DEVELOPMENT AND VALIDATION OF YOGA MODULE FOR OBSTRUCTIVE SLEEP APNEA

Background: Sleep is an essential component of human life because it provides for relaxation and recovery from the stresses of everyday living. Reduced sleep quantity or quality leads to sleep deprivation which may offer indirect dangers by affecting cognitive and physical performance and raising the chance of motor vehicle and occupational accidents. Insomnia chronic sleep debt snoring sleep apnea circadian rhythm disturbances (including shift work syndrome) RLS parasomnias and uncommon diseases such as narcolepsy are the most common sleep disorders found in sleep clinics according to experts. Obstructive Sleep apnea is a common disorder in which your breathing stops and starts periodically while you sleep. To determine the design and validation of an Integrated Yoga Module (IYM) for OSA patients. The ?rst phase - IYM for OSA - was created based on a survey of classic books and Materials and Procedures: recently available research studies. The designed IYM was validated by 20 subject matter (yoga) experts in the second phase. Lawshe's formula was used to calculate the content-validity ratio (CVR). Yoga practices were created for the OSA Results: Integrated Yoga Module. The ?nal Integrated Yoga Module featured yoga practises with CVR ?0.5 that were assessed by 20 yoga experts and agreed in faculty group discussion. The yoga practices were designed and validated for IYM for Conclusion: OSA. By applying Lawshe's content validity criteria 20 yoga professionals veri?ed the IYM design.

Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints / Avaliação dos achados endoscópicos superiores em pacientes com síndrome das pernas inquietas e queixas gástricas

Abstract Background: The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. Objective: To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. Methods: Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. Results: There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. Conclusions: The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.

Resumo Introdução: Os efeitos das doenças do sistema digestório sobre a Síndrome das Pernas Inquietas/doença de Willis-Ekbom (SPI/DWE) foram demonstrados previamente por testes sorológicos. No entanto, até o momento tal associação não foi corroborada por estudos histopatológicos. Objetivo: Investigar a relação entre a SPI/DWE, imagens de endoscopia digestiva alta e resultados histopatológicos em pacientes diagnosticados com SPI/DWE com queixas do sistema digestório. Métodos: Estudo caso-controle incluindo 100 pacientes com SPI/DWE e queixas dispépticas que foram submetidos à endoscopia digestiva alta, e 106 controles emparelhados para idade e sexo. O diagnóstico de SPI/DWE foi determinado com base nos quatro principais critérios do International RLS Study Group. Todos os pacientes foram submetidos à intervenção endoscópica do sistema digestório superior e a pelo menos uma biópsia gástrica e/ou antral. Resultados: Não houve diferença significativa entre os grupos em relação à úlcera gástrica endoscopicamente observada, úlcera duodenal, doença do refluxo gastroesofágico (DRGE) e positividade para Helicobacter pylori (HP) (p>0,05). Metaplasia intestinal e atrofia da mucosa foram mais comuns em pacientes com SPI/DWE em comparação aos controles (p=0,026 e p=0,017, respectivamente). Níveis de ferritina encontravam-se abaixo do valor de referência. Conclusão: A detecção de metaplasia intestinal grave, atrofia de mucosa e inflamação gástrica em pacientes com SPI/DWE com queixas dispépticas pode justificar a avaliação cuidadosa do sistema digestório nestes pacientes. Entretanto, são necessários estudos controlados e com amostras maiores com pacientes avaliados com biópsia por via endoscópica.

Patients with primary restless legs syndrome have higher prevalence of autonomic dysfunction and irritable bowel syndrome

<p><b>INTRODUCTION</b>Given the limited data on autonomic dysfunction in patients with primary restless legs syndrome (pRLS), we compared autonomic dysfunction and presence of irritable bowel syndrome (IBS) between patients with pRLS and control patients.</p><p><b>METHODS</b>Consecutive adult drug-naïve patients with pRLS, and age- and gender-matched healthy control patients were enrolled in this study. Diagnoses, based on validated self-reported questionnaires, were made using the following guidelines: Rome III classification system for functional gastrointestinal disorders for IBS; Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) for the presence of anxiety and depression, respectively; Pittsburgh Sleep Quality Index (PSQI) for severity of sleep disturbances; and Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) for autonomic dysfunction.</p><p><b>RESULTS</b>There were 88 patients with pRLS (18 male, 70 female) and 128 control patients (40 men, 88 women). The mean age of the pRLS patients and control patients was 50.3 ± 9.3 years and 49.7 ± 8.2 years, respectively. Overall, 41 (46.6%) of the patients with pRLS and 16 (12.5%) of the control patients had IBS. Among patients with pRLS, IBS was significantly more common and the total autonomic SCOPA-AUT scores were higher than those found among control patients. Among pRLS patients with IBS, total autonomic SCOPA-AUT, PSQI, BAI and BDI scores were significantly higher than among pRLS patients without IBS. The presence of IBS did not affect the severity of restless legs syndrome.</p><p><b>CONCLUSION</b>The presence of autonomic nervous system impairment in patients with pRLS and the strong link between IBS and pRLS merit further, more extensive investigation.</p>

