Risk of sleep problems in a clinical sample of children who stutter.

PURPOSE: Previous studies have shown increased prevalence of sleep problems among people who stutter. However, there is a lack of knowledge about what these sleep problems may specifically be. METHOD: Fifty children who stutter (CWS) from 6;0 to 12;9 years of age and 50 age- and gender-matched controls participated in this study. Parents did not report coexisting conditions, excepting stuttering and/or sleep problems. Sleep problems were investigated using a standardized questionnaire answered by parents. The questionnaire shows cut-off scores to identify the risk of sleep problems as a whole and on each one of the six subscales (i.e., disorders of initiating and maintaining sleep; sleep breathing disorders; disorders of arousal; sleep-wake transition disorders; disorders of excessive somnolence; and sleep hyperhidrosis). Scores above the cut-off are suggestive of sleep problems. RESULTS: Twenty-one CWS scored higher than the cut-off on the sleep questionnaire compared to only two controls (p < 0.00001). Specifically, CWS scored higher than controls in disorders of initiating and maintaining sleep, sleep-wake transition disorders (especially jerking, sleep talking, and bruxism), and disorders of excessive somnolence (p < 0.0083, corrected for multiple comparisons). DISCUSSION: Compared to controls, CWS are at greater risk for sleep problems, which are not consequences of coexisting disorders. Present findings confirm and expand current knowledge about sleep problems in CWS. Directionality possibilities and clinical implications are discussed.

Effects of rapid maxillary expansion on sleep disturbance scale for children: A longitudinal CASE-series study.

OBJECTIVE: To evaluate the effects of rapid maxillary expansion (RME) on Sleep Disturbance Scale for Children (SDSC) with maxillary atresia. MATERIALS AND METHODS: The sample consisted of 27 paediatric patients evaluated through a Brazilian version of the SDSC, answered by their guardians at the following experimental time points: T0 (before installing the Hyrax expander), T1 (on the day of expander stabilization), T2 (3 months after expander stabilization), T3 (immediately after expander removal, following 6 months of retention), and T4 (3 months post-retention). Multilevel Poisson analysis adjusted for repeated measures was performed to compare outcomes across the assessment time points. RESULTS: The mean age of patients was 9.1 years (SD = 1.46). The total SDSC scores decreased and were statistically significant from T2 onwards (P < .01), with a decrease of 24% at T4 compared with T1 (IRR 0.76; 95% CI 0.69-0.84). The mean scores at T4 were already lower than the cutoff point for risk of sleep disorders. Regarding the specific domains, there was a significant reduction in sleep breathing disorders, sleep-wake transition disorders, and disorders of excessive somnolence as of T2 (P < .01), T3 (P < .05) and T4 (P < .05), respectively. CONCLUSION: RME in children with maxillary atresia had a positive effect on the reduction of total SDSC scores after 3 months of expander stabilization, sustained over 6 and 9 months and significant reduction in sleep breathing disorders domain, sleep-wake transition disorders domain, and disorders of excessive somnolence domain over time points.

Repetitive Sleep Starts in Allan-Herndon-Dudley Syndrome.

Allan-Herndon-Dudley syndrome (AHDS) is caused by mutations in the SLC16A2 gene, encoding for the monocarboxylate transporter 8 (MCT8). Central hypothyroidism and chronic peripheral thyrotoxicosis result in a severe phenotype, mainly characterized by poor growth, intellectual disability, spastic tetraparesis, and movement disorders, including paroxysmal ones (startle reaction and paroxysmal dyskinesias). Seizures are rarely reported. We conducted a retrospective analysis on video electroencephalography (EEG) recordings in four subjects with AHDS, focused on paroxysmal events. Among other manifestations recorded on EEG, we diagnosed repetitive sleep starts (RSS) in all subjects. RSS are a paroxysmal nonepileptic phenomenon occurring during sleep, similar to epileptic spasms in their clinical and electromyography characteristics, but not related to any EEG change. This is the first report on RSS in AHDS. We present video-EEG polygraphic documentation, suggesting that RSS could be underestimated or misdiagnosed. The importance of a correct diagnosis is crucial in a therapeutic perspective.

Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española / Don Quixote de la Mancha and the description of biphasic sleep in Spanish literature

Introducción: El sueño bifásico o segmentado es el hábito de dormir un primer y un segundo sueño separados por una vigilia. El historiador Ekirch describe que así se dormía en los tiempos preindustriales antes de la potente iluminación artificial. Se basó en textos en diferentes idiomas, desde la Antigüedad hasta el siglo xx, pero llama la atención la ausencia de fuentes en español. Objetivo: Se revisó la literatura española en busca de referencias al sueño bifásico usando como palabras clave ‘primer sueño’ y ‘a los primeros gallos’. Desarrollo: En la segunda parte de Don Quijote de la Mancha (capítulo 68), Cervantes describe el sueño bifásico con notable acierto, correlacionando los biotipos de Quijote y Sancho con sus temperamentos y hábitos de sueño y alimentarios. Curiosamente, Ekirch cita el capítulo, pero no el sueño bifásico. En esta revisión reproduzco 11 textos en español (siglos xiii a xix), mayormente obras clásicas, que lo refieren, disponiendo sus fases en coincidencia con las horas en que se dividía la noche en la era preindustrial: 20:00-21:00 a 00:00, primer sueño; 00:00 a 03:00, vigilia; 03:00 a 06:00, segundo sueño. La Celestina aporta datos significativos. Estudios recientes probaron que este hábito es fisiológico y se adapta al estilo de vida que lo requiere. Conclusiones: Se identifican y citan por primera vez referencias al sueño bifásico en la literatura española, confirmando la hipótesis de Ekirch. El Quijote lo describe con mayor amplitud y agudeza.(AU)

Introduction: Biphasic or segmented sleep is the habit of sleeping a first and a second sleep separated by a watching. The historian A Ekirch found that this was how people slept in pre-industrial times before the powerful artificial lighting. He is based on texts in different languages, from Antiquity to the 20th century, but the absence of sources in Spanish is striking. Aim: Review the Spanish literature searching references of the biphasic sleep using the keywords ‘first sleep’ and ‘at the first cockcrow’. Development: In the Second Part of Don Quixote de la Mancha (Chapter 68), Cervantes describes biphasic sleep with remarkable success, correlating the biotypes of Quixote and Sancho with their temperaments and sleeping and eating habits. Strangely, Ekirch cites the chapter, but not biphasic sleep. In this review I reproduce eleven texts in Spanish (13th to 19th centuries), mostly classical works, which refer to it by arranging its phases in a way that coincides with the hours in which the night was divided in the pre-industrial era: 20:00-21:00 to 00:00, first sleep, 00:00 to 03:00, wakefulness; 03:00 to 06:00, second sleep. La Celestina provides significant data too. Recent studies proved that this habit is physiological, and it adapts to the lifestyle that requires it. Conclusions: References to biphasic sleep in Spanish literature are identified and cited for the first time, confirming Ekirch’s hypothesis. In Don Quixote, Cervantes describes it with great breadth and sharpness.

Lateral Subdermic Venous Plexus Insufficiency: The Association of Varicose Veins with Restless Legs Syndrome and Nocturnal Leg Cramps.

PURPOSE: To determine whether nocturnal symptoms of restless legs syndrome (RLS) and muscle cramps in the legs are associated specifically with lateral subdermic venous plexus (LSVP) insufficiency and whether treatment can provide symptomatic relief. MATERIALS AND METHODS: A retrospective cross-sectional observational study of 506 patients at a single site analyzed whether RLS or nighttime leg cramping symptoms were associated with venous reflux in the LSVP using comprehensive venous ultrasound. The treatment outcomes of ultrasound-guided foam sclerotherapy (USGFS) were followed up for 1 year. RESULTS: Of 209 patients who reported restless legs symptoms, 179 (85%) demonstrated an abnormal LSVP. A total of 214 patients reported nighttime muscle cramping, of whom 197 (92%) demonstrated an abnormal LSVP. Among 124 patients presenting with both the symptoms, 113 (91%) demonstrated an abnormal LSVP. Conversely, of 83 patients who presented with neither RLS nor nocturnal cramping, 2 (2%) had an abnormal LSVP. Among 242 symptomatic patients with an abnormal LSVP who underwent treatment, the technical success rate was 100%. At 90-day follow-up, 224 patients (93%) reported continued relief, which was maintained at 93% (224/242) at follow-up at 1 year. When substratified, 90 patients presented primarily with RLS or cramping and showed only LSVP reflux, and when treated, all 90 (100%) had significant or complete relief of the symptoms. CONCLUSIONS: LSVP insufficiency demonstrates an association with symptoms of RLS and nocturnal leg cramps. LSVP treatment using USGFS demonstrated high technical and clinical success rates, with symptomatic relief up to 1 year, most pronounced when the LSVP was the only treated vein.

