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1.
J Pers Med ; 13(3)2023 Mar 15.
Article in English | MEDLINE | ID: mdl-36983709

ABSTRACT

Background: There is a growing body of evidence suggesting a link between obstructive sleep apnea (OSA) and atrial fibrillation (AF). The primary objective of this study is to evaluate the association between OSA and AF in acute ischemic stroke. The secondary objective is to describe the clinical features of patients with acute ischemic stroke and concomitant OSA. Methods: We enrolled consecutive patients with acute ischemic stroke. All patients underwent full-night cardiorespiratory polygraphy. To determine if there is an association between AF and OSA, we compared the observed frequency of this association with the expected frequency from a random co-occurrence of the two conditions. Subsequently, patients with and without OSA were compared. Results: A total of 174 patients were enrolled (mean age 67.3 ± 11.6 years; 95 males). OSA and AF were present in 89 and 55 patients, respectively. The association OSA + AF was observed in 33/174 cases, which was not statistically different compared to the expected co-occurrence of the two conditions. Patients with OSA showed a higher neck circumference and body mass index, a higher prevalence of hypertension and dysphagia, and a higher number of central apneas/hypoapneas. In the multivariate analysis, dysphagia and hypertension were independent predictors of OSA. A positive correlation was observed between OSA severity, BMI, and neck circumference. The number of central apneas/hypoapneas was positively correlated with stroke severity. Conclusions: Our data suggest that OSA and AF are highly prevalent but not associated in acute stroke. Our findings support the hypothesis that OSA acts as an independent risk factor for stroke.

2.
Public Health ; 218: 75-83, 2023 May.
Article in English | MEDLINE | ID: mdl-36977367

ABSTRACT

OBJECTIVES: During the first wave of the COVID-19 pandemic, the Region of Lombardy in Italy and its Regional Emergency Service (Azienda Regionale Emergenza Urgenza [AREU]) created a dedicated 24/7 free phone service to help the Lombard population. After an invitation from their professional order, local midwives collaborated on the AREU project as volunteers to address the needs of women from antenatal to postnatal periods. The aim of this article was to explore the experiences of midwives who volunteered in the AREU project. STUDY DESIGN: This was a qualitative study using an interpretative phenomenological approach (IPA). METHODS: The experiences of midwives volunteering in AREU (N = 59) were explored using audio diaries. Written diaries were also offered as an alternative. Data collection took place between March and April 2020. Midwives were provided with semistructured guidance that indicated the main areas of interest of the study. The diaries were thematically analysed following a temporal criterion; a final conceptual framework was created from emerging themes and subthemes. RESULTS: The following five themes were identified: (1) choosing to join the volunteer project, (2) the day-to-day difficulties, (3) strategies to cope with the unexpected, (4) professional relationships and (5) reflecting on the personal experience. CONCLUSIONS: This is the first study to investigate the experiences of Italian midwives who volunteered in a public health project during a pandemic/epidemic. According to participants, taking part in the volunteer activities was informed by and impacted on both their professional and personal lives. Overall, the experiences of midwives who volunteered in AREU were positive and of humanitarian value. Providing midwifery services within a multidisciplinary team for the benefit of public health represented both a challenge and personal/professional enrichment.


Subject(s)
COVID-19 , Midwifery , Female , Pregnancy , Humans , Pandemics , COVID-19/epidemiology , Qualitative Research , Volunteers
3.
Neurology ; 96(2): e241-e249, 2021 01 12.
Article in English | MEDLINE | ID: mdl-33024021

ABSTRACT

OBJECTIVE: To describe the prevalence and characteristics of sleep-disordered breathing (SDB) in a large cohort of patients with genetically confirmed mitochondrial diseases. METHODS: This is a prospective observational study performed at the Neurophysiopatology Unit of Fondazione Policlinico Universitario A. Gemelli IRCCS. All participants had a defined mitochondrial disease and were investigated by full-night polysomnography. RESULTS: One hundred three consecutive patients were enrolled. SDB was demonstrated in 49 patients (47.6%). Regarding phenotypes, we found differences in distribution between the groups: patients affected by progressive external ophthalmoplegia with single or multiple mtDNA deletions frequently had obstructive apneas (50% and 43.8%) or REM-related hypoventilation when associated with m.3243A>G mutations (75%). Furthermore, a high percentage of participants with maternally inherited diabetes and deafness and myoclonic epilepsy with ragged-red fibers syndromes were characterized by obstructive sleep apnea and REM-related hypoventilation, respectively. In contrast to what has been described in previous studies, central sleep apnea was rarely reported in our cohort. CONCLUSIONS: SDB has a higher prevalence in mitochondrial diseases compared to general population-based data. Overall, these results suggest that patients characterized by a specific phenotype-genotype combination are most at risk of developing a specific subgroup of SDB. The early identification of this disorder is crucial in the management of these fragile patients.