Clinical Factors Related to the Response of IV Ferric Carboxymaltose Treatment in Patients with Restless Legs Syndrome

OBJECTIVES: Significant benefit of intravenous ferric carboxymaltose (FCM) for restless legs syndrome (RLS) has been demonstrated. However, clinical indicators to expect treatment response of RLS are not clarified. The aim of this study is to find out determinant factors to predict treatment outcome of FCM. METHODS: We enrolled consecutive 108 patients with RLS who visited sleep clinic and received FCM from April 2016 to November 2017. Obtained data were detailed history including international restless legs scale (IRLS) and questionnaires, comorbid diseases, medication. Complete blood cell count, serum iron, ferritin, and total iron-binding capacity were sampled before and after treatment. Treatment response was assessed about four weeks after FCM administration. Patients with more than 40% decrease on IRLS were classified into the responders. RESULTS: 99 patients (mean 54.5 y and 79 females) were included. 58 patients (58.6%) were classified to be responders. There were substantial differences in post-treatment IRLS and symptom reduction rate between responders (7.4±6.4, 77.5±18.6%) and non-responders (29.7±8.7, 7.4±10.3%). No significant differences were found in demographics, baseline IRLS, sleep, and mood status between two groups. Serum ferritin and transferrin saturation was significantly lower in responders (37.6 ng/mL, 25.0%) than non-responders (55.1 ng/mL, p=0.014 and 36.5%, p=0.001). Patients with a history of gastrectomy (n=8) showed an excellent response to FCM (83.8% of symptom reduction). Comorbid lumbosacral radiculopathy had lower response rate (29.4%). CONCLUSIONS: Peripheral iron compromised state and gastrectomy history may indicate good response to intravenous FCM in patients with RLS. Patients with lumbosacral radiculopathy tend to be poor responders to intravenous FCM.

Relationship of Limb Movements during Sleep with Nocturnal Sleep Parameters in the Community-Dwelling Elderly with Sleep Complaints / 신경정신의학

OBJECTIVES: The aim of this study was to examine the differences in subjective sleep quality and objective sleep parameters between groups with different severities of limb movements during sleep in elderly persons with sleep complaints. METHODS: We recruited adult subjects with sleep complaints from four areas in Gangwon-do. Nocturnal polysomnography studies were conducted for 159 subjects at Kangwon National University Hospital. A total of 72 subjects older than 60 years were finally selected, and we classified them into three groups according to the limb movement index (LMI) : 29 subjects with LMI below 15, 21 subjects with LMI between 15 and 44, and 22 subjects with LMI above 44. RESULTS: The proportion of existing restless legs syndrome (RLS) symptoms differed between the three groups, but was not statistically significant (p=0.051). No difference in nocturnal sleep parameters was observed between the three groups. In the total group, the limb movement arousal index showed positive correlation with respiratory arousal index (r=0.252, p<0.05). CONCLUSION: In elderly persons with sleep complaints, a greater LMI severity was associated with a tendency of higher comorbidity of RLS. Frequent arousals due to limb movements were not associated with a greater severity of limb movements during sleep severity, but with increased arousals due to respiratory events.

Association between Antipsychotic-Related Restless Legs Syndrome and the RORA Gene Polymorphism in Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The previous studies have suggested genetic vulnerability to restless legs syndrome (RLS) development. The occurrence of antipsychotic-related RLS could also be attributable to differences in genetic susceptibility. This study aimed to investigate whether Retinoid-related orphan receptor A (RORA) gene polymorphism is associated with antipsychotic-related RLS in schizophrenia. METHODS: We assessed symptoms of antipsychotic-induced RLS in 190 Korean schizophrenic patients and divided the subjects into two groups according to the International Restless Legs Syndrome Study Group diagnostic criteria : 1) subjects that met all of the criteria (n=44) and 2) the remaining subjects who were not considered to be RLS patients (n=146). Single-nucleotide polymorphism in the RORA gene was genotyped by PCR in 190 individuals. The chi2-test was conducted to compare differences between two groups. RESULTS: The frequencies of genotype (chi2=0.066, p=0.968) of the RORA gene (rs11071547) did not differ significantly between schizophrenic patients with and without RLS. The difference of allele frequencies (chi2=0.008, p=0.927) of the RORA gene (rs 11071547) between the schizophrenic patients with and without RLS were not significant. CONCLUSION: These results suggest that RORA gene polymorphism does not play a major role in susceptibility to antipsychotic-related RLS in schizophrenia.