Sleep disturbances and behavior in Smith-Magenis syndrome.

BACKGROUND: The Smith-Magenis syndrome (SMS) shows a collection of neurodevelopmental problems including mild to moderate intellectual disability, change-related anxiety, impulsivity, speech delay, Attention-Deficit/Hyperactivity Disorder (ADH) and sleep disturbances. Sleep disorders, when present, have been treated in several populations with consecutive improvements in cognitive and behavioral aspects. AIMS: To better understand the existing relationships between sleep disturbances and behavioral problems in SMS syndrome this study describes the sleep and behavior problems in the SMS and explores the possible relation between both. METHODS AND PROCEDURES: 17 individuals with SMS (50% males; 11.2 ± 4.9 years old) and 12 individuals with typical development (50% male; 11.1 ± 4.4 years old) were investigated using the Sleep Disturbance Scale for Children and the Child Behavior Checklist. RESULTS: A high percentage (60%) of individuals with SMS have an indication of sleep disorders, being the most frequent disorders the sleep-wake transition disorders, and disorders of initiating and maintaining sleep with sleep latency higher than acceptable and total sleep time below acceptable. More than 94% of the SMS group presented clinical or borderline scores on the total behavioral problems scale. The most common behavioral problems were Externalizing Problems, Thought and Attention, ADH and Aggressive problems. There was a positive correlation between disorders of initiating and maintaining sleep, sleep-wake transition disorders, disorders of arousal, disorders of excessive somnolence and behavioral problems. CONCLUSIONS AND IMPLICATIONS: The worse the sleep disturbances investigated, the more severe the behavioral problems characteristics reinforcing the importance to address the sleep problems in the treatment of SMS individuals.

Sleep talking versus sleep moaning: electrophysiological patterns preceding linguistic vocalizations during sleep.

STUDY OBJECTIVES: Sleep talking (ST) has been rarely studied as an isolated phenomenon. Late investigations over the psycholinguistic features of vocal production in ST pointed to coherence with wake language formal features. Therefore, we investigated the EEG correlates of Verbal ST as the overt manifestation of sleep-related language processing, with the hypothesis of shared electrophysiological correlates with wake language production. METHODS: From a sample of 155 Highly frequent STs, we recorded 13 participants (age range 19-30 years, mean age 24.6 ± 3.3; 7F) via vPSG for at least two consecutive nights, and a total of 28 nights. We first investigated the sleep macrostructure of STs compared to 13 age and gender-matched subjects. We then compared the EEG signal before 21 Verbal STs versus 21 Nonverbal STs (moaning, laughing, crying, etc.) in six STs reporting both vocalization types in Stage 2 NREM sleep. RESULTS: The 2 × 2 mixed analysis of variance Group × Night interaction showed no statistically significant effect for macrostructural variables, but significant main effects for Group with lower REM (%), total sleep time, total bedtime, sleep efficiency index, and greater NREM (%) for STs compared to controls. EEG statistical comparisons (paired-samples Student's t-test) showed a decrement in power spectra for Verbal STs versus Nonverbal STs within the theta and alpha EEG bands, strongly lateralized to the left hemisphere and localized on centro-parietal-occipitals channels. A single left parietal channel (P7) held significance after Bonferroni correction. CONCLUSIONS: Our results suggest shared neural mechanisms between Verbal ST and language processing during wakefulness and a possible functional overlapping with linguistic planning in wakefulness.

Short report: Sleep talking and mental health in children with developmental problems and typically developing children.