Subject(s)
Mitochondrial Diseases/diagnosis , Mitochondrial Diseases/physiopathology , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/physiopathology , Adult , Aged , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Mitochondrial Diseases/epidemiology , Polysomnography/methods , Prospective Studies , Sleep Apnea Syndromes/epidemiology
4.
Front Neurosci ; 14: 70, 2020.
Article in English | MEDLINE | ID: mdl-32116516

ABSTRACT

Severe spasticity is a frequent and disabling complication in patients presenting disorders of consciousness (DOC) that hinders their rehabilitative process, and is strongly correlated with pain reducing patients' quality of life. In these patients, abnormal postures may occur as an expression of severe brain damage. Here we present the case of a 52-year-old man in decorticate rigidity following a hypoxic-ischemic encephalopathy due to myocardial infarction who showed improvement of spasticity of upper limbs following intake of levetiracetam combined with the conventional neurorehabilitation program.

5.
Nord J Psychiatry ; 74(4): 244-250, 2020 May.
Article in English | MEDLINE | ID: mdl-31790624

ABSTRACT

Introduction: This study aims to evaluate napping in patients with insomnia compared with two control groups and to investigate the relationships between psychometric measures and napping habitude.Methods: Sixty-eight adult patients with chronic primary insomnia were enrolled; 27 men and 41 women, mean age 53.6 ± 13. All patients underwent 24 h ambulatory polysomnography (A-PSG). Prevalence of napping behavior in Insomnia Patients (I-group) was compared with Obstructive Sleep Apnea Syndrome (OSAS) patients (OSAS-group) and epilepsy patients (Ep-group). Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Berlin Questionnaire. Psychometric evaluation included Self-Administered Anxiety Scale (SAS #54), Beck Depression Inventory (BDI), Maudsley's Obsessive Compulsive Inventory (MOCI), Snaith-Hamilton Pleasure Scale (SHAPS), and Eating Attitude Test (EAT-26).Results: No significant differences resulted in prevalence and duration of naps in the three groups. In the comparison between nappers (N+, subject with at least one nap in A-PSG) and non-nappers (N-, subject with no naps in A-PSG) we observed significant differences in PSQI scores (N+ = 14.1 ± 2.7; N- =11.9 ± 3.3; Whitney U-test = 341.0; p = 0.004) and in EAT score (N+ = 9.8 ± 9.7; N- = 4.4 ± 5.6; Whitney U-test = 313.5, p = 0.0.14); no significant differences were measured in other psychometric parameters and in sleep macrostructural indexes.Conclusions: Our data are in accordance with previous findings outlining that N + insomniacs have higher PSQI scores than N-. Our results do not confirm the suggested association between napping and depressive or obsessive-compulsive symptoms. Conversely, we found a statistically significant difference (p = 0.0014) in EAT scores in N + and N-. Hyperarousal and REM sleep instability in insomniac patients may create an unbalance of the neuroendocrine hypothalamic regulation leading to an appetite alteration.


Subject(s)
Polysomnography/methods , Psychometrics/methods , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/psychology , Sleep/physiology , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Sleep Initiation and Maintenance Disorders/physiopathology , Surveys and Questionnaires
6.
J Ment Health ; 29(1): 20-26, 2020 Feb.
Article in English | MEDLINE | ID: mdl-29271275

ABSTRACT

Background: Chronic Insomnia is a severe and disabling condition characterized by difficulty in initiating or maintaining sleep, waking up too early, despite adequate opportunity and circumstances for sleep. Maladaptive thoughts and dysfunctional beliefs about sleep are considered crucial factors in developing and perpetuating this disorder.Aims: The aim of the study was to explore the usefulness, in patients with chronic insomnia, of a one-session psychoeducational intervention on sleep-related maladaptive thoughts and beliefs, and on sleep perception.Methods: Thirty-eight patients with chronic insomnia were enrolled in the study and randomly assigned to receive psychoeducational intervention (PI+) or to act as controls (PI-). Patients wore an actigraph and compiled a sleep diary for 14 d. After the first 7 d, only PI+ patients received one session of psychoeducational intervention.Results: A significant reduction of sleep related preoccupations, a reduction of dysfunctional beliefs about sleep, and an improvement of subjective perception of sleep were observed in the PI+ group, but not in the PI- group. No significant modification was observed for objective total sleep time.Conclusions: Our results suggest that one-session psychoeducational intervention is associated with a decrease of sleep-related maladaptive thoughts and beliefs, and with an improvement on subjective sleep perception.


