Sleep-Related Rhythmic Movements and Sleep Terrors: A Possible Common Neurophysiological Background in a Preschool Boy.

None: We report the case of a 3-year-old boy with a history of frequent and injurious sleep-related rhythmic movements and sleep terrors. We documented six episodes of body rocking and head banging via video polysomnography. No epileptic seizures were observed. In addition to the association between a sleep movement disorder and a disorder of arousal, our case shows that sleep-related rhythmic movements can arise not only during relaxed wakefulness or during a stable sleep stage, but also during a less clearly defined sleep stage during which it is difficult to further subtype non-rapid eye movement sleep. On the contrary, the portion of sleep without rhythmic movement episodes were clearly depicted with their physiological features. These findings might be of relevance for understanding the pathophysiology of both sleep-related rhythmic movements and sleep terrors and emphasize the importance to assess sleep using polysomnography, especially when episodes are frequent and injurious. The neurophysiological information obtained from this assessment might be helpful and guide an eventual treatment option.

Restless legs syndrome and nocturnal leg cramps: a review and guide to diagnosis and treatment.

Restless legs syndrome (RLS) and nocturnal leg cramps (NLCs) are common disorders affecting 7.0% and 24.1% of the population in some European countries, respectively. Patients suffering from RLS experience uncomfortable nocturnal sensations in the legs with the urge to move that dissipates while moving. NLC is characterized by abrupt muscle contraction, most often in the gastrocnemius or foot muscles, which occurs at night and may result in significant sleep disturbances. The diagnosis of these disorders has presented a challenge to health care providers because of symptom overlap with other sensory and motor disturbances with nocturnal predominance. Treatment options and approaches are lacking, partially because of our currently incomplete understanding of the pathophysiological mechanisms underlying these conditions. We reviewed the medical literature to provide a comprehensive assessment of RLS and NLC with a focus on improved diagnostic accuracy and treatment approaches.

Nocturnal leg cramps: Prevalence and associations with demographics, sleep disturbance symptoms, medical conditions, and cardiometabolic risk factors.

BACKGROUND: Nocturnal leg cramps (NLC) are common and poorly understood. OBJECTIVE: To determine the prevalence of NLC and associations with cardiometabolic, sleep, and behavioral risk factors in the US population. DESIGN: Cross-sectional epidemiology. PARTICIPANTS: National Health and Nutrition Examination Survey, 2005-2006 and 2007-2008 waves. MAIN OUTCOME(S) AND MEASURE(S): NLC were assessed with, "In the past month, how often did you have leg cramps while trying to sleep?" Responses were categorized as None, Mild, or Moderate-Severe. Demographics, medical history, sleep disturbances, and cardiometabolic risk factors were evaluated using the 2005-2006 dataset. Variables that demonstrated significant relationships to NLC after adjusting for age, sex, education, and BMI were assessed in the 2007-2008 dataset. Variables that were still significant were entered into a forward stepwise regression model combining both waves, to determine which variables best explained the variance in NLC. RESULTS: Prevalence was 24-25% reporting mild and 6% reporting moderate-severe NLC. NLC increased with age, lower education, unemployment, shorter sleep duration, all assessed sleep symptoms (nocturnal "leg jerks", snoring, snorting/gasping, difficulty falling asleep, difficulty maintaining sleep, non-restorative sleep, sleepiness, use of sleep medications), higher BMI, smoking, medical history (hypertension, heart failure, angina, stroke, arthritis, respiratory disease, and cancer), depression symptoms, and biomarkers (CRP, HbA1c, calcium, cadmium, red blood cells). Stepwise analysis showed that moderate-severe nocturnal leg cramps were associated with (in decreasing order of partial R2): leg jerks, poor overall health, arthritis, difficulty falling asleep, age, nonrestorative sleep, red blood cell count, lower education, angina, and difficulty maintaining sleep. CONCLUSIONS AND RELEVANCE: Based on this first large, representative study, NLC occurring >5x per month are reported by 6% of the adult US population. Sleep disturbance symptoms and health conditions are associated with higher frequency of NLC, suggesting that NLC is a marker, and possibly contributor, to poor sleep and general health.

[Ictal Speech Manifesting as Sleep Talking: A Case Report].

