Decreased cerebral vasomotor reactivity in patients with obstructive sleep apnea syndrome.

OBJECTIVE: In obstructive sleep apnea syndrome (OSAS), any of the activated neural, vascular, hemodynamic, metabolic, inflammatory, and thrombotic mechanisms may be related to increased cerebrovascular disease and risk of death; however, the possible pathophysiological process between obstructive sleep apnea syndrome and stroke has not been clearly explained. We hypothesize that alterations in vasomotor reactivity in patients may be responsible for their altered cerebral blood flow, and may contribute to the increased risk of ischemic stroke. METHODS: A total of 30 untreated patients with severe obstructive sleep apnea and 26 control subjects were included in the study. The mean blood flow velocity and breath holding index were measured in middle cerebral artery bilaterally in both patient and control groups by using transcranial Doppler ultrasound. We compared the values between two groups. RESULTS: The mean blood flow velocity and breath holding indexes were significantly decreased in the patient group when compared with the control group. There were no correlations between cerebral hemodynamic parameters and polysomnographic findings in patients. CONCLUSION: Our findings suggest that there was a deteriorated vasodilator response to hypercapnia in patients with OSAS. This deterioration may stem from chemoreceptors or endothelial damages that lead to vascular relaxation and vasodilatation in cerebrovascular circulation. This impaired cerebral vascular regulation may contribute to the increased risk of stroke in patients with OSAS.

Prevalence of insomnia and its clinical correlates in a general population in Turkey.

AIM: The prevalence of insomnia is influenced by environmental factors. This study aimed to investigate the prevalence of insomnia and its sociodemographic and clinical correlates in a general population-based survey in Turkey. METHODS: This population-based study included 4758 subjects among 5021 who participated in the Turkish Adult Population Epidemiology of Sleep Disorders study. Questionnaire items evaluating insomnia were adapted from the International Classification of Sleep Disorders II and the DSM-IV-TR. Subjects with restless legs syndrome were excluded. RESULTS: Insomnia was found to be associated with older age (18-24 years, 9.8%; 25-44 years, 11.7%; 45-64 years, 13.8%; 65 years or older, 13.9%), lower income level (<500 USD, 16.5%), time spent watching TV (6-8 h or more, 18.4%), tea consumption in the evening (≥6 glasses, 14.5%) and smoking status (current and ex-smoker, both 14.2%) in multiple logistic regression analysis. In respect to other medical disorders, insomnia was significantly associated with the presence of hypertension, diabetes and heart diseases after the adjustment for relevant risk factors for each disease, across all age and sex groups. CONCLUSIONS: Insomnia is a major health problem in our population, affecting subjects in the working age group and those of lower socioeconomic status. It should especially be screened in patients with chronic diseases. A relatively low proportion of insomnia diagnosed as a sleep disorder suggests that this condition and its clinical correlates are possibly under-recognized.

Quality of sexual life in men with obstructive sleep apnoea.

The study investigated the quality of sexual life of male obstructive sleep apnoea patients. Apnoea and non-apnoea participants were assessed with Golombok Rust Inventory of Sexual Satisfaction (GRISS) and Structured Clinical Interview for DSM-IV (SCID) before the sleep test. Folicule Stimulating Hormone (FSH), Luteinising Hormone (LH), prolactin, testosterone and oestrogen levels were also evaluated. The apnoea group had a higher BMI and lower LH and testosterone levels than the non-apnoea group. There were no differences between the apnoea, non-apnoea groups and within the apnoea groups (mild, moderate and high apnoea) in terms of sexual satisfaction. Although there was a change in the hormonal levels of obstructive sleep apnoea patients, the sexual life of apnoea patients was not affected at the clinical level.

The investigation of leptin and hypothalamic neuropeptides role in first attack psychotic male patients: olanzapine monotherapy.

