Factors Associated with Disruptive Behavioral Symptoms in Idiopathic Rapid Eye Movement Sleep Behavior Disorder

Background and Objective Little is known about the factors associated with disruptive behaviors in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD). Thus, we report the demographic and clinical characteristics of iRBD patients with disruptive behaviors. Methods Patients diagnosed as having iRBD through video-polysomnography were included in the present study. The REM sleep behavior disorder questionnaire-Hong Kong (RBDQ-HK) was used to divide participants into two groups according to the presence or absence of disruptive behaviors. Neuropsychological tests as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Beck Depression Inventory (BDI) were also conducted. Results Of 188 iRBD patients, 160 patients showed more disruptive behaviors and were of a younger age (66.8 ± 7.4 vs. 70.5 ± 6.0, p = 0.012), of a higher proportion of men (69.4% vs. 39.3%, p = 0.004), and showed lower Apnea-Hypopnea Indexes (AHI) (9.2 ± 0.9 vs. 17.8 ± 2.2, p < 0.001) than those without disruptive behavioral symptoms. No statistically significant differences in PSQI, ESS, BDI, or neuropsychological testing were found. In multiple logistic regression analysis, age ≥ 70 [odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.15–0.87, p = 0.023], male sex (OR = 2.80, 95% CI = 1.14–6.91, p = 0.025), and score of item 4 (violent or aggressive dreams) of RBDQ-HK (OR = 1.57, 95% CI = 1.17–2.12, p = 0.003) all showed a significant association with disruptive behaviors. Conclusions Age < 70, male sex, lower AHI, and frequent violent or aggressive dreams are associated with an increased risk of disruptive behavioral symptoms in iRBD. Therapeutic plans including clonazepam medication should be individualized considering patients’ demographic and clinical features

Broad targeting of resistance to apoptosis in cancer

Apoptosis or programmed cell death is natural way of removing aged cells from the body. Most of the anti-cancer therapies trigger apoptosis induction and related cell death networks to eliminate malignant cells. However, in cancer, de-regulated apoptotic signaling, particularly the activation of an anti-apoptotic systems, allows cancer cells to escape this program leading to uncontrolled proliferation resulting in tumor survival, therapeutic resistance and recurrence of cancer. This resistance is a complicated phenomenon that emanates from the interactions of various molecules and signaling pathways. In this comprehensive review we discuss the various factors contributing to apoptosis resistance in cancers. The key resistance targets that are discussed include (1) Bcl-2 and Mcl-1 proteins; (2) autophagy processes; (3) necrosis and necroptosis; (4) heat shock protein signaling; (5) the proteasome pathway; (6) epigenetic mechanisms; and (7) aberrant nuclear export signaling. The shortcomings of current therapeutic modalities are highlighted and a broad spectrum strategy using approaches including (a) gossypol; (b) epigallocatechin-3-gallate; (c) UMI-77 (d) triptolide and (e) selinexor that can be used to overcome cell death resistance is presented. This review provides a roadmap for the design of successful anti-cancer strategies that overcome resistance to apoptosis for better therapeutic outcome in patients with cancer

Awakening from Sleep with Numbness and Indescribable Odd Feeling: Nocturnal Panic Attack or Sleep-Related Epilepsy?

Paroxysmal events during sleep can be classified into parasomnias, sleep-related movements, psychiatric events, neurologic events, or medically related events. Diagnosis can be difficult because of the frequent overlap of clinical descriptors and lack of diurnal findings. We report a case of a 68-year-old man who presented to the hospital complaining of awakening from sleep with numbness, which was followed by an indescribable odd feeling. We discuss overlapping clinical features of nocturnal panic and sleep-related epilepsy

Awakening from Sleep with Numbness and Indescribable Odd Feeling: Nocturnal Panic Attack or Sleep-Related Epilepsy?

Paroxysmal events during sleep can be classified into parasomnias, sleep-related movements, psychiatric events, neurologic events, or medically related events. Diagnosis can be difficult because of the frequent overlap of clinical descriptors and lack of diurnal findings. We report a case of a 68-year-old man who presented to the hospital complaining of awakening from sleep with numbness, which was followed by an indescribable odd feeling. We discuss overlapping clinical features of nocturnal panic and sleep-related epilepsy

Age-Limited Effects of Low-Frequency Transcutaneous Electric Nerve Stimulation on Insomnia: A 4-Week Multi-Center, Randomized Controlled Study

Objective Insomnia disorder is a common condition with considerable harmful effects on health. We investigated the therapeutic effi-cacy and safety of low-frequency transcutaneous electric nerve stimulation (LF-TENS) as an alternative treatment option for insomnia disorder. Methods A 4-week, multi-center, randomized controlled study was conducted. A total of 160 individuals aged 40 to 80 years with in-somnia disorder were included and randomized to the experimental group receiving active device (n=81) or control group receiving sham device (n=79). Both groups used the device for four weeks, more than five days a week. The participants also completed pre-and post-intervention assessment with questionnaires, sleep diaries, wrist actigraphy, and blood tests. Results There was no significant between-group difference in the changes of mood and sleep parameters and blood test results among the two study groups. Meanwhile, in the exploratory sub-group analysis of patients aged over 60 years, the experimental group showed better improvement after intervention in the change of Pittsburgh Sleep Quality Index (PSQI) score (-2.63 +/- 3.25 vs.-1.20 +/- 2.28, p=0.039; Cohen&apos;s d=0.99 vs. 0.45) and blood cortisol level (-1.65 +/- 3.37 mu g/dL vs.-0.16 +/- 3.49 mu g/dL, p=0.007; Cohen&apos;s d=0.56 vs. 0.05). In addition, no serious adverse reaction occurred during the study period in both groups. Conclusion The effect of LF-TENS was limited to older patients aged over 60 years, which might be related to the modulation of hypo-thalamic-pituitary-adrenal axis activity. Psychiatry Investig 2022;19(6):451-461N