Sleep in multiple sclerosis and neuromyelitis optica spectrum disorder-the SEMN study.

PURPOSE: This study aimed to (1) evaluate in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) the presence of sleep disorders such as hypersomnia, fatigue, risk of apnea, and the presence of restless legs syndrome/Willis-Ekbom disease (RLS/WED); (2) evaluate quality of sleep in patients with MS and NMOSD; and (3) correlate them with clinical and imaging data. METHODS: The study was cross-sectional and was carried out in the sector of demyelinating diseases of the neurology service of HUGV-UFAM, Manaus, Brazil, from January 2017 to December 2020. RESULTS: Our sample consisted of 60 patients, 41 with MS and 19 with NMOSD. We found that patients with MS and NMOSD have poor sleep quality (65%) and hypersomnia (53% in MS; 47% in NMOSD), but low risk of apnea by STOP-BANG. The frequency of RLS/WE found was 14% in MS, and 5% in NMOSD. No correlation existed between sleep quality, number of relapses, and sleep quality for the Expanded Disability Status Scale (EDSS), i.e., fatigue/illness duration. CONCLUSION: Patients with MS and NMOSD have poor sleep quality, excessive sleepiness, and are at low risk for OSA, yet the frequency of RLS/WED is like that of the general population. There does not seem to be a significant difference between these sleep disorders in these demyelinating diseases of the CNS.

Central hypersomnia and chronic insomnia: expanding the spectrum of sleep disorders in long COVID syndrome - a prospective cohort study.

INTRODUCTION: Long-onset COVID syndrome has been described in patients with COVID-19 infection with persistence of symptoms or development of sequelae beyond 4 weeks after the onset of acute symptoms, a medium- and long-term consequence of COVID-19. This syndrome can affect up to 32% of affected individuals, with symptoms of fatigue, dyspnea, chest pain, cognitive disorders, insomnia, and psychiatric disorders. The present study aimed to characterize and evaluate the prevalence of sleep symptoms in patients with long COVID syndrome. METHODOLOGY: A total of 207 patients with post-COVID symptoms were evaluated through clinical evaluation with a neurologist and specific exams in the subgroup complaining of excessive sleepiness. RESULTS: Among 189 patients included in the long COVID sample, 48 (25.3%) had sleep-related symptoms. Insomnia was reported by 42 patients (22.2%), and excessive sleepiness (ES) was reported by 6 patients (3.17%). Four patients with ES were evaluated with polysomnography and test, multiple sleep latencies test, and actigraphic data. Two patients had a diagnosis of central hypersomnia, and one had narcolepsy. A history of steroid use was related to sleep complaints (insomnia and excessive sleepiness), whereas depression was related to excessive sleepiness. We observed a high prevalence of cognitive complaints in these patients. CONCLUSION: Complaints related to sleep, such as insomnia and excessive sleepiness, seem to be part of the clinical post-acute syndrome (long COVID syndrome), composing part of its clinical spectrum, relating to some clinical data.

COVID-19 and Central Nervous System Hypersomnias.

Purpose of review: Central nervous system (CNS) hypersomnias can be triggered by external factors, such as infection or as a response to vaccination. The 2019 coronavirus disease (COVID-19) pandemic, which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to a worldwide effort to quickly develop a vaccine to contain the pandemic and reduce morbidity and mortality. This narrative review is focused on the literature published in the past 2 years and provides an update on current knowledge in respect of the triggering of CNS hypersomnias by infection per se, vaccination, and circadian rhythm alterations caused by social isolation, lockdown, and quarantine. Recent findings: At present, there is no consensus on the association between hypersomnias and COVID-19 vaccination or infection per se; however, the data suggest that there has been an increase in excessive daytime sleepiness due to vaccination, but only for a short duration. Kleine Levin syndrome, hypersomnia, excessive daytime sleepiness, and narcolepsy were aggravated and exacerbated in some case reports in the literature. Both increased and decreased sleep duration and improved and worsened sleep quality were described. In all age groups, delayed sleep time was frequent in studies of patients with hypersomnolence. Summary: The hypothesis that there is a pathophysiological mechanism by which the virus, vaccination, and the effects of quarantine aggravate hypersomnias is discussed in this review.

Association of sleep spindle activity and sleepiness in children with sleep-disordered breathing.

