Decreased sleep quality and increased sleep related movements in patients with Tourette's syndrome.

OBJECTIVE: Sleep quality and movement patterns across sleep stages in patients with Tourette's syndrome were examined to determine the influence of syndrome severity on sleep quality and the differential effect of sleep stages on tic and non-tic movements. METHODS: Twenty five patients with Tourette's syndrome (mean age 29 (SD 7) years) and 11 control subjects (29 (5) years) were studied by polysomnography and simultaneous split screen video monitoring to record standard sleep variables as well as to evaluate movements to differentiate between tics and regular movements. Severity of Tourette's syndrome during the day was assessed with the Tourette's syndrome severity scale. RESULTS: Sleep was significantly more disturbed in patients with Tourette's syndrome than in controls, with decreased sleep efficiency and slow wave sleep percentage, increased sleep latency, percentage of stage I, percentage of awakeness, number of awakenings, and sleep stage changes and more overall movements during sleep. Severity of Tourette's syndrome during the day correlated significantly and positive with number of awakenings and sleep stage changes and negatively with sleep efficiency. In addition to an increased number of regular movements patients had tics in all sleep stages. Tic frequency as well as frequency of regular movements was significantly higher in REM than in non-REM sleep which was also the case for regular movements of the controls. No disturbance of either REM sleep percentage or REM latency was found. CONCLUSION: Despite normal total sleep time and unaltered REM sleep variables patients with Tourette's syndrome have markedly disturbed sleep. Severity of the syndrome during the day is an important predictor of sleep alteration in patients. The increased rate of tics during REM sleep parallels the overall increased movement activity of patients during REM as well as non-REM sleep. The increased motor activity may be attributable to a state of hyperarousal rather than a disturbed cholinergic system.

[Long-term antihypertensive effect of delayed-action molsidomine]. / Antihypertensive Langzeitwirkung von retardiertem Molsidomin.

The long-term antihypertensive efficacy of molsidomine 8 mg bid was studied in 24 patients with coronary artery disease in a double-blind, placebo-controlled trial of 3 weeks duration. Ambulatory 24-h blood pressure measurements were performed at days 1, 2, 7, 14, and 21. Sphygmomanometric measurements of blood pressure heart rate and a protocol for number and time of angina pectoris attacks were also taken. Following the application of molsidomine a reduction of mean 24-h systolic blood pressure of 14% and of mean diastolic blood pressure of 11% was observed. The duration of the blood-pressure-lowering action was 7 h. After 3 weeks of treatment with 8 mg molsidomine sr bid a persistent and significant reduction of systolic and diastolic blood pressure was found. A similar acute and long-term effect was found by manually measured blood pressures. Heart rate was unchanged under molsidomine while the frequency of angina pectoris was diminished. In conclusion, a long-lasting antihypertensive efficacy (without signs of tolerance) was found over a 3-week period of treatment with 8 mg molsidomine in a slow-release formulation given twice a day.