Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease

2006 ◽  
Vol 104 (4) ◽  
pp. 502-505 ◽  
Author(s):  
Kelly E. Lyons ◽  
Rajesh Pahwa
Keyword(s):  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Sleep Problems ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Early Morning ◽  
Patient Reported ◽  
Stn Dbs

Object The aim of this study was to assess the long-term effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) on sleep, daytime sleepiness, and early morning dystonia and to evaluate the relationship between total sleep time and motor function. Methods Patients who had undergone bilateral STN DBS and a follow-up evaluation of 6 months (89 patients), 12 months (83 patients), and 24 months (43 patients) were included in this study. The patients were preoperatively assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) in the medication-on and -off conditions, and they completed patient diaries. A subset of patients also completed the Epworth Sleepiness Scale. These assessments were repeated postoperatively with stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as total sleep hours were significantly improved at 6, 12, and 24 months poststimulation and with no medication compared with baseline values. Increased sleep time was significantly correlated with improvements in bradykinesia but not with tremor or rigidity. Patient-reported sleep problems and early morning dystonia were reduced after STN DBS. Antiparkinsonian medications were significantly reduced after STN DBS; however, there were no changes in excessive daytime sleepiness 6, 12, or 24 months after surgery. Conclusions Bilateral STN DBS increased total sleep time and reduced patient-reported sleep problems and early morning dystonia for up to 24 months posttreatment. These changes in sleep were related to improvements in functioning, specifically those affected by bradykinesia. Despite significant reductions in antiparkinsonian medications, STN DBS did not reduce excessive daytime sleepiness.

scholarly journals A novel parameter is better than the AHI to assess nocturnal hypoxaemia and excessive daytime sleepiness in obstructive sleep apnoea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Changxiu Ma ◽  
Ying Zhang ◽  
Jiuyu Liu ◽  
Gengyun Sun
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Sleep Apnoea ◽  
Anthropometric Measures ◽  
Obstructive Sleep ◽  
Nocturnal Hypoxaemia ◽  
Better Than

AbstractTo evaluate whether the percentage of total sleep time spent with apnoea and hypopnoea duration time (AHT%) is better than the apnoea-hypopnoea index (AHI) for the assessment of nocturnal hypoxaemia and excessive daytime sleepiness (EDS) in patients with obstructive sleep apnoea (OSA). Patients with suspected OSA were enrolled. Polysomnography, Epworth Sleepiness Scale, self-administered surveys and anthropometric measures were performed. The efficiency of AHT% and the AHI was evaluated for nocturnal hypoxaemia and EDS. A total of 160 eligible participants were analysed. The median AHT% in normal, mild, moderate and severe OSA patients was significantly different in the four-group patients with OSA. Spearman rank correlations analysis found that the associations were stronger between AHT% with percentage of total sleep time and O2 saturation of < 90% and minimum nocturnal oxygen saturation than these parameters with the AHI. AHT% had a greater area under the curve than the AHI for predicting EDS in patients with OSA. AHT% was significantly higher in the EDS group. We present a novel parameter, AHT%, to evaluate nocturnal hypoxaemia and EDS in OSA patients. AHT% partially compensates for the shortcomings of the AHI. AHT% is better than the AHI for assessing nocturnal hypoxaemia and EDS. AHT% reflects different clinical characteristics associated with OSA from a new perspective.

Identification of Somatotopic Organization and Optimal Stimulation Site Within the Subthalamic Nucleus for Parkinson's Disease

2018 ◽  
Vol 17 (3) ◽  
pp. 239-246 ◽  
Author(s):  
Tatsuya Sasaki ◽  
Ken Kuwahara ◽  
Ittetsu Kin ◽  
Mihoko Okazaki ◽  
Susumu Sasada ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Lower Limbs ◽  
Somatotopic Organization ◽  
First Contact ◽  
Upper Third ◽  
Stn Dbs ◽  
Passive Movements ◽  
Common Target ◽  
Deep Brain

Abstract BACKGROUND Details of the somatotopy within the subthalamic nucleus (STN) are still poorly understood; however, the STN is a common target of deep brain stimulation (DBS) for Parkinson disease. OBJECTIVE To examine somatotopic organization within the STN and identify optimal stimulation sites from 77 surgical cases with microelectrode recording. METHODS STN-DBS was performed for 77 patients with Parkinson disease between 2010 and 2014. We performed passive movements of each joint and captured single neuronal activities to identify movement-related cells (MRCs). The sites of MRCs and active contacts were determined by measuring their distances from the first contact of DBS electrode. Their positional correlations were directly and indirectly analyzed. RESULTS The number of obtained MRCs was 264, of which 151 responded to multiple joints. The average x-, y-, and z-coordinates of the cells of the upper and lower limbs from the midcommisural point were 13.1 ± 1.1 and 12.7 ± 1.2, 0.22 ± 1.3 and −0.45 ± 1.5, and −2.5 ± 1.1 and −3.0 ± 1.4 mm, respectively. Most MRCs were distributed in the upper third of the STN, in its superior, lateral, and posterior regions, along the DBS electrode routes. Active contacts were observed to lie slightly inferior, medial, and posterior to the average MRC position. CONCLUSION Somatotopic organization of the STN was easier to observe in the present study than in previous studies. Optimal stimulation sites were located inferior, medial, and posterior to the average MRC location. The sites may correspond to associative or motor parts through which fibers from the supplementary motor area pass.