STUDY OBJECTIVES: The association of snoring and sleep-disordered breathing (SDB) with daytime sleepiness is well documented; however, the exact mechanisms, and especially the role of sleep microstructure that may account for this association remain incompletely understood. In a cohort of children with SDB, we aimed to compare sleep spindle activity between children with daytime sleepiness versus those without daytime sleepiness. METHODS: Children with SDB who reported daytime sleepiness were recruited and compared with age- and sex-matched SDB controls. Polysomnographic recordings were analyzed evaluating sleep spindle activity. A statistical comparison was carried out in both groups to assess the association between sleepiness and sleep spindle activity. RESULTS: Thirty-three children with SDB (mean age: 7.5 ± 1.7 years) were included, 10 with and 23 without daytime sleepiness. Spindle activity was lower in children with daytime sleepiness compared with those without; in stage N2, median (interquartile range) sleep spindle indexes were 77.5 (37.3) and 116.9 (71.2) (P = .015), respectively. CONCLUSIONS: Spindles were significantly reduced in children with SDB and daytime sleepiness. The exact mechanisms of this association remain unknown and future research is needed in order to establish the exact role of sleep spindle activity on daytime symptoms in children with SDB.

Caracterización clínico-espirométrica de pacientes asmáticos con síntomas nocturnos / Clinical-spirometric characterization of asthmatic patients with nocturnal symptoms

Introducción: Los síntomas nocturnos son frecuentes en asmáticos y pueden relacionarse con la gravedad, el grado de control del asma y la función pulmonar. Objetivos: Determinar las características demográficas, clínicas y espirométricas de pacientes asmáticos con síntomas nocturnos, que acuden a consulta externa de neumología. Métodos: Se realizó un estudio descriptivo transversal en 50 pacientes asmáticos con síntomas nocturnos, atendidos por consulta externa en el Hospital Neumológico Benéfico Jurídico, en el período comprendido de mayo de 2017 a mayo de 2018. Resultados: Predominó el sexo femenino (74,0 por ciento), la edad entre 40 y 59 años (52,0 por ciento), los antecedentes familiares de asma o alergia (60,0 por ciento) y múltiples comorbilidades asociadas (78,0 por ciento). La hipersomnia diurna estuvo presente en 80,0 por ciento de los casos, con una frecuencia significativamente elevada en pacientes con asma persistente moderada y severa, disminución de la reversibilidad aguda al broncodilatador, mal control de la enfermedad y limitación de la actividad física. Conclusiones: Los síntomas nocturnos en los pacientes asmáticos son frecuentes y se relacionan con la hipersomnia diurna, la gravedad del asma, el grado de control, la respuesta al broncodilatador y limitación de la actividad física(AU)

Introduction: Nighttime symptoms are frequent in asthmatics and can be related to severity, degree of asthma control and lung function. Objectives: To determine the demographic, clinical and spirometric characteristics of asthmatic patients with nocturnal symptoms, who go to an outpatient pulmonology clinic. Methods: A descriptive cross-sectional study was conducted in 50 asthmatic patients with nocturnal symptoms, they were assisted in the outpatient consultation at the Hospital Neumológico Benéfico Jurídico, from May 2017 to May 2018. Results: Female sex (74.0 percent), age ranging 40 and 59 years (52.0 percent), family history of asthma or allergy (60.0 percent) and multiple associated comorbidities (78.0 percent) predominated. Daytime hypersomnia was present in 80.0 percent of cases, with significantly elevated frequency in patients with moderate and severe persistent asthma, decreased acute reversibility to the bronchodilator, poor disease control, and limited physical activity. Conclusions: Nocturnal symptoms in asthmatic patients are frequent and are related to daytime hypersomnia, asthma severity, degree of control, response to the bronchodilator and limitation of physical activity(AU)

Sleep quality and related factors in postmenopausal women.