We present a 28-year-old female patient whose epilepsy started at the age of 19. MRI showed right perisylvian polymicrogyria. She exhibited various seizure symptoms, such as somatosensory aura involving the left leg, dyscognitive seizures, and amnesic seizures. Her mother indicated that the patient sometimes had "sleep talking", which was associated with presence of epileptic seizures of the next day. Long-term video electroencephalography (EEG) revealed that her episodes of "sleep talking" were epileptic events, specifically ictal speech, originating in the right hemisphere. The present case demonstrates the importance of considering "sleep talk" as an epileptic symptom. Careful history taking is fundamental to carry patients with possibly pathological "sleep talk" to the long-term video EEG, which will contribute correct diagnosis and treatment. (Received August 16, 2016; Accepted September 9, 2016; Published February 1, 2017).

A review of nocturnal leg cramps in older people.

Nocturnal leg cramps are common and troublesome, especially in later life, and have a significant impact on quality of life, particularly sleep quality. This article reviews the current state of knowledge regarding the diagnosis, frequency, pathophysiology and management of cramps. Recent evidence suggests that diuretic and long-acting beta-agonist therapy predispose to leg cramps. There is conflicting evidence regarding the efficacy of prophylactic stretching exercises in preventing cramps. Quinine remains the only medication proven to reduce the frequency and intensity of leg cramps. However, the degree of benefit from quinine is modest and the risks include rare but serious immune-mediated reactions and, especially in older people, dose-related side effects. Quinine treatment should be restricted to those with severe symptoms, should be subject to regular review and requires discussion of the risks and benefits with patients.

Valor diagnóstico de la poligrafía respiratoria en pacientes con baja probabilidad de síndrome de apneas e hipopneas durante el sueño / Diagnostic value of respiratory polygraphy in patients with low probability of obstructive sleep apnea syndrome

Introducción y objetivo: La polisomnografía (PSG) es el método estándar para el diagnóstico del síndrome de apneas e hipopneas del sueño (SAHS). Es una técnica cara, compleja y de poca disponibilidad, por lo que la poligrafía respiratoria (PR) es de uso habitual. La PR no está validada en casos de baja probabilidad; sin embargo, la normativa vigente contempla el tratamiento conservador en caso de PR negativa. Nos hemos propuesto estudiar la prevalencia y gravedad del SAHS mediante PSG, en una muestra de pacientes con baja probabilidad y PR negativa. Material y métodos: Estudio retrospectivo, observacional, descriptivo y analítico de pacientes con baja probabilidad de SAHS y PR negativa a los que se les realizó posteriormente una PSG. Se registraron datos antropométricos, clínicos y características del sueño. Resultados: Ochenta y dos pacientes fueron incluidos. En el registro de la PSG se observó un incremento de hipopneas (137,8 ± 70,1 frente a 51,2 ± 38,4 [p < 0,05]) y del índice de apneas e hipopneas (27,8 ± 15,6 frente a 11,7 ± 7,1 [p < 0,05]), así como un aumento del 17% en la prevalencia de SAHS, de un 35% de casos graves y una disminución de un 41% de los casos leves. Conclusión: De acuerdo con los resultados de este estudio, la PR subestima de forma estadísticamente significativa la prevalencia y gravedad del SAHS en pacientes con baja probabilidad. Es necesario un adecuado proceso de estratificación de riesgo para la correcta indicación de pruebas diagnósticas, y recomendable realizar una PSG cuando se ha realizado una PR con resultado negativo en estos pacientes (AU)

Introduction and objective: Polysomnography (PSG) is the gold standard technic for the diagnosis of obstructive sleep apnea syndrome (OSAS). It is an expensive, complex and not always available technic, meaning that respiratory polygraphy (RP) has become usual. Although RP is not validated in low probability patients, Spanish guidelines recommend conservative treatment in patients with negative RP. We intended to study the prevalence and severity of OSAS through PSG in a sample of patients with low probability and negative RP. Material and methods:Retrospective, observational, descriptive and analytic study of low probability OSAS patients with negative RP in whom a PSG was performed. Anthropometric, clinical and sleep data were collected. Results: Eighty-two patients were included. After PSG, a greater number of hypopneas (137.8 ± 70.1 vs. 51.2 ± 38.4 [P < .05]) and apnea hypopnea index (27.8 ± 15.6 vs. 11.7 ± 7.1 [P < .05]) was observed, as well as an increment in OSAS prevalence of 17%, which was 35% in severe OSAS. In mild OSAS, there was a decrement of 41%. Conclusion: According with the results of this study, RP significantly underestimates the prevalence and severity of OSAS in low probability patients. While it is necessary to adequately stratify the OSAS probability in order to correctly indicate diagnosis tests, we recommend performing a PSG in low probability patients with negative RP (AU)