BACKGROUND: Sleep talking although often considered benign is associated with poor mental health. However, it remains to be tested whether this association may be better explained by the presence of co-morbid sleep problems and the presence in survey samples of children with development disorders who tend to report a higher frequency of both sleep problems and poor mental health. AIM: The aim of the present study was to examine the association between sleep talking and mental health after controlling for comorbid sleep problems in typically developing children and children with developmental problems. METHODS: Parents of typically developing children (n = 1609) and children with either intellectual or developmental delay (n = 128) aged 5-10 years completed an omnibus survey which was administered through participating South Australian primary schools assessing mental health (Strengths and Difficulties Questionnaire) and sleep problems (Paediatric Sleep Survey Instrument). RESULTS: After controlling for co-morbid sleep problems, regression analyses revealed that sleep talking in typically developing children was an independent but weak predictor of worse emotional symptoms, conduct problems and peer relationship problems. By contrast, only a single significant association was observed in children with developmental problems. Paradoxically, sleep talking was associated with better prosocial behaviour. CONCLUSION: It is suggested that in typically developing children with a history of sleep talking, mental health merits evaluation at clinical interview while in both typically developing children and children with developmental problems, co-morbid sleep problems merit evaluation.

Factores predictores de la calidad del sueño en pacientes con migraña crónica / Predictive factors of sleep quality in patients with chronic migraine

Introducción: Uno de los factores contribuyentes en la cronificación de la migraña son los trastornos del sueño que pueden actuar como un factor precipitante y/o perpetuador en estos sujetos. El objetivo primario de este estudio fue identificar los factores predictores relacionados con la calidad del sueño en pacientes con migraña crónica (MC) y el objetivo secundario fue identificar si existían diferencias en variables psicológicas y de discapacidad entre los pacientes con MC que presentaban menor o mayor calidad del sueño. Métodos: Se llevó a cabo un estudio observacional, transversal, formado por 50 participantes con MC. Se registraron una serie de variables demográficas, psicológicas y de discapacidad mediante cuestionarios de autorregistro. Resultados: Se observaron correlaciones directas, moderadas-fuertes, entre las diferentes variables de discapacidad y psicológicas analizadas (p < 0,05). En la regresión, se estableció como variable criterio la calidad del sueño y las variables predictores fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y el catastrofismo ante el dolor que, en conjunto, explican el 33% de la varianza. En cuanto a la comparación de los grupos de mayor y menor afectación del sueño, se encontraron diferencias estadísticamente significativas en la variable de síntomas depresivos (p = 0,016) y catastrofismo ante el dolor (p = 0,036). Conclusiones: Los factores predictores de la calidad del sueño en pacientes con MC fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y, en menor medida, el catastrofismo ante el dolor. Los sujetos con peor calidad de sueño presentaron mayores niveles de catastrofismo ante el dolor y síntomas depresivos. (AU)

Introduction: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. Methods: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. Results: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). Conclusions: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms. (AU)

Effect of allergic rhinitis on sleep in children and the risk factors of an indoor environment.

PURPOSE: Allergic rhinitis (AR) is an independent risk factor for sleep disorders in children, including abnormal sleep behaviors. We investigated the occurrence of abnormal sleep behaviors in children with AR to determine indoor environmental risk factors affecting sleep. METHODS: This case-control study collected the sleep status and characteristics of the indoor environment of children aged 3-14 years with and without AR using a questionnaire. The differences between the two groups were compared using the Mann-Whitney U test, chi-square test, and Fisher's exact test. The indoor environmental factors affecting sleep behavior were analyzed using logistic regression analysis. RESULTS: Children with AR (n=427) had a higher probability of snoring (8.7 % vs. 2.9 %; P < 0.001), mouth breathing (14.1 % vs. 5.2 %; P < 0.001), restless sleep (6.6 % vs. 4.1 %; P = 0.047), sleep talking (3.3 % vs. 1.1 %; P = 0.003), and hyperhidrosis (16.4 % vs. 8.5 %; P < 0.001) than those without AR (n=1046). Emulsion wall paint (odds ratio (OR) = 2.779; 95 % confidence interval (CI), 1.332-5.796; P = 0.006) and tobacco exposure in early infancy (OR = 2.065; 95 % CI 1.079-3.950; P = 0.029) were associated with hyperhidrosis. CONCLUSION: Children with AR are more likely to have abnormal sleep behaviors than those without, including snoring, mouth breathing, restless sleep, sleep talking, and hyperhidrosis. Emulsion paint wall and tobacco smoke exposure in early infancy had a twofold higher risk of hyperhidrosis during sleep.

