of extract of Melissa, or to the control group (CG). Outpatient follow-up visits and weekly patient diaries were used to evaluate the parameters related with the quality of sleep and rest and the severity of symptoms most commonly associated with drug withdrawal. Results. After a follow-up of 90 days, fewer subjects in the group receiving herbal therapy reported anxiety (IG, 59%; CG, 77%), irritability (IG, 54%; CG, 84%), restlessness (IG, 52%; CG, 62%), or mood disorders (IG, 43%; CG, 64%), and a smaller proportion of this group suffered moderate or severe forms of these symptoms. In addition, the IG presented a shorter time to onset of sleep and fewer episodes of waking compared with the CG, as well as a greater mean duration of sleep after withdrawal. Although a larger proportion of patients in the IG reported a better quality of sleep and of derived rest, the differences observed did not reach statistical significance. Conclusions. Despite the limitations of the study, the results suggest that herbal therapy gives rise to a subjective improvement in the quality of certain sleep parameters and a reduction in the onset and severity of symptoms associated with benzodiazepine withdrawal in patients with primary insomnia. This treatment could constitute an effective option in the management of benzodiazepine withdrawal (AU)

[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.

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 / Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study

Introducción: La nocturia es uno de los principales síntomas asociados a la hiperplasia benigna de la próstata (HBP). Produce alteraciones importantes en el desarrollo del sueño, dando lugar a interrupción de éste, que puede ser causante de un deterioro significativo de la calidad de vida. Método: Se realizó un estudio epidemiológico, multicéntrico, transversal en pacientes con síntomas del tracto urinario inferior / HBP de 60 años o mayores. Mediante una única visita, se recogieron datos socio demográficos y clínicos y se evaluó la calidad de sueño de pacientes con y sin nocturia mediante dos cuestionarios específicos: Medical Outcomes Study Sleep Scale (MOS-Sleep Scale) y Cuestionario Oviedo del Sueño. Resultados: Se incluyó a un total de 249 pacientes, de los cuales 205 presentaban nocturia (82,3%) y 44 no presentaban nocturia (17,7%). Todos los pacientes debían presentar una puntuación en el International Prostate Symptom Score (IPSS) superior o igual a13, motivo por el cual no se incluyó a pacientes con sintomatología leve (el 62,9 moderados y el 37,1% graves). Se observó que los pacientes con nocturia presentaban más problemas de sueño que los pacientes sin nocturia (más alteraciones del sueño, menos adecuación del sueño, mayor somnolencia diurna, mayor preocupación por su funcionamiento socio laboral, etc.). Discusión: Los pacientes con nocturia indicaron que su calidad de sueño era muy inferior a la de pacientes con síntomas del tracto urinario inferior/HBP, pero sin nocturia. La nocturia era causa de interrupciones frecuentes del sueño, causando malestar y cansancio diurno en los individuos afectados. El uso de estrategias terapéuticas que palíen o eliminen este efecto indeseable puede ser causa de mejora en la calidad de sueño (y calidad de vida) de los pacientes con HBP (AU)

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 ¡Ý13, 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 (AU)

[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.

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 / Importance of nocturia and its impact on quality of sleep and quality of life in patient with benign prostatic hyperplasia

Introducción: La nocturia es la principal causa de insomnio o de interrupción del sueño en varones adultos, ello se traduce en un efecto negativo sobre la actividad diaria, la calidad de vida y la calidad del sueño. La valoración de la nocturia y su impacto en la Calidad de Vida (CdV) y en la Calidad del Sueño (CdS) en el paciente con HBP ha sido escasa desde el punto de vista de la investigación clínica, además de la falta de métodos específicos que evaluasen dicho impacto. Objetivos: Entre los objetivos del tratamiento de la HBP debería procurarse la mejora de la calidad de vida del paciente mediante el control de los síntomas tanto de día como de noche. Recientemente se han desarrollado instrumentos específicos para valorar la afectación de la nocturia en la CdV, como es el cuestionario N-QoL, así como la afectación en la CdS, por medio de las horas de sueño ininterrumpido (HUS). Sería interesante evaluar cómo la reducción de la nocturia originada por el tratamiento sobre los STUI/HBP puede influir en parámetros objetivos como las HUS, y cómo se traduce en una mejora de la calidad del sueño y de la calidad de vida. Esta valoración debería realizarse, con la ayuda de estas herramientas específicas, durante el desarrollo clínico de los tratamientos farmacológicos. Con objeto de abordar la nocturia como problema urológico en los pacientes con STUI/HBP, así como de conocer la fisiología del sueño y el efecto de la nocturia sobre el sueño y sobre la calidad de vida, se celebró en Madrid una reunión de expertos urólogos que congregó a una cincuentena de profesionales de toda España. Este artículo presenta los principales conceptos expuestos en esta reunión. Conclusiones: La nocturia es un síntoma de alta prevalencia en la población masculina de edad avanzada con STUI / HBP. El estudio PreNoc mostró una prevalencia de nocturia en España del 83% en pacientes ≥60 años diagnosticados de HBP. La nocturia es el síntoma más molesto en los pacientes con STUI/HBP

