[Diagnosing the hyperactive child who snores]. / Que faire devant un enfant ronfleur et hyperactif ?

Attention deficit hyperactivity disorder (ADHD) is a common disorder, often associated with sleep disorders. Patients with primary sleep disorders often present hyperactivity and/or attention deficit symptoms. Indeed, obstructive sleep disorder breathing (snoring, hypoventilation disorder, and obstructive sleep apnea syndrome) with poor sleep quality can mimic ADHD in children. In this case, inattention and hyperactivity behavior are induced by sleep disorders but do not constitute a clinical diagnosis of ADHD. Therefore, it can sometimes be difficult for the clinician to distinguish between a diagnosis of ADHD with comorbid sleep disorder and a sleep disorder that mimics ADHD symptoms. The objective of this article is to review the relations between ADHD and obstructive sleep disorder breathing and propose a decision tree to help diagnosis.

A prospective study evaluating sleep quality in Failed Back Surgery Syndrome patients treated by multicolumn spinal cord stimulation: study design protocol and presentation of the study population.

BACKGROUND AND PURPOSE: One of the main consequences of chronic pain syndrome is major impairment of the quality of sleep. Chronic pain and insomnia are independently linked to significant reductions in quality of life and psychiatric morbidity. Recent studies have suggested the efficacy of spinal cord stimulation (SCS) for the treatment of the back pain component in failed back surgery syndrome (FBSS) patients using a multicolumn lead. The main aim of this pilot study is to assess the influence and potential benefits of SCS on sleep quality in refractory FBSS patients implanted with multicolumn SCS and enrolled in the French multicentre ESTIMET study. METHODS: This is a single-centre, comparative, exploratory, pilot study. Sixteen FBSS patients enrolled in the ESTIMET study and implanted with multicolumn SCS will be monitored for 6months after implantation. Sleep parameters will be recorded by polysomnography, Psychomotor Vigilance Test and Osler tests, actigraphy, sleepiness scales, and sleep quality testing. Sleep will be evaluated before (at the inclusion visit) and after SCS implantation (at the 6-month visit). Secondary objectives will also assess the impact of SCS lead programming (mono vs. multicolumn SCS) and the influence of position-adaptive stimulation at night on sleep quality. TRIAL STATUS: The first patient of this ancillary study was enrolled on 21 May, 2012 and recruitment has now been achieved. Primary endpoint findings are expected to be available in 2015. CONCLUSION: By providing an analysis of the quality of sleep in chronic pain patients who are candidates for implanted neurostimulation, this new approach focuses on an important aspect of quality of life often overlooked in these poly-medication patients. It could show a real clinical benefit and underestimation of these analgesic innovative expensive techniques, where medico-economic analysis, would or would not promote access.