scholarly journals 1092 Attention-deficit/hyperactivity Disorder Symptoms And Sleep Characteristics Within A Seasonal Affective Disorder Spectrum

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A415-A416
Author(s):  
K N Kim ◽  
D L Wescott ◽  
P L Franzen ◽  
B P Hasler ◽  
K A Roecklein
Keyword(s):  
Sleep Quality ◽  
Sleep Duration ◽  
Adhd Symptom ◽  
Symptom Severity ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Adhd Symptoms ◽  
Depression Severity

Abstract Introduction Seasonal affective disorder (SAD) increases risk for attention-deficit/hyperactivity disorder (ADHD), although the mechanism linking SAD and ADHD is unknown. Prior research has identified insomnia and delayed sleep phase in both ADHD and SAD. We hypothesized that sleep duration and timing in SAD would be associated with the severity of ADHD symptoms. Methods Adults with SAD (n = 45) and subsyndromal SAD (S-SAD; n = 18) aged 19-66 years from Pittsburgh, PA., were assessed for ADHD symptoms, self-report sleep quality, depression severity, and daytime sleepiness in the Winter. Participants wore an Actiwatch for 4-14 days, from which we calculated sleep-onset latency, total sleep time, sleep midpoint, and sleep efficiency. We conducted a hierarchical multivariate linear regression to determine if sleep characteristics predict ADHD symptom severity in our sample while controlling for depressive symptoms. Age and gender were added in Step 1, seasonal depression severity in Step 2, actigraphy-based total sleep time, sleep onset latency, midpoint, and efficiency in Step 3, and self-reported sleep quality and daytime sleepiness in Step 4. Results Participants mostly scored in the “likely” or “highly likely” ADHD range (87.30%, n=55), higher than the national prevalence rate (4.4%). When controlling for age, gender, and depression severity, only shorter actigraphy-based total sleep time was associated with higher ADHD symptom severity (β=-0.30, p&lt;0.05). However, when self-reported sleep quality and daytime sleepiness were added as predictors, total sleep time was no longer a statistically-significant predictor of ADHD symptom severity and only daytime sleepiness predicted ADHD symptom severity (β=0.31, p&lt;0.05). Conclusion Our results suggest that individuals with SAD who experience daytime sleepiness and/or possibly shorter actigraphy-based sleep duration experience higher ADHD symptom severity. Treatments like Trans-C or CBT-I to improve daytime sleepiness and sleep duration may be indicated for SAD patients who present with comorbid ADHD symptoms. Support NIMH K.A.R. MH103303

scholarly journals Bilateral Subthalamic Nucleus Deep Brain Stimulation in Elderly Patients With Parkinson Disease: A Case-Control Study

2020 ◽  
Vol 19 (3) ◽  
pp. 234-240
Author(s):  
Kyle T Mitchell ◽  
John R Younce ◽  
Scott A Norris ◽  
Samer D Tabbal ◽  
Joshua L Dowling ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Intracerebral Hemorrhages ◽  
Disease Rating ◽  
Equivalent Reduction ◽  
Stn Dbs ◽  
Deep Brain

Abstract BACKGROUND Subthalamic nucleus deep brain stimulation (STN DBS) is an effective adjunctive therapy for Parkinson disease. Studies have shown improvement of motor function but often exclude patients older than 75 yr. OBJECTIVE To determine the safety and effectiveness of STN DBS in patients 75 yr and older. METHODS A total of 104 patients (52 patients &gt;75 yr old, 52 patients &lt;75 yr old) with STN DBS were paired and retrospectively analyzed. The primary outcome was change in Unified Parkinson Disease Rating Scale (UPDRS) subscale III at 1 yr postoperatively, OFF medication. Secondary outcomes were changes in UPDRS I, II, and IV subscales and levodopa equivalents. Complications and all-cause mortality were assessed at 30 d and 1 yr. RESULTS Both cohorts had significant improvements in UPDRS III at 6 mo and 1 yr with no difference between cohorts. Change in UPDRS III was noninferior to the younger cohort. The cohorts had similar worsening in UPDRS I at 1 yr, no change in UPDRS II, similar improvement in UPDRS IV, and similar levodopa equivalent reduction. There were similar numbers of postoperative intracerebral hemorrhages (2/52 in each cohort, more severe in the older cohort) and surgical complications (4/52 in each cohort), and mortality in the older cohort was similar to an additional matched cohort not receiving DBS. CONCLUSION STN DBS provides substantial motor benefit and reduction in levodopa equivalents with a low rate of complications in older patients, which is also noninferior to the benefit in younger patients. STN DBS remains an effective therapy for those over 75 yr.