Subject(s)
Cognitive Behavioral Therapy/methods , Sleep Initiation and Maintenance Disorders/therapy , Actigraphy , Aged , Female , Humans , Male , Middle Aged , Motor Activity , Sleep Initiation and Maintenance Disorders/diagnosis , Sleep Initiation and Maintenance Disorders/physiopathology , Treatment Outcome
7.
Pain Res Manag ; 2019: 5408732, 2019.
Article in English | MEDLINE | ID: mdl-31827655

ABSTRACT

Restless legs syndrome (RLS) is characterized by unpleasant sensations generally localized to legs, associated with an urge to move. A likely pathogenetic mechanism is a central dopaminergic dysfunction. The exact role of pain system is unclear. The purpose of the study was to investigate the nociceptive pathways in idiopathic RLS patients. We enrolled 11 patients (mean age 53.2 ± 19.7 years; 7 men) suffering from severe, primary RLS. We recorded scalp laser-evoked potentials (LEPs) to stimulation of different sites (hands and feet) and during two different time conditions (daytime and nighttime). Finally, we compared the results with a matched control group of healthy subjects. The Aδ responses obtained from patients did not differ from those recorded from control subjects. However, the N1 and the N2-P2 amplitudes' night/day ratios after foot stimulation were increased in patients, as compared to controls (N1: patients: 133.91 ± 50.42%; controls: 83.74 ± 34.45%; p = 0.016; Aδ-N2-P2: patients: 119.15 ± 15.56%; controls: 88.42 ± 23.41%; p = 0.003). These results suggest that RLS patients present circadian modifications in the pain system, which are not present in healthy controls. Both sensory-discriminative and affective-emotional components of pain experience show parallel changes. This study confirms the structural integrity of Aδ nociceptive system in idiopathic RLS, but it also suggests that RLS patients present circadian modifications in the pain system. These findings could potentially help clinicians and contribute to identify new therapeutic approaches.


Subject(s)
Chronobiology Disorders/physiopathology , Restless Legs Syndrome/physiopathology , Adult , Aged , Female , Humans , Laser-Evoked Potentials , Male , Middle Aged
8.
Med Lav ; 110(2): 93-101, 2019 Apr 19.
Article in English | MEDLINE | ID: mdl-30990471

ABSTRACT

BACKGROUND: Current Italian regulations and procedures for surface decontamination of antineoplastic drugs (ADs) are not clear. Therefore, most hospital pharmacies follow internal procedures as an interpretation of the recommended handling guidelines. OBJECTIVES: Our study compared 7 different cleaning procedures after controlled contamination of the work surface of a biological safety cabinet workbench in an Italian hospital oncology pharmacy (HOP) to determine which of them is more efficient and practical. Moreover, in order to approximate operative routine and improve risk awareness, cleaning procedures were carried out by the personnel that usually operate in the HOP. METHODS: Measured quantities, i.e. a drop (100 µL) of 5-FluoroUracil, IPhosfamide, CycloPhosphamide and Gemcitabine, were deposited on the work surface within precisely delimited areas. Following the wipe-test analysis using UPLC-MS/MS, the cleaning efficacy was calculated based on the ratio of the residual concentration of the AD, after the cleaning procedure, to the concentration of each AD before the procedure. RESULTS: Tested cleaning procedures were: 1) Hypo-Chlor®, hot water and Farmecol70®; 2) Hypo-Chlor® and hot water; 3) Farmecol70®; 4) Surfa'Safe SH® and hot water; 5) Amuchina® 10%, hot water and Farmecol70®; 6) Incidin® Oxyfoam and hot water; 7) liquid Marseille soap, hot water and Farmecol70®. Within the studied HOP, the Marseille soap was evaluated to be the optimal choice due to its efficacy, low cost, and the very short contact time needed before rinsing. DISCUSSION: The application of the protocol for procedure validation suggested here could be used in every HOP as a reliable industrial hygiene tool to demonstrate the validity of the chosen cleaning procedure.