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. Objetives: 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 ≥60 years old diagnosed of BPH. Nocturia is the most bothersome symptom in patients with STUI/BPH

Tratamiento farmacológico del insomnio: ventajas e inconvenientes. Cómo sustituir la medicación hipnótica / Pharmacological treatment of insomnia: advantages and disadvantages. Replacing hypnotics

La prevalencia estimada indica que alrededor de un tercio de la población adulta manifiesta síntomas de insomnio, de los que en un 9-12% manifiestan consecuencias diurnas. De éstos, sólo el 10% son tratados de forma adecuada. El insomnio es la mayoría de las veces un síntoma. Descubrir la etiología será fundamental para aplicar un correcto tratamiento. Existe una alta comorbilidad entre el insomnio y otras patologías médicas. Además de las causas médicas, los factores sociales, del entorno, psicológicos, conductuales y cronobiológicos también pueden causar insomnio. Pero realmente, una de las causas más frecuentes de insomnio crónico es el llamado insomnio psicofisiológico. Consiste en la presencia de ansiedad diurna somatizada con la asociación de unos hábitos de sueño erróneos. El tratamiento del insomnio debe estar dirigido hacia la eliminación de la causa que produce el trastorno, y provocar una mejoría sintomática. El insomnio transitorio y de corta duración, puede ser tratado con fármacos hipnóticos. En el insomnio crónico siempre tendrá que tratarse la causa que lo produce y los fármacos hipnóticos se utilizarán como complemento. El insomnio crónico está asociado a un aumento del riesgo de depresión y un uso (o incluso abuso) crónico de hipnóticos (AU)

Estimates indicate that around one third of the adult population has insomnia symptoms, of which 9%-12% has diurnal consequences. Of these, only 10% receive adequate treatment. Insomnia is usually only a symptom. Discovering its etiology is fundamental in order to apply correct treatment .There is a high comorbidity between medical insomnia and other pathologies. In addition to medical causes, social, environmental, psychological, behavioral and chronobiological factors also can also cause insomnia. One of the frequent causes of chronic insomnia is psychophysical insomnia. It consists of the presence of externalized diurnal anxiety along with counterproductive sleep habits. The treatment of insomnia ust be directed towards the elimination of the causes that produce the problem, and to alleviate the symptoms. Transitory, shot term insomnia can be dealt with using hypnotics. In chronic insomnia, the root causes that produce it need to be treated and hypnotics us ed as a complement. Chronic insomnia is associated with an increased risk of depression and a chronic use (or even abuse) of hypnotics (AU)

[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.

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

Introducción: Los pacientes con síndrome de apnea del sueño (SAOS) leve o moderado precisan una ampliación de la oferta terapéutica acorde con la intensidad de su enfermedad. Objetivo: Valorar la posibilidad de incluir los inhibidores de la bomba de protones (IBP) al arsenal terapéutico de estos pacientes. Material y métodos: Se diseña un estudio prospectivo entre pacientes con cuadro clínico de SAOS registrando de forma simultánea polisomnografía (PSG) nocturna y pHmetría de 24 horas de dos canales. Resultados: En esta primera fase del estudio se han recogido un total de 18casos, de los que en tres (16,7%) la pHmetría proximal durante la noche resultó positiva. Estos tres pacientes fueron tratados con IBP durante un mínimo de 3 meses siendo el resultado satisfactorio en dos. Conclusión: El tratamiento con IBP puede ser una alternativa terapéutica útil en algunos pacientes con SAOS de intensidad leve o moderada (AU)

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 (AU)

[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.

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

Introducción. Presentamos el caso de un paciente con amputación de ambas piernas con un síndrome de piernas inquietas (SPI). Este síndrome se caracteriza por sensación de inquietud en las piernas y necesidad imperiosa de movilizarlas. Caso clínico. Se trata de un paciente de 62 años, que consultó por insomnio de inicio y mantenimiento. Se interpretó la etiología del insomnio como un cuadro ansioso-distímico, que mejoró con la medicación adecuada. Cinco meses después volvió a la consulta con la misma sintomatología (insomnio de inicio). Reinterrogado el paciente, obervamos que presentaba claros síntomas de SPI, a pesar de la ausencia de sus extremidades inferiores. El tratamiento con ropinirol solucionó el cuadro clínico. Conclusión. No conocemos la existencia de otros casos similares, pero es probable que el escaso conocimiento existente sobre el SPI haga que muchos pacientes con amputaciones presenten el problema y no se hayan diagnosticado correctamente (AU)

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 (AU)

[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.