[Anti-voltage-gated potassium channel (VGKC) complex/leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated limbic encephalitis mimicking dementia with Lewy bodies in a patient with subacute REM sleep behavior disorder].

A 73-year-old woman was admitted to our hospital owing to abnormal diurnal behavior, sudden brief episodes of impaired awareness, and loud nocturnal sleep talking. Her symptoms had developed gradually over several months and had been treated as dementia with Lewy bodies (DLB) at another clinic. Video-polysomnography revealed brief sleep talking and gross movements associated with REM sleep without atonia. 18F-FDG PET revealed increased glucose metabolism in both medial temporal lobes. These findings led to a diagnosis of limbic encephalitis (LE) comorbid with REM sleep behavior disorder (RBD). After two courses of intravenous methylprednisolone pulse therapy, her symptoms gradually improved. Her illness was later confirmed as anti-voltage-gated potassium channel (VGKC) complex/leucine-rich glioma-inactivated protein 1 (LGI1) antibody-associated LE using serum analyses. Clinical features of anti-VGKC complex/LGI1 antibody-associated LE can mimic those of DLB, particularly when comorbid with RBD.

Health-related quality of life associated with nocturnal leg cramps in primary care: a mixed methods study.

BACKGROUND: Although nocturnal leg cramps are common, little research is available about their impact on quality of life. This mixed-methods study explored the impact of nocturnal leg cramps on health-related quality of life (HRQoL). METHODS: The study included primary care patients (>50 years) who reported suffering from nocturnal leg cramps (2016-2017). In the quantitative phase, patients completed a questionnaire about their HRQoL (SF-36) and the frequency of their cramps, and we computed the SF-36 scores. Then, we conducted a qualitative study using semi-structured interviews with patients with various levels of HRQol to explore their perception of the impact of cramps on their lives. RESULTS: A total of 114 patients (49%) agreed to participate in the quantitative study (mean age: 71, women: 62%) and 15 patients were included in the qualitative study (mean age: 69, women: 67%). The number of cramps in the previous week was low (mean: 1.6 (SD 1.5)). The SF-36 mean physical and mental summary scores were 43 and 50, respectively, and the domain scores were similar to a comparative general population. Whilst some patients reported little interference with their daily lives, others reported a major decrease in their HRQoL. SF-36 scores were not sufficient to describe the cramp-related impairment, as patients from all levels of SF-36 scores reported major impacts of NLC in the interviews. CONCLUSIONS: Some patients describe a specific impact of cramps on their lives, regardless of their HRQoL. These patients should be the target of future intervention trials.

Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of Lumbar Degenerative Disorders: A Retrospective Study.

BACKGROUND: The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD. METHODS: From October 2017 to June 2019, 126 patients with LDD were enrolled. All patients received shock wave therapy, once every two days for four weeks in total. Each treatment consisted of 2,000 shocks with a frequency of 8-10 shocks per second. To analyze the therapeutic progress, the following tests were performed (before and after therapy; 1- and 3-month follow-up) to assess pain and functional efficiency: (1) Visual Analog Scale (VAS), (2) the frequency and duration of muscle cramps, and (3) Fugl-Meyer (LL). RESULTS: Mean BMI of the participants was 26.1 ± 3.0 kg/m2. There was no statistically significant difference in terms of age or BMI between the groups (p > 0.05). Although all scoring parameters improved in both groups, the improvement in the ESWT group was more pronounced in pain (p < 0.001 and p < 0.001, respectively). A review of the LMA scores of our patients demonstrated moderate functional limitations before treatment and increased functional status after treatment in all patients, while overall functional status was fully improved in patients of the ESWT group (p < 0.001). CONCLUSION: The ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.

A randomized, double-blind, placebo-controlled, multicenter study assessing the efficacy of magnesium oxide monohydrate in the treatment of nocturnal leg cramps.