The mechanism underlying the weight gain due to treatment with olanzapine and other second generation antipsychotics has not been fully understood. To examine olanzapine's weight gain effects, we accepted first attack psychotic patients with no medication (pre-treatment) (n=22) and the healthy control group (n=26) in this study. After patients diagnosis, they were hospitalized and then treated for four weeks with olanzapine (post-treatment). We used case-control association design to test body mass index (BMI) and biochemical changes in each group. We also investigated peripheral leptin and neuropeptides/hormones namely, pro-opiomelanocortin (POMC), cocaine and amphetaime regulated transcript (CART), and neuropeptide Y (NPY) levels. These neuropeptides which are synthesized/secreted from arcuate nucleus of hypothalamus affect food intake and therefore, body weight. After 4 weeks of olanzapine treatment; BMI (body mass index), waist circumference, blood triglyceride, total cholesterol, and very low density lipoprotein (VLDL) levels were increased significantly in patients compared to their pre-treatment baseline. In pre-treatment, patients' NPY levels were significantly lower while α-MSH, the anorexigenic product of POMC levels were significantly higher vs. control. Both leptin and NPY levels were significantly increased in patients after the treatment but the NPY levels were also significantly lower in post-treatment vs. the control group. The CART levels did not change after the treatment. We may presume that the antagonist effect of olanzapine on the serotonin (5HT2CR and 5HT1BR) receptors of the arcuate hypothalamic neurons may be a basis for a deregulation of the neurohormones secretion.

The upper airway evaluation of habitual snorers and obstructive sleep apnea patients.

OBJECTIVE: To investigate the relationship between the Apnea Hypopnea Index (AHI) and upper airway examination findings of habitual snorers and obstructive sleep apnea (OSA) patients. MATERIALS AND METHODS: This study included 264 patients whose tonsils were evaluated in 4 grades. The Mallampati classification was used to determine the relationship between tongue and palate. All patients performed the Müller maneuver in a sitting position. The Fujita classification was used to define the type of obstruction. All patients had polysomnography and were divided into 4 groups according to AHI. Statistical analysis was performed to evaluate the relationship between examination findings and AHI. RESULTS: Of the patients, 133 (50.4%) were habitual snorers, 66 (25%) were mild OSA, 40 (15.2%) were moderate OSA and 25 (9.5%) were severe OSA patients. There was a positive correlation between neck circumference, BMI and AHI in males (p < 0.001). There was a significant difference between patient groups according to Mallampati classification, collapse at the velopharyngeal level and hypopharyngeal level and Fujita classification (all p < 0.001). There were significant relationships between tonsil size, Fujita classification, Mallampati classification, collapse ratios and AHI. CONCLUSION: We saw that hypopharyngeal area often contributes to obstruction and some examination methods correlate more with AHI. This can aid sleep physicians in the evaluation of OSA patients.

Demographic, clinical, and polysomnographic features in patients with narcolepsy: an experience of 181 patients with narcolepsy from a Turkish sleep center.

The present study was designed to describe the socio-demographic, clinical, and polysomnographic features of patients diagnosed with narcolepsy in our sleep center. This retrospective cross-sectional study was conducted on 181 patients diagnosed with narcolepsy based on the results of clinical evaluation, polysomnography (PSG), and multiple sleep latency test (MSLT) between 1993 and 2009. Approximately 70% of the patients had cataplexy, whereas 42% had hallucinations and 55.8% had sleep paralysis. Although sleep efficiency was higher (91.28 ± 5.89%) in patients with narcolepsy, they woke frequently during the night, and their percentages of deep sleep were low (stage 3, 5.12 ± 3.08%, stage 4, 9.60 ± 7.10%). Our study group was divided into two based on age: individuals aged <30 years (n = 152) and >30 years (n = 29). REM latency on PSG was shorter (t = 2.96, p = 0.004) and sleep onset REM (SOREM) on MSLT was higher (t = 2.56, p = 0.011) in the older group than in the younger group. Cataplexy is seen in most patients with narcolepsy. In older patients, REM latency on PSG is shorter and the number of SOREM on MSLT is higher.

[Event-related potentials in major depressive disorder: the relationship between P300 and treatment response]. / Majör Depresif Bozuklukta Olaya Iliskin Potansiyeller: Tedaviye Yanit ile P300 Arasindaki Iliski.