Subject(s)
Antineoplastic Agents , Occupational Exposure , Occupational Health , Pharmacy Service, Hospital , Chromatography, Liquid , Decontamination , Equipment Contamination , Italy , Tandem Mass Spectrometry
10.
Cephalalgia ; 38(6): 1093-1106, 2018 05.
Article in English | MEDLINE | ID: mdl-28762753

ABSTRACT

Background Migraine is a well-known feature of mitochondrial disorders (MDs). However, no systematic epidemiological data are available in large populations of patients. Aims The aim of this cross-sectional cohort study was to describe the prevalence and migraine characteristics in a large cohort of patients with mitochondrial encephalomyopathies. Methods We studied 93 consecutive patients with characterised MDs referred to our Neuromuscular Unit during a 12-month period. All patients (age range = 16-78 years; 31 men; 58 progressive external ophthalmoplegia [PEO], 12 myoclonic epilepsy with ragged red fibres [MERRF], eight mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes [MELAS], two mitochondrial neurogastrointestinal encephalomyopathy [MNGIE] and 13 other MDs) underwent a structured diagnostic headache interview using an operational diagnostic tool following the IHS criteria. If they met the criteria for migraine, they were included in the 'Migraine Group'. The other patients were counted in the 'No Migraine Group'. Patient demographic and migraine characteristics were examined. Clinical, neuroradiological and neurophysiological data were compared between groups. Results Migraine was reported in 35.5% of patients. Migraine without aura was the most common headache (81.8%). The migraine group showed younger age ( P < 0.01), increased prevalence of epilepsy ( P = 0.01), myoclonus ( P = 0.03), stroke-like episodes ( P = 0.03) and decreased prevalence of muscle weakness ( P < 0.01). Multivariate analysis showed that migraine was positively associated with absence of muscle weakness ( P = 0.04) and presence of EEG abnormalities ( P = 0.02). Conclusion Migraine has a higher prevalence in MDs compared with general population-based data, independently from genotype or phenotype. Migraine is not merely a phenotypic aspect of specific MDs but is rather the expression of vulnerability of the central nervous system, probably directly related with defects of the respiratory chain.


Subject(s)
Migraine Disorders/epidemiology , Migraine Disorders/etiology , Mitochondrial Diseases/complications , Adolescent , Adult , Aged , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Prevalence , Young Adult
11.
J Stroke Cerebrovasc Dis ; 27(3): 539-546, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29074066

ABSTRACT

BACKGROUND: Obstructive sleep apnea (OSA) and dysphagia are common in acute stroke and are both associated with increased risk of complications and worse prognosis. The aims of the present study were (1) to evaluate the prevalence of OSA and dysphagia in patients with acute, first-ever, ischemic stroke; (2) to investigate their clinical correlates; and (3) to verify if these conditions are associated in acute ischemic stroke. METHODS: We enrolled a cohort of 140 consecutive patients with acute-onset (<48 hours), first-ever ischemic stroke. Computed tomography (CT) and magnetic resonance imaging scans confirmed the diagnosis. Neurological deficit was measured using the National Institutes of Health Stroke Scale (NIHSS) by examiners trained and certified in the use of this scale. Patients underwent a clinical evaluation of dysphagia (Gugging Swallowing Screen) and a cardiorespiratory sleep study to evaluate the presence of OSA. RESULTS: There are 72 patients (51.4%) with obstructive sleep apnea (OSA+), and there are 81 patients (57.8%) with dysphagia (Dys+). OSA+ patients were significantly older (P = .046) and had greater body mass index (BMI) (P = .002), neck circumference (P = .001), presence of diabetes (P = .013), and hypertension (P < .001). Dys+ patients had greater NIHSS (P < .001), lower Alberta Stroke Programme Early CT Score (P < .001), with greater BMI (P = .030). The association of OSA and dysphagia was greater than that expected based on the prevalence of each condition in acute stroke (P < .001). CONCLUSIONS: OSA and dysphagia are associated in first-ever, acute ischemic stroke.