BACKGROUND: Magnesium supplements are widely used for prophylaxis and treatment of nocturnal leg cramps (NLC). However, there is little evidence in support of their effectiveness. The main impediment stems from the lack of assessments of cellular absorption. In the current study, we tested the efficacy and safety of a magnesium supplement - magnesium oxide monohydrate (MOMH), for which increased cellular absorption rates were demonstrated in an ex-vivo setting. METHODS: A randomized, double-blind, placebo-controlled multicenter study was conducted in hospitals and outpatient clinics in Ukraine, from February to August 2018. Eligible subjects received a capsule with MOMH 226 mg or placebo, once daily, at bedtime, for a 60-day period. The assessed parameters included frequency and duration of NLC episodes, quality of sleep, NLC-induced pain and quality of life sub-scores. The Fisher's Exact Test for comparison of groups by categorical variables was used. The Student's test or Mann-Whitney test were used for between-group comparison at different timepoints. ANCOVA followed by contrast analysis was used for comparison of groups at the end of the study. RESULTS: 175 (81%) out of 216 initially screened subjects completed the study. The number of NLC episodes has significantly decreased by the end of the study period as compared to baseline in both groups (p < 0.001 for both). There was a significant between-group difference in the magnitude of reduction in NLC episodes (p = 0.01), indicating a higher decrease in the MOMH group as compared to the placebo group (- 3.4 vs - 2.6, respectively). In addition, MOMH treatment resulted in a greater reduction in NLC duration (p < 0.007) and greater improvement in sleep quality (p < 0.001) as compared to placebo. CONCLUSIONS: MOMH was shown to be effective in the treatment of NLC as well as safe and well-tolerated. TRIAL REGISTRATION: NCT03807219 , retrospectively registered on January 16, 2019.

Repetitive sleep starts: An important differential diagnosis of infantile spasms.

OBJECTIVE: Repetitive sleep starts (RSS) are clusters of nonepileptic, spasm-like movements occurring during sleep onset. However, their characteristics have yet to be defined. We conducted a clinicoelectroencephalographic study of children with RSS to clarify their detailed characteristics. METHODS: To differentiate starts from epileptic spasms, we recruited children with brief "crescendo-decrescendo" muscle contractions that simultaneously involved the limbs and trunk without electroencephalogram changes, and that fulfilled the following criteria: (1) repeated occurrence (five or more) and (2) manifestation during sleep stage N1-N2. A total of nine children met these criteria. Their clinical information and video-electroencephalogram data were analyzed retrospectively. RESULTS: The background conditions observed at onset of RSS were perinatal hypoxic-ischemic encephalopathy (n = 4), West syndrome of unknown etiology (n = 1), and traumatic brain injury (n = 1). The age at onset of RSS, the number of starts in a given RSS cluster, the interval between starts, and the duration of surface electromyogram activity were between 3 and 46 months, 5 and 547, <1 and 60 s, and 0.3 and 5.4 s, respectively. None of the median value of these parameters differed between children with and without corticospinal tract injury. During the median follow-up period of 33 months, RSS disappeared spontaneously in five. CONCLUSION: This is the largest case series of RSS clarifying their clinicoelectroencephalographic characteristics reported to date. To avoid unnecessary antiepileptic therapies, clinicians should be aware of RSS and distinguish it from other disorders involving involuntary movements or seizures, especially epileptic spasms.

Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea.

CITATION: Children can exhibit a plethora of strange movements during sleep. Asymptomatic rhythmic movements of the head, neck, and trunk can be normal. When these interfere with sleep or cause self-injury, it is pathologic and termed rhythmic movement disorder. CITATION: Bishara J, Mitacek R. Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2137-2139.

Simultaneous administration of cocaine and caffeine dysregulates HCN and T-type channels.

