Obesity effects on sleep quality with anthropometric and metabolic changes

SUMMARY OBJECTIVE: Obesity is one of the etiological factors of sleep disorders (e.g., obstructive sleep apnea and restless leg syndrome). The aim of this study was to determine the effect of obesity on sleep quality by using the Pittsburgh Quality İndex and Berlin Question are and evaluate the association of sleep with anthropometric and metabolic parameters. METHODS: A total of 76 patients (41 females and 35 males) between the ages of 18 and 70 years with a body mass index >30 kg/m2 were included in this study. Homeostatic model assessment-insulin resistance, hemoglobin A1c, alanine aminotransferase, aspartate transaminase, total cholesterol, low-density lipoprotein, triglyceride, high-density lipoprotein, and thyroid-stimulating hormone levels were analyzed. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index, Berlin Questionnaire, and the Restless Leg Syndrome Questionnaire. RESULTS: A significant correlation was observed between Pittsburgh sleep quality index and body mass index, neck circumference, body fat index, muscle mass, hip and waist circumference, hemoglobin A1c, and homeostatic model assessment-insulin resistance (ps<0.005). The Pittsburgh sleep quality index median (2.5-97.5 percentile) value was 8 (2-18.6) in the patient group and 3.5 (0.1-7.9) in the control group (p<0.0001). Body mass index was found to be the predictor on Pittsburgh sleep quality index (R2=0.162, F=3.726, analysis of variance p=0.008). Notably, 88% (67) and 95% (57) of the poor sleepers were found to be at high risk for obstructive sleep apnea according to Berlin Questionnaire and Pittsburgh Sleep Quality Index, respectively. Also, the frequency of restless leg syndrome was 45% in obese individuals. CONCLUSIONS: We observed a significant correlation between Pittsburgh sleep quality index and the anthropometric and metabolic parameters. Also, the frequency of obstructive sleep apnea and restless leg syndrome was 88% and 45%, respectively, in obese individuals.

Gabapentin treatment in olanzapine-induced restless legs syndrome： a case report / 四川精神卫生

The purpose of this study is to suggest the physicians using olanzapine to strengthen the recognition and treatment of restless leg syndrome （RLS） in clinical practice. In this paper， one patient with schizophrenia suffered from RLS during olanzapine administration， which was characterized by unpleasant sensory disturbances in bilateral lower extremity at night， intense urges to move legs， and inability to sleep. After taking gabapentin， the above symptoms were significantly improved.

Clinical observation of acupuncture on restless leg syndrome / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of acupuncture (acupuncture for regulating the spirit) on restless leg syndrome and its concomitance symptoms of sleep disorder and anxiety, and to provide theoretical basis for the clinical application of acupuncture.@*METHODS@#A total of 60 patients were randomized into an observation group and a control group, 30 cases in each one. Conventional acupuncture at lower limbs' acupoints such as Zusanli (ST 36), Yanglingquan (GB 34) and Xuanzhong (GB 39) was applied in the control group. On the basis of the control group, acupuncture at Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13) was added in the observation group. In both groups, the treatment was given once a day, 6 times a week, one week as a course and totally 3 courses were required. Scores of international restless leg syndrome rating scale (IRLS), Pittsburgh sleep quality index (PSQI) and Hamilton anxiety scale (HAMA) were observed before and after treatment in the two groups.@*RESULTS@#Compared before treatment, scores of IRLS, PSQI and HAMA after treatment were decreased in both groups (<0.05), and the improvement in the observation group was superior to the control group (<0.05).@*CONCLUSION@#On the basis of conventional acupuncture, acupuncture can effectively relieve the discomforts of the lower limbs in patients with restless leg syndrome, improve the sleep disorder and anxiety, which is better than conventional acupuncture.

Risk factors of restless leg syndrome in maintenance hemodialysis patients / 第二军医大学学报

