ABSTRACT
One hundred thirty-three cases of restless legs syndrome (RLS), diagnosed with criteria recently formulated by an international study group, were studied by questionnaire and with all-night polysomnographic recordings. Results show that RLS starts at a mean age of 27.2 years and before age 20 in 38.3% of patients. Symptoms often appear in one leg only and also involve upper limbs in about half of all cases. Most patients (94%) report sleep-onset insomnia or numerous nocturnal awakenings due to RLS symptoms. A strong relationship was found between these complaints and polysomnographic findings; increasing sleep latency and number of awakenings and decreasing sleep efficiency were associated with worsening symptoms. Periodic leg movements in sleep (index > 5 movements/h sleep) were found in 80.2% of patients. This study shows that this percentage is increased when 2 recording nights are considered (most severe score). Eighty patients of 127 (63%) reported the presence of RLS in at least one of their first-degree relatives. In these families, 221 of 568 first-degree relatives (39%) were reported by the patients to be affected with RLS.
Subject(s)
Polysomnography , Restless Legs Syndrome/diagnosis , Adult , Aged , Cerebral Cortex/physiopathology , Female , Humans , Male , Middle Aged , Prognosis , Reaction Time/genetics , Reaction Time/physiology , Restless Legs Syndrome/genetics , Restless Legs Syndrome/physiopathology , Sleep Stages/genetics , Sleep Stages/physiologySubject(s)
Blindness/drug therapy , Circadian Rhythm/drug effects , Melatonin/administration & dosage , Sleep Wake Disorders/drug therapy , Blindness/genetics , Blindness/psychology , Child, Preschool , Chromosomes, Human, Pair 22 , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Humans , Sleep Initiation and Maintenance Disorders/drug therapy , Sleep Initiation and Maintenance Disorders/genetics , Sleep Initiation and Maintenance Disorders/psychology , Sleep Stages/drug effects , Sleep Wake Disorders/genetics , Sleep Wake Disorders/psychology , Trisomy/geneticsABSTRACT
There are several new developments with regard to semiology, diagnosis, physiopathology and the treatment of restless leg syndrome (RLS). We present here the hypothesis that motor manifestations of the RLS are synchronous to slowing of the cortical activity as measured by the spectral analysis of the EEG. When the subject is resting in bed with his leg outstretched, slowing of the EEG is observed, which could be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic at the frequency of approximately 1 every 20 seconds or sustained. Leg movements can be periodic or aperiodic accordingly. On the contrary, periodic leg movements in sleep (PLMS) occur in close temporal relationship with periodic arousal. These results raised the hypothesis that leg movements (RLS and PLMS) may appear at a critical level of cortical activation. This level is reached during sleepiness in the awake subject or during periodic micro-arousal when the subject is asleep. Other results suggest that these periodic changes in the level of cortical activation may also modulate other abnormal motor behavior in sleep such as rhythmic masticatory muscles activity as seen in sleep bruxism. The same mechanism may also be involved in setting the duration of apneic episodes during slow-wave sleep.
Subject(s)
Electroencephalography , Periodicity , Restless Legs Syndrome/physiopathology , Humans , Prevalence , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/epidemiologyABSTRACT
We suggest a classification for abnormal motor behavior during sleep based upon clinical and research studies. Abnormal motor behaviors are classified into four types: aperiodic myoclonic contractions, periodic and stereotype movements, complex and disorganized motor behaviors, complex and organized motor behaviors. Examples for each type are given to support the classification.
Subject(s)
Movement Disorders/classification , Sleep/physiology , Diagnosis, Differential , Humans , Movement Disorders/diagnosis , Periodicity , Stereotyped Behavior/physiologyABSTRACT
There are presently three main treatments for restless leg syndrome-periodic leg movements in sleep (RLS-PLMS). The benzodiazepines (especially clonazepam) are considered by most clinicians to be the treatment of choice in mild cases, especially in young subjects. In our experience, however, L-dopa and bromocriptine are more effective treatments, although no controlled studies have ever been conducted to compare their therapeutic benefits and the side effects of benzodiazepines and dopaminergic drugs. The use of opioids should be restricted to patients who have severe symptoms and who fail to respond to benzodiazepines or L-dopa. Propoxyphene was found less effective than L-dopa in decreasing PLMS, but some patients resistant to L-dopa may exhibit a masked therapeutic response to opioids. However, there is currently no method to predict the response to any treatment modality.
