Analisi dei parametri di risposta cerebrale e vegetativa agli eventi respiratori nel sonno in pazienti affetti da sindrome delle apnee morfeiche

The arousal scoring in Obstructive Sleep Apnea Syndrome (OSAS) is important to clarify the impact of the disease on sleep but the currently applied American Academy of Sleep Medicine (AASM) definition may underestimate the subtle alterations of sleep. The aims of the present study were to evaluate the impact of respiratory events on cortical and autonomic arousal response and to quantify the additional value of cyclic alternating pattern (CAP) and pulse wave amplitude (PWA) for a more accurate detection of respiratory events and sleep alterations in OSAS patients. A retrospective revision of 19 polysomnographic recordings of OSAS patients was carried out. Analysis was focused on quantification of apneas (AP), hypopneas (H) and flow limitation (FL) events, and on investigation of cerebral and autonomic activity. Only 41.1% of FL events analyzed in non rapid eye movement met the AASM rules for the definition of respiratory event-related arousal (RERA), while 75.5% of FL events ended with a CAP A phase. The dual response (EEG-PWA) was the most frequent response for all subtypes of respiratory event with a progressive reduction from AP to H and FL. 87.7% of respiratory events with EEG activation showed also a PWA drop and 53,4% of the respiratory events without EEG activation presented a PWA drop. The relationship between the respiratory events and the arousal response is more complex than that suggested by the international classification. In the estimation of the response to respiratory events, the CAP scoring and PWA analysis can offer more extensive information compared to the AASM rules. Our data confirm also that the application of PWA scoring improves the detection of respiratory events and could reduce the underestimation of OSAS severity compared to AASM arousal

Restless legs syndrome: a new entity of neuropathic pain? Treatment with prolonged release oxycodone/naloxone combination

Franco Gemignani,1 Andrea Melpignano,1,2 Giulia Milioli,1,2 Silvia Riccardi,1,2 Liborio Parrino1,2 1Neurology Unit, Department of Neurosciences, University of Parma, Parma, Italy; 2Sleep Disorders Center, Department of Neurosciences, University of Parma, Parma, Italy Abstract: Restless legs syndrome (RLS) is a disorder of sensorimotor integration characterized by an urge to move the legs when at rest, especially at night or in the evening, which is relieved by movement. Sensory symptoms may be prominent, often exhibiting features consistent with neuropathic pain. Iron deficiency and genetic factors are implicated in RLS causation in most patients. The pathogenetic model of impaired circadian dopaminergic modulation of sensorimotor integration circuitry at the spinal level is fitting with the co-occurrence of movement disorders, sensory symptoms, and sleep disruption in RLS. Accordingly, levodopa and dopamine agonists are effective for RLS symptoms, which compensate for the impaired descending control by diencephalo-spinal dopa(min)ergic pathway. Dopamine agonists are usually indicated as the first-line therapy, but their use in long-term treatment is often complicated by augmentation and impulse control disorder, thus alpha-2-delta ligands also are now considered the first line of treatment. It has been recognized that endogenous opioid system is also involved in the mechanisms generating RLS, possibly through an impaired modulation of pain pathways. Opioids can be considered as an alternative therapy, particularly in patients with augmentation and/or refractory to other treatments. Recently introduced prolonged-release oxycodone–naloxone was efficacious for short-term treatment of patients with severe RLS inadequately controlled with previous treatment. It will be important to assess whether opioids, as well as other drugs, are especially effective in definite RLS subtypes such as the painful phenotype. Keywords: small fiber neuropathy, allodynia, hyperalgesi

Can Sleep microstructure improve diagnosis of OSAS? Integrative information from CAP parameters

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Weight Status Is Related with Gender and Sleep Duration but Not with Dietary Habits and Physical Activity in Primary School Italian Children.