Objective To investigate the risk factors of restless leg syndrome (RLS) in maintenance hemodialysis patients. Methods The clinical data of 74 maintenance hemodialysis patients in Eastern Hepatobiliary Surgery Hospital of Navy Medical University (Second Military Medical University) from July 2016 to September 2017 were retrospectively analyzed. The gender, age, diabetes mellitus and other biochemical indicators of the patients with or without RLS were compared. The univariate logistic regression analysis was performed with the gender, age, diabetes mellitus and other biochemical indicators as covariates, and the RLS as dependent variable. According to the 2003 International Restless Leg Syndrome Study Group (IRLSSG) criteria, the patients with RLS were divided into mild, moderate, severe and very severe groups, with the patients without RLS as controls; the variables that were significantly different between the groups as analyzed by univariate logistic regression analysis were compared by t-test and multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve for the main relevant factors was plotted, and the area under the curve was calculated to determine the best critical value and the corresponding sensitivity and specificity. Results A total of 74 maintenance hemodialysis patients were enrolled in this study, including 46 males and 28 females; the patients aged from 21 to 87 years, with an average age of (56.70±14.52) years; 55 patients without RLS, and 19 with RLS. The serum calcium in patients with RLS was significantly higher than that without RLS ([2.56±0.38] mmol/L vs [2.26±0.29] mmol/L, t＝2.61, P＝0.02). Multivariate logistic regression analysis showed that serum parathyroid hormone (PTH)515.39 pg/mL was an independent risk factor for RLS in maintenance hemodialysis patients (OR＝1.00, 95% CI 1.00-1.01, P＝0.03). With the cutoff value being 515.39 pg/mL, area under ROC curve performed by PTH for RLS was 0.759, with the 95% CI being 0.610- 0.907, and the sensitivity and specificity being 0.47 and 0.98, respectively. Conclusion RLS is a common complication in maintenance hemodialysis patients. Chronic kidney disease-mineral and bone metabolism disorder may be related to the occurrence of RLS in maintenance hemodialysis patients.

Related factors for rapid eye movement sleep behavior disorder in early Parkinson disease / 中国神经精神疾病杂志

Objective To investigate the morbidity of rapid eye movement sleep behavior disorder(RBD) in early Parkinson disease (PD)and its related factors. Methods One hundred twenty-five early PD patients were divided into RBD group (n=51)and non-RBD group (n=74),according to the complicated with RBD.We collected the clinical data and used univariate and multivariate logistic regression methods to analyze the risk factors for rapid eye movement sleep behavior disorder in early Parkinson disease. Results The incidence of RBD is 40.80% in early PD patients.Univariate analysis showed that the age, the motor phenotype (akinetic-rigid-type), modified Hoehn-Yahr(H-Y)grade, freezing, constipation and restless leg syndrome (RLS)were significantly higher in RBD group than in non-RBD group (P<0.05). Multivariate logistic regression revealed that constipation ( P=0.001,95% CI:1.980~12.253,OR=12.912)and RLS (P=0.014, 95% CI: 1.322~12.015, OR=6.378 ) were independent influencing factors for RBD in early PD patients. Conclusion Early PD patients with constipation or RLS are prone to RBD.

Observations on the Efficacy of Penetrating Moxibustion plus Short Joint Needling in Treating Restless Leg Syndrome / 上海针灸杂志

Objective To investigate the clinical efficacy of penetrating moxibustion plus short joint needling in treating restless leg syndrome (RLS).Methods Ninety RLS patients were randomized to treatment and control groups,45 cases each.The treatment group received penetrating moxibustion plus short joint needling and the control group,conventional medication (vitamin B tablets,vitamin B12 tablets and alprazolam tablets).The Restless Leg Syndrome Rating Scale (RLSRS) score and the Pittsburgh Sleep Quality Index (PSQI) score were recorded in the two groups before and after 30 days of treatment.The clinical therapeutic effects were compared between the groups.Results There were statistically significant pre-/post-treatment differences in the RLSRS and PSQI scores in both groups (P＜0.05).There were statistically significant post-treatment differences in the RLSRS and PSQI scores between the treatment and control groups (P＜0.05).The total efficacy rate was 95.6％ in the treatment group and 42.2％ in the control group;there was a statistically significant difference between the two groups (P＜0.05).Conclusion Penetrating moxibustion plus short joint needling is an effective way to treat RLS.

A Case of Restless Legs Syndrome in Patient with Neurogenic Sciatic Nerve Tumor

Restless legs syndrome (RLS) is chronic neurological disorder, in which the primary symptoms is unpleasant and disturbing sensation accompanied by urge to move in multiple body parts especially in legs. RLS may present in distinct phenotypes often described as “primary” vs. “secondary.” Secondary RLS can arise from etiologies such as iron deficiency, pregnancy, peripheral neuropathy, and end-stage renal disease. We report a rare case of RLS associated with neurogenic tumor of the sciatic nerve. A 72-year-old man complained of recurrent and worsening RLS symptoms in his right lower extremity, despite medical treatment. Interestingly, we found a neurogenic tumor at the right greater sciatic notch region on magnetic resonance imaging of the hip.