OBJECTIVE: Although conflicting results have been obtained regarding P300 amplitude and latency in major depressive patients, most studies have reported that major depressive patients have smaller P300 amplitudes and longer latencies than healthy people. This study aimed to investigate the relationship between P300 and treatment response in major depressive disorder patients. METHODS: Twenty-eight patients suffering from major depression who completed 12 weeks of follow-up appointments and 28 healthy people, whose age and gender were matched with patients, were included in the study. Event-related potentials (P300) were recorded for patients before and after treatment with sertraline (50-200 mg/day) for 12 weeks. Treatment response was defined as a 50% or greater decrease in a given patient's total Hamilton Depression Rating Scale score. Pre-treatment and post-treatment P300 amplitude and latency values were compared for responders (n=18), non-responders (n=10) and healthy subjects. RESULTS: No significant difference was found between the P300 amplitude values of responders, non-responders and healthy subjects before or after treatment. Pre-treatment P300 latencies of non-responders were significantly longer than latencies of responders and healthy subjects. After treatment for depression, P300 latency values of responders were normalized, but non-responders still maintained longer P300 latencies than responders and healthy subjects. CONCLUSION: These findings suggest that delayed P300 latency may be related to a non-response to sertraline treatment. No relation was found between P300 amplitude and treatment response.

Association of sleep apnea with coronary slow-flow phenomenon.

BACKGROUND: Both obstructive sleep apnea (OSA) and coronary slow-flow phenomenon (CSFP) are known to share similar etiopathogenic mechanisms, such as chronic sympathetic activation, upregulation of inflammatory pathways, oxidative stress and, finally, endothelial dysfunction. OBJECTIVE: We evaluated whether there is an association between OSA and coronary flow rates. METHOD: We retrospectively reviewed medical records of all patients who underwent diagnostic nocturnal polysomnography for suspected OSA. Those who had coronary angiography performed within the same year of polysomnography were divided into two main groups: those with (group 1) and without (group 2) OSA; also, angiographic coronary TIMI (thrombolysis in myocardial infarction) frame counts (TFC) were compared between the groups. Patients with coronary arterial stenosis and angiograms with inadequate filling of the coronary arteries or visualization of the distal landmarks for frame counting were excluded from the study. RESULTS: There was a statistically significant difference between the groups regarding TFCs. We found a significant positive correlation between mean TFC and apnea-hypopnea index (r=0.611, P<0.001). CONCLUSION: The current study demonstrated that sleep apnea impairs coronary flow rates and is associated with CSFP.

Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea.

PURPOSE: Sleep and sleep position have a significant impact on physical, cardiac and mental health, and have been evaluated in numerous studies particularly in terms of lateral sleeping positions and their association with diseases. We retrospectively examined the relationship between the sleeping position and position-specific apnea-hypopnea index (AHI) in obstructive sleep apnea-hypopnea (OSA) patients. METHODS: We assessed the sleeping body position and the body position-specific AHI score in patients who were referred for suspected OSA and underwent diagnostic nocturnal polysomnography. In order to eliminate inter-individual differences, only those who had a similar percentage of time spent in the LSSP and RSSP for each patient were enrolled. To provide this validity, only subjects that had a similar percentage of left and right lateral sleep time (±10%) were included in the analysis. RESULTS: A total of 864 patients had nocturnal diagnostic PSG. Of them, 131 patients met the inclusion criteria. The percent rate spent in the supine sleeping position (SSP) was 31.3 ± 18.7%, in the LSSP was 31.8 ± 10% and in the RSSP was 32.6 ± 10.8%. Whereas the SSP-specific AHI score was the highest with 60.4 ± 36.2/h among all the sleeping position-specific AHI scores (p < 0.001), the LSSP-specific AHI score was statistically higher than that for RSSP (30.2 ± 32.6/h vs. 23.6 ± 30.1/h; p < 0.001). When comparing individuals sub-grouped based on OSA severity, there was a statistically significant difference between the LSSP-specific AHI score and RSSP-specific AHI score in patients with severe (p = 0.002) and moderate (p = 0.026), but not mild (p = 0.130) OSA. CONCLUSION: We found that the sleeping position had a significant influence on apneic events and RSSP decreased the frequency of obstructive respiratory events in patients with moderate and severe disease.

Influence of the severity of obstructive sleep apnea on nocturnal heart rate indices and its association with hypertension.