Factores asociados a la somnolencia diurna en adultos mayores chilenos / Dietary factors associated with daytime somnolence in healthy elderly of Chile

Objetivo. Determinar la prevalencia de somnolencia leve y excesiva y qué factores están asociados a la presencia de somnolencia diurna en adultos mayores. Métodos. Participaron 1.780 adultos mayores de 60 años, autónomos, de ambos sexos, de los cuales completaron toda la información 1.704 (70,9 ± 7,9 años; 62% mujeres). A cada uno de ellos se les realizó la encuesta de somnolencia de Epworth (ESE), el cuestionario de calidad de sueño de Pittsburg, además de solicitar información sobre consumo de tabaco, horario de cena, y una evaluación antropométrica. Una puntuación en ESE > 10 se consideró somnolencia y puntuaciones >15 somnolencia excesiva o severa. Resultados. Entre los menores de 80 años un 5,3% presentaron un ESE >15 y un 26,2% un ESE >10. En mayores de 80 años la prevalencia de somnolencia fue del 6,3% para ESE >15 y del 32,5% para ESE >10. En el modelo ajustado los factores asociados a incremento del riesgo de somnolencia (ESE > 10) fueron la edad mayor de 80 años (OR = 1,58; IC 95% = 1,14-2,19), y cenar después de las 21 horas (OR = 1,3; IC 95% = 1,01-1,68). Por el contrario, solo la edad mayor de 80 años se asociaba de manera independiente a somnolencia severa (OR = 1,81; IC 95% = 1,01-3,29). Conclusiones. Cenar después de las 21 horas y una edad por encima de los 80 años se asocian con mayor probabilidad de somnolencia diurna. En cambio solo la edad mayor de 80 años se asocia a somnolencia diurna severa (AU)

Aim. To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. Methods. A total of 1780 independent individuals 60 years and olderof both sexes (70.9 ± 7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score > 10 was considered drowsiness and scores > 15 excessive or severe drowsiness. Results. Among the population under 80 years, 5.3% showed ESE score > 15 and 26.2% an ESE score > 10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score > 15 and 32.5% for an ESE score > 10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE > 10) were age older than 80 years (OR = 1.58; 95% CI = 1.14 to 2.19) and dinner after 21 hours (OR = 1.3; 95% CI = 1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR = 1.81; 95% CI = 1.01 to 3.29). Conclusions. Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness (AU)

Exploding head syndrome.

Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided.

Sleep-related declarative memory consolidation and verbal replay during sleep talking in patients with REM sleep behavior disorder.

OBJECTIVE: To determine if sleep talkers with REM sleep behavior disorder (RBD) would utter during REM sleep sentences learned before sleep, and to evaluate their verbal memory consolidation during sleep. METHODS: Eighteen patients with RBD and 10 controls performed two verbal memory tasks (16 words from the Free and Cued Selective Reminding Test and a 220-263 word long modified Story Recall Test) in the evening, followed by nocturnal video-polysomnography and morning recall (night-time consolidation). In 9 patients with RBD, daytime consolidation (morning learning/recall, evening recall) was also evaluated with the modified Story Recall Test in a cross-over order. Two RBD patients with dementia were studied separately. Sleep talking was recorded using video-polysomnography, and the utterances were compared to the studied texts by two external judges. RESULTS: Sleep-related verbal memory consolidation was maintained in patients with RBD (+24±36% words) as in controls (+9±18%, p=0.3). The two demented patients with RBD also exhibited excellent nighttime consolidation. The post-sleep performance was unrelated to the sleep measures (including continuity, stages, fragmentation and apnea-hypopnea index). Daytime consolidation (-9±19%) was worse than night-time consolidation (+29±45%, p=0.03) in the subgroup of 9 patients with RBD. Eleven patients with RBD spoke during REM sleep and pronounced a median of 20 words, which represented 0.0003% of sleep with spoken language. A single patient uttered a sentence that was judged to be semantically (but not literally) related to the text learned before sleep. CONCLUSION: Verbal declarative memory normally consolidates during sleep in patients with RBD. The incorporation of learned material within REM sleep-associated sleep talking in one patient (unbeknownst to himself) at the semantic level suggests a replay at a highly cognitive creative level.

Recent advances in sleep-wake cycle and biological rhythms in bipolar disorder.