Frequencia dos disturbios de sono em mulheres na pos-menopausa com sobrepeso/obesidade / Frequency of sleep disturbances in overweight/obese postmenopausal women

OBJETIVOS: Avaliar a frequência dos distúrbios do sono, como apneia obstrutiva do sono, síndrome das pernas inquietas e insônia, em pacientes na pós-menopausa com sobrepeso/obesidade no ambulatório de distúrbios do sono no climatério. MÉTODOS: Foram selecionadas 34 pacientes na pós-menopausa, e os seguintes critérios de inclusão foram adotados: idade entre 50 e 70 anos, mínimo de 12 meses de amenorreia, Índice de Massa Corporal igual ou superior a 25 kg/m2, pacientes com queixas relacionadas ao sono e que tivessem sido submetidas a pelo menos uma polissonografia. As pacientes responderam a seis questionários sobre características do sono e sintomas do climatério e uso de medicações. Foram aferidos o peso e a altura em balança padronizada e as medidas das circunferências do abdome e do quadril. Para a análise estatística, o teste do χ2 foi utilizado para variáveis qualitativas, e o teste t de Student, para análise das variáveis quantitativas. RESULTADOS: A média de idade foi de 60,3 anos, o Índice de Massa Corporal médio de 31,6, o tempo de pós-menopausa médio de 11,6 anos e o Índice Menopausal de Kupperman médio de 19. Da amostra, 85,2% apresentou relação cintura/quadril igual ou superior a 0,8; metade apresentou escore igual ou superior a 9 na Escala de Epworth; 68% apresentou distúrbio do sono de acordo com o índice de Pittsburgh e 68% dos casos foram classificados como de alto risco para apneia do sono pelo Questionário Berlin. Na polissonografia, 70,5% apresentou eficiência do sono menor que 85%; 79,4% com latência do sono menor que 30 min; 58,8% com latência para sono REM menor que 90 min e 44,1% com apneia leve. Comparando os grupos, houve associação linear média entre IMC e IAH e relação ...

PURPOSE: To evaluate the frequency of sleep disorders, such as obstructive sleep apnea, restless leg syndrome and insomnia in overweight/obese postmenopausal women seen in a climacteric sleep disorders clinic. METHODS: Thirty-four postmenopausal women were selected using the following inclusion criteria: age between 50 and 70 years; at least 12 months of amenorrhea; body mass index (BMI) greater than or equal to 25 kg/m2; and sleep-related complaints with at least one previous polysomnography. Patients provided responses to 6 questionnaires related to sleep characteristics and menopausal symptoms. Weight and height were measured using standardized scales, and abdomen and hip circumferences were also measured. The statistical analyses were performed using the χ2 test for qualitative variables and using Student's t-test for quantitative variables. RESULTS: Patients' characteristics were as follows: mean age of 60.35 years; mean BMI of 31.62; an average of 11.61 postmenopausal years and an average Kupperman Index of 19. A total of 85.2% of the patients had a waist/hip ratio of less than 0.8. The Epworth Scale score was greater than or equal to 9 in 50% of patients; 68% had sleep disturbances according to the Pittsburgh Index, and 68% were classified as high-risk for sleep apnea by the Berlin Questionnaire. On polysomnography, 70.58% of the patients had a sleep efficiency lower than 85%; 79.41% had a sleep latency of less than 30 min; 58.82% had a REM sleep latency of less than 90 min, and 44.11% had mild apnea. When the groups were compared, a linear association was identified between BMI and the AHI average, and a relationship between high BMI and use of drugs for thyroid treatment was found. CONCLUSION: There was a high prevalence of sleep-disordered breathing, initial insomnia, fragmented sleep, and thyroid disorders in the group with higher BMI. .

Mortality associated with periodic limb movements during sleep in amyotrophic lateral sclerosis patients / Mortalidade associada aos movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica

OBJECTIVE: To describe the prevalence and severity of periodic limb movements during sleep in amyotrophic lateral sclerosis patients and to explore this fact as a predictor of severity of the condition with respect to mortality. METHODS: In this case-control study, questionnaire and polysomnographic data were analyzed from 35 amyotrophic lateral sclerosis patients. Controls were matched by age, genre, and body mass index. A Kaplan-Meier curve was used to compare the survival time of patients with periodic limb movements of sleep index below or above 5. RESULTS: The number of amyotrophic lateral sclerosis patients with an index greater than five was higher than controls (19 (53%) versus 4 (11%); p<0.0001), and the mean index was higher (23.55±40.07 versus 3.28±8.96; p=0.0009). Earlier mortality was more common in patients with more than five periodic limb movements per hour of sleep than patients with less than five periodic limb movements per hour of sleep (7/19 (37%) versus 1/16 (6%); p=0.04) in this group of patients that had a mean survival of 33 months. CONCLUSIONS: There were more periodic limb movements of sleep in amyotrophic lateral sclerosis patients than in the control population. The higher number of these movements in amyotrophic lateral sclerosis patients correlates with disease severity and may suggest poor survival.

