Rapid Eye Movement (REM) Sleep Behavior Disorder and REM Sleep with Atonia in the Young.

BACKGROUND: Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects. METHODS: A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period. RESULTS: Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects. CONCLUSION: We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.

Troubles du comportement en sommeil paradoxal et sommeil paradoxal sans atonie musculaire chez les jeunes. Contexte: Les troubles du comportement en sommeil paradoxal (TCSP) et le sommeil paradoxal sans atonie musculaire ont acquis une grande importance clinique. En effet, des données à long terme ont montré de quelle façon ils pouvaient progresser chez des adultes âgés atteints de maladies neurodégénératives. Toutefois, on en sait beaucoup moins au sujet des TCSP et du sommeil paradoxal sans atonie musculaire au sein des groupes d'âges plus jeunes. Cette étude entend donc comparer les caractéristiques cliniques et polysomnographiques (PSG) de jeunes patients donnant à voir des signes de TCSP à celles d'autres jeunes patients atteints d'autres troubles neurologiques et de sujets en bonne santé appariés en fonction de l'âge. Méthodes: Nous avons passé en revue de façon rétrospective les dossiers de jeunes patients (< 25 ans) donnant à voir des signes cliniques de TCSP et ayant été vus consécutivement. Les données recueillies ont été comparées aux données de patients atteints d'épilepsie, de troubles de l'attention avec hyperactivité et d'autisme ainsi qu'à celles de sujets en bonne santé soumis à des examens de PSG pendant une période de deux ans. Résultats: Au total, on a diagnostiqué chez 12 patients des TCSP. Ajoutons que 22 d'entre eux étaient atteints d'autisme alors que 10 étaient atteints de troubles de l'attention avec hyperactivité et 30 d'épilepsie. Mentionnons par ailleurs que 14 sujets en bonne santé ont été inclus dans cette étude. Après analyse, il s'est avéré que 8 patients atteints d'autisme (30 %), 3 de troubles de l'attention avec hyperactivité (30 %), 1 d'épilepsie (3,3 %) et 6 ayant donné à voir des symptômes ressemblant à ceux des TCSP (50 %) montraient des mouvements et des comportement anormaux en sommeil paradoxal. Des signes d'activité musculaire transitoire excessive et/ou d'activité musculaire durable lors d'épisodes de sommeil paradoxal ont été détectés chez tous les patients satisfaisant aux critères des TCSP, chez 16 patients autistes sur 22 (72 %), chez 6 patients atteint de troubles de l'attention avec hyperactivité sur 10 (60 %) en comparaison avec seulement 6 patients épileptiques sur 30 (20 %) et aucun parmi les sujets en bonne santé. Conclusion: Lors d'examens polysomnographiques, nous avons en définitive observé qu'une forte proportion de jeunes patients atteints d'autisme et de troubles de l'attention avec hyperactivité, ainsi que quelques-uns atteints d'épilepsie, donnaient à voir des signes de perte de sommeil paradoxal associés à l'atonie musculaire ainsi que des comportements ressemblant à ceux de jeunes patients atteints de TCSP.

Effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy versus healthy controls - A prospective study.

We aimed to evaluate the effect of sleep quality on memory, executive function, and language performance in patients with refractory focal epilepsy and controlled epilepsy and compare these with healthy individuals. We prospectively enrolled 37 adolescent and adult patients with refractory focal epilepsy (Group 1) and controlled epilepsy (Group 2) in each group. History pertaining to epilepsy and sleep were recorded, and all patients underwent overnight polysomnography. Language, memory, and executive function assessments were done using Western Aphasia Battery, Post Graduate Institute (PGI) memory scale, and battery of four executive function tests (Trail Making Test A & B, Digit symbol test, Stroop Task, and Verbal Fluency Test), respectively. Forty age- and sex-matched controls were also included in the study. Significant differences were noted in both objective and subjective sleep parameters among all the groups. On polysomnography, parameters like total sleep time, sleep efficiency, sleep latency, and rapid eye movement (REM) latency were found to be significantly worse in Group 1 as compared with Group 2. Cognitive and executive parameters were significantly impaired in Group 1. Shorter total sleep time, poorer sleep efficiency, and prolonged sleep latencies were observed to be associated with poor memory and executive function in patients with refractory epilepsy. Our study strongly suggests that sleep disturbances, mainly shorter total sleep time, poor sleep efficiency, and prolonged sleep latencies, are associated with impaired memory and executive function in patients with refractory focal epilepsy and to a lesser extent, among those with medically controlled epilepsy.

Evaluation of the diagnostic yield of ARQIP: A new restless legs syndrome diagnostic questionnaire and validation of its Hindi translation.