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

Introducción. La imposibilidad de tratar adecuadamente a los pacientes que presentan trastornos del sueño hace que los especialistas intentemos nuevas terapias farmacológicas, de acuerdo con la información del artículo de Salin-Pascual (1999) sobre el incremento del sueño profundo cuando se usaba la olanzapina como antipsicótico. Casos clínicos. Decidimos usar esta medicación en seis mujeres y tres varones, afectados de distintos problemas del sueño que condicionaban su insomnio crónico. Se utilizaron dosis de olanzapina que oscilaban entre los 2,5 y los 10 mg en dosis única. La anamnesis y la evolución clínica han sido nuestros criterios para elaborar los resultados y las conclusiones. El resultado fue positivo en ocho de los nueve pacientes, en cinco de ellos como monoterapia y en tres como politerapia. Conclusión. La población estudiada es insuficiente para establecer una probada eficacia del fármaco, pero el hecho de que en ocho de nuestros pacientes el tratamiento aportara una mejoría clara de la sintomatología, nos hace pensar que debe seguirse en esta línea de investigación (AU)

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 SalinPascual (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 (AU)

[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.

Estudio con 1.525 pacientes insomnes de etiología psiquiátrica / Study of 1525 patients with insomnia of psychiatric etiology

Presentamos una revisión de 1.525 casos de insomnio crónico, para determinar las distintas etiologías psiquiátricas responsables de éstos. La finalidad del estudio es llamar la atención sobre el elevado número de pacientes que acuden a una unidad de sueño, con síntomas de insomnio de inicio, mantenimiento y despertar precoz, cuya etiología es una enfermedad psiquiátrica. Llama la atención que mas del 94% de estos pacientes presentara un estado distímico y/o ansioso. El tratamiento farmacológico con psicotropos mejora el síntoma en la mayoría de los pacientes. Recalcamos que es imprescindible la colaboración entre especialistas de medicina del sueño y psiquiatras, para un diagnóstico y un tratamiento correctos de estos pacientes. Asimismo, insistimos en la necesidad que tenemos, todos los que nos dedicamos a la medicina del sueño, de formarnos de forma adecuada en estos campos de la psiquiatría, al menos en lo referente a realizar un diagnóstico etiológico adecuado. También hacemos hincapié en la presencia de algunos cuadros mixtos, como por ejemplo un síndrome de piernas inquietas, con un estado distímico, que se resuelve tratando el primero. La polisomnografia es útil para ayudar a mejorar el diagnóstico en estos casos (AU)

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

El principal inconveniente del tratamiento del síndrome de la apnea obstructiva del sueño (SAOS) con presión positiva nasal continua (nCPAP) es el incumplimiento, muchas veces debido a los efectos adversos del mismo. Mediante un análisis prospectivo de los pacientes tratados con nCPAP, se pretende demostrar la relación de las alteraciones nasales preexistentes con los efectos adversos de la utilización de nCPAP. Se han recogido 182 casos tratados con nCPAP y el 60 por ciento explicaron uno o más efectos adversos. De éstos, el 69 por ciento tenían dismorfia septal y 31 por ciento no (p=0,001). En los casos con efectos adversos de cariz nasal se observó un 80 por ciento de aumento de la tolerancia al nCPAP en los tratados médicamente y un 89 por ciento en los sometidos a septoplastia. Este trabajo pone en evidencia que los efectos adversos del tratamiento con nCPAP se relacionan de forma significativa con las alteraciones nasales preexistentes y que el tratamiento de éstas colabora a incrementar la tolerancia a nCPAP (AU)

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 (AU)

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.

Un paciente con insomnio

En este artículo se hace una revisión de las consideraciones básicas para el abordaje del insomnio. En primer lugar, se hace una descripción del problema clasificándolo en función de distintos criterios (gravedad, duración, forma de presentación, etc.) y unos comentarios sobre datos epidemiológicos. Seguidamente se exponen las diferentes etiologías del insomnio así como los requerimientos para realizar un buen diagnóstico diferencial. Por último, se exponen las distintas alternativas terapéuticas posibles en el insomnio en sus diferentes presentaciones (AU)