Subject(s)
Brain Ischemia/epidemiology , Deglutition Disorders/epidemiology , Sleep Apnea, Obstructive/epidemiology , Stroke/epidemiology , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnosis , Comorbidity , Deglutition , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Disability Evaluation , Female , Humans , Lung/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Prevalence , Prognosis , Respiration , Risk Factors , Rome/epidemiology , Sleep , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/physiopathology , Stroke/diagnosis , Time Factors , Tomography, X-Ray Computed , Young Adult
12.
Neurodegener Dis ; 17(6): 330-337, 2017.
Article in English | MEDLINE | ID: mdl-29169178

ABSTRACT

INTRODUCTION: The aim of the study was to evaluate the clinical reliability of subjective sleep evaluation, based on sleep and psychometric questionnaires, by comparing the results with those obtained with laboratory-based video-polysomnography (V-PSG). PATIENTS AND METHODS: Thirty consecutive Huntington disease (HD) patients were enrolled. Subjective evaluation of sleep included the Pittsburgh Sleep Quality Index (PSQI), the sleep questionnaire for HD (HDQ), the Epworth Sleepiness Scale, the Bologna questionnaire for sleepiness (BQ), the Berlin questionnaire, and the RBD questionnaire; the International Restless Legs Syndrome Study Group scale was administered to patients with positive screening. The psychometric evaluation included the Zung Anxiety Scale, the short form of the Beck Depression Inventory, and the Maudsley Obsessive-Compulsive Inventory. All patients underwent V-PSG. RESULTS: In sleepiness evaluation, the Epworth score was above the cutoff in 6 subjects, and the BQ detected a "high risk" of sleepiness in 7 cases. The results were concordant in 24 and discordant in 5 cases. In the evaluation of sleep quality, the PSQI score was above the cutoff in 18 subjects. According to the HDQ, 10 subjects were poor sleepers. The results were concordant with the PSQI in 20 subjects. DISCUSSION: All comparisons between scale scores and PSG results showed poor or totally absent concordance between subjective and objective measures. SIGNIFICANCE: The subjective evaluation of sleep in HD patients shows a poor correlation with PSG results.


Subject(s)
Huntington Disease/complications , Polysomnography , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/etiology , Surveys and Questionnaires , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Psychometrics , Reproducibility of Results
13.
Med Lav ; 108(4): 276-282, 2017 08 28.
Article in English | MEDLINE | ID: mdl-28853425

ABSTRACT

There is increasing evidence of a relationship between Obstructive Sleep Apnea (OSA) and cardiovascular diseases. The strong association between OSA and arterial hypertension, in particular in patients with resistant hypertension and/or a non-dipping profile, has been extensively reported. The relationship between OSA and high blood pressure (BP) has been found independent from a number of confounders, but several factors may affect this relationship, including age and sex. It is thus important to better assess pathophysiologic and clinical interactions between OSA and arterial hypertension, also aimed at optimizing treatment approaches in OSA and hypertensive patients with co-morbidities. Among possible mechanisms, cardiovascular autonomic control alterations, altered mechanics of ventilation, inflammation, endothelial dysfunction, and renin-angiotensin-aldosterone system should be considered with particular attention. Additionally, available studies also support the occurrence of a bidirectional association between OSA and cardiovascular alterations, in particular heart failure, stroke and cardiac arrhythmias, emphasizing that greater attention is needed to both identify and treat sleep apneas in patients with cardiovascular diseases. However, a number of aspects of such a relationship are still to be clarified, in particular with regard to gender differences, effect of sleep-related breathing disorders in childhood, and influence of OSA treatment on cardiovascular risk, and they may represent important targets for future studies.


Subject(s)
Cardiovascular Diseases/etiology , Sleep Apnea, Obstructive/complications , Humans , Hypertension/etiology
15.
Clin Neurophysiol ; 128(7): 1354-1363, 2017 07.
Article in English | MEDLINE | ID: mdl-28043770