OBJETIVO:Descrever a prevalência e a severidade dos movimentos periódicos de membros durante o sono nos pacientes com esclerose lateral amiotrófica e explorar isso como um preditor de severidade da doença e mortalidade. MÉTODOS: Estudo caso controle em que foram analisados 35 pacientes por questionários e polissonografia. Os controles foram pareados por idade, gênero, e índice de massa corporal. Uma curva de Kaplan-Meier foi usada para comparar o tempo de sobrevida em pacientes com índice de movimento periódico de membros durante o sono acima e abaixo de 5. RESULTADOS: O número de pacientes com esclerose lateral amiotrófica com índice de movimentos periódicos de membros durante o sono acima de cinco foi maior do que os controles (19 (53%) versus 4 (11%); p<0,0001) e a média do índice de movimentos periódicos de membros durante o sono também foi maior no grupo dos pacientes (23,55±40,07 versus 3,28±8,96; p=0,0009). A mortalidade precoce foi mais comum em pacientes com mais que cinco movimentos durante o sono por hora do que pacientes com menos do que cinco movimentos durante o sono por hora (7/19 (37%) versus 1/16 (6%); p=0,04). Nesse grupo, os pacientes tiveram sobrevida média de 33 meses. CONCLUSÃO:Houve um maior número de movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica do que na população controle. O maior número de movimentos periódicos de membros durante o sono em pacientes com esclerose lateral amiotrófica foi correlacionado com severidade da doença e pode sugerir menor sobrevida.

A case of primary restless leg syndrome aggravated by pregnancy / 대한산부인과학회지

Restless leg syndrome (RLS) is characterized by intense restlessness and unpleasant creeping sensations deep inside the lower legs, occurring during periods of rest, evening and night. These symptoms can be improved by movement. There are two different phenotypes of RLS. One early-onset form starts before 36 years old. It has mostly a familial history, severe symptoms, and highly genetically determined. And it is a highly dependent to iron level of the brain. The other delayed-onset form starts after 36 years old, mostly secondary, without familial history, with a rapid evolution in two or three years. And it is associated with frequent low ferritin level of serum. Pathophysiology of RLS remains incompletely understood. However, advanced studies suggest that RLS may be generated by dopamine dysfunction locally within the central nervous system. Dopaminergic agonists are the treatment of choice, if the symptoms are severe. And iron therapy improves RLS symptoms in iron deprived patients. Early detection during pregnancy is needed because RLS gives an important impact on sleep efficiency and quality of life. Recently we have experienced a case of primary RLS patient diagnosed at 24+3 weeks, treated by dopaminergic agonist ropinirole and iron. We describe this case with a brief review of the literature.

Restless legs syndrome: study of prevalence among medical school faculty members / Síndrome das pernas inquietas: estudo de prevalência entre professores do curso de medicina

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25 percent of the subjects evaluated and most were women (62.5 percent). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

O objetivo deste estudo foi analisar a prevalência da síndrome das pernas inquietas (SPI) e suas implicações clínicas em uma amostra envolvendo docentes de um curso de Medicina. Foi realizado um estudo transversal que envolveu 78 docentes do curso de Medicina de uma Universidade do Sul do Brasil. Os indivíduos avaliados responderam um questionário com perguntas epidemiológicas e de diagnóstico para SPI, assim como escalas de sonolência de Epworth e Stanford. Os portadores de SPI responderam questionário de gravidade. As variáveis foram analisadas quanto à significância estatística. Obtivemos uma prevalência de indivíduos portadores de SPI de 10,25 por cento, sendo 62,5 por cento destes do sexo feminino. A existência de sonolência diurna excessiva foi significativamente maior em pacientes portadores da síndrome (p=0,04). Os pacientes portadores de SPI possuíam idade significativamente inferior ao grupo não sindrômico (p=0,02). A SPI mostrou-se bastante prevalente em nossa amostra. A prevalência de sonolência diurna e menos idade mostrou importante relação com esta síndrome, enquanto outros fatores possivelmente relacionados não foram confirmados.