The cyclical nature of periodic switches in energy, motor activation and sleep-wake cycles in bipolar disorder suggests a strong underlying relationship with disturbances in chronobiology. Current research is refining our understanding of the various patterns of sleep-wake and biological rhythms alterations at early and later stages of this illness, as well as across its depressive/fatigue, manic/hypomanic and euthymic phases. This research focuses on early detection and subsequent monitoring to predict and better manage recurrent episodes. Sleep-wake cycle and biological rhythms disturbances are also well known to affect other key aspects of physical health (notably metabolic functions), cognitive performance and elevated risks for suicide. Increasing evidence now supports the integration of behavioural or pharmacological therapeutic strategies that target the sleep-wake and circadian systems in the ongoing treatment of various phases of bipolar disorder.

Factors associated with night-time calf muscle cramps: a case-control study.

INTRODUCTION: Although highly prevalent and painful, night-time calf muscle cramping is poorly understood, and no treatment has shown consistent efficacy or safety. METHODS: One hundred sixty adults were recruited from New South Wales, Australia, including 80 who had night-time calf cramping at least once per week and 80 age- and gender-matched adults who did not. Participants were assessed using reliable tests of lower limb strength, flexibility, morphometrics, circulation, and sensation, and were questioned about health and lifestyle factors, diet, medications, exercise, symptomatology, sleeping habits, and footwear. RESULTS: Conditional logistic regression identified 3 factors independently associated with night-time calf muscle cramps: muscle twitching (OR 4.6, 95% CI 1.6-15.5, P = 0.01); lower limb tingling (OR 4.1, 95% CI 1.6-10.3, P = 0.003); and foot dorsiflexion weakness (OR 1.02, 95% CI 1.01-1.03, P = 0.002), which represented other measures of lower limb weakness in the model. CONCLUSIONS: Night-time calf muscle cramps were associated with markers of neurological dysfunction and potential musculoskeletal therapeutic targets.

Stretching before sleep reduces the frequency and severity of nocturnal leg cramps in older adults: a randomised trial.

QUESTION: In adults who experience nocturnal leg cramps, does stretching of the calf and hamstring muscles each day just before sleep reduce the frequency and severity of the cramps? DESIGN: A randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS: Eighty adults aged over 55 years with nocturnal leg cramps who were not being treated with quinine. INTERVENTION: The experimental group performed stretches of the calf and hamstring muscles nightly, immediately before going to sleep, for six weeks. The control group performed no specific stretching exercises. Both groups continued other usual activities. OUTCOME MEASURES: Participants recorded the frequency of nocturnal leg cramps in a daily diary. Participants also recorded the severity of the pain associated with nocturnal leg cramps on a 10-cm visual analogue scale. Adverse events were also recorded. RESULTS: All participants completed the study. At six weeks, the frequency of nocturnal leg cramps decreased significantly more in the experimental group, mean difference 1.2 cramps per night (95% CI 0.6 to 1.8). The severity of the nocturnal leg cramps had also decreased significantly more in the experimental group than in the control group, mean difference 1.3 cm (95% CI 0.9 to 1.7) on the 10-cm visual analogue scale. CONCLUSION: Nightly stretching before going to sleep reduces the frequency and severity of nocturnal leg cramps in older adults. TRIAL REGISTRATION: NCT01421628.

Sleep-to-wake transition movement disorders.

Consciousness and vigilance level are important factors for the manifestation and variability of many disorders, including movement disorders. Usually lumped together into unspecified "Wakefulness," the transition between wakefulness and sleep--the pre-dormitum, and between sleep and wakefulness--the post-dormitum, possess intrinsic cerebral metabolic patterns and mental, behavioural, and neurophysiological characteristics which make these peculiar states of vigilance independent. Moreover, the pre- and post-dormitum, with the relative state-dependent changes in firing patterns of many neuronal supra-pinal populations, act to release pacemakers responsible for different sleep-related motor phenomena. The relevance of pre-dormitum and post-dormitum as states different from full wakefulness and full sleep is, indeed, indicated by disorders which appear exclusively during either state, including motor disorders such as propriospinal myoclonus and awakening epilepsy. We will focus on three paradigmatic physiological/pathological motor phenomena (rhythmic movement disorder, hypnic jerks, and propriospinal myoclonus) strictly linked to the sleep-wake transition periods. Thereafter we will briefly discuss how the process of pre-dormitum and post-dormitum can lead to such disruption of motor control.