RATIONALE: The abuse of psychostimulants has adverse consequences on the physiology of the central nervous system. In Argentina, and other South American countries, coca paste or "PACO" (cocaine and caffeine are its major components) is massively consumed with deleterious clinical consequences for the health and well-being of the general population. A scant number of studies have addressed the consequences of stimulant combination of cocaine and caffeine on the physiology of the somatosensory thalamocortical (ThCo) system. OBJECTIVES: Our aim was to study ion conductances that have important implications regulating sleep-wake states 24-h after an acute or chronic binge-like administration of a cocaine and caffeine mixture following previously analyzed pasta base samples ("PACO"-like binge") using mice. METHODS: We randomly injected (i.p.) male C57BL/6JFcen mice with a binge-like psychostimulants regimen during either 1 day (acute) or 1 day on/1 day off during 13 days for a total of 7 binges (chronic). Single-cell patch-clamp recordings of VB neurons were performed in thalamocortical slices 24 h after the last psychostimulant injection. We also recorded EEG/EMG from mice 24 h after being systemically treated with chronic administration of cocaine + caffeine versus saline, vehicle. RESULTS: Our results showed notorious changes in the intrinsic properties of the VB nucleus neurons that persist after 24-h of either acute or chronic binge administrations of combined cocaine and caffeine ("PACO"-like binge). Functional dysregulation of HCN (hyperpolarization-activated cyclic nucleotide-gated) and T-type VGC (voltage-gated calcium) channels was described 24-h after acute/chronic "PACO"-like administrations. Furthermore, intracellular basal [Ca2+] disturbances resulted a key factor that modulated the availability and the activation of T-type channels, altering T-type "window currents." As a result, all these changes ultimately shaped the low-threshold spikes (LTS)-associated Ca2+ transients, regulated the membrane excitability, and altered sleep-wake transitions. CONCLUSION: Our results suggest that deleterious consequences of stimulants cocaine and caffeine combination on the thalamocortical physiology as a whole might be related to potential neurotoxic effects of soaring intracellular [Ca2+].

Sueño y rendimiento académico en estudiantes universitarios: revisión sistemática / Sleep and academic performance in university students: a systematic review

INTRODUCCIÓN: Los estudiantes universitarios tienden a padecer problemas de regularidad, cantidad y calidad de sueño, que pueden afectar a su rendimiento académico. Estos problemas se relacionan con cambios propios de la fase del ciclo vital en la que se encuentran debido a diversos factores: madurativos, del desarrollo psicosocial (asociados con los procesos de individuación y socialización) y académicos. El estudio de la relación entre el sueño y el rendimiento académico en estudiantes universitarios es un área de investigación de interés creciente, que ha empezado a ser objeto de estudio en las últimas dos décadas. OBJETIVO: Revisión sistemática de la bibliografía existente sobre la relación del sueño y el rendimiento académico en los estudiantes universitarios. SUJETOS Y MÉTODOS: Se seleccionaron los artículos recogidos en la base de datos PubMed, siguiendo las directrices PRISMA. Se incluyeron los estudios que valoraban muestras de sujetos con una edad media entre 18 y 26 años, publicados en inglés o castellano, durante el período 2000-2019. Posteriormente, se evaluó la calidad de los artículos seleccionados siguiendo la normativa STROBE. RESULTADOS: Se identificaron 30 estudios, que fueron agrupados según distintos aspectos del sueño: somnolencia, duración, experiencia de privación total de sueño, calidad de sueño, cronotipo, regularidad y trastornos del sueño. CONCLUSIÓN: Los resultados de estos estudios sugieren que un sueño inadecuado afecta negativamente al rendimiento académico de los estudiantes universitarios

INTRODUCTION: University students tend to suffer from problems of sleep regularity, quantity and quality, which can affect their academic performance. These problems are related to changes typical of the phase of the life cycle in which they find themselves due to maturational, psychosocial development (associated with the processes of individuation and socialisation) and academic factors. The study of the relationship between sleep and academic performance in university students is an area of research of growing interest, which has started to be studied over the last two decades. AIM: To conduct a systematic review of the existing literature on the relationship between sleep and academic performance in university students. SUBJECTS AND METHODS: The articles included in the PubMed database were selected, following the PRISMA guidelines. Studies evaluating samples of subjects with an average age between 18 and 26 years, published in English or Spanish during the period 2000-2019 were included. Subsequently, the quality of the selected articles was evaluated according to the STROBE standard. RESULTS: Thirty studies were identified, which were grouped according to different aspects of sleep: drowsiness, duration, experience of total sleep deprivation, sleep quality, chronotype, regularity and sleep disorders. CONCLUSION. The results of these studies suggest that inadequate sleep has a negative effect on the academic performance of university students