scholarly journals 1241 A Case of Chronic Hypoventilation of Unknown Etiology with Improvement from a Wake Promoting Agent

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A473-A473
Author(s):  
Melissa Cole ◽  
Thomas Isaacs ◽  
Amee Patel
Keyword(s):  
Serum Ferritin ◽  
Daytime Sleepiness ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Chronic Insomnia ◽  
Sweat Test ◽  
Unknown Etiology ◽  
Serum Bicarbonate ◽  
Sleep Study ◽  
Work Up

Abstract Introduction We present a patient with chronic insomnia, excessive daytime sleepiness, and sleep-related hypoventilation that improved with a wake promoting agent in conjunction with BPAP. Report of Case A 15-year-old male with Cystic Fibrosis (single F508del mutation, positive sweat test, FEV1% of 98%) and Autism who presented with frequent headaches, chronic insomnia, and daytime sleepiness (PDSS of 22). Current medications included albuterol as needed. Sleep history was significant for restless leg symptoms. Labs revealed low serum ferritin. Sleep study two years prior showed an AHI of 3.4 and PMLD of 18.4. After completion of iron therapy and initiation of gabapentin, his chronic insomnia and serum ferritin improved. However, patient continued to have aggressive behavior, headaches, and snoring. Sleep study was repeated and revealed mild OSA with hypoventilation (AHI of 6.41, &gt;28% of total sleep time with TCO2 above 50 mm Hg). Initial serum bicarbonate was 29 mmol/L and progressively increased to 34 mmol/L. Due to evidence of persistent chronic hypoventilation, patient was trialed on BPAP. Subsequent sleep study with BPAP showed an AHI of 0, but with worsening sleep related hypoventilation (TCO2 of 56mmHg, &gt; 70% total sleep time with TCO2 above 50 mm Hg). Genetic, endocrine, and neurological work up for hypoventilation was negative. Due to persistent daytime sleepiness (PDSS of 24), MSLT was performed and showed evidence of hypersomnia. Modafinil was then initiated. With the combination of nocturnal BPAP use and Modafinil, daytime sleepiness improved (PDSS of 15) and he had normalization of CO2 and bicarbonate levels. Conclusion We present a patient with CF, with minimal lung disease, who demonstrated a negative work up for sleep related hypoventilation, in which dysregulation of control of breathing improved with the use of a wake promoting agent in conjunction with BPAP.

The effects of bilateral Subthalamic Nucleus Deep Brain Stimulation (STN DBS) on cognition in Parkinson disease

2008 ◽  
Vol 273 (1-2) ◽  
pp. 19-24 ◽  
Author(s):  
Jae-Hyeok Heo ◽  
Kyoung-Min Lee ◽  
Sun Ha Paek ◽  
Min-Jeong Kim ◽  
Jee-Young Lee ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Stn Dbs ◽  
Deep Brain

Sleep and Psychological Abuse Among Cohabiting Couples: A Pilot Study

Partner Abuse ◽  
2017 ◽  
Vol 8 (4) ◽  
pp. 347-360
Author(s):  
Sharon Rose ◽  
Linda Berg-Cross ◽  
Nancy A. Crowell
Keyword(s):  
Sleep Quality ◽  
Relationship Satisfaction ◽  
Sleep Deprivation ◽  
Daytime Sleepiness ◽  
Psychological Abuse ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Cohabiting Couples ◽  
Survey Results ◽  
The Relationship

This study explored the relationship between psychological abuse and sleep deprivation among nonclinical cohabiting couples. Thirty-one couples participated in completing a variety of sleep measures, a psychological abuse scale, and a relationship satisfaction survey. Results indicated a persistent relationship between everyday sleep deficits (sleep quality, daytime sleepiness, and self-reported total sleep time) and the perceived perpetration and felt victimization of psychological abuse. Overall, results were as hypothesized, but there were gender differences. Male psychological abuse victimization and perpetration were significantly related to sleep quality and daytime sleepiness, but for women, only sleep duration was predictive of felt victimization. The sleep variables were significantly related to women’s—but not men’s—reported relationship satisfaction. Overall, minimal sleep deprivation appears to be related to increased psychological abuse perpetration and victimization even among a normative population scoring outside the clinical range on these measures. Implications for prevention and treatment are discussed.

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