Sleep Complaints, Sleep and Breathing Disorders in Myotonic Dystrophy Type 2

PURPOSE OF REVIEW: To update the current knowledge concerning sleep complaints and breathing disorders in myotonic dystrophy type 2 (DM2) and to better understand if sleep and breathing symptoms may add a further clinical definition of DM2. RECENT FINDINGS: Although DM2 has been poorly evaluated, the most relevant sleep disorders are sleep-disordered breathing (SDB) (37.5-66.7%) and restless legs syndrome (RLS) (50-60%). Excessive daytime somnolence (EDS) is not consistent with SDB, and a large percentage of patients with sleep complaints (58-69%) report pain. In addition, respiratory dysfunctions are reported in 6 to 15% of DM2 patients, albeit few data are available regarding pulmonary restriction, hypoventilation, and non-invasive ventilation (NIV). SDB, RLS, and pain may contribute to sleep fragmentation and EDS in DM2. In addition, few studies report hypoventilation and pulmonary restriction, although there are no studies at all on NIV, except for limited clinical experiences. These findings suggest performing a careful pulmonary examination and NIV when required. Furthermore, sleep studies and respiratory evaluation should be recommended if OSA or respiratory muscle dysfunctions are suspected. A large polysomnographic study should be performed to clarify the link between sleep disorders, pain, and sleep disruption in DM2

Clinical characteristics of a large cohort of patients with narcolepsy candidate for pitolisant: a cross-sectional study from the Italian PASS Wakix® Cohort

Introduction Narcolepsy is a chronic and rare hypersomnia of central origin characterized by excessive daytime sleepiness and a complex array of symptoms as well as by several medical comorbidities. With growing pharmacological options, polytherapy may increase the possibility of a patient-centered management of narcolepsy symptoms. The aims of our study are to describe a large cohort of Italian patients with narcolepsy who were candidates for pitolisant treatment and to compare patients' subgroups based on current drug prescription (drug-naive patients in whom pitolisant was the first-choice treatment, switching to pitolisant from other monotherapy treatments, and adding on in polytherapy). Methods We conducted a cross-sectional survey based on Italian data from the inclusion visits of the Post Authorization Safety Study of pitolisant, a 5-year observational, multicenter, international study. Results One hundred ninety-one patients were enrolled (76.4% with narcolepsy type 1 and 23.6% with narcolepsy type 2). Most patients (63.4%) presented at least one comorbidity, mainly cardiovascular and psychiatric. Pitolisant was prescribed as an add-on treatment in 120/191 patients (62.8%), as switch from other therapies in 42/191 (22.0%), and as a first-line treatment in 29/191 (15.2%). Drug-naive patients presented more severe sleepiness, lower functional status, and a higher incidence of depressive symptoms. Conclusion Our study presents the picture of a large cohort of Italian patients with narcolepsy who were prescribed with pitolisant, suggesting that polytherapy is highly frequent to tailor a patient-centered approach

Topiramate-induced periodic limb movement disorder in a patient affected by focal epilepsy

Periodic limb movement disorder (PLMD) is characterized by pathological periodic limb movements during sleep, insomnia and/or diurnal sleepiness, and the absence of another primary sleep disorder. We report a patient with complex partial seizures who developed PLMD while taking topiramate (TPM). He had no evidence of metabolic and/or other conditions inducing PLMD. He also had fragmented sleep and disruptive PLMS on polysomnography, and PLMS subsided with change of antiepileptic drug. Topiramate may modulate the dopaminergic pathway by inhibition of glutamate release, thereby inducing PLMD as observed in our patient. Although a single case does not allow any generalization, PLMD should be considered in patients complaining of insomnia and treated with TPM

Effects of Transcranial Direct Current Stimulation on Sleep in Athletes: A Protocol of a Randomized Controlled Trial

Background: Sleep disturbances are common among athletes. There is recently a growing interest in improving sleep quality by using noninvasive brain stimulation techniques such as transcranial direct current stimulation (tDCS). We hypothesized that bilateral dorsolateral prefrontal cortex anodal tDCS could improve sleep in different sports athletes. A randomized controlled trial is to be conducted to test this hypothesis. Methods: Eighty-four athletes are selected based on specific eligibility criteria and randomly allocated to the intervention or control group. Each participant will receive a 20-min session of bilateral anodal tDCS with an intensity of 1.5 mA (0.057 mA/cm2) in density 3 times a week for 2 weeks. The tDCS current will be delivered only for 30 seconds in the control group. This study’s outcome is a set of subjective and objective sleep parameters. Conclusion: This study assessed the effect of a novel tDCS protocol represented by bilateral anodal stimulation and may result in important advances in sleep management among athletes. Because of the high incidence and impact of athletes’ poor sleep quality, it is particularly important to explore effective interventions. Trial Registration: ClinicalTrials.gov: NCT05318352

Dream Recall and Content versus the Menstrual Cycle: A Cross-Sectional Study in Healthy Women

The association between sleep and the menstrual cycle has been scarcely studied. This study aimed to investigate the association between dream recall and content and the menstrual cycle among a large sample of young women. To this aim, 944 women were asked about their day of menstrual cycle, whether they remembered the previous night’s dreams and if they did so to describe the dream content as pleasant or unpleasant. A total of 378 women recalled the previous nights’ dreams, with 199 reporting pleasant dream affect/content and 179 reporting unpleasant dream content. In women who recalled their dreams, there was an association of pleasant dream content with the luteal phase (p = 0.038). In conclusion, in women, the hormonal milieu of the luteal phase may influence dream content