Sleep disorders, resulting from hormonal changes and vasomotor symptoms, are common in both peri- and postmenopausal women. Poor sleep quality is associated with increased metabolic and cardiovascular risk, depression and a global impairment in health status. OBJECTIVES: Our study aimed to assess sleep quality in a sample of postmenopausal women and to identify the factors associated with poor sleep quality. It also considered the negative impact of sleep disorders such as insomnia, hypersomnia and breathing disturbances. SUBJECTS & METHODS: Data came from a cross-sectional study of 195 postmenopausal women conducted at the Italian Hospital of Buenos Aires, Argentina. Their sociodemographic, gynecological and clinical characteristics were recorded and sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Oviedo Sleep Questionnaire (Cuestionario Oviedo de Sueño, COS). RESULTS: The mean PSQI score was 6.90 ± 4.43. Sleep problems were common, with 46.7% of participants scoring over 5 on the PSQI. Snoring was reported by 13% of the patients (PSQI item 10 A). While 10% of the poor sleepers reported episodes of apnea during rest (PSQI item 10B), 7.1% reported leg spasm (PSQ I item 10C). The mean total COS score was 17.57 ± 7. According to COS item 1, all the subjects reported some dissatisfaction with the quality of their sleep. According to the COS, the prevalence of insomnia was 3.6% using ICD-10 criteria and 15.4% using DSM-IV criteria. The mean ESS score was 6.12 ± 4.09. CONCLUSION: Postmenopausal women are likely to complain of disturbed sleep. Almost half of the women in this survey said their sleep quality was impaired, and most of that group would benefit from medical attention.

Hypersomnia and Bipolar Disorder: A systematic review and meta-analysis of proportion.

BACKGROUND: Hypersomnia is a common problem amongst individuals with Bipolar Disorder (BD). The objective of this meta-analysis is to estimate the frequency of hypersomnia in individuals with BD, and identify associated factors METHODS: Our search focused on articles documenting the frequency of hypersomnia among individuals with BD indexed in PubMed database and in the Cochrane Library, following the recommendations from the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) Group. A meta-analysis of proportion was conducted; funnel plot and Egger's test were used for the assessment of publication bias. Subgroups analyses were performed in order to evaluate possible confounders and associated factors. RESULTS: We identified 10 studies, which included 1824 patients with BD. The overall estimate of the proportion of BD cases that reported hypersomnia was 29.9% [95% confidence interval (CI): 25.8 - 34.1%, I2 = 59.2%; p < .05]. The funnel plot and the Egger's test suggest a low risk of publication bias (p = .527). The polarity of mood state, Bipolar Disorder type, use of medication, age, diagnostic criteria and hypersomnia criteria were not significantly related to hypersomnia. LIMITATIONS: There is a possibility that smaller cross-sectional studies were not included. The high heterogeneity between studies is frequent in meta-analysis of both interventional and observational studies. Hypersomnia was not the primary outcome in some of the included studies. CONCLUSIONS: To our knowledge, this is the first systematic review and meta-analysis of hypersomnia prevalence in patients with BD. Further studies focused on clinical correlates and implications for health outcomes in BD are warranted.

Val158Met polymorphism in the COMT gene is associated with hypersomnia and mental health-related quality of life in a Colombian sample.

The identification of genes that are risk factors for major depressive disorder remains a main task for global psychiatric research. The Catechol-O-methyltransferase (COMT) gene has been an important candidate risk factor for several psychiatric disorders. Previous studies have shown that a functional polymorphism (Val158Met) in this gene has an effect on several brain circuits and endophenotypes of psychiatric relevance. The aim of this study was to explore the association of a functional polymorphism in the COMT gene with psychological distress, sleep problems and health-related quality of life. Two hundred seventy young Colombian subjects (mean age: 21.3 years; range: 18-57 years) completed the Patient Health Questionnaire-9, the Perceived Stress Scale, the Oviedo Sleep Questionnaire and the 12-Item Short-Form Health Survey and were genotyped for the Val158Met polymorphism (rs4680) in the COMT gene. A linear regression analysis, adjusting for potential confounding factors, was carried out. Subjects that were Met carriers (Val/Met and Met/Met genotypes) showed higher scores for hypersomnia (p=0.001) and lower scores for mental health-related quality of life (p=0.007), these associations remained significant after correcting for multiple testing. These findings support the hypothesis of a broad effect of the Val158Met polymorphism in the COMT gene on several dimensions of behavior and neuropsychiatric symptoms.

Menstruation-Related Hypersomnia Treated with Hormonal Contraception: Case Report and Review of Literature.