Restless legs syndrome in subjects with a knee prosthesis: evidence that symptoms are generated in the periphery

OBJECTIVE: There are no data adressing the prevalence of restless legs syndrome in subjects who have knee prosthesis. Therefore, we conducted a cross-sectional survey of subjects who underwent knee prosthesis surgery. METHOD: A total of 107 subjects (30 male, 77 female) were interviewed over the telephone regarding restless legs syndrome symptoms. If the patients exhibited symptoms of the syndrome, we conducted face-to-face interviews. Lastly, a therapeutic test with pramipexole was proposed for each subject. RESULTS: In our cohort, 7 males (23 percent) and 30 females (39 percent) had restless legs syndrome. Of these, 6 males and 23 females were submitted to face-to-face-interview. Of the males, 5 (83 percent) had restless legs after the knee surgeryexclusively in the operated leg- and reported no family restless legs history. One man had a prior case of bilateral restless legs syndrome, a positive family history and claimed exacerbation of symptoms in the operated leg. Among the females, 16 (69 percent) had restless legs prior to surgery. A total of 10 female patients reported bilateral symptoms, with fewer symptoms in the operated leg, while 6 displayed a worse outcome in the operated leg. The 7 females (31 percent) without restless legs prior to surgery and without a family history experienced symptoms only in the operated leg. All subjects responded favorably to the pramipexole therapeutic test. CONCLUSION: Our results suggest that secondary unilateral restless legs syndrome may ensue from knee prosthesis surgery and that the symptoms are generated in the peripheral nervous system.

Imbalance between thyroid hormones and the dopaminergic system might be central to the pathophysiology of restless legs syndrome: a hypothesis

Data collected from medical literature indicate that dopaminergic agonists alleviate Restless Legs Syndrome symptoms while dopaminergic agonists antagonists aggravate them. Dopaminergic agonists is a physiological regulator of thyroid-stimulating hormone. Dopaminergic agonists infusion diminishes the levels of thyroid hormones, which have the ability to provoke restlessness, hyperkinetic states, tremors, and insomnia. Conditions associated with higher levels of thyroid hormones, such as pregnancy or hyperthyroidism, have a higher prevalence of Restless Legs Syndrome symptoms. Low iron levels can cause secondary Restless Legs Syndrome or aggravate symptoms of primary disease as well as diminish enzymatic activities that are involved in dopaminergic agonists production and the degradation of thyroid hormones. Moreover, as a result of low iron levels, dopaminergic agonists diminishes and thyroid hormones increase. Iron therapy improves Restless Legs Syndrome symptoms in iron deprived patients. Medical hypothesis. To discuss the theory that thyroid hormones, when not counterbalanced by dopaminergic agonists, may precipitate the signs and symptoms underpinning Restless Legs Syndrome. The main cause of Restless Legs Syndrome might be an imbalance between the dopaminergic agonists system and thyroid hormones.

Restless Legs Syndrome Mimicking Lower Leg Pain of Spinal Origin :Report on Two Cases / 대한정형외과학회잡지

Restless legs syndrome (RLS) is a neurogenic disorder with the patients having a sensation of discomfort and an urge to move continuously. These symptoms can get worse during night and cause sleep disturbance. These symptoms can be misdiagnosed as lower leg pain of a spinal origin and the treatment can be wrongly focused on this. This treatment for an unproven state of symptoms can place clinicians in a difficult situation. We experienced RLS associated with spondylolisthesis and spinal stenosis, and we originally misdiagnosed the patient and wrongly treated the patient operatively with spinal fusion and posterior instrumentation. After an insufficient result, we diagnosed the patient with having RLS with the help of the neurology department and rehabilitation medical department. In one other case we diagnosed a RLS patient with the help of a neurologist and the patients had arrived an our department for total knee arthroplasty and spinal root block. We report on these cases so other orthopedic surgeons will not make same mistakes.

A Case of Restless Leg Syndrome Induced by Bupropion in a Patient with Bipolar Disorder / 대한정신약물학회지

A 35 year-old female patient with bipolar disorder, single manic episode in remission, were being followed up in the outpatient clinic regularly. Since she complained of depressive symtpoms, bupropion SR of 150 mg was adminstered. On 3 days after administration of bupropion SR, she complained of creeping and crawling sensation on both legs which was aggravated at night and attenuated with movement. She also had a difficulty in falling a sleep becuase of the discomfort of both legs and the urge to move. We observed these symptoms during 1 week, but her discomfort was not improved at all. Therefore we considered her symptoms as restless leg syndrome (RLS) induced by bupropion SR, and started clonazepam of 0.5 mg for the control of her discomfort on 10 days after bupropion SR administration. On the day after addition of clonazepam, her discomfort of both leg began to subside. Many cases of SSRI-induced RLS have been reported and these were explained by the dopamine hypoactivity related with stimulation of serotonin system. But, RLS induced by bupropion in this case cannot be explained by that hypothesis, so which suggested that more than one neurotransmitter system involves the pathogenesis of RLS. On our knowledge, this is the first one reporting RLS induced by bupropion.