ABSTRACT

OBJECTIVE: To evaluate EEG functional connectivity in the sensory-motor network, during wake and sleep, in patients with Huntington Disease (HD). METHODS: 23 patients with HD and 23 age- and sex-matched healthy controls were enrolled. EEG connectivity analysis was performed by means of exact Low Resolution Electric Tomography (eLORETA). RESULTS: In wake, HD patients showed an increase of delta lagged phase synchronization (T=3.60; p<0.05) among Broadman's Areas (BA) 6-8 bilaterally; right BA 6-8 and right BA 1-2-3; left BA 1-2-3 and left BA 4. In NREM, HD patients showed an increase of delta lagged phase synchronization (T=3.56; p<0.05) among left BA 1-2-3 and right BA 6-8. In REM, HD patients showed an increase of lagged phase synchronization (T=3.60; p<0.05) among the BA 6-8 bilaterally (delta band); left BA 1-2-3 and right BA 1-2-3 (theta); left BA 1-2-3 and right BA 4 (theta); left BA 1-2-3 and right BA 1-2-3 (alpha). CONCLUSIONS: Our results may reflect an abnormal function of the motor areas or an effort to counterbalance the pathological motor output. SIGNIFICANCE: Our results may help to understand the pathophysiology of sleep-related movement disorders in Huntington's Disease, and to define therapeutically strategies.


Subject(s)
Brain/physiopathology , Electroencephalography/methods , Huntington Disease/physiopathology , Nerve Net/physiopathology , Sensorimotor Cortex/physiopathology , Sleep Wake Disorders/physiopathology , Humans , Huntington Disease/diagnosis , Huntington Disease/epidemiology , Sleep/physiology , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/epidemiology
16.
J Clin Neurophysiol ; 34(1): 92-99, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27490325

ABSTRACT

PURPOSE: Hyperventilation (HV) is a commonly used electroencephalogram activation method. METHODS: We analyzed EEG recordings in 22 normal subjects and 22 patients with focal epilepsy of unknown cause. We selected segments before (PRE), during (HYPER), and 5 minutes after (POST) HV. To analyze the neural generators of EEG signal, we used standard low-resolution electromagnetic tomography (sLORETA software). We then computed EEG lagged coherence, an index of functional connectivity, between 19 regions of interest. A weighted graph was built for each band in every subject, and characteristic path length (L) and clustering coefficient (C) have been computed. Statistical comparisons were performed by means of analysis of variance (Group X Condition X Band) for mean lagged coherence, L and C. RESULTS: Hyperventilation significantly increases EEG neural generators (P < 0.001); the effect is particularly evident in cingulate cortex. Functional connectivity was increased by HV in delta, theta, alpha, and beta bands in the Epileptic group (P < 0.01) and only in theta band in Control group. Intergroup analysis of mean lagged coherence, C and L, showed significant differences for Group (P < 0.001), Condition (P < 0.001), and Band (P < 0.001). Analysis of variance for L also showed significant interactions: Group X Condition (P = 0.003) and Group X Band (P < 0.001). CONCLUSIONS: In our relatively small group of epileptic patients, HV is associated with activation of cingulate cortex; moreover, it modifies brain connectivity. The significant differences in mean lagged coherence, path length, and clustering coefficient permit to hypothesize that this activation method leads to different brain connectivity patterns in patients with epilepsy when compared with normal subjects. If confirmed by other studies involving larger populations, this analysis could become a diagnostic tool in epilepsy.


Subject(s)
Brain/physiopathology , Electroencephalography/methods , Epilepsies, Partial/diagnosis , Epilepsies, Partial/physiopathology , Hyperventilation/physiopathology , Tomography/methods , Adolescent , Adult , Aged , Analysis of Variance , Brain/diagnostic imaging , Female , Humans , Male , Middle Aged , Neural Pathways/physiopathology , Signal Processing, Computer-Assisted , Software , Young Adult
17.
J Neurol Sci ; 372: 387-392, 2017 Jan 15.
Article in English | MEDLINE | ID: mdl-27823835

ABSTRACT

INTRODUCTION: Fatigue and sleep disorders are frequently reported in patients affected by Multiple Sclerosis (MS) but the causes and the relationship are not yet fully understood. This study aimed at evaluating their prevalence, at determining the relationships between clinical findings of MS and the occurrence of sleep disorders and at investigating the relations between sleep disorders and fatigue. METHODS: One hundred and two MS patients were enrolled in the study. They were analyzed on both their clinical features (type of MS, disease duration, clinical severity, type of treatment, presence of spinal demyelinating lesions) and specific scales scores (Expanded Disability Status Scale, Modified Fatigue Impact Scale - MFIS, Self-Administered Anxiety Scale - SAS, Beck's Depression Inventory - BDI, Pittsburgh Sleep Quality Index - PSQI, Epworth Sleepiness Scale - ESS, and the Berlin's questionnaire for Obstruction Sleep Apnea Syndrome - OSAS). RESULTS: Patients with poor sleep quality are more frequently fatigued (p=0.001), have higher MFIS global scores (p<0.001), higher prevalence of RLS symptoms (p=0.049), and show higher scores at BDI (p=0.017) and SAS (p≤0.001). Conversely patients with fatigue show older age (p=0.005), higher prevalence of sleepiness (p=0.021), higher prevalence of RLS symptoms (p=0.030), higher prevalence of poor sleep quality (p<0.001) with higher PSQI scores (p<0.001), higher scores on the BDI (p<0.001) and SAS (p≤0.001). CONCLUSION: This study shows that MS is associated with a high prevalence of sleep complaints, including subjectively poor sleep quality, excessive daytime sleepiness, RLS and symptoms of OSAS. Further, it demonstrated a strict relation between fatigue and sleep disorders. Finally, it underlines their relationship with anxiety and depression in MS patients.