Menstrual-related hypersomnia (MRH) is a rare disorder consisting of recurrent hypersomnia that is temporally linked with menses. An unusual case of an 18-yearold female with repeated episodes of hypersomnia was referred to a psychiatrist and a neurologist. A review of the literature was done so that an accurate diagnosis could be made, thereby enabling the development of an appropriate treatment plan. Making an effective diagnosis was a challenge because of the similarity of the symptoms of MRH with other psychiatric disorders. As additional clinical features were identified and treatments were ruled ineffective, further diagnoses were proposed. The patient's symptoms ceased with oral contraceptive treatment. Hormones play a role in the menstrual cycle and frequently affect behavior (such as sleep patterns). This case underlines the importance of multidisciplinary evaluation and treatment in unusual cases. The potential role of hormone fluctuation in patients with psychiatric conditions should be considered when diagnosing and treating those who are unresponsive to traditional pharmacological treatments.

Estudo comparativo sobre qualidade do sono entre universitários de uma instituição de ensino do sul catarinense / Comparative study about sleep quality in students of a South brazilian university

O sono tem função biológica fundamental na consolidação da memória, na termorregulação, na conservação e restauração da energia e, na restauração do metabolismo energético cerebral. Suas alterações interferem no funcionamento físico, ocupacional, cognitivo e social do indivíduo, comprometendo a qualidade de vida. Logo, este estudo objetivou estudar a qualidade do sono de 309 acadêmicos dos cursos de Medicina, Engenharia Civil e Direito, das primeiras, segundas, sétimas e oitavas fases, da Universidade do Sul de Santa Catarina, através do questionário de Pittsburgh-PSQI. Este estudo respeita a norma 466/2012 do Conselho Nacional de Saúde e, foi aprovado pelo CEP da Universidade. Dos estudantes entrevistados, 51,7% são do sexo feminino. As idades variaram de 18 a 56 anos, com média de 23 anos. 45% dos estudantes eram do curso de Medicina, 25,8% eram do curso de Engenharia Civil e 25,2% eram do curso de Direito. Por meio do questionário PSQI verificou-se que os estudantes demoravam, em média, 25 minutos para iniciar o sono. A duração média do sono na amostra foi de 6h50min. A associação entre qualidade do sono e os diferentes cursos se mostrou estatisticamente significante (p=0,009). Verificou-se que a Medicina apresentou 64,7% dos alunos com qualidade do sono ruim, no Direito, 60,3% e, no curso de Engenharia Civil 44,6% dos estudantes. Logo, concluiu-se que a qualidade do sono ruim foi mais prevalente entre os estudantes de Medicina, se comparada ao Direito e à Engenharia Civil e, a pior qualidade do sono foi encontrada nos estudantes da oitava fase.

Sleep has a fundamental biological role in memory consolidation, thermoregulation, conservation and restoration of energy. Your changes interfere with physical, occupational, cognitive and social functioning of the person, affecting the quality of life. Therefore, this study aimed to study the sleep quality of 309 academics of Medicine, Civil Engineering and Law, on the first, second, seventh and eighth semesters of the University (UNISUL), through the Pittsburgh-PSQI questionnaire. This study regards the norm 466/2012 of the National Health Council (CNS) and was approved by the Concil of Ethic Research of the University. Of the students surveyed, 51.7% are female. The ages ranged from 18 to 56 years, averaging 23 years. 45% of students were Medicine students, 25.8% were Civil Engineering students and 25.2% were Law students. The PSQI questionnaire found that students lingered on average 25 minutes to fall asleep. The average sleep duration in the sample was 6h50min. The association between quality of sleep and the different courses was statistically significant (p=0.009). It was found that Medicine has 64.7% of students with poor sleep quality, in Law 60.3% has poor quality of sleep and, in the Civil Engineering 44.6% of the students. Therefore, it was concluded that poor sleep quality was more prevalent among medical students, compared to Law and Civil Engineering and the worst sleep quality was found in the students of the eighth semester.

Recurrent hypersomnia: Report of medication-responsive cases.

INTRODUCTION: Recurrent hypersomnia (RH) is a rare disorder without established treatment. METHODS: We report 2 RH medication-responsive cases with typical characteristics of Kleine-Levin syndrome (KLS). CASE-REPORTS: A 10 y.o. girl and a 14 y.o. boy presented with sudden sleepiness for 3-9 days (every 2-3 weeks). Physical examination, brain images and blood tests were normal. Polysomnographic findings were heterogenous, including disrupted sleep architecture. MSLTs revealed 2-3 SOREMPs and short sleep latency. Carbamazepine rendered girl׳s sleep normalization, while risperidone normalized boy׳s sleep cycles. CONCLUSIONS: Facing the absence of clinical trials in RH, reports of responsive cases are the available therapeutic evidence.