OBJECTIVE: Both heart rate (HR) and blood pressure parameters provide important information on the pathophysiology of the cardiovascular regulatory mechanisms, and are mainly affected by the autonomic nervous system. We sought to clarify whether the severity of obstructive sleep apnea (OSA) affects nocturnal HRs and whether there is a relationship between nocturnal HRs and the presence of hypertension. METHODS: We retrospectively reviewed medical records of all patients who performed nocturnal polysomnography with monitoring of HRs, and examined whether there is a relationship among the nocturnal HRs, the severity of OSA and the presence of hypertension. RESULTS: A total of 540 patients were included in the study. Nocturnal mean and maximal HRs were significantly higher in severe OSA group than in moderate (p=0.002 and p>0.05 in females; p<0.049 and p=0.044, in males, respectively) and mild OSA groups (p<0.001 and p=0.003, respectively in females, p<0.001 and p=0.004, respectively in males); and there was a positive correlation between the nocturnal mean HR and apnea-hypopnea index (Pearson's p=0.504, p<0.001 in female group; Pearson's p=0.254, p<0.001 in male group) and again the nocturnal mean HR and the presence of HT (Spearman's p=0.090, p=0.394 in female group; Spearman's p=0.272, p<0.001 in male group) in both gender groups. CONCLUSION: We found that nocturnal mean and maximal HRs to be associated with severity of OSA and the presence of hypertension. We speculated that increased nocturnal mean and maximal HRs caused by sympathetic nervous system activation in OSA might be one of the mechanisms in explaining the hypertension and OSA association.

[Sleep architecture in schizophrenia patients]. / Sizofreni Hastalarinda Uyku Yapisi

OBJECTIVE: Sleep disorders are a common and important part of schizophrenia's clinical Picture; however, the number of polysomnography-based studies of schizophrenia is limited and there is a lack of consensus regarding a specific sleep pattern in schizophrenia patients. As such, the aim of the present study was to investigate the sleep architecture in non-medicated schizophrenia patients. METHOD: The study included 13 adult male inpatients with schizophrenia, undifferentiated type, (based on DSM-IV-TR criteria) and an age- and sex-matched group of normal controls. The participants were studied during 2 consecutive nights in the sleep laboratory. The Brief Psychiatric Rating Scale (BPRS), Scale for Negative Symptoms (SANS), and Scale for Positive Symptoms (SAPS) were used for clinical assessment. Polysomnographic recordings obtained on the second night were used for analysis. RESULTS: Compared to the controls, the schizophrenic patients had less total sleep time, lower sleep efficiency, longer sleep latency, more awakenings, and increased duration of awakenings after falling asleep. In terms of sleep architecture, the schizophrenia patients showed no evidence of abnormal-slow wave sleep, but the percentage of REM sleep was reduced. REM sleep measures, including REM latency and density, did not significantly differ between the 2 groups. Based on correlation analysis between the sleep parameters and clinical symptoms, slow-wave sleep was inversely correlated with formal thought disorder. CONCLUSION: The findings indicate that in addition to decreased REM sleep time, disturbances in sleep initiation and maintenance were prominent in the non-medicated schizophrenia patients. The correlation between decreased decreased REM sleep and, slow-wave sleep, and formal thought disorder we observed in the patients might have been related to the underlying pathophysiology of schizophrenia.

Sleep stage and obstructive apneaic epoch classification using single-lead ECG.

BACKGROUND: Polysomnography (PSG) is used to define physiological sleep and different physiological sleep stages, to assess sleep quality and diagnose many types of sleep disorders such as obstructive sleep apnea. However, PSG requires not only the connection of various sensors and electrodes to the subject but also spending the night in a bed that is different from the subject's own bed. This study is designed to investigate the feasibility of automatic classification of sleep stages and obstructive apneaic epochs using only the features derived from a single-lead electrocardiography (ECG) signal. METHODS: For this purpose, PSG recordings (ECG included) were obtained during the night's sleep (mean duration 7 hours) of 17 subjects (5 men) with ages between 26 and 67. Based on these recordings, sleep experts performed sleep scoring for each subject. This study consisted of the following steps: (1) Visual inspection of ECG data corresponding to each 30-second epoch, and selection of epochs with relatively clean signals, (2) beat-to-beat interval (RR interval) computation using an R-peak detection algorithm, (3) feature extraction from RR interval values, and (4) classification of sleep stages (or obstructive apneaic periods) using one-versus-rest approach. The features used in the study were the median value, the difference between the 75 and 25 percentile values, and mean absolute deviations of the RR intervals computed for each epoch. The k-nearest-neighbor (kNN), quadratic discriminant analysis (QDA), and support vector machines (SVM) methods were used as the classification tools. In the testing procedure 10-fold cross-validation was employed. RESULTS: QDA and SVM performed similarly well and significantly better than kNN for both sleep stage and apneaic epoch classification studies. The classification accuracy rates were between 80 and 90% for the stages other than non-rapid-eye-movement stage 2. The accuracies were 60 or 70% for that specific stage. In five obstructive sleep apnea (OSA) patients, the accurate apneaic epoch detection rates were over 89% for QDA and SVM. CONCLUSION: This study, in general, showed that RR-interval based classification, which requires only single-lead ECG, is feasible for sleep stage and apneaic epoch determination and can pave the road for a simple automatic classification system suitable for home-use.