Subject(s)
Restless Legs Syndrome/drug therapy , Sleep Wake Disorders/drug therapy , Anti-Anxiety Agents/adverse effects , Anti-Anxiety Agents/therapeutic use , Clonazepam/adverse effects , Clonazepam/therapeutic use , Dextropropoxyphene/adverse effects , Dextropropoxyphene/therapeutic use , Dopamine Agents/adverse effects , Dopamine Agents/therapeutic use , Humans , Levodopa/adverse effects , Levodopa/therapeutic use , Narcotics/adverse effects , Narcotics/therapeutic use , Polysomnography , Restless Legs Syndrome/physiopathology , Sleep Stages/drug effects , Sleep Stages/physiology , Sleep Wake Disorders/physiopathologyABSTRACT
The parasomnias comprises a group of disorders that intrude into the sleep process and are not primarily disorders of sleep and wake states per se. These disorders are manifestations of central nervous system activation usually transmitted through skeletal muscle or autonomic nervous system channels (ICSD 1990). The parasomnias are divided into four groups: Arousal disorders (sleepwalking, night terrors, and confusionnal arousal), sleep-wake transition disorders (rhythmic movement disorder, sleep starts), REM sleep parasomnias (nightmares, sleep paralysis, hallucinations, and REM sleep behavior disorders), and other parasomnias (sleeptalking, nocturnal enuresis, and nocturnal bruxism.
Subject(s)
Bruxism/physiopathology , Dreams/physiology , Enuresis/physiopathology , Sleep Wake Disorders/physiopathology , Somnambulism/physiopathology , Adult , Bruxism/etiology , Child , Child, Preschool , Enuresis/etiology , Humans , Infant , Polysomnography , Sleep Wake Disorders/drug therapy , Sleep Wake Disorders/etiology , Sleep, REMABSTRACT
REM sleep behavior disorder (RBD) is characterized by the intermittent absence of REM sleep EMG atonia and the appearance of elaborate motor activity associated with dream mentation. There are no specific diagnostic criteria for RBD based upon polysomnographic findings. We describe a new scoring method and show its sensitivity to treatment with clonazepam. An increased phasic submental EMG density occurs in RBD patients, but REM density is similar to that of controls. Clonazepam selectively decreases REM sleep phasic activity but exerts no effect on REM sleep atonia. Periodic limb movements in sleep (PLMS) occur equally in both REM and NREM sleep in RBD patients, suggesting that normal suppression of PLMS in REM sleep is due to motor inhibition.
Subject(s)
Sleep Wake Disorders/physiopathology , Sleep, REM/physiology , Adult , Aged , Electroencephalography , Electromyography , Female , Humans , Male , Middle Aged , Reaction Time/physiologyABSTRACT
Gamma-hydroxybutyrate (GHB) is a drug currently used to treat narcolepsy. The present study documents its effect on sleep organization in healthy subjects. GHB and a placebo were given at bedtime and before a morning nap in a double-blind fashion. GHB administered before nocturnal or diurnal sleep increases stages 3 and 4 and decreases stage 1 non-rapid eye movement (NREM) sleep. In addition, GHB improves REM efficiency at night and reduces wake time after sleep onset when administered before a morning nap recording. GHB also slightly decreases REM latency when administered in the morning, and this effect is correlated with age. Hypotheses regarding mechanisms of action GHB and the involvement of hypothalamic structures in the regulation of REM sleep are discussed.
Subject(s)
Circadian Rhythm/drug effects , Hydroxybutyrates/pharmacology , Sleep Stages/drug effects , Sleep, REM/drug effects , Sodium Oxybate/pharmacology , Administration, Oral , Adult , Brain Stem/drug effects , Clinical Trials as Topic , Double-Blind Method , Electroencephalography , Female , Humans , Male , Middle Aged , Reaction Time/drug effects , Receptors, Cholinergic/drug effectsABSTRACT
Periodic leg movements during sleep (PMS) is a disorder frequently encountered in narcolepsy. In the present study, 12 narcoleptic patients (six with PMS and six without) were recorded in a sleep laboratory for 2 consecutive nights before and after treatment with gamma-hydroxybutyrate (GHB) taken at bedtime for 1 month. Treatment resulted in decreased rapid eye movement (REM) sleep latency and increased REM efficiency without change in the total duration of REM sleep. GHB was associated with the appearance of pathological levels of PMS in patients who were unaffected before treatment. These results are discussed in relation to the role of dopamine in the physiopathology of narcolepsy and PMS.