Sonolência excessiva diurna: aspectos clínicos, diagnósticos e terapêuticos / Excessive daytime sleepiness: clinical, diagnostic and therapeutic aspects

A sonolência excessiva diurna (SED) é uma queixa prevalente e com grande impacto na qualidade de vida e na produtividade laborativa, além de trazer potenciais riscos de acidentes individuais e populacionais. Pacientes com doenças neurológicas, psiquiátricas, clínicas, além das próprias doenças do sono, com frequência se queixam de SED, cansaço e fadiga. O reconhecimento e o pronto tratamento desses sintomas e suas causas é importante. A abordagem pode ser farmacológica, não-farmacológica ou ambas. O acompanhamento deve ser criterioso e deve estimular a aderência, para que as melhorias na SED sejam de longo prazo.

Excessive daytime sleepiness (EDS) is a common and prevalent complaint with a great impact in quality of life and labor productivity, thus increasing potential life-threatening situations for the patient itself and the population. Patients with neurological, psychiatric, clinical disorders besides primary sleep disorders often complain of EDS, tiredness and fatigue. The recognition and prompt treatment of these symptoms and their causes are important. The approach can be pharmacological, non-pharmacological or both. Monitoring must be careful and should encourage adherence for improvements in EDS are long term.

Trastornos del sueño asociados a la hipertensión arterial / Sleeping Disorders associated to High Blood Pressure

Se realizó un estudio transversal con el objetivo de establecer la relación existente entre los trastornos del sueño y la Hipertensión Arterial. La muestra estuvo formada por el total de pacientes hipertensos pertenecientes a tres consultorios médicos del Policlínico Universitario Turcios Lima en el municipio de Pinar del Río, en el periodo comprendido de enero 2006 a diciembre de 2006. Para dicho estudio se aplicó una encuesta donde se recogen datos relacionados con los trastornos del sueño más frecuentes que presentaban los pacientes. Se utilizó el método estadístico de la prueba de hipótesis de comparación de proporciones para los niveles de significación hasta 1%. Se obtuvo como resultado un elevado por ciento (81,07%) de pacientes con trastornos del sueño, el insomnio y el ronquido resultaron los trastornos más frecuentes, un tercio de los pacientes refirió síntomas subjetivos de apnea obstructiva del sueño y la mitad de los pacientes ingerían psicofármacos para dormir.

A cross-sectional study was aimed at establishing the relationship between the sleeping disorders and the high blood pressure. The sample was comprised of the total of hypertensive patients attending to three medical offices belonging to"Turcios Lima" Teaching Policlinic in Pinar del Rio municipality between January- December 2006. A survey was applied for compiling the data related to the most frequent sleeping disorders in patients .The statistical method of the hypothesis testing of comparison of proportions was used with significant levels up 1%.It was obtained a high percentage of patients with sleeping disorders (81, 07) being insomnia and snore the most frequent disorders presented, a third of patients had subjective symptoms of obstructive sleeping apnea and the half of patients used sleeping drugs.

Narcolepsia: reporte de evidencia y revisión bibliográfica / Narcolepsy: evidence report and bibliographic revision

El sueño es una función fisiológica cuyo mecanismo aún no está bien precisado; sin embargo, la distinción entre sueño normal o sueño lento, y sueño paradójico o sueño REM (Rapid Eye Movements), es un buen aporte a la clínica. La narcolepsia es un trastorno del sueño caracterizado por ataques de somnolencia diurna asociados a un trastorno del sueño REM donde sus componentes normales (sueños y pérdida de tono muscular) se disocian e invaden la vigilia del sujeto. Se narra el caso de un paciente con narcolepsia cuyo principal antecedente es el estar sometido a un estrés emocional intenso. Se realiza una revisión de la bibliografía publicada sobre esta patología, en la que se destaca las principales características para diagnosticar este trastorno del sueño.

Sleep is a physiological function. Its mechanism is not yet specified; nevertheless differences between normal or slow sleep and paradoxical or REM (Rapid Eye Movements) sleep is a good contribution to clinic. Narcolepsy is a sleep disorder with fits of drowsiness as its essential feature, associated to a disorder of REM sleep in which its normal features (dreams and loss of muscle tone) are dissociated and invade the wake phase of the individual. A case of a patient with narcolepsy is told whose main record is being under an intense emotional stress. Published bibliography about this disorder is checked stressing the main features to make the diagnosis of this sleep disorder.