The prevalence of overweight and obesity in children has risen greatly worldwide. Diet and poor physical activity are the two risk factors usually examined, but epidemiological evidence exists suggesting a link between sleep duration and overweight/obesity in children. The aim of this study was to describe the relationship among body mass index (BMI), diet quality, physical activity level, and sleep duration in 690 children attending the 5th grade in primary schools (9-11 years old) in the city of Parma (Italy) involved in the Giocampus educational program. This was achieved through (i) measuring anthropometric data to compute body mass index; (ii) administering a food questionnaire to evaluate adherence to the Mediterranean Diet (KIDMED score); and (iii) administering a lifestyle questionnaire to classify children physical activity level (PAL), sleep duration, and school achievement. A highly significant negative association was found between BMI and sleep hours. Moreover, there was a significant positive association between PAL and KIDMED scores. No evidence was found of association between BMI and PAL, nor between BMI and KIDMED score. Data from this study established that BMI is correlated to gender and sleep duration, defining sleep habits as one of the factors linked to overweight and obesity

Time-varying analysis of the heart rate variability during A-phases of sleep: Healthy and pathologic conditions

In the present study, a comparison of the heart rate variability (HRV) behavior between healthy subjects and Nocturnal Front Lobe Epilepsy (NFLE) patients was carried out during the A-phases of sleep. The A-phases are short cortical events that interrupt the basal oscillation of the sleep stages and form the cyclic alternating pattern phenomenon. HRV was assessed by means of standard temporal measures and frequency measures based on time-varying autoregressive (TVAR) models. The analysis of HRV, in relation to the A-phases occurrence, was performed selecting two segments: one before the onset of the A-phase and one during the A-phase time. The results showed a significant increment in the heart rate during the A-phases in both, healthy subjects and NFLE patients. In addition, a major participation of the sympathetic nervous system was found in both healthy and pathologic conditions based on the sympatho-vagal index (LF/HF) during A-phases. The intensity of the shift towards sympathetic activity is related of A-phase type, where the largest shift is found in A3 phases. However, the NFLE patients present a weaker autonomic response during A-phases. The results suggest that the autonomic cardiac response related with the surveillance mechanism of NFLE patients is affected

Polysomnographic study of intermittent zolpidem treatment in primary sleep maintenance insomnia

BACKGROUND AND PURPOSE: Treatment of chronic insomnia with nightly hypnotics is efficacious, but discontinuation is recommended after 1 month, less than the average disease duration. This study was undertaken to determine the efficacy of intermittent administration. PATIENTS AND METHODS: A double-blind study was carried out on 8 patients (age, 32.8 +/- 9 years; 3 men) with primary sleep maintenance insomnia longer than 1 month. Polysomnography of conventional sleep parameters, cyclic alternating patterns (CAPs), and arousals was performed. Perception of sleep quality was assessed on a visual analog scale. After an adaptation night, baselines were recorded followed by 6 consecutive nights of alternating treatment with zolpidem (10 mg) or placebo. RESULTS: Significant improvements on baseline values (P < 0.0001) were observed on all 3 active treatment nights for total sleep time, sleep efficiency, CAP time, CAP rate, subtype A2, arousals, and arousal index. Deep non-rapid eye movement sleep increased with the second and third doses of active treatment (P < 0.0001). Rapid eye movement sleep increased during the last 3 polysomnographic recordings (P < 0.014). Sleep quality (visual analog scale) improved on all nights after the initial dose of active treatment (P < 0.0001). There was no evidence of rebound insomnia with placebo. CONCLUSIONS: Intermittent treatment with zolpidem in primary insomnia patients improves CAP parameters and arousals, as well as sleep duration and quality, in the absence of rebound insomnia

Sleep, Sleep Structure and Sleep Disorders in a Cohort of Patients Affected by ALS

Amyotrophic Lateral Sclerosis is a neurodegenerative disease, mostly due to progressive loss of motor neurons, with poor prognosis. Although motor involvement is predominant, other systems may be altered, and, among these, also sleep. The aim of this study is to evaluate sleep in a cohort of patients affected by ALS. We consecutively enrolled 48 patients, whom underwent to clinical and instrumental evaluation, including a full night video-PSG. They were compared to 15 control subjects. Respect to controls, patients had fragmented sleep, with poor sleep efficiency, higher amount of WASO and N1 sleep stage, and lower percentage of N2 and REM sleep stages, despite they perceived a sleep of good quality. Moreover, 33% of patients underwent video-PSG was diagnosed with OSAS, and 14, 28% with nocturnal respiratory insufficiency. Start NIV early is known to raise QOL, prolong life expectancy, and improve compliance to subsequent 24h NIV and tracheal ventilation. Furthermore, sleep of bad quality is a cardiovascular risk factor. In conclusion, in patients with ALS, instrumental assessment of sleep in early stages of the disease should be mandatory