Polysomnography in patients with post-traumatic stress disorder.

AIMS: The purpose of the present study was to investigate sleep structure in post-traumatic stress disorder (PTSD) patients with and without any psychiatric comorbidities. The relationship between sleep variables and measurements of clinical symptom severity were also investigated. METHODS: Sleep patterns of 24 non-medicated male PTSD patients and 16 age- and sex-matched normal controls were investigated on polysomnography on two consecutive nights. Six PTSD-only patients and 15 PTSD patients with major depressive disorder (MDD) were also compared to normal controls. Sleep variables were correlated with PTSD symptoms. RESULTS: Compared to the normal controls, the PTSD patients with MDD had difficulty initiating sleep, poor sleep efficiency, decreased total sleep time, decreased slow wave sleep (SWS), and a reduced rapid eye movement (REM) sleep latency. The PTSD patients without any comorbid psychiatric disorders had moderately significant disturbances of sleep continuity, and decreased SWS, but no abnormalities of REM sleep. REM sleep latency was inversely proportional to the severity of startle response. SWS was found to be inversely correlated with the severity of psychogenic amnesia. CONCLUSIONS: PTSD patients have disturbance of sleep continuity, and SWS deficit, without the impact of comorbid depression on sleep. The relationship between SWS and the inability to recall an important aspect of trauma may indicate the role of sleep in the consolidation of traumatic memories. The relationship between the severity of the startle response and REM latency may suggest that REM sleep physiology shares common substrates with the symptoms of PTSD.

The association between serum levels of neopterin and number of depressive episodes of major depression.

BACKGROUND: There is an interaction between the immune system and the central nervous system by means of hormones, peptides, and neurotransmitters. The aims of the present study were to determine whether the serum neopterin levels in patients with major depression (MD) differ from a healthy control group and to investigate the relationship between previous MD episodes and serum neopterin levels. METHODS: Thirty patients who were admitted to the GATA Psychiatry Outpatient Clinics and were diagnosed with MD according to DSM-IV, and who agreed to participate in the study, were included in the study. Twenty-six healthy volunteers matched for age, gender, and level of education who agreed to participate in the study were served as controls. Peripheral venous blood samples were obtained from the patients and the control group for complete blood count, routine biochemistry, and the detection of serum neopterin levels. The analyses were performed in the laboratory of the GATA Department of Biochemistry. RESULTS: There was no significant difference between the MD group and the healthy controls with respect to age, level of education, smoking, and gender. Serum neopterin levels of the MD group who had experienced two or more episodes were higher than the first-episode group and the control group. Age of onset and the number of previous episodes had an independent impact on serum neopterin levels in MD patients, while smoking did not show any effect. CONCLUSION: In the present study, the neopterin levels of patients who had experienced two or more episodes were higher than the first-episode depressive group and healthy control group. It was also found that the number of previous depressive episodes and the ages of the MD cases had an independent effect on serum neopterin levels.

Impact of endoscopic sinus surgery on sleep quality in patients with chronic nasal obstruction due to nasal polyposis.

OBJECTIVE: The aim of this study was to investigate the effect of endoscopic sinus surgery on sleep quality in a patient group who has chronic nasal obstruction resulting from nasal polyposis. METHODS: Twenty-seven patients with nasal polyposis, filling at least 50% of each nasal passage, were enrolled in the study. Assessment of nasal patency was determined by nasal endoscopy and acoustic rhinometry. All patients underwent endoscopic sinus surgery with polypectomy. Sleep quality was evaluated, using visual analog scale, Epworth sleepiness scale, and polysomnography before and 3 months after the surgery. RESULTS: Nasal resistance decreased significantly after the surgery (P < 0.01). Snoring scores were significantly improved postoperatively (P < 0.01) and completely disappeared in 9 of 27 patients. A significant improvement occurred in mean daytime sleepiness scores in the postoperative period (4.14) as compared with the preoperative values (9.44; P < 0.01). There was no significant difference between preoperative (6.85) and postoperative (5.53) mean values of apnea-hypopnea index (P = 0.55). CONCLUSIONS: Endoscopic sinus surgery with polypectomy significantly improves sleep quality, including snoring and daytime sleepiness in patients with chronic nasal obstruction due to nasal polyposis. However, it has a limited benefit on apnea-hypopnea index scores.