Subject(s)
Fatigue/etiology , Multiple Sclerosis/complications , Sleep Wake Disorders/etiology , Surveys and Questionnaires , Adult , Aged , Aged, 80 and over , Cohort Studies , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Male , Middle Aged , Prevalence
18.
Clin EEG Neurosci ; 48(1): 60-71, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27094758

ABSTRACT

The aim of the study was to evaluate the EEG modifications in patients with Huntington disease (HD) compared with controls, by means of the exact LOw REsolution Tomography (eLORETA) software. We evaluated EEG changes during wake, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. Moreover, we reviewed the literature concerning EEG modifications in HD. Twenty-three consecutive adult patients affected by HD were enrolled, 14 women and 9 men, mean age was 57.0 ± 12.4 years. Control subjects were healthy volunteers (mean age 58.2 ± 14.6 years). EEG and polygraphic recordings were performed during wake (before sleep) and during sleep. Sources of EEG activities were determined using the eLORETA software. In wake EEG, significant differences between patients and controls were detected in the delta frequency band (threshold T = ±4.606; P < .01) in the Brodmann areas (BAs) 3, 4, and 6 bilaterally. In NREM sleep, HD patients showed increased alpha power (T = ±4.516; P < .01) in BAs 4 and 6 bilaterally; decreased theta power (T = ±4.516; P < .01) in the BAs 23, 29, and 30; and decreased beta power (T = ±4.516; P < .01) in the left BA 30. During REM, HD patients presented decreased theta and alpha power (threshold T = ±4.640; P < .01) in the BAs 23, 29, 30, and 31 bilaterally. In conclusion, EEG data suggest a motor cortex dysfunction during wake and sleep in HD patients, which correlates with the clinical and polysomnographic evidence of increased motor activity during wake and NREM, and nearly absent motor abnormalities in REM.


Subject(s)
Brain/physiopathology , Electroencephalography/methods , Huntington Disease/diagnosis , Huntington Disease/physiopathology , Sleep , Wakefulness , Adult , Aged , Aged, 80 and over , Diagnosis, Computer-Assisted/methods , Female , Humans , Male , Middle Aged , Polysomnography/methods , Reproducibility of Results , Sensitivity and Specificity , Software
19.
Sleep ; 38(9): 1489-95, 2015 Sep 01.
Article in English | MEDLINE | ID: mdl-25845698

ABSTRACT

STUDY OBJECTIVES: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). DESIGN: Cross-sectional cohort study. SETTING: Sleep laboratory. PATIENTS: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). INTERVENTIONS: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). MEASUREMENTS AND RESULTS: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m(2). No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P < 0.02). UHMDRS correlated positively with the ESS score (P < 0.005), and negatively with the percentage of REM sleep. CONCLUSIONS: Patients with Huntington disease showed a severe sleep disruption and a high prevalence of periodic limb movements, but no evidence of sleep disordered breathing or REM sleep behavior disorder.


Subject(s)
Huntington Disease/complications , Huntington Disease/physiopathology , Polysomnography , Sleep Wake Disorders/complications , Sleep/physiology , Adult , Aged , Aged, 80 and over , Arousal , Cohort Studies , Cross-Sectional Studies , Female , Humans , Huntington Disease/genetics , Male , Middle Aged , Movement , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/physiopathology , Restless Legs Syndrome/complications , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/physiopathology , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/physiopathology , Sleep Apnea, Obstructive/diagnosis , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/physiopathology , Sleep, REM , Video Recording , Wakefulness
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