BACKGROUND: Restless legs syndrome (RLS) is misdiagnosed due to a variety of clinical presentations and lack of a diagnostic biomarker. Sociocultural differences in patients' reporting of symptoms further contribute to this under diagnosis. We developed an expanded diagnostic tool for RLS, incorporating all International RLS Study Group (IRLSSG) diagnostic criteria with a number of additional questions mainly focusing on specific sociocultural influences in RLS symptom reporting among Indians. The purpose of this study was to examine the change in the diagnostic yield of RLS, if any, through administration of this expanded questionnaire. MATERIALS AND METHODS: The AIIMS RLS questionnaire for Indian patients (ARQIP) was developed in English language, and then translated into Hindi. All consecutive patients attending Neurology and sleep disorders clinic with complaints of leg discomfort were recruited in the study. Two examiners evaluated all patients with complaints of leg discomfort seen by a senior Sleep Medicine expert, one using only IRLSSG diagnostic criteria and the other using the ARQIP. Patients were categorized as RLS or "no-RLS" by the expert, and this was considered as the "standard" for analysis. RESULTS: A total of 155 participants (78 males, 50.3%) with a mean age of 44.1 ± 14.5 years were enrolled. A total of 105 patients were diagnosed as having RLS (group 1) and the rest as having "non-RLS" (group 2). The ARQIP was found to have a much higher sensitivity (100% vs 73%), specificity (44% vs 32.7%), negative predictive value (100% vs 36.4%), and positive predictive value (79% vs 70%) compared to the standard questionnaire. The diagnostic yield of this tool was 26.7% (Confidence interval = 100-73.3). CONCLUSIONS: The ARQIP for RLS diagnosis, validated in this study, has been observed to have a high sensitivity and a negative predictive value with a high diagnostic accuracy.

Multipronged Treatment of Insomnia - Outcomes from an Apex Sleep Disorders Clinic in India.

INTRODUCTION: A large proportion of the population suffers from disturbed sleep and a majority of these present to clinicians with the complaint of insomnia. Many of these people possibly suffer from other primary sleep disorders such as sleep apnea; however, insomnia disorder also remains an extremely common condition directly impacting the quality of life and work efficiency of affected people. While a number of approaches are used for treatment by many clinicians, a much smaller percentage can seek help from specialty sleep clinics. Since very little data are available regarding the effectiveness of treatment offered, this retrospective study aims at examining the outcome of chronic insomnia patients attending to a quaternary care specialty sleep center. METHODS: Consecutive patients with the presenting complaint of and diagnosis of insomnia, during a study period of 2 years between 2013 and 2015, were identified and analyzed. Patients were classified based on the comorbidity and types of treatment received. Life stressors were also identified and analyzed. Outcomes were reviewed for those who had follow-up data available. RESULTS: Based on the defined inclusion criteria, 102 patients could be analyzed. Among these, at least 3-month follow-up was available for 48 patients. It was observed that among patients for whom at least 3-month follow-up was available, 91.4% (43/48) showed a good response to treatment with physician-administered cognitive behavioral therapy for insomnia along with treatment for comorbid conditions. CONCLUSION: With correct diagnostic classification, as well as appropriate and easily available treatment strategies, excellent treatment outcomes are observed at specialty sleep clinics.

Restless legs syndrome, a predictor of subcortical stroke: a prospective study in 346 stroke patients.

OBJECTIVE: The objective of this study was to assess the prevalence of restless legs syndrome (RLS) among patients with stroke and to examine the anatomical correlation between location of stroke and RLS symptoms. METHODS: We administered a pre-structured sleep questionnaire to consecutive stroke patients seen in our neurology services department over a 3-year period. Unconscious (Glasgow Coma Scale score <15) or aphasic, renally impaired, or neuropathic patients were excluded. Diagnosis of RLS was established according to the criteria of the International Restless Legs Syndrome Study Group (IRLSSG), and polysomnography was conducted. RESULTS: Of 346 stroke patients, 35 (10.11%) fulfilled IRLSSG diagnostic criteria for RLS, which had existed for an average (±standard deviation) of 60 ± 40 months before stroke. The mean age of onset was 52.94 (±10.32) years. Twenty-four patients (68%) had RLS symptoms contralateral to the hemisphere involved in the stroke (eight with unilateral and 16 with grossly asymmetrical RLS). Twenty-nine of 35 patients (82.86%) had imaging evidence of subcortical (16 with hemorrhagic and 13 with ischemic) stroke. Patients with pre-stroke RLS differed from those without it only by subcortical location of the stroke (82.9% vs 31.5% respectively, p < 0.001). The most significant differentiating factor between patients with subcortical stroke and those with cortical stroke was pre-stroke RLS (22.83% vs 2.74%, p < 0.001), the others being history of hypertension and hemorrhagic stroke type. CONCLUSION: RLS, especially unilateral or asymmetrical, might frequently pre-exist in patients presenting with subcortical stroke. The common laterality may suggest an important predictive value for RLS, and may form an important point for future research.