Restless leg syndrome, sleep quality and fatigue in multiple sclerosis patients

We have tested the hypothesis that restless leg syndrome (RLS) is related to quality of sleep, fatigue and clinical disability in multiple sclerosis (MS). The diagnosis of RLS used the four minimum criteria defined by the International Restless Legs Syndrome Study Group. Fatigue was assessed by the Fatigue Severity Scale (FSS >27), quality of sleep by the Pittsburgh Sleep Quality Index (PSQI >6), excessive daytime sleepiness by the Epworth Sleepiness Scale (ESS >10) and clinical disability by the Expanded Disability Status Scale (EDSS). Forty-four patients (32 women) aged 14 to 64 years (43 ± 14) with disease from 0.4 to 23 years (6.7 ± 5.9) were evaluated. Thirty-five were classified as relapsing-remitting, 5 as primary progressive and 4 as secondary progressive. EDSS varied from 0 to 8.0 (3.6 ± 2.0). RLS was detected in 12 cases (27 percent). Patients with RLS presented greater disability (P = 0.01), poorer sleep (P = 0.02) and greater levels of fatigue (P = 0.03). Impaired sleep was present in 23 (52 percent) and excessive daytime sleepiness in 3 cases (6.8 percent). Fatigue was present in 32 subjects (73 percent) and was associated with clinical disability (P = 0.000) and sleep quality (P = 0.002). Age, gender, disease duration, MS pattern, excessive daytime sleepiness and the presence of upper motor neuron signs were not associated with the presence of RLS. Fatigue was best explained by clinical disability and poor sleep quality. Awareness of RLS among health care professionals may contribute to improvement in MS management.

A genética dos distúrbios do sono na infância e adolescência: [revisão] / The genetics of sleep disorders in childhood and adolescence: [review]

OBJETIVO: O objetivo deste artigo é revisar a literatura sobre a genética dos distúrbios do sono na infância e adolescência. FONTES DOS DADOS: As palavras-chave "sono" e "genética" foram usadas para pesquisar por artigos publicados nos últimos cinco anos no banco de dados MEDLINE. A seguir, seus resumos foram analisados. A pesquisa também incluiu artigos clássicos, com a primeira descrição dos genes. SÍNTESE DOS DADOS: A recorrência familiar de muitos distúrbios do sono é um achado freqüente, mas loci genéticos foram descobertos para poucos deles. Descrevemos aqui distúrbios do sono transmitidos por herança genética e também aqueles que apresentam altos índices de recorrência familiar, apesar de nenhum gene específico haver sido encontrado. CONCLUSÕES: Apesar da maioria dos distúrbios do sono ainda não terem uma base molecular identificada, técnicas modernas são cada vez mais utilizadas para determinar a contribuição dos genes ao sono e aos seus distúrbios associados. A importância clínica destas descobertas pode estar relacionada com a melhoria de métodos diagnósticos, mas também como alvo para o desenvolvimento de medicações específicas.

OBJECTIVE: To review the literature regarding the genetics of sleep disorders in childhood and adolescence. SOURCES: Articles published in the past 5 years were searched on MEDLINE using the keywords sleep and genetics. Abstracts were then analyzed. Classical articles with the first description of genes were also included. SUMMARY OF THE FINDINGS: We often find familial recurrence in many sleep disorders. However, gene loci were discovered for only a few of them. We describe sleep disorders transmitted by genetic heritance and also those in that, although a gene was not found, familial recurrence is high. CONCLUSION: Although most of the sleep disorders do not have by now an identified molecular basis, modern techniques are being increasingly applied to determine the contribution of genes to sleep and its associated disorders. The clinical importance of these discoveries may relate not only to improving diagnostic methods but also as a target for drug development.

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.

A Case of Restless Leg Syndrome Induced by Mirtazapine in a Patient with Major Depressive Disorder / 대한정신약물학회지

Mirtazapine is a novel antidepressant and has a unique dual action profile, combining the enhancement of the noradrenergic neurotransmitter system with specific actions on particular serotonergic receptor subtypes. The authors report a case of restless leg syndrome induced by mirtazapine. The patient (46 years old male) with major depressive disorder developed typical restless leg syndrome from the initial period of administration of mirtazapine. Restless leg syndrome was not relieved by reduction of mirtazapine and disappeared rapidly after discontinuation of mirtazapine. The major difference of the case from previously reported cases is the onset time of symptoms. We may consider that mirtazapine can induce dopaminergic side effect like a restless leg syndrome promptly as its fast-acting antidepressant effect.