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors.

OBJECTIVE: To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor (SSRI) treatment. METHODS: Forty-nine outpatients in remission from major depressive disorder with SSRI treatment and experiencing treatment-emergent sexual dysfunction were invited to participate and 33 (25 women and 8 men) were included in this 8-week open-label study. All patients continued her/his current SSRI treatment (dosages unchanged) and started on mirtazapine augmentation of 15 mg/day during the first week and 30 mg/day throughout the rest of the study. The Hamilton rating scale for depression (HAM-D), the psychotropic-related sexual dysfunction questionnaire (PRSexDQ), and the Golombok and Rust Inventory of Sexual Satisfaction (GRISS) were given to all patients at baseline and at each follow-up (end of the first, second, fourth, sixth, and eight weeks). RESULTS: Mirtazapine augmentation led to significant reductions in HAM-D, PRSexDQ, and GRISS scores throughout the study especially after week 4 and 48.5% of patients (n = 16) reported that they had no overall sexual dysfunction at the end of the study. CONCLUSIONS: Mirtazapine augmentation is a good choice for the treatment of SSRI-induced sexual dysfunction, and the results are typically seen later after 4-8 weeks.

Gender differences in polysomnographic findings in Turkish patients with obstructive sleep apnea syndrome.

In this study, we evaluated the gender differences in body mass index (BMI), age and their effects on apnea-hypopnea index during total sleep time (AHI(TST)) in the Turkish population who were diagnosed with obstructive sleep apnea syndrome (OSAS) and compared them with data from the literature. A computerized database of 244 Turkish patients (194 males, 50 females) who had undergone overnight polysomnography (PSG) and diagnosed with OSAS at Bayindir Hospital sleep laboratory between October 2004 and January 2007 was reviewed. The male:female ratio of the patients was 3.88:1. Male patients were significantly younger compared to females (48.87 +/- 10.82 vs 52.94 +/- 12.14 years, respectively, P = 0.003). The BMI and AHI(TST) were similar in male and female patients (BMI = 29.52 +/- 4.63 vs 31.17 +/- 6.08 kg/m2, respectively, P = 0.083) (AHI(TST) = 27.45 +/- 22.97 vs 24.77 +/- 23.83, respectively, P = 0.149). For the male and female groups, AHI(TST) increased as BMI increased (P = 0.03, 0.04). The median values of AHI(TST) in male group, for the normal, overweight and obese + pathological obese groups were 12.45, 20.20 and 23.50, respectively, whereas the median values of AHI(TST) in female group were 11.10, 10.95 and 26.20, respectively. In the normal and obese + pathological obese groups, there was no statistically significant difference according to gender, whereas in the overweight group, male patients had significantly higher AHI(TST) (P = 0.02). There was no statistically significant difference between the male and female patients regarding the severity of OSAS (P = 0.358). However, there was a male tendency to moderate and severe OSAS in the normal and overweight BMI groups. In Turkish patients with OSAS, there was no gender difference in BMI and AHI(TST) and female patients were significantly older than the males. The OSAS was diagnosed in men nearly four times more often than in women.

Evaluation of periodic leg movements and associated transcranial magnetic stimulation parameters in restless legs syndrome.

Restless legs syndrome (RLS), a sensorimotor disorder characterized by unpleasant sensations commonly localized in the legs, is frequently associated with periodic limb movements (PLMs) during sleep. We investigated the role of transcranial magnetic stimulation (TMS) and cortical silent period (CSP) duration as diagnostic and monitoring tools in 20 patients with primary RLS before and after 1 month of treatment and also studied 15 normal age- and gender-matched subjects. Polysomnographic assessment was undertaken and the PLM index determined in 17 of the 20 patients. We also studied the correlation between sleep efficiency index and CSP duration because of the increasing severity of the sleep disturbance and PLMs in patients with RLS. Our results demonstrate that the duration of the CSP was reduced in patients with RLS, and that dopaminergic treatment normalized this duration. There was no correlation between the PLM index and CSP duration. It may be speculated that PLMs and the CSP are due to different inhibitory mechanisms and they may be used separately as diagnostic and monitoring tools in patients with primary RLS.